Clinical Cardiology最新文献

{"title":"SGLT2 Inhibitors and Sleep Quality in Heart Failure: Implications for Patient-Centered Outcomes","authors":"Surender Himral,&nbsp;Jaibharat Sharma,&nbsp;Shivali Sandal,&nbsp;Kunal Mahajan","doi":"10.1002/clc.70208","DOIUrl":"https://doi.org/10.1002/clc.70208","url":null,"abstract":"<p>We read with great interest the article by Erbay et al. [<span>1</span>] evaluating the impact of sodium-glucose co-transporter-2 (SGLT2) inhibitors on sleep quality, anxiety, and quality of life in patients with heart failure (HF). The study contributes meaningfully to the dialog surrounding patient-centered outcomes in HF management. However, several important methodological limitations essential for interpretation were not sufficiently discussed in the manuscript. First, the nonrandomized, physician-directed allocation of SGLT2 inhibitor therapy in this study introduces a substantial potential for selection bias and confounding by indication. Physicians may preferentially prescribe SGLT2 inhibitors to patients who are perceived to be more likely to benefit, be clinically stable, or demonstrate better adherence [<span>2</span>]. Such confounding can extend beyond the measured baseline parameters and affect both clinical and subjective outcomes, including sleep and anxiety. Second, the study groups were imbalanced with respect to key baseline characteristics: the SGLT2 cohort was notably younger and had a significantly higher prevalence of diabetes mellitus (DM). Both age and DM status independently alter sleep architecture, anxiety, and overall quality of life, increasing the risk that these factors, rather than the intervention itself, underpin the observed improvements [<span>3</span>]. In small sample sizes, the capacity to statistically adjust for these complex interrelations is inherently limited. Third, sleep quality assessment in the study relied solely on the Pittsburgh Sleep Quality Index (PSQI), a validated but subjective questionnaire, without incorporating objective sleep measures such as actigraphy or polysomnography. Given the high prevalence of undiagnosed sleep-disordered breathing in HF and the recognized limitations of self-reported measures in this population, the absence of objective evaluation may introduce measurement bias and limit causal inference [<span>4</span>]. Fourth, the study is limited by its short follow-up duration (6 months) and the absence of granular data on changes in concurrent HF and psychotropic medications during follow-up. Short-term improvements may not be sustained over time, and undocumented modifications in concomitant therapy can confound the attribution of the observed benefits exclusively to SGLT2 inhibitors. Furthermore, differential attrition, particularly resulting from hospitalization or mortality, exacerbates the potential for survivor bias [<span>5</span>], a critical consideration in the HF population. Taken together, these limitations underscore the need for cautious interpretation of the reported benefits and reinforce the imperative for future randomized, controlled, and objectively assessed studies with longer follow-ups to establish the patient-centered efficacy of SGLT2 inhibitors in HF.</p><p>All authors contributed to the writing of the correspondence and have approved the fina","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70208","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methodological and Statistical Concerns Regarding “Can Sodium-Glucose Co-Transporter-2 Inhibitors Improve Sleep Quality, Anxiety, and Quality of Life in Patients With Heart Failure?”","authors":"Rajeev Gupta,&nbsp;Shekhar Vohra,&nbsp;Anshul Yadav,&nbsp;Neelesh Gupta,&nbsp;Rohit Mody","doi":"10.1002/clc.70203","DOIUrl":"https://doi.org/10.1002/clc.70203","url":null,"abstract":"<p>The recent article by Erbay et al. reporting improved sleep quality, anxiety, and quality of life in heart failure patients receiving SGLT2 inhibitors [<span>1</span>] addresses a clinically important but underexplored area. However, several methodological limitations merit attention before these findings are generalized.</p><p>First, there was a significant baseline imbalance in Pittsburgh Sleep Quality Index (PSQI) scores between groups (5.0 vs. 6.0, <i>p</i> = 0.036). This difference, favoring the SGLT2 inhibitor group at baseline, may partially explain the magnitude of improvement observed. While within-group analyses were performed, regression models should have included baseline PSQI as a covariate to mitigate this confounding [<span>2</span>].</p><p>Second, the multivariate logistic regression did not adjust for several potential confounders that could influence patient-reported outcomes, including changes in diuretic dosing, concurrent initiation of other guideline-directed medical therapies, and intercurrent hospitalizations. These variables are known to impact congestion, sleep, and mood in heart failure [<span>3, 4</span>].