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

{"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":4.6,"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":4.6,"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":4.6,"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":4.6,"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":4.6,"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":4.6,"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":"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}

{"title":"Uptitration of statin therapy in women and men: a population-based cohort study.","authors":"Pauline Kiss, Alicia Uijl, Diederick E Grobbee, Monika Hollander, Elisabeth Smits, Miriam C J M Sturkenboom, Sanne A E Peters","doi":"10.1093/ehjqcco/qcaf017","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf017","url":null,"abstract":"<p><strong>Aims: </strong>Statins are widely used for the prevention and management of cardiovascular disease (CVD). Women have been shown to be less likely to receive guideline-recommended dose of statins and reach target lipid levels. This study aims to examine sex differences in titration patterns of statin therapy and in the attainment of cholesterol targets in a Dutch healthcare setting.</p><p><strong>Methods: </strong>Data on statin dispensing was extracted from the PHARMO Data Network between 2011-2020. New-statin users with at least two recorded statin dispenses were included. Cox proportional hazards models were used to study the association between sex and time to first uptitration of intensity and Poisson regressions were used to estimate sex differences in the attainment of cholesterol targets within six and eighteen months after statin initiation.</p><p><strong>Results: </strong>We identified 68 150 new users of statin therapy (46% women) with a median age of 65 years [Q1-Q3: 57-72]. The cumulative incidence of uptitration after three years of follow-up was 10% in women and 12% in men. After adjustment for age, CVD and other individual characteristics, women were 28% less likely to be uptitrated compared to men (adjusted HR for women vs men 0.72 (95%CI 0.69-0.75)). The adjusted RR of achieving cholesterol target levels within six and eighteen months after statin initiation in women vs men were 0.95 (95%CI 0.93-0.97) and 0.98 (95%CI 0.97-0.99).</p><p><strong>Conclusion: </strong>Among new statin users, women are less likely to be uptitrated compared to men and to achieve cholesterol target levels.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958967","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":"Predictors of Arrhythmic Events in Hypertrophic Cardiomyopathy Patients with an Implantable Cardioverter-Defibrillator: A Systematic Review and Meta-Analysis.","authors":"Sotirios Chiotis, Ioannis Doundoulakis, Aikaterini Zgouridou, Christos Piperis, Dimitrios Raptis, Aliki Peletidi, Aikaterini Vassilikou, Maria Toumpourleka, Fotios Economou, Aristi Boulmpou, Vassileios P Vassilikos, Georgios Giannopoulos","doi":"10.1093/ehjqcco/qcaf021","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf021","url":null,"abstract":"<p><strong>Background: </strong>Hypertrophic cardiomyopathy (HCM) is a common genetic cardiac disorder and a leading cause of sudden cardiac death (SCD). Implantable cardioverter-defibrillators (ICDs) are critical for SCD prevention, but risk stratification remains challenging.</p><p><strong>Objective: </strong>To evaluate the predictive performance of conventional risk factors for arrhythmic events in HCM patients with ICDs.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and Clinical Trials from inception to November 2024, including studies reporting hazard ratios (HRs) for clinical, electrocardiographic, and imaging predictors of arrhythmic events in ICD recipients with HCM. Pooled HRs were calculated using random-effects model.</p><p><strong>Results: </strong>12 studies of 3,297 HCM patients with ICDs (91% primary prevention, 9% secondary prevention) were included, with a mean age of 50 years. The annual arrhythmic event rate was 5% (95% CI: 4-7%) during a mean follow-up of 4 years. Significant predictors of arrhythmic events included non-sustained ventricular tachycardia (NSVT) (HR: 2.19, 95% CI: 1.62-2.98), left ventricular ejection fraction (LVEF) < 50% (HR: 1.91, 95% CI: 1.27-2.89), intraventricular pressure gradient (IVPG) > 30 mmHg (HR: 1.92, 95% CI: 1.03-3.56), and secondary prevention indication (HR: 2.18, 95% CI: 1.39-3.41). Sensitivity analysis in the primary prevention subgroup confirmed NSVT and LVEF < 50% as consistently significant predictors, while other traditional risk factors showed limited predictive value.</p><p><strong>Conclusion: </strong>Specific markers remain strong predictors of arrhythmic events in HCM patients with ICDs, but other traditional risk factors may lack predictive utility.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990746","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":"5-Year Outcomes Following Catheter Ablation for Paroxysmal Atrial Fibrillation: A Propensity Matched Analysis of 51,182 Patients from a Real World Cohort.","authors":"Ahmed Maraey, Dharmindra Dulal, Ahmed Elzanaty, Mahmoud Khalil, Hadeer Elsharnoby, Mohammad Alqadi, Omar Kahaly, Abhishek Maan, Paul Chacko","doi":"10.1093/ehjqcco/qcaf020","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf020","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) poses significant risks of stroke and mortality. Catheter ablation (CA) has emerged as a superior rhythm control strategy compared to medical therapy, but its long-term benefits in AF, in ischemic stroke prevention, remain underexplored.</p><p><strong>Methods: </strong>This observational study analyzed data from the TriNetX Research Network, encompassing over 115 million patients. Adults diagnosed with paroxysmal atrial fibrillation (PAF) between 2012 and 2019 were stratified into CA and non-CA groups. Propensity score matching (PSM) accounted for baseline differences in demographics, comorbidities, and medication use. The primary outcome was ischemic stroke rates at five years, with and without prior ischemic stroke. Secondary outcomes included all-cause mortality. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to estimate adjusted hazard ratios (HRs).</p><p><strong>Results: </strong>Among 791,013 patients with PAF, 53,178 (6.7%) underwent CA. Post-PSM, ischemic stroke rates were significantly lower in the CA group (7.96% vs. 9.52%, HR: 0.823, 95% CI: 0.785-0.863, p < 0.0001), even after excluding patients with prior ischemic stroke (de-novo ischemic stroke) (4.70% vs. 6.43% HR: 0.709, 95% CI: 0.665-0.756, p < 0.0001). All-cause mortality was markedly reduced (9.33% vs. 20.68% HR: 0.388, 95% CI: 0.373-0.404, p < 0.0001).</p><p><strong>Conclusion: </strong>This large-scale study demonstrates that in PAF patients CA is associated with lower ischemic stroke rates and all-cause mortality compared to a PSM group without CA. These findings support urgent evaluation of CA in managing PAF and highlight its role in potentially improving survival and reducing stroke risk. Further trials are needed to support these findings.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996836","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}