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

{"title":"Cardiac rehabilitation programme accreditation and certification: Comparing international practices, mapping standards, benchmarks, and future directions - A scoping review.","authors":"Lamees Abdullah Mohammed Ali, Asmaa El-Heneidy, Jenna Taylor, Julie Redfern, Robyn Gallagher, Dion Candelaria, Emma E Thomas","doi":"10.1093/ehjqcco/qcag131","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcag131","url":null,"abstract":"<p><strong>Aims: </strong>Programme accreditation and certification are key mechanisms for standardising, assuring, and continuously improving the quality of cardiac rehabilitation. Comparative evidence on existing accreditation and certification schemes remains limited. This review compared these schemes to identify key characteristics, standards, convergences, divergences, implementation, and gaps to inform future quality improvement directions.</p><p><strong>Methods: </strong>A scoping review following PRISMA-ScR guidelines was conducted searching four databases, grey literature and accreditation bodies' websites (August-September 2025). Cardiac rehabilitation certification schemes with publicly accessible descriptive or evaluative documentation were included. Extracted data were analysed narratively.</p><p><strong>Results: </strong>Eleven peer-reviewed studies and 38 organisational documents met the inclusion criteria. Four schemes from USA, United Kingdom, Europe, and the International Council of Cardiovascular Prevention and Rehabilitation were included in the comparative analysis because sufficient public documentation was available. Certification standards were mapped across schemes, consolidated into 18 and classified according to Donabedian domains. Thirteen standards were universal (endorsed by all four schemes) or near-universal (endorsed by three) including multidisciplinary care, assessments, exercise, education, and counselling; however, their operationalisation varies. Certification uptake was concentrated in high-income settings. Reported barriers were related to resources, cost, and infrastructure. Evidence of certification impact was limited.</p><p><strong>Conclusion: </strong>Shared standards suggest broad consensus on the core components of high-quality cardiac rehabilitation. Resource, cost, and infrastructure barriers may influence certification accessibility and adoption. Leveraging shared standards while allowing flexible implementation pathways may support broader uptake of quality-assured cardiac rehabilitation. Further rigorous evaluation is needed to determine whether certification translates into sustained improvements in service quality and meaningful health gains.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809757","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 continuity of care in the management of atrial fibrillation in primary care.","authors":"Nicholas R Jones, Amir Mashia Jaafari, Fd Richard Hobbs","doi":"10.1093/ehjqcco/qcag133","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcag133","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809766","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 recognition to action: guideline-directed medical therapy in dystrophin-related cardiomyopathy.","authors":"Juliana Levy","doi":"10.1093/ehjqcco/qcag126","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcag126","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805094","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":"Sex Differences in Coronary Inflammation and Clinical Outcomes Among Patients with Plaque-Positive Non-Obstructive Coronary Artery Disease: A long-term dual-center follow-up study.","authors":"Bowen Li, Yong Chen, Xueqiao Yang, Huiyu Chen, Runze Zhu, Jian Wang, Bing Kang, Ximing Wang, Hui Gu","doi":"10.1093/ehjqcco/qcag134","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcag134","url":null,"abstract":"<p><strong>Background: </strong>The influence of sex on coronary inflammation in patients with non-obstructive coronary artery disease (CAD) remains unclear. This study aims to determine sex differences in coronary inflammation, quantified by pericoronary fat attenuation index (pFAI) derived from coronary computed tomography angiography (CCTA), and their impact on clinical outcomes among patients with plaque-positive non-obstructive CAD.</p><p><strong>Methods: </strong>This study retrospectively included 1395 patients with plaque-positive non-obstructive CAD who underwent CCTA (61±10 years, 55.2% males). Major adverse cardiovascular events (MACEs) were defined as cardiac death, non-fatal myocardial infarction, rehospitalization for heart failure or unstable angina, and late revascularization.</p><p><strong>Results: </strong>After a median follow-up of 85 months (interquartile range [IQR]: 72-99), 177 patients experienced MACEs. Male sex was independently associated with elevated coronary inflammation (pFAI > -70.1 HU; OR=1.36, P=0.047). Male patients had a significantly higher cumulative rate of MACE than female patients (P<0.001). Furthermore, patients with coronary inflammation (pFAI > -70.1 HU) exhibited significantly worse long-term outcomes than those without, and consistent findings were observed in both male and female subgroups (all P<0.001). In multivariable Cox regression analysis, pFAI remained independently associated with MACEs in patients with non-obstructive CAD (HR=2.33, P<0.001) and provided incremental prognostic value beyond clinical variables and traditional CCTA metrics (AUC: 0.683-0.781, P<0.001).