1
|
Peniston S, Sivaramakrishnan D, Holloway A. Undiagnosed and uncontrolled hypertension in rural African adults: a scoping review protocol of primary health care interventions. BMJ Open 2024; 14:e081937. [PMID: 38589263 PMCID: PMC11015176 DOI: 10.1136/bmjopen-2023-081937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Non-communicable diseases cause 74% of global deaths, with cardiovascular diseases as the major contributor. Hypertension, a primary risk factor for cardiovascular disease, is highly prevalent in Africa. Diagnosis, treatment and control rates are notably limited in rural areas. This limitation results in increased risks of premature mortality and complications such as stroke due to socioeconomic, cultural and geographical challenges. Progress in African countries enhancing hypertension services through primary health care interventions exists. However, a comprehensive review of all primary health care interventions addressing undiagnosed and uncontrolled hypertension in rural African settings is lacking. This scoping review aims to categorise primary health care interventions targeting undiagnosed and uncontrolled hypertension in rural African adults. Intervention components will be mapped to the four stages outlined in the hypertension care cascade to develop a pilot intervention logic model for rural African adults with hypertension. METHOD AND ANALYSIS The scoping review protocol will adhere to the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Studies considered for inclusion will include any intervention delivered by any healthcare provider in a rural African primary care setting targeting any stage of hypertension care. Eight databases will be searched without date restrictions, supplemented by grey literature and reference list searches. A two-stage screening process (title/abstract and full text) will determine evidence source eligibility. All eligible sources of evidence will be extracted, charted and evaluated using the Template for Intervention Description and Replication checklist. A pilot logic model categorising and mapping interventions to the four stages of the hypertension care cascade will be visually presented and analysed using narrative synthesis. ETHICS AND DISSEMINATION No primary data will be collected; therefore, ethics approval is not required. Findings will be disseminated to local health authorities in Ghana and other African Regions and through national and international conferences and publications in peer-reviewed journals.
Collapse
Affiliation(s)
- Sandra Peniston
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
- Scottish Collaboration for Public Health Research and Policy, The University of Edinburgh, Edinburgh, UK
- School of Nursing, Faculty of Health, York University, Toronto, ON, Canada
| | - Divya Sivaramakrishnan
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
- Scottish Collaboration for Public Health Research and Policy, The University of Edinburgh, Edinburgh, UK
| | - Aisha Holloway
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| |
Collapse
|
2
|
Granot Y, Sapir OR, Laufer-Perl M, Viskin D, Banai S, Topilsky Y, Havakuk O. Prognostic impact of combined non-severe aortic stenosis and mitral regurgitation on clinical outcomes: a single-centre retrospective study. BMJ Open 2024; 14:e080914. [PMID: 38553077 PMCID: PMC10982784 DOI: 10.1136/bmjopen-2023-080914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/11/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES Though the concomitant occurrence of non-severe aortic stenosis (AS) and mitral regurgitation (MR) is highly prevalent, there are limited data to guide clinical decision-making in this condition. Here, we attempt to determine an aortic valve area (AVA) cut-off value associated with worse clinical outcomes in patients with combined non-severe AS and MR. METHODS Single-centre, retrospective analysis of consecutive patients who underwent echocardiography examination between 2010 and 2021 with evidence of combined non-severe AS and MR. We excluded patients with ≥moderate aortic valve regurgitation or mitral stenosis, as well as patients who underwent any aortic or mitral intervention either prior or following our assessment (n=372). RESULTS The final cohort consisted of 2933 patients with non-severe AS, 506 of them with >mild MR. Patients with both pathologies had lower cardiac output and worse diastolic function.Patients with an AVA ≤1.35 cm² in the presence of >mild MR had the highest rates of heart failure (HF) hospitalisations (HR 3.1, IQR 2.4-4, p<0.001) or mortality (HR 2, IQR 1.8-2.4, p<0.001), which remained significant after adjusting for clinical and echocardiographic parameters. CONCLUSION Patients with combined non-severe AS and MR have a higher rate of HF hospitalisations and mortality. An AVA≤1.35 cm² in the presence of >mild MR is associated with worse clinical outcomes.
Collapse
Affiliation(s)
- Yoav Granot
- Icahn School of Medicine, New York, New York, USA
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Orly Ran Sapir
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, New York, USA
| | - Michal Laufer-Perl
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dana Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ofer Havakuk
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
3
|
Williams NH, Collins B, Comerford TJ, Dodd S, Fisher M, Hardwick B, Hennessy S, Jolly K, Jones I, Lane D, Lip GYH, Morgan E, Ralph P, Thijssen D, Singh SJ. Effectiveness and cost-effectiveness of a web-based cardiac rehabilitation programme for people with chronic stable angina: protocol for the ACTIVATE (Angina Controlled Trial Investigating the Value of the 'Activate your heart' Therapeutic E-intervention) randomised controlled trial. BMJ Open 2024; 14:e084509. [PMID: 38531561 DOI: 10.1136/bmjopen-2024-084509] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Chronic stable angina is common and disabling. Cardiac rehabilitation is routinely offered to people following myocardial infarction or revascularisation procedures and has the potential to help people with chronic stable angina. However, there is insufficient evidence of effectiveness and cost-effectiveness for its routine use in this patient group. The objectives of this study are to compare the effectiveness and cost-effectiveness of the 'Activate Your Heart' cardiac rehabilitation programme for people with chronic stable angina compared with usual care. METHODS AND ANALYSIS ACTIVATE is a multicentre, parallel-group, two-arm, superiority, pragmatic randomised controlled trial, with recruitment from primary and secondary care centres in England and Wales and a target sample size of 518 (1:1 allocation; allocation sequence by minimisation programme with built-in random element). The study uses secure web-based allocation concealment. The two treatments will be optimal usual care (control) and optimal usual care plus the 'Activate Your Heart' web-based cardiac rehabilitation programme (intervention). Outcome assessment and statistical analysis will be performed blinded; participants will be unblinded. Outcomes will be measured at baseline and at 6 and 12 months' follow-up. Primary outcome will be the UK version of Seattle Angina Questionnaire (SAQ-UK), physical limitations domain at 12 months' follow-up. Secondary outcomes will be the remaining two domains of SAQ-UK, dyspnoea, anxiety and depression, health utility, self-efficacy, physical activity and the incremental shuttle walk test. All safety events will be recorded, and serious adverse events assessed to determine whether they are related to the intervention and expected. Concurrent economic evaluation will be cost-utility analysis from health service perspective. An embedded process evaluation will determine the mechanisms and processes that explain the implementation and impacts of the cardiac rehabilitation programme. ETHICS AND DISSEMINATION North of Scotland National Health Service Research Ethics Committee approval, reference 21/NS/0115. Participants will provide written informed consent. Results will be disseminated by peer-reviewed publication. TRIAL REGISTRATION NUMBER ISRCTN10054455.
Collapse
Affiliation(s)
- Nefyn H Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Brendan Collins
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK
| | - Terence J Comerford
- Patient and Public Involvement, National Institute for Health and Care Research Applied Research Collaboration North West Coast, Liverpool, UK
| | - Susanna Dodd
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Michael Fisher
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ben Hardwick
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Sophie Hennessy
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ian Jones
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Deirdre Lane
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Erica Morgan
- Patient and Public Involvement, National Institute for Health and Care Research Applied Research Collaboration North West Coast, Liverpool, UK
| | - Penelope Ralph
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Dick Thijssen
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
4
|
Hou J, Li M, Han J, Yu S, Jia X, Sun F, Zhang Y. Northern Shanghai Study II: systematic assessment and management of early organ damage and its role in preventing and reducing cardiovascular risk-protocol of a prospective study. BMJ Open 2023; 13:e073423. [PMID: 38159946 PMCID: PMC10759065 DOI: 10.1136/bmjopen-2023-073423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Cardiovascular diseases are the leading cause of death and disease burden in China. However, there is a lack of prospective cohort studies suitable for evaluating early organ damage and its role in preventing and reducing cardiovascular risk among Chinese residents. This study intends to establish the first database based on the phenotypes of all early structural and functional damage of cardiovascular organs in Chinese population. Moreover, a digital follow-up mechanism will be formed, a prospective population cohort will be established, a biological sample bank for early cardiovascular organ damage will be established, and an intervention and management system for early damage of cardiovascular organs will be explored. METHODS AND ANALYSIS This study is a prospective cohort study built on the foundation of the Northern Shanghai Study I. People aged 18-75 years are enrolled. After the recruitment, first, corresponding physical measurements and clinical examinations are conducted to collect cardiovascular risk factors and establish the demographic baseline of the study population. Next, the latest equipment is used to evaluate early structural and functional cardiovascular organ damage including heart, macrovessels, microcirculation, renal function and fundus. Meanwhile, the blood, urine, faeces and other biological samples of participants are collected to establish the cardiometabolic and gut microbiota analysis databases. The population is followed up every 2 years. Comprehensive assessment of early organ damage will be used to predict cardiovascular risk, guide people to change lifestyles to achieve early prevention and provide corresponding treatment recommendations. ETHICS AND DISSEMINATION This study was approved by the Shanghai Tenth People's Hospital Institutional Review Board. All participants signed a written consent form. The results of this study will be disseminated in peer-reviewed journals. Ethics approval: SHYS-IEC-5.0/22k148/P01. TRIAL REGISTRATION NUMBER NCT05435898.
Collapse
Affiliation(s)
- Jingjing Hou
- Department of Cardiology,Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Moran Li
- Department of Cardiology,Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Han
- Department of Cardiology,Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shikai Yu
- Department of Cardiology,Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xinming Jia
- Clinical Medicine Scientific and Technical Innovation Center,Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fenyong Sun
- Department of Clinical Laboratory Medicine,Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi Zhang
- Department of Cardiology,Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
5
|
Xiao W, Liu S, Huang Z, Jin D, Yang Y, Li F, Duan J, Wang J, Li Y, Deng P, Wang W, Meng C, Wu J, Cai J, Li Y, Hong Y. Non-high-density lipoprotein cholesterol levels as a risk factor for short-term mortality in elderly Chinese: a large-scale, population-based cohort study. BMJ Open 2023; 13:e078216. [PMID: 38097241 PMCID: PMC10728999 DOI: 10.1136/bmjopen-2023-078216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES To explore the association between non-high-density lipoprotein (non-HDL) and mortality risk, both short-term and long-term, in Chinese people. DESIGN A prospective cohort study. SETTING The National Basic Public Health Service (BPHS) in China. PARTICIPANTS Including 621 164 elderly individuals around Hunan Province who underwent healthcare management receiving check-ups in China BPHS from 2010 to 2020. EXCLUSION CRITERIA (1) missing information on gender; (2) missing records of lipid screening; (3) missing information on key covariates; and (4) missing records of comorbidities (cardiovascular disease, hypertension, diabetes, cancer.) PRIMARY AND SECONDARY OUTCOME MEASURES: The study's primary endpoint was all-cause and cause-specific mortality, sourced from Hunan's CDC(Center for Disease Control and Prevention)-operated National Mortality Surveillance System, tracking participants until 24 February 2021. RESULTS 26 758 (4.3%) deaths were recorded, with a median follow-up of 0.83 years. Association between non-HDL and mortality was non-linear after multivariable adjustment, with the optimum concentration (OC) being 3.29 and 4.85 mmol/L. Compared with OC, the risk increased by 1.12-fold for non-HDL <3.29 mmol/L (HR: 1.12 (1.09 to 1.15)) and 1.08-fold for non-HDL ≥4.85 mmol/L (HR: 1.08 (1.02 to 1.13)) for all-cause mortality. Furthermore, there is also an increased risk of cardiovascular mortality (HR for non-HDL <3.29: 1.10 (1.06 to 1.32) and HR for non-HDL ≥4.85: 1.07 (1.01 to 1.14)). However, cancer mortality risk was significantly increased only for non-HDL <3.29 mmol/L (HR: 1.11 (1.04 to 1.18)). Non-optimum concentration of non-HDL had significant effects on both the long-term and the short-term risk of mortality, especially for risks of mortality for all-cause (log HR:0 .086 (0.038 to 0.134)), cardiovascular (log HR:0 .082 (0.021 to 0.144)), and cancer (log HR:0 .187 (0.058 to 0.315)) within 3 months. A two-sided value of p <0.05 was considered to be statistically significant. CONCLUSIONS Non-HDL was non-linearly associated with the risk of mortality, and non-optimal concentrations of non-HDL significantly increased short-term mortality in elderly Chinese, which needs more attention for cardiovascular disease prevention.
Collapse
Affiliation(s)
- Weiwei Xiao
- General Medicine Department, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Shiqi Liu
- Chlinical Research Center, Central South University Third Xiangya Hospital, Changsha, Hunan, China
| | - Zheng Huang
- Neurosurgery, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Donghui Jin
- Disease Control and Prevention of Hunan Province, Changsha, Hunan, China
| | - Yiping Yang
- Chlinical Research Center, Central South University Third Xiangya Hospital, Changsha, Hunan, China
| | - Fei Li
- Chlinical Research Center, Central South University Third Xiangya Hospital, Changsha, Hunan, China
| | - Jingwen Duan
- Chlinical Research Center, Central South University Third Xiangya Hospital, Changsha, Hunan, China
| | - Jie Wang
- Chlinical Research Center, Central South University Third Xiangya Hospital, Changsha, Hunan, China
| | - Yalan Li
- Chlinical Research Center, Central South University Third Xiangya Hospital, Changsha, Hunan, China
| | - Peizhi Deng
- Chlinical Research Center, Central South University Third Xiangya Hospital, Changsha, Hunan, China
| | - Wei Wang
- Chlinical Research Center, Central South University Third Xiangya Hospital, Changsha, Hunan, China
| | - Changjiang Meng
- Chlinical Research Center, Central South University Third Xiangya Hospital, Changsha, Hunan, China
| | - Jingjing Wu
- Chlinical Research Center, Central South University Third Xiangya Hospital, Changsha, Hunan, China
| | - Jingjing Cai
- Central South University Third Xiangya Hospital, Changsha City, China
| | - Yan Li
- Chlinical Research Center, Central South University Third Xiangya Hospital, Changsha, Hunan, China
| | - Yuan Hong
- Chlinical Research Center, Central South University Third Xiangya Hospital, Changsha, Hunan, China
- Department of Cardiology, Central South University Third Xiangya Hospital, Changsha, Hunan, China
| |
Collapse
|
6
|
Graby J, Khavandi A, Gillison F, Smith T, Murphy D, Peacock O, McLeod H, Dastidar A, Antoniades C, Thompson D, Rodrigues JCL. 'Super Rehab': can we achieve coronary artery disease regression? A feasibility study protocol. BMJ Open 2023; 13:e080735. [PMID: 38086597 PMCID: PMC10729239 DOI: 10.1136/bmjopen-2023-080735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Patients diagnosed with coronary artery disease (CAD) are currently treated with medications and lifestyle advice to reduce the likelihood of disease progression and risk of future major adverse cardiovascular events (MACE). Where obstructive disease is diagnosed, revascularisation may be considered to treat refractory symptoms. However, many patients with coexistent cardiovascular risk factors, particularly those with metabolic syndrome (MetS), remain at heightened risk of future MACE despite current management.Cardiac rehabilitation is offered to patients post-revascularisation, however, there is no definitive evidence demonstrating its benefit in a primary prevention setting. We propose that an intensive lifestyle intervention (Super Rehab, SR) incorporating high-intensity exercise, diet and behavioural change techniques may improve symptoms, outcomes, and enable CAD regression.This study aims to examine the feasibility of delivering a multicentre randomised controlled trial (RCT) testing SR for patients with CAD, in a primary prevention setting. METHODS AND ANALYSIS This is a multicentre randomised controlled feasibility study of SR versus usual care in patients with CAD. The study aims to recruit 50 participants aged 18-75 across two centres. Feasibility will be assessed against rates of recruitment, retention and, in the intervention arm, attendance and adherence to SR. Qualitative interviews will explore trial experiences of study participants and practitioners. Variance of change in CAD across both arms of the study (assessed with serial CT coronary angiography) will inform the design and power of a future, multi-centre RCT. ETHICS AND DISSEMINATION Ethics approval was granted by South West-Frenchay Research Ethics Committee (reference: 21/SW/0153, 18 January 2022). Study findings will be disseminated via presentations to relevant stakeholders, national and international conferences and open-access peer-reviewed research publications. TRIAL REGISTRATION NUMBER ISRCTN14603929.
