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Knoll K, Rosner S, Gross S, Dittrich D, Lennerz C, Trenkwalder T, Schmitz S, Sauer S, Hentschke C, Dörr M, Kloss C, Schunkert H, Reinhard W. Combined telemonitoring and telecoaching for heart failure improves outcome. NPJ Digit Med 2023; 6:193. [PMID: 37848681 PMCID: PMC10582035 DOI: 10.1038/s41746-023-00942-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023] Open
Abstract
Telemedicine has been shown to improve the outcome of heart failure (HF) patients in addition to medical and device therapy. We investigate the effectiveness of a comprehensive telehealth programme in patients with recent hospitalisation for HF on subsequent HF hospitalisations and mortality compared to usual care in a real-world setting. The telehealth programme consists of daily remote telemonitoring of HF signs/symptoms and regular individualised telecoaching sessions. Between January 2018 and September 2020, 119,715 patients of a German health insurer were hospitalised for HF and were eligible for participation in the programme. Finally, 6065 HF patients at high risk for re-hospitalisation were enroled. Participants were retrospectively compared to a propensity score matched usual care group (n = 6065). Median follow-up was 442 days (IQR 309-681). Data from the health insurer was used to evaluate outcomes. After one year, the number of hospitalisations for HF (17.9 vs. 21.8 per 100 patient years, p < 0.001), all-cause hospitalisations (129.0 vs. 133.2 per 100 patient years, p = 0.015), and the respective days spent in hospital (2.0 vs. 2.6 days per year, p < 0.001, and 12.0 vs. 13.4, p < 0.001, respectively) were significantly lower in the telehealth than in the usual care group. Moreover, participation in the telehealth programme was related to a significant reduction in all-cause mortality compared to usual care (5.8 vs. 11.0 %, p < 0.001). In a real-life setting of ambulatory HF patients at high risk for re-hospitalisation, participation in a comprehensive telehealth programme was related to a reduction of HF hospitalisations and all-cause mortality compared to usual care.
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Affiliation(s)
- Katharina Knoll
- German Heart Centre Munich, Department of Cardiology, Technical University Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Stefanie Rosner
- German Heart Centre Munich, Department of Cardiology, Technical University Munich, Munich, Germany
| | - Stefan Gross
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Dino Dittrich
- Health Care Systems GmbH (HCSG), Pullach im Isartal, Germany
| | - Carsten Lennerz
- German Heart Centre Munich, Department of Cardiology, Technical University Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Teresa Trenkwalder
- German Heart Centre Munich, Department of Cardiology, Technical University Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | | | | | | | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Christian Kloss
- Health Care Systems GmbH (HCSG), Pullach im Isartal, Germany
| | - Heribert Schunkert
- German Heart Centre Munich, Department of Cardiology, Technical University Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Wibke Reinhard
- German Heart Centre Munich, Department of Cardiology, Technical University Munich, Munich, Germany.
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Zito A, Restivo A, Ciliberti G, Laborante R, Princi G, Romiti GF, Galli M, Rodolico D, Bianchini E, Cappannoli L, D'Oria M, Trani C, Burzotta F, Cesario A, Savarese G, Crea F, D'Amario D. Heart failure management guided by remote multiparameter monitoring: A meta-analysis. Int J Cardiol 2023; 388:131163. [PMID: 37429443 DOI: 10.1016/j.ijcard.2023.131163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Several implant-based remote monitoring strategies are currently tested to optimize heart failure (HF) management by anticipating clinical decompensation and preventing hospitalization. Among these solutions, the modern implantable cardioverter-defibrillator and cardiac resynchronization therapy devices have been equipped with sensors allowing continuous monitoring of multiple preclinical markers of worsening HF, including factors of autonomic adaptation, patient activity, and intrathoracic impedance. OBJECTIVES We aimed to assess whether implant-based multiparameter remote monitoring strategy for guided HF management improves clinical outcomes when compared to standard clinical care. METHODS A systematic literature research for randomized controlled trials (RCTs) comparing multiparameter-guided HF management versus standard of care was performed on PubMed, Embase, and CENTRAL databases. Incidence rate ratios (IRRs) and associated 95% confidence intervals (CIs) were calculated using the Poisson regression model with random study effects. The primary outcome was a composite of all-cause death and HF hospitalization events, whereas secondary endpoints included the individual components of the primary outcome. RESULTS Our meta-analysis included 6 RCTs, amounting to a total of 4869 patients with an average follow-up time of 18 months. Compared with standard clinical management, the multiparameter-guided strategy reduced the risk of the primary composite outcome (IRR 0.83, 95%CI 0.71-0.99), driven by statistically significant effect on both HF hospitalization events (IRR 0.75, 95%CI 0.61-0.93) and all-cause death (IRR 0.80, 95%CI 0.66-0.96). CONCLUSION Implant-based multiparameter remote monitoring strategy for guided HF management is associated with significant benefit on clinical outcomes compared to standard clinical care, providing a benefit on both hospitalization events and all-cause death.
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Affiliation(s)
- Andrea Zito
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Attilio Restivo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Ciliberti
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Renzo Laborante
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Princi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulio Francesco Romiti
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Daniele Rodolico
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Emiliano Bianchini
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Cappannoli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Marika D'Oria
- Open Innovation Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alfredo Cesario
- Open Innovation Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; CEO, Gemelli Digital Medicine & Health Srl, Rome, Italy
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
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Jin X, Zhou Y, Wu Y, Xie M. Safety and efficacy of steerable versus non-steerable sheaths for catheter ablation of atrial fibrillation systematic review and meta-analysis. BMJ Open 2023; 13:e068350. [PMID: 37734901 PMCID: PMC10514598 DOI: 10.1136/bmjopen-2022-068350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVES With the development of radiofrequency (RF) ablation technology. In recent years, more and more patients with atrial fibrillation (AF) have been treated with RF ablation. Steerable sheaths (SS) have been widely used in RF ablation of AF. The aim of this meta-analysis was to compare the efficacy and safety of AF ablation using SS and non-steerable sheaths (NSS). METHODS From the beginning to March 2022, we conducted a comprehensive, systematic search of the databases PubMed, MEDLINE, EMBASE, Web of Science and the Cochrane Library to finish the study. For categorical and continuous data, we used ORs and mean difference to calculate the effect. We also estimated the 95% CI. RESULTS Five studies of RF ablation of AF were selected, three prospective and two retrospective, involving 282 SS and 236 NSS ablation patients. The rate of recurrence of AF or atrial arrhythmias was 27.3% versus 42.8% (OR: 0.52, 95% CI 0.36, 0.76, z=3.41, p=0.0006) and acute pulmonary vein (PV) reconnection (8.7% vs 17.4%, OR: 0.47, 95% CI 0.23, 0.95, z=2.10, p=0.04). In the SS group and the NSS group, the total ablation time (p=0.25), fluoroscopy time (p=0.26) and total operative time (p=0.35) were not significantly different. CONCLUSIONS Compared with the use of NSS, the use of SS for RF ablation of AF can effectively reduce the recurrence rate of AF and the occurrence of acute PVs reconnection events. However, there is no advantage in shortening the total RF time, fluoroscopy time, total surgical time and reducing complications.
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Affiliation(s)
- Xinyao Jin
- Department of Cardiology, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Yuqing Zhou
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuanhong Wu
- Department of Cardiology, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Mingbin Xie
- Department of Cardiology, Hangzhou Red Cross Hospital, Hangzhou, China
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Sachdeva P, Kaur K, Fatima S, Mahak F, Noman M, Siddenthi SM, Surksha MA, Munir M, Fatima F, Sultana SS, Varrassi G, Khatri M, Kumar S, Elder M, Mohamad T. Advancements in Myocardial Infarction Management: Exploring Novel Approaches and Strategies. Cureus 2023; 15:e45578. [PMID: 37868550 PMCID: PMC10587445 DOI: 10.7759/cureus.45578] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
In the landscape of healthcare, the management of myocardial infarction (MI) stands as a pivotal challenge and a critical juncture where advancements are reshaping the trajectory of patient care. Myocardial infarction, commonly known as a heart attack, remains a foremost contributor to global morbidity and mortality. Conventional management strategies have historically focused on rapid restoration of blood flow through revascularization techniques. However, the last decade has witnessed a profound transformation, with a burgeoning emphasis on precision medicine and innovative interventions. This contextual backdrop sets the stage for a deep dive into the realm of novel diagnostic modalities, spanning high-sensitivity biomarkers, advanced imaging techniques, and data-driven algorithms. These innovations facilitate not only early detection but also the stratification of patients, paving the way for individualized treatment plans. By targeting the underlying mechanisms of myocardial damage, these interventions hold the promise of attenuating the impact of MI and promoting cardiac regeneration. It examines the integration of telemedicine, wearable devices, and remote monitoring platforms, bridging the gap between patients and caregivers while enabling timely interventions. Additionally, the psychosocial aspects of MI recovery are explored, highlighting the integration of psychological support and lifestyle interventions to enhance long-term well-being. By exploring novel diagnostics, innovative therapies, and holistic patient-centered strategies, it underscores the collaborative efforts of medical practitioners, researchers, and technological pioneers in reshaping the trajectory of MI care. As we stand at the intersection of medical advancement and compassionate patient management, embracing these novel approaches promises a future where the impact of myocardial infarction can be mitigated, and lives can be extended and enriched.
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Affiliation(s)
- Pranav Sachdeva
- General Medicine, Government Medical College & Hospital, Chandigarh, Chandigarh, IND
| | - Kawanpreet Kaur
- General Medicine, Government Medical College & Hospital, Chandigarh, Chandigarh, IND
| | - Saba Fatima
- Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Fnu Mahak
- Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | | | | | | - Mishaal Munir
- Medicine, Ghurki Trust and Teaching Hospital, Lahore, PAK
- Internal Medicine, Lahore Medical & Dental College, Lahore, PAK
| | - Fnu Fatima
- Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | | | | | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, Karachi, PAK
| | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Mahir Elder
- Interventional Cardiology, Heart and Vascular Institute, Detroit, USA
| | - Tamam Mohamad
- Cardiovascular Surgery, Wayne State University, Detroit, USA
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Kerwagen F, Koehler K, Vettorazzi E, Stangl V, Koehler M, Halle M, Koehler F, Störk S. Remote patient management of heart failure across the ejection fraction spectrum: A pre-specified analysis of the TIM-HF2 trial. Eur J Heart Fail 2023; 25:1671-1681. [PMID: 37368507 DOI: 10.1002/ejhf.2948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/27/2023] [Accepted: 06/20/2023] [Indexed: 06/29/2023] Open
Abstract
AIMS The benefit of non-invasive remote patient management (RPM) for patients with heart failure (HF) has been demonstrated. We evaluated the effect of left ventricular ejection fraction (LVEF) on treatment outcomes in the TIM-HF2 (Telemedical Interventional Management in Heart Failure II; NCT01878630) randomized trial. METHODS AND RESULTS TIM-HF2 was a prospective, randomized, multicentre trial investigating the effect of a structured RPM intervention versus usual care in patients who had been hospitalized for HF within 12 months before randomization. The primary endpoint was the percentage of days lost due to all-cause death or unplanned cardiovascular hospitalization. Key secondary endpoints were all-cause and cardiovascular mortality. Outcomes were assessed by LVEF in guideline-defined subgroups of ≤40% (HF with reduced EF [HFrEF]), 41-49% (HF with mildly reduced EF [HFmrEF]), and ≥50% (HF with preserved EF [HFpEF]). Out of 1538 participants, 818 (53%) had HFrEF, 224 (15%) had HFmrEF, and 496 (32%) had HFpEF. Within each LVEF subgroup, the primary endpoint was lower in the treatment group, i.e. the incidence rate ratio [IRR] remained below 1.0. Comparing intervention and control group, the percentage of days lost was 5.4% versus 7.6% for HFrEF (IRR 0.72, 95% confidence interval [CI] 0.54-0.97), 3.3% versus 5.9% for HFmrEF (IRR 0.85, 95% CI 0.48-1.50) and 4.7% versus 5.4% for HFpEF (IRR 0.93, 95% CI 0.64-1.36). No interaction between LVEF and the randomized group became apparent. All-cause and cardiovascular mortality were also reduced by RPM in each subgroup with hazard ratios <1.0 across the LVEF spectrum for both endpoints. CONCLUSION In the clinical set-up deployed in the TIM-HF2 trial, RPM appeared effective irrespective of the LVEF-based HF phenotype.
