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

{"title":"Acoramidis for ATTR cardiomyopathy: value, access, and the duty to treat.","authors":"Daniela Di Lisi, Daniela Tomasoni, Alberto Aimo","doi":"10.1093/ehjqcco/qcag101","DOIUrl":"10.1093/ehjqcco/qcag101","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"1065-1067"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148177471","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":"Access to cardiac implantable electronic device therapy in the European Society of Cardiology EuroAsia region: a comparative analysis of implantation activity, infrastructure, and health financing.","authors":"Ulvi Mirzoyev, Bahram Kadyrov, Erkin Mirrakhimov, Cecilia Linde, Thomas Lüscher, Jacek Bil, Robert J Gil","doi":"10.1093/ehjqcco/qcag099","DOIUrl":"10.1093/ehjqcco/qcag099","url":null,"abstract":"<p><strong>Aims: </strong>Access to cardiac implantable electronic device (CIED) therapy varies substantially across Europe, yet data from the European Society of Cardiology (ESC) EuroAsia region remain limited. We aimed to compare implantation activity of pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices across ESC EuroAsia Task Force (TF) countries and to examine how infrastructure, workforce capacity, and health financing patterns relate to device uptake.</p><p><strong>Methods and results: </strong>National-level aggregated data were collected in 2025 through a standardized ESC EuroAsia TF survey and contextualized using European Heart Rhythm Association Atlas indicators and World Bank/World Health Organization Health Expenditure Data. Implantation rates per million population were compared across Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Turkmenistan, and Uzbekistan. Pacemaker implantation showed moderate variability (21-333 per million), whereas ICD (0.1-172 per million) and particularly CRT (1-135 per million) implantation demonstrated pronounced disparities. Countries with higher density of implanting centres and greater electrophysiology workforce availability-most notably Georgia-had substantially higher per capita ICD and CRT implantation rates. Exploratory analyses suggested moderate positive correlations between national health expenditure (%gross domestic product) and ICD and CRT implantation rates, whereas financing structure (out-of-pocket vs. government share) showed no consistent association.</p><p><strong>Conclusion: </strong>Cardiac implantable electronic device implantation activity in the ESC EuroAsia region follows a clear complexity gradient (PM > ICD > CRT), indicating that access to advanced device therapy is primarily determined by system capacity rather than guideline awareness alone. Strengthening predictable reimbursement pathways, structured referral networks, workforce development, and national registries may reduce inequities and narrow the evidence-practice gap in sudden cardiac death prevention and heart failure management.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"1068-1080"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148177452","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":"The importance of the urinary albumin/creatinine ratio in contemporary clinical practice: the key we have in our pocket and forget to use.","authors":"Marzia De Biasio","doi":"10.1093/ehjqcco/qcag095","DOIUrl":"10.1093/ehjqcco/qcag095","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"901-902"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148160357","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":"Beyond blood pressure: beta-blockers and the emerging era of precision hypertension.","authors":"Emanuele Bobbio, Renzo Laborante","doi":"10.1093/ehjqcco/qcag107","DOIUrl":"10.1093/ehjqcco/qcag107","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"1050-1052"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148428589","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":"From pyramid to temple: evolution of heart failure therapy in the new Renaissance.","authors":"Marzia De Biasio","doi":"10.1093/ehjqcco/qcag110","DOIUrl":"10.1093/ehjqcco/qcag110","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"1096-1098"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148428569","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 