European heart journal open最新文献

{"title":"Reasons for gender inequities in invasive electrophysiology: a survey on family issues and career paths of female and male electrophysiology fellows in Germany.","authors":"Johanna Mueller-Leisse, Henrike Aenne Katrin Hillmann, Joerg Eiringhaus, Eleonora Angelini, Nizar Karfoul, Stephan Hohmann, David Duncker","doi":"10.1093/ehjopen/oeae070","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae070","url":null,"abstract":"<p><strong>Aims: </strong>Female physicians are underrepresented in invasive electrophysiology (EP) for multiple reasons. Despite an increasing focus on the topic, it is unclear what aspects are predominant.</p><p><strong>Methods and results: </strong>We conducted a survey on career paths of current or former EP fellows in Germany to elucidate how gender and family affected their careers. 231 fellows (24.2% female) were invited. 110 participants completed the survey (30.9% female, mean age 41.0 ± 5.0 years, and 79.1% with children). Female and male participants with children reported similar career goals and achievements before parenthood, but afterwards women changed their career paths more often. Major reasons were personal priorities followed by lack of flexibility at work and at home. Women covered the majority of childcare. At the time of the survey, 80.0% of women and 96.4% of men with a former career goal of invasive EP were active in invasive EP. Independent of age, women were in lower-level positions, had accomplished fewer professional achievements, were less satisfied with their work and had fewer children. 56.5% of women did not feel supported by their employers regarding family issues. 82.6% reported there was no satisfactory day care. 69.6% were unable to continue to follow their career during pregnancy, mostly due to restrictions by employers (75.0%). Dedicated policies for pregnant workers or support programmes were scarce.</p><p><strong>Conclusion: </strong>Beside the distribution of childcare at home, lack of flexibility and support by employers as well as working and fluoroscopy restrictions during pregnancy hamper women in EP and should be addressed.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 5","pages":"oeae070"},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11382543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304543","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":"Colchicine for cardiovascular and limb risk reduction in Medicare beneficiaries with peripheral artery disease: emulation of target trials.","authors":"Patrick Heindel, James J Fitzgibbon, Eric Secemsky, Deepak L Bhatt, Mohammed Al-Omran, Subodh Verma, Ibrahim A Almaghlouth, Arin Madenci, Mohamad A Hussain","doi":"10.1093/ehjopen/oeae062","DOIUrl":"10.1093/ehjopen/oeae062","url":null,"abstract":"<p><strong>Aims: </strong>Recent evidence from randomized trials demonstrates that colchicine can reduce the risk of major adverse cardiovascular events (MACE) in patients with coronary artery disease. Colchicine's effect on lower-extremity peripheral artery disease (PAD) is not known.</p><p><strong>Methods and results: </strong>To make inferences about the real-world effectiveness of colchicine in PAD, we emulated two target trials leveraging the variable prescribing practice of adding colchicine vs. a non-steroidal anti-inflammatory drug (NSAID) to urate-lowering therapy in patients with gout and PAD. Emulated Trial 1 compared colchicine initiators with NSAID initiators. Emulated Trial 2 compared long-term (indefinite) and short-term (3 months) treatment strategies after initiating colchicine. Eligible individuals were those continuously enrolled in Medicare receiving care at a multicentre academic health system between July 2007 and December 2019. The primary outcome for both trials was a 2 year composite of major adverse limb events (MALE), MACE, and all-cause mortality. Secondary outcomes included MALE and death, MACE and death, and individual components of the primary outcome. Inverse probability weighting was used to adjust for confounding. Percentile-based 95% confidence intervals (CIs) were estimated using non-parametric bootstrapping. A total of 1820 eligible patients were included; the mean age was 77 years [standard deviation (SD) 7], 32% were female, and 9% were non-White. The mean (SD) duration of colchicine and NSAID therapy was 247 (345) and 137 (237) days, respectively. In the emulation of Trial 1, the risk of the primary composite outcome of MALE, MACE, and death at 2 years was 29.9% (95% CI 27.2%, 32.3%) in the colchicine group and 31.5% (28.3%, 34.6%) in the NSAID group, with a risk difference of -1.7% (95% CI -6.5%, 3.1%) and a risk ratio of 0.95 (95% CI 0.83, 1.07). Similar findings were noted in the emulation of Trial 2, with a risk of the primary composite outcome at 2 years of 30.7% (95% CI 23.7%, 38.1%) in the long-term colchicine group and 33.4% (95% CI 29.4%, 37.7%) in the short-term group, with a risk difference of -2.7% (95% CI -10.3%, 5.4%) and risk ratio of 0.92 (95% CI 0.70, 1.16).