</p><p>Third, the subgroup analyses by ejection fraction status are based on small sample sizes, limiting statistical power and precision. Without reporting interaction <i>p</i>-values, the assertion of consistent benefit across EF strata is premature [<span>5</span>].</p><p>Fourth, multiple SF-36 domains and other secondary outcomes were tested without correction for multiplicity. In this setting, the risk of false-positive findings is high, particularly in small observational cohorts [<span>6</span>].</p><p>Lastly, the study's observational, single-center design precludes definitive causal inference, yet several statements in the discussion imply a treatment effect. This language should be tempered to reflect association rather than causation [<span>7</span>].</p><p>Given the increasing integration of SGLT2 inhibitors into heart failure care, it is critical that conclusions about novel patient-reported benefits be supported by rigorous methodology. Randomized controlled trials incorporating objective sleep measures (e.g., polysomnography) and adequate adjustment for confounding are needed to validate these intriguing findings.</p><p>Use of AI for paraphrasing and in analyzing the statistical model used in the study.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70203","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144927315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Ascertainment and Exposure Classification in Acute Myocardial Infarction Mortality Studies Involving Psychoactive Substance Use","authors":"Noor-ul-Eman Haider,&nbsp;Syed Muhammed Rayyan,&nbsp;Muhammad Abbas","doi":"10.1002/clc.70202","DOIUrl":"https://doi.org/10.1002/clc.70202","url":null,"abstract":"<p>We welcome the recent analysis of acute myocardial infarction (AMI) death in US adults aged ≥ 65 with documented psychoactive substance abuse disorders [<span>1</span>]. Attention by the authors to an elderly population is well-timed, in light of increased co-occurrence of cardiovascular disease and substance abuse in the elderly. Two important limitations—one clinical, the other methodological—are acknowledged, however, because they affect substantially both validity and interpretability of the results.</p><p>Epidemiological studies that use death certificate data for employment are fraught with a very high potential for case ascertainment bias in this particular situation. In elderly populations, AMI is frequently listed on death certificates by clinical history or circumstantial information in place of verifying electrocardiography or cardiac biomarker tests [<span>2</span>]. Challenging presentations, cross-competing comorbidities, and silent myocardial infarction are not uncommon in this group and make both under- and overattribution of AMI as a cause of death more likely [<span>3</span>].</p><p>Equally problematic is the determination of psychoactive substance use. Toxicology is not the norm for older deaths unless there is obvious suspicion, and when it is done, it can be a restricted panel only [<span>4</span>]. This results in severe underreporting of drug use. Social stigma, clinician refusal to report, and ignorance regarding how to distinguish from prescribed versus nonprescribed use contribute to the risk of misclassification. When both outcome and exposure are tainted by classification error, cause-specific mortality rate estimates can distort changes in reporting patterns rather than capturing epidemiologic trends. Follow-up analyses using mortality registry data here need to be controlled for this dual-source bias to maintain interpretive validity.</p><p>Second, operationalization of exposure—reducing all ICD-10 F10–F19 categories into a single combined “psychoactive substance use disorder” category—is clinically restrictive. All of those codes cannot be collapsed into one usefully homogeneous category from the viewpoint of cardiovascular pathophysiology. Risk of AMI due to alcohol is secondary to chronic remodeling and arrhythmogenesis of the myocardium; cocaine and amphetamines via acute coronary vasospasm and proarrhythmic effects; opioids via hypoxia and bradyarrhythmia; sedatives via induction of hypotension and delay in conduction [<span>5</span>].