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Affiliation(s)
- Fabian Kerwagen
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
- Department of Medicine I, Cardiology, University Hospital Würzburg, Würzburg, Germany
| | - Kerstin Koehler
- Centre for Cardiovascular Telemedicine, Campus Charité Mitte, German Heart Center Charité, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Verena Stangl
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care, Campus Charité Mitte, German Heart Center Charité, Berlin, Germany
| | - Magdalena Koehler
- Ludwig-Maximilians Universität München, Munich, Germany
- Department of Preventive Sports Medicine and Sports Cardiology, University Hospital 'Klinikum rechts der Isar', School of Medicine, Technical University Munich, Munich, Germany
| | - Martin Halle
- Department of Preventive Sports Medicine and Sports Cardiology, University Hospital 'Klinikum rechts der Isar', School of Medicine, Technical University Munich, Munich, Germany
| | - Friedrich Koehler
- Centre for Cardiovascular Telemedicine, Campus Charité Mitte, German Heart Center Charité, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
- Department of Medicine I, Cardiology, University Hospital Würzburg, Würzburg, Germany
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6
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Scholte NTB, Gürgöze MT, Aydin D, Theuns DAMJ, Manintveld OC, Ronner E, Boersma E, de Boer RA, van der Boon RMA, Brugts JJ. Telemonitoring for heart failure: a meta-analysis. Eur Heart J 2023; 44:2911-2926. [PMID: 37216272 PMCID: PMC10424885 DOI: 10.1093/eurheartj/ehad280] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/24/2023] Open
Abstract
AIMS Telemonitoring modalities in heart failure (HF) have been proposed as being essential for future organization and transition of HF care, however, efficacy has not been proven. A comprehensive meta-analysis of studies on home telemonitoring systems (hTMS) in HF and the effect on clinical outcomes are provided. METHODS AND RESULTS A systematic literature search was performed in four bibliographic databases, including randomized trials and observational studies that were published during January 1996-July 2022. A random-effects meta-analysis was carried out comparing hTMS with standard of care. All-cause mortality, first HF hospitalization, and total HF hospitalizations were evaluated as study endpoints. Sixty-five non-invasive hTMS studies and 27 invasive hTMS studies enrolled 36 549 HF patients, with a mean follow-up of 11.5 months. In patients using hTMS compared with standard of care, a significant 16% reduction in all-cause mortality was observed [pooled odds ratio (OR): 0.84, 95% confidence interval (CI): 0.77-0.93, I2: 24%], as well as a significant 19% reduction in first HF hospitalization (OR: 0.81, 95% CI 0.74-0.88, I2: 22%) and a 15% reduction in total HF hospitalizations (pooled incidence rate ratio: 0.85, 95% CI 0.76-0.96, I2: 70%). CONCLUSION These results are an advocacy for the use of hTMS in HF patients to reduce all-cause mortality and HF-related hospitalizations. Still, the methods of hTMS remain diverse, so future research should strive to standardize modes of effective hTMS.
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Affiliation(s)
- Niels T B Scholte
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Muhammed T Gürgöze
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Dilan Aydin
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Dominic A M J Theuns
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Eelko Ronner
- Department of Cardiology, Reinier de Graaf Hospital, Reinier de Graafweg 5, Delft, South Holland 2625 AD, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Robert M A van der Boon
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, South Holland 3015 GD, The Netherlands
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Buttar C, Lakhdar S, Nso N, Guzman-Perez L, Dao T, Mahmood K, Hendel R, Lavie CJ, Collura G, Trandafirescu T. Meta-Analysis Comparing Outcomes of Remote Hemodynamic Assessment Versus Standard Care in Patients With Heart Failure. Am J Cardiol 2023; 192:79-87. [PMID: 36758268 DOI: 10.1016/j.amjcard.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/17/2022] [Accepted: 12/26/2022] [Indexed: 02/09/2023]
Abstract
In patients with congestive heart failure (CHF), remote hemodynamic monitoring can reduce heart failure exacerbation and mortality. In this study, we compared the effectiveness of remote hemodynamic monitoring with that of standard care in the management of patients with CHF. The remote monitoring group included 7,733 patients, and the control group included 7,567 patients. Chi-square test and I-square statistics were used to assess heterogeneity. Risk ratios (RRs) were calculated using fixed-effects and random-effects methods to determine the risk of all-cause hospitalization and CHF-related hospitalization (primary outcomes) and all-cause mortality and device outcomes (secondary outcomes). Pooled findings indicated a 7% lower risk of all-cause hospitalization in the remote monitoring group than that in the control group (RR 0.93, 95% confidence interval [CI] 0.89 to 0.98, p = 0.004). The results also revealed a 32% lower risk of CHF-related hospitalization in the remote monitoring group than that in the control group (RR 0.68, 95% CI 0.65 to 0.71, p <0.001). No statistically significant differences were noted between the groups in terms of all-cause mortality (RR 0.97, 95% CI 0.87 to 1.07, p = 0.53) and device outcomes (RR 1.23 95% CI 0.92 to 1.65, p = 0.16). These results provided evidence regarding the comparable effectiveness of remote CHF monitoring and routine care. The current evidence is insufficient to introduce remote hemodynamic CHF monitoring; however, our results suggest that the integration of telemonitoring systems with routine medical management may improve heart failure care.
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Affiliation(s)
- Chandan Buttar
- Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana.
| | - Sofia Lakhdar
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.
| | - Nso Nso
- Department of Cardiology, University of Chicago, Illinois
| | - Laura Guzman-Perez
- Division of Cardiology, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, New York
| | - Tristan Dao
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Kiran Mahmood
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Hendel
- Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Carl J Lavie
- Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana
| | - Giovina Collura
- Division of Cardiology, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, New York
| | - Theo Trandafirescu
- Division of Critical Care Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, New York
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8
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Efficacy of ICD/CRT-D Remote Monitoring in Patients With HFrEF: a Bayesian Meta-analysis of Randomized Controlled Trials. Curr Heart Fail Rep 2022; 19:435-444. [PMID: 36205832 DOI: 10.1007/s11897-022-00579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE OF REVIEW To evaluate remote monitoring using implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) devices as an adjunctive tool to the traditional care of patients with heart failure (HF). RECENT FINDINGS We included 11 trials encompassing 5965 patients. Absolute risk difference (ARD) with 95% credible interval (CrI) was estimated. Pooled (posterior) risk difference was computed using Bayesian hierarchical methods. The ARD for mortality was centered at - 0.01 (95% CrI: - 0.03; 0.01, Tau: 0.02), with an 82% probability of ARD of ICD/CRT-D remote monitoring with respect to control being less than 0. The ARD for cardiovascular mortality was centered at - 0.03 (95% CrI: - 0.11; 0.05, Tau: 0.10), with an 84% probability of ARD of ICD/CRT-D remote monitoring with respect to control being less than 0. ICD/CRT-D remote monitoring in patients with HF is associated with a higher probability of reduced all-cause and cardiovascular mortality compared with standard care alone.
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9
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Hafkamp FJ, Tio RA, Otterspoor LC, de Greef T, van Steenbergen GJ, van de Ven ART, Smits G, Post H, van Veghel D. Optimal effectiveness of heart failure management - an umbrella review of meta-analyses examining the effectiveness of interventions to reduce (re)hospitalizations in heart failure. Heart Fail Rev 2022; 27:1683-1748. [PMID: 35239106 PMCID: PMC8892116 DOI: 10.1007/s10741-021-10212-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) is a major health concern, which accounts for 1-2% of all hospital admissions. Nevertheless, there remains a knowledge gap concerning which interventions contribute to effective prevention of HF (re)hospitalization. Therefore, this umbrella review aims to systematically review meta-analyses that examined the effectiveness of interventions in reducing HF-related (re)hospitalization in HFrEF patients. An electronic literature search was performed in PubMed, Web of Science, PsycInfo, Cochrane Reviews, CINAHL, and Medline to identify eligible studies published in the English language in the past 10 years. Primarily, to synthesize the meta-analyzed data, a best-evidence synthesis was used in which meta-analyses were classified based on level of validity. Secondarily, all unique RCTS were extracted from the meta-analyses and examined. A total of 44 meta-analyses were included which encompassed 186 unique RCTs. Strong or moderate evidence suggested that catheter ablation, cardiac resynchronization therapy, cardiac rehabilitation, telemonitoring, and RAAS inhibitors could reduce (re)hospitalization. Additionally, limited evidence suggested that multidisciplinary clinic or self-management promotion programs, beta-blockers, statins, and mitral valve therapy could reduce HF hospitalization. No, or conflicting evidence was found for the effects of cell therapy or anticoagulation. This umbrella review highlights different levels of evidence regarding the effectiveness of several interventions in reducing HF-related (re)hospitalization in HFrEF patients. It could guide future guideline development in optimizing care pathways for heart failure patients.
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Affiliation(s)
| | - Rene A. Tio
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Luuk C. Otterspoor
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Tineke de Greef
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | | | - Arjen R. T. van de Ven
- Netherlands Heart Network, Veldhoven, The Netherlands
- St. Anna Hospital, Geldrop, The Netherlands
| | - Geert Smits
- Netherlands Heart Network, Veldhoven, The Netherlands
- Primary care group Pozob, Veldhoven, The Netherlands
| | - Hans Post
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Dennis van Veghel
- Netherlands Heart Network, Veldhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
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10
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Koehler F, Störk S, Schulz M. Telemonitoring of heart failure patients is reimbursed in Germany: challenges of real-world implementation remain. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:121-122. [PMID: 36713016 PMCID: PMC9707926 DOI: 10.1093/ehjdh/ztac017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, 97078 Würzburg, Germany,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Martin Schulz
- Institute of Pharmacy, Freie Universität Berlin, 12169 Berlin, Germany
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11
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Wu A, Li H. Efficacy of different telemonitoring strategies on chronic heart failure care: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28937. [PMID: 35446288 PMCID: PMC9276155 DOI: 10.1097/md.0000000000028937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Growing interest on the effects of telemonitoring on patients with chronic heart failure (CHF) has led to a rise in the number of trials addressing the same or very similar research questions with a concomitant increase in discordant findings. Therefore, we conducted a protocol for systematic review and meta-analysis to compare the effects of different telemonitoring strategies on clinical outcomes in patients with CHF. METHODS Two individual researchers conducted the platform searches on the PubMed, Cochrane Library, and Embase databases from inception to February 2022. Literature retrieving was carried out through a combined searching of subject terms ("MeSH" on PubMed and "Emtree" on "Embase") and free terms on the platforms of PubMed and Embase, and through keywords searching on platform of Cochrane Library. Systematic review and meta-analysis of the data will be performed in STATA13.0 software according to the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Two authors independently performed the literature searching, data extraction, and quality evaluation. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials (RCTs). RESULTS The results will be submitted to a peer-reviewed journal. CONCLUSION This meta-analysis will provide a comprehensive analysis and synthesis that can be used as an evidence map to inform practitioners and policy makers about the effectiveness of telemonitoring interventions for patients with CHF.
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12
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Kotalczyk A, Imberti JF, Lip GYH, Wright DJ. Telemedical Monitoring Based on Implantable Devices-the Evolution Beyond the CardioMEMS™ Technology. Curr Heart Fail Rep 2022; 19:7-14. [PMID: 35174451 PMCID: PMC8853059 DOI: 10.1007/s11897-021-00537-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 12/11/2022]
Abstract
Purpose of the Review We aimed to provide an overview of telemedical monitoring and its impact on outcomes among heart failure (HF) patients. Recent Findings Most HF readmissions may be prevented if clinical parameters are strictly controlled via telemedical monitoring. Predictive algorithms for patients with cardiovascular implantable electronic devices (e.g., Triage-HF Plus by Medtronic or HeartLogic by Boston Scientific) were developed to identify patients at significantly increased risk of HF events. However, randomized control trial-based data are heterogeneous regarding the advantages of telemedical monitoring in HF patients. The likelihood of adverse clinical outcomes increases when pulmonary artery pressure (PAP) rises, usually days to weeks before clinical manifestations of HF. A wireless monitoring system (CardioMEMS™) detecting changes in PAP was proposed for HF patients. CardioMEMS™ transmits data to the healthcare provider and allows to institute timely intensification of HF therapies. CardioMEMS™-guided pharmacotherapy reduced a risk of HF-related hospitalization (hazard ratio [HR]: 0.72; 95% confidence interval (CI) 0.60–0–0.85; p < 0.01). Summary Relevant developments and innovations of telemedical care may improve clinical outcomes among HF patients. The use of CardioMEMS™ was found to be safe and cost-effective by reducing the rates of HF hospitalizations.
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Affiliation(s)
- Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Jacopo F Imberti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - David Justin Wright
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK. .,Liverpool Heart & Chest Hospital, Liverpool, UK.
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13
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[Telemedicine in chronic heart failure-From clinical studies to standard care]. Internist (Berl) 2022; 63:266-273. [PMID: 35138432 DOI: 10.1007/s00108-022-01268-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
Telemedicine has the potential to solve many current and especially future challenges in medical care. Using the example of heart failure (HF), the transition of telemedicine from clinical studies to standard care is presented. In patients with chronic HF, randomized controlled trials have shown that telemedicine-based care leads to a reduction in mortality and cardiovascular morbidity. Based on these data, the Federal Joint Committee (G-BA) decided that for the first time a digital method should be introduced into standard care for high-risk patients with reduced left ventricular ejection fraction. In the future, this group of patients will be entitled to telemedical care using active rhythm devices or noninvasive measuring devices. The indications are assessed by the primary treating physician (PBA), who works together with a telemedicine center (TMZ) managed through cardiology that receives daily telemetric data and notifies the PBA of abnormal findings. Alternatively, a cardiologist PBA with an associated TMZ infrastructure can also provide telemedical care. In the future, advanced technologies such as artificial intelligence or mobile communication standard 5G will help to make telemedicine both widely available and usable for alternative sensor technology.
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14
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Piskulic D, McDermott S, Seal L, Vallaire S, Norris CM. Virtual visits in cardiovascular disease: a rapid review of the evidence. Eur J Cardiovasc Nurs 2021; 20:816-826. [PMID: 34632501 PMCID: PMC8524521 DOI: 10.1093/eurjcn/zvab084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/06/2021] [Accepted: 09/01/2021] [Indexed: 12/01/2022]
Abstract
Given the high prevalence of cardiovascular disease (CVD) in Canada and globally, as well as the staggering cost to human life and health systems, there is an urgent need to understand the successful applications of telemedicine in cardiovascular medicine. While telemedicine in cardiology is well documented, reports on virtual care in the form of synchronous, real-time communication between healthcare providers and patients are limited. As a result of the immediate suspension of ambulatory services for cardiology in Alberta, Canada, due to the Coronavirus Disease 2019 pandemic, we undertook a rapid review on the impact of non-virtual visits in cardiovascular ambulatory settings on patients’ healthcare utilization and mortality. Evidence from 12 randomized control trials and 7 systematic reviews was included in the rapid review, with the majority of papers (n = 15) focusing on telemedicine in heart failure. Based on our appraisal of evidence from the last 5 years, virtual visits are non-inferior, or more effective, in reducing hospitalizations and visits to emergency departments in patients with CVD compared to traditional standard in-clinic/ambulatory care. The evidence for a superior effect of virtual visits in reducing mortality was not supported in this review. While telemedicine is an appropriate tool for CVD follow-up care, more research into the efficacy of different components of telemedicine and virtual visits is required.
