European heart journal. Quality of care & clinical outcomes最新文献

{"title":"Aiming at a Better Guidance in the Post-Pulmonary Embolism Syndrome Management: Is the Gap Fully Filled Out?","authors":"Giulia Crisci, Marco Guazzi","doi":"10.1093/ehjqcco/qcaf071","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf071","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical Circulatory Support Devices versus Standard Medical Therapy for Treatment of Myocardial Infarction Complicated by Cardiogenic Shock: a Network Meta-Analysis.","authors":"Rosie Freer, Olivia Frost, Adithya Sreenivas, Sheref Zaghloul, Jonathan Bray, Mahmood Ahmad, Rui Providência","doi":"10.1093/ehjqcco/qcaf072","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf072","url":null,"abstract":"<p><strong>Aim: </strong>Cardiogenic shock (CS) is a common sequitur in acute myocardial infarction (AMI), with significant associated mortality. Mechanical circulatory support (MCS) devices have been used in the management of AMI complicated by CS (AMICS). The relative safety and efficacy of these devices in this context is not yet fully established. Our aim is to provide an up-to-date analysis of outcomes to guide future clinical decisions.</p><p><strong>Methods and results: </strong>We conducted a frequentist network meta-analysis assessing mortality and complications associated with MCS devices, using exclusively randomised controlled trials (RCTs). The devices studied were; Intra-Aortic Balloon Pump (IABP), Impella®, Extracorporeal Membrane Oxygenation (ECMO), and TandemHeart®.A total of eighteen RCTs were identified, with a combined patient population of 1,907. Impella® reduced 6-12 month mortality versus standard medical therapy (risk ratio (RR) 0.81, p < 0.05), but increased requirement for renal replacement therapy, limb complications and major bleeding (RR 1.6, p = 0.02, RR 4.8, p = 0.02, and RR 2.0, p = 0.004 respectively). No other form of MCS demonstrated a statistically significant mortality benefit when compared to medical therapy; however, ECMO increased vascular complications and major bleeding (RR 3.1, p = 0.003 and RR 2.4, p = 0.0001 respectively), and TandemHeart® increased limb complications (RR 19, p = 0.05).</p><p><strong>Conclusion: </strong>Impella® support in AMICS was associated with a long-term survival benefit. Impella®, ECMO and TandemHeart® use were associated with increased morbidity.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the modern heart failure epidemic: Growing burden, root causes and widening inequalities.","authors":"Petar M Seferović, Marija M Polovina","doi":"10.1093/ehjqcco/qcaf070","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf070","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of symptom relief and quality of life improvement after atrial fibrillation ablation.","authors":"Mark J Mulder, Michiel J B Kemme, Nikki van Pouderoijen, Luuk H G A Hopman, Marthe J Huntelaar, Herbert A Hauer, Giovanni J M Tahapary, Albert C van Rossum, Cornelis P Allaart","doi":"10.1093/ehjqcco/qcaf045","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf045","url":null,"abstract":"<p><strong>Aims: </strong>The primary goal of atrial fibrillation (AF) ablation is to improve AF-related symptoms and quality of life. Previous studies have observed a discrepancy between objective recurrence of AF after ablation and patient-perceived change of symptoms. Although predictors of freedom of AF recurrence after AF ablation have been widely studied, factors associated with symptom relief and quality of life improvement remain underexplored. The present study aimed to investigate determinants of symptom reduction and improvement in quality of life after AF ablation.</p><p><strong>Methods and results: </strong>A total of 382 AF patients (68% paroxysmal AF, 67% male, mean age 63 ± 9 years) undergoing AF ablation were included. Patient-reported outcomes were assessed using the Toronto Atrial Fibrillation Severity Scale (AFSS) and 36-Item Short-Form Health Survey (SF-36) score. Patients completed both the AFSS and SF-36 score pre-ablation, and post-ablation at 4 months and 1 year follow-up. Atrial tachyarrhythmia recurrence was documented in 139 patients (36%) at 1 year follow-up. AF symptom severity, patient-perceived AF burden and quality of life improved from baseline to 1 year follow-up, particularly in patients without atrial tachyarrhythmia recurrence. Greater baseline AFSS-derived symptom severity and patient-perceived AF burden were associated with a greater improvement of AF symptom severity and patient-perceived AF burden after ablation.</p><p><strong>Conclusion: </strong>This study shows that patients with lower quality of life and greater AF symptom severity and patient-perceived AF burden benefit most from AF ablation, suggesting that more emphasis should be put on the burden of AF symptoms in clinical decision-making.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Trends in risk factors among young patients with acute myocardial infarction: a nationwide cohort study.","authors":"","doi":"10.1093/ehjqcco/qcaf063","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf063","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Outcomes and Safety of Semaglutide in Non-Overweight Populations with Type 2 Diabetes: A Comparison with Dipeptidyl Peptidase 4 Inhibitors.","authors":"Takefumi Kishimori, Takao Kato, Atsuyuki Wada, Akira Tani, Ryosuke Yamaji, Jumpei Koike, Yoshihiro Iwasaki, Takehiro Matsumoto, Takafumi Yagi, Masaharu Okada","doi":"10.1093/ehjqcco/qcaf065","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf065","url":null,"abstract":"<p><strong>Background: </strong>The effects of semaglutide on non-overweight patients with type 2 diabetes (T2D) remain unclear. We retrospectively compared all-cause mortality, cardiovascular outcomes, and adverse events in patients with T2D with a body mass index (BMI) <25 kg/m² who received semaglutide or dipeptidyl peptidase 4 (DPP-4) inhibitors.