Archives of Cardiovascular Diseases最新文献

{"title":"Management of heart failure in private practice: Current situation","authors":"M. Villaceque ,&nbsp;F. Zorès ,&nbsp;F. Mouquet ,&nbsp;A.-F. Plane ,&nbsp;C. Bachelet ,&nbsp;B. Gellen ,&nbsp;B. Lequeux ,&nbsp;E. Berthelot","doi":"10.1016/j.acvd.2024.10.029","DOIUrl":"10.1016/j.acvd.2024.10.029","url":null,"abstract":"<div><h3>Introduction</h3><div>The optimization of care for heart failure (HF) patients often remains imperfect, particularly in terms of increasing pharmacological treatments and monitoring warning signs at home. To enhance practices in this field, we conducted a survey to better understand the habits of private cardiologists and the current obstacles to managing HF patients.</div></div><div><h3>Objective</h3><div>To better understand the habits of private cardiologists and the current obstacles to manage HF patients.</div></div><div><h3>Method</h3><div>A working group of private cardiologists who are members of the GICC established a questionnaire distributed to all private cardiologists between January and March 2024 via a QR code during JESFC events, as well as email dissemination and social media through the cardiologists’ union and the SFC. Responses were collected anonymously.</div></div><div><h3>Results</h3><div>252 cardiologists completed the questionnaire, although 52 were not usable. The average age was 54 years, with a majority practicing in group practices (107) and 34% combining practice in both outpatient clinics and hospitals. Responding cardiologists reported seeing an average of 15 HF patients per week. 98% of them believe that private cardiologists play an important role in HF management, especially for compensated chronic HF. Obstacles to this management included lack of training, complexity of care, and lack of time. Regarding available tools for HF management, 41% utilized tele-expertise and 48% telemonitoring. Reasons for not utilizing tele-expertise included perceived complexity (30%), unfamiliarity with the tool (25%), work habits (preference for phone calls for 20% of practitioners), or perceived uselessness (18%). Reasons for not using telemonitoring included complexity (45%), unfamiliarity with the tools (22%), low reimbursement (12%), or perceived uselessness (10%). Private cardiologists expressed a need for specific training in HF management in the form of Continuing Professional Development (57%) or practical guidelines (49%), facilitated by the GICC (68%).</div></div><div><h3>Conclusion</h3><div>This sample of private cardiologists believes they have a key role in managing chronic HF. However, they face the complexity of this task and express a need for specific training. Greater awareness of new telemedicine tools could contribute to improving patient management.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S37"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart failure therapeutic units enhance adherence to ESC guidelines","authors":"O. Ferchichi ,&nbsp;Z. Ibn El Hadj ,&nbsp;L. Mariem ,&nbsp;Z. Oumayma ,&nbsp;H. Ben Arbia ,&nbsp;A. Sghaier ,&nbsp;M.A. Almi ,&nbsp;S. Bousnina ,&nbsp;R. Chaabouni ,&nbsp;S. Allegui ,&nbsp;S. Aouni ,&nbsp;A. Ben Halima ,&nbsp;E. Bennour ,&nbsp;I. Kammoun","doi":"10.1016/j.acvd.2024.10.028","DOIUrl":"10.1016/j.acvd.2024.10.028","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure persists as a widespread health concern globally, affecting approximately 1–2% of the population in developed nations. Despite medical advancements, heart failure remains a significant cause of morbidity and mortality, primarily attributed to inadequate adherence to the latest ESC guidelines.</div></div><div><h3>Objective</h3><div>To underscore the importance of heart failure therapeutic units (HFTU) in aligning with ESC guidelines.