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Tang N, Zhou Q, Liu S, Li K, Liu Z, Zhang Q, Sun H, Peng C, Hao J, Qi C. Development and trends in research on hypertension and atrial fibrillation: A bibliometric analysis from 2003 to 2022. Medicine (Baltimore) 2024; 103:e38264. [PMID: 38788040 PMCID: PMC11124767 DOI: 10.1097/md.0000000000038264] [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: 12/26/2023] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND This study aimed to comprehensively analyze research related to hypertension and atrial fibrillation, 2 common cardiovascular diseases with significant global public health implications, using bibliometric methods from 2003 to 2022. METHODS From the Web of Science Core Collection database, literature on the theme of hypertension and atrial fibrillation was retrieved. Subsequently, comprehensive bibliometric analyses were conducted across multiple dimensions utilizing software tools such as VOSviewer, Citespace, Pajek, Scimago Graphica, and ClusterProfiler. These analyses encompassed examinations of the literature according to country/region, institution, authors, journals, citation relationships, and keywords. RESULTS It revealed an increasing interest and shifting focus in research over the years. The analysis covered 7936 relevant publications, demonstrating a gradual rise in research activity regarding hypertension combined with atrial fibrillation over the past 2 decades, with a stable growth trend in research outcomes. Geographically, Europe and the Americas, particularly the United States, have shown the most active research in this field, while China has also gained importance in recent years. Regarding institutional contributions, internationally renowned institutions such as the University of Birmingham and the Mayo Clinic have emerged as core forces in this research direction. Additionally, Professor Lip Gregory, with his prolific research output, has stood out among numerous scholars. The American Journal of Cardiology has become a primary platform for publishing research related to hypertension and atrial fibrillation, highlighting its central role in advancing knowledge dissemination in this field. The research focus has shifted from exploring the pathophysiological mechanisms to investigating the treatment of complications and risk factors associated with hypertension and atrial fibrillation. Future research will focus on in-depth exploration of genetic and molecular mechanisms, causal relationship exploration through Mendelian randomization studies, and the application of machine learning techniques in prediction and treatment, aiming to promote the development of precision medicine for cardiovascular diseases. CONCLUSION In conclusion, this study provides a comprehensive overview of the developmental trajectory of research on hypertension and atrial fibrillation, presenting novel insights into trends and future research directions, thus offering information support and guidance for research in this crucial field of cardiovascular medicine.
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Affiliation(s)
- Nan Tang
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Qiang Zhou
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Shuang Liu
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Kangming Li
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhen Liu
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Qingdui Zhang
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Huamei Sun
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Cheng Peng
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ji Hao
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chunmei Qi
- Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Kamada H, Kawasoe S, Kubozono T, Ninomiya Y, Enokizono K, Yoshimoto I, Iriki Y, Ikeda Y, Miyata M, Miyahara H, Tokushige K, Ohishi M. Simple risk scoring using sinus rhythm electrocardiograms predicts the incidence of atrial fibrillation in the general population. Sci Rep 2024; 14:9628. [PMID: 38671212 PMCID: PMC11053076 DOI: 10.1038/s41598-024-60219-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Atrial fibrillation (AF) is an arrhythmic disease. Prediction of AF development in healthy individuals is important before serious complications occur. We aimed to develop a risk prediction score for future AF using participants' data, including electrocardiogram (ECG) measurements and information such as age and sex. We included 88,907 Japanese participants, aged 30-69 years, who were randomly assigned to derivation and validation cohorts in a ratio of 1:1. We performed multivariate logistic regression analysis and obtained the standardised beta coefficient of relevant factors and assigned scores to them. We created a score based on prognostic factors for AF to predict its occurrence after five years and applied it to validation cohorts to assess its reproducibility. The risk score ranged from 0 to 17, consisting of age, sex, PR prolongation, QT corrected for heart rate prolongation, left ventricular hypertrophy, premature atrial contraction, and left axis deviation. The area under the curve was 0.75 for the derivation cohort and 0.73 for the validation cohort. The incidence of new-onset AF reached over 2% at 10 points of the risk score in both cohorts. Thus, in this study, we showed the possibility of predicting new-onset AF using ECG findings and simple information.
