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

{"title":"The Yentl syndrome revisited: under-diagnosis and under-treatment in women with wild-type amyloid transthyretin cardiomyopathy.","authors":"Roberta Poletti, Alberto Aimo, Michele Emdin","doi":"10.1093/ehjqcco/qcag091","DOIUrl":"10.1093/ehjqcco/qcag091","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"977-979"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148020419","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":"More from less: the case of non-invasive imaging in angina with non-obstructive coronary artery disease.","authors":"Supriya Shore, Venkatesh L Murthy","doi":"10.1093/ehjqcco/qcag097","DOIUrl":"10.1093/ehjqcco/qcag097","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"1009-1010"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166846","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":"Association of lipoprotein(a) level and major adverse cardiovascular events in adult cancer survivors with atherosclerotic disease.","authors":"Kyuwoong Kim, Minkyoung Kim, Jiye Han, Tae Joon Jun, Young-Hak Kim","doi":"10.1093/ehjqcco/qcag045","DOIUrl":"10.1093/ehjqcco/qcag045","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"1123-1125"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482786","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":"Large-scale AI analysis reveals missed opportunities in albuminuria testing and disease-modifying therapy implementation.","authors":"Marnicq van Es, Jonas Erzeel, Michiel De Wever, Matthias Dupont, Petra Nijst, Joris Penders, Wai Hong Wilson Tang, Gianluigi Savarese, Ben Sprangers, Pieter Martens, Wilfried Mullens","doi":"10.1093/ehjqcco/qcag054","DOIUrl":"10.1093/ehjqcco/qcag054","url":null,"abstract":"<p><strong>Aims: </strong>Albuminuria is a key diagnostic and prognostic biomarker of chronic kidney disease (CKD), associated with adverse cardiovascular and renal outcomes. Despite guideline recommendations, urine albumin-to-creatinine ratio (UACR) testing is infrequently performed in cardiology. This study assessed the uptake of UACR testing, the estimated prevalence of undiagnosed albuminuria, and the use of disease-modifying therapies in patients with cardio-kidney-metabolic (CKM) disease.</p><p><strong>Methods and results: </strong>We conducted a retrospective cohort study of all adults seen at the cardiology department of a tertiary referral centre between 2019 and 2024. Data were extracted using CTcue, an AI-driven platform. Albuminuria was defined as UACR ≥30 mg/g. A weighted logistic regression model estimated albuminuria prevalence in untested patients. Among 77 351 patients (44.8% female, mean age 64.4 years), only 8.9% had a recorded UACR, of whom 46.4% had albuminuria. Testing rates were low across high-risk groups: 29.9% in diabetes, 21.7% in heart failure, and 13.7% in hypertension. In untested patients, the predicted prevalence of albuminuria was 36.6%, and highest in those with eGFR <30 mL/min/1.73m2 (70.0%), heart failure (47.8%), or diabetes (46.8%). Use of disease-modifying therapies was low, even among patients with confirmed albuminuria. In patients with documented vs. predicted albuminuria, 43.0% vs. 39.1% received renin-angiotensin system inhibitors, 12.8% vs. 5.7% received SGLT2 inhibitors, and <1% in both groups received finerenone.</p><p><strong>Conclusion: </strong>Albuminuria is substantially underdetected in cardiology practice, possibly contributing to underuse of effective CKM therapies. Systematic UACR screening with structured treatment protocols may help close this gap and improve outcomes for patients with CKM disease.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"891-900"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640629","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":"Physician-patient sex dyads and management of dyslipidaemia and hypertension in primary care: findings from two population-based studies.","authors":"Shun Yi, Mayssam Nehme, Idris Guessous, Carole Clair, Sophie Moeschler, Marie Méan, Pedro Marques-Vidal","doi":"10.1093/ehjqcco/qcag058","DOIUrl":"10.1093/ehjqcco/qcag058","url":null,"abstract":"<p><strong>Aims: </strong>The objective of this study was to examine the associations between physician-patient sex dyads and the prevalence, treatment, and control of dyslipidaemia and hypertension in primary care.