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

{"title":"Impact of intravascular ultrasound for coronary bifurcations treated with last generations stents: insights from the BIFURCAT-ULTRA registry.","authors":"Francesco Bruno, Ki Hong Choi, Ovidio De Filippo, Hyun Kuk Kim, Mattia Doronzo, Yun-Kyeong Cho, Tineke H Pinxterhuis, Jeehoon Kang, Alessio Mattesini, Young Bin Song, Raffaele Piccolo, Bon-Kwon Koo, Wojciech Wańha, Jong Lee, Bernardo Cortese, Hyeon-Cheol Gwon, Leor Perl, Hyo-Soo Kim, Domenico Tuttolomondo, Mario Iannaccone, Woo Jung Chun, Davide Capodanno, Attilio Leone, Alessandra Truffa Giachet, Seung-Ho Hur, Giulio Stefanini, Seung Hwan Han, Javier Escaned, Antonino Carmeci, Gianluca Campo, Giuseppe Patti, Clemens von Birgelen, Gaetano Maria de Ferrari, Chang-Wook Nam, Fabrizio D'Ascenzo","doi":"10.1093/ehjqcco/qcae091","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcae091","url":null,"abstract":"<p><strong>Background: </strong>Bifurcation lesions are associated with higher rates of major adverse cardiovascular events (MACE).</p><p><strong>Aim: </strong>To investigate the impact of imaging-guided PCI in a real-world population with coronary bifurcation lesions.</p><p><strong>Methods: </strong>From the ULTRA-BIFURCAT registry, we compared IVUS vs. angiographic guidance in a cohort of 3486 propensity matched patients. MACE a composite of all-cause death, myocardial infarction (MI), target-lesion revascularization (TLR) and stent-thrombosis was the primary endpoint. Subgroup analyses were performed for unprotected left main (ULM) and non-ULM disease.</p><p><strong>Results: </strong>PSM generated 1743 pairs. MACE occurred in 154 (9%) patients in the IVUS guided group and in 199 (11%) patients in the angio-guided group (p = 0.09). IVUS guidance was associated with lower MACE in the ULM population [HR 0.62, 95% CI 0.46-0.83], but had no impact in the non-ULM population [HR 1.12, 95% CI 0.83-1.51], p for interaction = 0.006. IVUS was associated with reduction in all-MI [HR 0.32, 95% CI 0.16-0.64] in the ULM population and with lower ST in the non-ULM population [HR 0.24, 95% CI 0.08-0.71]. Provisional stenting was associated with lower MACE in the ULM population [HR 0.67, 95% CI 0.45-0.98], whereas kissing balloon [HR 0.75, 95% CI 0.56-0.99] and ultra-thin stents [HR 0.44, 95% CI 0.29-0.67] were protective factors in the non-ULM population.</p><p><strong>Conclusions: </strong>In a real-world scenario, IVUS guidance during DES implantation is associated with a lower rate of MACE in patients with ULM coronary bifurcation lesions. In non-ULM bifurcations, no difference was observed on MACE, while IVUS guidance was associated with a lower rate of ST.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681044","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":"Treatment with PCSK9 monoclonal antibodies is associated with discontinuation of oral lipid lowering therapy.","authors":"Ingrid Engebretsen, Kristina Malene Ødegaard, Sigrun Halvorsen, Christoffer Bugge, Ivar Sønbø Kristiansen, Henrik Støvring, John Munkhaugen","doi":"10.1093/ehjqcco/qcae099","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcae099","url":null,"abstract":"<p><strong>Aims: </strong>Proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9 mAbs) are recommended for high-risk patients if the low-density lipoprotein cholesterol (LDL-C) targets are not achieved with statins and ezetimibe. We studied persistence and adherence to 1) PCSK9 mAbs and 2) statins and ezetimibe in a nationwide cohort of incident PCSK9 mAb users.</p><p><strong>Methods and results: </strong>Information on all PCSK9 mAb users ≤80 years from 2015 through 2023 were extracted from the Norwegian Drug Registry. Discontinuation was defined as a gap in treatment ≥180 days and ≥90 days. Adherence was measured as the proportion of days covered (PDC) during the initial year of PCSK9 mAb therapy. We analyzed adherence of statins and ezetimibe before and after PCSK9 mAb initiation. Of 4,784 patients initiating PCSK9 mAbs, median age was 63 years, 41% were female, 61% had atherosclerotic disease, and 34% had familial hypercholesterolemia. Within three years after initiation, 17% experienced a PCSK9 mAb treatment gap exceeding 180 days. In the 12-month period preceding PCSK9 mAb initiation, 74% dispensed statins whereas 67% dispensed ezetimibe. These numbers were reduced to 35% for statins and 42% for ezetimibe during the 12-month period after PCSK9 mAb initiation. Atherosclerotic disease, using ≥3 statins previously, and older age were significantly associated with discontinuation of statins and ezetimibe.