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

{"title":"The European Heart Journal. Quality of Care and Clinical Outcome in the years to come: a salutation from the incoming Editor-in-Chief.","authors":"Massimo Piepoli, Andrea Attanasio","doi":"10.1093/ehjqcco/qcaf013","DOIUrl":"10.1093/ehjqcco/qcaf013","url":null,"abstract":"","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"225-227"},"PeriodicalIF":4.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742679","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":"Assessment of the safety and efficacy of catheter ablation for atrial fibrillation in very elderly patients: insight from the national prospective registry study.","authors":"Koichi Inoue, Michikazu Nakai, Teiichi Yamane, Kengo Kusano, Seiji Takatsuki, Kazuhiro Satomi, Yoshitaka Iwanaga, Koshiro Kanaoka, Reina Tonegawa-Kuji, Yoko Sumita, Misa Takegami, Yoko M Nakao, Akihiko Nogami, Yoshihiro Miyamoto, Wataru Shimizu","doi":"10.1093/ehjqcco/qcae072","DOIUrl":"10.1093/ehjqcco/qcae072","url":null,"abstract":"<p><strong>Background and aims: </strong>This study evaluated the safety and efficacy of catheter ablation in treating atrial fibrillation (AF) among the elderly population.</p><p><strong>Methods and results: </strong>A total of 170 017 AF ablation procedures prospectively enrolled from 482 facilities between 2017 and 2020 were analysed. They were stratified into six age groups, ranging from <65 to ≥85 years, in 5-year increments. A cut-off of 80 years was set for dividing participants into two groups. The primary endpoints included procedure-related complications and 1-year arrhythmia recurrence after a 3-month blanking period. Patients ≥80 years constituted 7.2% of procedures in 2017, which significantly increased to 9.6% by 2020 (P < 0.001). This older group predominantly comprised women with smaller stature and body mass index, a higher prevalence of paroxysmal AF, and a higher rate of initial ablation procedures. The overall complication rate was 2.8%, showing a positive correlation with age (P < 0.001), peaking at 4.3% for patients ≥85 years. Older age remained a significant independent risk factor for complications (odds ratio: 1.36 [1.24, 1.49], P < 0.001). Cardiac tamponade, ischaemic stroke, and sick sinus syndrome were more common in the elderly. The recurrence rate in the total population was 16.0% and did not differ significantly between age groups (log-rank P = 0.473), remaining consistent even after adjusting for multiple variables.</p><p><strong>Conclusion: </strong>Although age increases complication risk, recurrence rates remained steady across age groups, suggesting that AF ablation is a reasonable option for elderly individuals, contingent on careful patient selection for safety.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"323-333"},"PeriodicalIF":4.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145415","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":"Non-invasive physiological assessment of intermediate coronary stenoses from plain angiography through artificial intelligence: the STARFLOW system.","authors":"Ovidio De Filippo, Raffaele Mineo, Michele Millesimo, Wojciech Wańha, Federica Proietto Salanitri, Antonio Greco, Antonio Maria Leone, Luca Franchin, Simone Palazzo, Giorgio Quadri, Domenico Tuttolomondo, Enrico Fabris, Gianluca Campo, Alessandra Truffa Giachet, Francesco Bruno, Mario Iannaccone, Giacomo Boccuzzi, Nicola Gaibazzi, Ferdinando Varbella, Wojciech Wojakowski, Michele Maremmani, Guglielmo Gallone, Gianfranco Sinagra, Davide Capodanno, Giuseppe Musumeci, Paolo Boretto, Pawel Pawlus, Andrea Saglietto, Francesco Burzotta, Marco Aldinucci, Daniela Giordano, Gaetano Maria De Ferrari, Concetto Spampinato, Fabrizio D'Ascenzo","doi":"10.1093/ehjqcco/qcae024","DOIUrl":"10.1093/ehjqcco/qcae024","url":null,"abstract":"<p><strong>Background: </strong>Despite evidence supporting use of fractional flow reserve (FFR) and instantaneous waves-free ratio (iFR) to improve outcome of patients undergoing coronary angiography (CA) and percutaneous coronary intervention, such techniques are still underused in clinical practice due to economic and logistic issues.</p><p><strong>Objectives: </strong>We aimed to develop an artificial intelligence (AI)-based application to compute FFR and iFR from plain CA.