</p><p><strong>Methods and results: </strong>We analysed two Swiss population-based studies using mixed-effects logistic models to compare dyslipidaemia and hypertension management across four physician-patient sex dyads (male physician-male patient, male physician-female patient, female physician-male patient, and female physician-female patient). Age-stratified analyses (≥50, ≥60 years) examined whether dyad-outcome associations differed by patient age. Among 8635 participants (54.9% females, with a mean age of 63 years in the CoLaus study and 48 years in the Bus Santé study), female participants had a lower prevalence of dyslipidaemia and hypertension than male participants across both study samples, irrespective of physician sex. For dyslipidaemia, in CoLaus, female participants had higher odds of lipid-lowering therapy, yet lower odds of low-density lipoprotein cholesterol control, regardless of physician sex; in Bus Santé, female participants managed by male physicians had lower odds of lipid control (adjusted odds ratios (OR) 0.52, 95% confidence intervals (CI) 0.28-0.95) compared to male physician-male patient dyads. For hypertension, in CoLaus, female physician-female patient dyads had lower odds of antihypertensive treatment (adjusted OR 0.62, 95% CI 0.42-0.92) than male physician-male patient dyads; in Bus Santé, treatment and control did not differ significantly by dyad. Most differences were more pronounced in patients aged 60 years or older.</p><p><strong>Conclusion: </strong>In primary care, patterns of risk-factor management were associated with both patient and physician sex, with dyad-related differences that may reflect patient-sex patterns but differ in magnitude across regions and age groups.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"1099-1107"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147701892","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":"Beta-blockers in patients with uncomplicated arterial hypertension: data from the Campania Salute Network Registry.","authors":"Christian Basile, Costantino Mancusi, Ilaria Fucile, Valentina Trimarco, Eduardo Bossone, Maria Lembo, Grazia Canciello, Daniela Pacella, Giuseppe Giugliano, Maria Angela Losi, Raffaele Piccolo, Raffaele Izzo, Carmine Morisco, Giovanni Esposito","doi":"10.1093/ehjqcco/qcag089","DOIUrl":"10.1093/ehjqcco/qcag089","url":null,"abstract":"<p><strong>Aims: </strong>The role of beta-blockers in the management of uncomplicated arterial hypertension remains a subject of clinical debate. While beta-blockers are established cornerstones for heart failure and post-myocardial infarction care, their independent efficacy in reducing major adverse cardiovascular events (MACE) in patients without these compelling indications is less clear. This study aimed to evaluate the association between beta-blocker use and MACE in a real-world hypertensive population without prevalent cardiovascular diseases.</p><p><strong>Methods and results: </strong>We analysed 6702 hypertensive patients from the Campania Salute Network (CSN) registry without prevalent coronary or cerebrovascular disease, valvular heart disease, or heart failure. The association between beta-blocker use and MACE was assessed using three statistical approaches: multivariable-adjusted Cox proportional hazards regression, propensity score matching (PSM), and overlap weighting (OW). An intention-to-treat (ITT) analysis was performed based on baseline prescription, and an exploratory per-protocol (PP) sensitivity analysis was conducted to evaluate the role of sustained treatment adherence. At baseline, 18.1% (n = 1247) of patients were receiving a beta-blocker. Over a median follow-up of 52 months, 308 MACE (4.5%) occurred. After multivariable adjustment and weighting, beta-blocker use was not associated with a lower risk of MACE in the ITT population (Adjusted hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.86-1.52; PSM HR 1.18, 95% CI 0.82-1.70; OW HR 1.10, 95% CI 0.82-1.46). In the exploratory PP sensitivity analysis, even among adherent patients, beta-blocker therapy was not associated with a lower risk of MACE. Conversely, adherence to renin-angiotensin system inhibitors and statins was associated with a lower risk of MACE. Beta-blocker users also exhibited a higher prevalence of metabolic risk factors, including elevated triglycerides, glycaemia, and uric acid levels.</p><p><strong>Conclusion: </strong>In patients with uncomplicated hypertension, beta-blocker use was not associated with a lower risk of MACE, regardless of treatment adherence. These findings are consistent with clinical guidelines that prioritize non-beta-blocker regimens and recommend using beta-blockers in the presence of compelling indications.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"1036-1049"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148020406","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":"GLP-1 receptor agonists: from glycaemic control to cardio-reno-metabolic disease modification.","authors":"Dimitrios Farmakis, Konstantinos I Karampinos, Gerasimos Filippatos","doi":"10.1093/ehjqcco/qcag096","DOIUrl":"10.1093/ehjqcco/qcag096","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"995-997"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148160325","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":"Temporal changes in guideline-directed medical therapy score and clinical outcomes in patients with heart failure.","authors":"Toshifumi Tamura, Toshiyuki Nagai, Motoki Nakao, Yoshifumi Mizuguchi, Taro Koya, Atsushi Tada, Fusako George, Isao Yokota, Yoshiya Kato, Shogo Imagawa, Yusuke Tokuda, Masashige Takahashi, Junichi Matsumoto, Ko Motoi, Yutaka Wakamatsu, Masaharu Machida, Takahiko Saito, Toshihisa Anzai","doi":"10.1093/ehjqcco/qcag105","DOIUrl":"10.1093/ehjqcco/qcag105","url":null,"abstract":"<p><strong>Aims: </strong>Optimization of guideline-directed medical therapy (GDMT) is a cornerstone of management in heart failure (HF). The GDMT scoring system was developed to quantify both the use and intensification of GDMT. This study investigated the longitudinal changes in the GDMT score and its association with clinical outcomes in contemporary practice.