</div></div><div><h3>Method</h3><div>This study was a prospective, descriptive, single-center investigation carried out in our cardiology department over a duration of 12 months. We included 159 patients diagnosed with chronic heart failure, who were divided into two groups to receive care either in the HFTU or usual care, regardless of their initial ejection fraction. Patients allocated to the HFTU had more frequent follow-up visits, prompt initiation of optimal treatment, and transition to second-line therapy if symptoms persisted compared to those receiving usual care. At the end of the follow-up period, we investigated the relationship between enrollment in the HFTU and adherence to ESC guidelines.</div></div><div><h3>Results</h3><div>The mean age of our cohort was 62.5<!--> <!-->±<!--> <!-->11.7 years, with a male predominance at 80.5%. Among the 159 patients, 108 patients allocated to the HFTU while 51 received usual care. Ischemic heart disease was the most prevalent underlying condition, accounting for 57.9% of cases. The average left ventricular ejection fraction was 31.6<!--> <!-->±<!--> <!-->8.31%. The prescription rates of beta-blockers, Angiotensin-Converting Enzyme inhibitors/Angiotensin II Receptor Blockers, Sodium-Glucose Co-Transporter 2 inhibitors, and mineralocorticoid receptor antagonists were 98.1%, 85.6%, 84.3%, and 79.6% respectively, in the HFTU group compared to 94.1%, 70.6%, 31.4%, and 88.2% respectively, in the usual care group.</div><div>Throughout the follow-up period, the HFTU group demonstrated significantly greater adoption of optimal medical treatment compared to those receiving usual care (54,6% vs. 7,8%; <em>P</em> <!-->&lt;<!--> <!-->0,001).</div></div><div><h3>Conclusion</h3><div>HFTU enhance adherence to ESC guidelines, thus combating therapeutic inertia and potentially improving the prognosis of heart failure.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S37"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of a regional heart failure (HF) unit in facilitating access to heart transplantation (HTx) in a non-HTx facility","authors":"J. Costa,&nbsp;P. Marine,&nbsp;L. Trousselle,&nbsp;P. Durdon,&nbsp;L. Lombardot,&nbsp;J. Dangy,&nbsp;K. Caron,&nbsp;D. Metz","doi":"10.1016/j.acvd.2024.10.026","DOIUrl":"10.1016/j.acvd.2024.10.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Accessing heart transplantation (HTx) for patients with advanced heart failure (HF) can be difficult, especially in areas without local transplant centers. To address this issue, the University Hospital of Reims (UHR) has established a regional pathway within its HF unit since 2018.</div></div><div><h3>Objective</h3><div>To evaluate the effects of creating a dedicated HF unit on regional accessibility to HTx.</div></div><div><h3>Method</h3><div>This study utilized data from the Annual Medical and Scientific Report (RAMS) by the French Biomedicine Agency (ABM), covering the years 2014–2022. Three indicators of HTx activity in the former Champagne-Ardenne region were collected: the HTx listing rate per million inhabitants, the HTx transplantation rate per million inhabitants, and the cumulative 12-month HTx transplantation rate. Each indicator was transformed into a national index (the regional/national ratio) to adjust for annual variations. The trends from 2014 to 2022 were examined using regression analysis, and non-parametric tests assessed HTx activity before and after the establishment of the HF unit in 2018.</div></div><div><h3>Results</h3><div>Between 2014 and 2022, the median HTx-listing indicator was 1.04 (interquartile range (IQR): 0.95 to 1.22), showing a tendency to increase (<em>P</em> <!-->=<!--> <!-->0.12) (<span><span>Fig. 1</span></span>). Notably, from 2019 to 2022, the median HTx-listing indicator significantly increased to 1.51 (IQR: 1.18 to 1.83), in contrast to 0.95 (IQR: 0.83 to 0.96) during 2014–2018 (<em>P</em>-value<!--> <!-->=<!--> <!