</p><p><strong>Conclusion: </strong>In a real-world sample of patients with PAD and gout, estimates of the effect of colchicine were consistent across two analyses and provided no conclusive evidence that colchicine decreased the risk of adverse cardiovascular or limb events and death. The cardiovascular and limb benefits of colchicine in older, comorbid populations with PAD and advanced systematic atherosclerosis remain uncertain.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 4","pages":"oeae062"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11339712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038043","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":"One-month DAPT after biodegradable-polymer everolimus-eluting stent implantation in patients at high-bleeding risk: an individual patient data pooled analysis of the SENIOR and POEM trials.","authors":"Carlo A Pivato, Giulio Stefanini, Daniele Giacoppo, Georgios Sideris, Luca Testa, Dragica Paunovic, Carlo Briguori, Ciro Indolfi, Bernhard Reimers, Peter Sinnaeve, Olivier Varenne","doi":"10.1093/ehjopen/oeae068","DOIUrl":"10.1093/ehjopen/oeae068","url":null,"abstract":"<p><strong>Aims: </strong>Dual antiplatelet therapy (DAPT) can be shortened up to 1 month in high-bleeding risk (HBR) patients receiving a contemporary biodegradable-polymer sirolimus-eluting stent. We aimed to summarize the evidence on a similar DAPT regimen after biodegradable-polymer everolimus-eluting stent (EES) implantation in patients at HBR.</p><p><strong>Methods and results: </strong>We pooled the individual participant data from the available trials evaluating this strategy, namely, the SENIOR and the POEM trials. Inclusion criteria were ≥1 biodegradable-polymer EES implantation and ≤1-month duration of DAPT. The primary endpoint was the 1-year composite of cardiovascular death, myocardial infarction, or stroke. Major bleeding was defined as Bleeding Academic Research Consortium (BARC) type 3-5 bleeding. Landmark analyses were performed at 1 month, the time point for intended DAPT interruption. We included 766 participants (age 77.5 ± 8.2 years, women 31.9%), 323 from the SENIOR and 443 from the POEM trial. The primary endpoint occurred in 45 participants (6.0%; 95% confidence interval [CI], 4.3-7.7%) through 1 year of follow-up, with 21 (2.8%; 95% CI, 1.6-3.9%) events during the first month and 24 (3.4%; 95% CI, 2.0-4.7%) thereafter. The incidences of cardiovascular death, myocardial infarction, and stroke were 2.2% (95% CI, 0.36-2.50%), 3.1% (95% CI, 1.8-4.3%), and 1.2% (95% CI, 0.4-2.0%), respectively. BARC type 3-5 bleeding ocuurred in 1.1% (95% CI, 0.3-1.8%) at 1 month and 2.9% (95% CI, 1.6-4.1%) at 1 year.</p><p><strong>Conclusion: </strong>HBR patients receiving biodegradable-polymer EES had few ischemic and bleeding events when given 1 month of DAPT. One-month DAPT after biodegradable-polymer EES implantation seems safe in patients at HBR.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 4","pages":"oeae068"},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11339713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038046","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":"Colchicine improves clinical outcomes in patients with coronary disease, will it result in similar benefits in peripheral artery disease?","authors":"Jean-Claude Tardif, Sabine Cuthill","doi":"10.1093/ehjopen/oeae063","DOIUrl":"10.1093/ehjopen/oeae063","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 4","pages":"oeae063"},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11339708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038044","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":"Efficacy of renal denervation as an adjunct to pulmonary vein isolation for atrial fibrillation treatment: a systematic review and meta-analysis.","authors":"Karish Thavabalan, Majed Sheikh, YuZhi Phuah, Sanjay K Rajput, Noor Fatima, Aman Sutaria, Jonathan J H Bray, Mahmood Ahmad, Hannah Glatzel, Reubeen Ahmad, Lily