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Affiliation(s)
- Danijela Piskulic
- Alberta Health Services, Cardiovascular Health & Stroke Strategic Clinical Network, Alberta Health Services, Suite 300, North Tower, 10030-107 Street NW, Edmonton, AB T5J 3E4, Canada
| | - Susanna McDermott
- Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Lauren Seal
- St. Albert Public Library, 1010 880 St. Albert Trail, St. Albert, AB T8N 3Z9, Canada
| | - Shelley Vallaire
- Alberta Health Services, Cardiovascular Health & Stroke Strategic Clinical Network, Alberta Health Services, Suite 300, North Tower, 10030-107 Street NW, Edmonton, AB T5J 3E4, Canada
| | - Colleen M Norris
- Alberta Health Services, Cardiovascular Health & Stroke Strategic Clinical Network, Alberta Health Services, Suite 300, North Tower, 10030-107 Street NW, Edmonton, AB T5J 3E4, Canada.,Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada
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15
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Efficacy of remote physiological monitoring-guided care for chronic heart failure: an updated meta-analysis. Heart Fail Rev 2021; 27:1627-1637. [PMID: 34609716 DOI: 10.1007/s10741-021-10176-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
Previous studies have reported contradictory findings on the utility of remote physiological monitoring (RPM)-guided management of patients with chronic heart failure (HF). Multiple databases were searched for studies that evaluated the clinical efficacy of RPM-guided management versus standard of care (SOC) for HF patients. The primary outcome was HF-related hospitalization (HFH). The secondary outcomes were all-cause mortality, cardiovascular-related (CV) mortality, and emergency department (ED) visits. Pooled relative risk (RR) and corresponding 95% confidence intervals (CIs) were calculated and combined using a random-effects model. A total of 16 randomized controlled trials, including 8679 HF patients (4574 managed with RPM-guided therapy vs. 4105 managed with SOC), were included in the final analysis. The average follow-up period was 15.2 months. There was no significant difference in HFH rate between the two groups (RR: 0.94; 95% CI: 0.84-1.07; P = 0.36). Similarly, there were no significant differences in CV mortality (RR 0.86, 95% CI 0.73-1.02, P = 0.08) or in ED visits (RR 0.80, 95% CI 0.59-1.08, P = 0.14). However, RPM-guided therapy was associated with a borderline statistically significant reduction in all-cause mortality (RR: 0.88; 95% CI: 0.78-1.00; P = 0.05). Subgroup analysis based on the strategy of RPM showed that both hemodynamic and arrhythmia telemonitoring-guided management can reduce the risk of HFH (RR: 0.79; 95% CI: 0.64-0.97; P = 0.02) and (RR: 0.79; 95% CI: 0.67-0.94; P = 0.008) respectively. Our study demonstrated that RPM-guided diuretic therapy of HF patients did not reduce the risk of HFH but can improve survival. Hemodynamic and arrhythmia telemonitoring-guided management could reduce the risk of HF-related hospitalizations.
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16
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Hiddemann M, Prescher S, Koehler K, Koehler F. Telemedizin bei Herzinsuffizienz – Translation von klinischen Studien in die Regelversorgung. AKTUELLE KARDIOLOGIE 2021. [DOI: 10.1055/a-1506-5821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungFür telemedizinische Mitbetreuung von Patient*innen mit chronischer Herzinsuffizienz besteht Evidenz bezüglich der Senkung von Letalität und kardiovaskulärer Morbidität. Nach aktuellem Beschluss des Gemeinsamen Bundesausschusses (G-BA) wird erstmals eine digitale Methode in die Regelversorgung überführt. Hochrisikopatient*innen mit reduzierter linksventrikulärer Ejektionsfraktion haben künftig einen Leistungsanspruch, entweder mittels aktiver Implantate (ICD, CRT-P und CRT-D) oder mittels telemedizinischer Heimmessgeräte betreut zu werden. Die Indikation zum Telemonitoring stellt der/die primär behandelnde Arzt/Ärztin (PBA). Der tägliche Vitaldatentransfer erfolgt an ein kardiologisch geführtes Telemedizinzentrum (TMZ), welches den/die PBA bei auffälligen Befunden zeitnah benachrichtigt. Der/die PBA entscheidet im Einzelfall über den Bedarf einer telemedizinischen 24/7-Mitbetreuung. Ein/e kardiologische/r PBA mit einer TMZ-Infrastruktur kann die telemedizinische
Mitbetreuung der eigenen Patient*innen übernehmen.
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Affiliation(s)
- Meike Hiddemann
- Medizinischen Klinik m. S. Kardiologie und Angiologie – Arbeitsbereich kardiovaskuläre Telemedizin, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - Sandra Prescher
- Medizinischen Klinik m. S. Kardiologie und Angiologie – Arbeitsbereich kardiovaskuläre Telemedizin, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - Kerstin Koehler
- Medizinischen Klinik m. S. Kardiologie und Angiologie – Arbeitsbereich kardiovaskuläre Telemedizin, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - Friedrich Koehler
- Medizinischen Klinik m. S. Kardiologie und Angiologie – Arbeitsbereich kardiovaskuläre Telemedizin, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
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17
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Koi T, Kataoka N, Imamura T, Kinugawa K. Drastic Cardiac Reverse Remodeling Following Catheter Ablation in Patients with Atrial Fibrillation and Heart Failure. ACTA ACUST UNITED AC 2021; 57:medicina57050511. [PMID: 34065174 PMCID: PMC8160769 DOI: 10.3390/medicina57050511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
In the management of atrial fibrillation in patients with heart failure, rate control is recommended, whereas the implication of rhythm control remains controversial. We experienced a 65-year-old man who had compensated heart failure due to hypertensive heart disease and atrial fibrillation with well-controlled heart rate (<100 bpm). At three months following the catheter ablation procedure, the left ventricular ejection fraction improved from 40% up to 65%. The implication of rhythm control using catheter ablation in improving cardiac reverse remodeling should be validated in large-scale clinical studies.
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18
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Taylor ML, Thomas EE, Snoswell CL, Smith AC, Caffery LJ. Does remote patient monitoring reduce acute care use? A systematic review. BMJ Open 2021; 11:e040232. [PMID: 33653740 PMCID: PMC7929874 DOI: 10.1136/bmjopen-2020-040232] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Chronic diseases are associated with increased unplanned acute hospital use. Remote patient monitoring (RPM) can detect disease exacerbations and facilitate proactive management, possibly reducing expensive acute hospital usage. Current evidence examining RPM and acute care use mainly involves heart failure and omits automated invasive monitoring. This study aimed to determine if RPM reduces acute hospital use. METHODS A systematic literature review of PubMed, Embase and CINAHL electronic databases was undertaken in July 2019 and updated in October 2020 for studies published from January 2015 to October 2020 reporting RPM and effect on hospitalisations, length of stay or emergency department presentations. All populations and disease conditions were included. Two independent reviewers screened articles. Quality analysis was performed using the Joanna Briggs Institute checklist. Findings were stratified by outcome variable. Subgroup analysis was undertaken on disease condition and RPM technology. RESULTS From 2050 identified records, 91 studies were included. Studies were medium-to-high quality. RPM for all disease conditions was reported to reduce admissions, length of stay and emergency department presentations in 49% (n=44/90), 49% (n=23/47) and 41% (n=13/32) of studies reporting each measure, respectively. Remaining studies largely reported no change. Four studies reported RPM increased acute care use. RPM of chronic obstructive pulmonary disease (COPD) was more effective at reducing emergency presentation than RPM of other disease conditions. Similarly, invasive monitoring of cardiovascular disease was more effective at reducing hospital admissions versus other disease conditions and non-invasive monitoring. CONCLUSION RPM can reduce acute care use for patients with cardiovascular disease and COPD. However, effectiveness varies within and between populations. RPM's effect on other conditions is inconclusive due to limited studies. Further analysis is required to understand underlying mechanisms causing variation in RPM interventions. These findings should be considered alongside other benefits of RPM, including increased quality of life for patients. PROSPERO REGISTRATION NUMBER CRD42020142523.
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Affiliation(s)
- Monica L Taylor
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Emma E Thomas
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Liam J Caffery
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Woolloongabba, Queensland, Australia
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19
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Butter C, Sperzel J. Gerätebasierte rhythmologische Diagnostik und Therapie in COVID-19-Zeiten. DER KARDIOLOGE 2021; 15:272-281. [PMCID: PMC8130805 DOI: 10.1007/s12181-021-00482-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/14/2023]
Abstract
Die COVID-Pandemie mit ihrer ersten und zweiten Welle hat uns gezwungen, über eine sinnvolle Nutzung unserer medizinischen Ressourcen nachzudenken und Eingriffe nach ihrer Notwendigkeit und Dringlichkeit zu graduieren. Diese Selektion ist insbesondere in der Kardiologie in jedem einzelnen Fall schwierig und riskant. Die aktuellen Empfehlungen in der Herzschrittmacher‑, Defibrillatortherapie und Nachsorge werden aufgezeigt mit dem Ziel, die individuelle ärztliche Entscheidung auf nachvollziehbare und belastbare Argumente zu stützen und diese auch den Patienten gegenüber begründen zu können. Diese Überlegungen haben in einzelnen Ländern zu einem deutlichen Rückgang von Schrittmacher- und Defibrillatorimplantationen geführt ebenso wie Ablation bei supraventrikulären Arrhythmien. Die Auswirkungen der Pandemie lassen sich aus den Aktivitätsprofilen der rhythmologischen Implantate nachvollziehen. Die Notwendigkeit und Chancen einer telemedizinischen Überwachung sind in dieser Zeit nachdrücklich deutlich geworden, ebenso wie die bislang unzureichende Nutzung und mangelnde Struktur. Die aktuelle positive G‑BA(Gemeinsamer Bundesausschuss)-Bewertung der telemedizinischen Überwachung bei Herzinsuffizienz weist in die richtige Richtung, die Umsetzung und Vergütung wird jedoch für weitere Diskussionen sorgen. Ein neuer Algorithmus, der auf einer Herztonerkennung beruht und im ersten AV(atrioventrikulären)-sequenziellen sondenlosen Herzschrittmacher Verwendung findet, wird diskutiert. Bisher stützen sich die Indikationen für eine primärprophylaktische ICD(implantierbarer Kardioverter-Defibrillator)-Implantation im Wesentlichen auf die linksventrikuläre Ejektionsfraktion insbesondere bei der nichtischämischen Kardiomyopathie. Die Notwendigkeit und Bedeutung von intramuralem Fibrose- und Narbennachweis in der Magnetresonanztomographie (MRT) werden diskutiert und könnten die Entscheidungsfindung unterstützen.
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Affiliation(s)
- Christian Butter
- Immanuel Klinikum Bernau Herzzentrum Brandenburg, Universitätsklinikum der Medizinischen Hochschule Brandenburg, Ladeburger Str. 17, 16321 Bernau bei Berlin, Deutschland
| | - Johannes Sperzel
- Abteilung für Kardiologie, Kerckhoff-Klinik GmbH, Bad Nauheim, Deutschland
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20
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Sardu C, Paolisso P, Ducceschi V, Santamaria M, Sacra C, Massetti M, Ruocco A, Marfella R. Cardiac resynchronization therapy and its effects in patients with type 2 DIAbetes mellitus OPTimized in automatic vs. echo guided approach. Data from the DIA-OPTA investigators. Cardiovasc Diabetol 2020; 19:202. [PMID: 33248462 PMCID: PMC7700711 DOI: 10.1186/s12933-020-01180-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives To evaluate the effects of cardiac resynchronization therapy (CRTd) in patients with type 2 diabetes mellitus (T2DM) optimized via automatic vs. echocardiography-guided approach. Background The suboptimal atrio-ventricular (AV) and inter-ventricular (VV) delays optimization reduces CRTd response. Therefore, we hypothesized that automatic CRTd optimization might improve clinical outcomes in T2DM patients. Methods We designed a prospective, multicenter study to recruit, from October 2016 to June 2019, 191 consecutive failing heart patients with T2DM, and candidate to receive a CRTd. Study outcomes were CRTd responders rate, hospitalizations for heart failure (HF) worsening, cardiac deaths and all cause of deaths in T2DM patients treated with CRTd and randomly optimized via automatic (n 93) vs. echocardiography-guided (n 98) approach at 12 months of follow-up. Results We had a significant difference in the rate of CRTd responders (68 (73.1%) vs. 58 (59.2%), p 0.038), and hospitalizations for HF worsening (12 (16.1%) vs. 22 (22.4%), p 0.030) in automatic vs. echocardiography-guided group of patients. At multivariate Cox regression analysis, the automatic guided approach (3.636 [1.271–10.399], CI 95%, p 0.016) and baseline highest values of atrium pressure (automatic SonR values, 2.863 [1.537–6.231], CI 95%, p 0.006) predicted rate of CRTd responders. In automatic group, we had significant difference in SonR values comparing the rate of CRTd responders vs. non responders (1.24 ± 0.72 g vs. 0.58 ± 0.46 g (follow-up), p 0.001), the rate of hospitalizations for HF worsening events (0.48 ± 0.29 g vs. 1.18 ± 0.43 g, p 0.001), and the rate of cardiac deaths ( 1.13 ± 0.72 g vs. 0.65 ± 0.69 g, p 0.047). Conclusions Automatic optimization increased CRTd responders rate, and reduced hospitalizations for HF worsening. Intriguingly, automatic CRTd and highest baseline values of SonR could be predictive of CRTd responders. Notably, there was a significant difference in SonR values for CRTd responders vs. non responders, and about hospitalizations for HF worsening and cardiac deaths. Clinical trial ClinicalTrials.gov Identifier NCT04547244.