-->0.03) (<span><span>Fig. 2</span></span>A). The overall median HTx rate indicator was 1.29 (IQR: 1.15 to 1.60), with regression analysis indicating a non-significant upward trend (<em>P</em>-value<!--> <!-->=<!--> <!-->0.0624) throughout the period (<span><span>Fig. 1</span></span>). In the 2019–2022 timeframe, the median HTx indicator notably rose to 1.61 (IQR: 1.57 to 1.63), compared to 0.95 (IQR: 0.58 to 1.15) during 2014–2018 (<em>P</em>-value<!--> <!-->=<!--> <!-->0.02) (<span><span>Fig. 2</span></span>B). The overall median 12-month cumulative HTx indicator stood at 1.07 (IQR: 0.97 to 1.13), with regression analysis showing a statistically significant upward trend (<em>P</em>-value<!--> <!-->=<!--> <!-->0.0095) over the full period (<span><span>Fig. 1</span></span>). Specifically, in the 2019–2022 period, the median 12-month cumulative HTx indicator significantly climbed to 1.14 (IQR: 1.11 to 1.17), as opposed to 0.97 (IQR: 0.96 to 1.00) during 2014–2018 (<em>P</em>-value<!--> <!-->=<!--> <!-->0.032) (<span><span>Fig. 2</span></span>C).</div></div><div><h3>Conclusion</h3><div>The establishment of a dedicated Heart Failure (HF) unit within a non-Heart Transplant (HTx) facility has potentially increased the regional HTx accessibility, underscoring the importance of HF units in improving HTx access.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S35-S36"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PRADOC: A multicentre randomized controlled trial to assess the efficiency of PRADO-IC, a nationwide pragmatic transition care management plan for hospitalized patients with heart failure in France","authors":"F. Roubille ,&nbsp;J.-P. Labarre ,&nbsp;M. Galinier ,&nbsp;P. Berdague ,&nbsp;N. Erika ,&nbsp;Q. Delbaere ,&nbsp;M. Robin ,&nbsp;E. Prunet ,&nbsp;F. Leclercq ,&nbsp;J.-L. Pasquie ,&nbsp;L. Papinaud ,&nbsp;G. Mercier ,&nbsp;J.-E. Ricci ,&nbsp;G. Cayla","doi":"10.1016/j.acvd.2024.10.021","DOIUrl":"10.1016/j.acvd.2024.10.021","url":null,"abstract":"<div><h3>Introduction</h3><div>The PRADO-IC is a transition care programme designed to improve the coordination of care between hospital and home that was generalized in France in 2014. The PRADO-IC consists of an administrative assistant who visits patients during hospitalization to schedule follow-up visits.</div></div><div><h3>Objective</h3><div>The aim of the present study was to evaluate the PRADO-IC programme based on the hypotheses provided by health authorities.</div></div><div><h3>Method</h3><div>The PRADOC study is a multicentre controlled randomized open-label mixed-method trial of the transition programme PRADO-IC vs. usual management in patients hospitalized with heart failure (SOC group; <span><span>NCT03396081</span><svg><path></path></svg></span>).</div></div><div><h3>Results</h3><div>A total of 404 patients were recruited between April 2018 and May 2021 (<span><span>Fig. 1</span></span>).</div><div>The mean patient age was 75 years (±12 years) in both groups. The two groups were well balanced regarding severity indices. At discharge, patients homogeneously received the recommended drugs. There was no difference between groups regarding hospitalizations for acute heart failure at 1 year, with 24.60% in the SOC group and 25.40% in the PRADO-IC group during the year following the index hospitalization [hazard ratio (HR)<!--> <!-->=<!--> <!-->1.04, 95% confidence interval (CI)<!--> <!-->=<!--> <!-->0.69–1.56; <em>P</em> <!-->=<!--> <!-->0.85] or cardio-vascular mortality (HR<!--> <!-->=<!--> <!-->0.67, 95% CI<!--> <!-->=<!--> <!-->0.34–1.31; <em>P</em> <!-->=<!--> <!-->0.24).</div></div><div><h3>Conclusion</h3><div>The PRADO-IC has not significantly improved clinical outcomes, though a trend toward reduced cardiovascular mortality is evident. These results will help in understanding how transitional care programmes remain to be integrated in current patients’ pathways, including telemonitoring, and to better tailor individualized approaches.