Snell, Niraj S Kumar, Carmen-Lucía García-Pérez, Luciano Candilio, Rui Providencia","doi":"10.1093/ehjopen/oeae065","DOIUrl":"10.1093/ehjopen/oeae065","url":null,"abstract":"<p><strong>Aims: </strong>Catheter ablation, consisting of pulmonary vein isolation (PVI), is the most effective treatment modality for the management of symptomatic patients with atrial fibrillation (AF). Unfortunately, this procedure has a considerable relapse rate, ranging from 15 to 50% depending on AF type and other patient factors. Hypertension (HTN) is associated with a higher risk of developing AF and can also be managed with a catheter-based procedure-renal denervation (RDN). This meta-analysis aimed to compare the effect of PVI with and without RDN in hypertensive patients with AF.</p><p><strong>Methods and results: </strong>OVID MEDLINE and Embase were searched on 1 February 2023 and trials that reported the effects of RDN on AF recurrence in hypertensive patients were included. A total of 637 patients across 8 randomised controlled trials were included. The results from the pooled analysis showed that when compared with PVI alone, RDN added to PVI: (1) Lowered AF recurrence [RR 0.67 (0.53, 0.85), <i>P</i> = 0.001, <i>I</i> ² = 23%, NNT = 5.9 patients]; (2) Reduced both systolic blood pressure and diastolic blood pressure, with medium effect size, as reflected by standardised mean differences of 0.5 (<i>P</i> = 0.02, <i>I</i> ² = 80%) and 0.43 (<i>P</i> = 0.006, <i>I</i> ² = 60%), respectively; and (3) was not associated with a decrease in estimated glomerular filtration rate (+7.19 mL/min/1.73 m², <i>P</i> = 0.15, <i>I</i> ² = 89%).</p><p><strong>Conclusion: </strong>Adding RDN to PVI in patients with AF and resistant HTN was associated with a reduction of blood pressure levels and AF recurrence. Consideration to RDN should be given as an adjunctive treatment for patients with AF and resistant HTN.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 4","pages":"oeae065"},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038045","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":"It is time to address the contribution of cholesterol in all apoB-containing lipoproteins to atherosclerotic cardiovascular disease.","authors":"Peter P Toth, Maciej Banach","doi":"10.1093/ehjopen/oeae057","DOIUrl":"10.1093/ehjopen/oeae057","url":null,"abstract":"<p><p>On average, LDL particles are the most populous lipoprotein in serum under fasting conditions. For many reasons, it has been the primary target of lipid-lowering guidelines around the world. In the past 30 years, we have witnessed remarkable changes in each iteration of dyslipidaemia guidelines, with LDL-cholesterol (LDL-C) targets becoming lower and lower among patients at high and very high risk for atherosclerotic cardiovascular disease (ASCVD). The world over, goal attainment rates are low, and hence, ASCVD prevalence remains unacceptably high. Inadequate LDL-C lowering is a major issue in contemporary cardiovascular (CV) medicine. Another issue that vexes even the most astute clinician is that of 'residual risk', meaning the excess risk that remains even after LDL-C is appropriately reduced. In recent years, an important new component of residual risk has emerged: triglyceride-enriched lipoproteins or remnant lipoproteins. These precursors to LDL particles can assume outsized importance among patients with derangements in triglyceride metabolism (e.g. genetic variants, insulin resistance, and diabetes mellitus) and may be more atherogenic than LDL species. Consequently, to reduce total risk for acute CV events, the time has come to include the entire spectrum of apoB-containing lipoproteins in approaches to both risk evaluation and treatment.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 4","pages":"oeae057"},"PeriodicalIF":0.0,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142010104","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":"Ventricular volume asymmetry as a novel imaging biomarker for disease discrimination and outcome prediction","authors":"Celeste McCracken, Liliana Szabo, Z. A. Abdulelah, Dorina Condurache, H. Vago, T. Nichols, Steffen E Petersen, S. Neubauer, Z. Raisi-Estabragh","doi":"10.1093/ehjopen/oeae059","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae059","url":null,"abstract":"\u0000 \u0000 \u0000 Disruption of the predictable symmetry of the healthy heart may be an indicator of cardiovascular risk. This study defines the population distribution of ventricular asymmetry and its relationships across a range of prevalent and incident cardiorespiratory diseases.