and renal outcomes of GLP-1 receptor agonists in type 2 diabetes mellitus: a systematic review and meta-analysis.","authors":"Mushood Ahmed, Tallal Mushtaq Hashmi, Maryam Shahzad, Rohma Zia, Hadiah Ashraf, Raheel Ahmed, Muhammad Rashid, Stephen J Greene, Robert J Mentz, Marat Fudim, Gregg C Fonarow, Jamal S Rana","doi":"10.1093/ehjqcco/qcag079","DOIUrl":"10.1093/ehjqcco/qcag079","url":null,"abstract":"<p><strong>Aims: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as a foundational therapeutic option for type 2 diabetes mellitus (T2DM), offering glycaemic control and cardiovascular benefits. This systematic review and meta-analysis evaluate the impact of GLP-1RAs on cardiovascular outcomes in patients with T2DM.</p><p><strong>Methods and results: </strong>We conducted a comprehensive search of PubMed, Embase, and Cochrane Library up to 31 March 2025, for randomized controlled trials (RCTs) comparing GLP-1RAs with placebo in T2DM patients. Risk ratios (RR) with 95% confidence intervals (CIs) were pooled using a random-effects model. Twenty RCTs involving 83 004 patients were included. GLP-1RAs significantly reduced the risk of major adverse cardiovascular events (RR 0.87, 95% CI 0.83-0.92), all-cause death (RR 0.89, 95% CI 0.84-0.93), cardiovascular death (RR 0.88, 95% CI 0.81-0.94), myocardial infarction (RR 0.87, 95% CI 0.79-0.96), stroke (RR 0.88, 95% CI 0.81-0.96) and composite renal outcome (RR 0.80, 95% CI 0.73-0.88) compared to placebo. In addition, a trend of reduction in heart failure hospitalizations (RR 0.93, 95% CI 0.85-1.01), and coronary revascularization (RR = 0.87, 95% CI 0.74 to 1.01) was observed with GLP-1 RAs without reaching statistical significance.</p><p><strong>Conclusion: </strong>GLP-1RAs are associated with improved cardiovascular outcomes in patients with T2DM. These findings support current guideline recommendations and highlight their cardioprotective benefits beyond glycaemic control in patients with T2DM.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"980-994"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960660","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":"Sodium-glucose cotransporter 2 inhibitors across cardio-reno-metabolic disease and body mass index: a meta-analysis of randomized controlled trials.","authors":"Dimitrios Farmakis, Konstantinos I Karampinos, Chris J Kapelios, Sotiria Liori, Katerina Fountoulaki, Gerasimos Filippatos","doi":"10.1093/ehjqcco/qcag061","DOIUrl":"10.1093/ehjqcco/qcag061","url":null,"abstract":"<p><strong>Aims: </strong>Obesity is a central driver of cardio-reno-metabolic (CRM) disease and may influence pharmacological responsiveness. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve outcomes in heart failure (HF), chronic kidney disease (CKD), and type 2 diabetes (T2D), but whether body mass index (BMI) modifies these benefits across a broad CRM spectrum remains uncertain.</p><p><strong>Methods and results: </strong>We performed a meta-analysis of randomized controlled trials (RCTs) comparing SGLT2i with placebo in patients with HF, CKD, and/or T2D and reported BMI-stratified outcomes using a cutoff of 30 kg/m2. Outcomes included the composite of cardiovascular death or HF hospitalization and its components, and all-cause death. Random-effects meta-analyses were performed using risk ratios (RR). Eight RCTs encompassing 57 356 patients were included (mean BMI 29.95 kg/m2). SGLT2i significantly reduced the risk of cardiovascular death or HF hospitalization in patients with BMI <30 kg/m2 (RR 0.80, 95% CI 0.72-0.89) and BMI ≥30 kg/m2 (RR 0.80, 95% CI 0.75-0.85), with no evidence of effect modification by BMI, an effect primarily driven by reductions in heart failure hospitalizations. Consistent benefits were observed for HF hospitalization (RR 0.75 for BMI <30 kg/m2 and 0.74 for BMI ≥30 kg/m2) and all-cause mortality (RR 0.83 for BMI <30 kg/m2 and 0.89 for BMI ≥30 kg/m2). Meta-regression identified disease category and SGLT2i molecule as sources of heterogeneity, without altering the absence of BMI interaction. Sensitivity, cumulative, and bootstrap analyses confirmed the robustness of the results.</p><p><strong>Conclusion: </strong>Across a broad CRM population, SGLT2i reduce cardiovascular death or HF hospitalization and all-cause death irrespective of BMI.