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S33"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of DES coronary restenosis in a real-life setting in North African centers","authors":"F. Boukerche ,&nbsp;M. Kerrouche","doi":"10.1016/j.acvd.2024.10.078","DOIUrl":"10.1016/j.acvd.2024.10.078","url":null,"abstract":"<div><h3>Introduction</h3><div>One of the main causes of failure of angioplasty with stent implantation is in-stent restenosis (ISR). Even though its incidence has considerably decreased in recent years, it remains the Achilles’ heel of the interventional approach in patients with coronary disease.</div></div><div><h3>Objective</h3><div>We aimed to determine the predisposing factors of the different types of restenosis and evaluate the comparative efficacy and safety of the 2 most frequently used treatments of stent restenosis: drug-eluting balloon (DEB) and placement of a new drug-eluting stent (redo-DES).</div></div><div><h3>Method</h3><div>A prospective longitudinal analytical bicentric study, including all consenting patients presenting on coronary angiography in-stent restenosis, whether in the context of the exploration of stable angina or acute coronary syndrome. The different characteristics, mechanisms (analysis of initial PCI procedure, stent enhancement, and IVUS) management, and prognosis were noted. An angiographic control was systematically carried out between 6 and 12 months in patients treated with a Redo-DES or DEB (<span><span>Fig. 1</span></span>).</div></div><div><h3>Results</h3><div>A total of 73 patients were evaluated: the mean age was 61.3<!--> <!-->±<!--> <!-->10.2 years and 80.8% were male. The more frequent risk factor was diabetes with 67.1% (47 patients), and the main clinical presentation was CCS in 56.2% (41patients). The mean delay of in-stent restenosis occurrence was 20 months (4–48 months). The related artery includes the LAD in 61.6% and the two main characteristics of the initial lesion were calcified in 68.5% and the longest (&gt;<!--> <!-->24 mm) in 53.4% of patients. Stent under expansion was the most found mechanism in 54.8%. More than a half of the patients were treated with Redo-stenting and 34.2% with a DEB. The angiographic control was good with only two significant redo-restenosis in patients treated with a DEB and three in patients treated with a DES.</div></div><div><h3>Conclusion</h3><div>Diabetes mellitus, calcified and long lesions are the most important factors related to in-stent restenosis. Stent under expansion was the most found mechanism. Redo-stenting and DEB are safe and efficient treatments.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S16-S17"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What about markers inflammation on cardiac amyloidosis?","authors":"A. Zaroui ,&nbsp;G. Neculae ,&nbsp;B. Mélanie ,&nbsp;M. Kharoubi ,&nbsp;S. Oghina ,&nbsp;G.S. Chadha ,&nbsp;S. Bourgoin-Voillard ,&nbsp;J.-P. Bastard ,&nbsp;S. Fellahi ,&nbsp;T. Damy","doi":"10.1016/j.acvd.2024.10.051","DOIUrl":"10.1016/j.acvd.2024.10.051","url":null,"abstract":"<div><h3>Introduction</h3><div>Prognosis in cardiac amyloidosis has always been associated with amyloid infiltration, but there is increasing evidence of the role of inflammation and systemic immune response caused by the toxicity of free light chains and amyloid fibrils. However, there is very little knowledge about the systemic inflammation markers, their differential value, and prognostic significance in amyloidosis subtypes.</div></div><div><h3>Objective</h3><div>Differential value of inflammation markers and prognostic significance in amyloidosis subtypes.</div></div><div><h3>Method</h3><div>Prognostic markers well-known in AA amyloidosis, such as IL-6, calprotectin, and amyloide serique A (SAA), were measured at diagnosis and compared among AL, ATTR amyloidoses, and other cardiopathies.