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

{"title":"Global burden of heart failure and its underlying causes in 204 countries and territories, 1990-2021.","authors":"Qin-Fen Chen, Lifen Chen, Christos S Katsouras, Chenyang Liu, Jingjing Shi, Dongjie Liang, Guangze Xiang, Han Zhu, Hetong Liao, Weihong Lin, Xi Zhou, Xiao-Dong Zhou","doi":"10.1093/ehjqcco/qcae110","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcae110","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) presents a significant global health challenge due to its rising prevalence and impact on disability.</p><p><strong>Aims: </strong>This study aims to comprehensively analyze the global burden of HF and its underlying causes.</p><p><strong>Methods: </strong>Using data from the Global Burden of Disease Study 2021, we analyzed the prevalence and Years Lived with Disability (YLD) of HF, examining its implications across diverse demographics and geographic regions.</p><p><strong>Results: </strong>In 2021, approximately 55.5 million (95% UI 49.0-63.8) people worldwide were affected by HF, a significant increase from 25.4 million (95% UI 22.3-29.2) in 1990. The age-standardized prevalence rate per 100 000 people was 676.7 (95% UI 598.7-776.8) overall, with males experiencing a higher rate at 760.8 (95% UI 673.2-874.7) compared to females at 604.0 (95% UI 535.0-692.3). The age-standardized prevalence YLD rates increased by 5.5% (95% CI 2.7-8.5) and 5.9% (95% CI 2.9-9.0) during this period. Ischemic heart disease emerged as the primary cause of HF, with an age-standardized prevalence rate of 228.3 (95% UI 118.2-279.6), followed by hypertensive heart disease at 148.3 (95% UI 117.3-186.3), and cardiomyopathy/myocarditis at 62.0 (95% UI 51.2-73.2). Noteworthy, countries in the high Socio-Demographic Index (SDI) quintile exhibited higher HF prevalence rates but maintained stable trends. In contrast, countries in lower SDI quintiles, while initially experiencing lower prevalence rates, showed increased age-standardized HF prevalence and YLD rates over the same period.</p><p><strong>Conclusions: </strong>HF emerges as a significant and growing public health challenge globally, influenced by distinct socioeconomic gradients.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946769","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":"Hypertrophic cardiomyopathy management: a systematic review of the clinical practice guidelines and recommendations.","authors":"Mihir M Sanghvi, Eamon Dhall, C Anwar A Chahal, Constantinos O'Mahony, Saidi A Mohiddin, Konstantinos Savvatis, Fabrizio Ricci, Patricia B Munroe, Steffen E Petersen, Nay Aung, Mohammed Y Khanji","doi":"10.1093/ehjqcco/qcae117","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcae117","url":null,"abstract":"<p><strong>Aims: </strong>In light of recent advances in imaging techniques, molecular understanding and therapeutic options in hypertrophic cardiomyopathy (HCM), we performed a systematic review of current guidelines for the diagnosis and management of HCM in order to identify consensus and discrepant areas in the clinical practice guidelines.</p><p><strong>Methods and results: </strong>We systematically reviewed the English language guidelines and recommendations for the management of HCM in adults. MEDLINE and EMBASE databases were searched for guidelines published in the last 10 years. Following a systematic search, three guidelines on the diagnosis and management of HCM were identified, all of which were robustly developed (AGREE rigour of development score ≥50%). These guidelines were authored by the major European (ESC; 2023), American (AHA/ACC/AMSSM/HRS/PACES/SCMR; 2024) and Japanese (JCS/JHFS; 2018) cardiovascular societies. There was broad consensus on echocardiographic recommendations, the medical and invasive management of HCM, the application of genetic testing and family screening, and exercise and reproductive recommendations in HCM. There were areas of variability in the definition and diagnostic criteria for HCM, cardiovascular magnetic resonance (CMR) imaging recommendations and assessment of sudden cardiac death (SCD) risk and prevention strategies. Due to the JCS/JHFS guideline being older, there are no recommendations on the use of cardiac myosin ATPase inhibitors.</p><p><strong>Conclusion: </strong>Contemporary guidelines for HCM achieve consensus across a broad range of criteria and recommendations concerning diagnosis and management. However, variations in the approach towards risk assessment for SCD exist between the guidelines. There are also more subtle differences concerning diagnostic criteria and the utility of late gadolinium enhancement for risk stratification, which will likely evolve as the evidence-base broadens.