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Showing 141–160 of 2058 publications.
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Zhu, Alison Y.; Rajendran, Saissan; Hajian, Hamid; Aitken, Sarah JoyObjective: There is significant practice variation in the use of antithrombotic therapy after endovascular intervention for lower limb peripheral arterial disease, with differences in medication choice and duration. Prescriber decision making is complex, and patient factors have been shown to substantially contribute to prescribing variation. To determine the influence of patient factors on antithrombotic prescribing, a discrete choice experiment was distributed to vascular surgeons and trainees across Australia and Aotearoa New Zealand. Methods: After pilot testing, the discrete choice experiment questionnaire was distributed to 300 vascular surgeons and trainee members of the Australian and New Zealand Society for Vascular Surgery. Multinomial logistic regression models were used to analyse patient factors that had the most influence on decisions to prescribe a second antithrombotic agent, and the preferred choice of antithrombotic (clopidogrel 75 mg daily or rivaroxaban 2.5 mg twice daily) in addition to aspirin 100 mg daily. The odds ratio (OR) with 95% confidence interval (CI) reported preference strength. Results: A total of 44 questionnaires were completed between September and October 2023, reaching the 15% targeted response rate. Prescribing a second antithrombotic was more likely after femoropopliteal stenting compared with angioplasty (OR 1.89, 95% CI 1.20 2.13), and in chronic limb threatening ischaemia compared with intermittent claudication (OR 1.58, 95% CI 1.20 2.13). Most respondents preferred clopidogrel over rivaroxaban (62%), with over a third of respondents exclusively prescribing clopidogrel. Patients with stents (OR 1.77, 95% CI 1.32 2.37) or moderate bleeding risk (OR 1.38, 95% CI 0.97 1.84) were more likely to receive clopidogrel than rivaroxaban. Conclusion: This study demonstrates that vascular surgeons primarily prioritise antithrombotic prescribing decisions by procedure type. Clopidogrel is more likely to be prescribed than rivaroxaban as a second agent in combination with aspirin, especially after stenting. Knowing these clinician preferences can target implementation strategies towards supporting decision making in subgroups of patients according to individual risk profiles. 2024 The Author(s)
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Simonenko, Maria A.; Hansen, Dominique D.; Niebauer, Josef; Volterrani, Maurizio; Adamopoulos, Stamatis N.; Amarelli, Cristiano; Ambrosetti, Marco; Anker, Stefan D.; Bay-Gen, Antoni; Ben-Gal, Tuvia; Bowen, Thomas Scott; Cacciatore, Francesco M.; Caminiti, Giuseppe; Cavarretta, Elena; Chioncel, O. Dragomir; Coats, Andrew J.S.; Cohen-Solal, Alain; D'Ascenzi, Flavio; de Pablo, Carmen; Gevaert, Andreas B.; Gustafsson, Finn; Kemps, H. M.; Hill, Loreena Michelle; Jaarsma, Tiny; Jankowska, Ewa Anita; Joyce, Emer; Krkel, Nicolle; Lain?ak, Mitja; Lund, Lars H.; Moura, Brenda; Nytrn, Kari; Osto, Elena; PIEPOLI, MASSIMO Francesco; Potena, Luciano; Rakisheva, Amina G.; Rosano, Giuseppe Massimo Claudio; Savarese, Gianluigi; Seferovic, Petar M.; Thompson, David R.; Thum, Thomas; van Craenenbroeck, Emeline M.F.Little is known either about either physical activity patterns, or other lifestyle-related prevention measures in heart transplantation (HTx) recipients. The history of HTx started more than 50 years ago but there are still no guidelines or position papers highlighting the features of prevention and rehabilitation after HTx. The aims of this scientific statement are (i) to explain the importance of prevention and rehabilitation after HTx, and (ii) to promote the factors (modifiable/non-modifiable) that should be addressed after HTx to improve patients' physical capacity, quality of life and survival. All HTx team members have their role to play in the care of these patients and multidisciplinary prevention and rehabilitation programmes designed for transplant recipients. HTx recipients are clearly not healthy disease-free subjects yet they also significantly differ from heart failure patients or those who are supported with mechanical circulatory support. Therefore, prevention and rehabilitation after HTx both need to be specifically tailored to this patient population and be multidisciplinary in nature. Prevention and rehabilitation programmes should be initiated early after HTx and continued during the entire post-transplant journey. This clinical consensus statement focuses on the importance and the characteristics of prevention and rehabilitation designed for HTx recipients. The Authors. Published by John Wiley & Sons Limited and Oxford University Press on behalf of the European Society of Cardiology, and Frontiers Media SA on behalf of the European Society for Organ Transplantation.
