CJC Open最新文献

{"title":"Factors Associated With Withdrawal of Life-Sustaining Therapy After Out-of-Hospital Cardiac Arrest","authors":"Michael D. Elfassy MD, MSc ,&nbsp;Mena Gewarges MD ,&nbsp;Steve Fan PhD ,&nbsp;Bianca McLean MD ,&nbsp;Dustin Tanaka MD ,&nbsp;Amrita Bagga MD ,&nbsp;Stephen A. Bennett MD ,&nbsp;Isabella Janusonis MD ,&nbsp;Shamara Nadarajah MD ,&nbsp;Clara Osei-Yeboah MD ,&nbsp;Jeremy Rosh MD, MSc ,&nbsp;Daniel Teitelbaum MD, MSc ,&nbsp;Jaime C. Sklar MD, MSc ,&nbsp;Manpreet Basuita MD ,&nbsp;Damon C. Scales MD, PhD ,&nbsp;Adriana C. Luk MD, MSc ,&nbsp;Paul Dorian MD, MSc","doi":"10.1016/j.cjco.2024.11.013","DOIUrl":"10.1016/j.cjco.2024.11.013","url":null,"abstract":"<div><h3>Background</h3><div>Out-of-hospital cardiac arrest (OHCA) is a leading cause of global mortality. Most patients get hypoxic brain injury, which often leads to the withdrawal of life-sustaining therapy (WLST) because of concerns of poor neurologic prognosis. This study describes the rates and reasons for WLST and identifies factors associated with early WLST, defined as occurring within 72 hours of admission.</div></div><div><h3>Methods</h3><div>We conducted a multicentered, retrospective cohort study of adult OHCA patients admitted to 3 large academic hospitals in Toronto from January 2012 to December 2019. Data were extracted from medical records and analyzed using descriptive statistics and cause-specific hazards regression models to identify factors associated with WLST and documented goals of care (GOC) discussions.</div></div><div><h3>Results</h3><div>Among 264 patients (median age 66 years, 76.5% male), the in-hospital mortality rate was 62.1%. Of the nonsurvivors, 67.1% died following WLST (90% of cases because of concern of poor neurologic prognosis), with 50% of WLST occurring &lt;72 hours from admission. Formal declaration of brain death only occurred 9.8% of the time. Older age significantly increased the risk of early WLST. GOC discussions were documented only 56.4% of the time in the overall cohort and significantly associated with WLST across all time periods.</div></div><div><h3>Conclusions</h3><div>This study highlights the high incidence of WLST, and specifically early WLST, in OHCA patients. GOC discussions are routinely undocumented and is associated with a higher likelihood of WLST. These findings underscore heterogeneity of practice, and the influence of GOC discussions in education and shared decision making.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 4","pages":"Pages 449-455"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792030","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":"Women’s Improvements in Cardiorespiratory Fitness Following Cardiac Rehabilitation Differ by Body Mass Index Category","authors":"Heather E. Conradson RN, PhD ,&nbsp;Daniele Chirico PhD ,&nbsp;Kathryn King-Shier RN, PhD, FESC ,&nbsp;Codie Rouleau RPsych PhD ,&nbsp;Tavis S. Campbell PhD ,&nbsp;Sandeep Aggarwal MD, FRCPC ,&nbsp;Ross Arena PhD ,&nbsp;Trina Hauer MSc ,&nbsp;Stephen B. Wilton MD, MSc ,&nbsp;Tamara M. Williamson PhD","doi":"10.1016/j.cjco.2024.12.007","DOIUrl":"10.1016/j.cjco.2024.12.007","url":null,"abstract":"<div><h3>Background</h3><div>Improving women’s cardiovascular outcomes requires optimizing cardiorespiratory fitness (CRF), as higher CRF predicts improved mortality in people with cardiovascular disease (CVD). As such, increasing CRF is a key goal of cardiac rehabilitation (CR). This study assesses the potential influence of body habitus, assessed by body mass index (BMI), on improvements in CRF in women with CVD.