European heart journal open最新文献

{"title":"Predicted cardiovascular risk reduction with tirzepatide vs. semaglutide: interpretative considerations from the SURMOUNT-5 <i>post hoc</i> analysis.","authors":"Samit Ghosal, Binayak Sinha","doi":"10.1093/ehjopen/oeag071","DOIUrl":"10.1093/ehjopen/oeag071","url":null,"abstract":"","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag071"},"PeriodicalIF":4.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936581","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":"Comparison between no fasting vs. fasting in patients undergoing cardiac catheterization laboratory procedures: a systematic review and meta-analysis.","authors":"Pedro Segura-Saldaña, Mayita Alvarez-Vargas, Victor Ludeña-Meléndez, Juan Llaja-Socorro, Carlos Davila-Paredes, José Sánchez-Cárdenas, Estefani Galvez-Rodriguez, Arón Santillán-Rodríguez, Carlos Cabrera-Cruzado, Pedro Guerra-Canchari, Carlos Diaz-Arocutipa","doi":"10.1093/ehjopen/oeaf123","DOIUrl":"10.1093/ehjopen/oeaf123","url":null,"abstract":"<p><strong>Aims: </strong>Fasting prior to procedures in the cardiac catheterization laboratory is an established indication in clinical practice. However, the evidence supporting this recommendation is uncertain.</p><p><strong>Objectives: </strong>The aim of this systematic review and meta-analysis was to evaluate the impact of non-fasting vs. fasting before cardiac catheterization.</p><p><strong>Methods and results: </strong>PubMed, Embase, Scopus, and Web of Science databases were searched until September 2024. Randomized controlled trials comparing both strategies were included. Outcomes were hypoglycaemia, aspiration pneumonia, contrast-induced acute kidney injury (AKI), nausea/vomiting, hypotension, and patient satisfaction. Risk of bias was assessed using the RoB 2.0 tool. All meta-analyses were performed using a random-effects model. Six studies were included (<i>n</i> = 2736). The mean age ranged from 62 to 70 years, and 31% were female. There was no significant difference in the risk of hypoglycaemia [risk ratio (RR) 0.82, 95% confidence interval (CI) 0.49-1.38], aspiration pneumonia (RR 1.31, 95% CI 0.28-6.05), nausea/vomiting (RR 0.95, 95% CI 0.58-1.55), contrast-induced AKI (RR 1.87, 95% CI 0.94-3.72) between the non-fasting and fasting groups. In contrast, patients in the non-fasting group had a lower risk of hypotension (RR 0.57, 95% CI 0.38-0.86) and higher satisfaction scores (standardized mean difference -1.53, 95% CI -2.11 to -0.96) compared with the fasting group. The risk of bias was judged as some concerns in three of four studies.</p><p><strong>Conclusion: </strong>Our results suggest that in patients who underwent cardiac catheterization procedures, non-fasting was a safe strategy and provoked higher satisfaction compared to fasting.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeaf123"},"PeriodicalIF":4.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824940","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":"Baseline characteristics of patients enrolled in the AZIMUTH trial: an e-health-integrated, smartphone app-based model of care for heart failure patients.","authors":"Domenico D'Amario, Donato Antonio Paglianiti, Renzo Laborante, Stefano Elia, Gaetano Rizzo, Simona Giubilato, Maria Catalano, Francesco Amico, Maurizio Volterrani, Attilio Restivo, Stefano Patarnello, Sofoklis Kyriazakos, Alice Luraschi, Agni Delvinioti, Federica Tomassini, Konstantina Kostopoulou, Antonio Iaconelli, Enrico Incaminato, Francesco Canonico, Marco Gorini, Stefania Marcoli, Vincenzo Bartoli, Thomas Griffiths, Peter Fenici, Alfredo Cesario, Giuseppe Patti, Filippo Crea","doi":"10.1093/ehjopen/oeag072","DOIUrl":"10.1093/ehjopen/oeag072","url":null,"abstract":"<p><strong>Aims: </strong>The 'FondAZione A. Gemelli IRCCS Artificial Intelligence Empowered Digital PlatforM to sUpport paTients with Heart Failure' (AZIMUTH) study is a multicentre prospective outpatient trial assessing an app-based, e-health-integrated model of care for heart failure (HF) patients. Its primary aim is to evaluate the feasibility and patient/provider acceptance of the app-based intervention, while key secondary aims include assessing its clinical impact through changes in guideline-directed medical therapy (GDMT) prescription/adherence and quality of life.