Collapse
Affiliation(s)
- John Graby
- Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Health, University of Bath, Bath, UK
| | - Ali Khavandi
- Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | | | - David Murphy
- Cardiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Health, University of Bath, Bath, UK
| | | | | | | | - Charalambos Antoniades
- Acute Multidisciplinary Imaging & Interventional Centre, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | | | | |
Collapse
|
7
|
Spruit JR, Jansen RWMM, de Groot JR, de Vries TAC, Hemels MEW, Douma RA, de Haan LR, Brinkman K, Moeniralam HS, de Kruif M, Dormans T, Appelman B, Reidinga AC, Rusch D, Gritters van den Oever NC, Schuurman RJ, Beudel M, Simsek S. Does atrial fibrillation affect prognosis in hospitalised COVID-19 patients? A multicentre historical cohort study in the Netherlands. BMJ Open 2023; 13:e071137. [PMID: 38070891 PMCID: PMC10729035 DOI: 10.1136/bmjopen-2022-071137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES The aim of this multicentre COVID-PREDICT study (a nationwide observational cohort study that aims to better understand clinical course of COVID-19 and to predict which COVID-19 patients should receive which treatment and which type of care) was to determine the association between atrial fibrillation (AF) and mortality, intensive care unit (ICU) admission, complications and discharge destination in hospitalised COVID-19 patients. SETTING Data from a historical cohort study in eight hospitals (both academic and non-academic) in the Netherlands between January 2020 and July 2021 were used in this study. PARTICIPANTS 3064 hospitalised COVID-19 patients >18 years old. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the incidence of new-onset AF during hospitalisation. Secondary outcomes were the association between new-onset AF (vs prevalent or non-AF) and mortality, ICU admissions, complications and discharge destination, performed by univariable and multivariable logistic regression analyses. RESULTS Of the 3064 included patients (60.6% men, median age: 65 years, IQR 55-75 years), 72 (2.3%) patients had prevalent AF and 164 (5.4%) patients developed new-onset AF during hospitalisation. Compared with patients without AF, patients with new-onset AF had a higher incidence of death (adjusted OR (aOR) 1.71, 95% CI 1.17 to 2.59) an ICU admission (aOR 5.45, 95% CI 3.90 to 7.61). Mortality was non-significantly different between patients with prevalent AF and those with new-onset AF (aOR 0.97, 95% CI 0.53 to 1.76). However, new-onset AF was associated with a higher incidence of ICU admission and complications compared with prevalent AF (OR 6.34, 95% CI 2.95 to 13.63, OR 3.04, 95% CI 1.67 to 5.55, respectively). CONCLUSION New-onset AF was associated with an increased incidence of death, ICU admission, complications and a lower chance to be discharged home. These effects were far less pronounced in patients with prevalent AF. Therefore, new-onset AF seems to represent a marker of disease severity, rather than a cause of adverse outcomes.
Collapse
Affiliation(s)
| | | | - Joris R de Groot
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | - Martin E W Hemels
- Department of Cardiology, Rijnstate, Arnhem, Arnhem, Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Renee A Douma
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
- Flevo Hospital, Almere, Netherlands
| | - Lianne R de Haan
- Flevo Hospital, Almere, Netherlands
- Medical Centre Alkmaar, Alkmaar, Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, OLVG, Amsterdam, Netherlands
| | - Hazra S Moeniralam
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Martijn de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
| | - Tom Dormans
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Brent Appelman
- Amsterdam UMC Locatie Meibergdreef, Amsterdam, Netherlands
| | - Auke C Reidinga
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Daisy Rusch
- Research, Martini Ziekenhuis, Groningen, Netherlands
| | | | | | - Martijn Beudel
- Neurology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
- Department of Internal Medicine, Section of Endocrinology, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
| |
Collapse
|
8
|
Hanif B, Sheikh S, Peerwani G, Cainzos-Achirica M, Javed W, Baqar JB, Samad Z, Bashir F, S Virani S, Nasir K, Aijaz S. PAKistan Study of prEmature coronary atHerosclerosis in young AdulTs (PAK-SEHAT): a prospective longitudinal study protocol investigating the prevalence, severity and determinants of atherosclerotic cardiovascular disease in the young adult Pakistani population. BMJ Open 2023; 13:e076045. [PMID: 37984941 PMCID: PMC10660834 DOI: 10.1136/bmjopen-2023-076045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/17/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Atherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity, mortality and health expenditures worldwide. Despite having higher ASCVD in the Pakistani population, data on subclinical coronary atherosclerosis in young Pakistanis remain scarce. The PAKistan Study of prEmature coronary atHerosclerosis in young AdulTs (PAK-SEHAT) aims to assess the prevalence, severity and determinants of subclinical coronary atherosclerosis among Pakistani men (35-60 years) and women (35-65 years) free of clinically symptomatic ASCVD and will assess 5-year rates of ASCVD events. METHODS AND ANALYSIS PAK-SEHAT is an ongoing prospective cohort study with 2000 participants from all provinces of Pakistan who will be interviewed at the baseline along with phlebotomy, measurement of carotid intima-media thickness (CIMT) and coronary CT angiography (CCTA). Phlebotomy will be repeated at 2.5 years, whereas CIMT and CCTA will be repeated at 5 years. We will report the frequency of maximal coronary stenosis ≥50% and ≥70%, number of coronary vessels with plaque and the number of coronary segments affected per participant on CCTA. We will use Cox proportional hazards regression models to evaluate the association between baseline characteristics and incident ASCVD events during follow-up. These associations will be presented as HRs with 95% CIs. ETHICS AND DISSEMINATION The study protocol was approved by the Tabba Heart Institute Institutional Review Board (THI/IRB/FQ/22-09-2021/016). All study procedures are consistent with the principles of the Declaration of Helsinki. Findings of the study will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT05156736.
Collapse
Affiliation(s)
- Bashir Hanif
- Department of Cardiology, Tabba Heart Institute, Karachi, Sindh, Pakistan
| | - Sana Sheikh
- Clinical Research Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Ghazal Peerwani
- Clinical Research Cardiology, Tabba Heart Institute, Karachi, Pakistan
| | - Miguel Cainzos-Achirica
- Department of Cardiology, Hospital del Mar, Barcelona, Spain
- Department of Cardiology, Institut Hospital del Mar d'Investigacions Mediques, Barcelona, Spain
| | - Wajiha Javed
- Department of Public Health, Getz Pharma, Karachi, Pakistan
| | | | - Zainab Samad
- Medicine, The Aga Khan University, Karachi, Pakistan
| | - Faiza Bashir
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Salim S Virani
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
- Department of Medicine, Texas Heart Institute, Houston, Texas, USA
| | - Khurram Nasir
- Department of Medicine, Houston Methodist, Houston, Texas, USA
- Department of Medicine, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | - Saba Aijaz
- Cardiology, Clinical Research Cardiology, Tabba Heart Institute, Karachi, Pakistan
| |
Collapse
|
9
|
Stark K, O'Leary PRE, Sakita FM, Ford JS, Mmbaga BT, Blass B, Gedion K, Coaxum LA, Rutta A, Galson SW, Rugakingira A, Manavalan P, Bloomfield GS, Hertz JT. Six month incidence of major adverse cardiovascular events among adults with HIV in northern Tanzania: a prospective observational study. BMJ Open 2023; 13:e075275. [PMID: 37984949 PMCID: PMC10660832 DOI: 10.1136/bmjopen-2023-075275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVES We aimed to prospectively describe incident cardiovascular events among people living with HIV (PLWH) in northern Tanzania. Secondary aims of this study were to understand non-communicable disease care-seeking behaviour and patient preferences for cardiovascular care and education. DESIGN A prospective observational study. SETTING This study was conducted at the Majengo HIV Care and Treatment Clinic, an outpatient government-funded clinic in Moshi, Tanzania PARTICIPANTS: Adult patients presenting to an HIV clinic for routine care in northern Tanzania were enrolled from 1 September 2020 to 1 March 2021. INTERVENTIONS At enrolment, participants completed a survey and a resting 12-lead ECG was obtained. At 6 month follow-up, a repeat survey regarding interim health events and repeat ECG was obtained. PRIMARY AND SECONDARY OUTCOME MEASURES Interim major adverse cardiovascular events (MACE) were defined by: self-reported interim stroke, self-reported hospitalisation for heart failure, self-reported interim myocardial infarction, interim myocardial infarction by ECG criteria (new pathologic Q waves in two contiguous leads) or death due to cardiovascular disease (CVD). RESULTS Of 500 enrolled participants, 477 (95.4%) completed 6 month follow-up and 3 (0.6%) died. Over the 6 month follow-up period, 11 MACE occurred (3 strokes, 6 myocardial infarctions, 1 heart failure hospitalisation and 1 cardiovascular death), resulting in an incidence rate of 4.58 MACE per 100 person-years. Of participants completing 6 month follow-up, 31 (6.5%) reported a new non-communicable disease diagnosis, including 23 (4.8%) with a new hypertension diagnosis. CONCLUSIONS The incidence of MACE among PLWH in Tanzania is high. These findings are an important preliminary step in understanding the landscape of CVD among PLWH in Tanzania and highlight the need for interventions to reduce cardiovascular risk in this population.
Collapse
Affiliation(s)
- Kristen Stark
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Paige R E O'Leary
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Francis M Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
| | - James S Ford
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania, United Republic of
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania, United Republic of
| | - Beau Blass
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kalipa Gedion
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Lauren A Coaxum
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alice Rutta
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
| | - Sophie Wolfe Galson
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Anzibert Rugakingira
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania, United Republic of
| | - Preeti Manavalan
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Gerald S Bloomfield
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Julian T Hertz
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
10
|
Juul Grabmayr A, Malta Hansen C, Bo N, Sheikh AP, Hassager C, Ersbøll A, Kjaergaard J, Lippert F, Tjørnhøj-Thomsen T, Gislason G, Torp-Pedersen C, Folke F. Community intervention to improve defibrillation before ambulance arrival in residential neighbourhoods with a high risk of out-of-hospital cardiac arrest: study protocol of a cluster-randomised trial (the CARAMBA trial). BMJ Open 2023; 13:e073541. [PMID: 37816557 PMCID: PMC10565309 DOI: 10.1136/bmjopen-2023-073541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/21/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION In Denmark, multiple national initiatives have been associated with improved bystander defibrillation and survival following out-of-hospital cardiac arrest (OHCA) in public places. However, OHCAs in residential neighbourhoods continue to have poor outcomes. The Cardiac Arrest in Residential Areas with MoBile volunteer responder Activation trial aims to improve bystander defibrillation and survival following OHCA in residential neighbourhoods with a high risk of OHCA. The intervention consists of: (1) strategically deployed automated external defibrillators accessible at all hours, (2) cardiopulmonary resuscitation (CPR) training of residents and (3) recruitment of residents for a volunteer responder programme. METHODS AND ANALYSIS This is a prospective, pair-matched, cluster-randomised, superiority trial with clusters of 26 residential neighbourhoods, testing the effectiveness of the intervention in a real-world setting. The areas are randomised for intervention or control. Intervention and control areas will receive the standard OHCA emergency response, including volunteer responder activation. However, targeted automated external defibrillator deployment, CPR training and volunteer responder recruitment will only be provided in the intervention areas. The primary outcome is bystander defibrillation, and the secondary outcome is 30-day survival. Data on patients who had an OHCA will be collected through the Danish Cardiac Arrest Registry. ETHICS AND DISSEMINATION Approval to store OHCA data has been granted from the Legal Office, Capital Region of Denmark (j.nr: 2012-58-0004, VD-2018-28, I-Suite no: 6222, and P-2021-670). In Denmark, formal approval from the ethics committee is only obtainable when the study regards testing medicine or medical equipment on humans or using genome or diagnostic imagine as data source. The Ethics Committee of the Capital Region of Denmark has evaluated the trial and waived formal approval unnecessary (H-19037170). Results will be published in peer-reviewed papers and shared with funders, stakeholders, and housing organisations through summaries and presentations. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04446585).
Collapse
Affiliation(s)
- Anne Juul Grabmayr
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Carolina Malta Hansen
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Nanna Bo
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Annam Pervez Sheikh
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Annette Ersbøll
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
- Department of Population Health and Morbidity, National Institute of Public Health, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Freddy Lippert
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Research Department, Copenhagen University Hospital - Emergency Medical Services Capital Region of Denmark, Ballerup, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte, Denmark
| |
Collapse
|
11
|
Zörner CR, Pallisgaard J, Schjerning AM, Jensen MK, Tønnesen J, Da Riis-Vestergaard L, Middelfart C, Rasmussen PV, Gislason G, Hansen ML. Temporal trends of hypertrophic cardiomyopathy in Denmark: a nationwide retrospective cohort study. BMJ Open 2023; 13:e074010. [PMID: 37666552 PMCID: PMC10481739 DOI: 10.1136/bmjopen-2023-074010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/27/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVES To describe the population of patients diagnosed with hypertrophic cardiomyopathy (HCM) in Denmark and determine temporal trends in incidence and patient characteristics over time. DESIGN Nationwide retrospective cohort study. SETTING Danish nationwide administrative and clinical registers and databases. PARTICIPANTS All patients aged ≥16 years diagnosed with HCM from 2005 to 2018. OUTCOMES MEASURES Time trends in HCM diagnosis, patient characteristics, comorbidities and pharmacotherapy were identified and tested for significance using the Cochran-Armitage trend test. RESULTS 3856 HCM patients were included (median age 68 years (IQR 56-78)). Although there were more males (53%), females were older (72 years vs 63 years) and more likely to have their type of HCM classified as obstructive (54% vs 38%). A consistent rise in HCM cases per year was detected and there was a significant decline in prevalence of heart failure (2005: 20% to 2018: 12%, p<0.001) and ischaemic heart disease (2005: 31% to 2019: 16%, p≤0.001). Prevalence of atrial fibrillation and stroke remained notable and unchanged. Lastly, the rate of hospitalisations decreased over time (2005: 64% to 2016: 46%, p<0.001), while the rate of outpatient follow-up increased (2005: 81% to 2016: 87%, p 0.003). CONCLUSION There was a consistent rise in HCM cases with decreasing morbidity burden. Females were older at diagnosis and more likely to have their type of HCM classified as obstructive. The rate of outpatient follow-up is increasing.
Collapse
Affiliation(s)
| | - Jannik Pallisgaard
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Anne-Marie Schjerning
- Department of Cardiology, Rigshospitalet, Kobenhavn, Denmark
- Danish Heart Foundation, Copenhagen, Denmark
| | | | - Jacob Tønnesen
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | | | | | - Peter Vibe Rasmussen
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
- Department of Cardiology, Bispebjerg Hospital, Kobenhavn, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
- Danish Heart Foundation, Copenhagen, Denmark
| | - Morten Lock Hansen
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
- Department of Cardiology, University of Copenhagen, Kobenhavn, Denmark
| |
Collapse
|
12
|
Szegedi N, Kroptkin E, Traykoc V, Abdrakhmanov A, Lorgat F, Sapelnikov O, Simons S, Amin M. Routine use of a 3D mapping system in the ablation of supraventricular arrhythmias with as low as reasonably achievable X-ray exposure (AALARA): protocol for a prospective, observational, multicentre, multinational, open-label registry study. BMJ Open 2023; 13:e072181. [PMID: 37541748 PMCID: PMC10407390 DOI: 10.1136/bmjopen-2023-072181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/18/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION The reduction of fluoroscopic exposure during catheter ablation of supraventricular arrhythmias is widely adopted by experienced electrophysiology physicians with a relatively short learning curve and is becoming standard of care in many parts of the world. While observational studies in the USA and some parts of Western Europe have evaluated the minimal fluoroscopic approach, there are scarce real-world data for this technique and generalisability of outcome in other economic regions. METHODS AND ANALYSIS The arrhythmias with as low as reasonably achievable X-ray exposure study is a prospective, observational, multicentre and multinational open-label registry study. Up to 700 patients undergoing catheter ablation for right-sided supraventricular arrhythmias (according to national guidelines) will be enrolled for the routine use of the EnSite Precision 3D mapping system. Participating sites are distributed in 13 countries from Central Eastern Europe, North and South Africa, the Middle East and the CIS (Commonwealth of Independent States), with different levels of expertise using minimal fluoroscopic exposure techniques. After electrophysiological procedure, patients will be followed up for 6 months either in-clinic or via telephone interview. Patients will be asked to complete a study questionnaire at enrolment and 6 months after the invasive procedure to assess quality of life changes secondary to the procedure. The study's primary objective is to describe ionising radiation exposure during catheter ablation when the EnSite Precision 3D mapping system is used in supraventricular tachycardia ablation. The study's secondary objective is to assess the safety and efficacy of this method. Furthermore, fluoroscopy timing, total procedure time, success rate and complications will be reported. ETHICS AND DISSEMINATION The study was approved by the ethics committee at Mohammed Bin Khalifa Specialist Cardiac Centre (BDF/R&REC/2020-504) and the medical ethics committees of all participating sites. Participants will be required to provide informed consent before enrolment in the study. The study results will be published and presented at conferences. TRIAL REGISTRATION NUMBER NCT04716270.