</div></div><div><h3>Methods</h3><div>Women (18+ years) diagnosed with CVD who completed a 12-week exercise-based CR program between 1996 and 2016 were included in this retrospective analysis. Women completed a symptom-limited graded exercise test before CR and at CR completion to determine CRF via peak metabolic equivalents (METs). Women were categorized by baseline BMI: normal = 18.5 to 24.9 kg/m², overweight = 25.0 to 29.9 kg/m², and obese ≥ 30 kg/m². Mixed analysis of covariance (ANCOVA) was performed to evaluate the impact of BMI classification on ΔMETs at 12 weeks.</div></div><div><h3>Results</h3><div>Data from 1313 women (mean age = 62 ± 11 years) were analyzed. Results from mixed ANCOVA indicated a significant time (pre-CR, 12 weeks) by BMI category interaction (F [2,1307] = 3.20, <em>P</em> = 0.041, ƞp² = 0.005). Follow-up analyses of variance (ANOVAs) showed significant improvements in ΔMETs in women with normal and overweight BMI categories (standard mean difference =1.03, n = 454 and 0.92, n = 461, respectively, <em>P</em> &lt; 0.001). However, ΔMETs among women classified as obese was nonsignificant using a Bonferroni-adjusted alpha of 0.017 (standardized mean difference [SMD] = 0.79, <em>P</em> = 0.028; n = 398).</div></div><div><h3>Conclusions</h3><div>A 12-week exercise-based CR program increased CRF in women classified as normal or overweight by BMI, whereas those with obesity did not realize similar improvements. Women with obesity may need tailored strategies to increase their improvements in CRF in CR.</div></div><div><h3>Clinical Trial Registration</h3><div>REB18-0083.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 4","pages":"Pages 525-534"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791435","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":"Sodium Glucose Cotransporter Inhibition in Acute Heart Failure: An In-Depth Review","authors":"Joey A. Mercier MD, FRCPC ,&nbsp;Aditya Sharma MD, FRCPC ,&nbsp;Magdaline Zawadka MD ,&nbsp;Thang Nguyen MD, FRCPC","doi":"10.1016/j.cjco.2024.12.008","DOIUrl":"10.1016/j.cjco.2024.12.008","url":null,"abstract":"<div><div>Inhibitors of the sodium glucose cotransporters were initially developed for the treatment of type 2 diabetes but have since been shown to provide many benefits in heart failure, especially in heart failure with reduced ejection fraction (HFrEF). Already an established and foundational therapy for HFrEF, many uncertainties remain with respect to the use and initiation of SGLT2 inhibitors in hospitalized settings and in sicker individuals. Unfortunately, clear guidance or guidelines on this topic is lacking, but over the past few years, several trials have come out attempting to answer this question. This in-depth review aims at summarizing the current evidence not only as it pertains to the use of SGLT2 inhibitors in acute decompensated heart failure but also during acute myocardial infarction. From a brief examination of the history of SGLT2 inhibitor development to an appraisal on where along the spectrum of heart failure SGTL2 inhibition initiation should be considered, this review will also focus on potential advantages of starting SGLT2 inhibition in hospitals, the likely “sweet spot” in terms of timing of initiation, the diuretic augmentation effects of SGLT2 inhibition and how it compares with more traditional sequential blockade with thiazides, and, finally, an in-depth review of the safety surrounding the use of SGLT2 inhibitors in hospitalized patients.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 4","pages":"Pages 380-389"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792022","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":"Readmission Mortality After TAVR: The Combined Effect of Teaching Hospital Status and Cause of Readmission","authors":"Carlos E. Diaz-Castrillon MD ,&nbsp;Dustin Kliner MD ,&nbsp;Derek Serna-Gallegos MD ,&nbsp;Catalin Toma MD ,&nbsp;AJ Conrad Smith MD ,&nbsp;Hemal Gada MD ,&nbsp;Amber Makani MD ,&nbsp;Irsa Hasan MD ,&nbsp;Takuya Ogami MD ,&nbsp;Yisi Wang MPH ,&nbsp;Ibrahim Sultan MD","doi":"10.1016/j.cjco.2024.12.014","DOIUrl":"10.1016/j.cjco.2024.12.014","url":null,"abstract":"<div><h3>Background</h3><div>Variability in transcatheter aortic valve replacement (TAVR) readmission rates highlights the importance of assessing post-discharge outcomes. Understanding how teaching hospital status and causes of readmission influence mortality could optimise post-TAVR care.