</div></div><div><h3>Results</h3><div>Pilot study of 147 patients (25 AL, 80 ATTR, and 42 others) with respective median ages of 76 years, 83 years, and 70 years, the median left ventricular function was 51.5% (±5), 52% (±4), and 48% (±6), with a median follow-up of 563 [20–590] days. Results showed a high incidence of inflammation with dissociation of markers in AL and ATTR-CA, For AL, the markers were higher,for ATTR-CA, there was some inflammatory substrate, less marked than in AL but more significant than in other cardiopathies. A certain population of ATTR-CA had a higher inflammatory profile (calprotectin and SAA). For other cardiopathies, the profile was rather homogeneous: the IL-6 was at 25.4<!--> <!-->±<!--> <!-->37 pg/ml, the Calprotectin at 10.3<!--> <!-->±<!--> <!-->21<!--> <!-->mg/L, and the SAA at 14.8<!--> <!-->±<!--> <!-->37<!--> <!-->mg/L compared to 8.5<!--> <!-->±<!--> <!-->9.9 pg/ml, 3.3<!--> <!-->±<!--> <!-->5.6<!--> <!-->mg/L, and 10.5<!--> <!-->±<!--> <!-->9.2<!--> <!-->mg/L, respectively, for ATTR and others cardopathies. Patients with elevated IL-6 levels were the most severe (higher Troponin, NT-proBNP, and lower LVEF). Calprotectin was well correlated with NT-proBNP and LVEF (<em>R</em> <!-->=<!--> <!-->0.76 and 0.77, <em>P</em> <!-->=<!--> <!-->0.04 and 0.001, respectively). IL-6 was the only marker with iprognostic value with a Hazard ratio of mortality at 2 years at 1.67 [1.11–12.45] in AL and ATTR amyloidoses (independent of troponin, LVEF, and NT-proBNP), and a value above 22 pg/ml increased mortality at 2 years by 20% in ATTR and early mortality by 33% in AL (3 months).</div></div><div><h3>Conclusion</h3><div>Inflammation is part of the pathophysiology of amyloidosis and increases morbidity and mortality, especially in AL amyloidosis. Treating amyloidosis would likely involve addressing this aspect in addition to others.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Pages S48-S49"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is unstable angina a benign disease? A prospective multicenter contemporary study","authors":"R. Jouen ,&nbsp;P.-A. Meunier ,&nbsp;L. Moulis ,&nbsp;P. Robert ,&nbsp;B. Lattuca ,&nbsp;G. Cayla ,&nbsp;M. Steinecker ,&nbsp;J.-C. Macia ,&nbsp;F. Leclercq","doi":"10.1016/j.acvd.2024.10.083","DOIUrl":"10.1016/j.acvd.2024.10.083","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The use of high sensitivity cardiac troponin (hs-cTn) for the diagnostic strategy of acute coronary syndromes (ACS) resulted in decrease of unstable angina (UA) to the benefit of NSTEMI. However, prognostic of UA remains controversial with no precise guidelines.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To evaluate clinical characteristics and prognostic of a contemporary patients with UA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Method&lt;/h3&gt;&lt;div&gt;The study included all patients admitted in 2 French university centres with the diagnostic of UA defined with clinical ischemic symptoms and T hs-cTn concentrations&lt;!--&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;99 percentile (undetectable:&lt;!--&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;5 ng/l or non-elevated:&lt;!--&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;14 ng/l) or&lt;!--&gt; &lt;!--&gt;≥&lt;!--&gt; &lt;!--&gt;99 percentile but mildly elevated (14–50 ng/l) without significant rise (&lt;&lt;!--&gt; &lt;!--&gt;20%) between 2 dosages. Only patients with significant coronary stenosis were included. The primary end-point included major events at 1-year follow-up (total mortality, new ACS, hospitalization for cardiac causes).