Collapse
Affiliation(s)
- Nandor Szegedi
- Semmelweis University Heart and Vascular Centre, Budapest, Hungary
| | - Evgeniy Kroptkin
- Federal Center for Cardiovascular Surgery, Krasnoyarsk region, Russian Federation
| | - Vassil Traykoc
- Federal Center for Cardiovascular Surgery, Krasnoyarsk region, Russian Federation
| | | | - Faizel Lorgat
- Christian Barnard Memorial Hospital, Cape Town, South Africa
| | - Oleg Sapelnikov
- Institute of Clinical Cardiology, Moscow, Russian Federation
| | | | - Mohammad Amin
- Cardiology, Mohammed bin Khalifa bin Salman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain
| |
Collapse
|
13
|
Eppler M, Singh N, Ding L, Magee G, Garg P. Discharge prescription patterns for antiplatelet and statin therapy following carotid endarterectomy: an analysis of the vascular quality initiative. BMJ Open 2023; 13:e071550. [PMID: 37491096 PMCID: PMC10373683 DOI: 10.1136/bmjopen-2022-071550] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVES Despite guidelines endorsing statin and single antiplatelet therapy (SAPT) therapy post-carotid endarterectomy (CEA), these medications may be either under or inappropriately prescribed. We determined rates of new statin prescriptions as well as change in antiplatelet therapy (APT) regimen at discharge. We identified characteristics associated with these occurrences. DESIGN We performed a retrospective Vascular Quality Initiative registry analysis of more than 125 000 patients who underwent CEA from 2013 to 2021. SETTING The Vascular Quality Initiative is a multicentre registry database including academic and community-based hospitals throughout the USA. PARTICIPANTS Patients age≥18 years undergoing CEA with available statin and APT data (preprocedure and postprocedure) were included. PRIMARY AND SECONDARY OUTCOME MEASURES We determined overall rates of statin and APT prescription at discharge. Multivariate logistic regression was used to determine clinical and demographic characteristics that were mostly associated with new statin prescription or changes in APT regimen at discharge. RESULTS Study participants were predominantly male (61%) and White (90%), with a mean age of 70.6±9.1. 13.1% of participants were not on statin therapy pre-CEA, and 48% of these individuals were newly prescribed one. Statin rates steadily increased throughout the study period: 36.2% in 2013 to 62% in 2021. A higher likelihood of new statin prescription was associated with non-race, diabetes, coronary heart disease, stroke, TIA and a non-elective indication. Older age, female gender, chronic obstructive pulmonary disease and prior carotid revascularisation were associated with a lower likelihood of new statin prescription. Nearly all participants were discharged on APT (63% SAPT and 37% dual antiplatelet therapy, DAPT). Among these individuals, 16% were discharged on a regimen that was different from the one on admission (11 947 (10.7%) of patients were upgraded to DAPT and 5813 (5.2%) were downgraded to SAPT). CONCLUSIONS Although statin use has substantially improved following CEA, more than half of individuals not on a statin preprocedure remained this way at discharge. In addition, DAPT at discharge was frequent, a quarter of whom were on SAPT preprocedure. Further efforts are needed to improve rates of new statin prescriptions, ensure appropriate APT intensity at discharge and determine how different discharge APT regimens impact outcomes.
Collapse
Affiliation(s)
- Michael Eppler
- Division of Cardiology, USC Keck School of Medicine, Los Angeles, California, USA
| | - Nikhil Singh
- Cardiology, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Li Ding
- Division of Cardiology, USC Keck School of Medicine, Los Angeles, California, USA
| | - Gregory Magee
- Division of Cardiology, USC Keck School of Medicine, Los Angeles, California, USA
| | - Parveen Garg
- Division of Cardiology, USC Keck School of Medicine, Los Angeles, California, USA
| |
Collapse
|
14
|
Shimokawahara H, Inami T, Kubota K, Taniguchi Y, Hashimoto H, Saito AM, Sekimizu M, Matsubara H. Protocol for a multicentre, double-blind, randomised, placebo-controlled trial of riociguat on peak cardiac index during exercise in patients with chronic thromboembolic pulmonary hypertension after balloon pulmonary angioplasty (THERAPY-HYBRID-BPA trial). BMJ Open 2023; 13:e072241. [PMID: 37407055 DOI: 10.1136/bmjopen-2023-072241] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES Balloon pulmonary angioplasty (BPA) and medical therapy, such as soluble guanylate cyclase stimulators, are recommended treatments for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are ineligible for pulmonary endarterectomy (PEA). However, monotherapy with BPA or medical therapy cannot always eliminate symptoms such as exertional dyspnoea. Thus, this study aims to clarify the efficacy of continuous treatment with riociguat in inoperable CTEPH patients with normalised haemodynamics after BPA. METHODS AND ANALYSIS This is a double-blind, multicentre, randomised, placebo-controlled trial. Participants with CTEPH who are ineligible for PEA will receive riociguat followed by BPA. Subsequently, participants will be randomised (1:1) into either riociguat continuing or discontinuing groups and will be observed for 16 weeks after randomisation. The primary endpoint will be the change in peak cardiac index (CI) during the cardiopulmonary exercise test. In the primary analysis, the least square mean differences and 95% CIs for the change in peak CI at 16 weeks between the groups will be estimated by a linear mixed-effects model with baseline value as a covariate, treatment group as a fixed effect and study institution as a random effect. ETHICS AND DISSEMINATION National Hospital Organisation Review Board for Clinical Trials (Nagoya) and each participating institution approved this study and its protocols. Written informed consent will be obtained from all participants. The results will be disseminated at medical conferences and in journal publications. REGISTRATION DETAILS Japan Registry of Clinical Trials: jRCT no. 041200052. CLINICALTRIALS gov by National Library of Medicine Registry ID: NCT04600492. TRIAL REGISTRATION NUMBER NCT04600492.
Collapse
Affiliation(s)
| | - Takumi Inami
- Department of Cardiovascular Medicine, Kyorin University Hospital, Mitaka, Japan
| | - Kayoko Kubota
- Department of Cardiovascular Medicine and Hypertension, Graduate school of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yu Taniguchi
- Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroya Hashimoto
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akiko M Saito
- Clinical Research Center, NHO Nagoya Medical Center, Nagoya, Japan
| | | | - Hiromi Matsubara
- Department of Cardiology, NHO Okayama Medical Center, Okayama, Japan
| |
Collapse
|
15
|
Yuan X, Chu Q, Chen K, Wang Y, Zhang L, Zheng Y, Hu S. Multicentre, randomised, double-blind, parallel controlled trial to investigate timing of platelet inhibition after coronary artery bypass grafting: TOP-CABG trial study. BMJ Open 2023; 13:e070823. [PMID: 37385747 PMCID: PMC10314523 DOI: 10.1136/bmjopen-2022-070823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 05/24/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION Dual antiplatelet therapy (DAPT), referred to as the combination of aspirin and P2Y12 receptor antagonist (clopidogrel or ticagrelor), potentially improves patency of saphenous vein grafts (SVG) after coronary artery bypass grafting (CABG), while it is further proposed that DAPT potentially increases bleeding risk. Compared with DAPT, de-escalated DAPT (De-DAPT) is an effective antiplatelet strategy for acute coronary syndrome treatment, which significantly reduces the risk of bleeding without increasing the incidence of major adverse cardiovascular events. However, insufficient evidence is available to determine the timing of DAPT after CABG. METHODS AND ANALYSIS ETHICS AND DISSEMINATION: The Ethics Committee in Fuwai hospital approved this study (2022-1774). Fifteen centres agreed to participate the TOP-CABG trial, and the study has been approved in these 15 centres by whose ethics committee. The results of the trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05380063.
Collapse
Affiliation(s)
- Xin Yuan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Qing Chu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Kai Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Yang Wang
- National Clinical Research Centre of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Lihua Zhang
- National Clinical Research Centre of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yingli Zheng
- Department of Pharmacy, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Shengshou Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| |
Collapse
|
16
|
Abdullayev K, Chico TJ, Manktelow M, Buckley O, Condell J, Van Arkel RJ, Diaz V, Matcham F. Stakeholder-led understanding of the implementation of digital technologies within heart disease diagnosis: a qualitative study protocol. BMJ Open 2023; 13:e072952. [PMID: 37369399 PMCID: PMC10410804 DOI: 10.1136/bmjopen-2023-072952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Cardiovascular diseases are highly prevalent among the UK population, and the quality of care is being reduced due to accessibility and resource issues. Increased implementation of digital technologies into the cardiovascular care pathway has enormous potential to lighten the load on the National Health Service (NHS), however, it is not possible to adopt this shift without embedding the perspectives of service users and clinicians. METHODS AND ANALYSIS A series of qualitative studies will be carried out with the aim of developing a stakeholder-led perspective on the implementation of digital technologies to improve holistic diagnosis of heart disease. This will be a decentralised study with all data collection being carried out online with a nationwide cohort. Four focus groups, each with 5-6 participants, will be carried out with people with lived experience of heart disease, and 10 one-to-one interviews will be carried out with clinicians with experience of diagnosing heart diseases. The data will be analysed using an inductive thematic analysis approach. ETHICS AND DISSEMINATION This study received ethical approval from the Sciences and Technology Cross Research Council at the University of Sussex (reference ER/FM409/1). Participants will be required to provide informed consent via a Qualtrics survey before being accepted into the online interview or focus group. The findings will be disseminated through conference presentations, peer-reviewed publications and to the study participants.
Collapse
Affiliation(s)
| | - Timothy Ja Chico
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, Sheffield, UK
| | - Matthew Manktelow
- School of Computing, Engineering and Intelligent Systems, University of Ulster at Magee, Londonderry, UK
| | - Oliver Buckley
- School of Computing Sciences, University of East Anglia, Norwich, UK
| | - Joan Condell
- School of Computing, Engineering and Intelligent Systems, University of Ulster at Magee, Londonderry, UK
| | | | - Vanessa Diaz
- Department of Mechanical Engineering, University College London, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Faith Matcham
- School of Psychology, University of Sussex, Brighton, UK
| |
Collapse
|
17
|
Martin J. Persistent mortality and heart failure burden of anterior ST-segment elevation myocardial infarction following primary percutaneous coronary intervention: real-world evidence from the US Medicare Data Set. BMJ Open 2023; 13:e070210. [PMID: 37344119 PMCID: PMC10314428 DOI: 10.1136/bmjopen-2022-070210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/02/2023] [Indexed: 06/23/2023] Open
Abstract
OBJECTIVES We sought to compare the temporal trends in the incidence of death and rehospitalisation for congestive heart failure (CHF) following anterior ST-elevation myocardial infarction (STEMI) in a Medicare cohort of beneficiaries treated with primary percutaneous coronary intervention (PCI) in 2005 (n=1479) with those treated in 2016 through quarter (Q) 2 of 2017 (n=22 432). DESIGN This retrospective analysis examined outcomes using both descriptive and regression analysis to control for differences in patient clinical characteristics over time. PRIMARY OUTCOME MEASURES The primary outcomes are 1 year and 2 year rates of mortality and re-hospitalisation for CHF. RESULTS The 1 year mortality rate was numerically higher in the 2016 cohort at 10.3% (95% CI 9.9 to 10.7) versus 8.9% (CI 7.4 to 10.3; p=0.068). The 2 year mortality rate was significantly higher in the 2016 cohort at 14.5% (CI 13.9 to 15.1) versus 11.4% (CI 9.2 to 13.6; p<0.01). The 1 year rehospitalisation for CHF was lower in the 2016 cohort at 10.6% (CI 10.0 to 11.2) versus 16.7% (CI 14.0 to 19.4; p<0.001), but the 2 year rate was not significantly different at 19.3% (CI 17.7 to 20.9) versus 20.7% (CI 16.4 to 24.9; p=0.55). After adjustment for covariates with two models, the 1 year mortality increased by 2.3% (CI 0.8 to 3.7; p<0.01) and 4.1% (CI 2.6 to 5.6; p<0.001) in the 2016 cohort. The 2 year adjusted mortality also increased by 4.2% (CI 2.0 to 6.4; p<0.001) and 6.5% (CI 4.2 to 8.7; p<0.001) in the 2016 cohort. The risk adjusted trends for rehospitalisation for CHF were similar to the unadjusted findings. CONCLUSIONS Despite prior improvements in STEMI outcomes in the reperfusion era related to the broad adoption of timely PCI, there is a persistent high mortality and CHF burden in Medicare beneficiaries with anterior STEMI. New strategies that address reperfusion injury and enhance myocardial salvage are needed.
Collapse
Affiliation(s)
- Jack Martin
- Department of Scientific Affairs, Main Line Health System, Sharpe-Strumia Research Foundation of the Bryn Mawr Hospital, Newtown Square, PA, USA
- Department of Drug Development Solutions, ICON plc, Dublin, Dublin, Ireland
| |
Collapse
|
18
|
Appelboam A, Osborne R, Ukoumunne O, Black S, Boot S, Richards N, Scotney N, Rhodes S, Cranston T, Hawker R, Gillett A, Jones B, Hawton A, Dayer M, Creanor S. Evaluation of the prehospital use of a Valsalva assist device in the emergency treatment of supraventricular tachycardia (EVADE SVT): study protocol for a stepped wedge cluster randomised controlled trial. BMJ Open 2023; 13:e073315. [PMID: 37290949 PMCID: PMC10255124 DOI: 10.1136/bmjopen-2023-073315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/21/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Patients with episodes of supraventricular tachycardia (SVT), a common heart arrhythmia, are often attended by ambulance services. International guidelines advocate treatment with the Valsalva manoeuvre (VM), but this simple physical treatment has a low success rate, with most patients requiring conveyance to hospital. The Valsalva Assist Device (VAD) is a simple device that might help practitioners and patients perform a more effective VM and reduce the need for patients to be taken to hospital. METHODS AND ANALYSIS This stepped wedge cluster randomised controlled trial, conducted within a UK ambulance service, compares the current standard VM with a VAD-delivered VM in stable adult patients presenting to the ambulance service with SVT. The primary outcome is conveyance to hospital; secondary outcomes measures include cardioversion rates, duration of ambulance care and number of subsequent episodes of SVT requiring ambulance service care. We plan to recruit approximately 800 patients, to have 90% power to detect an absolute reduction in conveyance rate of 10% (from 90% to 80%) between the standard VM (control) and VAD-delivered VM (intervention). Such a reduction in conveyance would benefit patients, the ambulance service and receiving emergency departments. It is estimated potential savings would pay for devices for the entire ambulance trust within 7 months. ETHICS AND DISSEMINATION The study has been approved by the Oxford Research Ethics Committee (reference 22/SC/0032). Dissemination will be through peer-reviewed journal publication, presentation at national and international conferences and by the Arrhythmia Alliance, a patient support charity. TRIAL REGISTRATION NUMBER ISRCTN16145266.
Collapse
Affiliation(s)
- Andrew Appelboam
- Medical School, University of Exeter, Exeter, UK
- Academic Department of Emergency Medicine, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Ria Osborne
- Research, Audit and Improvement, South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | - Obioha Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| | - Sarah Black
- Research, Audit and Improvement, South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | - Suzanne Boot
- South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | | | - Natalie Scotney
- South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | - Shelley Rhodes
- Exeter Clinical Trials Unit, University of Exeter Medical School, Exeter, UK
| | - Tim Cranston
- Exeter Clinical Trials Unit, University of Exeter Medical School, Exeter, UK
| | - Ruth Hawker
- PPI Representative, honorary SWASFT contract, South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | - Annette Gillett
- Peninsula Childhood Disability Research Unit (PenCRU), University of Exeter Medical School, Exeter, UK
| | - Ben Jones
- Exeter Clinical Trials Unit, University of Exeter Medical School, Exeter, UK
| | - Annie Hawton
- NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
- Health Economics Group, University of Exeter, Exeter, Devon, UK
| | - Mark Dayer
- Cardiology, Taunton and Somerset NHS Foundation Trust, Taunton, UK
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Siobhan Creanor
- Exeter Clinical Trials Unit, University of Exeter Medical School, Exeter, UK
| |
Collapse
|
19
|
He P, Pan Y, Jiang J, Fan F, Zhou J, Xia Y, Liu J, Yang N, Hao Y, Li J, Liu J, Zhao D, Huo Y. In-hospital therapies and determinants of treatment strategy selection in patients with atrial fibrillation and left ventricular systolic dysfunction in China: a retrospective study based on the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project, 2015-2019. BMJ Open 2023; 13:e070070. [PMID: 37277219 DOI: 10.1136/bmjopen-2022-070070] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVES The optimal treatment strategy remains debatable in patients with atrial fibrillation (AF) and heart failure. Our objectives were to summarise in-hospital therapies and determine factors associated with treatment strategy selections. DESIGN A retrospective study analysing the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) project from 2015 to 2019. SETTING The CCC-AF project included patients from 151 tertiary and 85 secondary hospitals across 30 provinces in China. PARTICIPANTS Patients with AF and left ventricular systolic dysfunction (LVSD, defined as left ventricular ejection fraction<50%) were included, with 5560 patients in the study sample. METHODS Patients were classified by treatment strategies. In-hospital treatments and trends of therapies were analysed. Multiple logistic regression models were used to find determinants of treatment strategies. RESULTS Rhythm control therapies were used in 16.9% of patients with no significant trends (p trend=0.175). Catheter ablation was used in 5.5% of patients, increasing from 3.3% in 2015 to 6.6% in 2019 (p trend<0.001). Factors negatively associated with rhythm control included increased age (OR 0.973, 95% CI 0.967 to 0.980), valvular AF (OR 0.618, 95% CI 0.419 to 0.911), AF types (persistent: OR 0.546, 95% CI 0.462 to 0.645; long-standing persistent: OR 0.298, 95% CI 0.240 to 0.368), larger left atrial diameters (OR 0.966, 95% CI 0.957 to 0.976) and higher Charlson Comorbidity Index scores (CCI 1-2: OR 0.630, 95% CI 0.529 to 0.750; CCI≥3: OR 0.551, 95% CI 0.390 to 0.778). Higher platelet counts (OR 1.025, 95% CI 1.013 to 1.037) and prior rhythm control attempts (electrical cardioversion: OR 4.483, 95% CI 2.369 to 8.483; catheter ablation: OR 4.957, 95% CI 3.072 to 7.997) were positively associated with rhythm control strategies. CONCLUSION In China, non-rhythm control strategy remained the dominant choice in patients with AF and LVSD. Age, AF types, prior treatments, left atrial diameters, platelet counts and comorbidities were major determinants of treatment strategies. Guideline-adherent therapies should be further promoted. STUDY REGISTRATION NUMBER NCT02309398.