</p><p><strong>Conclusion: </strong>In this high-risk cohort of incident PCSK9 mAb users, more than 1 out of 2 stopped taking statin treatment whereas 40% discontinued ezetimibe. There is a major potential for improving adherence to oral LLD treatment following initiation of PCSK9 mAb.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675367","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 indicators for improved cardiovascular care: learnings from the National Institute for Health and Care Excellence.","authors":"Mark Minchin, Chris Wilkinson, Suleman Aktaa, Chris P Gale","doi":"10.1093/ehjqcco/qcae097","DOIUrl":"10.1093/ehjqcco/qcae097","url":null,"abstract":"","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616904","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":"Economic evaluation of the Liverpool heart failure virtual ward model.","authors":"D Rasoul, I Chattopadhyay, T Mayer, J West, H Stollar, C Black, C Oguguo, R Kaur, R MacDonald, J Pocock, B Uzdzinska, B Umpleby, N Hex, G Y H Lip, R Sankaranarayanan","doi":"10.1093/ehjqcco/qcae095","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcae095","url":null,"abstract":"<p><strong>Background: </strong>A virtual ward (VW) supports patients who would otherwise need hospitalisation by providing acute care, remote monitoring, investigations, and treatment at home. By March 2024 the VW programme had treated 10 950 patients across six speciality VWs, including heart failure (HF). This evaluation presents the economic assessment of the Liverpool HF VW.</p><p><strong>Method: </strong>A comprehensive economic cost comparison model was developed by York Health Economics Consortium (University of York) to compare the costs of the VW to standard hospital inpatient care (SC). The model included direct VW costs and additional costs across the care pathway. Costs and resource use for 648 patients admitted to the HF VW were calculated for 30 days post discharge and total cohort costs were extrapolated to a full year. Primary outcomes included costs related to length of stay, readmissions, and NHS 111 contact.</p><p><strong>Results: </strong>The total cost for the HF VW pathway, including set-up costs, was £467 524. This results in an incremental net cost benefit of £735 512 compared to the total SC cost of £1 203 036, indicating a substantial net cost benefit of £1 135 per patient per episode (PPPE). This advantage remains despite initial setup expenses and ongoing costs such as home visits, virtual consultations, point-of-care (POC) testing and home monitoring equipment.</p><p><strong>Conclusion: </strong>Our HF VW model offers a substantial net cost benefit, driven by reduced hospital stays, fewer emergency department visits, and lower readmission rates. The study highlights the importance of considering system-wide impacts and continuous monitoring of VWs as they develop.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616787","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":"The burden and trends of heart failure caused by ischemic heart disease at the global, regional, and national levels from 1990 to 2021.","authors":"Hongwei Zhang, Xiaoyu Zheng, Pingping Huang, Lijun Guo, Yuan Zheng, Dawu Zhang, Xiaochang Ma","doi":"10.1093/ehjqcco/qcae094","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcae094","url":null,"abstract":"<p><strong>Background: </strong>Ischemic heart disease (IHD) is a major cause of heart failure (HF), a condition expected to increasingly affect global health and economics. This study evaluates the global burden, trends, and disparities of HF linked to IHD, aiming to inform health policy development.</p><p><strong>Methods: </strong>Data from the Global Burden of Disease Study 2021 (GBD2021) is analyzed using Joinpoint regression, decomposition analysis, and Bayesian age-period-cohort analysis (BAPC). Health disparities are assessed through the Socio-demographic Index (SDI) via the Slope Index of Inequality (SII) and the Concentration Index (CI), with future trends projected from 2022 to 2045.