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Chioncel O, Čelutkienė J, Bělohlávek J, Kamzola G, Lainscak M, Merkely B, Miličić D, Nessler J, Ristić AD, Sawiełajc L, Uchmanowicz I, Uuetoa T, Turgonyi E, Yotov Y, Ponikowski P. Heart failure care in the Central and Eastern Europe and Baltic region: status, barriers, and routes to improvement. ESC Heart Fail 2024. [PMID: 38520086 DOI: 10.1002/ehf2.14687] [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: 03/27/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 03/25/2024] Open
Abstract
Despite improvements over recent years, morbidity and mortality associated with heart failure (HF) are higher in countries in the Central and Eastern Europe and Baltic region than in Western Europe. With the goal of improving the standard of HF care and patient outcomes in the Central and Eastern Europe and Baltic region, this review aimed to identify the main barriers to optimal HF care and potential areas for improvement. This information was used to suggest methods to improve HF management and decrease the burden of HF in the region that can be implemented at the national and regional levels. We performed a literature search to collect information about HF epidemiology in 11 countries in the region (Bulgaria, Croatia, Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Serbia, and Slovenia). The prevalence of HF in the region was 1.6-4.7%, and incidence was 3.1-6.0 per 1000 person-years. Owing to the scarcity of published data on HF management in these countries, we also collected insights on local HF care and management practices via two surveys of 11 HF experts representing the 11 countries. Based on the combined results of the literature review and surveys, we created national HF care and management profiles for each country and developed a common patient pathway for HF for the region. We identified five main barriers to optimal HF care: (i) lack of epidemiological data, (ii) low awareness of HF, (iii) lack of national HF strategies, (iv) infrastructure and system gaps, and (v) poor access to novel HF treatments. To overcome these barriers, we propose the following routes to improvement: (i) establish regional and national prospective HF registries for the systematic collection of epidemiological data; (ii) establish education campaigns for the public, patients, caregivers, and healthcare professionals; (iii) establish formal HF strategies to set clear and measurable policy goals and support budget planning; (iv) improve access to quality-of-care centres, multidisciplinary care teams, diagnostic tests, and telemedicine/telemonitoring; and (v) establish national treatment monitoring programmes to develop policies that ensure that adequate proportions of healthcare budgets are reserved for novel therapies. These routes to improvement represent a first step towards improving outcomes in patients with HF in the Central and Eastern Europe and Baltic region by decreasing disparities in HF care within the region and between the region and Western Europe.
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Affiliation(s)
- Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu', Bucharest, Romania
- Carol Davila University of Medicine, Bucharest, Romania
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University/State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Jan Bělohlávek
- Second Department of Medicine, Cardiovascular Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czechia
| | - Ginta Kamzola
- Latvian Centre of Cardiology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
- Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Natural Sciences and Mathematics, University of Maribor, Maribor, Slovenia
| | - Béla Merkely
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Davor Miličić
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Jadwiga Nessler
- Department of Coronary Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Arsen D Ristić
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
| | | | | | - Yoto Yotov
- First Department of Internal Diseases, Faculty of Medicine, Medical University of Varna, Varna, Bulgaria
| | - Piotr Ponikowski
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
- Wrocław Medical University, Wrocław, Poland
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2
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Heikkilä E, Katajamäki T, Salminen M, Irjala K, Viljanen A, Koivula MK, Pulkki K, Isoaho R, Kivelä SL, Viitanen M, Löppönen M, Vahlberg T, Viikari L. New reference limits for cardiac troponin T and N-terminal b-type natriuretic propeptide in elders. Clin Chim Acta 2024; 556:117844. [PMID: 38403147 DOI: 10.1016/j.cca.2024.117844] [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: 01/14/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND AIMS Our aim was to define reference limits for cardiac troponin T (cTnT) and N-terminal pro B-type natriuretic peptide (proBNP) that would better reflect their concentrations in older people. In addition, the incidence of acute myocardial infarctions (AMIs) was studied using these reference limits in an older population with and without previous heart diseases. MATERIALS AND METHODS A population-based study with a ten-year follow-up. The reference population was formed by 763 individuals aged over 64 years, with no diagnoses of heart or kidney diseases. RESULTS There was a significant increase in cTnT and proBNP concentrations with age. The 99 % reference limits for cTnT were 25 ng/L, 28 ng/l, 38 ng/l, and 71 ng/l for men in five-year-intervals starting from 64 to 69 years to 80 years and older, and 18 ng/L, 22 ng/l, 26 ng/l, and 52 ng/L for women, respectively. The 97.5 % reference limits for proBNP were 272 ng/L, 287 ng/l, 373 ng/l and 686 ng/L for men, and 341 ng/L, 377 ng/l, 471 ng/l, and 794 ng/L for women, respectively. Elevated proBNP was statistically significantly associated with future AMIs in subjects with and without a previous heart disease. CONCLUSIONS Age-specific reference limits for cTnT and proBNP are needed to better evaluate cardiac symptoms.