Collapse
Affiliation(s)
- Pengkang He
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yannan Pan
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jie Jiang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jing Zhou
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yulong Xia
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jun Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Na Yang
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yongchen Hao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jing Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| |
Collapse
|
20
|
Alcock S, Singh S, Wiens EJ, Singh N, Ande SR, Lampron K, Huang B, Kirkpatrick I, Trivedi A, Schaffer SA, Shankar JS. CT perfusion for Assessment of poor Neurological outcome in Comatose Cardiac Arrest Patients (CANCCAP): protocol for a prospective study. BMJ Open 2023; 13:e071166. [PMID: 37270194 DOI: 10.1136/bmjopen-2022-071166] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Cardiac arrest remains one of the most common causes of death with the majority occurring outside of hospitals (out of hospital cardiac arrest). Despite advancements in resuscitation management, approximately 50% of comatose cardiac arrest patients (CCAP) will suffer a severe unsurvivable brain injury. To assess brain injury, a neurological examination is conducted, however, its reliability in predicting outcomes in the first days following cardiac arrest is limited. Non-contrast CT is the most employed scan to assess hypoxic changes, even though it is not sensitive to early hypoxic-ischaemic changes in the brain. CT perfusion (CTP) has shown high sensitivity and specificity in brain death patients, although its use in predicting poor neurological outcome in CCAP has not yet been explored. The purpose of this study is to validate CTP for predicting poor neurological outcome (modified Rankin scale, mRS≥4) at hospital discharge in CCAP. METHODS AND ANALYSIS The CT Perfusion for Assessment of poor Neurological outcome in Comatose Cardiac Arrest Patients study is a prospective cohort study funded by the Manitoba Medical Research Foundation. Newly admitted CCAP receiving standard Targeted Temperature Management are eligible. Patients undergo a CTP at the same time as the admission standard of care head CT. Admission CTP findings will be compared with the reference standard of an accepted bedside clinical assessment at the time of admission. Deferred consent will be used. The primary outcome is a binary outcome of good neurological status, defined as mRs<4 or poor neurological status (mRs≥4) at hospital discharge. A total of 90 patients will be enrolled. ETHICS AND DISSEMINATION This study has been approved by the University of Manitoba Health Research Ethics Board. The findings from our study will be disseminated through peer-reviewed journals and presentations at local rounds, national and international conferences. The public will be informed at the end of the study. TRIAL REGISTRATION NUMBER NCT04323020.
Collapse
Affiliation(s)
- Susan Alcock
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarbjeet Singh
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Evan J Wiens
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Navjit Singh
- University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Sudharsana Rao Ande
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristen Lampron
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Beili Huang
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Iain Kirkpatrick
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anurag Trivedi
- Section of Neurology, Department of Internal Medicine, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Stephen Allan Schaffer
- Sections of Cardiology and Critical Care Medicine, Department of Internal Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Jai Shiva Shankar
- Department of Radiology, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
- Department of Human Anatomy and Cell Science, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| |
Collapse
|
21
|
Johnston B, Hill RA, Blackwood B, Lip GYH, Welters ID. Development of Core Outcome Sets for trials on the management of Atrial fi Brill Ation in Critically Unwell patient S (COS-ABACUS): a protocol. BMJ Open 2023; 13:e067257. [PMID: 37120150 PMCID: PMC10186458 DOI: 10.1136/bmjopen-2022-067257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/07/2023] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common cardiac arrhythmia in critically unwell patients. New-onset AF (NOAF) affects 5%-11% of all admissions and up to 46% admitted with septic shock. NOAF is associated with increased morbidity, mortality and healthcare costs. Existing trials into the prevention and management of NOAF suffer from significant heterogeneity making comparisons and inferences limited. Core outcome sets (COS) aim to standardise outcome reporting, reduce inconsistency between trials and reduce outcome reporting bias. We aim to develop an internationally agreed COS for trials of interventions on the management of NOAF during critical illness. METHODS AND ANALYSIS Stakeholders including intensive care physicians, cardiologists and patients will be recruited from national and international critical care organisations. COS development will occur in five stages: (1) Outcomes included in trials, recent systematic reviews and surveys of clinician practice and patient focus groups will be extracted. (2) Extracted outcomes will inform a two-stage e-Delphi process and consensus meeting using Grading of Recommendations Assessment, Development and Evaluation methodology. (3) Outcome measurement instruments (OMIs) will be identified from the literature and a consensus meeting held to agree OMI for core outcomes. (4) Nominal group technique will be used in a final consensus meeting to the COS. (5) The findings of our COS will be published in peer-reviewed journals and implemented in future guidelines and intervention trials. ETHICS AND DISSEMINATION The study has been approved by the University of Liverpool ethics committee (Ref: 11 256, 21 June 2022), with a formal consent waiver and assumed consent. We will disseminate the finalised COS via national and international critical care organisations and publication in peer-reviewed journals.
Collapse
Affiliation(s)
- Brian Johnston
- Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Ruaraidh A Hill
- Liverpool Reviews & Implementation Group, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Bronagh Blackwood
- Queen's University Belfast Wellcome-Wolfson Institute for Experimental Medicine, Belfast, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Ingeborg D Welters
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| |
Collapse
|
22
|
Hou Z, Zhao MX, Sun Y, Zhang S, Yao S, Wang C, Wang M, Yun C, Xue H, Wu S. Resting heart rate and risk of atrial fibrillation in Chinese general population: Kailuan prospective cohort study. BMJ Open 2023; 13:e070312. [PMID: 37116993 PMCID: PMC10151892 DOI: 10.1136/bmjopen-2022-070312] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE Previous research has shown an association of higher heart rate with an increased risk of atrial fibrillation (AF). However, the relationship between resting heart rate (RHR) and AF is unknown. The aim of this study was to investigate the association between RHR and AF in the general population of China. DESIGN Prospective observational cohort study. SETTING Community based. PARTICIPANTS A total of 46 126 individuals from the Kailuan study who participated in the first three surveys (2006/2007, 2008/2009 and 2010/2011) and were followed up at 2-year intervals were enrolled. PRIMARY OUTCOME MEASURES The association between RHR and risk of incident AF was evaluated using Cox proportional hazards regression and restricted cubic spline models. RESULTS Two hundred and forty-one individuals (0.52%) developed AF during 7.5 years of follow-up. After adjustment for age, sex, low-density and high-density lipoprotein, physical activity, alcohol consumption, smoking status, body mass index, mean systolic blood pressure, and history of diabetes and hypertension, the HRs were 2.32 (95% CI 1.45 to 3.72) for an RHR <60 beats/min and 2.80 (1.13 to 6.94) for an RHR ≥100 beats/min in comparison with an RHR of 70-80 beats/min. Restricted cubic spline models revealed a U-shaped relationship between RHR and incident AF. CONCLUSION These findings indicate that RHR and incident AF have a U-shaped relationship in the Chinese general population. Both lower and higher RHRs were associated with an increased risk of AF.
Collapse
Affiliation(s)
- Ziwei Hou
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Mao Xiang Zhao
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yizhen Sun
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Sijing Zhang
- Clinical medicine, Nankai University, Tianjin, China
| | - Siyu Yao
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Chi Wang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Miao Wang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Cuijuan Yun
- Clinical medicine, Nankai University, Tianjin, China
| | - Hao Xue
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China
| |
Collapse
|
23
|
Bavishi A, Kliethermes SA, Petek B, Moulson N, Mellacheruvu P, Churchill TW, Harmon K, Patel MR, Baggish AL, Drezner JA, Mutharasan RK. Clinical spectrum of COVID-19 complications in young adults: combined analysis of the American Heart Association COVID-19 Cardiovascular Disease Registry and the Outcomes Registry for Cardiac Conditions in Athletes. BMJ Open 2023; 13:e069943. [PMID: 37045581 PMCID: PMC10105915 DOI: 10.1136/bmjopen-2022-069943] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND While young adults 18-24 years old bear a significant proportion of COVID-19 diagnoses, the risk factors for hospitalisation and severe COVID-19 complications in this population are poorly understood. OBJECTIVE The objective of this study was to identify risk factors for hospitalisation and other COVID-19 complications across the health spectrum of young adults diagnosed with COVID-19 infection. STUDY DESIGN Retrospective cohort study. PARTICIPANTS Young adults (aged 18-24) with confirmed COVID-19 infection from the American Heart Association (AHA) COVID-19 Cardiovascular Disease Registry of hospitalised patients and the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA) study of collegiate athletes. The AHA registry included 636 young adults from 152 hospitals. The ORCCA registry consisted of 3653 competitive college athletes from 42 colleges and universities. INTERVENTION None (exposure to COVID-19). PRIMARY AND SECONDARY OUTCOME MEASURES Main outcomes included hospitalisation, death, major adverse cardiovascular events (MACE) and other severe clinical events. RESULTS In comparison to the ORCCA registry, patients in the AHA registry were more likely to be female (59% vs 33%); had higher average body mass index (BMI) (32.4 vs 25.6); and had increased prevalence of diabetes (10% vs 0.4%), hypertension (7% vs 0.6%), chronic kidney disease (2% vs 0%) and asthma (14% vs 8%), all with p<0.01. There were eight (2%) deaths in the AHA hospitalised registry compared with zero in the ORCCA cohort. BMI was a statistically significant predictor of death in the hospitalised cohort (OR 1.05, 95% CI 1.00, 1.10). No significant predictors of MACE or other severe clinical events were identified. CONCLUSIONS The risk of cardiac events in young adults aged 18-24 diagnosed with COVID-19 infection is low. Patients who were hospitalised (AHA registry) were more likely to have pre-existing medical comorbidities and higher BMI than healthy collegiate athletes (ORCCA registry). Once hospitalised, elevated BMI is associated with increased mortality although other drivers of MACE and other severe clinical events remain unclear.
Collapse
Affiliation(s)
- Aakash Bavishi
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Bradley Petek
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathaniel Moulson
- Department of Cardiology, The University of British Columbia Library Vancouver Campus, Vancouver, British Columbia, Canada
| | - Pranav Mellacheruvu
- Department of Internal Medicine, Washington State University Elson S Floyd College of Medicine, Spokane, Washington, USA
| | - Timothy W Churchill
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kimberly Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Manesh R Patel
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Aaron L Baggish
- Department of Sports Science, University of Lausanne, Lausanne, Switzerland
| | - Jonathan A Drezner
- Department of Family Medicine, Washington State University Spokane, Spokane, Washington, USA
| | - Raja Kannan Mutharasan
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
24
|
Abstract
OBJECTIVE The objective of this study was to determine the diagnostic accuracy in detecting valvular heart disease (VHD) by heart auscultation, performed by medical doctors. DESIGN/METHODS A systematic literature search for diagnostic studies comparing heart auscultation to echocardiography or angiography, to evaluate VHD in adults, was performed in MEDLINE (1947-November 2021) and EMBASE (1947-November 2021). Two reviewers screened all references by title and abstract, to select studies to be included. Disagreements were resolved by consensus meetings. Reference lists of included studies were also screened. The results are presented as a narrative synthesis, and risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. MAIN OUTCOME MEASURES Sensitivity, specificity and likelihood ratios (LRs). RESULTS We found 23 articles meeting the inclusion criteria. Auscultation was compared with full echocardiography in 15 of the articles; pulsed Doppler was used as reference standard in 2 articles, while aortography and ventriculography was used in 5 articles. One article used point-of-care ultrasound. The articles were published from year 1967 to 2021. Sensitivity of auscultation ranged from 30% to 100%, and specificity ranged from 28% to 100%. LRs ranged from 1.35 to 26. Most of the included studies used cardiologists or internal medicine residents or specialists as auscultators, whereas two used general practitioners and two studied several different auscultators. CONCLUSION Sensitivity, specificity and LRs of auscultation varied considerably across the different studies. There is a sparsity of data from general practice, where auscultation of the heart is usually one of the main methods for detecting VHD. Based on this review, the diagnostic utility of auscultation is unclear and medical doctors should not rely too much on auscultation alone. More research is needed on how auscultation, together with other clinical findings and history, can be used to distinguish patients with VHD. PROSPERO REGISTRATION NUMBER CRD42018091675.
Collapse
Affiliation(s)
- Anne Herefoss Davidsen
- General Practice Research Unit, Department of Community Medicine, UiT The Arctic University, Tromso, Norway
| | - Stian Andersen
- General Practice Research Unit, Department of Community Medicine, UiT The Arctic University, Tromso, Norway
| | - Peder Andreas Halvorsen
- General Practice Research Unit, Department of Community Medicine, UiT The Arctic University, Tromso, Norway
| | - Henrik Schirmer
- Department of Clinical Medicine, University of Oslo Faculty of Medicine, Lørenskog, Norway
- Department of Cardiology, Akershus University Hospital, Lorenskog, Norway
| | - Eirik Reierth
- Science and Health Library, UiT The Arctic University, Tromso, Troms, Norway
| | - Hasse Melbye
- General Practice Research Unit, Department of Community Medicine, UiT The Arctic University, Tromso, Norway
| |
Collapse
|
25
|
Rao K, Bhatia K, Chan B, Cowan M, Saad N, Baer A, Sritharan H, Bromhead I, Whalley D, Allahwala UK, Hansen P, Bhindi R. Prospective observational study on the accuracy of predictors of high-grade atrioventricular conduction block after transcatheter aortic valve implantation (CONDUCT-TAVI): study protocol, background and significance. BMJ Open 2023; 13:e070219. [PMID: 36889832 PMCID: PMC10008405 DOI: 10.1136/bmjopen-2022-070219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Aortic stenosis is the most common cardiac valve pathology worldwide and has a mortality rate of over 50% at 5 years if left untreated. Transcatheter aortic valve implantation (TAVI) is a minimally invasive and highly effective alternative treatment option to open-heart surgery. High-grade atrioventricular conduction block (HGAVB) is one of the most common complications after TAVI and requires a permanent pacemaker. Due to this, patients are typically monitored for 48 hours post TAVI, however up to 40% of HGAVB may delayed, and occur after discharge. Delayed HGAVB can cause syncope or sudden unexplained cardiac death in a vulnerable population, and no accurate methods currently exist to identify patients at risk. METHODS AND ANALYSIS The prospective observational study on the accuracy of predictors of high-grade atrioventricular conduction block after transcatheter aortic valve implantation (CONDUCT-TAVI) trial is an Australian-led, multicentre, prospective observational study, aiming to improve the prediction of HGAVB, after TAVI. The primary objective of the trial is to assess whether published and novel invasive electrophysiology predictors performed immediately before and after TAVI can help predict HGAVB after TAVI. The secondary objective aims to further evaluate the accuracy of previously published predictors of HGAVB after TAVI, including CT measurements, 12-lead ECG, valve characteristics, percentage oversizing and implantation depth. Follow-up will be for 2 years, and detailed continuous heart rhythm monitoring will be obtained by inserting an implantable loop recorder in all participants. ETHICS AND DISSEMINATION Ethics approval has been obtained for the two participating centres. Results of the study will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ACTRN12621001700820.
Collapse
Affiliation(s)
- Karan Rao
- Cardiology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
- North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Kunwardeep Bhatia
- Cardiology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Bernard Chan
- Cardiology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Mitchell Cowan
- Cardiology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Natasha Saad
- Cardiology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Alexandra Baer
- North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Hari Sritharan
- Cardiology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Ingrid Bromhead
- Cardiology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - David Whalley
- Cardiology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Usaid K Allahwala
- Cardiology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Peter Hansen
- Cardiology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- North Shore Private Hospital, Sydney, New South Wales, Australia
| | - Ravinay Bhindi
- Cardiology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
- North Shore Private Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
26
|
Reed MJ, Grubb N, Lang C, Goodacre S, O'Brien R, Weir CJ, Thokala P, Freeman N, Blackstock C, Dinsmore L, Boyd J, Adamestam I, Macrae P, Hannigan R, Lobban T. Multicentre open label randomised controlled trial of immediate enhanced ambulatory ECG monitoring versus standard monitoring in acute unexplained syncope patients: the ASPIRED study. BMJ Open 2023; 13:e069530. [PMID: 36822806 PMCID: PMC9950891 DOI: 10.1136/bmjopen-2022-069530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION Diagnosing underlying arrhythmia in emergency department (ED) syncope patients is difficult. There is a evidence that diagnostic yield for detecting underlying arrhythmia is highest when cardiac monitoring devices are applied early, ideally at the index visit. This strategy has the potential to change current syncope management from low diagnostic yield Holter to higher yield ambulatory monitoring, reduce episodes of syncope, reduce risk of recurrence and its potential serious consequences, reduce hospital admissions, reduce overall health costs and increase quality of life by allowing earlier diagnosis, treatment and exclusion of clinically important arrhythmias. METHODS AND ANALYSES This is a UK open prospective parallel group multicentre randomised controlled trial of an immediate 14-day ambulatory patch heart monitor vs standard care in 2234 patients presenting acutely with unexplained syncope. Our patient focused primary endpoint will be number of episodes of syncope at 1 year. Health economic evaluation will estimate the incremental cost per syncope episode avoided and quality-adjusted life year gained. ETHICS AND DISSEMINATION Informed consent for participation will be sought. The ASPIRED trial received a favourable ethical opinion from South East Scotland Research Ethics Committee 01 (21/SS/0073). Results will be disseminated via scientific publication, lay summary and visual abstract. TRIAL REGISTRATION NUMBER ISRCTN 10278811.