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"912-923"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635644","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":"Endotype-informed therapy and effects on illness perception and psychological health in patients with chest pain and no obstructive coronary artery disease.","authors":"Conor P Bradley, Gemma McKinley, Vanessa Orchard, Christina Tiller, Beth Stanley, Daniel Ang, Andrew J Morrow, Robert Sykes, Pamela Gildea, Maria Petty, Richard Brogan, David Carrick, Damien Collison, Hany Eteiba, Angie Ghattas, Richard Good, Francis Joshi, Mitchell Lindsay, Peter McCartney, James McGowan, Ross McGeoch, Keith Robertson, Paul Rocchiccioli, Aadil Shaukat, Stuart Watkins, Peter Kellman, Alex McConnachie, Colin Berry","doi":"10.1093/ehjqcco/qcag081","DOIUrl":"10.1093/ehjqcco/qcag081","url":null,"abstract":"<p><strong>Aims: </strong>Patients with angina and no obstructive coronary artery disease (ANOCA) experience persistent symptoms, adverse illness perceptions, and psychological distress, often driven by diagnostic uncertainty. We evaluated whether non-invasive stress perfusion cardiovascular magnetic resonance (CMR), used to define ischaemic endotypes and guide targeted therapy, improves illness perception and psychological health compared with standard angiography-guided care.</p><p><strong>Methods and results: </strong>The Coronary microvascular angina Cardiac Magnetic Resonance imaging (CorCMR) trial was a prospective, multicentre, randomized controlled superiority trial. Patients with chest pain undergoing invasive coronary angiography showing no obstructive coronary artery disease were randomized 1:1 to CMR-guided endotype-specific management (intervention) or standard angiography-guided care (control). Illness perception was assessed using the Brief Illness Perception Questionnaire (BIPQ). Psychological health was assessed using the Patient Health Questionnaire-4 (PHQ-4). Assessments occurred at baseline, 6 months, and 12 months. A total of 250 participants were randomized (126 control, 124 intervention; mean age 63.3 years, 50.4% female). At 6 months, BIPQ scores were significantly lower in the intervention vs. control group [adjusted mean difference -8.67 (95% CI -12.04, -5.30); P < 0.001], with sustained benefit at 12 months [adjusted mean difference -10.80 (95% CI -14.27, -7.33); P < 0.001]. PHQ-4 scores were also significantly reduced at 6 months [adjusted mean difference -0.88 (95% CI -1.19, -0.57); P < 0.001] and 12 months [adjusted mean difference -0.97 (95% CI -1.29, -0.65); P < 0.001].</p><p><strong>Conclusion: </strong>In patients with ANOCA, non-invasive CMR-guided endotyping linked to targeted therapy resulted in substantial and sustained improvements in illness perception and psychological health, highlighting the importance of diagnostic clarification in addressing the psychological burden of this condition.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"998-1008"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166822","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":"Severe LVOT obstruction in HCM: effects on exercise capacity and outcomes from cardiopulmonary exercise testing combined with stress echocardiography.","authors":"Raffaella Mistrulli, Federica Re, Guido Giacalone, Tatyana Storozhenko, Paolo Ciacci, Anna Di Cristo, Armando Ferrera, Domenico Gabrielli, Geza Halasz","doi":"10.1093/ehjqcco/qcag056","DOIUrl":"10.1093/ehjqcco/qcag056","url":null,"abstract":"<p><strong>Aims: </strong>Hypertrophic cardiomyopathy (HCM) is a complex disease in which left ventricular outflow tract (LVOT) obstruction influences both functional capacity and clinical outcomes. However, the clinical relevance of varying obstruction severity remains debated. To evaluate the relationship between LVOT gradient severity and both exercise performance and long-term prognosis in HCM using combined cardiopulmonary exercise testing and stress echocardiography (TTE-CPET).