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Affiliation(s)
- Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80131, Naples, Italy.
| | - Pasquale Paolisso
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Valentino Ducceschi
- Unit of Cardiovascular Diseases and Arrhythmias, "Vecchio Pellegrini" Hospital, Naples, Italy
| | - Matteo Santamaria
- Unit of Cardiovascular Diseases and Arrhythmias, "Gemelli Molise", Campobasso, Italy
| | - Cosimo Sacra
- Unit of Cardiovascular Diseases and Arrhythmias, "Gemelli Molise", Campobasso, Italy
| | - Massimo Massetti
- Unit of Cardiovascular Diseases and Arrhythmias, "Gemelli Molise", Campobasso, Italy.,Department of Cardiac Surgery and Cardiovascular Diseases, "Catholic University of Sacred Heart", Rome, Italy
| | - Antonio Ruocco
- Unit of Cardiovascular Diseases and Arrhythmias, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80131, Naples, Italy
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21
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Jang JP, Lin HT, Chen YJ, Hsieh MH, Huang YC. Role of Remote Monitoring in Detection of Atrial Arrhythmia, Stroke Reduction, and Use of Anticoagulation Therapy - A Systematic Review and Meta-Analysis. Circ J 2020; 84:1922-1930. [PMID: 33012748 DOI: 10.1253/circj.cj-20-0633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of remote monitoring (RM) in atrial arrhythmia detection, stroke reduction, and anticoagulation therapy remains unknown, particularly for patients with implantable or wearable cardiac devices.Methods and Results:We performed a systematic review and meta-analysis to evaluate the role of RM in atrial arrhythmia detection, stroke reduction and anticoagulation therapeutic intervention. Online databases were queried to include randomized controlled trials comparing detection of atrial arrhythmia and stroke risk between patients undergoing RM and those receiving in-office (IO) follow-up. Outcomes and complications of RM-guided anticoagulation therapy and conventional therapy in patients with atrial fibrillation were also reviewed. A total of 16 studies were included. Compared with patients receiving IO follow-up, patients undergoing RM had a significantly higher detection rate of atrial arrhythmia (risk ratio [RR], 1.363; 95% confidence interval [CI], 1.147-1.619), and a lower risk of stroke (RR, 0.539; 95% CI, 0.301-0.936). The higher rate of atrial arrhythmia was only noted in patients with wearable devices (RR, 4.070; 95% CI, 2.408-6.877), and the lower risk of stroke was only noted in patients with cardiovascular implantable electronic devices (CIED) (RR, 0.513; 95% CI, 0.265-0.996). CONCLUSIONS RM is effective for atrial arrhythmia detection in patients using wearable devices and for reducing the risk of stroke in patients with CIED.
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Affiliation(s)
- Jia-Pei Jang
- Center of Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University
| | - Hui-Ting Lin
- Center of Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University
| | - Yu-Jen Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University.,Institute of Public Health, National Yang-Ming University
| | - Ming-Hsiung Hsieh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University.,Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
| | - Yu-Chen Huang
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University.,Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University.,Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University
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22
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Alkharaza A, Al-Harbi M, El-Sokkari I, Doucette S, MacIntyre C, Gray C, Abdelwahab A, Sapp JL, Gardner M, Parkash R. The effect of revascularization on mortality and risk of ventricular arrhythmia in patients with ischemic cardiomyopathy. BMC Cardiovasc Disord 2020; 20:455. [PMID: 33087069 PMCID: PMC7576697 DOI: 10.1186/s12872-020-01726-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background There is clear evidence that patients with prior myocardial infarction and a reduced ejection fraction benefit from implantation of a cardioverter-defibrillator (ICD). It is unclear whether this benefit is altered by whether or not revascularization is performed prior to ICD implantation. Methods This was a retrospective cohort study following patients who underwent ICD implantation from 2002 to 2014. Patients with ischemic cardiomyopathy and either primary or secondary prevention ICDs were selected for inclusion. Using the electronic medical record, cardiac catheterization data, revascularization status (percutaneous coronary intervention or coronary bypass surgery) were recorded. The outcomes were mortality and ventricular arrhythmia. Results There were 606 patients included in the analysis. The mean age was 66.3 ± 10.1 years, 11.9% were women, and the mean LVEF was 30.5 ± 12.0, 58.9% had a primary indication for ICD, 82.0% of the cohort had undergone coronary catheterization prior to ICD implantation. In the overall cohort, there were fewer mortality and ventricular arrhythmia events in patients who had undergone prior revascularization. In patients who had an ICD for secondary prevention, revascularization was associated with a decrease in mortality (HR 0.46, 95% CI (0.24, 0.85) p = 0.015), and a trend towards fewer ventricular arrhythmia (HR 0.62, 95% CI (0.38, 1.00) p = 0.051). There was no association between death or ventricular arrhythmia with revascularization in patients with primary prevention ICDs. Conclusion Revascularization may be beneficial in preventing recurrent ventricular arrhythmia, and should be considered as adjunctive therapy to ICD implantation to improve cardiovascular outcomes.
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Affiliation(s)
- Ahmad Alkharaza
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada
| | - Mousa Al-Harbi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ihab El-Sokkari
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada
| | - Steve Doucette
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Ciorsti MacIntyre
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada
| | - Christopher Gray
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada
| | - Amir Abdelwahab
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada
| | - John L Sapp
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada
| | - Martin Gardner
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada
| | - Ratika Parkash
- Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada.
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23
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Kotalczyk A, Kalarus Z, Wright DJ, Boriani G, Lip GYH. Cardiac Electronic Devices: Future Directions and Challenges. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:325-338. [PMID: 33061681 PMCID: PMC7526741 DOI: 10.2147/mder.s245625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/02/2020] [Indexed: 12/26/2022] Open
Abstract
Cardiovascular implantable electronic devices (CIEDs) are essential management options for patients with brady- and tachyarrhythmias or heart failure with concomitant optimal pharmacotherapy. Despite increasing technological advances, there are still gaps in the management of CIED patients, eg, the growing number of lead- and pocket-related long-term complications, including cardiac device–related infective endocarditis, requires the greatest care. Likewise, patients with CIEDs should be monitored remotely as a part of a comprehensive, holistic management approach. In addition, novel technologies used in smartwatches may be a convenient tool for long-term atrial fibrillation (AF) screening, especially in high-risk populations. Early detection of AF may reduce the risk of stroke and other AF-related complications. The objective of this review article was to provide an overview of novel technologies in cardiac rhythm–management devices and future challenges related to CIEDs.
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Affiliation(s)
- Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - David Justin Wright
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
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24
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Desai A, Mohammed T, Patel KN, Almnajam M, Kim AS. 5-Fluorouracil Rechallenge After Cardiotoxicity. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924446. [PMID: 32860674 PMCID: PMC7483515 DOI: 10.12659/ajcr.924446] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patient: Male, 66-year-old Final Diagnosis: Colon adenocarcinoma • ventricular arrhythmia Symptoms: Cardiac arrest • syncope Medication: — Clinical Procedure: Cardiac catheterization • Cardiac Electronic Implantable Device (CEID) Specialty: Cardiology • General and Internal Medicine • Oncology
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Affiliation(s)
- Aakash Desai
- Department of Medicine, University of Connecticut Health, Farmington, CT, USA
| | - Turab Mohammed
- Department of Medicine, University of Connecticut Health, Farmington, CT, USA
| | - Kunal N Patel
- Department of Epidemiology and Biostatistics, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Mansour Almnajam
- Division of Cardiology, Department of Medicine, University of Connecticut Health, Farmington, CT, USA
| | - Agnes S Kim
- Division of Cardiology, Department of Medicine, University of Connecticut Health, Farmington, CT, USA
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25
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Ajibade A, Younas H, Pullan M, Harky A. Telemedicine in cardiovascular surgery during COVID-19 pandemic: A systematic review and our experience. J Card Surg 2020; 35:2773-2784. [PMID: 32881081 PMCID: PMC7460963 DOI: 10.1111/jocs.14933] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective The SAR‐COV‐2 pandemic has had an unprecedented effect on the UK's healthcare systems. To reduce spread of the virus, elective treatments and surgeries have been postponed or canceled. There has been a rise in the use of telemedicine (TM) as an alternative way to carry outpatient consultations. This systematic review aims to evaluate the extent to which TM may be able to support cardiac and vascular surgery patients in the COVID‐19 era. Methods We looked into how TM can support the management of patients via triaging, preoperative, and postoperative care. Evaluations targeted the clinical effectiveness of common TM methods and the feasibility of applying those methods in the UK during this pandemic. Results Several studies have published their evidence on the benefit of TM and its benefit during COVID‐19, the data related to cardiovascular surgery and how this will impact future practice of this speciality is emerging and yet larger studies with appropriate timing of outcomes to be published. Conclusion Overall, the use of virtual consultations and remote monitoring is feasible and best placed to support these patients via triaging and postoperative monitoring. However, TM can be limited by the need of sophisticated technological requirement and patients’ educational and know‐how computer literacy level.
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Affiliation(s)
- Ayomikun Ajibade
- Birmingham Medical School, University of Birmingham, Birmingham, UK
| | - Hiba Younas
- St George's Medical School, University of London, London, UK
| | - Mark Pullan
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Integrative Biology, Faculty of Life Sciences, University of Liverpool, Liverpool, UK
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26
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Kahr PC, Trenson S, Schindler M, Kuster J, Kaufmann P, Tonko J, Hofer D, Inderbitzin DT, Breitenstein A, Saguner AM, Flammer AJ, Ruschitzka F, Steffel J, Winnik S. Differential effect of cardiac resynchronization therapy in patients with diabetes mellitus: a long-term retrospective cohort study. ESC Heart Fail 2020; 7:2773-2783. [PMID: 32652900 PMCID: PMC7524059 DOI: 10.1002/ehf2.12876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/04/2020] [Accepted: 06/16/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) has become an important therapy in patients with heart failure with reduced left ventricular ejection fraction (LVEF). The effect of diabetes on long-term outcome in these patients is controversial. We assessed the effect of diabetes on long-term outcome in CRT patients and investigated the role of diabetes in ischaemic and non-ischaemic cardiomyopathy. METHODS AND RESULTS All patients undergoing CRT implantation at our institution between November 2000 and January 2015 were enrolled. The study endpoints were (i) a composite of ventricular assist device (VAD) implantation, heart transplantation, or all-cause mortality; and (ii) reverse remodelling (improvement of LVEF ≥ 10% or reduction of left ventricular end-systolic volume ≥ 15%). Median follow-up of the 418 patients (age 64.6 ± 11.6 years, 22.5% female, 25.1% diabetes) was 4.8 years [inter-quartile range: 2.8;7.4]. Diabetic patients had an increased risk to reach the composite endpoint [adjusted hazard ratio (aHR) 1.48 [95% CI 1.12-2.16], P = 0.041]. Other factors associated with an increased risk to reach the composite endpoint were a lower body mass index or baseline LVEF (aHR 0.95 [0.91; 0.98] and 0.97 [0.95; 0.99], P < 0.01 each), and a higher New York Heart Association functional class or creatinine level (aHR 2.14 [1.38; 3.30] and 1.04 [1.01; 1.05], P < 0.05 each). Early response to CRT, defined as LVEF improvement ≥ 10%, was associated with a lower risk to reach the composite endpoint (aHR 0.60 [0.40; 0.89], P = 0.011). Reverse remodelling did not differ between diabetic and non-diabetic patients with respect to LVEF improvement ≥ 10% (aHR 0.60 [0.32; 1.14], P = 0.118). However, diabetes was associated with decreased reverse remodelling with respect to a reduction of left ventricular end-systolic volume ≥ 15% (aHR 0.45 [0.21; 0.97], P = 0.043). In patients with ischaemic cardiomyopathy, survival rates were not significantly different between diabetic and non-diabetic patients (HR 1.28 [0.83-1.97], P = 0.101), whereas in patients with non-ischaemic cardiomyopathy, diabetic patients had a higher risk of reaching the composite endpoint (HR 1.65 [1.06-2.58], P = 0.027). The latter effect was dependent on other risk factors (aHR 1.47 [0.83-2.61], P = 0.451). The risk of insulin-dependent patients was not significantly higher than in patients under oral antidiabetic drugs (HR 1.55 [95% CI 0.92-2.61], P = 0.102). CONCLUSIONS Long-term follow-up revealed diabetes mellitus as independent risk factor for all-cause mortality, heart transplantation, or VAD in heart failure patients undergoing CRT. The detrimental effect of diabetes appeared to weigh heavier in patients with non-ischaemic compared with ischaemic cardiomyopathy.
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Affiliation(s)
- Peter C Kahr
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Sander Trenson
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland.,Cardiovascular Sciences, University Hospital Leuven, Leuven, Belgium
| | - Matthias Schindler
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Joël Kuster
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Philippe Kaufmann
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland.,Department of Medicine, GZO Zurich Regional Health Center, Wetzikon, Switzerland
| | - Johanna Tonko
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Daniel Hofer
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Devdas T Inderbitzin
- Department of Cardiovascular Surgery, University Heart Center Zurich, Zurich, Switzerland
| | - Alexander Breitenstein
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Andreas J Flammer
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Jan Steffel
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
| | - Stephan Winnik
- Department of Cardiology, University Heart Center Zurich, Raemistr. 100, Zurich, 8091, Switzerland
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27
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Planinc I, Milicic D, Cikes M. Telemonitoring in Heart Failure Management. Card Fail Rev 2020; 6:e06. [PMID: 32377385 PMCID: PMC7199128 DOI: 10.15420/cfr.2019.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/11/2019] [Indexed: 12/24/2022] Open
Abstract
Telemonitoring (TM) aims to predict and prevent worsening heart failure (HF) episodes and improve self-care, patient education, treatment adherence and survival. There is a growing number of TM options for patients with HF, but there are numerous challenges in reaching positive outcomes. Conflicting evidence from clinical trials may be the result of the enormous heterogeneity of TM devices tested, differences in selected patient populations and variabilities between healthcare systems. This article covers some basic concepts of TM, looking at the recent advances in the most frequently used types of TM and the evidence to support its use in the care of people with HF.