</p><p><strong>Methods and results: </strong>Consecutive patients performing FFR or iFR or both were enrolled. A specific multi-task deep network exploiting 2 projections of the coronary of interest from standard CA was appraised. Accuracy of prediction of FFR/iFR of the AI model was the primary endpoint, along with sensitivity and specificity. Prediction was tested both for continuous values and for dichotomous classification (positive/negative) for FFR or iFR. Subgroup analyses were performed for FFR and iFR.A total of 389 patients from 5 centers were enrolled. Mean age was 67.9 ± 9.6 and 39.2% of patients were admitted for acute coronary syndrome. Overall, the accuracy was 87.3% (81.2-93.4%), with a sensitivity of 82.4% (71.9-96.4%) and a specificity of 92.2% (90.4-93.9%). For FFR, accuracy was 84.8% (77.8-91.8%), with a sensitivity of 81.9% (69.4-94.4%) and a specificity of 87.7% (85.5-89.9%), while for iFR accuracy was 90.2% (86.0-94.6%), with a sensitivity of 87.2% (76.6-97.8%) and a specificity of 93.2% (91.7-94.7%, all confidence intervals 95%).</p><p><strong>Conclusion: </strong>The presented machine-learning based tool showed high accuracy in prediction of wire-based FFR and iFR.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"343-352"},"PeriodicalIF":4.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142389028","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":"Supraventricular ectopic activity predicts postoperative atrial fibrillation, new-onset atrial fibrillation, and worse survival in obstructive hypertrophic cardiomyopathy.","authors":"Changrong Nie, Changsheng Zhu, Minghu Xiao, Zining Wu, Qiulan Yang, Zhengyang Lu, Tao Lu, Yanhai Meng, Shuiyun Wang","doi":"10.1093/ehjqcco/qcae101","DOIUrl":"10.1093/ehjqcco/qcae101","url":null,"abstract":"<p><strong>Background: </strong>Supraventricular ectopic activity (SVEA) is a marker of foci that may initiate atrial fibrillation (AF) and is associated with worse survival. The types and frequencies of SVEA for predicting postoperative AF (POAF), new-onset AF, and clinical outcomes in obstructive hypertrophic cardiomyopathy (oHCM) remain unknown.</p><p><strong>Methods and results: </strong>Our study consecutively recruited 961 patients with oHCM. All patients underwent a 24-h Holter monitor before surgery. POAF incidence was 20.7% and increased with the burden of premature atrial contractions (PACs). Multivariable analysis showed that supraventricular tachycardia (SVT) was independently associated with POAF, with the model including SVT yielding the largest area under the curve (AUC) [0.710, 95% CI 0.670-0.750] for predicting POAF. During a median follow-up of 2.9 years, 12 deaths, 60 new-onset AF, and 139 composite endpoints were observed. A Spearman correlation indicated a linear relationship between the incidence of new-onset AF and composite endpoints with PAC frequency. The Kaplan-Meier survival curves demonstrated that patients with PACs >200 beats/day had significantly higher cumulative rates of new-onset AF [HR 3.13, (95% CI 1.74-5.62), P < 0.001] and composite endpoints [HR 2.00, (95% CI 1.30-3.06), P = 0.002] than their counterparts. Adding PACs >200 beats/day to the multivariable model significantly improved net reclassification improvement (NRI) and integrated discrimination improvement (IDI) for predicting new-onset AF (NRI = 0.264, IDI = 0.033) and composite endpoints (NRI = 0.233, IDI = 0.014).</p><p><strong>Conclusion: </strong>The incidence of POAF was 20.7%, increasing with PACs severity. Furthermore, PACs burden was positively associated with a higher incidence of adverse events. Specially, PACs >200 beats/day may best predict a higher incidence of new-onset AF and worse survival.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"271-281"},"PeriodicalIF":4.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823889","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":"Stroke outcomes in patients with new onset perioperative atrial fibrillation complicating major abdominal surgery compared with patients with new onset non-perioperative atrial fibrillation.","authors":"Amine Tas, Emil Loldrup Fosbøl, Morten Vester-Andersen, Jakob Burcharth, Jawad Haider Butt, Lars Køber, Anna Gundlund","doi":"10.1093/ehjqcco/qcae064","DOIUrl":"10.1093/ehjqcco/qcae064","url":null,"abstract":"<p><strong>Background: </strong>Major emergency abdominal surgery is associated with postoperative complications and high mortality. Long-term outcomes in patients with perioperative atrial fibrillation (POAF) have recently received increased attention, especially POAF in non-thoracic surgery.