</p><p><strong>Methods and results: </strong>We retrospectively analysed 388 HCM patients undergoing TTE-CPET, stratified into four groups based on peak LVOT gradient: <30 mmHg, 30-49 mmHg, 50-79 mmHg, and ≥80 mmHg. Clinical, echocardiographic, and CPET data were compared. The primary outcome was a composite of NYHA class worsening, heart failure hospitalization, new-onset atrial fibrillation, or progression to end-stage HCM, assessed over a median follow-up of 7.4 years. Only patients with severe obstruction (≥80 mmHg, n = 82) showed significantly lower peak VO2 (15.9 vs. 19.7 mL/kg/min, P = 0.003), higher pulmonary pressures, more advanced diastolic dysfunction, and greater symptom burden. They also had a higher incidence of adverse events (50.0% vs. 31.6%, P = 0.011) and worse event-free survival (log-rank P = 0.011). A peak gradient ≥80 mmHg independently predicted adverse outcomes (HR: 1.87; P = 0.009), even after adjustment. Patients with intermediate gradients (30-79 mmHg) had generally preserved outcomes, though some exhibited early structural or functional changes.</p><p><strong>Conclusion: </strong>Severe dynamic LVOT obstruction identifies a high-risk HCM subgroup with impaired exercise capacity and poor prognosis. Intermediate gradients may still warrant close monitoring. TTE-CPET offers critical insight for risk stratification and early intervention.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"1111-1122"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635591","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":"Tafamidis in women with wild-type transthyretin cardiac amyloidosis: an international cohort study.","authors":"Philippe Debonnaire, Wouter L'Hoyes, Karl Dujardin, Erwan Donal, Nicolas Verheyen, Matthias Dupont, Johan De Sutter, Philippe Timmermans, Anne-Catherine Pouleur, Steven Droogmans, Victor Sarli Issa, Raluca Dulgheru, Madelien Regeer, Ruxandra Jurcut, Antoine Bondue, Alexandre Bohyn, Kris Bogaerts, Emma Christiaen, Nicolas Wyseure, Mélanie Bezard, David Zach, Nora Schwegel, Robbe Knapen, Lars Buytaert, Nils de Marneffe, Nina Ajmone Marsan, Robert Adam, René Tavernier, Ian Buysschaert, Sander Trenson","doi":"10.1093/ehjqcco/qcag074","DOIUrl":"10.1093/ehjqcco/qcag074","url":null,"abstract":"<p><strong>Aims: </strong>The natural history and response to tafamidis treatment in women with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) remain insufficiently characterized. Current study aimed to explore sex-differences in clinical presentation, natural course, and tafamidis treatment efficacy, focusing on women with ATTRwt-CM.</p><p><strong>Methods and results: </strong>An international, multicentric cohort of ATTRwt-CM subjects was evaluated, including for all-cause mortality. In total, 1454 patients were studied (mean age 81 ± 7y), including 307 (21.1%) females. At presentation, females were ∼3 years older than males with slightly worse phenotype, including higher indexed left ventricular wall thickness and National Amyloidosis Centre (NAC) disease stage (P < 0.050). Heart failure with preserved ejection fraction and hypertension coincided more often in women (P = 0.001). Natural disease course was poor without sex-difference, even when age-corrected (P = 0.210). Tafamidis was initiated in 1055 patients, 12% less in females (P < 0.001), although reasons for non-initiation and discontinuation did not show heterogeneity by sex (P = 0.116 and P = 0.304, respectively), indicating structural undertreatment. After 1.9 (0.9-3.3) years of median follow-up, 409 (28.1%) patients died. Tafamidis related to lower mortality in the overall and propensity score-matched cohort (n = 742, HR 0.44, 95% CI 0.32-0.61, P < 0.001), without sex-difference (female HR 0.76, 95% CI 0.52-1.11, P = 0.150) nor sex-based treatment efficacy interaction (P = 0.381). NAC disease stages strongly related to mortality under tafamidis treatment (HR 2.13%, 95%, 1.81-2.50, P < 0.001), but female sex did not (HR 0.82, 95% CI 0.53-1.27, P = 0.365).</p><p><strong>Conclusion: </strong>Women with ATTRwt-CM are prone to underdiagnosis and undertreatment, despite similar poor natural course and tafamidis treatment efficacy. Initiatives to increase diagnostic awareness and disease modifying treatment initiation in women are urgently needed.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"965-976"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147795435","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}