</p><p>By combining these mechanistically different exposures, the study conceals substance-specific patterns of mortality and prevents investigators from being able to determine whether trends are a result of stimulant-induced acute events, alcohol-induced chronic damage, or polypharmacy effects. This limitation reduces the value of the study for cardiologists, addiction specialists, and policymakers who need substance-specific data to implement effective interventions. Further","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144918635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Pulmonary Hypertension in Individuals With Heart Failure: A Systematic Review and Meta-Analysis","authors":"Maaedah Khan,&nbsp;Rhea Suribhatla,&nbsp;Jak Spencer,&nbsp;Nadia Daniel,&nbsp;Alex Pitcher,&nbsp;Christiana Kartsonaki","doi":"10.1002/clc.70197","DOIUrl":"https://doi.org/10.1002/clc.70197","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Heart failure (HF) is a leading cause of hospitalizations worldwide. HF can lead to pulmonary hypertension (PH) and co-occurrence of HF and PH is associated with a poor prognosis. This systematic review and meta-analysis aim to estimate the prevalence of PH in patients with HF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched MEDLINE and EMBASE for studies reporting the prevalence of PH amongst HF patients. A meta-analysis of PH prevalence, including subgroup analyses, was conducted using a random-effects model. Subgroup analyses and meta-regressions by comorbidities and patient characteristics were done. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-four papers with 259 665 HF patients were included, of which 46 004 also had PH. The overall PH prevalence estimate in individuals with HF is 46.6% (95% CI: 39.6%–53.7%). Prevalence varied by diagnostic method, with studies using right heart catheterization reporting the highest estimates (62.5%; 52.0%–72.0%), hospital recorded data the lowest (18.4%; 14.4%–23.3%), and echocardiography 45.7% (37.1%–54.6%). Prevalence was higher in HF with preserved (47.2%; 34.8%–60.0%) than reduced ejection fraction (35.7%; 22.6%–51.3%). Prospective studies show higher estimates (60.1%; 50.7%–68.8%) than retrospective studies (37.3%; 29.5%–45.9%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is the first systematic review and meta-analysis investigating the prevalence of PH in HF patients and shows that the prevalence of PH in this patient population is strikingly high. There is notable variability in estimates reported by different studies, largely attributed to differences in the diagnostic method of PH. Future studies with robust, standardized methodologies are needed to estimate prevalence more accurately.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70197","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial Fibrillation and Obstructive Sleep Apnea: Do Mortality Trends Reflect Disease Burden or Diagnostic Gaps?","authors":"Naoya Kataoka,&nbsp;Teruhiko Imamura","doi":"10.1002/clc.70200","DOIUrl":"https://doi.org/10.1002/clc.70200","url":null,"abstract":"<p>The authors demonstrated a striking and consistent rise in atrial fibrillation (AF)–related mortality involving obstructive sleep apnea (OSA), particularly among elderly, female, rural, and minority populations [<span>1</span>]. This important analysis highlights the growing public health burden of AF–OSA overlap. However, several issues merit further clarification and discussion.</p><p>The authors report a steep increase in AF-related mortality involving OSA over the past two decades [<span>1</span>]. However, as AF prevalence and mortality have also generally increased in the U.S. population [<span>2</span>], it is unclear whether the observed trend is specific to patients with comorbid OSA or merely reflects overall AF epidemiology. A comparative analysis of mortality trends in AF patients without OSA would be helpful to determine the additive risk associated with OSA.</p><p>During the study period (1999–2020), catheter ablation became increasingly adopted for rhythm control in AF [<span>3</span>]. Recent studies suggest that AF ablation is associated with improved long-term outcomes, particularly in younger male patients [<span>4</span>]. Yet, despite these advances, AF-related mortality in patients with OSA continued to rise. How do the authors interpret this apparent contradiction? Were these procedures less commonly used or less effective in the OSA subgroup?</p><p>The study identifies AF (ICD-10 I48.x) as the “underlying” cause of death and OSA (G47.33) as a “contributing” condition [<span>1</span>]. However, the clinical circumstances in which AF is recorded as the primary cause of death—distinct from its role as a comorbidity in stroke, heart failure, or sudden death—are not well defined. It would be informative to clarify how “AF-related mortality” was operationalized in this study and whether misclassification or variation in coding practices may have influenced the observed trends.