</p><p><strong>Purpose: </strong>This study aimed to compare long-term AF related hospitalization and stroke in patients with POAF in relation to major emergency abdominal surgery and in patients with non-perioperative AF.</p><p><strong>Methods and results: </strong>We crosslinked data from Danish nationwide registries and identified all patients who underwent major emergency abdominal surgery (2000-2018) and were diagnosed with POAF, and patients who developed AF in a non-perioperative setting. Patients with POAF were matched in a 1:5 ratio on age, sex, year of AF diagnosis, and oral anticoagulation (OAC) status at the beginning of follow-up with patients with non-perioperative AF. From discharge, we examined adjusted hazard ratios (HRs) of stroke using multivariable Cox regression analysis. The study population comprised 1041 (out of 42 021 who underwent major emergency abdominal surgery) patients with POAF and 5205 patients with non-perioperative AF. The median age was 78 years [interquartile range: 71-84] for those initiated on OAC therapy and 78 years [interquartile range: 71-85] for those not initiated on OAC therapy. During the first year of follow up, POAF was associated with similar rates of stroke as non-perioperative AF {patients initiated on OAC: HR 0.96 [95% confidence interval (CI) 0.52-1.77] and patients not initiated on OAC: HR 0.69 (95% CI 0.41-1.15)}.</p><p><strong>Conclusion: </strong>POAF in relation to major emergency abdominal surgery was associated with similar rates of stroke as non-perioperative AF. These results suggest that POAF not only carry an acute burden but also a long-term burden in patients undergoing major emergency abdominal surgery.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"249-258"},"PeriodicalIF":4.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141765794","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":"Contemporary trends in incident ischaemic stroke, intracranial haemorrhage, and mortality in individuals with atrial fibrillation.","authors":"Jean Jacques Noubiap, Janet J Tang, Thomas A Dewland, Gregory M Marcus","doi":"10.1093/ehjqcco/qcae022","DOIUrl":"10.1093/ehjqcco/qcae022","url":null,"abstract":"<p><strong>Background: </strong>The prognosis for atrial fibrillation (AF) patients is based on data that is decades old. Given evolving standards of clinical practice, we sought to evaluate temporal trends in clinically important outcomes among patients with AF.</p><p><strong>Methods and results: </strong>California's Department of Health Care Access and Information databases were used to identify adults aged ≥18 years with AF receiving hospital-based care in California. We compared three time-periods: 2005-2009, 2010-2014, and 2015-2019. International Classification of Diseases codes were used to identify chronic diseases and acute events. The outcomes were incident ischaemic stroke, intracranial haemorrhage, and overall mortality. We included 2 009 832 patients with AF (52.7% males, 70.7% Whites, and mean age of 75.0 years), divided in three cohorts: 2005-2009 (n = 738 954), 2010-2014 (n = 609 447), and 2015-2019 (n = 661 431). Each outcome became substantially less common with time: compared with 2005-2009, AF patients diagnosed in 2015-2019 experienced a 34% (adjusted hazard ratio [HR] 0.66, 95% confidence interval 0.64-0.69), 22% (HR 0.78, 0.75-0.82), and 24% (HR 0.76, 0.75-0.77) reduction in risk of incident ischaemic stroke, intracranial haemorrhage, and mortality, respectively. Between 2005-2009 and 2015-2019, patients aged ≥65 years experienced more reductions in each outcome compared with younger patients (P < 0.001 for all), and declines in each outcome were significantly lower for Hispanics and Blacks compared with white patients.