European Heart Journal - Quality of Care and Clinical Outcomes最新文献

{"title":"Polypharmacy on first admission to hospital for people with heart failure: baseline findings from the PULSE cohort.","authors":"Janine Beezer, Andrew L Clark, Adam Todd, Andrew Kingston, John Casement, Lucy Pages, Andrew Husband","doi":"10.1093/ehjqcco/qcaf032","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf032","url":null,"abstract":"<p><strong>Aim: </strong>To define and characterise polypharmacy in people with heart failure.</p><p><strong>Methods: </strong>The PULSE dataset is a bespoke single centre, retrospective, longitudinal, observational cohort database of patients hospitalised for heart failure, capturing data from the first heart failure admission through to death or end of data collection, including all subsequent admissions. First admission with heart failure was used to define baseline polypharmacy.</p><p><strong>Results: </strong>There were 660 patients included in the dataset, 55.6% male, mean age 76.1 (± SD12.3). Median number of medications on admission was 9 and on discharge 10 (25th-75th centile 7-12). Polypharmacy prevalence was 87.3% on admission, increasing at discharge to 95.1% (p<0.001). Mean medication complexity index score increased from 28.5 (±SD 14.9) at admission to 31.8 (± 14.1) at discharge; (p<0.001). Number of medications on admission increased with increasing age (p<0.001), higher Charlson Comorbidity Index (p<0.001), numerically more comorbidities (p<0.001), higher clinical frailty scale (p<0.001), longer length of stay (p=0.03), worse New York Heart Association class of symptoms (p=0.04) and a diagnosis of heart failure with preserved ejection fraction compared to heart failure with reduced ejection fraction (p=0.002). Cardiovascular medications contributed 50% of medications. Prescribing of heart failure medications reduced with increased polypharmacy.</p><p><strong>Conclusion: </strong>Polypharmacy is common on first admission to hospital for people with heart failure. More medications at admission is associated with increasing age, co-morbidity, and frailty. People with polypharmacy are more likely to have a heart failure with preserved ejection fraction diagnosis, have worse symptoms and a longer hospital stay.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of anticoagulation and outcomes after mechanical aortic valve replacement in patients with atrial fibrillation: a nationwide cohort study.","authors":"Joonas Lehto, Rikhard Björn, Olli Halminen, Miika Linna, Jari Haukka, Jukka Putaala, Pirjo Mustonen, Janne Kinnunen, Juha Hartikainen, Juhani K E Airaksinen, Tuomas O Kiviniemi, Mika Lehto","doi":"10.1093/ehjqcco/qcaf028","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf028","url":null,"abstract":"<p><strong>Background and aims: </strong>Mechanical aortic valve replacement (AVR) remains the primary treatment for younger patients with severe aortic valve disease. However, limited information is available regarding the quality of the required lifelong Vitamin K Antagonist (VKA) therapy, atrial fibrillation (AF), and their relationship with adverse events after AVR. This study assessed the quality of VKA therapy prior to bleeding and ischemic events following mechanical AVR in AF patients.</p><p><strong>Methods: </strong>The registry-based FinACAF study combining data from several Finnish healthcare registers covers all patients diagnosed with AF during 2007-2018 in Finland. This analysis included patients undergoing mechanical AVR before or after the AF diagnosis.</p><p><strong>Results: </strong>A total of 1086 patients with mechanical AVR and AF either before (41.2%) or after (58.8%) the operation were identified. Cumulative incidence estimates at 10 years after AVR were 27.9% for significant bleeding, 5.8% for intracranial hemorrhage, 12.8% for ischemic stroke, and 7.2% for myocardial infarction. Time in Therapeutic Range (TTR) <80% with INR target 2.0-3.5 was associated with higher bleeding occurrence (aHR 1.97, 1.39-2.79, p<0.001). TTR with INR target ≥2.0 was associated with higher stroke occurrence (aHR/SD 1.22, 1.01-1.46, p=0.035). Mortality was high (28.9%/10 years), and TTR <80% was associated with higher mortality (aHR 2.74, 2.00-3.76, p<0.001).