Collapse
Affiliation(s)
- Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
- Acute Care Edinburgh, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Neil Grubb
- Department of Cardiology, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Chris Lang
- Department of Cardiology, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Steve Goodacre
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Rachel O'Brien
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Praveen Thokala
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Nicola Freeman
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Caroline Blackstock
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Lynn Dinsmore
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Julia Boyd
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Imad Adamestam
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Pam Macrae
- ASPIRED study Patient Advisory Group, Edinburgh, UK
| | | | - Trudie Lobban
- ASPIRED study Patient Advisory Group, Edinburgh, UK
- Arrhythmia Alliance, Chipping Norton, UK
| |
Collapse
|
27
|
He H, Lachlan T, Chandan N, Lim VG, Kimani P, Ng GA, Ali A, Randeva H, Osman F. Obstructive Sleep Apnoea and Cardiac Arrhythmias (OSCA) trial: a nested cohort study using injectable loop recorders and Holter monitoring in patients with obstructive sleep apnoea. BMJ Open 2023; 13:e070884. [PMID: 36792325 PMCID: PMC9950886 DOI: 10.1136/bmjopen-2022-070884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) is associated with increased cardiovascular mortality despite continuous positive airways pressure (CPAP) therapy. This excess risk may be related to increased arrhythmia risk, especially atrial fibrillation (AF). The true incidence of arrhythmia in patients with OSA is unknown. Implantable loop recorders (ILR) are powerful tools for detecting arrhythmias long-term. Cardiac autonomic function may be important in arrhythmogenesis in these patients but needs further study. We aim to identify the true incidence of arrhythmias (especially AF) using ILRs, assess cardiac autonomic function using Holter monitors in patients with OSA and explore cardiovascular outcomes. METHODS AND ANALYSIS A two-centre (University Hospital Coventry and St. Cross Hospital, Rugby) nested cohort study using Reveal LINQ (Medtronic, UK) ILR to identify precise arrhythmia (atrial/ventricular) incidence in patients with moderate-severe OSA. 200 patients will be randomised 1:1 to standard care alone or standard care+ILR (+Holter monitor at baseline and 12 months). The primary objective is to compare arrhythmia detection over 3 years between the two groups. Cardiac autonomic function will be assessed in the ILR-arm at baseline and 12 months post CPAP. Secondary objectives will explore the mechanisms linking OSA and arrhythmia using cardiac autonomic function parameters based on Holter recordings and circulating biomarkers (high sensitivity Troponin-T, N-terminal pro B-type natriuretic peptide, matrix metalloproteinase-9, fibroblast growth factor 23, high sensitivity C-reactive protein, interleukin-6 and tumour necrosis factor-α) before and after CPAP initiation in the ILR-arm. ETHICS AND DISSEMINATION This study has been approved by the Health Research Authority after examination by the Solihull Research and Ethics Committee. The main ethical considerations was the minimally invasive nature of ILR insertion outside of usual care. Patient advisory groups were consulted with a positive outcome for this type of research. We plan on publishing papers in peer-reviewed journals based on the primary objective and any interesting findings from secondary objectives. We will endeavour to publish all relevant data. TRIAL REGISTRATION NUMBER NCT03866148.
Collapse
Affiliation(s)
- Hejie He
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Thomas Lachlan
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- University of Warwick Warwick Medical School, Coventry, UK
| | - Nakul Chandan
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ven Gee Lim
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Peter Kimani
- Warwick Medical School, University of Warwick Faculty of Medicine, Coventry, UK
| | - G Andre Ng
- Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Asad Ali
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Harpal Randeva
- R&D Institute of Cardio-metabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Faizel Osman
- University of Warwick Warwick Medical School, Coventry, UK
- R&D Institute of Cardiometabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| |
Collapse
|
28
|
Guan Y, Qi Y, Zheng L, Yang J, Zhang M, Zhang Q, Ji L. Data mining techniques for detecting signals of adverse drug reaction of cardiac therapy drugs based on Jinan adverse event reporting system database: a retrospective study. BMJ Open 2023; 13:e068127. [PMID: 36669842 PMCID: PMC9872458 DOI: 10.1136/bmjopen-2022-068127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Cardiac therapy drugs are widely used in the treatment of heart disease. However, the concern regarding adverse events (AEs) of cardiac therapy drugs have been rising. This study aimed to analyse cardiac therapy drug-related AEs using the Jinan adverse event reporting system (JAERS) database mining and conduct a comprehensive evaluation to provide safe medication information for patients. DESIGN Retrospective observational study. SETTING In this study, cardiac therapy drug-related AEs were detected using the JAERS database from January 2000 to March 2022. METHODS Reports of cardiac therapy drug-related AEs were extracted from JAERS database, and the basic information of patients, reports and common AEs were analysed. Four disproportionality analysis methods, proportional reporting ratio (PRR), reporting odds ratio (ROR), Bayesian Confidence Propagation Neural Network (BCPNN), Medicines and Healthcare products Regulatory Agency (MHRA), were used to detect cardiac therapy drug-related signals. We further checked whether the detected signals exist on drug labels in China and two developed countries, the USA and Japan. RESULTS In total, 168 314 AEs were reported, of which 4788 were associated with cardiac therapy drugs. Using the PRR, ROR, MHRA and BCPNN method, we detected 52 signals, 52 signals, 33 signals and 43 signals, respectively. Among the 52 signals, 14 were not included on the drug labels of China. One (isosorbide mononitrate-head bilges) was not included on the drug labels of the three countries. CONCLUSION We identified 14 new cardiac therapy drug signals that did not appear on drug labels in China and 1 new signal that did not appear on drug labels in 3 counties. A causal link between cardiac therapy drugs and AEs should be evaluated in further studies.
Collapse
Affiliation(s)
- Yuyao Guan
- Department of Pharmacy, Shandong University Affiliated Shandong Provincial Third Hospital, Jinan, Shandong, China
| | - Yingmei Qi
- Jinan Adverse Drug Reactions and Medical Device Adverse Event Monitoring Center, Jinan, Shandong, China
| | - Lei Zheng
- Department of Pharmacy, Shandong University Affiliated Shandong Provincial Third Hospital, Jinan, Shandong, China
| | - Jing Yang
- Department of Pharmacy, Shandong University Affiliated Shandong Provincial Third Hospital, Jinan, Shandong, China
| | - Mingzhu Zhang
- Department of Pharmacy, Shandong University Affiliated Shandong Provincial Third Hospital, Jinan, Shandong, China
| | - Qiuhong Zhang
- Jinan Adverse Drug Reactions and Medical Device Adverse Event Monitoring Center, Jinan, Shandong, China
| | - Lei Ji
- Shandong Provincial Key Laboratory of Applied Microbiology, Ecology Institute, Qilu University of Technology, Jinan, Shandong, China
| |
Collapse
|
29
|
Akowuah E, Mathias A, Bardgett M, Harrison S, Kasim AS, Loughran K, Ogundimu E, Trevis J, Wagnild J, Witharana P, Hancock HC, Maier RH. Prehabilitation in elective patients undergoing cardiac surgery: a randomised control trial (THE PrEPS TRIAL) - a study protocol. BMJ Open 2023; 13:e065992. [PMID: 36604134 PMCID: PMC9827267 DOI: 10.1136/bmjopen-2022-065992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Prehabilitation prior to surgery has been shown to reduce postoperative complications, reduce length of hospital stay and improve quality of life after cancer and limb reconstruction surgery. However, there are minimal data on the impact of prehabilitation in patients undergoing cardiac surgery, despite the fact these patients are generally older and have more comorbidities and frailty. This trial will assess the feasibility and impact of a prehabilitation intervention consisting of exercise and inspiratory muscle training on preoperative functional exercise capacity in adult patients awaiting elective cardiac surgery, and determine any impact on clinical outcomes after surgery. METHODS AND ANALYSIS PrEPS is a randomised controlled single-centre trial recruiting 180 participants undergoing elective cardiac surgery. Participants will be randomised in a 1:1 ratio to standard presurgical care or standard care plus a prehabilitation intervention. The primary outcome will be change in functional exercise capacity measured as change in the 6 min walk test distance from baseline. Secondary outcomes will evaluate the impact of prehabilitation on preoperative and postoperative outcomes including; respiratory function, health-related quality of life, anxiety and depression, frailty, and postoperative complications and resource use. This trial will evaluate if a prehabilitation intervention can improve preoperative physical function, inspiratory muscle function, frailty and quality of life prior to surgery in elective patients awaiting cardiac surgery, and impact postoperative outcomes. ETHICS AND DISSEMINATION A favourable opinion was given by the Sheffield Research Ethics Committee in 2019. Trial findings will be disseminated to patients, clinicians, commissioning groups and through peer-reviewed publication. TRIAL REGISTRATION NUMBER ISRCTN13860094.
Collapse
Affiliation(s)
- Enoch Akowuah
- Department of Cardiothoracic Surgery, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, MIddlesbrough, UK
- South Tees Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Ayesha Mathias
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Michelle Bardgett
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Samantha Harrison
- School of Health and Life Sciences, Teeside University, Middlesbrough, UK
| | | | - Kirsti Loughran
- School of Health and Life Sciences, Teeside University, Middlesbrough, UK
| | | | - Jason Trevis
- Department of Cardiothoracic Surgery, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, MIddlesbrough, UK
| | | | - Pasan Witharana
- Department of Cardiothoracic Surgery, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, MIddlesbrough, UK
| | - Helen C Hancock
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca H Maier
- South Tees Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
30
|
Tilton E, Mitchelson B, Anderson A, Peat B, Jack S, Lund M, Webb R, Wilson N. Cohort profile: methodology and cohort characteristics of the Aotearoa New Zealand Rheumatic Heart Disease Registry. BMJ Open 2022; 12:e066232. [PMID: 36585142 PMCID: PMC9809252 DOI: 10.1136/bmjopen-2022-066232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To create a cohort with high specificity for moderate and severe rheumatic heart disease (RHD) in New Zealand, not reliant on International Classification of Diseases discharge coding. To describe the demography and cardiac profile of this historical and contemporary cohort. DESIGN AND PARTICIPANTS Retrospective identification of moderate or severe RHD with disease onset by 2019. Case identification from the following data sources: cardiac surgical databases, RHD case series, percutaneous balloon valvuloplasty databases, echocardiography databases, regional rheumatic fever registers and RHD clinic lists. The setting for this study was a high-income country with continued incidence of acute rheumatic fever (ARF). FINDINGS TO DATE A Registry cohort of 4959 patients was established. The initial presentation was RHD without recognised prior ARF in 41%, and ARF in 59%. Ethnicity breakdown: Māori 38%, Pacific 33.5%, European 21.9%, other 6.7%. Ethnic disparities have changed significantly over time. Prior to 1960, RHD cases were 64.3% European, 25.3% Māori and 6.7% Pacific. However, in contrast, from 2010 to 2019, RHD cases were 10.7% European, 37.4% Māori and 47.2% Pacific.Follow-up showed 32% had changed region of residence within New Zealand from their initial presentation. At least one cardiac intervention (cardiac surgery, transcatheter balloon valvuloplasty) was undertaken in 64% of the cohort at a mean age of 40 years. 19.8% of the cohort had multiple cardiac interventions. At latest follow-up, 26.9% of the cohort died. Of those alive, the mean follow-up is 20.5+19.4 years. Māori and Pacific led governance groups have been established to provide data governance and oversight for the registry. FUTURE PLANS Detailed mortality and morbidity of the registry cases will be defined by linkage to New Zealand national health data collections. The contemporary cohort of the registry will be available for future studies to improve clinical management and outcomes for the 3450 individuals living with chronic RHD.
Collapse
Affiliation(s)
- Elizabeth Tilton
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Health, Te Whatu Ora - Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
| | - Bryan Mitchelson
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Health, Te Whatu Ora - Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
| | - Anneka Anderson
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Briar Peat
- General Medicine, Middlemore Hospital, Te Whatu Ora - Health New Zealand, Counties Manukau, Auckland, New Zealand
| | - Susan Jack
- Public Health South, Southern District Health Board, Dunedin, New Zealand
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Mayanna Lund
- Cardiology Department, Middlemore Hospital, Te Whatu Ora - Health New Zealand, Counties Manukau, Auckland, New Zealand
| | - Rachel Webb
- Department of Paediatric Infectious Diseases, Starship Children's Health, Te Whatu Ora - Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
- 7KidzFirst Children's Hospital, Te Whatu Ora - Health New Zealand, Counties Manukau, Auckland, New Zealand
| | - Nigel Wilson
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Health, Te Whatu Ora - Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
| |
Collapse
|
31
|
Abstract
OBJECTIVE To synthesise the current knowledge on barriers and facilitators to deprescribing cardiovascular medications (CVMs) at the levels of patients, informal caregivers and healthcare providers (HCPs). DESIGN/SETTING We conducted a systematic review of studies exploring/assessing patient, informal caregiver and/or HCP barriers and/or facilitators to deprescribing CVMs. DATA SOURCES Ovid/MEDLINE and Embase from January 2003 to November 2021. DATA EXTRACTION AND SYNTHESIS We performed a deductive thematic analysis based on the framework of specific barriers and facilitators to deprescribing CVMs created by Goyal et al. We added a quantification of the occurrence of categories and themes in the selected articles to identify the resounding themes that indicate the greater impetus to address in future research. RESULTS Most frequent deprescribing barriers for patients, informal caregivers and HCPs included uncertainty due to lack of evidence regarding CVM deprescribing (in n=10 studies), fear of negative consequences following deprescribing (n=13) and social influences (n=14). A frequently reported facilitator to deprescribing, especially for patients and informal caregivers, was the occurrence of adverse drug events (n=7). Another frequently reported facilitator for patients were dislike of CVMs (n=9). Necessity and benefit of CVMs were seen as barriers or facilitators similarly by patients and HCPs. CONCLUSION The differences in patient, informal caregiver and HCP regarding barriers and facilitators to deprescribing CVMs stress the need for ground discussions about beliefs and preferences of each stakeholder implicated in deprescribing decisions. Furthermore, HCP uncertainty regarding CVM deprescribing highlights the need to provide HCPs with tools that enable sharing the risks and benefits of deprescribing with patients and ensure a safe deprescribing process. PROSPERO REGISTRATION NUMBER CRD42020221973.
Collapse
Affiliation(s)
- Laureline Brunner
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carole Elodie Aubert
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
32
|
Lathlean T, Kieu D, Franke KB, O'Callaghan N, Boyd MA, Mahajan R. Impact of health literacy and its interventions on health outcomes in those with atrial fibrillation: a systematic review protocol. BMJ Open 2022; 12:e065407. [PMID: 36456030 PMCID: PMC9716799 DOI: 10.1136/bmjopen-2022-065407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is associated with increased risk of stroke, heart failure and death. Health literacy, an aspect that falls within precision health, has been recognised as an important factor. We will be focusing on the impact of these interventions specifically to AF and its health outcomes. METHODS AND ANALYSIS This protocol is informed by the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols. The results will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to determine the impacts of health literacy interventions on AF outcomes. Searches will be carried out on databases including MEDLINE, EMBASE, Web of Science, CINAHL, Emcare, Cochrane Library and Google Scholar. Citations will be collected via Endnote 20, then into Covidence for duplicate removal, and article screening. Extraction will occur using a standardised extraction tool and studies will be synthesised using best evidence synthesis. Downs and Black's checklist will be used for risk of bias and assessment of overall quality of evidence will use the Grading of Recommendations, Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION Approval from human research ethics committee is not required. Dissemination will occur in peer-reviewed journals and conference presentations. PROSPERO REGISTRATION NUMBER CRD42022304835.
