Global Heart最新文献

{"title":"Spontaneous Abortion and Myocardial Infarction: A Mendelian Randomization Investigation and Transcriptomic Analysis.","authors":"Shiqing Xiang, Qingxia You, Fangxiang Mu, Nian Zhang","doi":"10.5334/gh.1392","DOIUrl":"10.5334/gh.1392","url":null,"abstract":"<p><strong>Background: </strong>A link has been found between spontaneous abortion (SA) and myocardial infarction (MI). However, there is still a lack of comprehensive knowledge regarding the genetic links and biological mechanisms between SA and MI. An investigation of the causal association between SA and MI, along with the associated signaling networks, was conducted using univariate Mendelian randomization (MR) and transcriptome analysis.</p><p><strong>Methods: </strong>Data from genome-wide association studies (GWAS) for SA and MI were analyzed using the FinnGen consortium database. To assess the causality between SA and MI, various methods were employed including inverse-variance-weighted (IVW), weighted median, simple mode, and weighted mode analyses. Sensitivity analysis was conducted using heterogeneity, pleiotropy, and the Leave-One-Out (LOO) approach. Transcriptomic analysis of the GSE60993 dataset was performed to identify differentially expressed genes (DEGs) associated with single nucleotide polymorphisms (SNPs). Following this, two bioinformatics analyses were carried out.</p><p><strong>Results: </strong>Based on IVW results, SA was found to be causally associated with MI (OR = 1.095, 95%CI 1.012-1.186). Sensitivity analysis was subsequently conducted to validate the robustness of our findings. Through differential analysis, three key genes - GNAQ, ELP3, and TES - were identified as closely linked to processes related to ribosome biogenesis, DNA replication, and congenital immune deficiency. Furthermore, strong correlations were observed with various immunologic gene sets, including the Major Histocompatibility Complex (MHC), immunoactivators, and immunosuppressors.</p><p><strong>Conclusion: </strong>This study reveals a robust causal relationship between SA and MI, highlighting genetic and immunological pathways that could inform future research and therapeutic approaches.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"12"},"PeriodicalIF":3.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atherosclerotic Cardiovascular Diseases in Middle Delta of Egypt: A Systematic Analysis of Risk Factors Associated with the Rising Burden of the Disease.","authors":"Mohamed Khalfallah, Marwa Habib, Ahmed Mustafa Kishk, Baraka Saeed, Shreen Hemdan, Ahmad Eissa, Ahmed A Aboomar, Rasha Youssef Hagag, Basma Elnagar","doi":"10.5334/gh.1395","DOIUrl":"10.5334/gh.1395","url":null,"abstract":"<p><strong>Background: </strong>The popularity of behavioural and metabolic risk factors associated with atherosclerotic cardiovascular diseases (ACVDs) has increased because of social progress, rapid economic development, population aging, and changes in social ideology. We aimed to perform a systematic analysis of risk factors associated with the rising rate of ACVDs in Egypt.</p><p><strong>Methods: </strong>This study was carried out on 1,700 participants. The patients were classified into two groups: group 1 included patients with ACVDs, and group 2 (control group) included healthy individuals. All data recorded included patients' anthropometric measurements, and laboratory and clinical examinations were collected.</p><p><strong>Results: </strong>The rising burden of ACVDs in Egypt was caused by a variety of risk factors, including diabetes mellitus, smoking, hypertension, dyslipidemia, obesity, and a lack of physical activity. The dominant risk factors recognized through multivariate regression analysis were the existence of metabolic syndrome (OR = 1.463; 95% CI, 1.056-2.026; P = 0.022), increased psychosocial stress among the patients (OR = 1.404; 95% CI, 1.008-1.953; P = 0.044), excessive consumption of high-fat, processed, and fast food (OR = 1.964; 95% CI, 1.489-2.590; P = 0.001), and decreased the income (OR = 1.865; 95% CI, 1.454-2.391; P = 0.001).</p><p><strong>Conclusions: </strong>Patients who suffer from uncontrolled diabetes, dyslipidemia, and metabolic syndrome are the most liable to have ACVDs. Psychosocial stress and the excessive intake of processed, high-fat, and fast food are augmenting leading risk features, especially in low-income populations.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"11"},"PeriodicalIF":3.