</p><p><strong>Methods and results: </strong>Feasibility is defined as ≥70% of participants maintaining active engagement with the app during follow-up. The platform integrates patient-reported symptoms, connected measurements, medication reminders, and two-way messaging, with clinician review of alerts and trends. Between December 2021 and January 2024, 300 adults with chronic HF, irrespective of left ventricular ejection fraction (LVEF), were enrolled across four Italian centres. Median age was 66 years (IQR 59-73), 78.3% were male, and 82.3% were NYHA Class I-II. LVEF distribution was balanced (HFrEF 35.3%, HFmrEF 25.7%, HFpEF 38.7%). Comorbidities were frequent: hypertension 81.3%, dyslipidaemia 75.7%, ischaemic heart disease 41.0%, diabetes 29.7%, atrial fibrillation 29.7%, and chronic kidney disease 21.7%. At enrolment, RASi/ARNI were prescribed in 69.6%, beta-blockers in 76.9%, MRAs in 16.1%, and SGLT2i in 23.7%. Compared with HFrEF-focused trials, uptake of foundational classes was lower, consistent with the broader LVEF spectrum and real-world constraints.</p><p><strong>Conclusion: </strong>The AZIMUTH cohort represents a contemporary, heterogeneous HF population with variable and suboptimal GDMT uptake. Digital health interventions have the potential to optimize care delivery and increase adherence in real-world settings.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag072"},"PeriodicalIF":4.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229833","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":"Cilostazol for heart rate increase in atrial fibrillation with slow ventricular response: an exploratory randomized controlled trial.","authors":"Gabriela Hinkelmann Berbert, Rogerio Braga Andalaft, Bruno Pereira Valdigem, Luciana Vidal Armaganijan, Fabio Antonio Venancio, Dalmo Antonio Ribeiro Moreira","doi":"10.1093/ehjopen/oeag068","DOIUrl":"10.1093/ehjopen/oeag068","url":null,"abstract":"<p><strong>Aims: </strong>Atrial fibrillation (AF) with slow ventricular response is a clinically challenging condition, particularly in elderly patients with multiple comorbidities. Current therapeutic options for the chronic pharmacological management of bradycardia remain limited. The aim of this study was to evaluate the effects of cilostazol on heart rate (HR) and ventricular arrhythmia in patients with permanent AF and a slow ventricular response.</p><p><strong>Methods and results: </strong>This was a randomized, double-blind, placebo-controlled trial including 26 patients with permanent AF and a mean HR <65bpm on 24-hour Holter monitoring. Patients were randomized to receive cilostazol 100 mg twice daily (<i>n</i> = 14) or placebo (<i>n</i> = 12) for 3 months. The primary endpoint was the increase in mean HR. After 30 days of treatment, the cilostazol group demonstrated a significant increase in minimum HR (from 34.17 to 39.14 bpm; <i>P</i> = 0.032) and mean HR (from 55.42 to 64.43 bpm; <i>P</i> = 0.013) compared to placebo. The total number of QRS complexes increased significantly (from 73879 to 85249 <i>P</i> = 0.029), and the number of cardiac pauses (>2.5 s) was significantly reduced (mean from 56.25 to 2.57 and median from 5.5 to 0.0 <i>P</i> = 0.018). No significant differences were observed in the incidence of ventricular arrhythmias. Adverse effects were mild and included headache and gastrointestinal symptoms, with no statistical difference between groups.</p><p><strong>Conclusion: </strong>Cilostazol significantly increased HR in patients with AF and slow ventricular response without increasing ventricular arrhythmias. These findings suggest that cilostazol may represent a pharmacological alternative for selected patients when pacemaker implantation is not immediately feasible.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag068"},"PeriodicalIF":4.3,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966078","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":"Beyond the conventional risk factors in the management of atherosclerosis in women: a call to action for careful consideration of obesity and inflammation.","authors":"Mirvat Alasnag, Antonia Sambola, Izabella Uchmanowicz, Marta Kaluzna, Pierre François Sabouret, Laura Serrano, Valeria Paradies, Biljana Parapid, Shrilla Banerjee, Anne Bachelot, Martine Gilard, Michał Hawranek, Vijay Kunadian, Alaide Chieffo, Roxana Mehran, Stephane Manzo Silberman","doi":"10.1093/ehjopen/oeag055","DOIUrl":"10.1093/ehjopen/oeag055","url":null,"abstract":"<p><p>Conventional risk factors do not completely explain the burden of atherosclerotic cardiovascular disease (ASCVD) in women. Obesity and chronic low-grade inflammation are recognized as important contributors to atherosclerotic