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Affiliation(s)
- Elisa Heikkilä
- Faculty of Medicine, Department of Clinical Chemistry, University of Turku, Turku, Finland; Southwest Finland Wellbeing Services County, Turku University Hospital, Laboratory Division, Turku, Finland.
| | - Taina Katajamäki
- Faculty of Medicine, Department of Clinical Chemistry, University of Turku, Turku, Finland; Southwest Finland Wellbeing Services County, Turku University Hospital, Laboratory Division, Turku, Finland
| | - Marika Salminen
- Faculty of Medicine, Department of General Practice, University of Turku and Turku University Hospital, Turku, Finland; Southwest Finland Wellbeing Services County, Turku University Hospital Services, Geriatric Medicine, 20521 Turku, Finland
| | - Kerttu Irjala
- Faculty of Medicine, Department of Clinical Chemistry, University of Turku, Turku, Finland
| | - Anna Viljanen
- Southwest Finland Wellbeing Services County, Turku University Hospital, Domain of General Practice and Rehabilitation, Turku, Finland; Faculty of Medicine, Department of Geriatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Marja-Kaisa Koivula
- HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland; Faculty of Medicine, Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland
| | - Kari Pulkki
- HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland; Faculty of Medicine, Clinical Chemistry and Hematology, University of Helsinki, Helsinki, Finland
| | - Raimo Isoaho
- Faculty of Medicine, Department of General Practice, University of Turku and Turku University Hospital, Turku, Finland
| | - Sirkka-Liisa Kivelä
- Faculty of Medicine, Department of General Practice, University of Turku and Turku University Hospital, Turku, Finland; Faculty of Pharmacy, Division of Social Pharmacy, University of Helsinki, Helsinki, Finland
| | - Matti Viitanen
- Faculty of Medicine, Department of Geriatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Minna Löppönen
- Southwest Finland Wellbeing Services County, Turku University Hospital Services, General Medicine, Finland
| | - Tero Vahlberg
- Faculty of Medicine, Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - Laura Viikari
- Southwest Finland Wellbeing Services County, Turku University Hospital Services, Geriatric Medicine, 20521 Turku, Finland; Southwest Finland Wellbeing Services County, Turku University Hospital, Domain of General Practice and Rehabilitation, Turku, Finland
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3
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Monroe RE, Thrasher J. Chapter 4: Summary and a Patient Perspective on Living with Heart Failure. Am J Med 2024; 137:S35-S42. [PMID: 38184325 DOI: 10.1016/j.amjmed.2023.04.012] [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: 08/10/2022] [Accepted: 04/18/2023] [Indexed: 01/08/2024]
Abstract
This chapter is intended to provide a plain language overview of heart failure suitable for non-medical professionals, including patients and caregivers, and a patient perspective on living with heart failure.
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Affiliation(s)
- Rhonda E Monroe
- BOOST - Better Outcomes Optimal Scientific Therapies, Washington, DC; Heart Failure Society of America Advocacy Committee, Charlotte, NC.