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Affiliation(s)
- Hiroyuki Kamada
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shin Kawasoe
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
| | - Yuichi Ninomiya
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Kei Enokizono
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Issei Yoshimoto
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yasuhisa Iriki
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Masaaki Miyata
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | | | | | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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3
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Wu J, Nadarajah R. The growing burden of atrial fibrillation and its consequences. BMJ 2024; 385:q826. [PMID: 38631724 DOI: 10.1136/bmj.q826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Jianhua Wu
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Ramesh Nadarajah
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Kostopoulos G, Effraimidis G. Epidemiology, prognosis, and challenges in the management of hyperthyroidism-related atrial fibrillation. Eur Thyroid J 2024; 13:e230254. [PMID: 38377675 PMCID: PMC11046323 DOI: 10.1530/etj-23-0254] [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: 12/04/2023] [Accepted: 02/20/2024] [Indexed: 02/22/2024] Open
Abstract
Atrial fibrillation (AF) is a common condition with a global estimated prevalence of 60 million cases, and the most common cardiac complication of hyperthyroidism, occurring in 5-15% of overtly hyperthyroid patients. Additionally, subclinical hyperthyroidism and high-normal free T4 have been associated with an increased risk in the development of AF. Hyperthyroidism-related AF is a reversible cause of AF, and the majority of patients spontaneously revert to sinus rhythm in 4-6 months during or after restoration of euthyroidism. Therefore, restoring thyroid function is an indispensable element in hyperthyroidism-related AF management. Rate control with beta-blockers consists another first-line therapy, reserving rhythm control in cases of persistent hyperthyroidism-related AF. It is still controversial whether hyperthyroidism is an independent risk factor of stroke in nonvalvular AF. As a result, initiating anticoagulation should be guided by the clinical thromboembolic risk score CHA2DS2-VASc score in the same way it is applied in patients with non-hyperthyroidism-related AF. Treatment with the novel direct oral anticoagulants appears to be as beneficial and may be safer than warfarin in patients with hyperthyroidism-related AF. In this review, we address the epidemiology, prognosis, and diagnosis of hyperthyroidism-related AF, and we discuss the management strategies and controversies in patients with hyperthyroidism-related AF.
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Affiliation(s)
- Georgios Kostopoulos
- Department of Endocrinology and Metabolism, Ippokratio General Hospital of Thessaloniki, Greece
| | - Grigoris Effraimidis
- Department of Endocrinology and Metabolic Diseases, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Nadarajah R, Wu J, Arbel R, Haim M, Zahger D, Benita TR, Rokach L, Cowan JC, Gale CP. Risk of atrial fibrillation and association with other diseases: protocol of the derivation and international external validation of a prediction model using nationwide population-based electronic health records. BMJ Open 2023; 13:e075196. [PMID: 38070890 PMCID: PMC10729260 DOI: 10.1136/bmjopen-2023-075196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/04/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is a major public health issue and there is rationale for the early diagnosis of AF before the first complication occurs. Previous AF screening research is limited by low yields of new cases and strokes prevented in the screened populations. For AF screening to be clinically and cost-effective, the efficiency of identification of newly diagnosed AF needs to be improved and the intervention offered may have to extend beyond oral anticoagulation for stroke prophylaxis. Previous prediction models for incident AF have been limited by their data sources and methodologies. METHODS AND ANALYSIS We will investigate the application of random forest and multivariable logistic regression to predict incident AF within a 6-month prediction horizon, that is, a time-window consistent with conducting investigation for AF. The Clinical Practice Research Datalink (CPRD)-GOLD dataset will be used for derivation, and the Clalit Health Services (CHS) dataset will be used for international external geographical validation. Analyses will include metrics of prediction performance and clinical utility. We will create Kaplan-Meier plots for individuals identified as higher and lower predicted risk of AF and derive the cumulative incidence rate for non-AF cardio-renal-metabolic diseases and death over the longer term to establish how predicted AF risk is associated with a range of new non-AF disease states. ETHICS AND DISSEMINATION Permission for CPRD-GOLD was obtained from CPRD (ref no: 19_076). The CPRD ethical approval committee approved the study. CHS Helsinki committee approval 21-0169 and data usage committee approval 901. The results will be submitted as a research paper for publication to a peer-reviewed journal and presented at peer-reviewed conferences. TRIAL REGISTRATION NUMBER A systematic review to guide the overall project was registered on PROSPERO (registration number CRD42021245093). The study was registered on ClinicalTrials.gov (NCT05837364).