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Surgery to Manage Rheumatic Heart Disease in Africa Is Complex - a Geographic Perspective.","authors":"Jordan Leith, Kevin R An, Lamia Harik, William Zhu, Michele Dell'Aquila, Taylor Brashear, Robert N Peck, Castigliano M Bhamidipati","doi":"10.5334/gh.1394","DOIUrl":"10.5334/gh.1394","url":null,"abstract":"<p><strong>Background: </strong>Rheumatic heart disease (RHD) is the most common form of acquired heart disease in Africa, often requiring surgical intervention. Previous studies have demonstrated the need for more cardiac surgeons in Africa but have not outlined their distribution relative to populations and incident cases.</p><p><strong>Objective: </strong>We estimate rheumatic heart disease incidence and cardiac surgical capacity to manage RHD in Africa. By characterizing geographic catchment areas served by the nearest cardiac surgeon(s), we estimate patient travel distance and the unmet surgical need.</p><p><strong>Methods: </strong>Subnational population, RHD incidence, cardiac surgeon, and geographic data were collected from credible, publicly accessible sources. Quantum Geographic Information System (QGIS 3.32) was used to create a subnational map of Africa and conduct nearest neighbor analyses to determine the location and distance of each subnational region's nearest cardiac surgeon. Catchment areas were defined and characterized. Incident RHD case-to-capacity ratios (ICCR) and surgical need were calculated. Incident RHD and surgical need were mapped at the subnational level across Africa. The human development index (HDI) of each region was then incorporated to assess the impact of socioeconomic disparities.</p><p><strong>Results: </strong>A total of 779 subnational regions from 54 countries were included in the analysis. The African continent has an estimated 509 cardiac surgeons practicing in 74 subnational regions (corresponding to 74 catchment areas) and 1,027,974 incident cases of RHD annually. The average distance to travel for care by a cardiac surgeon was found to be 312.01 km (193.87 miles). The ICCR due to RHD for the African continent was 10.64.</p><p><strong>Conclusions: </strong>Access to cardiac surgical care is limited across Africa despite the high incidence of RHD. While nearly all areas of the continent would benefit from increasing cardiac surgical capacity, attention should be paid towards strategic development of geographically accessible cardiac surgical centers to equitize care for RHD.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"10"},"PeriodicalIF":3.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the World Health Organization's Hearts Model for Hypertension and Diabetes Management: A Pilot Implementation Study in Guatemala.","authors":"Irmgardt Alicia Wellmann, Luis Fernando Ayala, Taryn M Valley, Vilma Irazola, Mark D Huffman, Michele Heisler, Peter Rohloff, Rocío Donis, Eduardo Palacios, Manuel Ramírez-Zea, David Flood","doi":"10.5334/gh.1397","DOIUrl":"10.5334/gh.1397","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization HEARTS Technical Package is a widely implemented global initiative to improve the primary care management of cardiovascular disease risk factors. The study's objective is to report outcomes from a pilot implementation trial of integrated hypertension and diabetes management based on the HEARTS model in Guatemala.</p><p><strong>Methods: </strong>We conducted a single-arm pilot implementation trial over six months from October 2023 to May 2024 in 11 Guatemalan Ministry of Health primary care facilities in two districts. The pilot evaluated a package of five HEARTS-aligned implementation strategies to improve the pharmacological treatment of hypertension and diabetes. The primary outcomes were feasibility and acceptability, measured through 20 structured interviews with Ministry of Health employees and by examining enrolment and retention data. Secondary outcomes included a suite of implementation and clinical outcomes, including treatment rates. When baseline data were available, we analyzed secondary outcomes as the net change from baseline or using an interrupted time series approach.</p><p><strong>Results: </strong>The study enrolled 964 patients, of whom 58.8% had hypertension only, 30.4% had diabetes only, and 10.8% had both conditions. Surveys on feasibility and acceptability among Ministry of Health staff had a median score of 5.0 (IQR: 5.0 to 5.0) and 5.0 (IQR range: 4.8 to 5.0), respectively, exceeding the prespecified benchmark of ≥3.5. Both districts achieved the prespecified benchmark of enrolling ≥25 hypertension patients and ≥25 diabetes patients. Only 36% of patients attended a follow-up visit within three months, lower than the prespecified benchmark of ≥75%. Monthly treatment rates during the pilot increased by 22.3 (95% CI: 16.2 to 28.4; P < 0.001) and 3.5 (95% CI: -1.6 to 8.7; P = 0.17) patients per month for hypertension and diabetes, respectively.