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 1682 patients admitted for ACS during the study period (December 2021–February 2023), 210 were diagnosed to have UA (12.5%). Mean age of patients with UA was 66&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;12 years, with predominantly males (68.1%). The patients with UA had undetectable (&lt;em&gt;n&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;4), non-elevated (&lt;em&gt;n&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;80) or moderately elevated T hs-cTn with no kinetics (&lt;em&gt;n&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;126). At least 2 cardiovascular risk factors were observed in 60.9% patients and a history of coronary artery disease (CAD) was found in 46.6% patients. Coronary angiography showed multitroncular disease in 56,7% patients and a mean SYNTAX 1 score of 8.27&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;5.06. Percutaneous coronary angioplasty was performed in 88.6% patients while 7.14% required bypass surgery. Only one adverse event occurred during the hospital phase related to documented stroke. Regarding the primary outcome, 55 patients had an adverse event (26.2% [20.2–32.1]) mainly related to new ACS (&lt;span&gt;&lt;span&gt;Table 1&lt;/span&gt;&lt;/span&gt;). The level of troponin was not associated with the primary outcome in univariate analysis nor was the SYNTAX I score. In multivariate logistic regression analysis, ≥&lt;!--&gt; &lt;!--&gt;3 cardiovascular risk factors (OR 1.93 [1.01–3.69], &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.0194), history of CAD (OR 3.09 [1.63–5.87], &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.0005), previous antiplatelet therapy (OR 2.54 [1.11–5.84], &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.0279) and tritroncular disease (OR 2.66 [1.24–5.69], &lt;em&gt;p&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.0118) were significantly associated with major events at follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Incidence of UA is low (12.5% of all ACS) but with a 1-year incidence of major cardiac events high (26.2%), mainly related to new acute coronary event. UA is therefore not a benign disease and secondary prevention","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S19"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a post-myocardial infarction sexuality education session on erectile dysfunction, anxiety and depression","authors":"E. Allouche ,&nbsp;R. Laajimi ,&nbsp;A. Chetoui ,&nbsp;H. Ben Jemaa ,&nbsp;F. Boudiche ,&nbsp;M.S. Aissa ,&nbsp;W. Ouechtati Ben Attia ,&nbsp;H. Ben Ahmed ,&nbsp;L. Bezdah","doi":"10.1016/j.acvd.2024.10.065","DOIUrl":"10.1016/j.acvd.2024.10.065","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with coronary artery disease (CAD) experience a decline in their quality of life due to the onset of depression, anxiety, and erectile dysfunction (ED) following an acute event.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate the impact of a post-myocardial infarction (MI) sexuality education session on ED, anxiety, and depression.</div></div><div><h3>Method</h3><div>The study was a prospective randomized trial, involving stable coronary men in the Cardiology Department of Charles Nicolle Hospital. It included one 100 patients randomly assigned to either an intervention group or a control group. During the initial interview, the patients’ erectile dysfunction (ED) was evaluated using the IIEF-5 score, and anxiety disorders were assessed using the DASS-21 score. The intervention group received an individual post-myocardial infarction (MI) sexuality education session. After three months, both groups were reassessed using the same scores.</div></div><div><h3>Results</h3><div>During the first interview there was no difference between the intervention group and the control group with high rates of ED (94% <em>vs.</em> 90%), depression (74% <em>vs.</em> 78%) and anxiety (96% <em>vs.</em> 90%). The intervention group exhibited significantly lower rates of ED (42% <em>vs.</em> 70%, <em>p</em> <!-->=<!--> <!-->0.005), depression (32% <em>vs.</em> 62%, <em>p</em> <!-->=<!--> <!-->0.003), and anxiety (50% <em>vs.