</p><p><strong>Conclusion: </strong>The risks of stroke, intracranial haemorrhage, and death have significantly declined among AF patients, although differences in the magnitude of improvement of these outcomes by demographic groups were observed. Commonly described estimates of the prognosis for AF patients should be updated to reflect contemporary care.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"228-238"},"PeriodicalIF":4.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856502","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":"Atrial fibrillation status and associations with adverse clinical outcomes in patients hospitalized with COVID-19: a large unselected statewide population-linkage study.","authors":"Jia Yi Anna Ne, Clara K Chow, Vincent Chow, Karice Hyun, Leonard Kritharides, David Brieger, Austin Chin Chwan Ng","doi":"10.1093/ehjqcco/qcae115","DOIUrl":"10.1093/ehjqcco/qcae115","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is common in COVID-19 patients. The impact of AF on major-adverse-cardiovascular-events (MACE is defined as all-cause mortality, myocardial infarction, ischaemic stroke, cardiac failure, or coronary revascularization), recurrent AF admission, and venous thromboembolism in hospitalized COVID-19 patients is unclear.</p><p><strong>Methods and results: </strong>Patients admitted with COVID-19 (1 January 2020 to 30 September 2021) were identified from the New South Wales Admitted-Patient-Data-Collection database, stratified by AF status (no-AF vs. prior-AF or new-AF during index COVID-19 admission) and followed-up until 31 March 2022. Multivariable Cox regression and competing risk analyses were performed to assess the impact of AF on MACE and non-fatal outcomes respectively. Our cohort comprised 145 293 COVID-19 patients (median age 67.4 years old; 49.7% males): new-AF, n = 5140 (3.5%); prior-AF, n = 23 204 (16.0%). During a median follow-up of 9 months, prior-AF and new-AF patients had significantly higher MACE events (44.7% vs. 36.2% vs. 18.0%) and all-cause mortality (36.0% vs. 28.7% vs. 15.2%) compared to no-AF patients (both logrank P < 0.001). After adjusting for age, gender, intensive-care-unit admission, referral source, and comorbidities, compared to no-AF, new-AF and prior-AF groups were independently associated with MACE [adjusted hazard ratio (aHR) = 1.15, 95% confidence interval (CI) = 1.09-1.20; aHR = 1.36, 95% CI = 1.33-1.40, respectively]. Competing risk analyses showed rehospitalization rates for ischaemic stroke, cardiac failure, and AF, but not venous thromboembolism, were significantly higher in these patients. Both new-AF and prior-AF patients had higher rehospitalization rates for ischaemic stroke compared to no-AF patients, independent of CHA2DS2VASc.</p><p><strong>Conclusion: </strong>COVID-19 patients with AF are at high risk of adverse clinical outcomes. Such patients may need increased surveillance and consideration for early anticoagulation.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"291-299"},"PeriodicalIF":4.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921304","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":"Post-discharge pharmacotherapy in people with atrial fibrillation hospitalized for acute myocardial infarction: an Australian cohort study 2018-22.","authors":"Claire T Deakin, Juliana de Oliveira Costa, David Brieger, Jialing Lin, Andrea L Schaffer, Michael Kidd, Sallie-Anne Pearson, Michael O Falster","doi":"10.1093/ehjqcco/qcae068","DOIUrl":"10.1093/ehjqcco/qcae068","url":null,"abstract":"<p><strong>Background: </strong>Dual antiplatelet therapy with P2Y12 inhibitors (P2Y12i) and aspirin following acute myocardial infarction (AMI) prevents future ischaemic events. People with atrial fibrillation (AF) also require oral anticoagulants (OAC), increasing bleeding risk. Guidelines recommend post-discharge prescribing of direct OAC with clopidogrel and discontinuation of P2Y12i after 12 months, but little is known about use in clinical practice.</p><p><strong>Aim: </strong>To describe post-discharge use of OACs and P2Y12i in people with AF and a history of OAC use hospitalized for AMI.