Open Heart最新文献

{"title":"Peripandemic outcomes of infants treated for sentinel congenital heart diseases in England and Wales.","authors":"Qi Huang, Deborah A Lawlor, John Nolan, Ferran Espuny-Pujol, Massimo Caputo, Christina Pagel, Sonya Crowe, Rodney Cg Franklin, Kate L Brown","doi":"10.1136/openhrt-2024-002964","DOIUrl":"10.1136/openhrt-2024-002964","url":null,"abstract":"<p><strong>Background: </strong>Infants with congenital heart disease (CHD) are clinically vulnerable to cardiac deteriorations and intercurrent infections. We aimed to quantify the impact of health system disruptions during the COVID-19 pandemic, on their clinical outcomes and whether these differed by socioeconomic and ethnic subgroups.</p><p><strong>Methods: </strong>In this population-based cohort study, we used linked electronic healthcare datasets from England and Wales to identify infants with nine sentinel CHDs born and undergoing intervention in 2018-2022. The outcomes of cardiac intervention timing, infant mortality and hospital care utilisation, were described by birth eras, and risk factors were explored using multivariable regression.</p><p><strong>Results: </strong>Of 4900 included infants, 1545 (31.5%) were born prepandemic (reference), 1175 (24.0%) in the transition period, 1375 (28.0%) during restrictions and 810 (16.5%) postrestrictions. The casemix was hypoplastic left heart syndrome (195; 3.9%), functionally univentricular heart (180; 3.7%), transposition (610; 13.5%), pulmonary atresia (290; 5.9%), atrioventricular septal defect (590; 12.1%), tetralogy of Fallot (820; 16.7%), aortic stenosis (225; 4.6%), coarctation (740; 15.1%) and ventricular septal defect (1200; 24.5%).Compared with prepandemic, there was no evidence for delay in treatment procedures in transition, restrictions or postrestrictions eras. Infant mortality increased for those born in the transition period, adjusted OR 1.60 (95% CI 1.06, 2.42) p=0.01, but not in restrictions or postrestrictions. The days spent at home were similar with birth in transition and restrictions, but fewer for postrestrictions, adjusted days difference -2 (95% CI -4, 0), p=0.05.Outcomes did not vary by pandemic birth era according to social characteristics. There was higher infant mortality in the deprived versus non-deprived binary category (adjusted OR 1.56 (95% CI 1.11, 2.18), p=0.004) and there were fewer days spent at home for the most versus least deprived neighbourhood quintile (adjusted difference -4 (95% CI -6, -2), p<0.001).</p><p><strong>Conclusions: </strong>Specialist care for infants with CHD during the pandemic, in terms of pathway procedure timing and healthcare contacts, was not compromised. Increased healthcare utilisation postpandemic and heath inequality based on socioeconomic status require further evaluation.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical use and impact of mechanical circulatory support for myocardial infarction-related cardiogenic shock in the Netherlands: a registry-based propensity-matched analysis.","authors":"Margriet Bogerd, Alexander M Griffioen, Jeroen J H Bunge, Elma J Peters, Sanne Ten Berg, Marijke J C Timmermans, Adriaan O Kraaijeveld, Erik Lipsic, Luuk C Otterspoor, Gabe Bleeker, José M Montero-Cabezas, Krischan D Sjauw, Martijn Meuwissen, Eric A Dubois, Robert-Jan M van Geuns, José P S Henriques","doi":"10.1136/openhrt-2024-002846","DOIUrl":"10.1136/openhrt-2024-002846","url":null,"abstract":"<p><strong>Background: </strong>Despite limited beneficial evidence, mechanical circulatory support (MCS) is commonly used in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS). In this Dutch registry, we investigated MCS usage, associated patient characteristics and clinical outcomes.</p><p><strong>Methods: </strong>This real-world, multicentre registry included CS patients undergoing percutaneous coronary intervention between 2017 and 2021 in 14 Dutch hospitals. The impact on clinical outcomes was analysed after 1:1 average propensity-score (aPS) matching.