| | - James Thrasher
- Arkansas Diabetes and Endocrinology Center, Little Rock, Ark; Medical Investigations, Inc, Little Rock, Ark
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4
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Forsyth P, Young S, Hughes K, James R, Oxley C, Kelly R, Jones R, Briggs S, Mackay-Thomas L, Millerick Y, Simpson M, Taylor CJ, Beggs S, Piper S, Duckett S. Multiprofessional heart failure self-development framework. Open Heart 2024; 11:e002554. [PMID: 38242561 PMCID: PMC10806483 DOI: 10.1136/openhrt-2023-002554] [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] [Accepted: 12/25/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Heart failure remains a key public health priority across the globe. The median age of people with heart failure admitted to hospital in the UK is 81 years old. Many such patients transcend the standard interventions that are well characterised and evidenced in guidelines, into holistic aspects surrounding frailty, rehabilitation and social care. Previous published competency frameworks in heart failure have focused on the value of doctors, nurses and pharmacists. We aimed to provide an expert consensus on the minimum heart failure-specific competencies necessary for multiple different healthcare professionals, including physiotherapists, occupational therapists, dietitians and cardiac physiologists. METHODS The document has been developed focussing on four main parts, (1) establishing a project working group of expert professionals, (2) a literature review of previously existing published curricula and competency frameworks, (3) consensus building, which included developing a structure to the framework with ongoing review of the contents to adapt and be inclusive for each specialty and (4) write up and dissemination to widen the impact of the project. RESULTS The final competency framework displays competencies across seven sections; knowledge (including subheadings on heart failure syndrome, diagnosis and clinical management); general skills; heart failure-specific skills; clinical autonomy; multidisciplinary team working; teaching and education; and research and development. CONCLUSION People with heart failure can be complex and have needs that require input from a broad range of specialties. This publication focuses on the vital impact of wider multidisciplinary groups and should help define the generic core heart failure-specific competencies needed to support future pipelines of professionals, who regularly interact with and deliver care for patients with heart failure.
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Affiliation(s)
- Paul Forsyth
- Pharmacy, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Susan Young
- Physiotherapy, Aneurin Bevan University Health Board, Newport, UK
| | - Kirsty Hughes
- Physiotherapy, Forth Valley Royal Hospital, Larbert, UK
| | - Ruby James
- Occupational Therapy, Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Cheryl Oxley
- Cardiac Physiology Services, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Ruth Kelly
- Cardiac Physiology Services, Golden Jubilee National Hospital, Clydebank, UK
| | - Rebecca Jones
- Dietetics, St George's University Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Susan Piper
- Cardiology, King's College Hospital, London, UK
| | - Simon Duckett
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
- Department of Cardiology, Keele University, Keele, UK
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5
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Belfiore A, Stranieri R, Novielli ME, Portincasa P. Reducing the hospitalization epidemic of chronic heart failure by disease management programs. Intern Emerg Med 2024; 19:221-231. [PMID: 38151590 DOI: 10.1007/s11739-023-03458-7] [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] [Accepted: 10/10/2023] [Indexed: 12/29/2023]
Abstract
Chronic heart failure is the most common cause of hospitalization in Europe and rates are steadily increasing due to aging of the population. Hospitalization identifies a fundamental change in the natural history of heart failure (HF) increasing the risk of re-hospitalization and mortality. Heart failure management programs improve the quality of care for HF patients and reduce hospitalization burden. The goals of the heart failure management programs include optimization of drug therapy, patient education, early recognition of signs of decompensation, and management of comorbidities. Randomized clinical trials evidenced that system of care for heart failure patients improved adherence to treatment and reduced unplanned re-admissions to hospital. Multidisciplinary programs and home-visiting have shown improved efficacy with reductions in HF and all-cause hospitalizations and mortality. Community HF clinics should take care of the management of stable patients in strict contact with primary care, while hospital out-patients clinics should care of patients with severe disease or persistent clinical instability, candidates to advanced treatment options. In any case a holistic, patient-centered approach is suggested, to optimize care considering the needs of the individual patient. Telemonitoring is a new opportunity for HF patients, because it allows the continuity of care at home. All heart failure patients should require follow-up in a specific management program, but most of date come from clinical trials that included high-risk patients. While clinical trials have a specified duration (from months to some years), lifelong follow-up is recommended with differentiated approaches according to the patient's need.