</p><p><strong>Methods: </strong>Based on the TriNetX database of electronic medical records between 2018 and 2020, we identified 340,721 patients with T2D with a BMI <25 kg/m². Of the 6,789 patients who received semaglutide, 2,454 who received DPP-4 inhibitors after diagnosis were excluded. Of the 41,141 patients who received DPP-4 inhibitors, 5,252 patients who received GLP-1 receptor agonists after diagnosis were excluded. After propensity score matching, 4,194 patients were included in each group. The primary outcome was the 3-year cumulative incidence of all-cause mortality; the secondary outcomes were acute myocardial infarction (AMI) and stroke. The adverse events included nausea, vomiting, diarrhoea, and hypoglycaemia.</p><p><strong>Results: </strong>The semaglutide group had a significantly lower risk of all-cause mortality compared to the DPP-4 inhibitor group (6.1% vs. 10.7%, p<0.001; hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.45-0.65). Semaglutide was not associated with the incidence of AMI (6.1% vs. 7.1%, p=0.173; HR 0.87, 95%CI 0.72-1.06) or stroke (8.4% vs. 7.7%, p=0.220; HR 1.11, 95%CI 0.94-1.32). Adverse events, including nausea and vomiting, diarrhoea, and hypoglycaemia, were not significantly different between the groups.</p><p><strong>Conclusions: </strong>In patients with T2D and BMI <25 kg/m2, semaglutide was associated with a lower 3-year risk of all-cause mortality than DPP-4 inhibitors.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life Satisfaction as Modifiable CVD Prevention Target: Cross-Cultural Mediation in Aging Cohorts.","authors":"Changxing Liu, Zhirui Zhang, Chengjia Li, Tianwei Meng, Boyu Wang, Jia Chen, Zejun Liu, Yabin Zhou, He Wang, Zhiping Liu","doi":"10.1093/ehjqcco/qcaf066","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf066","url":null,"abstract":"<p><strong>Objective: </strong>To examine the prospective association between life satisfaction and cardiovascular disease (CVD) risk among older adults across international cohorts and evaluate potential mediating pathways.</p><p><strong>Methods: </strong>Harmonized data from four aging cohorts-HRS, ELSA, SHARE, and CHARLS-included 101,474 participants aged ≥60 with 267,903 observations (2010-2020). Life satisfaction was categorized as low/high using validated scales (e.g., SWLS). Incident CVD (fatal/non-fatal events) was analyzed using generalized estimating equations (GEE), adjusting for demographics, health, behaviors, social factors, and depression. Mediation models assessed loneliness as a potential pathway; sensitivity analyses tested robustness to competing risks and reverse causation.</p><p><strong>Results: </strong>Over a median follow-up of 6.2 years, higher life satisfaction was associated with lower CVD risk (pooled HR = 0.86, 95% CI: 0.79-0.91, p < 0.001). This association remained robust after excluding participants with baseline depression (HR = 0.84, 95% CI: 0.78-0.90) and in competing risk models. The inverse association between life satisfaction and CVD was consistent across subgroups such as age, gender, education level, and loneliness status. No statistically significant effect modification was detected (all P for interaction > 0.05). Effect sizes across cohorts ranged from SHARE(HR = 0.79, 95% CI: 0.72-0.86, p < 0.001) to CHARLS(HR = 0.93, 95% CI: 0.88-0.98, p =0.017). Loneliness mediated 13.4% of the association (p = 0.003).</p><p><strong>Conclusion: </strong>Elevated life satisfaction is independently associated with reduced CVD risk in older adults, with loneliness as a partial mediator. Enhancing well-being and reducing loneliness may support cardiovascular health in aging populations.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Quality Improvement Interventions in Cardiac Rehabilitation on Processes and Patient Outcomes: A Systematic Review and Meta-analysis.","authors":"Sanuri Wijesekera Kankanamge, Robyn Gallagher, Sherry L Grace, Ling Zhang, Michelle Cunich, Dion Candelaria","doi":"10.1093/ehjqcco/qcaf067","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf067","url":null,"abstract":"<p><strong>Aims: </strong>Significant variability in Cardiac rehabilitation (CR) program content and delivery persists. Quality improvement interventions enhance adherence to standards and reduce variability, yet synthesized evidence of their characteristics and effectiveness in CR is lacking. This meta-analysis aimed to evaluate the effects of quality improvement interventions on CR processes and patient outcomes.</p><p><strong>Methods: </strong>Scopus, CENTRAL, Medline, Embase, and CINAHL were searched for studies published from January, 2000 to November, 2024. Study selection in Covidence, data extraction and risk of bias assessment were completed. Where possible, meta-analyses were conducted using RevMan v5.3, random-effects model. Outcomes not suitable for meta-analysis were reported narratively.