Collapse
Affiliation(s)
- Timothy Lathlean
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Don Kieu
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Kyle B Franke
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nathan O'Callaghan
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Mark A Boyd
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth, South Australia, Australia
| | - Rajiv Mahajan
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth, South Australia, Australia
| |
Collapse
|
33
|
Cirillo C, Nakou E, Georgiopoulos G, Tountas C, Victor K, Marvaki A, Desai N, Fisher R, Ryan M, Demir OM, Corcoran E, O'Gallagher K, Sinclair H, Pericao A, Dhariwal A, Stylianidis V, Hua A, Nabeebaccus AA, Pearson P, Fonseca T, Osborne A, Toth E, Zuckerman M, Shah AM, Perera D, Monaghan M, Carr-White G, Papachristidis A. Predictors of in-hospital mortality in critically ill patients with COVID-19: a large dual tertiary centre study. BMJ Open 2022; 12:e059358. [PMID: 36456009 PMCID: PMC9716800 DOI: 10.1136/bmjopen-2021-059358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 09/07/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the relationship of echocardiographic parameters, laboratory findings and clinical characteristics with in-hospital mortality in adult patients with COVID-19 admitted to the intensive care units (ICU) in two large collaborating tertiary UK centres. DESIGN Observational retrospective study. SETTING The study was conducted in patients admitted to the ICU in two large tertiary centres in London, UK. PARTICIPANTS Inclusion criteria were: (1) patients admitted to the ICU with a COVID-19 diagnosis over a period of 16 weeks. and (2) underwent a transthoracic echocardiogram on the first day of ICU admission as clinically indicated.No exclusion criteria applied.Three hundred patients were enrolled and completed the follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome measure in this study was in-hospital mortality in patients admitted to the ICU with COVID-19 infection. RESULTS Older age (HR: 1.027, 95% CI 1.007 to 1.047; p=0.008), left ventricular (LV) ejection fraction<35% (HR: 5.908, 95% CI 2.609 to 13.376; p<0.001), and peak C reactive protein (CRP) (HR: 1.002, 95% CI 1.001 to 1.004, p=0.001) were independently correlated with mortality in a multivariable Cox regression model. Following multiple imputation of variables with more than 5% missing values, random forest analysis was applied to the imputed data. Right ventricular (RV) basal diameter (RVD1), RV mid-cavity diameter (RVD2), tricuspid annular plane systolic excursion, RV systolic pressure, hypertension, RV dysfunction, troponin level on admission, peak CRP, creatinine level on ICU admission, body mass index and age were found to have a high relative importance (> 0.7). CONCLUSIONS In patients with COVID-19 in the ICU, both severely impaired LV function and impaired RV function may have adverse prognostic implications, but older age and inflammatory markers appear to have a greater impact. A combination of echocardiographic and laboratory investigations as well as demographic and clinical characteristics appears appropriate for risk stratification in patients with COVID-19 who are admitted to the ICU.
Collapse
Affiliation(s)
- Chiara Cirillo
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Eleni Nakou
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Christos Tountas
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Kelly Victor
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Apostolia Marvaki
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Nishita Desai
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard Fisher
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Ozan M Demir
- Cardiovascular Division, King's College London, London, UK
| | - Eleanor Corcoran
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Kevin O'Gallagher
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Hannah Sinclair
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ana Pericao
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anender Dhariwal
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Alina Hua
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Adam Abner Nabeebaccus
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Peter Pearson
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Tiago Fonseca
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Osborne
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Eva Toth
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Mark Zuckerman
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Ajay M Shah
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
- King's College London, British Heart Foundation Centre, London, UK
| | - Divaka Perera
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Mark Monaghan
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Gerald Carr-White
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Alexandros Papachristidis
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| |
Collapse
|
34
|
Keithler AN, Wilson AS, Yuan A, Sosa JM, Bush KNV. Temporal trends in anticoagulation management for US active duty personnel with atrial fibrillation. BMJ Open 2022; 12:e049394. [PMID: 36446457 PMCID: PMC9710344 DOI: 10.1136/bmjopen-2021-049394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED ObjectivesThis study aims to investigate US active duty (AD) military members diagnosed with atrial fibrillation (AF) and the temporal trends of systemic anticoagulation (AC). Our secondary objective is to study the AC prescriptions in AD military members diagnosed with AF and associated military dispositions and deployment rates. DESIGN AND SETTING A retrospective investigation of Tricare pharmacy AC prescriptions within the San Antonio Military Health System from January 2004 to July 2019 for AD individuals diagnosed with AF was performed. PARTICIPANTS 386 AD personnel with non-valvular AF were analysed (mean age 35.0±9.4 years; mean body mass index, 28.3±4.3 kg/m2; 93% male; 57% Caucasian, 94% paroxysmal AF). OUTCOMES The temporal trends of systemic AC prescriptions were the primary outcome measures. The association between AC prescriptions and military dispositions and deployments were secondary outcomes of interest. STATISTICAL ANALYSIS The association between AC management, future deployments and military disposition was analysed using χ2 and Fisher's exact test for categorical variables. The t-test was used for comparison of continuous variables. RESULTS CHA2DS2-VASc and HAS-BLED scores were low (0.39±0.65 and 0.86±0.63, respectively). 127 (33%) members received warfarin and 58 (15%) received direct oral anticoagulants (DOACs). Rates of military retention were not different between AC histories (no AC (64%) vs warfarin (75%) vs DOAC (65%); p=0.425). There was a significant trend of more recent utilisation of DOACs compared with warfarin (p<0.0001). When adjusted for temporal changes in deployment rates, there was no significant difference in deployment between AC groups (no AC (39%) vs warfarin (49%) vs DOAC (27%); p=0.9472). CONCLUSIONS This is the first report describing AC utilisation in US AD military members with AF. Young AD personnel with low stroke and bleeding risks do not commonly receive AC prescriptions. DOAC prescription rates are increasing and predominate over warfarin for AC indications.
Collapse
Affiliation(s)
| | - Andrew S Wilson
- Division of Cardiology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Alexander Yuan
- Division of Cardiology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Jose M Sosa
- Division of Cardiology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Kelvin N V Bush
- Division of Cardiology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| |
Collapse
|
35
|
Akbari-Khezrabadi A, Zibaeenezhad MJ, Shojaeefard E, Naseri A, Mousavi S, Sarejloo S, Karimi M, Hosseinpour M, Salimi M, Bazrafshan M, Salimi A, Parsa N, Sayadi M, Razeghian-Jahromi I, Zibaeenejad F, Mohammadi SS, Bazrafshan Drissi H. Can anthropometric indices predict the chance of hypertension? A multicentre cross-sectional study in Iran. BMJ Open 2022; 12:e062328. [PMID: 36418117 PMCID: PMC9685002 DOI: 10.1136/bmjopen-2022-062328] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study aims to assess the prevalence of hypertension (HTN), and determine the relationship between HTN and anthropometric indices including fat distribution, body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) in Shiraz Heart Study. SETTING In this cross-sectional study, subjects were enrolled in 25 clinics in Shiraz. I.R. Iran between 2019 and 2021. PARTICIPANTS A total number of 7225 individuals were selected, aged between 40 and 70 years of whom 52.3% were female. Among the people living in Shiraz, individuals living far from clinics, cases of mental or physical disabilitiy and documented cardiovascular diseases were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome: The association of body composition, WHR, WHtR and BMI with HTN. SECONDARY OUTCOME The sensitivity and specificity of the WHtR for the prediction of HTN. RESULTS HTN prevalence was 19.3%. Obesity prevalence was estimated to be 28.5%. WHR and lean body mass showed a significant association with HTN (p<0.05). Receiver operating characteristic for WHtR yielded an area under the curve of 0.62 (95% CI 0.61 to 0.64) and 0.63 (95% CI 0.62 to 0.65) for males and females, respectively. The optimal threshold value yielded 0.54 in men and 0.61 in women. The sensitivity was 72.3% and 73.9% in women and men, with specificity of 48.4% and 44.3%, respectively. CONCLUSION HTN had a meaningful association with all the noted anthropometric indices. WHtR performed well as a predictor of HTN.
Collapse
Affiliation(s)
- Ali Akbari-Khezrabadi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Mohammad Javad Zibaeenezhad
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Ehsan Shojaeefard
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Arzhang Naseri
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Shahrokh Mousavi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Shirin Sarejloo
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Mohammadreza Karimi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Morteza Hosseinpour
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Maryam Salimi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Mehdi Bazrafshan
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Amirhossein Salimi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Nader Parsa
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Mehrab Sayadi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Iman Razeghian-Jahromi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Fatemeh Zibaeenejad
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Seyyed Saeed Mohammadi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| | - Hamed Bazrafshan Drissi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (the Islamic Republic of)
| |
Collapse
|
36
|
Li X, Yan F, Liu X, Li M, Li J, Chen Y, Li C. Acute coronary syndrome screening in patients presenting with arteriosclerosis in health check-ups: a case-control study. BMJ Open 2022; 12:e062596. [PMID: 36418121 PMCID: PMC9685184 DOI: 10.1136/bmjopen-2022-062596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This research aimed to develop a simple and effective acute coronary syndrome (ACS) screening model in order to intervene early and focus on prevention in patients presenting with arteriosclerosis. DESIGN A case-control study. SETTING The study used a cross-sectional survey to collect data from 2243 patients who completed anonymous electronic medical record (EMR) data and coronary angiography was gathered at a hospital in Shandong Province between December 2013 and April 2016. PARTICIPANTS Adults 18 years old and above diagnosed as ACS or non-ACS according to the records in hospital EMR database, and with completed basic information (age and sex). PREDICTORS 54 laboratory biomarkers and demographic factors (age and sex). STATISTICAL ANALYSIS A dataset without missing data of all patients' laboratory indicators and demographic factors was divided into training set and validation set after being balanced. After the training set balanced, area under the curve of random forest (AUCRF) and least absolute shrinkage and selection operator (LASSO) regression were used for feature extraction. Then two set random forest models were established with the different feature sets, and the process of comparison and analysis was made to evaluate models for the optimal model including sensitivity, accuracy and AUC receiver operating characteristic curves with the internal validation set. MAIN OUTCOME MEASURES To establish an ACS screening model. RESULTS An RF model with 31 features selected by LASSO with an AUC of 0.616 (95% CI 0.650 to 0.772), a sensitivity of 0.832 and an accuracy of 0.714 in the validation set. The other RF model with 27 features selected by AUCRF with an AUC of 0.621 (95% CI 0.664 to 0.785), a sensitivity of 0.849 and an accuracy of 0.728 in the validation set. CONCLUSIONS The established ACS screening model with 27 clinical features provides a better performance for practical solution in predicting ACS.
Collapse
Affiliation(s)
- Xiaoxing Li
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Fangkun Yan
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xinhui Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Mingzhuo Li
- Center for Big Data Research in Health and Medicine, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jiangbing Li
- Department of Cardiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yuguo Chen
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Chuanbao Li
- Department of Emergency and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, Shandong, China
| |
Collapse
|
37
|
Ekrami NK, Magni FT, Dayalani V, van Gelder IC, Groenveld HF, Tieleman RG, Wiesfeld AC, Tan ES, Rienstra M, Blaauw Y, Mulder BA. Assessment of sex-related differences and outcome in patients who underwent cryoballoon pulmonary vein isolation for atrial fibrillation: an observational cohort study. BMJ Open 2022; 12:e063359. [PMID: 36368743 PMCID: PMC9660622 DOI: 10.1136/bmjopen-2022-063359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pulmonary vein isolation (PVI) is widely accepted as an effective and safe treatment for symptomatic atrial fibrillation (AF). However, data on sex-related differences and associations with clinical outcome and safety of PVI with cryoballoon ablation are limited. We sought to compare sexrelated efficacy and safety of cryoballoon ablation and identify sex-related associations with clinical outcomes. METHODS AND RESULTS We included 650 consecutive patients with AF undergoing PVI with cryoballoon ablation at our institution between 2013 and 2017. The efficacy outcome was the first documented recurrence (>30 s) of AF, atrial flutter or atrial tachycardia (AF/AT) or repeat ablation during follow-up, after a 90-day blanking period. The safety outcome was the incidence of periprocedural complications. Mean age of the population was 58±10, and 210 (32.3%) patients were women. Women were older, had a higher body mass index, had more renal dysfunction and less coronary artery disease as compared with men. The rate of AF/AT recurrence was similar between women and men at 12-month follow-up (27.6% vs 24.8%, p=0.445). The incidence of periprocedural complications was higher in women (12.9% vs 4.6%; p<0.001), specifically groin haematomas and phrenic nerve palsy. On multivariate analysis, left atrial volume index (adjusted OR 1.05, 95% CI 1.00 to 1.10; p=0.032) was associated with the incidence of procedural complications in women. For men, no relation with complications could be found. CONCLUSION The efficacy of cryoballoon ablation was similar between women and men; however, women had a higher risk of procedural complications.
Collapse
Affiliation(s)
- Neda Khalilian Ekrami
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Federico T Magni
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Vijay Dayalani
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Isabelle C van Gelder
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Hessel F Groenveld
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Robert G Tieleman
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Ans Cp Wiesfeld
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Eng S Tan
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Yuri Blaauw
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Bart A Mulder
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
38
|
Horvat O, Halgato T, Stojšić-Milosavljević A, Paut Kusturica M, Kovačević Z, Bukumiric D, Tomas A. Identification of patient-related, healthcare-related and knowledge-related factors associated with inadequate blood pressure control in outpatients: a cross-sectional study in Serbia. BMJ Open 2022; 12:e064306. [PMID: 36323484 PMCID: PMC9639095 DOI: 10.1136/bmjopen-2022-064306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To determine rate of blood pressure (BP) control and to analyse patient-related, medication-related and healthcare system-related factors associated with poor BP control in outpatients with hypertension (HT). DESIGN Cross-sectional study. SETTING Two study sites with different levels of healthcare (primary healthcare (PHC) and secondary level of healthcare (SHC)) in Vojvodina, Northern Serbia. PARTICIPANTS A total of 581 patients (response rate 96.8%) visiting their primary care physician between July 2019 and June 2020 filled out a pretested semistructured questionnaire and had a BP reading during their regular appointments. PRIMARY AND SECONDARY OUTCOME MEASURES Data on demographics, medication, BP control (target systolic BP≤140 mm Hg and∕ or diastolic BP≤90 mm Hg) and knowledge on HT was collected. Based on the median of knowledge score, patients were classified as having poor, average and adequate knowledge. RESULTS Majority of the respondents (74.9%) had poorly controlled BP and had HT longer than 10 years. Larger number of patients at PHC site was managed with monotherapy while at the SHC majority received three or more antihypertensive drugs. Respondents from SHC showed a significantly lower knowledge score (9, 2-15) compared with the respondents from PHC (11, 4-15, p=0.001). The share of respondents with adequate knowledge on HT was significantly higher in the group with good BP control (26% and 9.2%, respectively). In a multivariate regression analysis, factors associated with poor BP control were knowledge (B=-1.091; p<0001), number of drugs (B=0536; p<0001) and complications (B=0898; p=0004). CONCLUSIONS Poor BP control is common in outpatients in Serbia, irrespective of the availability of different levels of healthcare. Patients with poor knowledge on HT, with complications of HT and those with multiple antihypertensive drugs, were at particular risk of poor BP control. Our study could serve as a basis for targeted interventions to improve HT management.
Collapse
Affiliation(s)
- Olga Horvat
- Department of Pharmacology and Toxicology, Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
| | - Tinde Halgato
- Health Center "Dr Janoš Hadži" Bačka Topola, Novi Sad, Serbia
| | - Anastazija Stojšić-Milosavljević
- Department of Pharmacology and Toxicology, Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Milica Paut Kusturica
- Department of Pharmacology and Toxicology, Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
| | - Zorana Kovačević
- Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, Novi Sad, Serbia
| | - Dragica Bukumiric
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Ana Tomas
- Department of Pharmacology and Toxicology, Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
| |
Collapse
|
39
|
Ye C, Han X, Chen Y, Liu F, Ma H, Yang Y, Liu Y, Hu Q, Yao Q, Xie W, Xu D. Stroke prevention of thoracoscopic left atrial appendage clipping in patients with non-valvular atrial fibrillation at high risk of stroke and bleeding: study protocol for a non-randomised controlled clinical trial. BMJ Open 2022; 12:e063931. [PMID: 36307161 PMCID: PMC9621168 DOI: 10.1136/bmjopen-2022-063931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Non-valvular atrial fibrillation (NVAF) is a high-risk factor for ischaemic stroke. The 2016 European Society of Cardiology Atrial Fibrillation Management guidelines recommend oral anticoagulants (OACs) to prevent stroke in men with CHA2DS2-VASc scores ≥2 and women ≥3. However, in patients with a high risk of stroke and a high risk of bleeding (HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (> 65 years), Drugs/alcohol concomitantly) score≥3), OAC had a higher risk of bleeding. Left atrial appendage closure (LAAC) is non-inferior to OAC as a means of preventing stroke in several studies. As a minimally invasive intervention to prevent stroke, transthoracic LAAC (TS-LAAC) has a high successful closure rate, but there is a lack of literature reports directly comparing it with OAC. Our research compares TS-LAAC with novel oral anticoagulants (NOACs) and provides an appropriate programme for stroke prevention in a specific population. METHODS AND ANALYSIS This is a non-randomised controlled trial study protocol, and we will conduct this study from April 2022 to April 2025. The study included 186 patients with confirmed NVAF, 93 of whom completed thoracoscopic LAAC, and the control group treated with NOACs. The primary outcome was the incidence of stroke and systemic embolism, as well as the composite endpoint events (stroke, systemic embolism, myocardial infarction, bleeding, cardiovascular death, etc). Secondary outcomes were ischaemic stroke, haemorrhagic stroke, any bleeding events, death from cardiovascular causes, death from all causes, residual root rate in the surgery group, device-related thrombosis in the surgery group, changes in blood pressure, cardiac chamber size changes, etc. Each subject completed at least 1 year of follow-up. ETHICS AND DISSEMINATION The study has been approved by the Medical Ethics Committee of Beijing Tiantan Hospital, Capital Medical University, China (approval number: KY2022-013-02). The results from this study will be disseminated through manuscript publications and national/international conferences. TRIAL REGISTRATION NUMBER ChiCTR2200058109.