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Affiliation(s)
- Anna Belfiore
- Clinica Medica "A. Murri" & Division Internal Medicine, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University "Aldo Moro" Medical School, Bari, Italy.
| | - Rosa Stranieri
- Clinica Medica "A. Murri" & Division Internal Medicine, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University "Aldo Moro" Medical School, Bari, Italy
| | - Maria Elena Novielli
- Clinica Medica "A. Murri" & Division Internal Medicine, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University "Aldo Moro" Medical School, Bari, Italy
| | - Piero Portincasa
- Clinica Medica "A. Murri" & Division Internal Medicine, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University "Aldo Moro" Medical School, Bari, Italy
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6
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Charman SJ, Okwose NC, Taylor CJ, Bailey K, Fuat A, Ristic A, Mant J, Deaton C, Seferovic PM, Coats AJS, Hobbs FDR, MacGowan GA, Jakovljevic DG. Feasibility of the cardiac output response to stress test in suspected heart failure patients. Fam Pract 2022; 39:805-812. [PMID: 35083480 PMCID: PMC9508869 DOI: 10.1093/fampra/cmab184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Diagnostic tools available to support general practitioners diagnose heart failure (HF) are limited. OBJECTIVES (i) Determine the feasibility of the novel cardiac output response to stress (CORS) test in suspected HF patients, and (ii) Identify differences in the CORS results between (a) confirmed HF patients from non-HF patients, and (b) HF reduced (HFrEF) vs HF preserved (HFpEF) ejection fraction. METHODS Single centre, prospective, observational, feasibility study. Consecutive patients with suspected HF (N = 105; mean age: 72 ± 10 years) were recruited from specialized HF diagnostic clinics in secondary care. The consultant cardiologist confirmed or refuted a HF diagnosis. The patient completed the CORS but the researcher administering the test was blinded from the diagnosis. The CORS assessed cardiac function (stroke volume index, SVI) noninvasively using the bioreactance technology at rest-supine, challenge-standing, and stress-step exercise phases. RESULTS A total of 38 patients were newly diagnosed with HF (HFrEF, n = 21) with 79% being able to complete all phases of the CORS (91% of non-HF patients). A 17% lower SVI was found in HF compared with non-HF patients at rest-supine (43 ± 15 vs 51 ± 16 mL/beat/m2, P = 0.02) and stress-step exercise phase (49 ± 16 vs 58 ± 17 mL/beat/m2, P = 0.02). HFrEF patients demonstrated a lower SVI at rest (39 ± 15 vs 48 ± 13 mL/beat/m2, P = 0.02) and challenge-standing phase (34 ± 9 vs 42 ± 12 mL/beat/m2, P = 0.03) than HFpEF patients. CONCLUSION The CORS is feasible and patients with HF responded differently to non-HF, and HFrEF from HFpEF. These findings provide further evidence for the potential use of the CORS to improve HF diagnostic and referral accuracy in primary care.
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Affiliation(s)
- Sarah J Charman
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Nduka C Okwose
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Research Centre (CSELS), Institute for Health and Wellbeing, Faculty of Health and Life Sciences, Coventry University, and University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Clare J Taylor
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Kristian Bailey
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ahmet Fuat
- Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust & School of Medicine, Pharmacy and Health, Durham University, Durham, United Kingdom
| | - Arsen Ristic
- Department of Cardiology, Faculty of Medicine, University of Belgrade, Clinical Centre of Serbia, Belgrade, Serbia
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Christi Deaton
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Petar M Seferovic
- Department of Cardiology, Faculty of Medicine, University of Belgrade, Clinical Centre of Serbia, Belgrade, Serbia
| | - Andrew J S Coats
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome, Italy
| | - F D Richard Hobbs
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, United Kingdom
| | - Guy A MacGowan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Djordje G Jakovljevic
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Research Centre (CSELS), Institute for Health and Wellbeing, Faculty of Health and Life Sciences, Coventry University, and University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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7
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Calcagno S, BiondiZoccai G, Stankovic T, Szabo E, Szabo AB, Kecskes I. Novel tech throws knock-out punch to ECG improving GP referral decisions to cardiology. Open Heart 2022; 9:openhrt-2021-001852. [PMID: 35190470 PMCID: PMC8862477 DOI: 10.1136/openhrt-2021-001852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose In a comparator study, designed with assistance from the Food and Drug Administration, a State-of-the-Art (SOTA) ECG device augmented with automated analysis, the comparator, was compared with a breakthrough technology, Cardio-HART (CHART). Methods The referral decision defined by physician reading biosignal-based ECG or CHART report were compared for 550 patients, where its performance is calculated against the ground truth referral decision. The ground truth was established by cardiologist consensus based on all the available measurements and findings including echocardiography (ECHO). Results The results confirmed that CHART analysis was far more effective than ECG only analysis: CHART reduced false negative rates 15.8% and false positive (FP) rates by 5%, when compared with SOTA ECG devices. General physicians (GP’s) using CHART saw their positive diagnosis rate significantly increased, from ~10% to ~26% (260% increase), and the uncertainty rate significantly decreased, from ~31% to ~1.9% (94% decrease). For cardiology, the study showed that in 98% of the cases, the CHART report was found to be a good indicator as to what kind of heart problems can be expected (the ‘start-point’) in the ECHO examination. Conclusions The study revealed that GP use of CHART resulted in more accurate referrals for cardiology, resulting in fewer true negative or FP—healthy or mildly abnormal patients not in need of ECHO confirmation. The indirect benefit is the reduction in wait-times and in unnecessary and costly testing in secondary care. Moreover, when used as a start-point, CHART can shorten the echocardiograph examination time.