</p><p>The authors correctly point out the rising burden of AF-related mortality in the presence of OSA [<span>1</span>]. Yet over the same period, mortality from stroke and heart failure—two major downstream complications of AF—has generally declined, partly due to improvements in anticoagulation and HF management [<span>5</span>]. This discrepancy raises the question of whether the increase in AF-related deaths reflects actual clinical deterioration or improved documentation of AF on death certificates.</p><p>While the use of CDC WONDER provides valuable national-level insights [<span>1</span>], the reliance on death certificate data introduces several limitations. OSA is often underdiagnosed, particularly among women, minorities, and older adults—groups in whom mortality increases were most pronounced. Additionally, data on OSA severity, AF subtype, comorbidities (e.g., heart failure, chronic kidney disease), and continuous positive airway pressure adherence were not available. These unmeasured variables may have played an important role in shaping th","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70200","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on the Observational Study on Statin Intensity Following CABG","authors":"Murat Abdulhamit Ercişli,&nbsp;Ahmet Süsenbük","doi":"10.1002/clc.70198","DOIUrl":"https://doi.org/10.1002/clc.70198","url":null,"abstract":"<p>We read with interest the article titled “Effect of Statin Intensity on Cardiovascular Outcomes and Survival Following Coronary Artery Bypass Grafting” recently published in Clinical Cardiology [<span>1</span>]. The study addresses a crucial area concerning optimal lipid management in patients undergoing Coronary Artery Bypass Grafting (CABG), particularly the impact of statin intensity on long-term cardiovascular outcomes.</p><p>While we commend the authors for conducting this relevant and timely observational study, we would like to raise several points for clarification and discussion, which might significantly impact the interpretation of the results:</p><p>First, we note considerable discrepancies in patient numbers between the comparison groups: No-statin (156 patients), low/moderate-intensity statin (1301 patients), and high-intensity statin (397 patients). Although the authors acknowledged this statistical concern due to the observational study design, such imbalanced group sizes may inherently introduce bias and confounding, limiting the reliability and generalizability of the conclusions.</p><p>Second, the authors mentioned that older patients and women were less likely to receive statins or were prescribed lower-intensity statins. This finding raises concerns regarding potential selection bias or disparities in clinical practice. It would be helpful for the authors to elaborate further on possible reasons for these discrepancies and their potential influence on clinical outcomes.</p><p>Third, the study did not adequately track patient compliance or continued usage of statins over the follow-up period, which is pivotal to understanding the true impact of the medication. Given that statin adherence significantly influences clinical outcomes, this limitation might have considerably affected the study's conclusions.</p><p>Additionally, the authors defined Major Adverse Cardiovascular Events (MACE) broadly to include acute coronary syndrome (ACS), cerebrovascular accident (CVA), and cardiovascular mortality. However, the study did not consider graft occlusion rates directly, which could significantly affect revascularization rates and subsequent MACE. Including graft occlusion data might have provided additional critical insights into statin efficacy.</p><p>Lastly, the timing of lipid measurements, which were taken variably between 1 and 3 months postoperatively, could introduce measurement bias. This variability in follow-up LDL measurements might limit the robustness of the conclusions drawn about the efficacy of lipid management.</p><p>Despite these concerns, the findings strongly suggest potential long-term benefits associated with high-intensity statin therapy in reducing cardiovascular risks post-CABG, especially evident beyond 2 years. This underscores the importance of robust randomized controlled trials to conclusively establish the most effective lipid-lowering strategies in post-CABG patients.