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921347","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":"Atrial fibrillation status and associations with adverse clinical outcomes in patients hospitalised 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":"https://doi.org/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 defined as all-cause mortality, myocardial infarction, ischemic stroke, cardiac failure or coronary revascularisation), recurrent AF admission and venous thromboembolism in hospitalised COVID-19 patients is unclear.</p><p><strong>Methods: </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-Mar-2022. Multivariable Cox regression and competing risk analyses were performed to assess the impact of AF on MACE and non-fatal outcomes respectively.</p><p><strong>Results: </strong>Our cohort comprised 145293 COVID-19 patients (median age 67.4yo; 49.7% males): new-AF, n=5140 (3.5%); prior-AF, n=23204 (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 rehospitalisation rates for ischemic stroke, cardiac failure and AF, but not venous thromboembolism, were significantly higher in these patients. Both new-AF and prior-AF patients had higher rehospitalisation rates for ischemic stroke compared to no-AF patients, independent of CHA2DS2VASc.</p><p><strong>Conclusions: </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":""},"PeriodicalIF":4.8,"publicationDate":"2025-01-02","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":"Sex-based analysis of NSTEMI processes of care and outcomes by hospital: a nationwide cohort study.","authors":"Nicholas Weight, Saadiq Moledina, Evangelos Kontopantelis, Harriette Van Spall, Mohammed Dafaalla, Alaide Chieffo, Mario Iannaccone, Denis Chen, Muhammad Rashid, Josepa Mauri-Ferre, Jacqueline E Tamis-Holland, Mamas A Mamas","doi":"10.1093/ehjqcco/qcae011","DOIUrl":"10.1093/ehjqcco/qcae011","url":null,"abstract":"<p><strong>Background: </strong>Contemporary studies demonstrate that non-ST-segment elevation myocardial infarction (NSTEMI) processes of care vary according to sex. Little is known regarding variation in practice between geographical areas and centres.</p><p><strong>Methods: </strong>We identified 305 014 NSTEMI admissions in the United Kingdom (UK) Myocardial Ischaemia National Audit Project (MINAP), 2010-17, including female sex (110 209). Hierarchical, multivariate logistic regression models were fitted, assessing for differences in primary outcomes according to sex. Risk-standardized mortality rates (RSMR) were calculated for individual hospitals to illustrate the correlation with variables of interest. 'Heat maps' were plotted to show regional and sex-based variation in the opportunity-based quality indicator score (surrogate for optimal processes of care).</p><p><strong>Results: </strong>Women presented older (77 years vs. 69 years, P < 0.001) and were more often Caucasian (93% vs. 91%, P < 0.001). Women were less frequently managed with an invasive coronary angiogram (58% vs. 75%, P < 0.001) or percutaneous coronary intervention (35% vs. 49%, P < 0.001). In our hospital-clustered analysis, we show a positive correlation between the RSMR and the increasing proportion of women treated for NSTEMI (R2 = 0.17, P < 0.001). There was a clear negative correlation between the proportion of women who had an optimum OBQI score during their admission and RSMR (R2 = 0.22, P < 0.001), with a weaker correlation in men (R2 = 0.08, P < 0.001). Heat maps according to the Clinical Commissioning Group (CCG) demonstrate significant regional variation in the OBQI score, with women receiving poorer quality care throughout the UK.</p><p><strong>Conclusion: </strong>There was a significant variation in the management of patients with NSTEMI according to sex, with widespread geographical variation. Structural changes are required to enable improved care for women.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"750-762"},"PeriodicalIF":4.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139697183","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":"Long-term survival after surgical treatment for post-infarction mechanical complications: results from the Caution study.","authors":"Matteo Matteucci, Daniele Ronco, Mariusz Kowalewski, Giulio Massimi, Michele De Bonis, Francesco Formica, Federica Jiritano, Thierry Folliguet, Nikolaos Bonaros, Sandro Sponga, Piotr Suwalski, Andrea De Martino, Theodor Fischlein, Giovanni Troise, Guglielmo Actis Dato, Filiberto Giuseppe Serraino, Shabir Hussain Shah, Roberto Scrofani, Jurij Matija Kalisnik, Andrea Colli, Claudio Francesco Russo, Marco Ranucci, Matteo Pettinari, Adam Kowalowka, Matthias Thielmann, Bart Meyns, Fareed Khouqeer, Jean-Francois Obadia, Udo Boeken, Caterina Simon, Shiho Naito, Andrea Musazzi, Roberto Lorusso","doi":"10.1093/ehjqcco/qcae010","DOIUrl":"10.1093/ehjqcco/qcae010","url":null,"abstract":"<p><strong>Aims: </strong>Mechanical complications (MCs) are rare but potentially fatal sequelae of acute myocardial infarction (AMI). Surgery, though challenging, is considered the treatment of choice. The authors sought to study the early and long-term results of patients undergoing surgical treatment for post-AMI MCs.