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Affiliation(s)
- Simone Calcagno
- Division of Cardiology, Santa Maria Goretti Hospital, Latina, Italy
| | - Giuseppe BiondiZoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Tatjana Stankovic
- Division of Cardiology, Regional Hospital Dr Radivoj Simonovic Sombor, Sombor, Serbia
| | - Erzsebet Szabo
- Division of Cardiology, Senta General Hospital, Senta, Serbia
| | | | - Istvan Kecskes
- Cardiology Research and Scientific Advancements, UVA Research, Toronto, Ontario, Canada
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8
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Gtif I, Bouzid F, Charfeddine S, Abid L, Kharrat N. Heart failure disease: An African perspective. Arch Cardiovasc Dis 2021; 114:680-690. [PMID: 34563468 DOI: 10.1016/j.acvd.2021.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
Heart failure remains a health challenge in Africa, associated with significant rates of hospitalization, morbidity and mortality. The current review aims to summarize the most recent data on the epidemiology, aetiology, risk factors and management of heart failure, comparing countries in North Africa and sub-Saharan Africa. There is a paucity of data on heart failure epidemiology, aetiology and management, and on the sociodemographic characteristics of African patients with heart failure. Heart failure prevalence has been evaluated among all medical admissions or admissions to cardiac units or emergency departments in a few hospital-based studies conducted in countries in North Africa and sub-Saharan Africa. Common causes of heart failure in Africa include ischaemic heart disease, hypertensive heart disease, dilated cardiomyopathy and valvular heart disease. The aetiology of heart failure differs between countries in North Africa and sub-Saharan Africa. Diagnosing heart failure proves challenging in Africa because of a lack of basic tools and the necessary human resources. The principal drugs used frequently for heart failure therapy are lacking in sub-Saharan Africa. The clinical profile of heart failure in sub-Saharan Africa differs from that in North African countries; this is related to aetiological factors, socioeconomic status and availability of diagnostic tools. There is an evident need to establish a large multicentre registry to evaluate the heart failure burden in almost all African countries, and to highlight the major cardiovascular risk factors and co-morbidities. The present review highlights the importance of this syndrome in Africa, and calls for improvements in its early diagnosis, treatment and, possibly, prevention.
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Affiliation(s)
- Imen Gtif
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia.
| | - Fériel Bouzid
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia
| | - Salma Charfeddine
- Department of Cardiology, Hédi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, 3000 Sfax, Tunisia
| | - Leila Abid
- Department of Cardiology, Hédi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, 3000 Sfax, Tunisia
| | - Najla Kharrat
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia
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9
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Toth PP, Gauthier D. Heart failure with preserved ejection fraction: strategies for disease management and emerging therapeutic approaches. Postgrad Med 2020; 133:125-139. [PMID: 33283589 DOI: 10.1080/00325481.2020.1842620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Approximately 50% of patients with heart failure (HF) have a preserved ejection fraction (HFpEF), and the incidence of HFpEF is increasing relative to HF with reduced ejection fraction (HFrEF). Both types of HF are associated with reduced survival and increased risk for hospitalization. However, in contrast to HFrEF, there are no approved treatments specifically indicated for HFpEF, and current therapy is largely focused on management of symptoms and comorbidities. Diagnosis of HFpEF in the outpatient setting also presents unique challenges compared with HFrEF because of factors including a high burden of comorbidities in HFpEF and difficulties in distinguishing HFpEF from normal aging. Primary care providers (PCPs) play a pivotal role in the delivery of holistic, patient-centric care from diagnosis to management and palliative care. As the prevalence of HF continues to rise in an aging population, PCPs will need to play a greater role in HFpEF care. This article will review HFpEF etiology and pathophysiology, diagnostic workup, and management of symptoms and comorbidities, with a focus on the critical role of PCPs throughout the clinical course of HFpEF.