</p><p><strong>Conclusion: </strong>Among patients with plaque-positive non-obstructive CAD, males exhibited worse long-term outcomes than females and showed a stronger association with coronary inflammation. pFAI is independently associated with long-term prognosis and may enhances risk stratification in these patients.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805044","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":"Estimated VESALIUS-Like Eligibility and Projected Cardiovascular Benefit in US Adults.","authors":"Ramzi Ibrahim, Julia Zanco, Vinicius De Sousa Barzon Serra, Chadi Ayoub, Reza Arsanjani, Sadeer Al-Kindi","doi":"10.1093/ehjqcco/qcag130","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcag130","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805078","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":"Comparative Outcomes of Direct Oral Anticoagulants Versus Aspirin After Ventricular Tachycardia Ablation.","authors":"Yong Hao Yeo, Thai Hau Koo, Min Choon Tan, Dan Sorajja, Hicham El-Masry, Pasquale Santangeli, Koji Higuchi, Jakub Sroubek, Justin Lee","doi":"10.1093/ehjqcco/qcag132","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcag132","url":null,"abstract":"","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805046","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":"Deterministic Economic Modelling Study of Tafamidis in Transthyretin Amyloid Cardiomyopathy Across Four European Healthcare Systems.","authors":"Kossar Hosseini, Nicolas Girerd, François Roubille, Luca Monzo, Guillaume Baudry, Jonathan Epstein, Francis Guillemin, Jean-Marc Boivin","doi":"10.1093/ehjqcco/qcag129","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcag129","url":null,"abstract":"<p><strong>Introduction: </strong>Tafamidis has been demonstrated to improve survival and quality of life in transthyretin amyloid cardiomyopathy (ATTR-CM). However, its cost-effectiveness has been reported to exceed the threshold of $100,000/quality-adjusted life years [QALY] in the US healthcare system. This study aimed to evaluate costs associated with utilities (QALYs) gained for ATTR-CM in France, Spain, Germany, and the United Kingdom (UK), and to conduct a deterministic modelling study using case-scenarii based on various assumptions at a European level.</p><p><strong>Methods: </strong>Data on costs and QALY were extracted using MEDLINE. The lack of data on the cost of the cardiac amyloidosis in patients treated with tafamidis led us to modelling our study based on heart failure assumptions. We used QALY gained in the tafamidis group as reported for ATTR-CM patients in the ATTR-ACT trial to determine the incremental cost-effectiveness ratio (ICER) of tafamidis compared with standard care. A sensitivity analysis was conducted with assumptions on costs and QALYs gained.</p><p><strong>Results: </strong>Incremental cost-effectiveness ratios (ICER) for each country largely exceeded the threshold of €100,000/QALY, ranging from €398,136/QALY gained in France to €1,398,706/QALY gained in Germany. The sensitivity analysis revealed large variations of the ICER, with only 27.4%, 0.2%, 13% and 9% probability of cases below the acceptability threshold of €100,000/QALY in France, Spain, Germany and UK, respectively.</p><p><strong>Conclusion: </strong>While tafamidis offers a significant improvement in patients' quality of life and survival, these exploratory scenario-based estimates showing high cost-effectiveness ratio in some European countries, may raise public health and cost management concerns.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805059","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":"Volume-outcome analysis of in-hospital complications after cardiac implantable electronic device implantation: a 250 000-case study‡.","authors":"Paulina Vitkauskė, Maurilio Gutzeit, Heike Jaegers, Heinz-Jürgen Adomeit, Susanne Macher-Heidrich, Fuad Hasan, Markus Zarse, Harilaos Bogossian, Uwe Wiegand, Axel Kloppe, Carsten Israel, Bernd Lemke","doi":"10.1093/ehjqcco/qcag109","DOIUrl":"https://doi.org/10.1093/ehjqcco/qcag109","url":null,"abstract":"<p><strong>Aims: </strong>Although implantation volume of cardiac implantable electronic device (CIED) is widely considered a prognostic factor, Germany continues to show a wide distribution of hospitals performing CIED procedures, with annual volumes ranging from fewer than 10 to over 500 cases. Using a new statistical volume-outcome model, we examined the existence and shape of the relationship between complication rates and hospital volume.</p><p><strong>Methods and results: </strong>The analysis is based on data from all first inpatient CIED implantations performed between 1 January 2010 and 31 December 2020, in hospitals across North Rhine-Westphalia. All peri- and post-operative complications documented in mandatory quality assurance were included. A possible association between implantation volume and quality was assessed using a flexible generalized additive mixed model. Out of 249 118 cases, the overall complication rate was 2.4%, with lead-related issues being the most common (1.5%). Forest plot analysis identified American Society of Anaesthesiologists Class 4-5, New York Heart Association Class IV, subclavian vein access, and dual-chamber pacemaker systems as the strongest predictors of complications. Volume-outcome analysis revealed a significant association between implantation volume and complications, particularly among pacemaker patients [P < 0.001, area under the curve (AUC) 0.7], and showed a relevant reduction in hospital stays and healthcare costs. Modelling suggested that a 50-case annual cut-off could prevent ∼16% of complications, requiring ∼16% of patients to be redirected to other hospitals.