</p><p><strong>Conclusions: </strong>Implementation of an integrated hypertension and diabetes model based on HEARTS was generally feasible and acceptable in the Ministry of Health in Guatemala. Findings can refine national scale-up in Guatemala and inform HEARTS implementation projects in other settings.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"9"},"PeriodicalIF":3.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability and Implementation Challenges of Benzathine Penicillin G Secondary Prophylaxis for Rheumatic Heart Disease in Ethiopia: A Qualitative Study.","authors":"Eshetie Melese Birru, Kevin T Batty, Laurens Manning, Stephanie L Enkel, Brioni R Moore","doi":"10.5334/gh.1393","DOIUrl":"10.5334/gh.1393","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Monthly intramuscular injections of benzathine penicillin G (BPG) remain the cornerstone of secondary prophylaxis for acute rheumatic fever and rheumatic heart disease (RHD). The barriers to successful delivery of BPG may be patient- or service-delivery-dependent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of the present study was to explore the perceived acceptability and implementation challenges of BPG treatment for RHD, from the perspective of healthcare providers (HCPs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methodology: &lt;/strong&gt;A descriptive qualitative study using semi-structured interview guides was conducted in four public hospitals in Ethiopia. Physicians and nurses who had at least 1 year of experience in delivering RHD secondary prophylaxis were recruited. The interviews were audio recorded, transcribed verbatim, and translated into English for analysis using framework method thematic analysis. Identified behavioral factors were mapped onto a theoretical framework of acceptability (TFA), and the Capability, Opportunity, Motivation-Behavior (COM-B) model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result: &lt;/strong&gt;Twenty-two interviews were conducted with HCPs (mean age 39 years, 55% nurses). Insights into BPG use and acceptability were categorized into four major themes related to: (1) individual factors (e.g., fear of anaphylactic reaction), (2) health system barriers (e.g., BPG shortage), (3) patient/caregiver perceptions (e.g., reliance on injectables, over expectation of treatment outcomes), and (4) product (e.g., injection pain, needle blockage).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;HCPs identified facilitators and barriers which highlight the complexities associated with BPG as secondary prophylaxis for RHD in Ethiopia. Based on these data, we suggest RHD control programs should (1) provide cross-disciplinary training and education programs to support safe and context-appropriate delivery of BPG (2) improve resourcing of health facilities to facilitate safe drug delivery, (3) establish a comprehensive system for auditing severe adverse reactions post-BPG injection to generate robust pharmacovigilance data, and consider alternative approaches to BPG delivery including access to improved formulations (e.g., BPG suspension formulations in pre-filled syringes).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Highlights: &lt;/strong&gt;- Key barriers included (a) resistance from healthcare providers to administer benzathine penicillin G (BPG) due to their concerns about injection-related severe adverse events, and potential repercussions should an event occur, (b) poor community and healthcare provider awareness of the disease and its treatment, (c) lack of resources to manage adverse events, and (d) injection pain.- Key enablers included (a) perceived superior treatment benefits of BPG and (b) co-administration of lidocaine/analgesics to reduce injection pain.- Recommendations to address identified challenges include (a) improved training/education on RHD diagnosis, disease progression, and tr","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"8"},"PeriodicalIF":3.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"End-User Experience of the 2012 WHF Echocardiographic Criteria for Diagnosis of Rheumatic Heart Disease: A Global Survey.","authors":"Lene Thorup, Cleonice Mota, Krishna Kumar, Joselyn Rwebembera, James Marangou, Julius Chacha Mwita, Kate Ralston, Bo Reményi, Andrea Beaton, Liesl Zühlke, Ana Olga Mocumbi","doi":"10.5334/gh.1388","DOIUrl":"10.5334/gh.1388","url":null,"abstract":"","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"7"},"PeriodicalIF":3.