\u0000 \u0000 \u0000 \u0000 The analysis includes 44,796 UK Biobank participants (average age 64.1±7.7 years; 51.9% women). Cardiovascular magnetic resonance (CMR) metrics were derived using previously validated automated pipelines. Ventricular asymmetry was expressed as the ratio of left and right ventricular (LV, RV) end-diastolic volumes. Clinical outcomes were defined through linked health records. Incident events were those occurring for the first time after imaging, longitudinally tracked over an average follow-up time of 4.75 ± 1.52 years. The normal range for ventricular symmetry was defined in a healthy subset. Participants with values outside the 5th-95th percentiles of the healthy distribution were classed as either LV dominant (LV/RV > 112%) or RV dominant (LV/RV < 80%) asymmetry. Associations of LV and RV dominant asymmetry with vascular risk factors, CMR features, and prevalent and incident cardiovascular diseases were examined using regression models, adjusting for vascular risk factors, prevalent diseases, and conventional CMR measures. LV-dominance was linked to an array of pre-existing vascular risk factors and cardiovascular diseases, and a two-fold increased risk of incident heart failure, non-ischemic cardiomyopathies, and left-sided valvular disorders. RV dominance was associated with an elevated risk of all-cause mortality.\u0000 \u0000 \u0000 \u0000 Ventricular asymmetry has clinical utility for cardiovascular risk assessment, providing information that is incremental to traditional risk factors and conventional CMR metrics.\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"2 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141804816","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":"Role of myocardial MicroRNAs in the long-term ventricular remodelling of patients with aortic stenosis","authors":"A. Gabriel, Marina C Costa, Daniel Caldeira, R. Plácido, J. Rigueira, P. Carrilho-Ferreira, Susana Gonçalves, Ricardo Ferreira, Ângelo Nobre, Fausto J. Pinto, F. Enguita, Ana G Almeida","doi":"10.1093/ehjopen/oeae060","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae060","url":null,"abstract":"\u0000 \u0000 \u0000 We hypothesize that miRs are key players in the dynamics of the hypertrophy phenotype in aortic stenosis (AS) patients. In our study, we aimed to identify the transcriptional patterns (protein-coding transcripts and miRs) from myocardial sample biopsies that could be associated with the absence of left ventricle (LV) mass regression after aortic valve replacement (AVR in patients with severe AS and LV hypertrophy.\u0000 \u0000 \u0000 \u0000 We prospectively included 40 patients with severe AS, LV hypertrophy and preserved EF undergoing AVR. Myocardial biopsies obtained during surgery were analysed for transcriptomic analysis performed by next generation sequencing. At a 1-year follow-up, no hypertrophy reversal was observed in about half of the patients in the absence of patient-prothesis mismatch, prosthesis dysfunction of uncontrolled hypertension. Predictors of mass regression were assessed From clinical, echocardiographic, biochemical variables as well as from 300 miRs obtained from myocardial specimens, allowing the identification 29 differentially expressed. miR 4709-3p was found as a positive independent predictor of hypertrophy regression together with hs-TNT as a negative predictor. Gene transcripts RFX1, SIX5, MAPK8IF3 and PKD1 were predicted as simultaneous targets of five upregulated miRs suggesting its importance in LV hypertrophy.\u0000 \u0000 \u0000 \u0000 In our cohort, tissue miR 4709-3p and hs-TNT were independent predictors of hypertrophy regression. The hypertrophy reversal process will likely depend from a complex network where miRNAs may have an important role, allowing a potential opportunity for therapy.\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"33 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141809071","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":"Early and Short-term Use of PCSK9-Inhibitors on Coronary Plaque Stability in Acute Coronary Syndrome","authors":"Hiroki Uehara, T. Kajiya, Masami Abe, M. Nakata, Shingo Hosogi, Shinichiro Ueda","doi":"10.1093/ehjopen/oeae055","DOIUrl":"https://doi.org/10.1093/ehjopen/oeae055","url":null,"abstract":"\u0000 \u0000 \u0000 Proprotein convertase anti-subtilisin-kexin type 9 inhibitors (PCSK9Is) improve plaque volume and composition and reduce major adverse coronary events in chronic coronary artery disease.