</p><p><strong>Results: </strong>In 2021, global HF cases due to IHD were over 19.16 million, with an age-standardized prevalence rate (ASPR) of 228.31 per 100 000 [95% UI, 188.18 to 279.55] and age-standardized years lived with disability (ASYLDs) rate of 20.43 per 100 000 [95% UI, 13.55 to 28.7].In 2021, there was a 2.87% increase in ASPR and ASYLDs compared to 1990, primarily driven by population growth and aging.Significant reductions in global ASPR and ASYLDs disparities are observed, though the disease burden has intensified in countries with lower SDI levels. Projections indicate that by 2045, while the prevalence and YLDs for HF caused by IHD will increase, while the ASPR and ASYLDs are expected to decrease.</p><p><strong>Conclusion: </strong>The global burden of HF from IHD remains a significant concern. Urgent improvements in the allocation of medical resources and the implementation of effective prevention and management strategies are necessary to address this issue.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616905","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":"Psoriasis and risk of new-onset degenerative valvular heart disease: a prospective cohort study.","authors":"Zuoxiang Wang, Junxing Lv, Sheng Zhao, Zheng Yin, Wence Shi, Dejing Feng, Can Wang, Ziang Li, Xiaojin Gao, Yongjian Wu","doi":"10.1093/ehjqcco/qcae096","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcae096","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence indicates that degenerative valvular heart disease (VHD) and psoriasis share overlapping risk factors and simultaneous presence of inflammation, yet this relationship has not been thoroughly explored.</p><p><strong>Methods: </strong>Drawing on the prospective cohort data from the UK Biobank, baseline information on psoriasis and the incidence of eight specific types of degenerative VHD-aortic stenosis (AS), aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid stenosis, tricuspid regurgitation, pulmonary stenosis, and pulmonary regurgitation-during the follow-up period were recorded. Cox proportional hazards models were conducted to estimate the association between psoriasis and the risk of degenerative VHD, adjusted for demographic indicators, lifestyle factors, comorbidities, and medication.</p><p><strong>Results: </strong>A total of 494 510 participants were included in the study. Among the participants without psoriasis, 13 672 events of degenerative VHD were observed during a median follow-up of 13.78 years, yielding an incidence rate of 2.14 per 1 000 person-years. In contrast, In the psoriasis group (n = 10 917), 422 events of degenerative VHD were reported during a median follow-up of 13.70 years, corresponding to an incidence rate of 2.93 per 1 000 person-years. After fully adjusting, participants with psoriasis had a significantly increased risk of AS (HR, 1.24; 95% CI, 1.07-1.43), yet no significant associations were observed between psoriasis and the risk of other degenerative valve diseases. In sex subgroup analyses, there was an interaction between sex and psoriasis in the occurrence of AS (p-interaction = 0.039), suggesting a high risk in women.</p><p><strong>Conclusions: </strong>Psoriasis was significantly associated with the risk of new-onset AS and may be more distinct in females, while no significant associations were observed between psoriasis and the risk of developing other degenerative valve diseases.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616903","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":"Loss of quality of life and increased societal costs in patients with hypertrophic cardiomyopathy: the AFFECT-HCM study.","authors":"S A C Schoonvelde, I Wiethoff, P P Zwetsloot, A Hirsch, C Knackstedt, T Germans, M Sikking, A F L Schinkel, M A van Slegtenhorst, J M A Verhagen, R A de Boer, S M A A Evers, M Hiligsmann, M Michels","doi":"10.1093/ehjqcco/qcae092","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcae092","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertrophic cardiomyopathy (HCM) is the most prevalent inherited cardiac disease. The impact of HCM on quality of life (QoL) and societal costs remains poorly understood. This prospective multi-centre burden of disease study estimated QoL and societal costs of genotyped HCM patients and genotype-positive phenotype-negative (G+/P-) subjects.