</div></div><div><h3>Methods</h3><div>Using the National Readmissions Database, we identified 155,298 TAVR admissions from 2012 to 2020. We evaluated the interaction effect between teaching status and cause of readmission on readmission-related mortality through adjusted mixed-effects models.</div></div><div><h3>Results</h3><div>Overall, 18.9% of patients (n = 29,479) had a nonelective readmission within 90 days, with no significant difference between teaching and nonteaching hospitals (19.3% vs 18.9%; <em>P</em> &gt; 0.05). Cardiac-related readmissions accounted for 42.7% of cases, while noncardiac readmissions made up 57.3%, with no differences observed in their distribution between teaching and nonteaching hospitals. The unadjusted 90-day readmission mortality rate was 3.8%, without significant differences between teaching and nonteaching hospitals (3.8% vs 4.1%; <em>P</em> = 0.38). A downward trend in nonelective readmission and readmission-related mortality rates was observed, regardless of teaching status. An interaction effect between teaching status and the cause of readmission was identified: Noncardiac readmissions to teaching hospitals were associated with increased odds of death (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.59-2.07; <em>P</em> &lt; 0.001) compared with nonteaching hospitals, whereas cardiac readmissions to teaching hospitals were associated with decreased odds of in-hospital mortality (OR 0.55, 95% CI 0.48-0.62; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Our findings indicate a differential association between teaching hospital status and 90-day readmission mortality, contingent on the cause of readmission. Further research, including the use of metrics such as failure to rescue, is needed to better understand the relationship between patient-level variables and teaching hospital status.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 4","pages":"Pages 481-488"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791430","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":"Pathophysiological and Prognostic Importance of an ExtraCardiac Comorbidity Burden in Patients with Heart Failure with Preserved Ejection Fraction","authors":"Yuki Saito MD, PhD ,&nbsp;Tomonari Harada MD, PhD ,&nbsp;Naoki Yuasa MD ,&nbsp;Kazuki Kagami MD, PhD ,&nbsp;Yuta Tani MSc ,&nbsp;Ayami Naito MD ,&nbsp;Fumitaka Murakami MD ,&nbsp;Tomoaki Ishii RS ,&nbsp;Toshimitsu Kato MD, PhD ,&nbsp;Naoki Wada MD, PhD ,&nbsp;Yasuo Okumura MD, PhD ,&nbsp;Hideki Ishii MD, PhD ,&nbsp;Masaru Obokata MD, PhD","doi":"10.1016/j.cjco.2025.01.004","DOIUrl":"10.1016/j.cjco.2025.01.004","url":null,"abstract":"<div><h3>Background</h3><div>Extracardiac comorbidities are highly prevalent in patients with heart failure with preserved ejection fraction (HFpEF). We investigated the pathophysiological contribution of an extracardiac comorbidity burden to cardiac function, exercise capacity, and prognosis in patients with HFpEF.</div></div><div><h3>Methods</h3><div>A total of 775 patients (372 HFpEF patients and 403 control subjects) underwent exercise echocardiography, with simultaneous expired gas analysis. We separated the previously validated Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score into cardiac, extracardiac, and demographic categories. An Extracardiac burden was defined as an extracardiac domain score ≥ 5 (median value).