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Affiliation(s)
- Ivo Planinc
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Centre Zagreb Zagreb, Croatia
| | - Davor Milicic
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Centre Zagreb Zagreb, Croatia
| | - Maja Cikes
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Centre Zagreb Zagreb, Croatia
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28
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Jung M, Kim JS, Song JH, Kim JM, Park KY, Lee WS, Kim SW, Lip GYH, Shin SY. Usefulness of P Wave Duration in Embolic Stroke of Undetermined Source. J Clin Med 2020; 9:jcm9041134. [PMID: 32326500 PMCID: PMC7230630 DOI: 10.3390/jcm9041134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022] Open
Abstract
The investigation of the potential association between ischemic stroke and subclinical atrial fibrillation (SCAF) is important for secondary prevention. We aimed to determine whether SCAF can be predicted by atrial substrate measurement with P wave signal-averaged electrocardiography (SAECG). We recruited 125 consecutive patients with embolic stroke of undetermined source (ESUS) and 125 patients with paroxysmal atrial fibrillation as controls. All participants underwent P wave SAECG at baseline, and patients with ESUS were followed up with Holter monitoring and electrocardiography at baseline, 3, 6, and 12 months after discharge and every 6 months thereafter. In the ESUS group, 32 (25.6%) patients were diagnosed with SCAF during follow-up. There were no significant differences between the groups regarding atrial substrate. P wave duration (PWD) was a significant predictor of SCAF. Stroke recurrence occurred in 22 patients (17.6%), and prolonged PWD (≥ 135 ms) predicted stroke recurrence more robustly than SCAF detection. In ESUS patients, PWD can be a useful biomarker to predict SCAF and to identify patients who are more likely to have a recurrent embolic stroke associated with an atrial cardiopathy. Further research is needed for supporting the utility and applicability of PWD.
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Affiliation(s)
- Moonki Jung
- Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Chung-Ang University, Seoul 06973, Korea; (M.J.); (J.H.S.); (W.-S.L.); (S.W.K.)
| | - Jin-Seok Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do 15355, Korea;
| | - Ju Hyeon Song
- Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Chung-Ang University, Seoul 06973, Korea; (M.J.); (J.H.S.); (W.-S.L.); (S.W.K.)
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University, Seoul 06973, Korea; (J.-M.K.); (K.-Y.P.)
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University, Seoul 06973, Korea; (J.-M.K.); (K.-Y.P.)
| | - Wang-Soo Lee
- Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Chung-Ang University, Seoul 06973, Korea; (M.J.); (J.H.S.); (W.-S.L.); (S.W.K.)
| | - Sang Wook Kim
- Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Chung-Ang University, Seoul 06973, Korea; (M.J.); (J.H.S.); (W.-S.L.); (S.W.K.)
| | - Gregory YH Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L69 3BX, UK
- Correspondence: (G.Y.H.L.); or (S.Y.S.); Tel.: +82-2-6299-2871 (S.Y.S.); Fax: +82-2-823-0160 (S.Y.S.)
| | - Seung Yong Shin
- Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Chung-Ang University, Seoul 06973, Korea; (M.J.); (J.H.S.); (W.-S.L.); (S.W.K.)
- Correspondence: (G.Y.H.L.); or (S.Y.S.); Tel.: +82-2-6299-2871 (S.Y.S.); Fax: +82-2-823-0160 (S.Y.S.)
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29
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miR-21 and NT-proBNP Correlate with Echocardiographic Parameters of Atrial Dysfunction and Predict Atrial Fibrillation. J Clin Med 2020; 9:jcm9041118. [PMID: 32295105 PMCID: PMC7230176 DOI: 10.3390/jcm9041118] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 12/21/2022] Open
Abstract
This study aimed to investigate the association of circulating biomarkers with echocardiographic parameters of atrial remodelling and their potential for predicting atrial fibrillation (AF). In patients with and without AF (n = 21 and n = 60) the following serum biomarkers were determined: soluble ST2 (sST2), Galectin-3 (Gal-3), N-terminal pro-brain natriuretic peptide (NT-proBNP), microRNA (miR)-21, -29a, -133a, -146b and -328. Comprehensive transthoracic echocardiography was performed in all participants. Biomarkers were significantly altered in patients with AF. The echocardiographic parameter septal PA-TDI, indicating left atrial (LA) remodelling, correlated with concentrations of sST2 (r = 0.249, p = 0.048), miR-21 (r = -0.277, p = 0.012), miR-29a (r = -0.269, p = 0.015), miR-146b (r = -0.319, p = 0.004) and miR-328 (r = -0.296, p = 0.008). In particular, NT-proBNP showed a strong correlation with echocardiographic markers of LA remodelling and dysfunction (septal PA-TDI: r = 0.444, p < 0.001, LAVI/a': r = 0.457, p = 0.001, SRa: r = 0.581, p < 0.001). Multivariate Cox regressions analysis highlighted miR-21 and NT-proBNP as predictive markers for AF (miR-21: hazard ratio (HR) 0.16; 95% confidence interval (CI) 0.04-0.7, p = 0.009; NT-proBNP: HR 1.002 95%CI 1.001-1.004, p = 0.006). Combination of NT-proBNP and miR-21 had the best accuracy to discriminate patients with AF from those without AF (area under the curve (AUC)= 0.843). Our findings indicate that miR-21 and NT-proBNP correlate with echocardiographic parameters of atrial remodeling and predict AF, in particular if combined.
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30
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Modulation of SERCA in Patients with Persistent Atrial Fibrillation Treated by Epicardial Thoracoscopic Ablation: The CAMAF Study. J Clin Med 2020; 9:jcm9020544. [PMID: 32079238 PMCID: PMC7074346 DOI: 10.3390/jcm9020544] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To evaluate atrial fibrillation (AF) recurrence and Sarcoplasmic Endoplasmic Reticulum Calcium ATPase (SERCA) levels in patients treated by epicardial thoracoscopic ablation for persistent AF. BACKGROUND Reduced levels of SERCA have been reported in the peripheral blood cells of patients with AF. We hypothesize that SERCA levels can predict the response to epicardial ablation. METHODS We designed a prospective, multicenter, observational study to recruit, from October 2014 to June 2016, patients with persistent AF receiving an epicardial thoracoscopic pulmonary vein isolation. RESULTS We enrolled 27 patients. Responders (n = 15) did not present AF recurrence after epicardial ablation at one-year follow-up; these patients displayed a marked remodeling of the left atrium, with a significant reduction of inflammatory cytokines, B type natriuretic peptide (BNP), and increased levels of SERCA compared to baseline and to nonresponders (p < 0.05). Furthermore, mean AF duration (Heart rate (HR) 1.235 (1.037-1.471), p < 0.05), Left atrium volume (LAV) (HR 1.755 (1.126-2.738), p < 0.05), BNP (HR 1.945 (1.895-1.999), p < 0.05), and SERCA (HR 1.763 (1.167-2.663), p < 0.05) were predictive of AF recurrence. CONCLUSIONS Our data indicate for the first time that baseline values of SERCA in patients with persistent AF might be predictive of failure to epicardial ablative approach. Intriguingly, epicardial ablation was associated with increased levels of SERCA in responders. Therefore, SERCA might be an innovative therapeutic target to improve the response to epicardial ablative treatments.
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31
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Predieri B, Leo F, Candia F, Lucaccioni L, Madeo SF, Pugliese M, Vivaccia V, Bruzzi P, Iughetti L. Glycemic Control Improvement in Italian Children and Adolescents With Type 1 Diabetes Followed Through Telemedicine During Lockdown Due to the COVID-19 Pandemic. Front Endocrinol (Lausanne) 2020; 11:595735. [PMID: 33424771 PMCID: PMC7793913 DOI: 10.3389/fendo.2020.595735] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/11/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND/OBJECTIVE To minimize the wide spread of coronavirus disease (COVID-19) pandemic, Italy was placed in an almost complete lockdown state that forced people to "stay at home". Aim of this study was to evaluate the effects of lockdown on glycemic control in children and adolescents with type 1 diabetes (T1D) followed through telemedicine. SUBJECTS/METHODS This observational study involved patients with T1D using the real-time continuous glucose monitoring (CGM) Dexcom G6®. Ambulatory glucose profile data from the 3-months before schools closure (November 26, 2019-February 23, 2020; T0) and from the 3-months of consecutive lockdown (February 24-May 18, 2020; T1) were compared. RESULTS Sixty-two children and adolescents (11.1 ± 4.37 years, 50% males) with T1D (median time disease 3.67 years) were enrolled in the study. Insulin total daily dose was unchanged, while time spent on physical activities was decreased (p<0.0001). Despite the lack of statistical significance, median value of the glucose management indicator decreased from 7.4% to 7.25%. Glucose standard deviation (p<0.0001) and coefficient of variation (p=0.001) improved across the study. Median time in range increased from 60.5% to 63.5% (p=0.008), time above range decreased from 37.3% to 34.1% (p=0.048), and time below range decreased from 1.85% to 1.45% (p=0.001). CONCLUSIONS Overall, in our children and adolescents with T1D glycemic control improved during lockdown. Despite patients were confined to their homes and limited to exercise, our data suggest that the use of real-time CGM, the continuous parental management, and the telemedicine can display beneficial effects on T1D care.
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Affiliation(s)
- Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
- *Correspondence: Barbara Predieri,
| | - Francesco Leo
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Candia
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Lucaccioni
- Pediatric Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Policlinic, Modena, Italy
| | - Simona F. Madeo
- Pediatric Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Policlinic, Modena, Italy
| | - Marisa Pugliese
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Vivaccia
- Department of Metabolic Diseases and Clinical Nutrition, Azienda Ospedaliero-Universitaria Policlinic, Modena, Italy
| | - Patrizia Bruzzi
- Pediatric Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Policlinic, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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Li F, Tu X, Li D, Jiang Y, Cheng Y, Jia Y, Zhang X, Fu H, Hu H, Jiang J, Zeng R. Is ablation to atrial fibrillation termination of persistent atrial fibrillation the end point?: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18045. [PMID: 31764827 PMCID: PMC6882606 DOI: 10.1097/md.0000000000018045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The ideal ablation strategy and end point for persistent atrial fibrillation (AF) have not been well founded. Defining periprocedural AF termination as the end point of catheter ablation is still controversial. This meta-analysis aimed to analyze the differences between periprocedural AF termination and non-termination in the long-term AF recurrence rate and postoperative complications. METHODS Randomized controlled trials (RCTs) were identified by a systematic search of electronic databases including PubMed, EMBASE, and Cochrane library from January 2008 to August 2019. The primary outcome was freedom from AF or any atrial arrhythmia without antiarrhythmic drugs at the long-term (≥12 months) follow-up. The secondary outcome was overall postoperative complication rates. The risk ratio (RR) with 95% confidence interval (CI) was pooled for these outcomes. A forest plot, fixed-effects model or random-effect model, Q test, I statistic, and Egger funnel plot were used in the statistical analysis. RESULTS Fourteen RCTs were included in this meta-analysis. Overall, no significant difference was found in freedom from AF at the long-term follow-up between patients in whom AF termination was achieved and not achieved (RR = 0.93, 95% CI = 0.78-1.09, P = .36, I = 69%). Patients with AF non-termination had a lower complication occurrence rate than those with AF termination (RR = 1.74, 95% CI = 1.11-2.73, P = .02, I = 0%). CONCLUSION Our meta-analysis suggests that AF termination is not a reliable procedural end point during ablation of persistent AF.
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Affiliation(s)
| | | | - Dongze Li
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Department of Cardiology, West China Hospital
- Disaster Medical Center, Sichuan University, Chengdu, Sichuan, PR China
| | | | | | - Yu Jia
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Department of Cardiology, West China Hospital
- Disaster Medical Center, Sichuan University, Chengdu, Sichuan, PR China
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[Position paper telemonitoring : From the Nucleus Members of the AG33 Telemonitoring of the DGK and associated members]. Herzschrittmacherther Elektrophysiol 2019; 30:287-297. [PMID: 31278607 DOI: 10.1007/s00399-019-0630-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The position paper of the working group 33/Telemonitoring in the German Society for Cardiology e. V. (DGK) discusses the importance of digital solutions in the German health care system and highlights the application possibilities and potentials of telemonitoring in the treatment of patients with cardiac diseases. In addition to telemonitoring of acute ischaemic diseases, acute coronary syndrome and acute cardiac arrhythmias, telemonitoring of chronic cardiac diseases is discussed. Chronic diseases, such as chronic heart failure, are age-associated and present society with the great challenge of providing high-quality, yet cost-efficient care to an increasing number of patients in the future. Telemonitoring offers an opportunity to meet this challenge. However, the introduction of telemonitoring and the associated changes for patients, doctors and other service providers must be accompanied by measures to ensure the acceptance of telemonitoring and the secure handling of sensitive data as well as the quality of telemonitoring services.