</p><p><strong>Methods and results: </strong>This multicentre prospective cohort study included 680 patients with chronic HF with reduced ejection fraction. The patients were classified into the uptitration (n = 282) and no uptitration (n = 398) groups according to changes in the GDMT score over 9 months. The GDMT score incorporated the use and dose of guideline-recommended drugs including quadruple therapy, ivabradine, and vericiguat. The primary outcome was a composite of all-cause death and hospitalization for worsening HF. Inverse probability of treatment weighting was used to adjust for baseline differences. Uptitration rates at 9 months were 31.8% for renin-angiotensin system blockers, 28.2% for β-blockers, 10.6% for mineralocorticoid receptor antagonists, and 11.9% for sodium-glucose cotransporter 2 inhibitors. Uptitration was independently associated with baseline GDMT score, age, left ventricular ejection fraction, blood pressure, and renal function. Furthermore, uptitration was associated with a lower incidence of the primary outcome than no uptitration (adjusted HR, 0.65; 95% CI, 0.43-0.98).</p><p><strong>Conclusion: </strong>In this contemporary chronic HF cohort, the GDMT score incorporating guideline-recommended drugs revealed suboptimal implementation and intensification of GDMT over 9 months. Greater increases in GDMT score were associated with improved clinical outcomes, supporting the clinical relevance of longitudinal GDMT optimization.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"1084-1095"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148285069","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":"Potential bias in efficacy estimates due to intercurrent treatment discontinuations.","authors":"Bjorn Redfors, Jacky Choi, Mario Gaudino, Harmony R Reynolds, Judy Zhong","doi":"10.1093/ehjqcco/qcag084","DOIUrl":"10.1093/ehjqcco/qcag084","url":null,"abstract":"<p><strong>Aims: </strong>Treatment discontinuation is a common intercurrent event in randomized clinical trials (RCTs) that can bias treatment effect estimates, yet it remains under recognized and inconsistently addressed. Antithrombotic trials provide a relevant case, as bleeding-related discontinuation is common and more often occur in patients at increased risk also for ischaemic events.</p><p><strong>Methods and results: </strong>We reviewed large antithrombotic RCTs published in The New England Journal of Medicine (2020-2025) to assess reporting and analytic handling of treatment discontinuation. We also conducted simulations to examine how discontinuation patterns influence efficacy estimates under three scenarios: discontinuation only in the treatment arm, in both arms with similar patterns, and in both arms but outcome-associated only in the treatment arm. Treatment policy (intention-to-treat) and while-on-treatment strategies were compared within the ICH E9(R1) framework. Among fourteen reviewed antithrombotic RCTs, about one-third of patients discontinued treatment in trials with more than 6 months follow-up, with higher imbalance in open-label studies. Over half of discontinuations were safety-related, yet timing and temporary interruptions were rarely reported. Most reported both ITT and per-protocol (PP) analyses, with PP assuming non-informative censoring and yielding larger efficacy estimates. In simulations, treatment policy and while-on-treatment strategies were biased when discontinuation was outcome-associated, while Simon-Makuch curves helped identify prognostic discontinuation differing by treatment arm.</p><p><strong>Conclusion: </strong>Discontinuation is common, prognostically meaningful, and often oversimplified in analysis, threatening the validity of RCT findings. Explicitly addressing discontinuation as an intercurrent event within the estimand framework, along with stratified outcome curves, can improve interpretation and support more robust trial conclusions.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"1011-1022"},"PeriodicalIF":4.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148102490","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":"Strengthening the Pre-Hospital Chain of Survival for Out-of-Hospital Cardiac Arrest.","authors":"Alexander Calderone, Eli Segal, Emilie Belley-Côté, Marc-André d'Entremont, Thao Huynh","doi":"10.1093/ehjqcco/qcag140","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcag140","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946444","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}