</div></div><div><h3>Results</h3><div>Compared to control subjects (n = 403) and patients with HFpEF without an extracardiac burden (n = 185), patients with HFpEF with an extracardiac burden (n = 187) had higher natriuretic peptide levels and worse exercise capacity. They also had worse ventilatory efficiency and worse peripheral O₂ extraction during exercise. Kaplan–Meier analysis revealed that HFpEF patients with an extracardiac burden had a significantly higher risk of the composite outcome of all-cause mortality and worsening HF events than did those without this burden (log-rank <em>P</em> &lt; 0.0001). Cox regression analysis showed that the extracardiac domain score was significantly associated with a higher risk of the composite events (<em>P</em> &lt; 0.0001). In contrast, an extracardiac comorbidity burden was not associated with impaired exercise capacity, worse ventilatory efficiency, impaired peripheral O₂ extraction, or worse clinical outcomes in control subjects.</div></div><div><h3>Conclusions</h3><div>An extracardiac comorbidity burden in patients with HFpEF is associated with relevant pathophysiological features characterized by impaired exercise capacity, worse ventilatory efficiency, impaired O₂ extraction and utilization in the periphery, and poor clinical outcomes.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 4","pages":"Pages 402-411"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792025","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":"DOAC Score for Predicting Clinical Outcomes After Left Atrial Appendage Closure","authors":"Masahiko Asami MD ,&nbsp;Yu Horiuchi MD ,&nbsp;Jun Tanaka MD ,&nbsp;Daiki Yoshiura MD ,&nbsp;Masanori Taniwaki MD ,&nbsp;Kota Komiyama MD, PhD ,&nbsp;Hitomi Yuzawa MD, PhD ,&nbsp;Kengo Tanabe MD, PhD ,&nbsp;Mitsuru Sago CE ,&nbsp;Shuhei Tanaka MD, PhD ,&nbsp;Ryuki Chatani MD ,&nbsp;Toru Naganuma MD ,&nbsp;Yohei Ohno MD, PhD ,&nbsp;Tomoyuki Tani MD ,&nbsp;Hideharu Okamatsu MD ,&nbsp;Kazuki Mizutani MD, PhD ,&nbsp;Yusuke Watanabe MD, PhD ,&nbsp;Masaki Izumo MD, PhD ,&nbsp;Mike Saji MD, PhD ,&nbsp;Shingo Mizuno MD ,&nbsp;Kentaro Hayashida MD, PhD","doi":"10.1016/j.cjco.2025.01.009","DOIUrl":"10.1016/j.cjco.2025.01.009","url":null,"abstract":"<div><h3>Background</h3><div>The direct-acting oral anticoagulant (DOAC) score has been validated for assessing the bleeding risk in patients with atrial fibrillation (AF). However, data on DOAC scores in patients undergoing percutaneous left atrial appendage closure (LAAC) is limited. This study aimed to evaluate the predictive impact of the DOAC score on clinical events following LAAC and compare it with that of the HAS-BLED (<strong>H</strong>ypertension, <strong>A</strong>bnormal renal and liver function, <strong>S</strong>troke, <strong>B</strong>leeding history or predisposition, <strong>L</strong>abile international normalized ratio [INR], <strong>E</strong>lderly [age ≥65 years], <strong>D</strong>rugs and alcohol concomitantly) score.</div></div><div><h3>Methods</h3><div>In this prospective, multicenter, observational study, patients with nonvalvular AF (NVAF) undergoing LAAC were categorized by the DOAC score into higher (HBR) and lower bleeding risk groups. The primary endpoints of all-cause death, stroke, and bleeding were evaluated at 3 months and 1 year.</div></div><div><h3>Results</h3><div>Among 1464 patients (mean age 77.1 years; 67.6% male), the HBR group (923 patients) had a lower body mass index, more frequent comorbidities, and higher risk profiles for bleeding and stroke. The device, technical, and procedural success rates were high and similar between groups. At 1 year, the primary endpoint was higher in the HBR group (17.6% vs 12.4%, <em>P</em> = 0.01), influenced by differences in bleeding events (10.9% vs 7.6%, <em>P</em> = 0.045). The DOAC score showed superior predictive value for the primary endpoint compared with the HAS-BLED score.