</p><p>We appreciate the authors' ","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Underrepresented Factors in Cardiovascular Mortality Trends Among Chronic Kidney Disease Patients: A Call for Comprehensive Intervention Strategies","authors":"Shaher Yar,&nbsp;Zahin Shahriar,&nbsp;Sumaiya Ahmed,&nbsp;Muhammad Shehzad Asif","doi":"10.1002/clc.70199","DOIUrl":"https://doi.org/10.1002/clc.70199","url":null,"abstract":"&lt;p&gt;I read with great interest the comprehensive retrospective analysis by Ahmad et al. examining cardiovascular mortality trends in chronic kidney disease (CKD) patients from 1999 to 2020 [&lt;span&gt;1&lt;/span&gt;]. While the authors excellently document demographic disparities and temporal patterns in cardiovascular mortality, their work highlights several critical gaps that warrant further discussion, particularly regarding the underutilization of evidence-based interventions and the impact of emerging therapeutic paradigms on cardiovascular outcomes in CKD patients.&lt;/p&gt;&lt;p&gt;The study period (1999−2020) captures a transformative era in CKD management, yet the authors do not adequately address how the introduction of novel therapies may explain certain mortality trends. The 2024 KDIGO guidelines now emphasize SGLT2 inhibitors as cornerstone therapy, showing remarkable cardiovascular benefits in CKD populations [&lt;span&gt;2&lt;/span&gt;]. Recent meta-analyses demonstrate that SGLT2 inhibitors reduce major adverse cardiovascular events by 9%−14% in CKD patients, with particularly strong effects on heart failure hospitalization and cardiovascular death [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Similarly, the emergence of non-steroidal mineralocorticoid receptor antagonists (MRAs) like finerenone has revolutionized CKD-cardiovascular care. The pooled FIDELITY analysis demonstrated a 14% reduction in cardiovascular death, myocardial infarction, stroke, and heart failure hospitalization, with a 23% reduction in CKD progression [&lt;span&gt;4&lt;/span&gt;]. These therapeutic advances, introduced toward the end of the study period, likely contributed to the stabilization of mortality rates observed by Ahmad et al.&lt;/p&gt;&lt;p&gt;The significant racial and geographic disparities documented by the authors reflect deeper healthcare access issues that extend beyond demographic risk factors. Research demonstrates that up to 98% of people with kidney failure in low-income regions cannot access kidney replacement therapy, compared to 30% in high-income countries [&lt;span&gt;5&lt;/span&gt;]. Within the United States, these disparities manifest as differential access to nephrology care, with rural and minority populations experiencing delays in specialist referral and reduced access to evidence-based therapies [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The authors' observation that non-metropolitan areas exhibited higher age-adjusted mortality rates (8.6 vs. 8.1 per 100 000) underscores the critical role of healthcare infrastructure in cardiovascular outcomes. Studies show that less than one-third of community healthcare settings in resource-limited areas can access essential diagnostics for CKD monitoring, further contributing to delayed intervention and poor outcomes [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The study period concludes in 2020, capturing the early COVID-19 pandemic impact. Recent evidence demonstrates that COVID-19 significantly amplifies cardiovascular risk in CKD patients, with a twofold increased risk of cardiovascular death within 30 days and a 64","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70199","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144905528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to “Physician and Patient Preferences for Oral Anticoagulation Therapy Decision Making in Atrial Fibrillation: Results From a National Best–Worst Scaling Survey in Türkiye”","authors":"Pref-Af Study Group","doi":"10.1002/clc.70193","DOIUrl":"https://doi.org/10.1002/clc.70193","url":null,"abstract":"<p>K. Kılıckesmez, D. Aras, M. Degertekin, et al., “Physician and Patient Preferences for Oral Anticoagulation Therapy Decision Making in Atrial Fibrillation: Results From a National Best–Worst Scaling Survey in Türkiye,” <i>Clinical Cardiology</i> 47 (2024): e70038. https://doi.org/10.1002/clc.70038</p><p>In the published version of this article, the <b>Pref-Af Study Group</b> was missing in the author by-line. The correct author list should be:</p><p>K. Kılıckesmez, D. Aras, M. Degertekin, N. Ozer, B. Hacibedel, K. Helvacioglu, U. Koc, B. Ozdengulsun, E. Dundar Ahi, Pref-Af Study Group, and O. Ergene</p><p>Additionally, the <b>Acknowledgments</b> section has been updated as follows:</p><p>Medical writing and editorial support was provided by Ferda Kiziltas at remedium Consulting Group. The Pref-Af study group contributed to this study during the data collection and the names of the contributors as follows: Betul Balaban Kocas, Firdevs Aysenur Ekizler, Ayse Colak, Ahmet Anil Baskurt, Erdal Durmus, and Ugur Nadir Karakulak.</p><p>We apologize for this error.