risk. This viewpoint explains the role of obesity-driven inflammation in the development and management of atherosclerosis in women. Abdominal obesity promotes a proinflammatory and prothrombotic environment that accelerates atherogenesis. Women with higher inflammatory biomarker levels and experience sex-specific risk-modifying stages, such as polycystic ovary syndrome, pregnancy-related conditions, and menopause, have higher risk for cardiovascular events, including atherosclerosis. We review evidence for antiobesity and anti-inflammatory therapies. Integrating obesity and inflammation into ASCVD care in women requires targeted screening, risk assessment, and sex-stratified research approaches. This viewpoint highlights the relation between obesity and atherosclerosis.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag055"},"PeriodicalIF":4.3,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792928","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":"Prevalence and incidence of left ventricular systolic dysfunction and adverse outcomes in patients receiving <i>de novo</i> and replacement pacemaker therapy for bradycardia.","authors":"Nurul H Abdul Samad, John Gierula, Judith E Lowry, Sam Straw, Samuel D Relton, Stephe Kamalathasan, Richard M Cubbon, Mark T Kearney, Klaus K Witte, Maria F Paton","doi":"10.1093/ehjopen/oeag069","DOIUrl":"10.1093/ehjopen/oeag069","url":null,"abstract":"<p><strong>Aims: </strong>Right ventricular pacing (RVP) is associated with left ventricular systolic dysfunction (LVSD) and heart failure (HF). We investigated the prevalence and predictors of LVSD and adverse HF outcomes in patients undergoing <i>de novo</i> or replacement RVP for bradycardia.</p><p><strong>Methods and results: </strong>Prospective data were collected from 1024 patients receiving <i>de novo</i> (2014-2017, <i>n</i> = 514) or generator replacement (2008-2011, <i>n</i> = 510) RVP at a UK tertiary centre. Logistic regression models were used to identify predictors of LVSD, defined as left ventricular ejection fraction (LVEF) < 50%, and subsequent HF hospitalization (HFH) and all-cause mortality. Overall, 61% were male; mean age 76 ± 11 years. <i>De novo</i> patients were more often male (66% vs. 56%) and more likely to have ischaemic heart disease (IHD; 31% vs. 14%) and diabetes (24% vs. 6%), but less likely to have atrial fibrillation (AF; 25% vs. 33%) than replacement patients (all <i>P</i> < 0.01). LVSD was present in 344 (37%) and was more frequent in <i>de novo</i> than replacement cases (20% vs. 17%, <i>P</i> < 0.01). Independent predictors of LVSD were IHD [odds ratio (OR) = 2.56, confidence interval (CI): 1.58-4.13] and ventricular pacing burden >80% (OR = 2.13, CI: 1.29-3.52). Over a median 30 (IQR: 16-42) months, 341 (33%) experienced HFH or death, more commonly after replacement than <i>de novo</i> RVP (25% vs. 8%, <i>P</i> < 0.01). Predictors of adverse outcomes included replacement status [hazard ratio (HR) = 2.27, CI: 1.78-4.16], older age, AF, and LVEF <50%.</p><p><strong>Conclusion: </strong>LVSD is common in RVP recipients and largely driven by comorbidities rather than pacing burden. Screening and targeted therapy in high-risk patients may improve outcomes and optimize resource use.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 3","pages":"oeag069"},"PeriodicalIF":4.3,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148229625","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":"Monitored anaesthesia care without endotracheal intubation and general anaesthesia in pulsed field atrial fibrillation ablation.","authors":"Weijia Wang, Swecha Goel, Susan J Estrada, Elliot Hwang, Jacob Obholz, Qiying Dai, Humberto J Vidaillet, Sanjay Kumar, Param P Sharma","doi":"10.1093/ehjopen/oeag070","DOIUrl":"10.1093/ehjopen/oeag070","url":null,"abstract":"<p><strong>Aims: </strong>Pulsed field ablation for atrial fibrillation offers shorter procedural times and improved safety compared with thermal ablation, but the optimal anaesthesia strategy remains uncertain. Most centres in the USA use general anaesthesia with endotracheal intubation, whereas monitored anaesthesia care without endotracheal intubation may be a safe and efficient alternative.</p><p><strong>Objectives: </strong>To compare procedural efficiency and safety between monitored anaesthesia care and general anaesthesia for pulsed field ablation.