</p><p><strong>Results: </strong>This AMI-CS registry included 2217 patients with a mean age of 66.4 (±12.3) years and predominantly male (72.8%, n=1613). MCS was deployed in 516 patients (23.3%), of which the intra-aortic balloon pump was used most frequently (n=253, 49.0%). Impella was used in 94 patients (18.2%), extracorporeal membrane oxygenation in 68 patients (13.2%) and 95 patients (18.4%) received multiple devices. Patients receiving MCS were younger (64.2 vs 67.0, p<0.01), presented with lower mean arterial pressures (74.7 vs 78.4 mm Hg, p<0.01), higher heart rates (88.3 vs 81.7 beats per minute, p<0.01) and higher initial lactate levels (6.4 vs 5.4 mmol/L, p<0.01). The percentage of resuscitated patients was comparable among MCS and non-MCS patients (38.6% vs 42.2%, p=0.17). The 30-day mortality rate was higher in MCS patients (55.0% vs 34.7%, p<0.01). After aPS-matching (n=970), 30-day mortality remained higher for MCS patients (53.8% vs 44.7%, p<0.01), with an associated OR of 1.44 (95% CI 1.12 to 1.85, p<0.01).</p><p><strong>Conclusions: </strong>Despite limited evidence, MCS was used in a fourth of all AMI-CS patients. MCS usage was associated with an increased 30-day mortality in this real-world setting, even after propensity-matching.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of a community first responder system for out-of-hospital cardiac arrest in Belgium.","authors":"Bianca de Greef, Cornelia Genbrugge, Sanjay Verma, Goran Medic, Joachim Maurer, Tom A Kooy, Olivier Hoogmartens, Marc Sabbe","doi":"10.1136/openhrt-2024-003098","DOIUrl":"10.1136/openhrt-2024-003098","url":null,"abstract":"<p><strong>Objective: </strong>Out-of-hospital cardiac arrest (OHCA) is a major public health challenge across Europe, with a survival rate of only 8.5% to hospital discharge. Implementing a community first responder (CFR) system, including earlier Basic Life Support and defibrillation, can enhance survival rates and neurological outcomes. This study assesses the cost-effectiveness of two scenarios for implementing such a system in Belgium.</p><p><strong>Methods: </strong>A decision tree and the long-term Markov model were used to evaluate cost-effectiveness by comparing two scenarios with current care standards. Scenario 1 involved an awareness campaign on OHCA, while Scenario 2 included implementing a CFR system with automated external defibrillator (AED) integration, dispatch centre linkage and training for citizen responders. The analysis covered survival to the emergency department, hospital, discharge and neurologically intact survival, with sensitivity analyses to test robustness.</p><p><strong>Results: </strong>The awareness campaign and implementation of the CFR system resulted in an incremental cost-effectiveness ratio of €14,976 and €16,442 per quality-adjusted life year gained for scenarios 1 and 2, respectively. Both scenarios showed improvements in survival rates at various stages, including hospital discharge and neurologically intact survival.</p><p><strong>Conclusion: </strong>This study highlights the benefits of enhancing Belgium's CFR for OHCA patients. It suggests that accessible AEDs, trained CFRs and an integrated emergency response system could improve survival rates and quality of life. These findings can guide policy and resource decisions, potentially improving the effectiveness and cost-efficiency of OHCA emergency services. Additionally, this approach could serve as a model for other regions aiming to strengthen their response to time-sensitive emergencies.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertrophic cardiomyopathy and atrial fibrillation: the Cardiomyopathy/Myocarditis Registry of the EURObservational Research Programme of the European Society of Cardiology.","authors":"Katarzyna Mizia-Stec, Juan R Gimeno, Philippe Charron, Perry M Elliott, Juan Pablo Kaski, Aldo Pietro Maggioni, Michal Tendera, Luigi Tavazzi, Maciej T Wybraniec, Cécile Laroche, Alida Caforio","doi":"10.1136/openhrt-2024-002876","DOIUrl":"10.1136/openhrt-2024-002876","url":null,"abstract":"<p><strong>Background: </strong>Hypertrophic cardiomyopathy (HCM) is commonly associated with atrial fibrillation (AF), but its impact on outcomes in real-world practice is uncertain. The aim of the study was to evaluate the clinical profile and prognosis of patients with HCM and AF.