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Affiliation(s)
- Peter P Toth
- Preventive Cardiology, CGH Medical Center, Rock Falls, IL, USA.,Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diane Gauthier
- Section of Cardiology, Boston University School of Medicine, Boston, MA, USA
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10
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Understanding the management of heart failure with preserved ejection fraction: a qualitative multiperspective study. Br J Gen Pract 2020; 70:e880-e889. [PMID: 33139334 DOI: 10.3399/bjgp20x713477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/19/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND About half of all people with heart failure have heart failure with preserved ejection fraction (HFpEF), in which the heart is stiff. This type of heart failure is more common in older people with a history of hypertension, obesity, and diabetes mellitus. Patients with HFpEF are often managed in primary care, sometimes in collaboration with specialists. Knowledge about how best to manage this growing population is limited, and there is a pressing need to improve care for these patients. AIM To explore clinicians' and patients'/carers' perspectives and experiences about the management of HFpEF to inform the development of an improved model of care. DESIGN AND SETTING A multiperspective qualitative study involving primary and secondary care settings across the east of England, Greater Manchester, and the West Midlands. METHOD Semi-structured interviews and focus groups were conducted. Transcribed data were analysed using framework analysis and informed by the normalisation process theory (NPT). RESULTS In total, 50 patients, nine carers/relatives, and 73 clinicians were recruited. Difficulties with diagnosis, unclear illness perceptions, and management disparity were identified as important factors that may influence management of HFpEF. The NPT construct of coherence reflected what participants expressed about the need to improve the identification, understanding, and awareness of this condition in order to improve care. CONCLUSION There is a pressing need to raise the public and clinical profile of HFpEF, develop a clear set of accepted practices concerning its management, and ensure that systems of care are accessible and attuned to the needs of patients with this condition.
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Hinton W, Feher M, Munro N, de Lusignan S. Does Renal Function or Heart Failure Diagnosis Affect Primary Care Prescribing for Sodium-Glucose Co-Transporter 2 Inhibitors in Type 2 Diabetes? Diabetes Ther 2020; 11:2169-2175. [PMID: 32671574 PMCID: PMC7434824 DOI: 10.1007/s13300-020-00878-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Sodium-glucose co-transporter 2 inhibitors (SGLT2is) are a unique class of drugs currently used in the management of type 2 diabetes (T2D). There are emerging data from cardiovascular outcome trials confirming renal and heart failure benefits of these drugs independent of glucose lowering. By contrast, the current licencing indications of these drugs are mainly limited to their glucose-lowering effects, and not to renal or heart failure benefits. It is therefore timely to ascertain whether the presence of these clinical conditions may influence prescribing choices for patients with T2D. Our aims are to report prescribing of SGLT2is in people with T2D according to their renal function and presence of heart failure. Co-prescribing with diuretics will also be explored. METHODS We will perform a cross-sectional analysis of people with T2D in the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network. The RCGP RSC includes more than 1500 volunteer practices throughout England and parts of Wales, and a representative sample of over 10 million patients. The proportion of adults with T2D ever prescribed an SGLT2i will be determined. Within this cohort, we will calculate the percentage of SGLT2is prescribed according to renal function, and the proportion of prescriptions in people with co-morbid heart failure, stratified by body mass index categories. The percentage of SGLT2is prescribed as an add-on to a diuretic or following discontinuation of prescribing for a diuretic will also be reported. Multilevel logistic regression will be performed to explore the association between heart failure and renal function, and propensity to prescribe SGLT2is. PLANNED OUTPUTS The study findings will be submitted to a primary care/diabetes-focused conference, and for publication in a peer reviewed journal.
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Affiliation(s)
- William Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Michael Feher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Neil Munro
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
- Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London, UK.