</em> 76%, <em>p</em> <!-->=<!--> <!-->0.007) compared to the control group during the second interview. There was a significant decrease in the rates of ED (42% <em>vs.</em> 94%, <em>p</em> <!-->&lt;<!--> <!-->0.001), depression (32% <em>vs.</em> 74%, <em>p</em> <!-->=<!--> <!-->0.001), and anxiety (50% <em>vs.</em> 96%, <em>p</em> <!-->&lt;<!--> <!-->0.001) among patients in the intervention group during the second interview, compared to the first. In contrast, there was no significant difference in the prevalence of ED, depression, and anxiety between the first and second interviews for patients in the control group. Patients in the Intervention Group experienced a significant improvement in ED and anxiety (<em>p</em> <!-->&lt;<!--> <!-->0.001) and OR (95% CI) to 4,53 [1,95–10,51].</div></div><div><h3>Conclusion</h3><div>Therefore, it is imperative to incorporate sexuality education into therapeutic education and cardiac rehabilitation programs for post-MI coronary heart disease patients. This will undoubtedly have a positive impact on sexual function and anxiety disorders.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S10"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex differences in management of LDL-cholesterol in patients with chronic coronary syndrome","authors":"J. Mesnier ,&nbsp;L. Giovachini ,&nbsp;G. Ducrocq ,&nbsp;R. Ferrari ,&nbsp;I. Ford ,&nbsp;J.-C. Tardif ,&nbsp;M. Tendera ,&nbsp;K. Fox ,&nbsp;P.G. Steg","doi":"10.1016/j.acvd.2024.10.056","DOIUrl":"10.1016/j.acvd.2024.10.056","url":null,"abstract":"<div><h3>Introduction</h3><div>Effective management of low-density lipoprotein cholesterol (LDL-C) is crucial for preventing recurrent cardiovascular (CV) events in patients with chronic coronary syndrome (CCS). Sex may impact the LDL-C management.</div></div><div><h3>Objective</h3><div>We examined sex-specific LDL-C management in CCS patients, assessing target achievement rates and their implications for CV outcomes.</div></div><div><h3>Method</h3><div>In the international CLARIFY registry, we included 22,134 CCS patients with baseline LDL-C measurements. LDL-C levels were monitored annually over the 5-year follow-up period. Target LDL-C was set at 100 mg/dL, in line with prevailing recommendations at that time. Sex-specific differences in LDL-C were adjusted forage, geographical region and indication for lipid lowering drugs (stroke, MI, PAD). The primary endpoint was the incidence of MACE, defined as CV death or MI during the 5-year follow-up, evaluated using multivariable analysis adjusted for known predictors of recurrent CV events in CCS patients.</div></div><div><h3>Results</h3><div>Of 22,134 patients, 21.6% were women. Upon inclusion (6.5<!--> <!-->±<!--> <!-->6.3 years after CCS diagnosis), women were more likely than men to have LDL-C levels above the recommended threshold (45.6% vs. 37.4%; aOR 1.47, 95%CI 1.38–1.58, <em>P</em> <!-->&lt;<!--> <!-->0.001, <span><span>Fig. 1</span></span>) and less likely to receive statin treatment (82.7% vs. 85.4%, <em>P</em> <!-->&lt;<!--> <!-->0.001). The discrepancies endured over the 5-year observation period, with women consistently showing lower likelihood of achieving LDL-C targets at 1, 2, 3, 4, and5 years post-inclusion (<em>P</em> <!-->&lt;<!--> <!-->0.001 for all time points). Overall, women were less likely than men to have all available LDL-C concentrations within the target range (37.8% vs. 44.6%; aOR 0.70, 95% CI 0.64–0.76, <em>P</em> <!-->&lt;<!--> <!-->0.001) and more likely to never reach the target LDL-C goal during follow-up (22.6% vs. 17.5%; aOR 1.43, 95% CI 1.32–1.55, <em>P</em> <!-->&lt;<!--> <!-->0.001). Failing to achieve at least one LDL-C concentration below100 mg/dL was associated with an increased risk of subsequent MACE (adjusted HR 1.57, 95%CI 1.38–1.77, <em>P</em> <!-->&lt;<!--> <!