</div></div><div><h3>Conclusions</h3><div>The DOAC score is a reliable predictor of composite outcomes, including death, stroke, and bleeding, in patients undergoing LAAC, demonstrating superior utility compared with the HAS-BLED score. This scoring system may improve risk stratification and patient management in daily clinical practice.</div></div><div><h3>Clinical Trial Registration</h3><div>UMIN-ID: UMIN000038498 (OCEAN-LAAC registry).</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 4","pages":"Pages 420-428"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792027","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":"First-line vs Second-Line Catheter Ablation Therapy for Patients with Atrial Fibrillation—Data from a National Multicentre Registry","authors":"Ranin Hilu MD ,&nbsp;Mahmoud Suleiman MD ,&nbsp;Adi Elias MD, MPH ,&nbsp;Ibrahim Marai MD ,&nbsp;Roy Beinart MD ,&nbsp;Eyal Nof MD ,&nbsp;Yoav Michowitz MD ,&nbsp;Michael Glikson MD ,&nbsp;Yuval Konstantino MD ,&nbsp;Moti Haim MD ,&nbsp;David Luria MD ,&nbsp;David Pereg MD ,&nbsp;Avishag Laish-Farkash MD, PhD ,&nbsp;Alexander Omelchenko MD ,&nbsp;Israeli Working Group on Pacing and Electrophysiology","doi":"10.1016/j.cjco.2025.01.014","DOIUrl":"10.1016/j.cjco.2025.01.014","url":null,"abstract":"<div><h3>Background</h3><div>An early catheter ablation treatment strategy is effective for rhythm control in patients with atrial fibrillation (AF). In clinical practice, most patients undergo catheter ablation as a second-line treatment, following a trial of antiarrhythmic drugs (AADs). We aimed to investigate the effectiveness and safety of AF catheter ablation performed as a first-line vs a second-line approach, based on data from the nationwide, multicentre Israeli Catheter Ablation Registry.</div></div><div><h3>Methods</h3><div>Following AF catheter ablation, patients were stratified into 2 groups—first-line vs second-line therapy approaches. The second-line group included AF patients who were referred for catheter ablation following treatment with at least one AAD. The primary endpoint was the 1-year freedom from AF recurrence. The secondary endpoints included 1-year hospitalizations, death, cerebrovascular events, and the composite of adverse cardiac events.</div></div><div><h3>Results</h3><div>The 923 participants had a mean age of 66 ± 4.5 years. Catheter ablation was performed as a first-line therapy in 192 patients (20.8%). Median times from AF diagnosis to catheter ablation were 1.5 and 3 years in the first- and second-line groups, respectively. Patients in the first-line group were younger, had a shorter AF duration, and more frequently had a normal left atrial size prior to the procedure. The primary endpoint of AF recurrence at 1 year did not differ significantly between the groups (24.9% vs 30%, <em>P</em> = 0.205). No significant differences in the incidence of secondary outcomes occurred.</div></div><div><h3>Conclusions</h3><div>Mildly delayed AF catheter ablation for patients with AF did not compromise the procedure’s efficacy or safety.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 4","pages":"Pages 429-434"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792028","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":"Impact of Paroxysmal Supraventricular Tachycardia on Pregnancy Outcomes","authors":"Arya Ardehali BSc ,&nbsp;Marla Kiess MD, FRCPC ,&nbsp;Valerie Rychel MD, FRCSC ,&nbsp;Amanda Barlow MD, FRCPC ,&nbsp;Jennifer Oakes MD, FRCSC ,&nbsp;Marc Deyell MD, FHRS ,&nbsp;Jasmine Grewal MD, FRCPC","doi":"10.1016/j.cjco.2025.01.008","DOIUrl":"10.1016/j.cjco.2025.01.008","url":null,"abstract":"<div><h3>Background</h3><div>Paroxysmal supraventricular tachycardia (PSVT) is one of the most common arrhythmias in pregnant women. However, studies investigating the risk of PSVT in pregnancy are lacking. In pregnancy, we aimed to determine the (1) proportion of women presenting with new-onset PSVT, (2) impact of prior PSVT history on episode severity and management, and (3) rate of adverse maternal and fetal or neonatal outcomes associated with PSVT.