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12
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Ferreira JP, Kraus S, Mitchell S, Perel P, Piñeiro D, Chioncel O, Colque R, de Boer RA, Gomez-Mesa JE, Grancelli H, Lam CSP, Martinez-Rubio A, McMurray JJV, Mebazaa A, Panjrath G, Piña IL, Sani M, Sim D, Walsh M, Yancy C, Zannad F, Sliwa K. World Heart Federation Roadmap for Heart Failure. Glob Heart 2020; 14:197-214. [PMID: 31451235 DOI: 10.1016/j.gheart.2019.07.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 12/26/2022] Open
Affiliation(s)
- João Pedro Ferreira
- National Institute of Health and Medical Research, Center for Clinical Multidisciplinary Research, University of Lorraine, Regional University Hospital of Nancy, Nancy, France
| | - Sarah Kraus
- Groote Schuur Hospital and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Pablo Perel
- London School of Tropical Hygiene and Medicine, London, United Kingdom
| | - Daniel Piñeiro
- Division of Medicine, Hospital de Clínicas Department of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Ovidiu Chioncel
- Institute of Emergency for Cardiovascular Diseases "C.C. Iliescu" Bucharest, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania
| | - Roberto Colque
- Coronary Care Unit, Sanatorio Allende Cerro, Cordoba, Argentina
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Hugo Grancelli
- Cardiology Department, Sanatorio Trinidad Palermo, Buenos Aires, Argentina
| | | | - Antoni Martinez-Rubio
- Department of Cardiology, University Hospital Sabadell Autonomous, University of Barcelona, Barcelona, Spain
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Alexandre Mebazaa
- Université de Paris, Paris, France; U942 MASCOT (cardiovascular MArkers in Stress COndiTions), National Institute of Health and Medical Research, France; Department of Anesthesia, Burn, Intensive Care, Saint Louis Lariboisière Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gurusher Panjrath
- Department of Medicine /Cardiology, George Washington University School of Medicine, George Washington University, Washington, DC, USA
| | - Ileana L Piña
- Wayne State University, Michigan, USA; Wayne State University, Michigan, USA
| | - Mahmoud Sani
- Department of Medicine, Bayero University Kano, Kano, Nigeria; Aminu Kano Teaching Hospital, Kano State, Kano, Nigeria
| | - David Sim
- Department of Cardiology, Heart Failure Program at the National Heart Center Singapore, Singapore
| | - Mary Walsh
- Department of Heart Failure and Cardiac Transplantation, St. Vincent Heart Center, Indianapolis, IN, USA
| | - Clyde Yancy
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Faiez Zannad
- Department of Cardiology, Centre d'Investigation Clinique (CIC), Centre Hospitalier Universitaire, University Henri Poincaré, Nancy, France
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Cardiology and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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13
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Charman S, Okwose N, Maniatopoulos G, Graziadio S, Metzler T, Banks H, Vale L, MacGowan GA, Seferović PM, Fuat A, Deaton C, Mant J, Hobbs RFD, Jakovljevic DG. Opportunities and challenges of a novel cardiac output response to stress (CORS) test to enhance diagnosis of heart failure in primary care: qualitative study. BMJ Open 2019; 9:e028122. [PMID: 30987993 PMCID: PMC6500186 DOI: 10.1136/bmjopen-2018-028122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To explore the role of the novel cardiac output response to stress (CORS), test in the current diagnostic pathway for heart failure and the opportunities and challenges to potential implementation in primary care. DESIGN Qualitative study using semistructured in-depth interviews which were audio recorded and transcribed verbatim. Data from the interviews were analysed thematically using an inductive approach. SETTING Newcastle upon Tyne, UK. PARTICIPANTS Fourteen healthcare professionals (six males, eight females) from primary (general practitioners (GPs), nurses, healthcare assistant, practice managers) and secondary care (consultant cardiologists). RESULTS Four themes relating to opportunities and challenges surrounding the implementation of the new diagnostic technology were identified. These reflected that the adoption of CORS test would be an advantage to primary care but the test had barriers to implementation which include: establishment of clinical utility, suitability for immobile patients and cost implication to GP practices. CONCLUSION The development of a simple non-invasive clinical test to accelerate the diagnosis of heart failure in primary care maybe helpful to reduce unnecessary referrals to secondary care. The CORS test has the potential to serve this purpose; however, factors such as cost effectiveness, diagnostic accuracy and seamless implementation in primary care have to be fully explored.