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Effects of Telemonitoring and Hemodynamic Monitoring on Mortality in Heart Failure: a Systematic Review and Meta-analysis. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40138-019-00181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tulppo MP, Kiviniemi AM, Junttila MJ, Huikuri HV. Home Monitoring of Heart Rate as a Predictor of Imminent Cardiovascular Events. Front Physiol 2019; 10:341. [PMID: 30971957 PMCID: PMC6445883 DOI: 10.3389/fphys.2019.00341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/13/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction: Previous studies have documented that day-to-day variability of heart rate (HR) has prognostic significance for cardiovascular (CV) events in general population. It is unknown how HR dynamics variate before imminent CV event in patients with coronary artery disease (CAD). Our aim was to study day-to-day variation in HR dynamics before the occurrence of CV event in patients with initially stable CAD. Methods: Forty-four patients with angiographically documented CAD from ARTEMIS study measured R-R intervals on a weekly basis at home for 2 years. Home measurements were performed in controlled conditions (3 min at supine and sitting) 1–2 times per week. Eleven patients had a CV event (7 acute coronary syndromes, 1 cardiac death, 2 new onset of arrhythmia needing hospitalization and 1 stroke), which occurred 11 ± 7 months after enrolment. Mean R-R interval was analyzed prospectively from the home measurements. For the patients with new CV event, average, and standard deviation (SD) of the mean R-R interval over 8 weeks preceding the CV event were calculated. For the patients without new CV event, corresponding period was determined by the median follow-up at the occurrence of new CV event. Results: There were no differences in the mean R-R interval analyzed over 8 weeks between the patients with and without new CV event. The variability of mean R-R interval over 8 weeks was greater in the patients with new CV event compared to the patients without new CV event at the supine (95 ± 34 vs. 59 ± 26 ms, p < 0.001) and sitting positions (92 ± 28 vs. 62 ± 24 ms, p < 0.001). Conclusion: Day-to-day variability of mean R-R interval is greater before the new CV event in CAD patients suggesting to a more unstable cardiac autonomic regulation preceding these events.
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Affiliation(s)
- Mikko P Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
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Tose Costa Paiva B, Fischer TH, Brachmann J, Busch S. Catheter ablation of atrial fibrillation-A key role in heart failure therapy? Clin Cardiol 2019; 42:400-405. [PMID: 30652321 PMCID: PMC6712384 DOI: 10.1002/clc.23150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/22/2018] [Accepted: 01/03/2019] [Indexed: 12/20/2022] Open
Abstract
Atrial fibrillation (AF) and heart failure (HF) are epidemic cardiac diseases and are often detected in the same patient. Recent evidence suggests that this is not a mere coincidence but that the strategy of AF treatment may impact HF development. This review comprehensively summarizes current trial data on rhythm and rate control strategies in atrial fibrillation with a special focus on catheter ablation of AF in HF patients. For a long time, rate and rhythm control strategies for AF have been regarded as equal regarding long term mortality. Decision making has been based on the symptoms of patients. Current trials, however, show that the treatment strategy of AF and its effectiveness may significantly impact survival of HF patients. The benefits of rhythm control in HF patients may have been masked by side effects of antiarrhythmic drugs. If rhythm control, however, is achieved by catheter ablation, a reduction of HF related mortality can be observed. As catheter ablation of AF may reduce mortality in HF patients, AF ablation should be preferred over medical treatment in HF patients. In general, HF patients may profit most from rigorous AF treatment.
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Affiliation(s)
| | - Thomas H Fischer
- II. Medizinische Klinik, Kardiologie, Angiologie, Pneumologie, Klinikum Coburg, Coburg, Germany
| | - Johannes Brachmann
- II. Medizinische Klinik, Kardiologie, Angiologie, Pneumologie, Klinikum Coburg, Coburg, Germany
| | - Sonia Busch
- II. Medizinische Klinik, Kardiologie, Angiologie, Pneumologie, Klinikum Coburg, Coburg, Germany
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Wang Z, Wang Y, Lin H, Wang S, Cai X, Gao D. Early characteristics of fulminant myocarditis vs non-fulminant myocarditis: A meta-analysis. Medicine (Baltimore) 2019; 98:e14697. [PMID: 30813218 PMCID: PMC6408109 DOI: 10.1097/md.0000000000014697] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/19/2019] [Accepted: 01/31/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Fulminant myocarditis (FM) is a sub-category myocarditis. Its primary characteristic is a rapidly progressive clinical course that necessitates hemodynamic support. FM can be difficult to predict at the onset of myocarditis. The aim of this meta-analysis was to identify the early characteristics in FM compared to those of non-fulminant myocarditis (NFM). METHODS We searched the databases of MEDLINE, EMBASE, CENTRAL, for studies comparing FM with acute NFM from January 1, 2000 to June 1, 2018. The baseline variables were compared in each study. Mean differences (MD) and relative ratios (RR) were calculated. RESULTS Seven studies (158 FM patients and 388 NFM patients) were included in the analysis. The FM group had significantly lower systolic blood pressure (SBP), higher creatine kinase (CK), wider QRS duration, lower left ventricular ejection fraction (LVEF), thicker left ventricular posterior wall diameter (LVPWd), higher incidence of ST depression, ventricular tachycardia/ventricular fibrillation (Vt/Vf) and syncope, less incidence of chest pain than the NFM groups. There was no difference in terms of heart rate (HR), c-reactive protein (CRP), fever, dyspnea, white blood cells (WBC), atrioventricular block (AVB), Q waves, ST elevation, interventricular septum diameter (IVSd), or end-diastolic left ventricular diameter (LVEDd) between FM and NFM. CONCLUSION We found that the lower SBP, higher CK, wider QRS duration, lower LVEF, thicker LVPWd, higher incidence of ST depression, Vt/Vf and syncope as well as lower incidence of chest pain were early characteristics of FM.
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Affiliation(s)
| | | | | | | | - Xianlei Cai
- Department of General surgery, Ningbo Medical Center Lihuili Hospital, Zhejiang, China
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Albarado-Ibañez A, Arroyo-Carmona RE, Sánchez-Hernández R, Ramos-Ortiz G, Frank A, García-Gudiño D, Torres-Jácome J. The Role of the Autonomic Nervous System on Cardiac Rhythm during the Evolution of Diabetes Mellitus Using Heart Rate Variability as a Biomarker. J Diabetes Res 2019; 2019:5157024. [PMID: 31211146 PMCID: PMC6532312 DOI: 10.1155/2019/5157024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/29/2018] [Accepted: 02/11/2019] [Indexed: 11/17/2022] Open
Abstract
Heart rate variability (HRV) is highly influenced by the Autonomic Nervous System (ANS). Several illnesses have been associated with changes in the ANS, thus altering the pattern of HRV. However, the variability of the heart rhythm is originated within the Sinus Atrial Node (SAN) which has its own variability. Still, although both oscillators produce HRV, the influence of the SAN on HRV has not yet been exhaustively studied. On the other hand, the complications of diabetes mellitus (DM), for instance, nephropathy, retinopathy, and neuropathy, increase cardiovascular morbidity and mortality. Traditionally, these complications are diagnosed only when the patient is already suffering from the negative symptoms these complications implicate. Consequently, it is of paramount importance to develop new techniques for early diagnosis prior to any deterioration on healthy patients. HRV has been proved to be a valuable, noninvasive clinical evidence for evaluating diseases and even for describing aging and behavior. In this study, several ECGs were recorded and their RR and PP intervals were analyzed to detect the interpotential interval (ii) of the SAN. Additionally, HRV reduction was quantified to identify alterations in the nervous system within the nodal tissue via measuring the SD1/SD2 ratio in a Poincaré plot. With 15 years of DM development, the data showed an age-dependent increase in HRV due to the axon retraction of ANS neurons from its effectors. In addition, these alterations modify the heart rhythm-producing fatal arrhythmias. Therefore, it is possible to avoid the consequences of DM identifying alterations in SAN previous to its symptomatic appearance. This could be used as an early diagnosis indicator.
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Affiliation(s)
- Alondra Albarado-Ibañez
- Universidad Nacional Autónoma de México, Centro de las Ciencias de la Complejidad, Circuito Mario de la Cueva 20, Insurgentes Sur, Delegación Coyoacán, C.P. 04510 Cd. de México, Mexico
- Benemérita Universidad Autónoma de Puebla, Instituto de Fisiología, 14 Sur 6301, Colonia Jardines de San Manuel, C.P. 72570 Puebla, Pue., Mexico
| | - Rosa Elena Arroyo-Carmona
- Benemérita Universidad Autónoma de Puebla, Facultad de Ciencias Químicas, 18 sur y avenida San Claudio colonia Jardines de San Manuel, C.P. 72570 Puebla, Pue., Mexico
| | - Rommel Sánchez-Hernández
- Benemérita Universidad Autónoma de Puebla, Instituto de Fisiología, 14 Sur 6301, Colonia Jardines de San Manuel, C.P. 72570 Puebla, Pue., Mexico
| | - Geovanni Ramos-Ortiz
- Universidad de Puebla, Escuela de Ciencias Químicas, Colonia Guadalupe Hidalgo, Puebla, Pue., Mexico
| | - Alejandro Frank
- Universidad Nacional Autónoma de México, Centro de las Ciencias de la Complejidad, Circuito Mario de la Cueva 20, Insurgentes Sur, Delegación Coyoacán, C.P. 04510 Cd. de México, Mexico
| | - David García-Gudiño
- Universidad Nacional Autónoma de México, Centro de las Ciencias de la Complejidad, Circuito Mario de la Cueva 20, Insurgentes Sur, Delegación Coyoacán, C.P. 04510 Cd. de México, Mexico
| | - Julián Torres-Jácome
- Benemérita Universidad Autónoma de Puebla, Instituto de Fisiología, 14 Sur 6301, Colonia Jardines de San Manuel, C.P. 72570 Puebla, Pue., Mexico
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Kort RSS, Tuininga YS, Bosker HA, Janssen M, Tukkie R. Telemonitoring with an implantable loop recorder in outpatient heart failure care : One year follow-up report from a prospective observational Dutch multicentre study. Neth Heart J 2018; 27:46-51. [PMID: 30511332 PMCID: PMC6311161 DOI: 10.1007/s12471-018-1198-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction In the care of heart failure patients, telemonitoring is receiving growing attention. The main purpose of this study was to determine the effect of continuous telemonitoring with an implantable loop recorder (ILR, Reveal XT), a novel strategy in the management of stable heart failure patients without a cardiac implantable device. Furthermore, little is known about the incidence of subclinical arrhythmias in this specific group of patients. Materials and Methods Stable heart failure patients, New York Heart Association Class II and III, without recent hospitalisation or upcoming intervention, were included. After implantation of the ILR there was regular contact with the research nurse on a pre-specified basis. Clinic visits and telephonic interviews were alternated for a minimum of 1 year. Parallel visits to their treating physician continued according to standard care. The treating physician was blinded for the ILR findings, accept for pre-specified, significant arrhythmic events. Results Thirty patients were included and followed for a median duration of 12 months. In 13 patients, data from the loop recorder led to therapeutic changes. One patient received a pacemaker. Eight patients developed atrial fibrillation, all subclinical, with a mean burden of 65.8 ± 173.2 min/day. Conclusion The use of an ILR could potentially impact patient management. Additional study is needed in different patient populations (e. g. higher risk groups) to assess if an ILR could also impact on endpoints such as heart failure hospitalisation.
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Affiliation(s)
- R S S Kort
- Department of Cardiology, Spaarne Gasthuis, Haarlem, The Netherlands.
| | - Y S Tuininga
- Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
| | - H A Bosker
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - M Janssen
- Department of Cardiology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - R Tukkie
- Department of Cardiology, Spaarne Gasthuis, Haarlem, The Netherlands
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Bjerre J, Rosenkranz SH, Christensen AM, Schou M, Jøns C, Gislason G, Ruwald AC. Driving following defibrillator implantation: development and pilot results from a nationwide questionnaire. BMC Cardiovasc Disord 2018; 18:212. [PMID: 30458722 PMCID: PMC6245910 DOI: 10.1186/s12872-018-0949-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implantable cardioverter defibrillator (ICD) implantation is associated with driving restrictions which may have profound effects on the patient's life. However, there is limited patient-reported data on the information given about driving restrictions, the adherence to the restrictions, the incidence of arrhythmic symptoms while driving, and the driving restrictions' effect on ICD patients' daily life and quality of life factors. A specific questionnaire was designed to investigate these objectives, intended for use in a nationwide ICD cohort. METHODS The conceptual framework based on literature review and expert opinion was refined in qualitative semi-structured focus group interviews with ten ICD patients. Content validity was pursued through pre-testing, including expert review and 28 cognitive interviews with patients at all ICD implanting centres in Denmark. Finally, the Danish Pacemaker and ICD registry was used to randomly select 50 ICD patients with a first-time implantation between January 1, 2013 and November 30, 2016 for pilot testing, followed by a test-retest on 25 respondents. Test-retest agreement was assessed using kappa statistics or intraclass correlation coefficients. RESULTS The pilot test achieved a response rate of 78%, whereof the majority were web-based (69%). Only 49% stated they had been informed about any driving restrictions after ICD implantation, whereas the number was 75% after appropriate ICD shock. Among respondents, 95% had resumed private driving, ranging from 1 to 90 days after ICD implantation. In those informed of a significant (≥ 1 month) driving ban, 55% stated the driving restrictions had impeded with daily life, especially due to limitations in maintaining employment or getting to/from work and 25% admitted they had knowingly been driving during the restricted period. There were six episodes of dizziness or palpitations not necessitating stopping the vehicle. Test-retest demonstrated good agreement of questionnaire items, with 69% of Kappa coefficients above 0.60. CONCLUSIONS We have developed a comprehensive questionnaire on ICD patients' perspective on driving. Pre-testing and pilot testing demonstrated good content validity, feasible data collection methods, and a robust response rate. Thus, we believe the final questionnaire, distributed to almost 4000 ICD patients, will capture essential evidence to help inform driving guidelines in this population.