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Ren, Jianfang; Wang, Zhao; Du, Nixon; Cheng, Wenlong; Ju, Lining ArnoldCardiovascular diseases, primarily driven by thrombosis, remain the leading cause of global mortality. Although traditional cell culture and animal models have provided foundational insights, they often fail to capture the complex pathophysiology of thrombosis, which hinders the development of targeted therapies for cardiovascular diseases. The advent of microfluidics and vascular tissue engineering has propelled the advancement of vessel-on-a-chip technologies, which enable the simulation of the key aspects of Virchows Triad: hypercoagulability, alteration in blood flow, and endothelial wall injury. With the ability to replicate patient-specific vascular architectures and hemodynamic conditions, vessel-on-a-chip models offer unprecedented insights into the mechanisms underlying thrombosis formation and progression. This review explores the evolution of microfluidic technologies in thrombosis research, highlighting breakthroughs in endothelialized devices and their roles in emulating conditions such as vessel stenosis, flow reversal, and endothelial damage. The limitations and challenges of the current vessel-on-a-chip systems are addressed, and future perspectives on the potential for personalized medicine and targeted therapies are presented. Vessel-on-a-chip technology holds immense potential for revolutionizing thrombosis research, enabling the development of targeted, patient-specific diagnostic tools and therapeutic strategies. Realizing this potential will require interdisciplinary collaboration and continued innovation in the fields of microfluidics and vascular tissue engineering. The Author(s) 2024.
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Abdin, Amr; Wilkinson, Chris G.; Aktaa, Suleman; Bm, Michael; Polovina, Marija M.; Rosano, Giuseppe Massimo Claudio; Lain?ak, Mitja; Lund, Lars H.; McDonagh, Theresa A.; Metra, Marco; Adamo, Marianna; Mindham, Richard; PIEPOLI, MASSIMO Francesco; Abdelhamid, Magdy A.; Stk, Stefan T.; Tokmakova, Mariya Petkova; Seferovic, Petar M.; Coats, Andrew J.S.; Gale, Chris P.Aims: To update the European Society of Cardiology (ESC) quality indicators (QIs) for the evaluation of the care and outcomes of adults with heart failure. Methods and results: The Working Group comprised experts in heart failure including members of the ESC Clinical Practice Guidelines Task Force for heart failure, members of the Heart Failure Association, and a patient representative. We followed the ESC methodology for QI development. The 2023 focused guideline update was reviewed to assess the suitability of the recommendations with strongest association with benefit and harm against the ESC criteria for QIs. All the new proposed QIs were individually graded by each panellist via online questionnaires for both validity and feasibility. The existing heart failure QIs also underwent voting to keep, remove or modify. Five domains of care for the management of heart failure were identified: (1) structural QIs, (2) patient assessment, (3) initial treatment, (4) therapy optimization, and (5) patient health-related quality of life. In total, 14 main and 3 secondary QIs were selected across the five domains. Conclusion: This document provides an update of the previously published ESC QIs for heart failure to ensure that these measures are aligned with contemporary evidence. The QIs may be used to quantify adherence to clinical practice as recommended in guidelines to improve the care and outcomes of patients with heart failure. 2024 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Nadel, James[No abstract available]
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Bate, Katharine A.; Genetzakis, Elijah; Vescovi, Joshua J.; Gray, Michael P.; Celermajer, David S.; McGuire, Helen M.; Grieve, Stuart M.; Vernon, Stephen Thomas; Cartland, Si; Yang, Jean Yee Hwa; Kavurma, Mary M.; Figtree, Gemma A.The risk-factor-based prediction of atherosclerotic coronary artery disease (CAD) remains suboptimal, particularly in the absence of any of the standard modifiable cardiovascular risk factors (SMuRFs), making the discovery of biomarkers that correlate with atherosclerosis burden critically important. We hypothesized that cytokines and receptors associated with inflammation in CADtumor necrosis factor-related apoptosis-inducing ligand (TRAIL), interleukin-18 (IL-18), and osteoprotegerin (OPG)would be independently associated with CAD. To determine this, we measured the serum biomarker levels of 993 participants from the BioHEART study who had CT coronary angiograms that were scored for severity of stenosis and plaque composition. We found that the quartiles of TRAIL, OPG, and IL-18 were significantly associated with disease scores, and that the IL-18/TRAIL and OPG/TRAIL ratios demonstrated significant differences between no CAD vs. STEMI whereas only the OPG/TRAIL ratio showed differences between no CAD and obstructive CAD (stenosis > 50%). However, these associations did not persist after adjustment for age, sex, SMuRFs, and a family history of CAD. In conclusion, TRAIL, IL-18, and OPG and the derived ratios of IL-18/TRAIL and OPG/TRAIL demonstrate significant associations with raw disease scores and risk factors, but these markers are not discriminatory biomarkers for the prediction of CAD when incorporated into multi-variable risk models. 2024 by the authors.