</p><p><strong>Methods and results: </strong>Patients who underwent surgical treatment for post-infarction MCs between 2001 through 2019 in 27 centres worldwide were retrieved from the database of the CAUTION study. In-hospital and long-term mortality were the primary outcomes. Cox proportional hazards regression models were used to determine independent factors associated with overall mortality. The study included 720 patients. The median age was 70.0 [62.0-77.0] years, with a male predominance (64.6%). The most common MC encountered was ventricular septal rupture (VSR) (59.4%). Cardiogenic shock was seen on presentation in 56.1% of patients. In-hospital mortality rate was 37.4%; in more than 50% of cases, the cause of death was low cardiac output syndrome (LCOS). Late mortality occurred in 133 patients, with a median follow-up of 4.4 [1.0-8.6] years. Overall survival at 1, 5, and 10 years was 54.0, 48.1, and 41.0%, respectively. Older age (P < 0.001) and post-operative LCOS (P < 0.001) were independent predictors of overall mortality. For hospital survivors, 10-year survival was 65.7% and was significantly higher for patients with VSR than those with papillary muscle rupture (long-rank P = 0.022).</p><p><strong>Conclusion: </strong>Contemporary data from a multicentre cohort study show that surgical treatment for post-AMI MCs continues to be associated with high in-hospital mortality rates. However, long-term survival in patients surviving the immediate post-operative period is encouraging.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"737-749"},"PeriodicalIF":4.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139702108","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":"Management of acute myocarditis: a systematic review of clinical practice guidelines and recommendations.","authors":"Vijay Shyam-Sundar, Adil Mahmood, Greg Slabaugh, Anwar Chahal, Steffen E Petersen, Nay Aung, Saidi A Mohiddin, Mohammed Y Khanji","doi":"10.1093/ehjqcco/qcae069","DOIUrl":"10.1093/ehjqcco/qcae069","url":null,"abstract":"<p><p>The management of acute myocarditis (AM) is addressed in multiple clinical guidelines. We systematically reviewed current guidelines developed by national and international medical organizations on the management of AM to aid clinical practice. Publications in MEDLINE, EMBASE and Cochrane were identified between 1 January 2013 and 12 April 2024. Additionally, the websites of relevant organizations and the Guidelines International Network, Guideline Central, and NHS knowledge and library hub were reviewed. Two reviewers independently screened titles and abstracts, two reviewers assessed the rigour of guideline development, and one reviewer extracted the recommendations. Two of the three guidelines identified showed good rigour of development. Those rigorously developed agreed on the definition of AM, sampling serum troponin as part of the workflow for AM, testing for B-type natriuretic peptides in heart failure, key diagnostic imaging in the form of cardiovascular magnetic resonance, coronary angiography to exclude significant coronary disease, indications for endomyocardial biopsy (EMB), and indications for immunosuppression and advanced treatment options. Discrepancies exist in sampling creatine kinase-myocardial bound as a marker of myocardial injury, indications for EMB, and indications for immunosuppression and treatment of uncomplicated AM. Evidence is lacking for the use of 18F-Fluorodeoxyglucose Positron Emission Tomography for myocardial imaging, exercise restriction, follow-up measures, and genetic testing, and there are few high-quality randomized trials to support treatment recommendations. Recommendations for management of AM in the guidelines have largely been developed from expert opinion rather than trial data.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"658-668"},"PeriodicalIF":4.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046501","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 Outcomes in Hospitalized Patients with Cancer and New versus Preexistent Atrial Fibrillation.","authors":"Ioanna Kosmidou, Megan Durkin, Eileen Vella, Neisha DeJesus, Sofia Romero, Rosalyn Gamboa, Paul Jenkins, Brian Shaffer, Richard Steingart, Jennifer Liu","doi":"10.1093/ehjqcco/qcad077","DOIUrl":"10.1093/ehjqcco/qcad077","url":null,"abstract":"<p><strong>Background: </strong>There is limited information on the prognostic impact of new onset versus preexistent atrial fibrillation (AF) in hospitalized patients with cancer.