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Affiliation(s)
- Jenny Bjerre
- Department of Cardiology, Cardiovascular Research, Copenhagen University Hospital Herlev-Gentofte, Kildegaardsvej 28, 2900, Hellerup, Denmark.
| | - Simone Hofman Rosenkranz
- Research and Test Center for Health Technologies, Copenhagen University Hospital, Rigshospitalet-Glostrup, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark
| | - Anne Mielke Christensen
- Department of Cardiology, Cardiovascular Research, Copenhagen University Hospital Herlev-Gentofte, Kildegaardsvej 28, 2900, Hellerup, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet-Glostrup, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Christian Jøns
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet-Glostrup, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Cardiovascular Research, Copenhagen University Hospital Herlev-Gentofte, Kildegaardsvej 28, 2900, Hellerup, Denmark
| | - Anne-Christine Ruwald
- Department of Cardiology, Cardiovascular Research, Copenhagen University Hospital Herlev-Gentofte, Kildegaardsvej 28, 2900, Hellerup, Denmark.,Department of Medicine, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark
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Borghetti G, von Lewinski D, Eaton DM, Sourij H, Houser SR, Wallner M. Diabetic Cardiomyopathy: Current and Future Therapies. Beyond Glycemic Control. Front Physiol 2018; 9:1514. [PMID: 30425649 PMCID: PMC6218509 DOI: 10.3389/fphys.2018.01514] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/09/2018] [Indexed: 12/14/2022] Open
Abstract
Diabetes mellitus and the associated complications represent a global burden on human health and economics. Cardiovascular diseases are the leading cause of death in diabetic patients, who have a 2–5 times higher risk of developing heart failure than age-matched non-diabetic patients, independent of other comorbidities. Diabetic cardiomyopathy is defined as the presence of abnormal cardiac structure and performance in the absence of other cardiac risk factors, such coronary artery disease, hypertension, and significant valvular disease. Hyperglycemia, hyperinsulinemia, and insulin resistance mediate the pathological remodeling of the heart, characterized by left ventricle concentric hypertrophy and perivascular and interstitial fibrosis leading to diastolic dysfunction. A change in the metabolic status, impaired calcium homeostasis and energy production, increased inflammation and oxidative stress, as well as an accumulation of advanced glycation end products are among the mechanisms implicated in the pathogenesis of diabetic cardiomyopathy. Despite a growing interest in the pathophysiology of diabetic cardiomyopathy, there are no specific guidelines for diagnosing patients or structuring a treatment strategy in clinical practice. Anti-hyperglycemic drugs are crucial in the management of diabetes by effectively reducing microvascular complications, preventing renal failure, retinopathy, and nerve damage. Interestingly, several drugs currently in use can improve cardiac health beyond their ability to control glycemia. GLP-1 receptor agonists and sodium-glucose co-transporter 2 inhibitors have been shown to have a beneficial effect on the cardiovascular system through a direct effect on myocardium, beyond their ability to lower blood glucose levels. In recent years, great improvements have been made toward the possibility of modulating the expression of specific cardiac genes or non-coding RNAs in vivo for therapeutic purpose, opening up the possibility to regulate the expression of key players in the development/progression of diabetic cardiomyopathy. This review summarizes the pathogenesis of diabetic cardiomyopathy, with particular focus on structural and molecular abnormalities occurring during its progression, as well as both current and potential future therapies.
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Affiliation(s)
- Giulia Borghetti
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Dirk von Lewinski
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Deborah M Eaton
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Harald Sourij
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Steven R Houser
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Markus Wallner
- Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States.,Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Shao M, Shang L, Shi J, Zhao Y, Zhang W, Zhang L, Li Y, Tang B, Zhou X. The safety and efficacy of second-generation cryoballoon ablation plus catheter ablation for persistent atrial fibrillation: A systematic review and meta-analysis. PLoS One 2018; 13:e0206362. [PMID: 30359452 PMCID: PMC6201921 DOI: 10.1371/journal.pone.0206362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/11/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Growing evidence suggests that second-generation cryoballoon ablation (2G-CB) is effective in patients with persistent atrial fibrillation (PerAF). The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI). The purpose of this study was to summarize the available data on the safety and mid-term (≥ 12 months) effectiveness of a 'PVI-only' strategy vs. a 'PVI-plus' strategy using 2G-CB in patients with PerAF. METHODS We searched the PubMed, EMBASE and Cochrane library databases for studies on 2G-CB for PerAF. Group analysis was based on the ablation approach: 'PVI-only' versus 'PVI-plus', the latter of which involved PVI plus other substrate modifications. Studies showing clinical success rates at a follow-up (FU) of ≥ 12 months were included. Complication rates were also assessed. Data were analyzed by applying a fixed effects model. RESULTS A total of 879 patients from 5 studies were analyzed. After a mid-term FU of 27 months, the overall success rate of 2G-CB for PerAF was 66.1%. In the 'PVI-plus' group, the success rate was 73.8%. In the 'PVI-only' group, the success rate was 53.6%. No heterogeneity was noted among studies (I2 = 0.0%, P = 0.82). Complications occurred in 5.2% of patients (P = 0.93), and the rate of phrenic nerve (PN) injury was 2.8% (P = 0.14). Vascular assess complications were the most frequent at 1.6% (P = 0.33). No death or myocardial infarction was reported. CONCLUSION 'PVI-plus' involving 2G-CB seems to be safe and effective for treating PerAF.
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Affiliation(s)
- Mengjiao Shao
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Luxiang Shang
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jia Shi
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yang Zhao
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wenhui Zhang
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ling Zhang
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yaodong Li
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Baopeng Tang
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xianhui Zhou
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Remote Monitoring of Implantable Cardioverter-Defibrillators, Cardiac Resynchronization Therapy and Permanent Pacemakers: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2018; 18:1-199. [PMID: 30443279 PMCID: PMC6235077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Under usual care, people with an implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy with or without a defibrillator (CRT-D and CRT-P, respectively), or a permanent pacemaker have follow-up in-person clinic visits. Remote monitoring of these devices allows the transfer of the information stored in the device so that it can be accessed by the clinic personnel via a secured website. METHODS We completed a health technology assessment, which included an evaluation of clinical benefits and harms, value for money, and patient preferences for remote monitoring of ICDs, CRTs, and permanent pacemakers plus clinic visits compared with clinic visits alone. This is an update of a 2012 health technology assessment. In addition to the eligible randomized controlled trials (RCTs) from the 2012 publication, we included RCTs identified through a systematic literature search on June 1, 2017. We assessed the risk of bias of each study using the Cochrane risk of bias tool and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We conducted an economic evaluation to determine the cost-effectiveness of remote monitoring blended with in-clinic follow-up compared to in-clinic follow-up alone in patients with an ICD, a CRT-D, or a pacemaker. We determined the budget impact of blended remote monitoring in patients implanted with ICD, CRT-D, CRT-P, or pacemaker devices from the perspective of the Ontario Ministry of Health and Long-Term Care. To understand patient experiences with remote monitoring, we interviewed 16 patients and family members. RESULTS Based on 15 RCTs in patients with implanted ICDs or CRT-Ds, remote monitoring plus clinic visits resulted in fewer patients with inappropriate ICD shocks within 12 to 37 months of follow-up (moderate quality evidence; absolute risk difference -0.04 [95% confidence interval -0.07 to -0.01]), fewer total clinic visits (moderate quality evidence), and a shorter time to detection and treatment of events (moderate quality evidence) compared with clinic visits alone. There was a similar risk of major adverse events (moderate quality evidence).Based on 6 RCTs in patients with pacemakers, remote monitoring plus clinic visits reduced the arrhythmia burden (high quality evidence), the time to detection and treatment of arrhythmias (high quality evidence), and the number of clinic visits (moderate quality evidence]) compared with clinic visits alone. Here again, there was a similar risk of major adverse events (high quality evidence).Results from the economic evaluation showed that among ICD and CRT-D recipients, blended remote monitoring (remote monitoring plus in-clinic follow ups) was more costly (incremental value of $4,354 per person) and more effective, providing higher quality-adjusted life years (incremental value of 0.19), compared to in-clinic follow-up alone. Among pacemaker recipients, blended remote monitoring was less costly (with an incremental saving of $2,370 per person) and more effective (with an incremental value of 0.12 quality-adjusted life years) than with in-clinic follow-up alone. We estimated that publicly funding remote monitoring could result in cost savings of $14 million over the first five years.Participants using remote monitoring reported that these devices provide important medical and safety benefits in managing their heart condition. Remote cardiac monitoring provides patients and their family members with an increased freedom. Their belief that the device will help with earlier detection of technical or clinical problems reduces the amount of stress and distraction their condition causes in their lives. CONCLUSIONS Remote monitoring of ICDs, CRT-Ds, and pacemakers plus clinic visits resulted in improved outcomes without increasing the risk of major adverse events compared with clinic visits alone. Remote monitoring is a cost-effective option for patients implanted with cardiac electronic devices. Patients reported positive experiences using remote monitoring, and perceived that the device provided important medical and safety benefits.
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Sardu C, Paolisso P, Sacra C, Santamaria M, de Lucia C, Ruocco A, Mauro C, Paolisso G, Rizzo MR, Barbieri M, Marfella R. Cardiac resynchronization therapy with a defibrillator (CRTd) in failing heart patients with type 2 diabetes mellitus and treated by glucagon-like peptide 1 receptor agonists (GLP-1 RA) therapy vs. conventional hypoglycemic drugs: arrhythmic burden, hospitalizations for heart failure, and CRTd responders rate. Cardiovasc Diabetol 2018; 17:137. [PMID: 30348145 PMCID: PMC6196445 DOI: 10.1186/s12933-018-0778-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
Objectives To evaluate clinical outcomes in patients with diabetes, treated by cardiac resynchronization therapy with a defibrillator (CRT-d), and glucagon-like peptide 1 receptor agonists (GLP-1 RA) in addition to conventional hypoglycemic therapy vs. CRTd patients under conventional hypoglycemic drugs. Background Patients with diabetes treated by CRTd experienced an amelioration of functional New York Association Heart class, reduction of hospital admissions, and mortality, in a percentage about 60%. However, about 40% of CRTd patients with diabetes experience a worse prognosis. Materials and methods We investigated the 12-months prognosis of CRTd patients with diabetes, previously treated with hypoglycemic drugs therapy (n 271) vs. a matched cohort of CRTd patients with diabetes treated with GLP-1 RA in addition to conventional hypoglycemic therapy (n 288). Results At follow up CRTd patients with diabetes treated by GLP-1 RA therapy vs. CRTd patients with diabetes that did not receive GLP-1 RA therapy, experienced a significant reduction of NYHA class (p value < 0.05), associated to higher values of 6 min walking test (p value < 0.05), and higher rate of CRTd responders (p value < 0.05). GLP-1 RA patients vs. controls at follow up end experienced lower AF events (p value < 0.05), lower VT events (p value < 0.05), lower rate of hospitalization for heart failure worsening (p value < 0.05), and higher rate of CRTd responders (p value < 0.05). To date, GLP-1 RA therapy may predict a reduction of AF events (HR 0.603, CI [0.411–0.884]), VT events (HR 0.964, CI [0.963–0.992]), and hospitalization for heart failure worsening (HR 0.119, CI [0.028–0.508]), and a higher CRT responders rate (HR 3.707, CI [1.226–14.570]). Conclusions GLP-1 RA drugs in addition to conventional hypoglycemic therapy may significantly reduce systemic inflammation and circulating BNP levels in CRTd patients with diabetes, leading to a significant improvement of LVEF and of the 6 min walking test, and to a reduction of the arrhythmic burden. Consequently, GLP-1 RA drugs in addition to conventional hypoglycemic therapy may reduce hospital admissions for heart failure worsening, by increasing CRTd responders rate. Trial registration NCT03282136. Registered 9 December 2017 “retrospectively registered”
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Affiliation(s)
- Celestino Sardu
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy.
| | - Pasquale Paolisso
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Cosimo Sacra
- Cardiovascular and Arrhythmias Department, John Paul II Research and Care Foundation, Campobasso, Italy
| | - Matteo Santamaria
- Cardiovascular and Arrhythmias Department, John Paul II Research and Care Foundation, Campobasso, Italy
| | - Claudio de Lucia
- Center for Translational Medicine, Temple University, Philadelphia, USA
| | - Antonio Ruocco
- Cardiovascular Diseases Department, Cardarelli Hospital, Naples, Italy
| | - Ciro Mauro
- Cardiovascular Diseases Department, Cardarelli Hospital, Naples, Italy
| | - Giuseppe Paolisso
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Maria Rosaria Rizzo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Michelangela Barbieri
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Raffaele Marfella
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
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Mene-Afejuku TO, López PD, Akinlonu A, Dumancas C, Visco F, Mushiyev S, Pekler G. Atrial Fibrillation in Patients with Heart Failure: Current State and Future Directions. Am J Cardiovasc Drugs 2018; 18:347-360. [PMID: 29623658 DOI: 10.1007/s40256-018-0276-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Heart failure affects nearly 26 million people worldwide. Patients with heart failure are frequently affected with atrial fibrillation, and the interrelation between these pathologies is complex. Atrial fibrillation shares the same risk factors as heart failure. Moreover, it is associated with a higher-risk baseline clinical status and higher mortality rates in patients with heart failure. The mechanisms by which atrial fibrillation occurs in a failing heart are incompletely understood, but animal studies suggest they differ from those that occur in a healthy heart. Data suggest that heart failure-induced atrial fibrosis and atrial ionic remodeling are the underlying abnormalities that facilitate atrial fibrillation. Therapeutic considerations for atrial fibrillation in patients with heart failure include risk factor modification and guideline-directed medical therapy, anticoagulation, rate control, and rhythm control. As recommended for atrial fibrillation in the non-failing heart, anticoagulation in patients with heart failure should be guided by a careful estimation of the risk of embolic events versus the risk of hemorrhagic episodes. The decision whether to target a rate-control or rhythm-control strategy is an evolving aspect of management. Currently, both approaches are good medical practice, but recent data suggest that rhythm control, particularly when achieved through catheter ablation, is associated with improved outcomes. A promising field of research is the application of neurohormonal modulation to prevent the creation of the "structural substrate" for atrial fibrillation in the failing heart.