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Ratwatte, Seshika D.; Celermajer, David S.Pulmonary hypertension (PH) is a serious potential complication of some congenital heart diseases (CHDs). PH encompasses a range of diseases which may be idiopathic or inherited, or secondary to cardiac, respiratory, systemic or thromboembolic conditions, amongst others. Our increasing understanding of the normal ranges of pulmonary haemodynamics, as well as evidence supporting the benefits of early treatment, has resulted in a number of recent revisions to the haemodynamic definition of PH. In this Review Article, we report on the recent updates to haemodynamic definitions and classification of PH, as reflected in the 2022 Pulmonary Hypertension Guidelines and particularly focus on the CHD related sub-type of PH, where the aetiology is often multi-factorial. 2024
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Nicholson, Calum; Strange, G. A.; Ayer, Julian Ganesh J.; Cheung, Michael M.H.; Grigg, Leeanne Elizabeth; Justo, Robert N.; Maxwell, Ryan; Wheaton, Gavin R.; Disney, Patrick J.S.; Yim, Deane L.S.; Stewart, S.; Cordina, Rachael Louise; Celermajer, David S.Background: Although several National Data Registries for Congenital Heart Disease (CHD) exist, few are comprehensive and contemporary. A National Australian CHD Registry has been developed that aims to redress this by creating the first comprehensive data collection for CHD children and adults, initially across Australia. Methods: We defined and collected a minimum dataset of demographics, diagnoses, and procedures from people with CHD presenting at participating quaternary CHD services Australia-wide. Data were collected from a range of clinical data sources. Diagnoses and procedures were standardised to the European Paediatric Congenital Code Short List. Methodological limitations were carefully documented. Results: From 8 participating institutions, an initial 359,084 patient records were assessed for eligibility and 68,234 unique individuals with structural CHD have been included in the current dataset. There were 20,395 (30 %) people with mild CHD, 25,157 (37 %) with moderate CHD, and 13,530 (20 %) with severe CHD (6 % unknown complexity). The most common diagnoses were Ventricular Septal Defect (16,781, 25 %), Atrial Septal Defect (6,607, 10 %), Aortic Valve Disorders (5516 8 %), Coarctation of the Aorta (5,321, 8 %), Tetralogy of Fallot (4,489, 7 %), Transposition of the Great Arteries (4,009, 6 %). Conclusion: The data presented here represents the most comprehensive cohort collected for the Australian CHD population thus far and is comparable with the largest contemporary CHD registries around the world. This Registry represents a key resource for improved understanding of the CHD population and will drive better care and outcomes for people living with CHD. 2024 The Authors
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Wadey, Curtis; Tomlinson, Owen William; Barker, Alan R.; Graham Stuart, Alan Graham; Tran, Derek L.; Laohachai, Karina; Ayer, Julian Ganesh J.; Weintraub, Robert G.; Cordina, Rachael Louise; Williams, Craig A.BACKGROUND: Peak oxygen consumption (peak VO<inf>2</inf>) is routinely measured in people who have congenital heart disease and is reported as a percentage of predicted value, based upon age-and sex-matched normative reference values (NRVs). This study aimed to identify which NRVs are being used, assess whether NRVs are being applied appropriately, and evaluate if recommended NRVs are valid when applied to people with congenital heart disease. METHODS AND RESULTS: A systematic scoping review identified studies that reported peak VO<inf>2</inf> percentage of predicted value in people with congenital heart disease. A modified risk of bias tool evaluated the included studies. Forty-five studies reported peak VO<inf>2</inf> percentage of predicted value, and only 21 (47%) studies described or provided a reference on how their percentage of predicted value was calculated. The most cited NRVs were from Wasserman (n=12) and Cooper and Weiler-Ravell (n=7). Risk of bias analysis judged 63% of studies as having some concerns. The NRVs recommended by the American Heart Association were applied to participants with a Fontan circulation (n=70; aged 26.56.4 years; 59% women) to examine validity. Predicted peak VO<inf>2</inf> values from the Wasserman NRV was not significantly associated to measured peak VO<inf>2</inf> values (men: b=0.31, R2 ?0.01; women: b=0.07, R2=0.02). CONCLUSIONS: Numerous NRVs have been applied to individuals with congenital heart disease and are often poorly reported and inappropriately matched to participants. The Wasserman NRV was the most cited but showed poor validity when applied to a Fontan cohort. 2024 The Author(s).