</div></div><div><h3>Methods</h3><div>Retrospective case-control study: 77 consecutive pregnancies in 75 women referred to the St Paul’s Hospital Cardiac Obstetrics Clinic (2010-2022) with a history or new presentation of PSVT. Maternal obstetric and fetal or neonatal adverse outcomes were compared to a healthy control group.</div></div><div><h3>Results</h3><div>Sixty-three pregnancies (82%) had a history of PSVT and 14 (18%) were new-onset in pregnancy. Sixty-eight percent of those with PSVT history had recurrence in pregnancy. Women with a recent history of PSVT within 5 years of pregnancy were more likely to experience recurrence than women with a remote history (81% vs 31%, <em>P</em> &lt; 0.001). This group also experienced more frequent PSVT during pregnancy and increased rates of chemical cardioversion (38% vs 13%, <em>P</em> = 0.05). There were similar rates of adverse obstetric (8% vs 2%, <em>P</em> = 0.24) and fetal or neonatal outcomes (17% vs 19%, <em>P</em> = 0.72) between the PSVT group and controls.</div></div><div><h3>Conclusions</h3><div>PSVT events were safely managed in pregnancy with similar obstetric and fetal or neonatal outcomes as controls. However, recurrence of PSVT during pregnancy is frequent and leads to management complexities among those with a history, reinforcing the need for pre-pregnancy counselling and catheter ablation for definitive management.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 4","pages":"Pages 441-448"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792029","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":"Rationale and Trial Design of Feedbacks Using Behavioural Economic Theories on STEP Counts (FOOTSTEPS) Trial in Patients With Cardiovascular Disease","authors":"Takahiro Suzuki MD, MPH ,&nbsp;Jiro Aoki MD, PhD ,&nbsp;Kohei Abe MD ,&nbsp;Taku Asano MD, PhD ,&nbsp;Daisuke Yoneoka PhD ,&nbsp;Shuntaro Sato PhD ,&nbsp;Jeffrey Rewley PhD ,&nbsp;Kotaro Miyata MD ,&nbsp;Masafumi Ono MD, PhD ,&nbsp;Akira Saito MD, MPH ,&nbsp;Takayoshi Kanie MD ,&nbsp;Kenta Okui MD ,&nbsp;Akinari Takahashi MD ,&nbsp;Koichiro Isa MD ,&nbsp;Satoshi Takasago MD ,&nbsp;Yumi Shiina MD, PhD ,&nbsp;Yosuke Nishihata MD, PhD ,&nbsp;Hiroyuki Niinuma MD, PhD ,&nbsp;Keita Masuda MD, PhD ,&nbsp;Yasufumi Kijima MD, PhD ,&nbsp;Atsushi Mizuno MD, PhD","doi":"10.1016/j.cjco.2024.12.009","DOIUrl":"10.1016/j.cjco.2024.12.009","url":null,"abstract":"<div><div>Physical activity is crucial for reducing cardiovascular disease (CVD) risk. Interventions for nonsupervised exercise therapy have not been broadly implemented, and few patients with CVD achieve the recommended activity levels (eg, 8000 daily steps). Behavioural economics-based programs increased physical activity in the general population; however, their effectiveness—including the impact of gain vs loss framing—in patients with CVD remains unclear. This study investigates the effectiveness of gamification with social incentives and support in promoting physical activity among patients with CVD using smartphone applications.