</p><p><strong>Objectives: </strong>We sought to determine the clinical impact of new onset AF (NOAF) compared with preexistent AF in hospitalized patients with cancer.</p><p><strong>Methods: </strong>All patients with cancer hospitalized over the course of 1 year with clinically manifest new or preexistent AF were enrolled in the Memorial Sloan Kettering Cancer Center AF registry. The relationship of NOAF to the primary composite outcome of all cause death, cardiovascular (CV) rehospitalization, or cerebrovascular event (CVE), as well as secondary CV endpoints, were analysed using proportional hazards regression. Where applicable, the competing risk of death was accounted for using methodology described by Fine and Gray.</p><p><strong>Results: </strong>Among 606 patients included in the analysis, 313 (51.7%) had NOAF and 293 (48.3%) had preexistent AF. Patients with NOAF were younger and had less frequent prior history of CV disease compared with patients with preexistent AF. At follow-up, patients with NOAF had a higher adjusted hazard for the primary composite outcome versus patients with prior AF (hazard ratio [HR] 1.64, 95% confidence interval [CI] 1.27, 2.13, P = 0.002), as well as the secondary CV composite outcome of clinical AF recurrence, CV death, CV rehospitalization, or CVE (HR 2.17, 95% CI 1.57, 2.99, P < 0.0001).</p><p><strong>Conclusions: </strong>In hospitalized patients with cancer and electrocardiographically manifest new versus preexistent AF, NOAF was associated with a higher risk for the primary composite outcome of all-cause death, CV rehospitalization, or CVE.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"689-697"},"PeriodicalIF":4.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139058239","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":"European Society of Cardiology quality indicators for the care and outcomes of adults undergoing transcatheter aortic valve implantation.","authors":"Noman Ali, Suleman Aktaa, Tanina Younsi, Ben Beska, Gorav Batra, Daniel J Blackman, Stefan James, Peter Ludman, Mamas A Mamas, Mohamed Abdel-Wahab, Britt Borregaard, Bernard Iung, Michael Joner, Vijay Kunadian, Thomas Modine, Antoinette Neylon, Anna S Petronio, Philippe Pibarot, Bogdan A Popescu, Manel Sabaté, Stefan Stortecky, Rui C Teles, Hendrik Treede, Chris P Gale","doi":"10.1093/ehjqcco/qcae006","DOIUrl":"10.1093/ehjqcco/qcae006","url":null,"abstract":"<p><strong>Aims: </strong>To develop a suite of quality indicators (QIs) for the evaluation of the care and outcomes for adults undergoing transcatheter aortic valve implantation (TAVI).</p><p><strong>Methods and results: </strong>We followed the European Society of Cardiology (ESC) methodology for the development of QIs. Key domains were identified by constructing a conceptual framework for the delivery of TAVI care. A list of candidate QIs was developed by conducting a systematic review of the literature. A modified Delphi method was then used to select the final set of QIs. Finally, we mapped the QIs to the EuroHeart (European Unified Registries on Heart Care Evaluation and Randomized Trials) data standards for TAVI to ascertain the extent to which the EuroHeart TAVI registry captures information to calculate the QIs. We formed an international group of experts in quality improvement and TAVI, including representatives from the European Association of Percutaneous Cardiovascular Interventions, the European Association of Cardiovascular Imaging, and the Association of Cardiovascular Nursing and Allied Professions. In total, 27 QIs were selected across 8 domains of TAVI care, comprising 22 main (81%) and 5 secondary (19%) QIs. Of these, 19/27 (70%) are now being utilized in the EuroHeart TAVI registry.</p><p><strong>Conclusion: </strong>We present the 2023 ESC QIs for TAVI, developed using a standard methodology and in collaboration with ESC Associations. The EuroHeart TAVI registry allows calculation of the majority of the QIs, which may be used for benchmarking care and quality improvement initiatives.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"723-736"},"PeriodicalIF":4.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139542190","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":"Diabetes mellitus and presentation, care and outcomes of patients with NSTEMI: the Association for Acute Cardiovascular Care-European Association of Percutaneous Cardiovascular Interventions EURObservational Research Programme NSTEMI Registry of the European Society of Cardiology.","authors":"Ramesh Nadarajah, Peter Ludman, Cécile Laroche, Yolande Appelman, Salvatore Brugaletta, Andrzej Budaj, Hector Bueno, Kurt Huber, Vijay Kunadian, Sergio Leonardi, Maddalena Lettino, Dejan Milasinovic, Ramzi Ajjan, Nikolaus Marx, Chris P Gale","doi":"10.1093/ehjqcco/qcae002","DOIUrl":"10.1093/ehjqcco/qcae002","url":null,"abstract":"<p><strong>Aims: </strong>Diabetes mellitus (diabetes) is common amongst patients with non-ST-segment elevation myocardial infarction (NSTEMI). We describe presentation, care, and outcomes of patients admitted with NSTEMI by diabetes status.