</p><p><strong>Results: </strong>Fifteen studies (76,856 participants) were eligible, including one randomized controlled trial, one retrospective observational study, and 13 pre-post studies. Meta-analysis of 11 studies (17,010 participants) showed that quality improvement interventions significantly improved CR referral (odds ratio [OR] 5.25; 95% confidence interval [CI] 3.11, 8.87). From subgroup analyses, patient education had the largest effect (OR 8.37; 95% CI 4.32, 16.21), followed by technology (OR 5.56; 95% CI 2.67, 11.58) and process changes (OR 5.31; 95% CI 2.53, 11.12). Narrative synthesis indicated that quality improvement interventions led to significant improvements in time from discharge to scheduled appointment (1/1 studies), attendance (3/4), prescription of guideline-directed medical therapy (1/1), and completion (1/1). Few studies reported patient outcomes.</p><p><strong>Conclusion: </strong>Quality improvement interventions improve referral to CR up to eight times. While caution is warranted, quality improvement interventions may also lower waits and increase program utilization. Future studies are needed.</p><p><strong>Registration: </strong>PROSPERO ID: CRD42024557586.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of life in patients with heart failure and implantable cardioverter defibrillator. Results from 9 274 patients in 42 outpatient heart failure clinics in the National Norwegian Heart Failure Registry.","authors":"Hanne Flagtvedt, Torstein Hole, Tore Wentzel-Larsen, Christer Reigstad Aase, Tone M Norekvål","doi":"10.1093/ehjqcco/qcaf062","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf062","url":null,"abstract":"<p><strong>Aims: </strong>Patients with heart failure (HF) have increased risk of sudden cardiac death, and treatment with an implantable cardioverter defibrillator (ICD) has become standard treatment for selected patient groups. HF is associated with impaired quality of life (QoL), but studies on QoL in patients with HF and ICD attending follow-up in outpatient HF-clinics is sparse. Hence, this study aimed to determine QoL over time in patients with HF with and without ICD using data from the first visit (baseline) and follow-up visit in 42 outpatient HF clinics.</p><p><strong>Methods and results: </strong>Longitudinal real-world data from the National Norwegian Heart Failure Registry (NNHFR) including 9 274 patients, of which 1 206 with ICD, were studied. QoL was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Patients with ICD were younger, more often men, and had a higher frequency of coronary artery disease (all p<0.001). At the first visit, no significant difference in QoL was found between patients with HF with and without ICD, and both groups had significant improvement in QoL from the first to the follow-up visit (p<0.001). However, patients with HF and ICD reported significantly less improvement (p<0.001).</p><p><strong>Conclusion: </strong>QoL in patients with ICD improves after follow-up in an outpatient HF clinic, although not to the same extent as in patients without ICD. Thus, tailored interventions through a combined HF-ICD care programme are needed to improve QoL in this subgroup of patients with both HF and ICD.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term survival after transcatheter aortic valve implantation in the modern era compared with the general population - a Nationwide Danish Cohort Study.","authors":"Marie Sofie Reinert, Eva Havers-Borgersen, Peter Laursen Graversen, Helene Vistisen, Jarl Emanuel Strange, Louise Marqvard Sørensen, Katra Hadji-Turdeghal, Ole De Backer, Lars Køber, Emil L Fosbøl","doi":"10.1093/ehjqcco/qcaf061","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcaf061","url":null,"abstract":"<p><strong>Objective: </strong>Recent advancements in transcatheter aortic valve implantation (TAVI) and patient selection have significantly improved the outcomes of TAVI. Yet it is unknown whether patients undergoing TAVI in the modern era have comparable mortality as the general population.</p><p><strong>Methods: </strong>All patients undergoing TAVI in Denmark (2015-2023) were matched on age and sex with controls from the general population (1:4). Patients were followed from 30-days post-TAVI until death or end of study (12/23). The 5-year all-cause mortality was examined by cumulative incidence functions and Cox-regression analyses. The 5-year all-cause hospitalization burden was analysed among those alive at 5-year post-index.</p><p><strong>Results: </strong>The study included 7,250 patients undergoing TAVI (median age 81.2 years (IQR 77.0-84.9), 57.3% men) and 29,000 controls. The absolute risk of death was 39.6% (95%CI 38.1-41.2) in the TAVI group, compared to 32.2% (95%CI 31.5-32.9) among controls. The associated all-cause mortality was similar between patients undergoing TAVI and controls (adjusted HR 0.95 [95%CI 0.90-1.01]). Stratification by age revealed a higher risk of death among the TAVI group aged <80 years compared to controls, while patients aged ≥80 years showed a lower risk of death. Patients undergoing TAVI experienced longer and more frequent hospitalizations compared to controls, while the relative difference decreased over time.</p><p><strong>Conclusion: </strong>Our findings suggest that TAVI was associated with long-term mortality and hospitalization rates comparable to the general population. Stratified by age, mortality was higher among TAVI patients <80 years and lower among those ≥80 years. These findings support patient selection, safety, and long-term outcomes of TAVI.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}