</p><p><strong>Methods: </strong>Overall, 1739 adult patients with HCM (40.9% women; median age: 55.5 years) were enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy/Myocarditis Registry. Clinical characteristics at baseline and cardiovascular endpoints at 1 year were prospectively assessed.</p><p><strong>Results: </strong>At baseline, AF was present in 478 (27.5%) patients; an additional 48 patients (2.8%) developed AF at 1-year follow-up. Oral anticoagulants (OAC) were administered at baseline in 69.5% of the patients. Patients with AF were older and more symptomatic, had higher body mass index, more prevalent cardiovascular risk factors, a history of sustained ventricular tachycardia and implantable cardioverter-defibrillator, lower left ventricular ejection fraction (LVEF), larger left atria (LA) and more advanced LV diastolic dysfunction (pp<0.001 for all). Age at enrolment (OR=1.068, p<0.001), symptom: palpitations (OR=2.191, p<0.001), LVEF (OR=0.978, p<0.001) and LA diameter (OR=1.094, p<0.001) were independent predictors of AF in HCM population. Patients with AF had a higher annual incidence of stroke/transient ischaemic attack (2.6 vs 0.9%, p=0.009) and a trend towards increased all-cause mortality in comparison to the non-AF cohort (3.4 vs 1.7%, p=0.053).</p><p><strong>Conclusions: </strong>AF affects nearly one-third of patients with HCM and is associated with higher symptom burden, increased prevalence of comorbidities, myocardial remodelling and increased annual risk of cerebral ischaemic events. In spite of this, the utilisation of OAC was suboptimal.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microcosting analysis of percutaneous coronary intervention with and without intracoronary imaging in an Irish tertiary referral centre.","authors":"Rory A Gallen, James F O'Mahony, Karen M Kuntz, Catherine McGorrian, Ivan P Casserly, Gavin J Blake","doi":"10.1136/openhrt-2024-002988","DOIUrl":"10.1136/openhrt-2024-002988","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous coronary intervention (PCI) is a well-established treatment for coronary artery disease, one of the most significant causes of morbidity and mortality worldwide. Intracoronary imaging, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), has been shown to improve outcomes for patients following PCI by reducing complications and the need for repeat procedures. Uptake remains highly variable, in part due to concerns over up-front costs.</p><p><strong>Aim: </strong>The purpose of this micro-costing analysis was to establish the costs and resource implications of PCI with and without intracoronary imaging.</p><p><strong>Methods: </strong>The costing model considered costs associated with the index procedure and related hospital admission and was designed using data obtained from primary data collection, previously published literature and expert opinion. Unit costs were established through communication with the hospital finance department and industry representatives and were reported in 2024 euro. Costs were categorised as staffing, capital and consumables. Staffing costs were calculated in accordance with local guidelines. Capital costs were averaged over a 10-year period. A sensitivity analysis was conducted to assess the impact of the use of IVUS and OCT during PCI.</p><p><strong>Results: </strong>The use of intracoronary imaging extends the average procedure time from 45 min to 60 min. The total procedural cost of PCI without intracoronary imaging was €3082. The incremental cost with intracoronary imaging was €752 for IVUS and €884 with OCT.</p><p><strong>Conclusion: </strong>This study provides robust data on the cost drivers of PCI with intracoronary imaging in Ireland which has not previously been described. This framework may be of use to finance departments and physicians alike when seeking to establish the cost and resource implications of future modifications to PCI procedures, such as the description of the impact of intracoronary imaging in this study.