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Affiliation(s)
- Sarah Charman
- Cardiovascular Research Centre, Newcastle University, Newcastle, UK
| | - Nduka Okwose
- Cardiovascular Research Centre, Newcastle University, Newcastle, UK
| | | | - Sara Graziadio
- NIHR In Vitro Diagnostics Co-operative, Newcastle University, Newcastle, UK
| | - Tamara Metzler
- Cardiovascular Research Centre, Newcastle University, Newcastle, UK
| | - Helen Banks
- Cardiovascular Research Centre, Newcastle University, Newcastle, UK
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Guy A MacGowan
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK
| | - Petar M Seferović
- Cardiology, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Ahmet Fuat
- Primary Care, Carmel Medical Practice, Darlington, UK
| | - Christi Deaton
- Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan Mant
- General Practice and Primary Care Research Unit, University of Cambridge, Cambridge, UK
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14
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Groenewegen A, Rutten FH. Near-home heart failure care. Eur J Heart Fail 2018; 21:110-111. [PMID: 30520538 DOI: 10.1002/ejhf.1345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Amy Groenewegen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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15
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Charman SJ, Okwose NC, Stefanetti RJ, Bailey K, Skinner J, Ristic A, Seferovic PM, Scott M, Turley S, Fuat A, Mant J, Hobbs RF, MacGowan GA, Jakovljevic DG. A novel cardiac output response to stress test developed to improve diagnosis and monitoring of heart failure in primary care. ESC Heart Fail 2018; 5:703-712. [PMID: 29943902 PMCID: PMC6073030 DOI: 10.1002/ehf2.12302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/15/2018] [Accepted: 04/16/2018] [Indexed: 12/28/2022] Open
Abstract
AIMS Primary care physicians lack access to an objective cardiac function test. This study for the first time describes a novel cardiac output response to stress (CORS) test developed to improve diagnosis and monitoring of heart failure in primary care and investigates its reproducibility. METHODS AND RESULTS Prospective observational study recruited 32 consecutive primary care patients (age, 63 ± 9 years; female, n = 18). Cardiac output was measured continuously using the bioreactance method in supine and standing positions and during two 3 min stages of a step-exercise protocol (10 and 15 steps per minute) using a 15 cm height bench. The CORS test was performed on two occasions, i.e. Test 1 and Test 2. There was no significant difference between repeated measures of cardiac output and stroke volume at supine standing and Stage 1 and Stage 2 step exercises (all P > 0.3). There was a significant positive relationship between Test 1 and Test 2 cardiac outputs (r = 0.92, P = 0.01 with coefficient of variation of 7.1%). The mean difference in cardiac output (with upper and lower limits of agreement) between Test 1 and Test 2 was 0.1 (-1.9 to 2.1) L/min, combining supine, standing, and step-exercise data. CONCLUSIONS The CORS, as a novel test for objective evaluation of cardiac function, demonstrates acceptable reproducibility and can potentially be implemented in primary care.
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Affiliation(s)
- Sarah J. Charman
- Cardiovascular Research Centre, Institutes of Cellular and Genetic Medicine, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Nduka C. Okwose
- Cardiovascular Research Centre, Institutes of Cellular and Genetic Medicine, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Renae J. Stefanetti
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Medical SchoolNewcastle UniversityNewcastle upon TyneUK
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Kristian Bailey
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Jane Skinner
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Arsen Ristic
- Cardiology Department, Clinical Centre Serbia, School of MedicineUniversity of BelgradeBelgradeSerbia
| | - Petar M. Seferovic
- Cardiology Department, Clinical Centre Serbia, School of MedicineUniversity of BelgradeBelgradeSerbia
| | | | | | - Ahmet Fuat
- Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust and School of Medicine, Pharmacy and HealthDurham UniversityDurhamUK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Richard F.D. Hobbs
- Nuffield Department of Primary Health Care SciencesUniversity of OxfordOxfordUK
| | - Guy A. MacGowan
- Cardiovascular Research Centre, Institutes of Cellular and Genetic Medicine, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Djordje G. Jakovljevic
- Cardiovascular Research Centre, Institutes of Cellular and Genetic Medicine, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
- RCUK Centre for Ageing and VitalityNewcastle UniversityNewcastle upon TyneUK
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