</p><p><strong>Methods and results: </strong>Consecutive adults who underwent pulsed field ablation for atrial fibrillation between 2024 and 2025 at Marshfield Clinic Health System were included. The anaesthesia approach was determined by operator preference. Procedural times, medication use, complications, and patient tolerance were recorded prospectively. Among 200 patients, 100 received monitored anaesthesia care without endotracheal intubation, and 100 received general anaesthesia. The mean age was 67 years, 42% were female, and the mean body mass index was 33 kilograms per square metre. Monitored anaesthesia care shortened case duration (77 vs. 95 min; <i>P</i> < 0.001) and laboratory time (118 vs. 153 min; <i>P</i> = 0.002) and required fewer adjunct medications (<i>P</i> < 0.001). Twenty-five procedures (25%) were challenging due to cough or motion but were all completed safely. Complications occurred in one monitored anaesthesia care case and six general anaesthesia cases (<i>P</i> = 0.054). Pulmonary vein isolation was achieved in all patients.</p><p><strong>Conclusion: </strong>Monitored anaesthesia care without endotracheal intubation was safe, efficient, and resource-sparing compared with general anaesthesia for pulsed field atrial fibrillation ablation.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag070"},"PeriodicalIF":4.3,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13159995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936592","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":"Physician-led telemedical care enhances blood pressure control in hypertension: a randomized-controlled pilot study (REMOTE-control-HTN).","authors":"Paula Sagmeister, Natalie Fischer, Diana Eckert, Luise Mentzel, Parham Shahidi, Charlotte Wolff, Holger Thiele, Karl Fengler","doi":"10.1093/ehjopen/oeag061","DOIUrl":"10.1093/ehjopen/oeag061","url":null,"abstract":"<p><strong>Aims: </strong>Despite advances in antihypertensive therapy, blood pressure (BP) control remains inadequate in many patients due to limited follow-up and insufficient medication titration.</p><p><strong>Methods and results: </strong>This single-centre, randomized controlled pilot trial was conducted at a tertiary academic hospital in Germany between December 2023 to September 2024. Sixty adults with uncontrolled hypertension (office BP >140/90 mmHg despite antihypertensive medication) were randomized 1:1 to standard care or physician-led telemedical care. All participants performed home BP measurements twice daily using validated telemedical devices. The intervention group received structured biweekly calls for BP review and medication optimization. The control group continued care with their general practitioners. The primary endpoint was time in target range (TTR) over 6 months, defined as the percentage of home BP readings below guideline thresholds (<130/80 mmHg for age <65, <140/90 mmHg for age ≥65). Group comparisons used <i>t</i>-tests. The study was registered at CinlicalTrials.gov Identifier [NCT07049289]. Fifty-six patients completed 6-month follow-up (mean age 61 ± 13 years, 61% male). Baseline BP was 161 ± 17/97 ± 12 mmHg. At 6 months, systolic BP decreased by -15.0 ± 9.8 mmHg in the intervention group vs. -4.0 ± 8.7 mmHg in the control group (<i>P</i> < 0.001). Mean systolic TTR was significantly higher in the telemedical care group (52.2 ± 24.2% vs. 36.0 ± 29.2%, <i>P</i> = 0.028), as was diastolic TTR (59.0 ± 31.0% vs. 37.1 ± 34.4%, <i>P</i> = 0.016), and total TTR (42.9 ± 27.5% vs. 24.8 ± 29.7%, <i>P</i> = 0.021). Measurement adherence was superior in the intervention group (83.2 ± 15.4% vs. 70.5 ± 25.9%, <i>P</i> = 0.033).</p><p><strong>Conclusion: </strong>Physician-supported telemedical care significantly improved BP control and measurement adherence over 6 months. Larger trials are needed to assess long-term clinical outcomes.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag061"},"PeriodicalIF":4.3,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824938","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":"Rate control treatment with calcium channel blockers and beta blockers for patients with atrial fibrillation: a systematic review and meta-analysis.","authors":"Tim Koldenhof, Barzi Gareb, Marcelle D Smit, Thijmen S A Bergwerff, Michiel Rienstra, Robert G Tieleman","doi":"10.1093/ehjopen/oeag062","DOIUrl":"10.1093/ehjopen/oeag062","url":null,"abstract":"<p><strong>Aims: </strong>Controlling heart rate is a key objective in atrial fibrillation (AF) management, commonly achieved with beta blockers or non-dihydropyridine calcium channel blockers, both class I guideline recommendations. However, their long-term effectiveness has rarely been compared. This review aimed to critically evaluate all available evidence comparing these drug classes in AF treatment.