</p><p><strong>Methods and results: </strong>Prospective cohort study including 2928 patients (1104 with prior diabetes, 1824 without) admitted to hospital with NSTEMI from 287 centres in 59 countries. Quality of care was evaluated based on 12 guideline-recommended care interventions. Outcomes included in-hospital acute heart failure, cardiogenic shock, repeat myocardial infarction, stroke/transient ischaemic attack (TIA), BARC Type ≥ 3 bleeding and death, as well as 30-day mortality. Patients with diabetes had higher comorbidity burden and more frequently presented with Killip Class II-IV heart failure (10.2% vs. 3.7%, P < 0.001), haemodynamic instability (7.1% vs. 3.7%, P < 0.001), and ongoing chest pain (43.1% vs. 37.0%, P < 0.001), than those without diabetes. Overall, care quality received was similar by diabetes status (60.0% vs. 60.5% received ≥ 80% of eligible care interventions, P = 0.786), but patients with diabetes experienced higher rates of in-hospital acute heart failure (15.3% vs. 6.8% P < 0.001), cardiogenic shock (4.5% vs. 2.5%, P = 0.002), stroke/TIA (2.0% vs. 0.8%, P = 0.006), and death (2.5% vs. 1.4%, P = 0.022), and higher 30-day mortality (3.3% vs. 2.0%, P = 0.025). Of NSTEMI with diabetes, only 1.9% and 9.0% received prescription for glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors, respectively, on discharge, and only 45.9% were referred for cardiac rehabilitation.</p><p><strong>Conclusion: </strong>NSTEMI patients with diabetes, compared with those without, present more clinically unwell and have worse outcomes despite receiving equal quality of care. Prescription of cardiovascular-protective glycaemic agents is an actionable target to reduce risk of further events.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"709-722"},"PeriodicalIF":4.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139402336","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":"Cost-effectiveness of catheter-based radiofrequency renal denervation for the treatment of uncontrolled hypertension: an analysis for the UK based on recent clinical evidence.","authors":"Andrew S P Sharp, Khoa N Cao, Murray D Esler, David E Kandzari, Melvin D Lobo, Roland E Schmieder, Jan B Pietzsch","doi":"10.1093/ehjqcco/qcae001","DOIUrl":"10.1093/ehjqcco/qcae001","url":null,"abstract":"<p><strong>Aims: </strong>Catheter-based radiofrequency renal denervation (RF RDN) has recently been approved for clinical use in the European Society of Hypertension guidelines and by the US Food and Drug Administration. This study evaluated the lifetime cost-effectiveness of RF RDN using contemporary evidence.</p><p><strong>Methods and results: </strong>A decision-analytic model based on multivariate risk equations projected clinical events, quality-adjusted life years (QALYs), and costs. The model consisted of seven health states: hypertension alone, myocardial infarction (MI), other symptomatic coronary artery disease, stroke, heart failure (HF), end-stage renal disease, and death. Risk reduction associated with changes in office systolic blood pressure (oSBP) was estimated based on a published meta-regression of hypertension trials. The base case effect size of -4.9 mmHg oSBP (observed vs. sham control) was taken from the SPYRAL HTN-ON MED trial of 337 patients. Costs were based on National Health Service England data. The incremental cost-effectiveness ratio (ICER) was evaluated against the UK National Institute for Health and Care Excellence (NICE) cost-effectiveness threshold of £20 000-30 000 per QALY gained. Extensive scenario and sensitivity analyses were conducted, including the ON-MED subgroup on three medications and pooled effect sizes. RF RDN resulted in a relative risk reduction in clinical events over 10 years (0.80 for stroke, 0.88 for MI, 0.72 for HF), with an increase in health benefit over a patient's lifetime, adding 0.35 QALYs at a cost of £4763, giving an ICER of £13 482 per QALY gained. Findings were robust across tested scenarios.</p><p><strong>Conclusion: </strong>Catheter-based radiofrequency RDN can be a cost-effective strategy for uncontrolled hypertension in the UK, with an ICER substantially below the NICE cost-effectiveness threshold.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"698-708"},"PeriodicalIF":4.8,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139402335","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}