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Liu Chung Ming, Clara; Wang, Xiaowei; Gentile, CarmineThis review explores the roles of the cholinergic system in the heart, comprising the neuronal and non-neuronal cholinergic systems. Both systems are essential for maintaining cardiac homeostasis by regulating the release of acetylcholine (ACh). A reduction in ACh release is associated with the early onset of cardiovascular diseases (CVDs), and increasing evidence supports the protective roles of ACh against CVD. We address the challenges and limitations of current strategies to elevate ACh levels, including vagus nerve stimulation and pharmacological interventions such as cholinesterase inhibitors. Additionally, we introduce alternative strategies to increase ACh in the heart, such as stem cell therapy, gene therapy, microRNAs, and nanoparticle drug delivery methods. These findings offer new insights into advanced treatments for regenerating the injured human heart. 2024 The Author(s)
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Elliott, Adrian D.; Middeldorp, Melissa E.; McMullen, Julie R.; Fatkin, Diane; Thomas, Liza; Gwynne, Kylie G.; Hill, Adam P.; Shang, Catherine; Hsu, Mengping; Vandenberg, Jamie I.; Kalman, Jonathan M.; Sanders, Prashanthan; Abhayaratna, Walter P.; Al-Falahi, Zaidon S.; Bell, James; Burrell, Louise M.; Delbridge, Lea M.Durham; Ganesan, Anand N.; Hall, Tanya; Hendriks, Jeroen M.L.; Hill, Adam; Hsu, Meng; Jenkins, Alicia J.; Kilkenny, Monique F.; Kizana, Eddy; La Gerche, AndrCrossed D.Sign; McMullen, Julie; Olaiya, Muideen Tunbosun; Ritchie, Rebecca H.; Sanders, Prash; Thijs, Vincent N.S.Atrial fibrillation (AF) is highly prevalent in the Australian community, ranking amongst the highest globally. The consequences of AF are significant. Stroke, dementia and heart failure risk are increased substantially, hospitalisations are amongst the highest for all cardiovascular causes, and Australians living with AF suffer from substantial symptoms that impact quality of life. Australian research has made a significant impact at the global level in advancing the care of patients living with AF. However, new strategies are required to reduce the growing incidence of AF and its associated healthcare demand. The Australian Cardiovascular Alliance (ACvA) has led the development of an arrhythmia clinical theme with the objective of tackling major research priorities to achieve a reduction in AF burden across Australia. In this summary, we highlight these research priorities with particular focus on the strengths of Australian research and the strategies needed to move forward in reducing incident AF and improving outcomes for those who live with this chronic condition. 2024
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Tocchetti, Carlo G.; Farmakis, Dimitrios T.; Koop, Yvonne; Andres, Maria Sol; Couch, Liam Steven; Formisano, Luigi; Ciardiello, Fortunato; Pane, Fabrizio; Au, Lewis; Emmerich, Max; Plummer, Chris John; Gulati, Geeta; Ramalingam, Sivatharshini; Cardinale, Daniela Maria; Brezden-Masley, Christine B.; Iakobishvili, Zaza; Thavendiranathan, Paaladinesh; Santoro, Ciro; Bergler-Klein, Jutta; Keramida, Kalliopi; De Boer, Rudolf A.; Maack, Christoph; Lgens, Esther; Rassaf, Tienush; Fradley, Michael G.; Moslehi, Javid J.; Yang, Eric H.; de Keulenaer, Gilles W.; Ameri, Pietro; Bax, Jeroen Joost J.; Neilan, Tomas G.; Herrmann, Joerg; Mbakwem, Amam Chinyere; Mirabel, Mariana M.; Skouri, Hadi N.; Hirsch, Emilio; Cohen-Solal, Alain; L Sverdlov, Aaron Leonid; van der Meer, Peter; Asteggiano, Riccardo; Barac, A.; Ky, Bonnie; Lenihan, Daniel J.; Dent, Susan Faye; Seferovic, Petar M.; Coats, Andrew J.S.; Metra, Marco; Rosano, Giuseppe Massimo Claudio; Suter, Thomas Martin; Lez-Ferndez, Teresa; Lyon, Alexander RichardThe advent of immunological therapies has revolutionized the treatment of solid and haematological cancers over the last decade. Licensed therapies which activate the immune system to target cancer cells can be broadly divided into two classes. The first class are antibodies that inhibit immune checkpoint signalling, known as immune checkpoint inhibitors (ICIs). The second class are cell-based immune therapies including chimeric antigen receptor T lymphocyte (CAR-T) cell therapies, natural killer (NK) cell therapies, and tumour infiltrating lymphocyte (TIL) therapies. The clinical efficacy of all these treatments generally outweighs the risks, but there is a high rate of immune-related adverse events (irAEs), which are often unpredictable in timing with clinical sequalae ranging from mild (e.g. rash) to severe or even fatal (e.g. myocarditis, cytokine release syndrome) and reversible to permanent (e.g. endocrinopathies).The mechanisms underpinning irAE pathology vary across different irAE complications and syndromes, reflecting the broad clinical phenotypes observed and the variability of different individual immune responses, and are poorly understood overall. Immune-related cardiovascular toxicities have emerged, and our understanding has evolved from focussing initially on rare but fatal ICI-related myocarditis with cardiogenic shock to more common complications including less severe ICI-related myocarditis, pericarditis, arrhythmias, including conduction system disease and heart block, non-inflammatory heart failure, takotsubo syndrome and coronary artery disease. In this scientific statement on the cardiovascular toxicities of immune therapies for cancer, we summarize the pathophysiology, epidemiology, diagnosis, and management of ICI, CAR-T, NK, and TIL therapies. We also highlight gaps in the literature and where future research should focus. 2024 European Society of Cardiology.
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Takagi, Sahoko; Satake, Shosuke; Sugimoto, Ken; Kuzuya, Masafumi; Akishita, Masahiro; Arai, Hidenori; Aprahamian, Ivan; Coats, Andrew J.S.; Klompenhouwer, Tatiana; Anker, Stefan D.; Wakabayashi, HidetakaBackground: Anorexia of aging (AA) is a condition in older adults that includes loss of appetite and reduced food intake. There is a lack of detailed analysis of the potential influence of educational initiatives in addressing AA. This study aimed to clarify the current state of knowledge and practice regarding AA and its relationship with the availability of continuing education opportunities among Japanese healthcare professionals involved in treating older patients. Methods: The Japan Geriatrics Society and the Japanese Association on Sarcopenia and Frailty, in collaboration with the Society on Sarcopenia, Cachexia, and Wasting Disorders, conducted an online questionnaire survey on the knowledge and practices in AA detection and management. Questions were asked in the areas of demographics, screening, definition/diagnosis, treatment, referral, and awareness, with those who participate in continuing education and professional development programmes in nutrition for their patients were classified as the education group and those who do not participate were classified as the non-education group. The results for each question were compared. Results: The analysis included 870 participants (physicians, 48%; registered dietitians, 16%; rehabilitation therapists, 14%; pharmacists, 12%; nurses, 6%; and other professionals, 5%). The education group (45%) was more likely than the non-education group (55%) to use the Mini-Nutritional Assessment Short Form (MNA-SF) to screen for AA (49% vs. 27%) and less likely not to use a validated tool (33% vs. 47%). More participants used evidence-based tools and materials for AA care (38% vs. 12%), and fewer used their clinical judgement (23% vs. 35%) or were unaware of the tools and materials (9% vs. 23%). The proportion using a team of professionals experienced in AA care were 47% and 24% of the education and non-education groups, respectively. By profession, few physicians used specific validated tools and resources for AA screening and treatment. More than half of the dietitians used the MNA-SF regardless of training opportunity availability. Regarding professional availability and team use, differences in educational opportunities were particularly large among physicians. Conclusions: Participation in continuing education programmes on nutrition is associated with responsiveness to AA screening and treatment and the availability of a team of professionals, which may influence the quality of AA treatment. Nutrition education may support the confidence of healthcare professionals working with older adults in AA with complex clinical signs and encourage them to conduct evidence-based practice. 2024 The Author(s). Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC.