</p><p><strong>Conclusions: </strong>Adverse events, particularly major bleeding, are common in AF patients following mechanical AVR, and mortality is high. Suboptimal TTR appears to predict bleeding episodes, ischemic stroke, and death, and it could be useful in high-risk patient identification and targeting of preventive strategies.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality Counts: Revisiting Anticoagulation After Mechanical Aortic Valve Replacement in Patients with Atrial Fibrillation.","authors":"Erwan Donal, Andromahi Zygouri, Prayuth Rasmeehirun","doi":"10.1093/ehjqcco/qcaf030","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf030","url":null,"abstract":"","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal trends in loss of expected lifetime associated with cardiovascular complications following newly diagnosed atrial fibrillation: A Danish nationwide cohort study from 2000-2022.","authors":"Nicklas Vinter, Søren Paaske Johnsen, Emelia J Benjamin, Gregory Y H Lip, Lars Frost","doi":"10.1093/ehjqcco/qcaf026","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf026","url":null,"abstract":"<p><strong>Background and aims: </strong>While advancements in care may improve the clinical course of atrial fibrillation (AF), data on trends in lost lifetime after developing cardiovascular complications are sparse.</p><p><strong>Methods: </strong>In this nationwide registry-based matched cohort study (January 1, 2000-December 31, 2022), we followed patients with ischemic stroke, gastrointestinal bleeding, intracranial bleeding, heart failure (HF), and myocardial infarction (MI) after AF and matched referents with AF. We estimated the average loss of life expectancy as the difference in restricted mean survival time between patients with AF with and without a complication and compared the loss between 2000-2010 and 2011-2022.</p><p><strong>Results: </strong>We followed 27,809 patients with ischemic stroke, 28,938 with gastrointestinal bleeding, 7,710 with intracranial bleeding, 50,914 with HF, and 14,141 with MI and their matched referents. The loss of lifetime improved for ischemic stroke (-2.1 vs. -1.8 years; difference 4.0 months, 95%CI 2.4 to 5.6; P<0.001). We found no evidence of trends for gastrointestinal (-1.7 vs. -1.8 years; difference -0.8 months, 95%CI -2.5 to 0.8; P=0.32) or intracranial bleeding (-3.3 vs. -3.1 years; difference 1.6 months, 95%CI -1.3 to 4.6; P=0.28). The loss of lifetime improved for HF (-2.1 vs. -1.9 years; difference 2.4 months, 95%CI 0.9 to 3.8; P=0.001), and MI (-1.6 vs. -1.1 years; difference 5.9 months, 95%CI 3.3-8.5; P<0.001).</p><p><strong>Conclusion: </strong>Among patients with AF, the loss of expected lifetime after incident ischemic stroke, HF, and MI improved modestly over the past two decades but not after gastrointestinal or intracranial bleeding. These findings support the development and evaluation of interventions that prevent and reduce severity of complications after AF, particularly for bleeding.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward a better definition of the metabolic/obese HFpEF phenotype?","authors":"Riccardo Inciardi, Gianluigi Savarese","doi":"10.1093/ehjqcco/qcaf027","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf027","url":null,"abstract":"","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A decade of follow-up: atrial fibrillation, pulmonary pressure, and the progression of tricuspid regurgitation.","authors":"Ranel Loutati, Asaf Katz, Amit Segev, Rafael Kuperstein, Avi Sabbag, Elad Maor","doi":"10.1093/ehjqcco/qcae075","DOIUrl":"10.1093/ehjqcco/qcae075","url":null,"abstract":"<p><strong>Background and aims: </strong>Long-term data on atrial fibrillation (AF) impact on tricuspid regurgitation (TR) progression and its relation to pulmonary pressure are scant. We investigated this association in a study spanning over a decade.