\u0000 \u0000 \u0000 \u0000 We evaluated the effects of the short-term use of PCSK9Is on coronary plaque stability in patients with acute coronary syndrome (ACS) using optical coherence tomography (OCT).\u0000 \u0000 \u0000 \u0000 This multicenter, open label randomized controlled trial. Enrolled 80 subjects met the inclusion criteria. Of these, 52 patients (age 60±11 years, 38 men, 14 women) with ST-elevated ACS who had undergone successful primary percutaneous coronary intervention with low-density lipoprotein cholesterol (LDL-C) levels >70 mg/dL while receiving high-intensity statins. Participants were randomly assigned to the PCSK9Is group (evolocumab 420 mg for 3 months, N=29) or the standard of care (SoC) group(N=23). OCT was performed at baseline (BL) and 3-months (3M) and 9- months (9M) after randomization to assess lipid-rich plaques in non-culprit lesions.The change in the minimum fibrous cap thickness (MFCT) from baseline to 9M was the primary endpoint.\u0000 \u0000 \u0000 \u0000 The percentage change in LDL-C levels from BL to 3M were significantly greater in the PCSK9Is group (-67.8±21.5% in the PCSK9Is group vs. -16.3±21.8% in the SoC group; p<0.0001) and though, the difference between two groups were disappeared from BL to 9M (-20.0±37.8% in the PCSK9Is group vs. -6.7±34.2% in the SoC group; p=0.20).The changes in MFCT from baseline to 9M were significantly greater in the PCSK9Is group, even after PCSK9Is discontinuation (100 μm [Interquartile range (IQR): 45–180 μm] vs. 50 μm [IQR: 0–110 μm]; p=0.032).\u0000 \u0000 \u0000 \u0000 Combination treatment with PCSK9Is and statins resulted in more marked plaque stabilization after ACS than SoC alone, and this effect persisted for 6 months after PCSK9I discontinuation.\u0000 \u0000 \u0000 \u0000 Adage-Joto study, UMIN ID No. 26516\u0000","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"119 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141811991","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":"Beta-blocker initiation under dobutamine infusion in acute advanced heart failure: a target trial emulation with observational data.","authors":"Yuichiro Mori, Kosuke Inoue, Hiroyuki Sato, Takahiro Tsushima, Shingo Fukuma","doi":"10.1093/ehjopen/oeae054","DOIUrl":"10.1093/ehjopen/oeae054","url":null,"abstract":"<p><strong>Aims: </strong>In patients with advanced heart failure requiring dobutamine infusion, it is usually recommended to initiate beta-blockers after weaning from dobutamine. However, beta-blockers are sometimes initiated under dobutamine infusion in a real-world scenario. The association between such early beta-blocker initiation with clinical outcomes is unknown. Therefore, this study investigates the association between initiating beta-blockers under dobutamine infusion and survival outcomes.</p><p><strong>Methods and results: </strong>This observational study with a multicentre inpatient-care database emulated a pragmatic randomized controlled trial (RCT) of the beta-blocker initiation strategy. First, 1151 patients on dobutamine and not on beta-blockers on the day of heart failure admission (Day 0) were identified. Among 1095 who met eligibility criteria, patients who were eventually initiated beta-blockers under dobutamine infusion by Day 7 (early initiation strategy) were 1:1 matched to those who were not initiated (conservative strategy). The methods of cloning, censoring, and weighting were applied to emulate the target trial. Patients were followed up for up to 30 days. The primary outcome was all-cause death. Among 780 matched patients (median age, 81 years), the adjusted hazard ratio was 1.11 (95% confidence interval 0.75-1.64, <i>P</i> = 0.59) for the early initiation strategy. The estimated 30-day all-cause mortalities in the early initiation strategy and the conservative strategy were 19.3% (10.6-30.7) and 16.2% (9.2-25.3), respectively. The results were consistent when we used different days to determine strategies (i.e. 5 and 9) instead of 7 days.</p><p><strong>Conclusion: </strong>The present observational study emulating a pragmatic RCT found no positive or negative association between beta-blocker initiation under dobutamine infusion and overall survival.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"4 4","pages":"oeae054"},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11247169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141621965","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}