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spirituality-Based Intervention in Hypertension: EFfects on Blood PrEssure and EndotheliaL Function-FEEL Trial Results.","authors":"Maria Emília Figueiredo Teixeira, Weimar Kunz Sebba Barroso, Andréa Araújo Brandão, Ana Luiza Lima Sousa, Roberto Esporcatte, Mário Henrique Elesbão de Borba, Ana Clara Neri Ávila Baleeiro, Beatriz Caldas Gonçalves, Enzo Inumaru, Enzo Mata de Sousa, Giovana Barros Leal, Henrique Soares de Araújo Pereira Farias, Juliana Alves de Souza, Lure Emilly Barreto da Silva, Matheus Canguçu de Paiva Queiroz, Frederico Rafael Moreira, Priscila Valverde de Oliveira Vitorino, John Eikelboom, Álvaro Avezum","doi":"10.5334/gh.1390","DOIUrl":"10.5334/gh.1390","url":null,"abstract":"<p><strong>Background: </strong>Emerging evidence suggests that spirituality improves patient outcomes, however, this has undergone only limited evaluation in randomized trials. Hypertension is a major cause of cardiovascular morbidity and mortality worldwide.</p><p><strong>Objectives: </strong>To evaluate whether a spirituality-based intervention, compared to a control group, can reduce blood pressure (BP) and improve endothelial function after 12 weeks in patients with mild or moderate hypertension (HTN).</p><p><strong>Methods: </strong>Open randomized controlled trial of adults with stage I or II hypertension. Following baseline evaluation, including lifestyle questionnaires, and measurements of office and central blood pressure (BP), home blood pressure monitoring (HBPM) and flow mediated dilation (FMD), patients were randomized to a spirituality-based intervention, which included training for forgiveness, gratitude, optimism, and life purpose delivered by daily WhatsApp communications, or to the control group (CG). Main outcomes were between group difference in change from baseline to 12 weeks in office and central BP, HBPM and FMD, using t-tests, analyses of covariance (ANCOVA) adjusting for baseline differences, and, in addition, missing data imputation as a sensitivity analysis.</p><p><strong>Results: </strong>Fifty-one patients were randomized to spirituality-based intervention and 49 to control group. Baseline characteristics were well balanced between groups. Spirituality training, compared with control, improved 7.6 mmHg office systolic blood pressure (SBP), 4.1 mmHg central SBP and 4.1 percentage points FMD. Compared to control group, t-test demonstrated statistical significance for office SBP (-7.04 mmHg, p = 0.047) and FMD (7.46 percentage points, p < 0.001), and ANCOVA adjustment for baseline differences showed statistical significance for central SBP (-6.99 mmHg, p = 0.038) and FFMD (7.95 percentage points, p < 0.001) There was no significant effect on HBPM.</p><p><strong>Conclusion: </strong>A spirituality-based intervention was associated with improved control of office SBP and FMD. These findings will be prospectively evaluated in a nationwide larger and well-powered RCT.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"6"},"PeriodicalIF":3.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate and Intermediate-Term Outcomes of Infants With Transposition of Great Arteries Who Underwent Balloon Atrial Septostomy in Sudan.","authors":"Sulafa K M Ali, Amna Elsheikh, Mohammed Abdulrahman Alhassan","doi":"10.5334/gh.1387","DOIUrl":"10.5334/gh.1387","url":null,"abstract":"<p><p>Transposition of great arteries (TGA) is a critical congenital heart disease leading to a fatal outcome if timely management is not provided. Management in low-income countries is challenging. A retrospective analysis was carried out at Sudan Heart Center for infants with TGA who underwent balloon atrial septostomy (BAS) from January 2010 to December 2020. Immediate clinical- and procedure-related outcomes were evaluated. Intermediate-term outcomes were studied using follow-up hospital records as well as direct telephone calls. The study included 75 infants (70% males) with a median age at presentation of 25 and at the time of BAS of 28 days. Pre-BAS median oxygen saturation was 48 (Interquartile Range (IQR) 40-60%). BAS was performed under fluoroscopy and echocardiography guidance with immediate success achieved in 98% of patients. Post-BAS oxygen saturation increased to 87 (IQR 85-90%) with a median improvement of 40% (p = 0.048), which was more significant in those less than 2 weeks of age. Minor complications occurred in 14 patients, and two patients (2.6%) died. Surgery (atrial in 44% and arterial switch operations in 41%) was performed in 39 patients (52%) at a mean age of three months with perioperative mortality of 30%. Infants who underwent surgery had a significantly higher survival rate (69%) compared to those who did not (5.6%) (p < 0.001). Patients with TGA present at a late age with good immediate outcomes of BAS. Access to surgery is limited with a high surgical mortality. Those who survived surgery had good intermediate-term outcomes while most unoperated patients died.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"5"},"PeriodicalIF":3.