Collapse
Affiliation(s)
- Cong Ye
- Department of Cardiac Surgery, Capital Medical University, Beijing, China
- Department of Cardiac Surgery, Beijing Tiantan Hospital, Beijing, China
| | - Xuesong Han
- Department of Cardiac Surgery, Beijing Tiantan Hospital, Beijing, China
| | - Yiming Chen
- Department of Cardiac Surgery, Beijing Tiantan Hospital, Beijing, China
| | - Fei Liu
- Department of Cardiac Surgery, Beijing Tiantan Hospital, Beijing, China
| | - Hao Ma
- Department of Cardiac Surgery, Beijing Tiantan Hospital, Beijing, China
| | - Yu Yang
- Department of Cardiac Surgery, Beijing Tiantan Hospital, Beijing, China
| | - Yang Liu
- Department of Cardiac Surgery, Beijing Tiantan Hospital, Beijing, China
| | - Qingfeng Hu
- Department of Cardiac Surgery, Beijing Tiantan Hospital, Beijing, China
| | - Qing Yao
- Department of Cardiac Surgery, Beijing Tiantan Hospital, Beijing, China
| | - Wenting Xie
- Department of Cardiac Surgery, Beijing Tiantan Hospital, Beijing, China
| | - Dong Xu
- Department of Cardiac Surgery, Beijing Tiantan Hospital, Beijing, China
| |
Collapse
|
40
|
Xiang J, He L, Li D, Wei S, Wu Z. Value of the systemic immune-inflammation index in predicting poor postoperative outcomes and the short-term prognosis of heart valve diseases: a retrospective cohort study. BMJ Open 2022; 12:e064171. [PMID: 36220322 PMCID: PMC9557268 DOI: 10.1136/bmjopen-2022-064171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Systemic immune-inflammation index (SII) is a novel biomarker that can predict poor outcomes in tumours, nervous system diseases and chronic heart failure. Here, we investigated the predictive value of SII on the poor postoperative outcomes and short-term prognosis of heart valve diseases (HVDs). DESIGN, SETTING AND PARTICIPANTS This retrospective cohort study enrolled all consecutive patients with HVDs (aortic stenosis, aortic regurgitation, mitral stenosis and mitral regurgitation) who underwent surgery (valve replacement or valve repair) at the Affiliated Hospital of North Sichuan Medical College between 2017 and 2020. MAIN OUTCOMES AND MEASURES Major complications in the perioperative period, all-cause mortality within 30 days and readmission within 30 days. RESULTS A total of 431 patients with HVDs were enrolled in this study, including 202 males and 229 females, aged 58.9±27.3 years. SII levels of patients in the poor outcomes group were significantly higher than those of patients in the favourable outcomes group (658.40±436.29 vs 335.72±174.76, respectively; p<0.001). Multivariate logistic regression analysis showed that age (OR 1.064, 95% CI 1.026 to 1.104, p=0.025), SII (OR 1.034, 95% CI 1.012 to 1.631, p=0.008) and aortic cross-clamping time (OR 1.013, 95% CI 1.004 to 1.023, p=0.006) were independent risk factors for poor outcomes and short-term prognosis in patients with HVD. The area under the curve of poor outcomes predicted by SII in patients with HVD was 0.806 (95% CI 0.763 to 0.848) and the optimised cut-off value 423.8×109 /L, with a sensitivity of 70.3% and specificity of 81.1%. The incidence of poor outcomes (p<0.001), 30-day mortality (p<0.001) and 30-day readmission rate (p=0.026) in the high SII group was significantly higher than that in the low SII group. CONCLUSIONS SII is closely related to poor postoperative outcomes and short-term prognosis of HVD and can serve as an independent predictive factor.
Collapse
Affiliation(s)
- Jun Xiang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Cardiovascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ling He
- Department of Paediatrics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Donglin Li
- Department of Cardiovascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Shuliang Wei
- Department of Cardiovascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
41
|
Chen W, Shi S, Jiang Y, Chen K, Liao Y, Huang R, Huang K. Association of sarcopenia with ideal cardiovascular health metrics among US adults: a cross-sectional study of NHANES data from 2011 to 2018. BMJ Open 2022; 12:e061789. [PMID: 36153025 PMCID: PMC9511583 DOI: 10.1136/bmjopen-2022-061789] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The American Heart Association (AHA) proposed the concept of ideal cardiovascular health (CVH) to reduce the risk of cardiovascular mortality. We attempted to broaden the impact of CVH and further contribute to AHA 2030 goals by identifying the relationship between CVH and non-cardiovascular diseases such as sarcopenia. DESIGN Cross-sectional survey SETTING: National Health and Nutrition Examination Survey conducted in the USA from 2011 to 2018. PARTICIPANTS This study included participants with reliable first 24-hour dietary recall and ≥20 years of age and excluded those who could not diagnose sarcopenia or insufficient data to calculate the CVH scores. PRIMARY AND SECONDARY OUTCOME MEASURES The prevalence of sarcopenia as measured by dual-energy X-ray absorptiometry. RESULTS This cohort study involving 9326 adults≥20 years comprised 4733 females (50.0%). The number of intermediate or ideal and poor CVH participants was 5654 and 3672 with mean CVH score of 9.70±0.03 and 5.66±0.04, respectively. After adjusting for related confounding factors, intermediate or ideal CVH was associated with an odds reduction of sarcopenia than poor CVH (adjusted OR (aOR): 0.36, 95% CI 0.26 to 0.50, p<0.001) and the odds of sarcopenia was significantly lower for each incremental increase of 1 in CVH metrics (aOR: 0.75, 95% CI 0.71 to 0.79, p<0.001). Moreover, if the number of ideal CVH metrics was>5, the odds of sarcopenia decreased by up to 84% (aOR: 0.16, 95% CI 0.08 to 0.30). CONCLUSIONS Our findings suggest a relationship between the CVH and the prevalence of sarcopenia in adults. The results of our study can contribute to achieving the 2030 public health goal of achieving CVH for all, which may be supported by efforts to reduce the prevalence of sarcopenia.
Collapse
Affiliation(s)
- Weihua Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Shanshan Shi
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Yizhou Jiang
- Department of Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kaihong Chen
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Ying Liao
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Rongchong Huang
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kun Huang
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| |
Collapse
|
42
|
Kowalewski M, Wańha W, Litwinowicz R, Kołodziejczak M, Pasierski M, Januszek R, Kuźma Ł, Grygier M, Lesiak M, Kapłon-Cieślicka A, Reczuch K, Gil R, Pawłowski T, Bartuś K, Dobrzycki S, Lorusso R, Bartuś S, Deja MA, Smolka G, Wojakowski W, Suwalski P. Stand-Alone Left Atrial appendage occlusion for throMboembolism prevention in nonvalvular Atrial fibrillatioN DiseasE Registry (SALAMANDER): protocol for a prospective observational nationwide study. BMJ Open 2022; 12:e063990. [PMID: 36130748 PMCID: PMC9494590 DOI: 10.1136/bmjopen-2022-063990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is a prevalent disease considerably contributing to the worldwide cardiovascular burden. For patients at high thromboembolic risk (CHA2DS2-VASc ≥3) and not suitable for chronic oral anticoagulation, owing to history of major bleeding or other contraindications, left atrial appendage occlusion (LAAO) is indicated for stroke prevention, as it lowers patient's ischaemic burden without augmentation in their anticoagulation profile. METHODS AND ANALYSIS Stand-Alone Left Atrial appendage occlusion for throMboembolism prevention in nonvalvular Atrial fibrillatioN DiseasE Registry (SALAMANDER) will be conducted in 10 heart surgery and cardiology centres across Poland to assess the outcomes of LAAO performed by fully thoracoscopic-epicardial, percutaneous-endocardial or hybrid endo-epicardial approach. The registry will include patients with nonvalvular AF at a high risk of thromboembolic and bleeding complications (CHA2DS2-VASc Score ≥2 for males, ≥3 for females, HASBLED score ≥2) referred for LAAO. The first primary outcome is composite procedure-related complications, all-cause death or major bleeding at 12 months. The second primary outcome is a composite of ischaemic stroke or systemic embolism at 12 months. The third primary outcome is the device-specific success assessed by an independent core laboratory at 3-6 weeks. The quality of life (QoL) will be assessed as well based on the QoL EQ-5D-5L questionnaire. Medication and drug adherence will be assessed as well. ETHICS AND DISSEMINATION Before enrolment, a detailed explanation is provided by the investigator and patients are given time to make an informed decision. The patient's data will be protected according to the requirements of Polish law, General Data Protection Regulation (GDPR) and hospital Standard Operating Procedures. The study will be conducted in accordance with the Declaration of Helsinki. Ethical approval was granted by the local Bioethics Committee of the Upper-Silesian Medical Centre of the Silesian Medical University in Katowice (decision number KNW/0022/KB/284/19). The results will be published in peer-reviewed journals and presented during national and international conferences. TRIAL REGISTRATION NUMBER NCT05144958.
Collapse
Affiliation(s)
- Mariusz Kowalewski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Michalina Kołodziejczak
- Department of Anaesthesiology and Intensive Care, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Michal Pasierski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Rafal Januszek
- Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Łukasz Kuźma
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Marek Grygier
- Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Maciej Lesiak
- Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Krzysztof Reczuch
- Centre for Heart Disease, University Hospital Wroclaw Department of Heart Disease, Wroclaw Medical University, Wrocław, Poland
| | - Robert Gil
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Tomasz Pawłowski
- Department of Invasive Cardiology, Center of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Sławomir Dobrzycki
- Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Stanislaw Bartuś
- Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Andrzej Deja
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
| |
Collapse
|
43
|
Williams K, Modi RN, Dymond A, Hoare S, Powell A, Burt J, Edwards D, Lund J, Johnson R, Lobban T, Lown M, Sweeting MJ, Thom H, Kaptoge S, Fusco F, Morris S, Lip G, Armstrong N, Cowie MR, Fitzmaurice DA, Freedman B, Griffin SJ, Sutton S, Hobbs FR, McManus RJ, Mant J, Safer Authorship Group T. Cluster randomised controlled trial of screening for atrial fibrillation in people aged 70 years and over to reduce stroke: protocol for the pilot study for the SAFER trial. BMJ Open 2022; 12:e065066. [PMID: 36691194 PMCID: PMC9472173 DOI: 10.1136/bmjopen-2022-065066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/16/2022] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is a common arrhythmia associated with 30% of strokes, as well as other cardiovascular disease, dementia and death. AF meets many criteria for screening, but there is limited evidence that AF screening reduces stroke. Consequently, no countries recommend national screening programmes for AF. The Screening for Atrial Fibrillation with ECG to Reduce stroke (SAFER) trial aims to determine whether screening for AF is effective at reducing risk of stroke. The aim of the pilot study is to assess feasibility of the main trial and inform implementation of screening and trial procedures. METHODS AND ANALYSIS SAFER is planned to be a pragmatic randomised controlled trial (RCT) of over 100 000 participants aged 70 years and over, not on long-term anticoagulation therapy at baseline, with an average follow-up of 5 years. Participants are asked to record four traces every day for 3 weeks on a hand-held single-lead ECG device. Cardiologists remotely confirm episodes of AF identified by the device algorithm, and general practitioners follow-up with anticoagulation as appropriate. The pilot study is a cluster RCT in 36 UK general practices, randomised 2:1 control to intervention, recruiting approximately 12 600 participants. Pilot study outcomes include AF detection rate, anticoagulation uptake and other parameters to incorporate into sample size calculations for the main trial. Questionnaires sent to a sample of participants will assess impact of screening on psychological health. Process evaluation and qualitative studies will underpin implementation of screening during the main trial. An economic evaluation using the pilot data will confirm whether it is plausible that screening might be cost-effective. ETHICS AND DISSEMINATION The London-Central Research Ethics Committee (19/LO/1597) and Confidentiality Advisory Group (19/CAG/0226) provided ethical approval. Dissemination will be via publications, patient-friendly summaries, reports and engagement with the UK National Screening Committee. TRIAL REGISTRATION NUMBER ISRCTN72104369.
Collapse
Affiliation(s)
- Kate Williams
- Strangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rakesh Narendra Modi
- Strangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Andrew Dymond
- Strangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah Hoare
- THIS (The Healthcare Improvement Studies) Institute, University of Cambridge, Cambridge, UK
| | - Alison Powell
- THIS (The Healthcare Improvement Studies) Institute, University of Cambridge, Cambridge, UK
| | - Jenni Burt
- THIS (The Healthcare Improvement Studies) Institute, University of Cambridge, Cambridge, UK
| | - Duncan Edwards
- Strangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jenny Lund
- Strangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rachel Johnson
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Mark Lown
- Primary Care Population Sciences and Medical Education, University of Southampton School, Southampton, UK
| | - Michael J Sweeting
- Department of Health Sciences, George Davies Centre, University of Leicester, Leicester, UK
| | - H Thom
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Stephen Kaptoge
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Francesco Fusco
- Strangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Morris
- Strangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Gregory Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Natalie Armstrong
- Department of Health Sciences, George Davies Centre, University of Leicester, Leicester, UK
| | - Martin R Cowie
- Guy's & St Thomas' NHS Foundation Trust, Royal Brompton Hospital, London, UK
- Faculty of Life Sciences and Medicine, Kings College London, London, UK
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - David A Fitzmaurice
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ben Freedman
- Heart research Institute, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Simon J Griffin
- Strangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Strangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jonathan Mant
- Strangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - The Safer Authorship Group
- Strangeways Research Laboratory, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| |
Collapse
|
44
|
Tong L, Liu YQ, Shen JH, B O M, Zhou Q, Duan XJ, Guo YF, Zhang XQ. Relationship between the red cell distribution width-to-platelet ratio and in-hospital mortality among critically ill patients with acute myocardial infarction: a retrospective analysis of the MIMIC-IV database. BMJ Open 2022; 12:e062384. [PMID: 36691156 PMCID: PMC9442484 DOI: 10.1136/bmjopen-2022-062384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 08/09/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES We aimed to investigate the association between red cell distribution width-to-platelet ratio (RPR), and in-hospital mortality in critically ill patients with acute myocardial infarction (AMI). DESIGN A retrospective cohort study. SETTING Data were collected from the Medical Information Mart for Intensive Care database (MIMIC-IV) consisting of critically ill participants between 2008 and 2019 at the Beth Israel Deaconess Medical Centre in Boston. PARTICIPANTS A total of 5067 patients with AMI were enrolled from the MIMIC-IV database. PRIMARY AND SECONDARY OUTCOME In-hospital mortality. RESULTS A total of 4034 patients survived, while 1033 died. In a multiple regression analysis adjusted for age, weight and ethnicity, RPR also showed a positive correlation with in-hospital mortality (HR 1.91, 95% CI 1.42 to 2.56, p<0.0001). Moreover, after adjusting for additional confounding factors, obvious changes were observed (HR 1.63, 95% CI 1.03 to 2.57, p=0.0357). In model 2, the high ratio quartile remained positively associated with hospital mortality compared with the low ratio quartile (HR 1.20, 95% CI 1.01 to 1. 43), with a p-value trend of 0.0177. Subgroup analyses showed no significant effect modifications on the association between RPR and in-hospital mortality in the different AMI groups (p>0.05). CONCLUSION RPR is an independent predictor of in-hospital mortality in critically ill patients with AMI.