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, regional and national burdens of cardiovascular disease attributable to secondhand smoke from 1990-2019: an age-period-cohort analysis.","authors":"Hong Jiang, Zeye Liu, Peijian Wei, Fengwen Zhang, Shouzheng Wang, Wen-Bin Ou-Yang, Xiaofei Li, Xiang-Bin Pan","doi":"10.1136/openhrt-2024-003079","DOIUrl":"10.1136/openhrt-2024-003079","url":null,"abstract":"<p><strong>Background: </strong>Over the past three decades, significant disparities in the global burden of cardiovascular disease (CVD) have been observed, particularly CVD attributed to secondhand smoke. However, a comprehensive understanding of global trends and their interaction with secondhand smoke remains inadequate.</p><p><strong>Methods: </strong>Using Global Burden of Disease data (1990-2019), an age-period-cohort analysis examined temporal trends in CVD mortality among secondhand smoke-exposed populations, considering age, period and cohort interactions.</p><p><strong>Results: </strong>Over the 30-year period, the global number of CVD deaths attributed to secondhand smoke increased substantially, from 432.6 thousand in 1990 (95% UI: 357.4-508.3) to 598.5 thousand in 2019 (95% UI: 489.7-713.5), representing a 38.4% increase (95% UI: 26.8%-49.5%). In 2019, CVD accounted for 45.9% of all deaths attributable to secondhand smoke among both sexes globally. Among these CVD deaths, ischaemic heart disease predominated, accounting for 66.4% of cases, compared with stroke. The distribution by sex revealed a slightly lower percentage of males (46.5%) than females (53.5%). Age-period-cohort models show overall global decline in CVD mortality due to secondhand smoke over 30 years, with regional, sex and subtype variations. Notably, a higher Sociodemographic Index (SDI) correlated with a greater reduction in mortality, exhibiting a significant 39.1% decrease in high SDI areas (95% UI: 35.6%-42.3%), in stark contrast to the minimal change observed in low SDI areas (0.1%, 95% UI: -52.4%-62.2%).</p><p><strong>Conclusions: </strong>This study highlights the importance of considering secondhand smoke as a modifiable CVD risk. Further research is needed to understand disparities in CVD burden across development levels, sexes and subtypes.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase 1 study of novel anti-platelet agent to overcome pharmacogenomic limitations of clopidogrel.","authors":"Anil Pareek, Nitin Chandurkar, Vivek Raut, Kumar Naidu","doi":"10.1136/openhrt-2024-003088","DOIUrl":"10.1136/openhrt-2024-003088","url":null,"abstract":"<p><strong>Aims: </strong>Clopidogrel is the most commonly prescribed thienopyridine as part of dual anti-platelet therapy for the treatment of cardiovascular diseases. However, clopidogrel responsiveness shows variability based on CYP2C19 polymorphism. Therefore, we planned a study with an objective of evaluating safety, tolerability, pharmacodynamics and pharmacokinetics of a novel thienopyridine antiplatelet agent AT-10 in healthy Indian subjects compared with standard dosage regimen of clopidogrel based on their CYP2C19 genotyping.</p><p><strong>Methods: </strong>Two CYP2C19 genotype-based groups were identified, that is, poor metabolisers and extensive metabolisers, with 20 subjects in each group (n=40) for participating in a randomised, two-period, crossover study. Each study period lasted 6 days including administration of loading and maintenance doses of AT-10 (40 mg/10 mg) or clopidogrel (300 mg/75 mg). The pharmacokinetics and pharmacodynamics were assessed on day 1 and day 6 at several time intervals.