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of Cardiovascular Healthcare Professionals Regarding Clinical Trials: A Survey-Based Study from the Middle East.","authors":"Zainab Atiyah Dakhil, Hasan Ali Farhan, Mohammed Dheyaa Marsool, Mohammed Saad Qasim, Michele Peters, Jose Leal","doi":"10.5334/gh.1389","DOIUrl":"10.5334/gh.1389","url":null,"abstract":"<p><strong>Background: </strong>Low-middle income countries harbor the highest burden of cardiovascular diseases globally, but there is an under-representation of these countries in cardiovascular clinical trials. This limits the generalizability of the trial results to these countries. There is a lack of data on insights of cardiologists in these countries regarding conducting and participating in clinical trials. We sought the views of cardiovascular healthcare professionals in Iraq on participation in clinical trials.</p><p><strong>Method: </strong>Cardiovascular professionals in Iraq were identified and contacted, via special platforms on social media specified for them, to answer a 30-item online survey.</p><p><strong>Results: </strong>We surveyed n = 255specialists (20% were women); interventional cardiologists constituted 44.7%, followed by cardiology trainees at 31%. Almost 30% reported having been involved in clinical trials, with data collection being the more frequently reported role (21.2%). Prior participation was not significantly associated with respondent gender, academic affiliation, or presence of institutional ethical committee. Of the total, 95.7% thought that clinical trials should be conducted in Iraq, with 58.8% reporting that they would participate if invited. The most common barriers to respondents' participation in trials were lack of electronic health records (52.2% of those surveyed) and time (51.4%), followed by the requirement of additional follow-up visits or investigations (34.1%). The most common motivators were establishing electronic health records (86.27%), education and training of the general population about clinical trials (84.7%), and dedicated training for healthcare providers about clinical trial basics (84.3%).</p><p><strong>Conclusion: </strong>Our work helps pave the path to implementing a robust clinical trial ecosystem in Iraq. Institutional and financial factors and a lack of dedicated research time are related to the cardiovascular clinical trial lag in Iraq. Future qualitative research can help in getting a deeper understanding of what is needed to create the right infrastructure.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"4"},"PeriodicalIF":3.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Time in Target Range of Resting Heart Rate With Adverse Clinical Outcomes in Patients With Acute Coronary Syndromes After Percutaneous Coronary Intervention.","authors":"Jianmei Zheng, Cen Chen, Zhongcai Fan, Qiang Ye, Yi Zhong, Jinsong Li, Hao Huang, Jianping Deng, Jinghong Zhao, Tinglin Xiong, Wenjie Tian, Xuemei Zhang","doi":"10.5334/gh.1384","DOIUrl":"10.5334/gh.1384","url":null,"abstract":"<p><p>Heart rate (HR) has been proved to be associated with major adverse cardiovascular events (MACE) in Acute coronary syndrome patients. However, the threshold value and clinical significance of time in target of resting heart rate (TTR-HR) remain insufficiently elucidated. Our study aimed to evaluate the independent association between TTR-HR and cardiovascular outcomes in the follow-up study of ACS. A total of 1455 ACS patients who underwent percutaneous coronary intervention (PCI) and were admitted to 22 hospitals between 2019 and 2022 were enrolled and followed up for 12 months. MACE was defined as a composite of cardiac death, nonfatal recurrent myocardial infarction, ischemic-driven revascularization, and ischemic stroke. The association between TTR-HR and cardiovascular outcomes was assessed using Cox regression model. Compared to patients with TTR-HR 0-50% and >50%-75%, patients with TTR-HR > 75%-100% were older and less alcohol user, less likely to use diuretics and anti-diabetic drugs, these patients had less comorbidities of hyperlipidemia, diabetes, heart failure, and cardiac shock. After 12 months follow up, the incidence of MACE and composite endpoint but not mortality was higher in patients with TTR-HR 0-50% and >50%-75% than those with TTR-HR > 75%-100%. After multivariate adjustment, TTR-HR [hazard ratio = 2.11, 95% CI: 1.19-3.74, p = 0.01] was independently associated with composite endpoint. In summary, our study demonstrates that TTR-HR holds significant prognostic value, with TTR-HR > 75%-100% being independently associated with reduced composite endpoint risk in ACS patients following PCI. These findings emphasize the importance of effective heart rate control in ACS patients following PCI.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"3"},"PeriodicalIF":3.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}