</p><p><strong>Methods: </strong>Participants were categorized into three groups based on genotype and phenotype: 1) G+/P- (left ventricular (LV) wall thickness <13 mm), 2) non-obstructive HCM (nHCM, LV outflow tract (LVOT) gradient <30 mmHg), and 3) obstructive HCM (oHCM, LVOT gradient ≥30 mmHg). We assessed QoL with EQ-5D-5L and Kansas City Cardiomyopathy Questionnaires (KCCQ). Societal costs were measured using medical consumption (iMCQ) and productivity cost (iPCQ) questionnaires. We performed subanalyses within three age groups: <40, 40-59, and ≥60 years.</p><p><strong>Results: </strong>From three Dutch hospitals, 506 subjects were enrolled (84 G+/P-, 313 nHCM, 109 oHCM; median age 59 years, 39% female). HCM (both nHCM and oHCM) patients reported reduced QoL vs G+/P- subjects (KCCQ: 88 vs 98, EQ-5D-5L: 0.88 vs 0.96; both p<0.001). oHCM patients reported lower KCCQ scores than nHCM patients (83 vs 89, p=0.036). Societal costs were significantly higher in HCM patients (€19,035/year vs €7,385/year) compared to G+/P- controls, mainly explained by higher healthcare costs and productivity losses. Being symptomatic and of younger age (<60 years) particularly led to decreased QoL and increased costs.</p><p><strong>Conclusion: </strong>HCM is associated with decreased QoL and increased societal costs, especially in younger and symptomatic patients. oHCM patients were more frequently symptomatic than nHCM patients. This study highlights the substantial disease burden of HCM and can aid in assessing new therapy cost-effectiveness for HCM in the future.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616902","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":"Impact of Low Physical Activity on Cardiovascular Disease Across Regions and Demographic Groups: Insights from the Global Burden of Disease Study.","authors":"Changxing Liu, Zhirui Zhang, Boyu Wang, Tianwei Meng, Chengjia Li, Hongwei Liu, Xulong Zhang, Kai Kang","doi":"10.1093/ehjqcco/qcae093","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcae093","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) is a leading cause of death globally, with low physical activity (LPA) as a significant modifiable risk factor. The prevalence of LPA remains high, necessitating a comprehensive assessment of its impact on CVD.</p><p><strong>Methods: </strong>We applied Joinpoint regression to assess trends in deaths and Disability-Adjusted Life Years (DALYs) and employed ARIMA models to project future BMI-related burdens.</p><p><strong>Results: </strong>From 1990 to 2021, CVD-related deaths due to LPA rose from 218,938 to 371,736 globally, with the most significant increases in Southeast Asia and Sub-Saharan Africa. DALYs surged from 4.47 million to 7.29 million. Although age-standardized death rates showed a slight decline in high-income countries (-2.27% EAPC), lower-income regions experienced a steady rise. YLDs grew from 344,680 to 725,181, while YLLs increased from 4.13 million to 6.57 million, with older adults (75+ years) carrying the highest burden.</p><p><strong>Conclusion: </strong>The growing burden of CVD linked to LPA highlights the urgent need for interventions, particularly in low- and middle-income countries, to reduce future risks and improve public health outcomes.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616820","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":"Clinical and genetic diagnosis of familial hypercholesterolaemia in patients undergoing coronary angiography: the Ludwigshafen Risk and Cardiovascular Health Study.","authors":"Stefan Molnar, Hubert Scharnagl, Graciela E Delgado, Bernhard K Krämer, Ulrich Laufs, Winfried März, Marcus E Kleber, Julius L Katzmann","doi":"10.1093/ehjqcco/qcad075","DOIUrl":"10.1093/ehjqcco/qcad075","url":null,"abstract":"<p><strong>Aims: </strong>To investigate the prevalence of familial hypercholesterolaemia (FH) and compare the performance of clinical criteria and genetic testing in patients undergoing coronary angiography.