</p><p><strong>Methods and results: </strong>We identified 1330 people hospitalized for AMI with a diagnosis of AF and history of OAC use in New South Wales, Australia, July 2018-June 2020. We identified three aspects of post-discharge antithrombotic medicine use with possible safety implications: (1) not being dispensed OACs; (2) dispensing OAC and P2Y12i combinations associated with increased bleeding (involving warfarin, ticagrelor, or prasugrel); and (3) P2Y12i use longer than 12 months.After discharge, 74.3% of people were dispensed an OAC, 45.4% were dispensed a P2Y12i, and 35.8% were dispensed both. People with comorbid heart failure or cancer were less likely to receive OACs. Only 11.2% of people who dispensed both an OAC and P2Y12i received combinations associated with increased bleeding; this was more common among people with chronic kidney disease or prior warfarin or statin use. A total of 44.6% of people dispensed both medicines continued P2Y12i for over 12 months; this was more common in people who received a revascularization or lived in areas of social disadvantage.</p><p><strong>Conclusion: </strong>We identified potential gaps in pharmacotherapy, including underuse of recommended therapies at discharge, use of combinations associated with increased bleeding, and P2Y12i use beyond 12 months. Prescribing vigilance across both hospital and community care is required.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"259-270"},"PeriodicalIF":4.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906254","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":"Beyond Obesity: Metabolic status as key driver for cardiovascular outcomes in patients undergoing invasive coronary angiography.","authors":"Eva Steinacher, Andreas Hammer, Ulrike Baumer, Felix Hofer, Niema Kazem, Max Lenz, Michael Leutner, Irene Lang, Christian Hengstenberg, Patrick Sulzgruber, Lorenz Koller, Alexander Niessner, Andreas Kammerlander","doi":"10.1093/ehjqcco/qcaf023","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf023","url":null,"abstract":"<p><strong>Aim: </strong>Metabolic disorders are established risk factors for coronary artery disease (CAD) and major adverse cardiovascular events (MACE). Although obesity is closely associated with metabolic disease, data on its role as a separate cardiovascular risk modifier in metabolically healthy individuals are limited, particularly in patients with CAD. Thus, this study aims to investigate risk profiles of metabolic phenotypes on outcomes in patients undergoing invasive coronary angiography (ICA).</p><p><strong>Methods: </strong>12-,760 patients evaluated for chronic coronary syndrome (CCS) were distinguished into four metabolic phenotypes: metabolically healthy/unhealthy non-obese/obese (MHN, MHO, MUN, MUO). The association of metabolic phenotypes with outcome was assessed using Cox regression models, adjusted for age, sex, and renal dysfunction.</p><p><strong>Results: </strong>Within the total study cohort (median age 68 years, 57.3% male), 56.5% presented metabolically healthy (43.3% MHN; 13.1% MHO) and 43.5% metabolically unhealthy (28.3% MUN; 15.2% MUO). Irrespective of CCS, metabolic phenotypes showed different risks for MACE, all-cause mortality, and revascularization. While metabolic disease emerged as a robust predictor of events, obesity alone did not (e.g., in patients with obstructive CCS: MHO vs. MHN: adj. HR 0.947 [95% CI 0.728 - 1.231], p = 0.683; MUO vs. MUN: adj. HR 0.974 [95% CI 0.809 - 1.172], p = 0.780). However, metabolically healthy individuals experienced lower event rates with increasing BMI.</p><p><strong>Conclusions: </strong>This study indicates metabolic health, rather than obesity, is a key predictor of adverse events in CCS prevention, revealing an obesity paradox in metabolically healthy individuals. Thus, cardiovascular risk assessment should prioritize metabolic health over BMI. Integrating metabolic profiling into routine evaluations may help optimize prevention and personalized treatment strategies.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959412","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":"Heart failure clinical registries vs. registering the reality of heart failure.","authors":"Alberto Cordero, Mª Amparo Quintanilla","doi":"10.1093/ehjqcco/qcaf025","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf025","url":null,"abstract":"","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997296","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}