</p><p><strong>Conclusion: </strong>This study demonstrates a statistically significant association between implantation volume and complication rates across all CIED procedures, with the effect being particularly pronounced among pacemaker patients.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766583","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":"Development and External Validation of an AI-ECG Algorithm for Estimating Elevated Serum NT-proBNP Levels.","authors":"Ciro Indolfi, Carmen Spaccarotella, Alberto Polimeni, Domenico Simone Castiello, Giovanni Esposito, Antonio Curcio, Adriana Gravina, Nicola Leone, Joonghee Kim, Federico Garoia, Gianfranco Sinagra, Thomas F Lüscher, Youngjin Cho","doi":"10.1093/ehjqcco/qcag128","DOIUrl":"10.1093/ehjqcco/qcag128","url":null,"abstract":"<p><strong>Background: </strong>N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a cornerstone biomarker for the diagnosis and management of heart failure, but its use may be limited by the need for blood testing and laboratory infrastructure. Artificial intelligence (AI) applied to electrocardiograms (ECGs) may offer a widely accessible, non-invasive approach to estimate NT-proBNP levels.</p><p><strong>Methods: </strong>We developed a convolutional neural network incorporating residual and attention-based layers to estimate NT-proBNP levels from standard 12-lead ECGs. The model was trained using 84,895 ECG-NT-proBNP pairs from 40,762 adult patients; 8,545 patients were held out for internal validation. The model generated a nine-level ECG-BNP score. External validation was conducted in 679 patients at two tertiary cardiovascular centers. Discrimination for prespecified thresholds (>250, >500, >1,000 pg/mL) was assessed by AUROC with 95% CIs; calibration and threshold-specific sensitivity, specificity, PPV/NPV were evaluated.</p><p><strong>Results: </strong>In internal validation, the AI-ECG score showed a strong correlation with measured NT-proBNP levels (Spearman ρ=0.85, p<0.001) and high discrimination across thresholds (AUROC >0.92). In external validation, the model achieved AUROCs of 0.866 (95% CI 0.838-0.894) for >250 pg/mL, 0.882 (95% CI 0.857-0.907) for >500 pg/mL, and 0.885 (95% CI 0.859-0.914) for >1,000 pg/mL. Performance was consistent across key clinical subgroups.</p><p><strong>Conclusions: </strong>An AI-enabled ECG model can identify patients with elevated NT-proBNP levels with good accuracy in both internal and external validation cohorts. This approach may help identify patients who should undergo confirmatory NT-proBNP testing, particularly when biomarker testing is delayed, unavailable, or not routinely performed. Prospective studies are warranted to define whether this strategy provides incremental clinical value and can be integrated into clinical pathways.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723376","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":"Socioeconomic deprivation and post-discharge mortality in heart failure: evidence from a nationwide universal health coverage system.","authors":"Hugo Guillermou, Vera Georgescu, Nicolas Girerd, Hariette G C Van Spall, Guillaume Baudry, Grégoire Mercier, François Roubille","doi":"10.1093/ehjqcco/qcag008","DOIUrl":"10.1093/ehjqcco/qcag008","url":null,"abstract":"<p><strong>Aims: </strong>Heart failure (HF) is characterized by high mortality rates during hospitalization and after discharge. Socioeconomic deprivation and inequalities are often barriers to effective treatment, substantially impacting mortality in chronic illnesses. We investigated the association between socioeconomic deprivation, all-cause mortality, and HF readmission among patients hospitalized for HF in France.</p><p><strong>Methods and results: </strong>We conducted a retrospective cohort study including all adults hospitalized for worsening HF in France in 2018, using data from the national health insurance database. We estimated the association between area-level socioeconomic disadvantage quintiles and income inequality quantified by the Gini index and the outcomes of all-cause mortality and HF readmission using adjusted survival models. Among 92 111 patients (median age 82 years; 50.5% female), 29.7% were readmitted and 25.9% died within 1 year. Higher levels of deprivation were associated with increased one-year mortality, with HR ranging from 1.03 to 1.06, but not consistently across all quintiles. This association persisted in adjusted analysis at 1 (HR 1.11, 1.07-1.16, P < 0.001, for the most vs. least deprived) and 2 years (HR 1.11, 1.07-1.15, P < 0.001). In contrast, socioeconomic deprivation was not significantly associated with readmission risk, and the Gini index showed no association with either mortality or readmission.</p><p><strong>Conclusion: </strong>In a country with universal healthcare, area-level socioeconomic deprivation was modestly associated with higher mortality after HF hospitalization, but not with readmission risk. Society-level income inequality showed no relationship with either outcome.</p>","PeriodicalId":520616,"journal":{"name":"European heart journal. Quality of care & clinical outcomes","volume":" ","pages":"664-675"},"PeriodicalIF":4.6,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147501553","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}