</p><p><strong>Results: </strong>Overall result of pharmacodynamic parameters showed that mean %inhibition of platelet aggregation between AT-10 and clopidogrel in all subjects at 6 hours postdose (loading dose) (AT-10: clopidogrel; 73.30% vs 18.53%) and 6 hours postdose on day 6 (maintenance dose) (AT-10: clopidogrel; 83.41% vs 51.19 %) obtained from the AT-10 group was significantly higher than the clopidogrel group. Further, %inhibition of platelet aggregation from AT-10 treatment in poor metaboliser group was significantly higher than the clopidogrel treatments in extensive metaboliser group.Overall pharmacokinetic comparison in all subjects indicates that AT-10 gives greater exposure to active Metabolite H4 than clopidogrel.</p><p><strong>Conclusion: </strong>AT-10 showed better inhibition of platelet aggregation in poor metabolizers as compared to Clopidogrel. AT-10 may emerge as a potential alternative to Clopidogrel as an anti-platelet drug. It can be further developed in clinical studies for the unmet medical needs in management of CVDs and overcome the pharmacogenomic limitations of Clopidogrel.</p><p><strong>Trial registration number: </strong>Clinical Trial Registry-India URL: http://ctri.nic.in.</p><p><strong>Registration number: </strong>CTRI/2021/03/032206.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of blood pressure and left ventricular mass with subclinical coronary atherosclerosis.","authors":"Enver De Wei Loh, Weiting Huang, Rehena Sultana, Siew Ching Kong, Chirk Jenn Ng, Swee Yaw Tan, Calvin Chin, Jonathan Jiunn Liang Yap, Khung K Yeo","doi":"10.1136/openhrt-2024-002791","DOIUrl":"10.1136/openhrt-2024-002791","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular (LV) mass is closely associated with atherosclerotic heart disease, but the mechanisms are not well defined. This study aimed to evaluate the risk factors associated with LV mass and subclinical coronary atherosclerosis, in an Asian population free of baseline cardiovascular disease.</p><p><strong>Methods: </strong>The SingHEART study is a population-based cohort in which individuals underwent ambulatory blood pressure (BP) monitoring, cardiac MRI to measure indexed LV mass index (LVMI) and coronary artery calcium (CAC) scoring. Individuals were stratified based on LVMI and the presence of CAC, and intergroup differences in risk factors were analysed. Logistic regression models were used to assess the interaction of BP and LVMI on prevalent CAC.</p><p><strong>Results: </strong>The study included 880 subjects (mean age 45.8±11.7 years, 51.4% women). Individuals with high LVMI had higher BP than those with normal LVMI. Across all LVMI groups, higher BP was associated with the presence of CAC. Compared with individuals with normotensive BP and normal LVMI, those with normotensive BP and high LVMI had no increased risk of prevalent CAC (p=0.530); however, risk was progressively higher in those with hypertensive BP and normal LVMI (risk ratio (RR) 1.47, 95% CI 1.13 to 1.91), or hypertensive BP and high LVMI (RR 1.72, 95% CI 1.26 to 2.36).</p><p><strong>Conclusions: </strong>In this healthy asymptomatic population, hypertension was the strongest risk factor for high LVMI and prevalent CAC. LV hypertrophy was a risk modifier, and its prognostic significance in adults without hypertension requires further study.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discrimination and calibration performances of non-laboratory-based and laboratory-based cardiovascular risk predictions: a systematic review.","authors":"Yihun Mulugeta Alemu, Sisay Mulugeta Alemu, Nasser Bagheri, Kinley Wangdi, Dan Chateau","doi":"10.1136/openhrt-2024-003147","DOIUrl":"10.1136/openhrt-2024-003147","url":null,"abstract":"<p><strong>Background and objective: </strong>This review compares non-laboratory-based and laboratory-based cardiovascular disease (CVD) risk prediction equations in populations targeted for primary prevention.</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Methods: </strong>We searched five databases until 12 March 2024 and used prediction study risk of bias assessment tool to assess bias. Data on hazard ratios (HRs), discrimination (paired c-statistics) and calibration were extracted. Differences in c-statistics and HRs were analysed.</p><p><strong>Protocol: </strong>PROSPERO (CRD42021291936).