</p><p><strong>Methods and results: </strong>Adults with echocardiographic evaluation before 2014, free of significant TR, were included. Patients were dichotomized by baseline AF, followed by stratification according to systolic pulmonary artery pressure (sPAP). The development of new significant TR and its impact on mortality were studied. Study population included 21 502 patients (median age 65, 40% female), 13% had baseline AF. During a median follow-up of 12 years, 11% developed significant TR. Compared with patients free of AF, patients with baseline AF were 3.5 and 1.3 times more likely to develop significant TR in univariate and multivariate models, respectively (95% CI 3.27-3.91, 1.18-1.44, P < 0.001 for both). The risk of TR progression was higher in patients with permanent AF and those treated with rate control strategy (hazard ratio 1.95 and 2.01, respectively; P < 0.001 for both). The association of AF with TR progression was sPAP-related, being more pronounced among patients with normal sPAP than among those with elevated sPAP (HR 1.5 vs. 1.18; P for interaction <0.001). TR progression was independently linked to a two-fold higher mortality risk, consistent regardless of baseline AF (P < 0.001).</p><p><strong>Conclusion: </strong>AF is an independent predictor of TR progression, especially in patients with normal sPAP. Subsequent research on strategies to prevent TR progression in this patient population is warranted.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"312-322"},"PeriodicalIF":4.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal trends of prescription rates, oral anticoagulants dose, clinical outcomes, and factors associated with non-anticoagulation in patients with incident atrial fibrillation.","authors":"Jo-Nan Liao, Yi-Hsin Chan, Ling Kuo, Chuan-Tsai Tsai, Chih-Min Liu, Tzeng-Ji Chen, Gregory Y H Lip, Shih-Ann Chen, Tze-Fan Chao","doi":"10.1093/ehjqcco/qcaf002","DOIUrl":"10.1093/ehjqcco/qcaf002","url":null,"abstract":"<p><strong>Aims: </strong>To analyse the temporal trends of oral anticoagulant (OAC) prescription, direct oral anticoagulant (DOAC) dose, clinical outcomes, and factors associated with non-anticoagulation in patients with incident atrial fibrillation (AF).</p><p><strong>Methods and results: </strong>During 1 January 2011-31 December 2020, a total of 249 107 patients with newly diagnosed AF were identified, and the 1-year risks of ischaemic stroke, intracranial haemorrhage (ICH), and all-cause mortality were analysed. OAC prescription increased from 22.1% in 2011 to 57.7% in 2020 with DOAC accounting for 91.0% of overall OAC prescriptions. Compared to patients with incident AF diagnosed in 2011, there were increasing trends for a greater decrease in the risks of ischaemic stroke during 2012-2020 and mortality during 2014-2020, while the risk of ICH did not change significantly. For DOAC users, higher dose use increased from 11.04% in 2012 to 44.29% in 2019-2020 temporally associated with a lower risk of ischaemic stroke in the years 2015-2017 and 2018-2020 compared to 2012-2014. Determining factors refraining from OAC use included some 'patient-related factors' and 'non-patient' factors (AF diagnosed at clinics by physicians other than cardiologist/neurologist/internal medicine and citizens outside municipalities).</p><p><strong>Conclusion: </strong>There was an increasing trend of OAC prescription, temporally associated with a decreased risk of ischaemic stroke and mortality. Among DOACs users, the risk of ischaemic stroke declined gradually, partly explained by the increasing prescriptions of higher dose DOACs. Both patient and non-patient factors were associated with non-anticoagulation. Further efforts are required to increase OAC prescription.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"300-311"},"PeriodicalIF":4.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimated annual healthcare costs after acute pulmonary embolism: results from a prospective multicentre cohort study.","authors":"Katharina Mohr, Philipp Mildenberger, Thomas Neusius, Konstantinos C Christodoulou, Ioannis T Farmakis, Klaus Kaier, Stefano Barco, Frederikus A Klok, Lukas Hobohm, Karsten Keller, Dorothea Becker, Christina Abele, Leonhard Bruch, Ralf Ewert, Irene Schmidtmann, Philipp S Wild, Stephan Rosenkranz, Stavros V Konstantinides, Harald Binder, Luca Valerio","doi":"10.1093/ehjqcco/qcae050","DOIUrl":"10.1093/ehjqcco/qcae050","url":null,"abstract":"<p><strong>Aims: </strong>Patients surviving acute pulmonary embolism (PE) necessitate long-term treatment and follow-up. We estimated, the chronic economic impact of PE on the German healthcare system.