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jianhua Wu
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Ronen Arbel
- Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Sapir College, Sderot, Israel
| | - Moti Haim
- Department of Cardiology, Soroka University Medical Center, Beer Sheva, Israel
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Doron Zahger
- Soroka University Medical Center, Beer Sheva, Israel
| | - Talish Razi Benita
- Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clalit Health Services, Tel Aviv, Israel
| | - Lior Rokach
- Department of Information Systems and Software Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - J Campbell Cowan
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Chris P Gale
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Di Bidino R, Piaggio D, Andellini M, Merino-Barbancho B, Lopez-Perez L, Zhu T, Raza Z, Ni M, Morrison A, Borsci S, Fico G, Pecchia L, Iadanza E. Scoping Meta-Review of Methods Used to Assess Artificial Intelligence-Based Medical Devices for Heart Failure. Bioengineering (Basel) 2023; 10:1109. [PMID: 37892839 PMCID: PMC10604154 DOI: 10.3390/bioengineering10101109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 10/29/2023] Open
Abstract
Artificial intelligence and machine learning (AI/ML) are playing increasingly important roles, permeating the field of medical devices (MDs). This rapid progress has not yet been matched by the Health Technology Assessment (HTA) process, which still needs to define a common methodology for assessing AI/ML-based MDs. To collect existing evidence from the literature about the methods used to assess AI-based MDs, with a specific focus on those used for the management of heart failure (HF), the International Federation of Medical and Biological Engineering (IFMBE) conducted a scoping meta-review. This manuscript presents the results of this search, which covered the period from January 1974 to October 2022. After careful independent screening, 21 reviews, mainly conducted in North America and Europe, were retained and included. Among the findings were that deep learning is the most commonly utilised method and that electronic health records and registries are among the most prevalent sources of data for AI/ML algorithms. Out of the 21 included reviews, 19 focused on risk prediction and/or the early diagnosis of HF. Furthermore, 10 reviews provided evidence of the impact on the incidence/progression of HF, and 13 on the length of stay. From an HTA perspective, the main areas requiring improvement are the quality assessment of studies on AI/ML (included in 11 out of 21 reviews) and their data sources, as well as the definition of the criteria used to assess the selection of the most appropriate AI/ML algorithm.
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Affiliation(s)
- Rossella Di Bidino
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS—The Graduate School of Health Economics and Management (ALTEMS), 00168 Rome, Italy
| | - Davide Piaggio
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (D.P.); (M.A.); (Z.R.); (L.P.)
| | - Martina Andellini
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (D.P.); (M.A.); (Z.R.); (L.P.)
| | - Beatriz Merino-Barbancho
- Life Supporting Technologies, Photonics Technology and Bioengineering Department, School of Telecommunication Engineering, Universidad Politécnica de Madrid, 28040 Madrid, Spain (L.L.-P.); (G.F.)
| | - Laura Lopez-Perez
- Life Supporting Technologies, Photonics Technology and Bioengineering Department, School of Telecommunication Engineering, Universidad Politécnica de Madrid, 28040 Madrid, Spain (L.L.-P.); (G.F.)
| | - Tianhui Zhu
- NIHR London In-Vitro Diagnostics Cooperative, Imperial College of London, London W2 1NY, UK
| | - Zeeshan Raza
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (D.P.); (M.A.); (Z.R.); (L.P.)