-->0.001), with similar associations observed in both men (aHR 1.66, 95% CI 1.44–1.91, <em>P</em> <!-->&lt;<!--> <!-->0.001) and women (aHR 1.31, 95% CI 1.01–1.70, <em>P</em> <!-->=<!--> <!-->0.05).</div></div><div><h3>Conclusion</h3><div>In patients with CCS, women consistently showed lower likelihood of reaching LDL-C targets throughout follow-up compared to men. Women were more likely to have no LDL-C concentration within recommended range during follow-up, which is particularly concerning given its association with an increased risk of CV events.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S5"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward a multidisciplinary approach: The increasing involvement of nurses in heart failure management","authors":"F. Zorès ,&nbsp;T. Damy ,&nbsp;A. Duchenne ,&nbsp;E. Huet ,&nbsp;C. Lecerf ,&nbsp;B. Lequeux ,&nbsp;E. Martin ,&nbsp;M. Moulin ,&nbsp;F. Mouquet ,&nbsp;B. Pedrono ,&nbsp;J. Redureau ,&nbsp;M. Salvat ,&nbsp;V. Thoré ,&nbsp;M. Villaceque ,&nbsp;E. Berthelot","doi":"10.1016/j.acvd.2024.10.044","DOIUrl":"10.1016/j.acvd.2024.10.044","url":null,"abstract":"<div><h3>Introduction</h3><div>The increasing prevalence of heart failure (HF), alongside the scarcity of medical time, necessitates the development of new practices and the promotion of task-sharing and skill-sharing. Over the past few years, new professions have emerged to facilitate the care of patients with HF: specialized nurses in heart failure management (ISPIC), advanced practice nurses (IPA), and telemonitoring nurses (ITS).</div></div><div><h3>Objective</h3><div>In spring 2023, the GICC (Groupe Insuffisance Cardiaque et Cardiomyopathies) distributed a questionnaire via email and social networks to better understand these new professions.</div></div><div><h3>Method</h3><div>196 usable questionnaires were collected, of which 106 (54%) had exhaustive responses. The majority of respondents were IPAs (59 (47%)), 45 (36%) were ISPICs, and 21 (17%) were ITSs. The average age was 44 years, similar across the three groups. Respondents had a median of 11 years of experience with CV pathologies, but IPAs had significantly less time working with cardiac patients than the other two groups.</div></div><div><h3>Results</h3><div>57% of IPAs, 81% of ISPICs, and 80% of ITSs have exclusive activity in cardiology (<em>P</em> <!-->=<!--> <!-->0.021). Outside of cardiology, the most frequently invested specialties are diabetology, geriatrics, and vascular medicine. 48% of the nurses exclusively work with HF patients.</div><div>Professional practice is mainly in public hospital structures (66%), with non-university hospital centers leading. Private practice is more common among IPAs than other professions (29% of IPAs vs. 5% for ISPICs and 0% for ITSs; <em>P</em> <!-->&lt;<!--> <!-->0.005).</div><div>Consultations for uptitration of medical therapy are conducted by 72% of IPAs and 55% of ISPICs. 94% of IPAs and 48% of ISPICs conduct clinical and biological follow-up consultations. A majority of nurses already perform or are in the process of implementing tools to coordinate patient care pathways. 70% of ISPICs participate in therapeutic patient education workshops, compared to only 37% of IPAs and 44% of ITSs (<em>P</em> <!-->=<!--> <!-->0.049). 100% of ITSs conduct telemonitoring, compared to only 46% of IPAs and 80% of ISPICs (<em>P</em> <!-->&lt;<!--> <!-->0.001).</div></div><div><h3>Conclusion</h3><div>This initial study highlights the already effective involvement of specialized nurses in the care of HF patients, despite disparities in training and practice mode. It also highlights differences in roles with patients for each of these professions. Studies with larger populations will further refine this preliminary work.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S45"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143150509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}