</p><p><strong>Methods and results: </strong>We calculated the direct cost of illness during the first year after discharge for the index PE, analysing data from a multicentre prospective cohort study in Germany. Main and accompanying readmission diagnoses were used to calculate DRG-based hospital reimbursements; anticoagulation costs were estimated from the exact treatment duration and each drug's unique national identifier; and outpatient post-PE care costs from guidelines-recommended algorithms and national reimbursement catalogues. Of 1017 patients enrolled at 17 centres, 958 (94%) completed ≥3-month follow-up; of those, 24% were rehospitalized (0.34 [95% CI 0.30-0.39] readmissions per PE survivor). Age, coronary artery, pulmonary and kidney disease, diabetes, and (in the sensitivity analysis of 837 patients with complete 12-month follow-up) cancer, but not recurrent PE, were independent cost predictors by hurdle gamma regression accounting for zero readmissions. The estimated rehospitalization cost was €1138 (95% CI 896-1420) per patient. Anticoagulation duration was 329 (IQR 142-365) days, with estimated average per-patient costs of €1050 (median 972; IQR 458-1197); costs of scheduled ambulatory follow-up visits amounted to €181. Total estimated direct per-patient costs during the first year after PE ranged from €2369 (primary analysis) to €2542 (sensitivity analysis).</p><p><strong>Conclusion: </strong>By estimating per-patient costs and identifying cost drivers of post-PE care, our study may inform decisions concerning implementation and reimbursement of follow-up programmes aiming at improved cardiovascular prevention.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"334-342"},"PeriodicalIF":4.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141476236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolving landscape of atrial fibrillation: diagnosis and therapy.","authors":"Andrea Attanasio, Gianluigi Guida, Giandomenico Disabato, Massimo Piepoli","doi":"10.1093/ehjqcco/qcaf015","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf015","url":null,"abstract":"","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":"11 3","pages":"223-224"},"PeriodicalIF":4.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relation of changes in ABC pathway compliance status to clinical outcomes in patients with atrial fibrillation: a report from the COOL-AF registry.","authors":"Rungroj Krittayaphong, Ply Chichareon, Komsing Methavigul, Sukrit Treewaree, Gregory Y H Lip","doi":"10.1093/ehjqcco/qcae039","DOIUrl":"10.1093/ehjqcco/qcae039","url":null,"abstract":"<p><strong>Aims: </strong>The Atrial fibrillation Better Care (ABC) pathway provides a framework for holistic care management of atrial fibrillation (AF) patients. This study aimed to determine the impact of changes in compliance to ABC pathway management on clinical outcomes.</p><p><strong>Methods and results: </strong>This is a prospective multicenter AF registry. Patients with non-valvular AF were enrolled and followed-up for 3 years. Baseline and follow-up compliance to the ABC pathway was assessed. The main outcomes were all-cause death, ischaemic stroke/systemic embolism, major bleeding, and heart failure. There studied 3096 patients (mean age 67.6 ± 11.1 years, 41.8% female). Patients were categorized into four groups: Group 1: ABC compliant at baseline and 1 year [n = 1022 (33.0%)]; Group 2: ABC non-compliant at baseline but compliant at 1 year [n = 307 (9.9%)]; Group 3: ABC compliant at baseline and non-compliant at 1 year [n = 312 (10.1%)]; and Group 4: ABC non-compliant at baseline and also at 1 year [n = 1455 (47.0%)]. The incidence rates [95% confidence intervals (CI)] of the composite outcome for Group 1-4 were 5.56 (4.54-6.74), 7.42 (5.35-10.03), 9.74 (7.31-12.70), and 11.57 (10.28-12.97), respectively. With Group 1 as a reference, Group 2-4 had hazard ratios (95% CI) of the composite outcome of 1.32 (0.92-1.89), 1.75 (1.26-2.43), and 2.07 (1.65-2.59), respectively.</p><p><strong>Conclusion: </strong>Re-evaluation of compliance status of the ABC pathway management is needed to optimize integrated care management and improve clinical outcomes. AF patients who were ABC pathway compliant at baseline and also at follow-up had the best clinical outcomes.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"239-248"},"PeriodicalIF":4.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141093108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}