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Weidner K, Behnes M, Schupp T, Rusnak J, Reiser L, Bollow A, Taton G, Reichelt T, Ellguth D, Engelke N, Hoppner J, El-Battrawy I, Mashayekhi K, Weiß C, Borggrefe M, Akin I. Type 2 diabetes is independently associated with all-cause mortality secondary to ventricular tachyarrhythmias. Cardiovasc Diabetol 2018; 17:125. [PMID: 30200967 PMCID: PMC6130079 DOI: 10.1186/s12933-018-0768-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/25/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The study sought to assess the prognostic impact of type 2 diabetes in patients presenting with ventricular tachyarrhythmias on admission. BACKGROUND Data regarding the prognostic outcome of diabetics presenting with ventricular tachyarrhythmias is limited. METHODS A large retrospective registry was used including all consecutive patients presenting with ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016. Patients with type 2 diabetes (diabetics) were compared to non-diabetics applying multivariable Cox regression models and propensity-score matching for evaluation of the primary prognostic endpoint of long-term all-cause mortality at 2 years. Secondary prognostic endpoints were cardiac death at 24 h, in-hospital death at index, all-cause mortality at 30 days, all-cause mortality in patients surviving index hospitalization at 2 years (i.e. "after discharge") and rehospitalization due to recurrent ventricular tachyarrhythmias at 2 years. RESULTS In 2411 unmatched high-risk patients with ventricular tachyarrhythmias, diabetes was present in 25% compared to non-diabetics (75%). Rates of VT (57% vs. 56%) and VF (43% vs. 44%) were comparable in both groups. Multivariable Cox regression models revealed diabetics associated with the primary endpoint of long-term all-cause mortality at 2 years (HR = 1.513; p = 0.001), which was still proven after propensity score matching (46% vs. 33%, log rank p = 0.001; HR = 1.525; p = 0.001). The rates of secondary endpoints were higher for in-hospital death at index, all-cause mortality at 30 days, as well as after discharge, but not for cardiac death at 24 h or rehospitalization due to recurrent ventricular tachyarrhythmias. CONCLUSION Presence of type 2 diabetes is independently associated with an increase of all-cause mortality in patients presenting with ventricular tachyarrhythmias on admission.
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Affiliation(s)
- Kathrin Weidner
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Linda Reiser
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Armin Bollow
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Gabriel Taton
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Reichelt
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Dominik Ellguth
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Niko Engelke
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jorge Hoppner
- Department of Diagnostic and Interventional Radiology, University Heidelberg, Heidelberg, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany
| | - Christel Weiß
- Institute of Biomathematics and Medical Statistics, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany
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Sardu C, Marfella R, Santamaria M, Papini S, Parisi Q, Sacra C, Colaprete D, Paolisso G, Rizzo MR, Barbieri M. Stretch, Injury and Inflammation Markers Evaluation to Predict Clinical Outcomes After Implantable Cardioverter Defibrillator Therapy in Heart Failure Patients With Metabolic Syndrome. Front Physiol 2018; 9:758. [PMID: 29997521 PMCID: PMC6028698 DOI: 10.3389/fphys.2018.00758] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/30/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Internal cardioverter defibrillator (ICD) therapy reduced all-cause mortality. Conversely, few studies reported that ICDs' shocks may reduce survival. Recently authors suggested that, multiple inflammatory and molecular pathways were related to worse prognosis in metabolic syndrome (MS) patients treated by ICDs. Therefore, it may be relevant to find new biomarkers to predict ICDs' shock and worse prognosis in treated patients. Methods: In 99 MS vs. 107 no MS patients treated by ICD for primary prevention, we evaluated all-cause mortality, cardiac deaths, hospitalization for heart failure, appropriate and inappropriate therapy, and survival after appropriate ICD therapy. Results: MS vs. no MS patients had higher levels of failing heart stress biomarkers. The highest values of ST2 were related to worse prognosis. Patients who had better survival after appropriate ICD therapy were those associated with lowest ST2 values. At multivariate Cox regression analysis, C reactive protein (CRP) (0.110 [0.027-0.446], p-value 0.002), troponine I (TnI) protein (0.010 [0.001-0.051], p-value 0.010), and B type natriuretic peptide (BNP) (1.151 [1.010-1.510], p-value 0.001), predicted all cause of deaths. BNP predicted cardiac deaths (1.010 [1.001-1.206], p-value 0.033). MS, and BNP predicted hospitalization for heart failure events (2.902 [1.345-4.795], p-value 0.001; 1.005 [1.000-1.016], p-value 0.007). ST2 predicted appropriate therapy (1.012 [1.007-1.260], p-value 0.001), as BNP (1.005 [1.001-1.160], p-value 0.028), LVEF (1.902 [1.857-1.950], p-value 0.001), and CRP (1.833 [1.878-1.993], p-value 0.028). ST2, and BNP predicted survival after ICD appropriate therapy (4.297 [1.985-9.302], p-value 0.001; 1.210 [1.072-1.685], p-value 0.024). Conclusions: ST2 values may differentiate MS patients with a higher risk of ICDs' therapy, and worse prognosis. Therefore, ST2 protein may be used as valid monitoring biomarker, and as a predictive biomarker in failing heart ICDs' patients affected by MS.
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Affiliation(s)
- Celestino Sardu
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Raffaele Marfella
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Matteo Santamaria
- Department of Cardiovascular and Arrhythmias, John Paul II Research and Care Foundation, Campobasso, Italy
| | - Stefano Papini
- Department of Cardiovascular and Arrhythmias, John Paul II Research and Care Foundation, Campobasso, Italy
| | - Quintino Parisi
- Department of Cardiovascular and Arrhythmias, John Paul II Research and Care Foundation, Campobasso, Italy
| | - Cosimo Sacra
- Department of Cardiovascular and Arrhythmias, John Paul II Research and Care Foundation, Campobasso, Italy
| | - Daniele Colaprete
- Department of Cardiovascular and Arrhythmias, John Paul II Research and Care Foundation, Campobasso, Italy
| | - Giuseppe Paolisso
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Maria R. Rizzo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Michelangela Barbieri
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Zheng R, Tian G, Zhang Q, Wu L, Xing Y, Shang H. Clinical Safety and Efficacy of Wenxin Keli-Amiodarone Combination on Heart Failure Complicated by Ventricular Arrhythmia: A Systematic Review and Meta-analysis. Front Physiol 2018; 9:487. [PMID: 29875671 PMCID: PMC5974952 DOI: 10.3389/fphys.2018.00487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/17/2018] [Indexed: 02/05/2023] Open
Abstract
Objectives: To evaluate possible adverse effects and efficacy of Wenxin keli (WXKL)-amiodarone combination on heart failure complicated by ventricular arrhythmia. Methods: Nine electronic literature databases (the Cochrane Library, PubMed, EMBASE, IPA, AMED, CBM, CNKI, VIP, and WanFang) were searched up to February 2018. Two authors extracted data and assessed risk of bias of the included studies independently. Randomized controlled trials (RCTs) and quasi-RCTs about WXKL-amiodarone combination and amiodarone alone were eligible for comparison. Results: Thirteen trials involving 1,126 patients were included. Risk of bias was assessed as high in three studies and unclear in the remaining 10 studies. Six trials reported adverse events (AE). There was no obvious difference between WXKL-amiodarone combination group and amiodarone group in reported AEs (OR 0.64; 95%CI 0.39-1.07). The total effective rate of WXKL-amiodarone combination group was greater than that of amiodarone group (RR 1.22; 95%CI 1.16-1.29). The pooled results showed that the combination group was more effective in reducing heart rate (MD -2.25; 95%CI -2.61 to -1.88, P = 0.46, I2 = 0%), the frequency of ventricular premature complexes (MD -2.03; 95%CI -2.41 to -1.65) and QT dispersion (MD 5.59; 95%CI 3.60-7.58). Conclusion: The WXKL-amiodarone combination is safe and shows more protective effects on heart failure combined with ventricular arrhythmia compared with amiodarone alone. Further research is warranted, ideally involving large, prospective, rigorous trials, in order to confirm these findings.
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Affiliation(s)
- Rui Zheng
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Guihua Tian
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Chinese Cochrane Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qin Zhang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
| | - Lin Wu
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yanwei Xing
- Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute of Integration of Traditional Chinese and Western Medicine, Guangzhou Medical University, Guangzhou, China
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Li KHC, Dong M, Gong M, Bazoukis G, Lakhani I, Ting YY, Wong SH, Li G, Wu WKK, Vassiliou VS, Wong MCS, Letsas K, Du Y, Laxton V, Yan BP, Chan YS, Xia Y, Liu T, Tse G. Atrial Fibrillation Recurrence and Peri-Procedural Complication Rates in nMARQ vs. Conventional Ablation Techniques: A Systematic Review and Meta-Analysis. Front Physiol 2018; 9:544. [PMID: 29892228 PMCID: PMC5985711 DOI: 10.3389/fphys.2018.00544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/27/2018] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives: Atrial fibrillation is a common abnormal cardiac rhythm caused by disorganized electrical impulses. AF which is refractory to antiarrhythmic management is often treated with catheter ablation. Recently a novel ablation system (nMARQ) was introduced for PV isolation. However, there has not been a systematic review of its efficacy or safety compared to traditional ablation techniques. Therefore, we conducted this meta-analysis on the nMARQ ablation system. Methods: PubMed and EMBASE were searched up until 1st of September 2017 for articles on nMARQ. A total of 136 studies were found, and after screening, 12 studies were included in this meta-analysis. Results: Our meta-analysis shows that the use of nMARQ was associated with higher odds of AF non-recurrence (n = 1123, odds ratio = 6.79, 95% confidence interval 4.01–11.50; P < 0.05; I2 took a value of 83%). Moreover, the recurrence rate of AF using nMARQ was not significantly different from that of traditional ablation procedures (n = 158 vs. 196; OR = 0.97, 95% confidence interval:0.59–1.61). No significant difference in complication rates was observed between these groups (RR: 0.86; 95% CI: 0.37–1.99; P > 0.05). There were four reported mortalities in the nMARQ group compared to none in the conventional ablation group (relative risk: 1.58; 95% CI: 0.09–29.24; P > 0.05). Conclusions: AF recurrence rates are comparable between nMARQ and conventional ablation techniques. Although general complication rates are similar for both groups, the higher mortality with nMARQ suggests that conventional techniques should be used for resistant AF until improved safety profiles of nMARQ can be demonstrated.
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Affiliation(s)
- Ka H C Li
- Faculty of Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Mei Dong
- Department of Cardiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai City, China
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - George Bazoukis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Ishan Lakhani
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Yan Y Ting
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Sunny H Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Guangping Li
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Department of Cardiology, Shandong University Qilu Hospital, Jinan, China
| | - William K K Wu
- Department of Anaesthesia and Intensive Care, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Martin C S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Konstantinos Letsas
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yimei Du
- Research Center of Ion Channelopathy, Institute of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Victoria Laxton
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Bryan P Yan
- Faculty of Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yat S Chan
- Faculty of Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tong Liu
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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Song J, Lyu Y, Wang M, Zhang J, Gao L, Tong X. Treatment of Human Urinary Kallidinogenase Combined with Maixuekang Capsule Promotes Good Functional Outcome in Ischemic Stroke. Front Physiol 2018; 9:84. [PMID: 29487537 PMCID: PMC5816573 DOI: 10.3389/fphys.2018.00084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/24/2018] [Indexed: 12/20/2022] Open
Abstract
Aims: To evaluate the clinical efficacy of Human Urinary Kallidinogenase (HUK) and Maixuekang capsule in the treatment of acute ischemic stroke (AIS) patients. Methods: In this study, from January 2016 to July 2016, 60 patients with acute ischemic stroke were enrolled and 56 patients with complete information of whom 21 patients received HUK+ basic treatment (HUK group), 16 patients received HUK+ Maixuekang capsule + basic treatment (HUK+ Maixuekang group), 19 patients received basic treatment (control group). 0.15 PNA unit of HUK injection plus 100 ml saline in intravenous infusion was performed in the HUK group and HUK+ Maixuekang group, with once a day for 14 consecutive days. 0.75 g Maixuekang capsules were taken in HUK+ Maixuekang group, with three times a day for 14 consecutive days. The National Institutes of Health Stroke Scale (NIHSS) scores in three groups were analyzed 7 days after treatment. The modified Rankin Scale (mRS) scores in three groups were analyzed 12 month after the treatment. Results: No difference was found in the NIHSS scores, age, gender, and comorbidities between three groups before treatment (p > 0.05). Seven days after treatment, the NIHSS scores in the HUK group and HUK+ Maixuekang group were significantly decreased than before (p HUK = 0.001, p HUK+Maixuekang < 0.001), and lower than that in the control group (p HUK = 0.032; p HUK+Maixuekang < 0.001). Twelve months after treatment, good functional outcome rate (12 month mRS score ≤ 2) in the HUK group and HUK+ Maixuekang group was significantly higher than that in the control group (p HUK = 0.049, p HUK+Maixuekang = 0.032). Conclusion: The treatment of HUK or HUK combined with Maixuekang capsule can effectively improve the neurological function and promote long-term recovery for AIS patients.
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Affiliation(s)
- Juexian Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yi Lyu
- Department of Medical Affairs, Techpool Biopharma Co., Ltd., Guangzhou, China
| | - Miaomiao Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li Gao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaolin Tong
- Guang'anmen Hospital, China Academy of Chinese Medical Science, Beijing, China
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