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 8","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70193","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality Trends Associated With Acute Myocardial Infarction and Psychoactive Substance Use in Older Adults: A US Nationwide Analysis (1999–2020)","authors":"Muhammad Hamza Shuja,&nbsp;Ramish Hannat,&nbsp;Ahmad Shahid,&nbsp;Komail Khalid Meer,&nbsp;Ayesha Mubbashir,&nbsp;Maliha Edhi,&nbsp;Irfan Ullah,&nbsp;Ahmad Alareed,&nbsp;Nitish Behary Paray,&nbsp;Raheel Ahmed,&nbsp;Bernardo Cortese,&nbsp;Michael E. Hall","doi":"10.1002/clc.70191","DOIUrl":"https://doi.org/10.1002/clc.70191","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acute myocardial infarction (AMI) remains a leading cause of mortality in the USA, particularly among individuals aged 65 and older. There is limited research about the association between psychoactive substance use and cardiovascular death due to AMI. This study aims to analyze trends in AMI-related mortality among older adults (aged ≥ 65) associated with psychoactive substance use in the USA from 1999 to 2020, with a focus on demographic and geographic variations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a descriptive analysis using death certificates from the CDC's WONDER database. Data were extracted for age, sex, race/ethnicity, urban–rural status, and geographic region. Crude mortality rates and AAMR were calculated, and temporal trends were assessed using Joinpoint regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 1999 and 2020, there were 231 359 AMI-related deaths among older adults with substance use disorders. Men (39.2) had a markedly higher mortality rate than women (15.0). Mortality rates increased across all age groups, with the most pronounced rise in those aged 85 and older (33.9). Metropolitan areas (22.3) experienced lower mortality rates than nonmetropolitan areas (37.9). The Midwest (32.3) consistently recorded the highest mortality rates, followed by the Northeast (25.0), South (24.5), and West (18.7).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study reveals notable temporal trends in AMI mortality among older adults with psychoactive substance use, highlighting significant demographic and regional disparities. These findings underscore the need for targeted interventions to address this growing public health issue.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 8","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70191","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Sodium-Glucose Co-Transporter-2 Inhibitors Improve Sleep Quality, Anxiety, and Quality of Life in Patients With Heart Failure?","authors":"Ilke Erbay,&nbsp;Naile Eris Gudul,&nbsp;Ahmet Furkan Suner,&nbsp;Pelin Aladag,&nbsp;Umit Karacar,&nbsp;Ahmet Avci","doi":"10.1002/clc.70190","DOIUrl":"https://doi.org/10.1002/clc.70190","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sodium-glucose co-transporter-2 (SGLT2) inhibitors improve cardiovascular outcomes in heart failure (HF), but their effect on sleep quality (SQ) and patient-centered outcomes remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aims to evaluate the impact of SGLT2 inhibitor use on SQ, anxiety, and quality of life in patients with HF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This longitudinal observational study included 95 HF patients grouped by SGLT2 inhibitor use. A total of 79 patients (SGLT2 inhibitor group: 33; non-SGLT2 inhibitor group: 46) completed a 6-month follow-up. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), anxiety with the Beck Anxiety Inventory (BAI), and quality of life with the Short Form-36 (SF-36). Subgroup analyses were conducted based on left ventricular ejection fraction (LVEF), and logistic regression was used to identify predictors of PSQI improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, PSQI scores were slightly better in the SGLT2 inhibitor group (<i>p</i> = 0.036), while BAI and SF-36 scores were similar. At follow-up, the SGLT2 inhibitor group showed significant improvements in PSQI (<i>p</i> &lt; 0.001) and BAI (<i>p</i> = 0.002), whereas no significant changes were observed in the non-SGLT2 inhibitor group for either PSQI (<i>p</i> = 0.698) or BAI (<i>p</i> = 0.373). PSQI improvement was observed in SGLT2 users regardless of LVEF. In multivariate analysis, SGLT2 inhibitor use was an independent predictor of PSQI improvement (adjusted OR: 4.255; <i>p</i> = 0.010).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SGLT2 inhibitor use was associated with improved SQ and reduced anxiety in patients with HF, suggesting symptom-related benefits beyond cardiovascular effects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 8","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144773999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}