</p><p><strong>Results: </strong>Nine studies (1 238 562 participants, 46 cohorts) identified six unique CVD risk equations. Laboratory predictors (eg, cholesterol and diabetes) had strong HRs, while body mass index in non-laboratory models showed limited effect. Median c-statistics were 0.74 for both models (IQR: lab 0.77-0.72; non-lab 0.76-0.70), with a median absolute difference of 0.01. Calibration measures between laboratory-based and non-laboratory-based equations were similar, although non-calibrated equations often overestimated risk.</p><p><strong>Conclusion: </strong>The discrimination and calibration measures between laboratory-based and non-laboratory-based models show minimal differences, demonstrating the insensitivity of c-statistics and calibration metrics to the inclusion of additional predictors. However, in most reviewed studies, the HRs for these additional predictors were substantial, significantly altering predicted risk, particularly for individuals with higher or lower levels of these predictors compared with the average.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial fibrillation outcomes in patients from Asia and non-Asia countries: insights from GARFIELD-AF.","authors":"Chun-Yan Cheng, Tian-Yu Lian, Xi-Jie Zhu, Saverio Virdone, Kai Sun, John Camm, Xian-Mei Li, Shinya Goto, Karen Pieper, Gloria Kayani, Xian-Hong Fang, Zhi-Cheng Jing, Ajay K Kakkar","doi":"10.1136/openhrt-2024-003109","DOIUrl":"10.1136/openhrt-2024-003109","url":null,"abstract":"<p><strong>Background: </strong>Differences in the clinical outcomes and level of risk among Asian versus non-Asian patients with atrial fibrillation (AF) have been sparsely investigated.</p><p><strong>Objective: </strong>To provide a contemporary prospective comparison of outcomes for newly diagnosed patients with AF, between Asian and non-Asian regions.</p><p><strong>Methods: </strong>Six Asian countries (China, Japan, India, Singapore, South Korea and Thailand) and 29 countries outside Asia participated in the Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF) study. Newly diagnosed patients with AF, enrolled between 2010 and 2016, were followed up for≥2 years. The outcome studies were all-cause, cardiovascular and non-cardiovascular mortality, non-haemorrhagic stroke/systemic embolism (SE), major bleeding. The association of geographical region with clinical outcomes (event rates per 100 person-years) were estimated using multivariable Cox models.</p><p><strong>Results: </strong>13 841/52 057 (26.6%) GARFIELD-AF participants were enrolled in Asia. Average age and prevalence of cardiovascular comorbidities were lower than in non-Asian countries and patients at high risk of stroke (ie, CHA₂DS₂-VASc≥2 excl. sex) were less frequently anticoagulated (60.1% vs 73.2%). Non-vitamin K oral anticoagulant (NOAC) was similar in both regions (∼28%), though Asian patients were more frequently underdosed. Both Asian and non-Asian patients who received NOAC at enrolment experienced lower all-cause mortality and non-haemorrhagic stroke/SE compared with patients on other treatments or none.All-cause mortality, non-cardiovascular mortality and major bleeding were less frequent in patients from Asia versus non-Asia (HR (95% CI): 0.62 (0.39 to 0.99), 0.52 (0.28 to 0.97), 0.58 (0.36 to 0.96), respectively). Associations of moderate-to-severe chronic kidney disease and vascular disease with increased risk of all-cause mortality were stronger in Asian versus non-Asian patients (interaction p values: 0.0250 and 0.0076, respectively). There was notable heterogeneity in oral anticoagulant (OAC) usage within the Asian countries.</p><p><strong>Conclusions: </strong>Patients in Asian countries had a lower risk of all-cause mortality and major bleeding compared to the rest of the world. NOAC had evident benefits for reducing mortality and stroke across populations. Further studies on sociocultural impacts on OAC outcomes are needed.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov NCT01090362.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}