| | - Melody Ni
- NIHR London In-Vitro Diagnostics Cooperative, Imperial College of London, London W2 1NY, UK
| | - Andra Morrison
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON K1S 5S8, Canada;
| | - Simone Borsci
- NIHR London In-Vitro Diagnostics Cooperative, Imperial College of London, London W2 1NY, UK
- Department of Learning, Data Analysis, and Technology, Cognition, Data and Education (CODE) Group, Faculty of Behavioural Management and Social Sciences, University of Twente, 7522 Enschede, The Netherlands
| | - Giuseppe Fico
- Life Supporting Technologies, Photonics Technology and Bioengineering Department, School of Telecommunication Engineering, Universidad Politécnica de Madrid, 28040 Madrid, Spain (L.L.-P.); (G.F.)
| | - Leandro Pecchia
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (D.P.); (M.A.); (Z.R.); (L.P.)
- School of Engineering, University Campus Bio-Medico, 00128 Rome, Italy
- International Federation of Medical and Biological Engineering, B-1090 Brussels, Belgium
| | - Ernesto Iadanza
- International Federation of Medical and Biological Engineering, B-1090 Brussels, Belgium
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
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Nadarajah R, Wu J, Hogg D, Raveendra K, Nakao YM, Nakao K, Arbel R, Haim M, Zahger D, Parry J, Bates C, Cowan C, Gale CP. Prediction of short-term atrial fibrillation risk using primary care electronic health records. Heart 2023; 109:1072-1079. [PMID: 36759177 PMCID: PMC10359547 DOI: 10.1136/heartjnl-2022-322076] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE Atrial fibrillation (AF) screening by age achieves a low yield and misses younger individuals. We aimed to develop an algorithm in nationwide routinely collected primary care data to predict the risk of incident AF within 6 months (Future Innovations in Novel Detection of Atrial Fibrillation (FIND-AF)). METHODS We used primary care electronic health record data from individuals aged ≥30 years without known AF in the UK Clinical Practice Research Datalink-GOLD dataset between 2 January 1998 and 30 November 2018, randomly divided into training (80%) and testing (20%) datasets. We trained a random forest classifier using age, sex, ethnicity and comorbidities. Prediction performance was evaluated in the testing dataset with internal bootstrap validation with 200 samples, and compared against the CHA2DS2-VASc (Congestive heart failure, Hypertension, Age >75 (2 points), Stroke/transient ischaemic attack/thromboembolism (2 points), Vascular disease, Age 65-74, Sex category) and C2HEST (Coronary artery disease/Chronic obstructive pulmonary disease (1 point each), Hypertension, Elderly (age ≥75, 2 points), Systolic heart failure, Thyroid disease (hyperthyroidism)) scores. Cox proportional hazard models with competing risk of death were fit for incident longer-term AF between higher and lower FIND-AF-predicted risk. RESULTS Of 2 081 139 individuals in the cohort, 7386 developed AF within 6 months. FIND-AF could be applied to all records. In the testing dataset (n=416 228), discrimination performance was strongest for FIND-AF (area under the receiver operating characteristic curve 0.824, 95% CI 0.814 to 0.834) compared with CHA2DS2-VASc (0.784, 0.773 to 0.794) and C2HEST (0.757, 0.744 to 0.770), and robust by sex and ethnic group. The higher predicted risk cohort, compared with lower predicted risk, had a 20-fold higher 6-month incidence rate for AF and higher long-term hazard for AF (HR 8.75, 95% CI 8.44 to 9.06). CONCLUSIONS FIND-AF, a machine learning algorithm applicable at scale in routinely collected primary care data, identifies people at higher risk of short-term AF.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Jianhua Wu
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Department of Dentistry, University of Leeds, Leeds, UK
| | - David Hogg
- School of Computing, University of Leeds, Leeds, UK
| | | | - Yoko M Nakao
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Kazuhiro Nakao
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Ronen Arbel
- Maximizing Health Outcomes Research Lab, Sapir College, Hof Ashkelon, Israel
- Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel
| | - Moti Haim
- Department of Cardiology, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Doron Zahger
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Cardiology, Soroka Medical Center, Beer Sheva, Israel
| | | | | | | | - Chris P Gale
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
- Cardiology, Leeds General Infirmary, Leeds, UK
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