</div><div>This 5-arm, randomized controlled trial will recruit adult patients with CVD from a single acute tertiary emergency hospital in Tokyo, Japan. Participants will be randomly assigned to 1 of 5 groups: control, gamification (loss framing), gamification (gain framing), gamification (loss framing) + social support, or gamification (gain framing) + social support. The smartphone application incorporates gamification elements: points, rankings, and framing effects. Participants in social support arms will nominate a family member or friend to receive weekly progress reports and provide encouragement. The intervention period is 6 weeks, followed by a 6-week follow-up. The primary outcome is the change in mean daily step count from baseline to the intervention period. The target sample size is 325 participants (65 per arm), and mixed-effects regression models will be used to assess changes in physical activity.</div><div>This trial will evaluate the effectiveness of gamification with social incentives and support to increase physical activity in patients with CVD. These findings may provide valuable evidence regarding the effectiveness of gamification systems in improving outcomes for this population.</div></div><div><h3>Trial Registration Number</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> ID NCT06446076</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 4","pages":"Pages 535-544"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792031","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":"Guideline Directed Anticoagulant Treatment and Dosing in a Contemporary Atrial Fibrillation Cohort: Analysis of the TRANSECT-AF Program","authors":"Cole Clifford MD ,&nbsp;Shaun G. Goodman MD, MSc ,&nbsp;Mary K. Tan MSc ,&nbsp;Jean Gregoire MD ,&nbsp;Jeffrey Habert MD ,&nbsp;Anil Gupta MD ,&nbsp;Walter Chow MD ,&nbsp;Shahin Jaffer MD, MHSc ,&nbsp;Sandeep G. Aggarwal MD ,&nbsp;Michael Heffernan MD ,&nbsp;Robert Maranda MD ,&nbsp;Kevin Saunders MD ,&nbsp;Andrew T. Yan MD","doi":"10.1016/j.cjco.2024.12.010","DOIUrl":"10.1016/j.cjco.2024.12.010","url":null,"abstract":"<div><h3>Background</h3><div>Optimal thromboprophylaxis in atrial fibrillation (AF) requires the accurate application of modern clinical guidelines. We evaluated the point prevalence and factors associated with nonguideline-directed anticoagulation and direct oral anticoagulant (DOAC) dosing in Canadian patients with AF.</div></div><div><h3>Methods</h3><div>TRANSECT-AF is a retrospective registry of consecutive Canadian patients with AF collected between March 2021 and August 2023. Patients were categorized as guideline directed therapy (GDT) or nonguideline-directed therapy (NGDT) based on concordance of their reported thromboprophylaxis with the CHADS-65 algorithm. Patients on GDT with a DOAC were subcategorized as concordant or discordant dosing based on concordance of their reported DOAC doses with the 2020 Canadian Cardiovascular Society AF dosing recommendations.</div></div><div><h3>Results</h3><div>In total, 3043 patients were included (median age 77, 37% women, median CHADS-VASc score 4, median HAS-BLED score 2) and 11% received NGDT, which was independently associated with younger age, lower thromboembolic risk, better renal function, and antiplatelet therapy. Within the GDT cohort, 32% of patients were on guideline discordant DOAC doses. Older age, lower body mass index, female sex, lower renal function, higher thromboembolic risk and non-apixaban DOAC use were independently associated with discordant dosing.</div></div><div><h3>Conclusions</h3><div>Within this Canadian AF registry, 11% of patients were on NGDT and 32% of patients on GDT with a DOAC were treated with a guideline-discordant dose. Our analysis describes predictors of guideline discordant anticoagulation and DOAC dosing that may be used to identify target populations for future quality improvement initiatives in AF thromboprophylaxis.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 4","pages":"Pages 412-419"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792026","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}