</p><p><strong>Methods and results: </strong>The prevalence of FH was determined with the Dutch Lipid Clinical Network (DLCN), US 'Make Early Diagnosis to Prevent Early Death' (US-MEDPED), Simon Broome (SB) criteria, the 'familial hypercholesterolaemia case ascertainment tool' (FAMCAT), and a clinical algorithm. Genetic screening was conducted with a custom array from Affymetrix (CARRENAL array) harbouring 944 FH mutations.The study cohort consisted of 3267 patients [78.6% with coronary artery disease (CAD)]. FH was diagnosed in 2.8%, 2.2%, 3.9%, and 7.9% using the DLCN, US-MEDPED, SB criteria, and the FAMCAT. The clinical algorithm identified the same patients as the SB criteria. Pathogenic FH mutations were found in 1.2% (1.2% in patients with CAD, 1.0% in patients without CAD). FH was more frequently diagnosed in younger patients. With genetic testing as reference, the clinical criteria achieved areas under the ROC curve [area under the curves (AUCs)] in the range of 0.56-0.68. Using only low-density lipoprotein cholesterol (LDL-C) corrected for statin intake, an AUC of 0.68 was achieved.</p><p><strong>Conclusion: </strong>FH is up to four-fold more prevalent in patients undergoing coronary angiography than in contemporary cohorts representing the general population. Different clinical criteria yield substantially different diagnosis rates, overestimating the prevalence of FH compared with genetic testing. LDL-C testing alone may be sufficient to raise the suspicion of FH, which then needs to be corroborated by genetic testing.</p><p><strong>Lay summary: </strong>In this study, we investigated the frequency of familial hypercholesterolaemia-a common genetic condition leading to markedly elevated low-density lipoprotein (LDL) cholesterol and increased risk of atherosclerosis-in 3267 patients undergoing coronary angiography according to commonly used diagnostic scoring systems and genetic testing.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"632-640"},"PeriodicalIF":4.8,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139402334","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":"Catheter ablation as an adjunctive therapy to ICD implantation in Brugada Syndrome.","authors":"Ioannis Doundoulakis, Sotirios Chiotis, Luigi Pannone, Domenico Giovanni Della Rocca, Antonio Sorgente, Athanasios Kordalis, Roberto Scacciavillani, Stefanos Zafeiropoulos, Lorenzo Marcon, Giampaolo Vetta, Eirini Pagkalidou, Gezim Bala, Alexandre Almorad, Erwin Ströker, Juan Sieira, Mark La Meir, Pedro Brugada, Dimitrios Tsiachris, Andrea Sarkozy, Gian Battista Chierchia, Carlo de Asmundis","doi":"10.1093/ehjqcco/qcae040","DOIUrl":"10.1093/ehjqcco/qcae040","url":null,"abstract":"<p><strong>Background: </strong>Brugada Syndrome (BrS) is a life-threatening cardiac arrhythmia disorder associated with an increased risk of ventricular arrhythmias (VAs) and sudden cardiac death. Current management primarily relies on implantable cardioverter-defibrillators (ICDs), but patients may experience ICD shocks. Catheter ablation (CA) has emerged as a potential intervention to target the arrhythmogenic substrate. This systematic review aims to evaluate the safety and efficacy of CA in BrS patients.</p><p><strong>Methods and results: </strong>Studies with BrS patients undergoing CA for VAs were included. Fourteen studies that involved a total population of 709 BrS patients, with CA performed in 528 of them, were included. CA resulted in the non-inducibility of VAs in 91% (95% CI: 83-99, I2 = 76%) and resolution of type 1 ECG Brugada pattern in 88% (95% CI: 81-96.2, I2 = 91%) of the patients. After a mean follow-up of 30.7 months, 87% (95% CI: 80-94, I2 = 82%) of patients remained free from VAs. The incidence of VAs during follow-up was significantly lower in the ablation cohort in comparison to the group receiving only ICD therapy (OR = 0.03, 95% CI: 0.01-0.12, I2 = 0%).</p><p><strong>Conclusion: </strong>CA shows potential as a therapeutic approach to reduce VAs and improve outcomes in BrS patients. While further research with a long follow-up period is required to confirm these findings, it represents a valuable tool as an add-on intervention to ICD implantation in BrS patients with a high burden of VAs.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"590-601"},"PeriodicalIF":4.8,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080912","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}