</p><p><strong>Methods and results: </strong>We systematically searched MEDLINE, Embase, Web of Science, and Cochrane Central for original studies published up to 1 March 2025. Eligible studies included AF patients, compared calcium channel blockers and beta blockers, and reported heart rate or other clinically relevant outcomes. The primary outcome was 24-hour heart rate on Holter monitoring. Meta-analyses were performed where data were sufficiently homogeneous. Of 1906 identified records, 25 met inclusion criteria. Five studies reported 24-h mean heart rate, showing no difference between drug classes (mean difference: 3.6 b.p.m., 95% CI: -2.9 to 10.1, <i>P</i> = 0.274). Eight studies reported maximum exercise heart rate, which was significantly higher with calcium channel blockers than with beta blockers (mean difference: 10.5 b.p.m., 95% CI: 3.3 to 17.7, <i>P</i> = 0.043). Other outcomes were too heterogeneous for meta-analysis, though three studies reported increased peak oxygen uptake with calcium channel blockers.</p><p><strong>Conclusion: </strong>Calcium channel blockers and beta blockers provide comparable control of mean heart rate in AF. However, patients on calcium channel blockers have a higher maximum heart rate during exercise. In our qualitative synthesis, some studies reported higher peak oxygen uptake calcium channel blocker treated patients, these results should be seen as hypothesis generating.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag062"},"PeriodicalIF":4.3,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13155099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147871056","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":"Cost-effectiveness of combined veno-arterial extracorporeal membrane oxygenation and Impella support (ECPELLA) in infarct-related cardiogenic shock.","authors":"Priyanka Boettger, Andrija Matetic, Jamschid Sedighi, Bernhard Unsoeld, Christoph Struenck, Michael Buerke, Dirk Westermann, Samuel Sossalla","doi":"10.1093/ehjopen/oeag064","DOIUrl":"10.1093/ehjopen/oeag064","url":null,"abstract":"<p><strong>Aims: </strong>Cardiogenic shock carries high early mortality. Combined veno-arterial extracorporeal membrane oxygenation and Impella support (ECPELLA) may improve outcomes but is costly and unevenly available across Europe. Its incremental clinical and economic value compared with guideline-directed medical therapy (GDMT) remains uncertain.</p><p><strong>Methods: </strong>We developed a calibrated partitioned-survival model comparing ECPELLA with GDMT over a 10-year horizon from a statutory health insurance payer perspective (2024€ reference costing environment). Costs, utilities, and survival inputs were derived from contemporary randomized trials and multinational registries. Uncertainty was assessed using probabilistic, deterministic, scenario, and value-of-information analyses. European cost-environment scenarios were explored to assess transferability.</p><p><strong>Results: </strong>ECPELLA yielded 4.05 quality-adjusted life-years (QALYs) at €195 000 vs. 3.10 QALYs at €95 000 for GDMT (incremental cost €100 000; incremental QALY 0.95), resulting in an incremental cost-effectiveness ratio (ICER) of €105 263 per QALY. Device and intensive care unit (ICU) costs and early survival effects were the main drivers of uncertainty. Cost-effectiveness improved in patients younger than 60 years, those with reversible myocardial dysfunction, early cannulation, and treatment in high-volume centres (ICER €60 000-80 000 per QALY), whereas neutral survival effects produced ICERs exceeding €300 000 per QALY. Value-of-information analysis indicated residual decision uncertainty.</p><p><strong>Conclusion: </strong>ECPELLA increased quality-adjusted survival at higher cost. In the base-case analysis, the ICER was €105 263 per QALY gained. In predefined scenario analyses, ICERs were lower in younger patients, those with recovery potential, early cannulation, and high-volume centres. Residual decision uncertainty was observed in value-of-information analyses.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"6 2","pages":"oeag064"},"PeriodicalIF":4.3,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13162026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936597","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}