Collapse
Affiliation(s)
- Li Tong
- Department of Nursing, First People's Hospital of Changde City, Changde, Hunan, China
| | - Yan-Qiong Liu
- Department of Nursing, First People's Hospital of Changde City, Changde, Hunan, China
| | - Jin Hua Shen
- Department of Nursing, First People's Hospital of Changde City, Changde, Hunan, China
| | - Min B O
- Department of Nursing, First People's Hospital of Changde City, Changde, Hunan, China
| | - Quan Zhou
- Department of Science and Education, First People's Hospital of Changde City, Changde, Hunan, China
| | - Xiang-Jie Duan
- Department of Infectious Diseases, First People's Hospital of Changde City, Changde, Hunan, China
| | - Ya Fen Guo
- Department of Nursing, First People's Hospital of Changde City, Changde, Hunan, China
| | - Xue Qing Zhang
- Department of Nursing, First People's Hospital of Changde City, Changde, Hunan, China
| |
Collapse
|
45
|
Bardan S, Kvaslerud AB, Andresen K, Kløve SF, Edvardsen T, Gullestad L, Broch K. Intravenous ferric derisomaltose in iron-deficient patients undergoing transcatheter aortic valve implantation due to severe aortic stenosis: study protocol of the randomised controlled IIISAS trial. BMJ Open 2022; 12:e059546. [PMID: 36691165 PMCID: PMC9442485 DOI: 10.1136/bmjopen-2021-059546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/13/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Iron deficiency is a prevalent comorbidity in patients with severe aortic stenosis and may be associated with procedural and clinical outcomes after transcatheter aortic valve implantation (TAVI). In the Intravenous Iron Supplement for Iron Deficiency in Patients with Severe Aortic Stenosis (IIISAS) trial, we aim to examine whether a single administration of ferric derisomaltose can improve physical capacity after TAVI. METHODS AND ANALYSIS This randomised, double-blind, placebo-controlled trial aims to enrol 150 patients with iron deficiency who are scheduled for TAVI due to severe aortic stenosis. The study drug and matching placebo are administered approximately 3 months prior to TAVI, and the patients are followed for 3 months after TAVI. Inclusion criteria are iron deficiency, defined as serum ferritin<100 µg/L or ferritin between 100 and 300 µg/L in combination with a transferrin saturation<20% and written informed consent. Exclusion criteria include haemoglobin<10 g/dL, red blood cell disorders, end-stage kidney failure, intolerance to ferric derisomaltose, and ongoing infections. The primary endpoint is the baseline-adjusted distance walked on a 6 min walk test (6MWT) 3 months after TAVI. Secondary end points include quality of life, New York Heart Association functional class (NYHA functional class), and skeletal muscle strength. ETHICS AND DISSEMINATION Ethical approval was obtained from the Regional Committee for Medical and Health Research of South-Eastern Norway and The Norwegian Medicines Agency. Enrolment has begun, and results are expected in 2022. The results of the IIISAS trial will be disseminated by presentations at international and national conferences and by publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04206228.
Collapse
Affiliation(s)
- Sara Bardan
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anette Borger Kvaslerud
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristoffer Andresen
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Sophie Foss Kløve
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Thor Edvardsen
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Lars Gullestad
- Faculty of Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kaspar Broch
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
46
|
Juknevičienė R, Simonavičius J, Mikalauskas A, Čerlinskaitė-Bajorė K, Arrigo M, Juknevičius V, Alitoit-Marrote I, Kablučko D, Bagdonaitė L, Vitkus D, Balčiūnas M, Zuozienė G, Barysienė J, Žaliaduonytė D, Stašaitis K, Kavoliūnienė A, Mebazaa A, Čelutkienė J. Soluble CD146 in the detection and grading of intravascular and tissue congestion in patients with acute dyspnoea: analysis of the prospective observational Lithuanian Echocardiography Study of Dyspnoea in Acute Settings (LEDA) cohort. BMJ Open 2022; 12:e061611. [PMID: 36581965 PMCID: PMC9438196 DOI: 10.1136/bmjopen-2022-061611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To evaluate the potential of soluble cluster of differentiation 146 (sCD146) in the detection and grading of congestion in patients with acute dyspnoea. DESIGN Subanalysis of the prospective observational Lithuanian Echocardiography Study of Dyspnoea in Acute Settings (LEDA) cohort. SETTING Two Lithuanian university centres. PARTICIPANTS Adult patients with acute dyspnoea admitted to the emergency department. METHODS Congestion was assessed using clinical and sonographic parameters. All patients underwent sCD146 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing. RESULTS The median value of sCD146 concentration in the study cohort (n=437) was 405 (IQR 315-509) ng/mL. sCD146 was higher in patients with peripheral oedema than in those without (median (IQR) 472 (373-535) vs 400 (304-501) ng/mL, p=0.009) and with pulmonary rales than in those without (439 (335-528) vs 394 (296-484) ng/mL, p=0.001). We found a parallel increase of estimated right atrial pressure (eRAP) and sCD146 concentration: sCD146 was 337 (300-425), 404 (290-489) and 477 (363-572) ng/mL in patients with normal, moderately elevated and high eRAP, respectively (p=0.001). In patients with low NT-proBNP, high sCD146 distinguished a subgroup with a higher prevalence of oedema as compared with patients with low levels of both biomarkers (76.0% vs 41.0%, p=0.010). Moreover, high sCD146 indicated a higher prevalence of elevated eRAP, irrespective of NT-proBNP concentration (p<0.05). CONCLUSION sCD146 concentration reflects the degree of intravascular and tissue congestion assessed by clinical and echocardiographic indices, with this association maintained in patients with low NT-proBNP. Our data support the notion that NT-proBNP might represent heart stretch while sCD146 rather represents peripheral venous congestion.
Collapse
Affiliation(s)
- Renata Juknevičienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Emergency Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Justas Simonavičius
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Aurimas Mikalauskas
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Kamilė Čerlinskaitė-Bajorė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Anesthesiology and Critical Care, Assistance Publique des Hopitaux de Paris, Paris, France
- Cardiovascular Markers in Stress Conditions (MASCOT), Inserm UMR-S 942, Paris, France
| | - Mattia Arrigo
- Department of Internal Medicine, Triemli Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Vytautas Juknevičius
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Irina Alitoit-Marrote
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Denis Kablučko
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Loreta Bagdonaitė
- Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Dalius Vitkus
- Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Mindaugas Balčiūnas
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Gitana Zuozienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jūratė Barysienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Diana Žaliaduonytė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kęstutis Stašaitis
- Department of Emergency Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aušra Kavoliūnienė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care, Assistance Publique des Hopitaux de Paris, Paris, France
- Cardiovascular Markers in Stress Conditions (MASCOT), Inserm UMR-S 942, Paris, France
- Université de Paris, Paris, France
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre for Innovative Medicine, State Research Institute, Vilnius, Lithuania
| |
Collapse
|
47
|
de Bruin R, van Dalen SL, Franx SJ, Simons SH, Flint RB, van den Bosch GE. Risk for neonatal hypoglycaemia and bradycardia after beta-blocker use during pregnancy or lactation: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e055292. [PMID: 36008071 PMCID: PMC9422831 DOI: 10.1136/bmjopen-2021-055292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Beta-blockers are often used during pregnancy to treat diseases such as pre-existing hypertension, arrhythmias or pregnancy-related hypertension. Since beta-blockers are able to cross the placenta and can pass into breast milk, they could potentially harm the neonate. Known potential neonatal side effects of maternal beta-blocker use are hypoglycaemia and bradycardia. This systematic review and meta-analysis aims to investigate the risk for neonatal hypoglycaemia and bradycardia after exposure to beta-blockers in utero or through lactation. METHODS AND ANALYSIS We will conduct a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic electronic search will be conducted using EMBASE, Medline, Cochrane Central Register of Trials and Web of Science from initiation to April 2021. Our primary outcome will be the risk for hypoglycaemia or bradycardia in neonates exposed to beta-blockers in utero or through lactation in comparison with unexposed neonates. All articles will be screened by title and abstract twice by different independent review authors. Next, standardised methodological quality assessment will be conducted for each included article and finally a meta-analysis will be performed. ETHICS AND DISSEMINATION Ethical approval is not required. The results of this study will help to assess the need for postnatal glucose and heart rate monitoring of the neonate after maternal beta-blocker exposure. Our findings will be communicated to the target audience through peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD42021264269.
Collapse
Affiliation(s)
- Rosalie de Bruin
- Faculty of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sarah L van Dalen
- Faculty of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Shamaya J Franx
- Faculty of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sinno Hp Simons
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Robert B Flint
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gerbrich E van den Bosch
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| |
Collapse
|
48
|
Apiyasawat S, Thongsri T, Jongpiputvanich K, Krittayaphong R. Outcome disparities in patients with atrial fibrillation based on insurance plan and educational attainment: a nationwide, multicenter and prospective cohort trial. BMJ Open 2022; 12:e053166. [PMID: 35948379 PMCID: PMC9379473 DOI: 10.1136/bmjopen-2021-053166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a complex disease. The management of AF requires continuous patient engagement and integrative healthcare. OBJECTIVES To explore the association between adverse AF-related clinical outcomes and the following two sociodemographic factors: educational attainment and insurance plan. DESIGN A nationwide, prospective, multicenter, cohort trial. SETTING National registry of 3402 patients with non-valvular AF in Thailand. PARTICIPANTS All patients enrolled in the registry, except those with missing information on educational attainment or insurance plan. Finally, data from 3026 patients (mean age 67 years, SD 11.3; 59% male sex) were analysed. PRIMARY OUTCOMES Incidences of all-cause mortality, ischaemic stroke and major bleeding during the 36-month follow-up period. Survival analysis was performed using restricted mean survival time (RMST) and adjusted for multiple covariates. The levels of the educational attainment were as follows: no formal education, elementary (grade 1-6), secondary (grade 7-12) and higher education (tertiary education). RESULTS The educational attainment of the majority of patients was elementary (N=1739, 57.4%). The predominant health insurance plans were the Civil Servant Medical Benefit Scheme (N=1397, 46.2%) and the Universal Coverage Scheme (N=1333, 44.1%). After 36 months of follow-up, 248 patients died (8.2%), 95 had ischaemic stroke (3.1%) and 136 had major bleeding (4.5%). Patients without formal education died 1.78 months earlier (adjusted RMST difference -1.78; 95% CI, -3.25 to -0.30; p=0.02) and developed ischaemic stroke 1.04 months sooner (adjusted RMST difference -1.04; 95% CI, -2.03 to -0.04; p=0.04) than those attained a level of higher education. There were no significant differences in RMSTs for all three clinical outcomes when considering the type of health insurance plan. CONCLUSION Educational attainment was independently associated with all-cause mortality and ischaemic stroke in patients with AF, but adverse clinical outcomes were not related to the types of health insurance in Thailand. TRIAL REGISTRATION NUMBER Thai Clinical Trial Registration; Study ID: TCTR20160113002.
Collapse
Affiliation(s)
- Sirin Apiyasawat
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tomon Thongsri
- Buddhachinaraj Hospital Medical School, Phitsanulok, Thailand
| | | | | |
Collapse
|
49
|
Wise A, Mannem D, Arthur W, Ottwell R, Greiner B, Srouji D, Wildes D, Hartwell M, Wright DN, Khojasteh J, Vassar M. Spin within systematic review abstracts on antiplatelet therapies after acute coronary syndrome: a cross-sectional study. BMJ Open 2022; 12:e049421. [PMID: 35918107 PMCID: PMC9351322 DOI: 10.1136/bmjopen-2021-049421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Spin is a reporting practice in which study results are misrepresented by overestimating efficacy or underestimating harm. Prevalence of spin varies between clinical specialties, and estimates are based almost entirely on clinical trials. Little is known about spin in systematic reviews. DESIGN We performed a cross-sectional analysis searching MEDLINE and Embase for systematic reviews and meta-analyses pertaining to antiplatelet therapies following acute coronary syndrome on 2 June 2020. Data were extracted evaluating the presence of spin and study characteristics, including methodological quality as rated by A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). All data extraction was conducted in a masked, duplicate manner from 2 June 2020 to 26 June 2020. PARTICIPANTS AND SETTING Not applicable. PRIMARY AND SECONDARY OUTCOME MEASURES We assessed abstracts of systematic reviews on antiplatelet therapy following acute coronary syndrome and evaluated the prevalence of the nine most severe types of spin. We additionally explored associations between spin and certain study characteristics, including quality. RESULTS Our searches returned 15 263 articles, and 185 systematic reviews met inclusion criteria. Of these 185 reviews, 31.9% (59/185) contained some form of spin in the abstract. Seven forms of spin (1, 2, 3, 4, 5, 7 and 9) among the nine most severe were identified. No instances of types 6 or 8 were found. There were no statistically significant relationships between spin and the evaluated study characteristics or AMSTAR-2 appraisals. CONCLUSIONS Spin was present in abstracts for systematic reviews and meta-analyses; subsequent studies are needed to identify correlations between spin and specific study characteristics. There were no statistically significant associations between spin and study characteristics or AMSTAR-2 ratings; however, implementing changes will ensure that spin is reduced in the field of cardiology as well as other fields of medicine.
Collapse
Affiliation(s)
- Audrey Wise
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Deepika Mannem
- Arkansas College of Osteopathic Medicine, Fort Smith, Arkansas, USA
| | - Wade Arthur
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Ryan Ottwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Benjamin Greiner
- The University of Texas Medical Branch at Galveston Department of Internal Medicine, Galveston, Texas, USA
| | - Derek Srouji
- Cardiology, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Daniel Wildes
- Cardiology, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Drew N Wright
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York, USA
| | - Jam Khojasteh
- School of Educational Foundations, Leadership and Aviation, Oklahoma State University - Tulsa, Tulsa, Oklahoma, USA
| | - Matthew Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| |
Collapse
|
50
|
Wong CK, Hai JJ, Lau YM, Zhou M, Lui HW, Lau KK, Chan KH, Mok TM, Liu Y, Feng Y, Tan N, Tam WC, Tam KC, Feng X, Zuo ML, Yin LX, Tan J, Zhang WJ, Jiang X, Huang X, Ye J, Liang Y, Jiang W, Lei Z, Huang D, Yue WS, Tan G, Yan BP, Evora MA, Chen JY, Siu CW. Protocol for Home-Based Solution for Remote Atrial Fibrillation Screening to Prevent Recurrence Stroke (HUA-TUO AF Trial): a randomised controlled trial. BMJ Open 2022; 12:e053466. [PMID: 35840293 PMCID: PMC9295642 DOI: 10.1136/bmjopen-2021-053466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Current international guidelines recommend ECG monitoring after an ischaemic stroke to detect atrial fibrillation (AF) in order to prevent stroke recurrence. However, optimal strategies to detect AF and the downstream management to prevent stroke recurrence remain to be established. The objective of the study was to explore the use of long-term home-based ECG monitoring for AF detection and stroke prevention in patients with a history of stroke. METHODS AND ANALYSIS This prospective, randomised, open-label trial with blinded endpoint adjudication aimed to evaluate the efficacy of long-term home-based ECG monitoring for AF detection and stroke prevention in a 24-month period. Patients aged >18 years with a history of ischaemic stroke will be stratified according to the time from the index ischaemic stroke: <1, 1-3 and >3 years and then randomised in 1:1 to (1) home-based AF screening and (2) control. The home-based AF screening system comprises (1) a handheld single-lead ECG recorder (Comfit Healthcare Devices, Hong Kong SAR, China) and (2) a patient-facing smartphone application specially designed for the study. Patients randomised to the home-based AF group will record a 30 s single-lead ECG using a specially designed handheld ECG device every morning or when symptomatic. All remotely obtained data will be automatically transmitted in real-time through the study smartphone application to a secured cloud hosting and analysed using an artificial intelligence-based diagnostic system. When a diagnosis of AF is made with the system, the patients will be called back for a formal cardiology consultation within 1 week. The primary endpoint is the time to first detection of AF at 24 months of follow-up. Secondary endpoints include recurrent stroke or transient ischaemic attack, initiation of long-term anticoagulation therapy, hospitalisation for heart failure, cardiovascular death and all-cause death. ETHICS AND DISSEMINATION The study protocol has been approved by the institutional review board of The University of Hong Kong, and Hong Kong West Cluster, Hospital Authority, Hong Kong SAR, China. Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04523649.
Collapse
Affiliation(s)
- Chun Ka Wong
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Jo Jo Hai
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Yuk-Ming Lau
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Mi Zhou
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Hin-Wai Lui
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Kui Kai Lau
- Neurology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Koon-Ho Chan
- Neurology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Toi Meng Mok
- Department of Medicine, Centro Hospitalar Conde de São Januário, Macau, Macau, China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
| | - Weng-Chio Tam
- Department of Medicine, Centro Hospitalar Conde de São Januário, Macau, Macau, China
| | - Kun-Chong Tam
- Department of Cardiology, Kiang Wu Hospital, Macau, Macau, China
| | - Xiuhua Feng
- Department of Cardiology, Kiang Wu Hospital, Macau, Macau, China
| | - Ming-Liang Zuo
- Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
| | - Li-Xue Yin
- Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, Sichuan, China
| | - Jing Tan
- Department of Ultrasound in Medicine, Sichuan Provincial People's Hospital Affiliated Wenjiang Hospital, Chengdu, China
| | - Wen-Jun Zhang
- Department of Ultrasound in Medicine, Sichuan Provincial People's Hospital Affiliated Wenjiang Hospital, Chengdu, China
| | - Xiaofei Jiang
- Department of Cardiology, Zhuhai People's Hospital, Zhuhai, China
| | - Xiaoyu Huang
- Department of Cardiology, People's Hospital of Yangjiang, Yangjiang, Guangdong, China
| | - Jianfeng Ye
- Department of Cardiology, Dongguan TCM Hospital, Dongguan, China
| | - Yan Liang
- Department of Cardiology, Maoming People's Hospital, Guangdong, China
| | - Wei Jiang
- Department of Cardiology, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China
| | - Zhen Lei
- Department of Cardiology, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China
| | - Duo Huang
- Medical Imaging Key Laboratory, Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Wen-Sheng Yue
- Medical Imaging Key Laboratory, Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Guanming Tan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Bryan P Yan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Mario Alberto Evora
- Department of Medicine, Centro Hospitalar Conde de São Januário, Macau, Macau, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| |
Collapse
|