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Keramida, Kalliopi; Farmakis, Dimitrios T.; Rakisheva, Amina G.; Tocchetti, Carlo G.; Ameri, Pietro; Asteggiano, Riccardo; Barac, A.; Bax, Jeroen Joost J.; Bay-Gen, Antoni; Bergler-Klein, Jutta; Bucciarelli-Ducci, Chiara; ?elutkiene, Jelena; Coats, Andrew J.S.; Cohen-Solal, Alain; Dent, Susan Faye; Filippatos, Gerasimos S.; Ghosh, Arjun Kumar; Herrmann, Joerg; Koop, Yvonne; Lenihan, Daniel J.; Lez-Ferndez, Teresa; Lyon, Alexander Richard; Mercurio, Valentina; Moura, Brenda; PIEPOLI, MASSIMO Francesco; Sener, Yusuf Ziya; Suter, Thomas Martin; L Sverdlov, Aaron Leonid; Tadic, Marijana Vaso; Thum, Thomas; van der Meer, Peter; van Linthout, Sophie A.; Metra, Marco; Rosano, Giuseppe Massimo Claudio[No abstract available]
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Pitt, Bertram A.; Anker, Stefan D.; Lund, Lars H.; Coats, Andrew J.S.; Filippatos, Gerasimos S.; Rossignol, Patrick; Weir, Matthew R.; Friede, Tim; Kosiborod, Mikhail N.; Metra, Marco; Bm, Michael; Ezekowitz, Justin A.; Bay-Gen, Antoni; Mentz, Robert J.; Ponikowski, Piotr P.; Senni, Michele; Pi, Ileana L.; Pinto, Fausto J.; van der Meer, Peter; Bahit, Cecilia M.; B?lohlek, Jan; Brugts, Jasper Jan; Perrin, Amandine; Waechter, Sandra; Budden, Jeffrey J.; Butler, Javed J.Background: Hyperkalemia (HK) is associated with suboptimal reninangiotensin system (RAS) inhibitor and mineralocorticoid receptor antagonist (MRA) use in heart failure with reduced ejection fraction (HFrEF). Objectives: This study sought to assess characteristics and RAS inhibitor/MRA use in patients receiving patiromer during the DIAMOND (Patiromer for the Management of Hyperkalemia in Subjects Receiving RAASi Medications for the Treatment of Heart Failure) run-in phase. Methods: Patients with HFrEF and HK or past HK entered a run-in phase of ?12 weeks with patiromer-facilitated RAS inhibitor/MRA optimization to achieve ?50% recommended RAS inhibitor dose, 50 mg/d MRA, and normokalemia. Patients achieving these criteria (randomized group) were compared with the run-in failure group (patients not meeting the randomization criteria). Results: Of 1,038 patients completing the run-in, 878 (84.6%) were randomized and 160 (15.4%) were run-in failures. Overall, 422 (40.7%) had HK entering run-in with a similar frequency in the randomized and run-in failure groups (40.3% vs 42.5%; P = 0.605). From start to the end of run-in, in the randomized group, an increase was observed in target RAS inhibitor and MRA use in patients with HK (RAS inhibitor: 76.8% to 98.6%; MRA: 35.9% to 98.6%) and past HK (RAS inhibitor: 60.5% to 98.1%; MRA: 15.6% to 98.7%). Despite not meeting the randomization criteria, an increase after run-in was observed in the run-in failure group in target RAS inhibitor (52.5% to 70.6%) and MRA use (15.0% to 48.1%). This increase was observed in patients with HK (RAS inhibitor: 51.5% to 64.7%; MRA: 19.1% to 39.7%) and past HK (RAS inhibitor: 53.3% to 75.0%; MRA: 12.0% to 54.3%). Conclusions: In patients with HFrEF and HK or past HK receiving suboptimal RAS inhibitor/MRA therapy, RAS inhibitor/MRA optimization increased during patiromer-facilitated run-in. 2024 The Authors
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Paratz, Elizabeth Davida; Nadel, James; Humphries, Julie Ann; Rowe, Stephanie J.; Fahy, Louise; La Gerche, AndrCrossed D.Sign; Prior, David Lloyd; Celermajer, David S.; Strange, G. A.; Playford, David A.Aims: Increasing aortic dilation increases the risk of aortic dissection. Nevertheless, dissection occurs at dimensions below guideline-directed cut-offs for prophylactic surgery. Currently, there are no large-scale population imaging data assessing aortic dimensions before dissection. Methods and results: Patients within the National Echo Database of Australia were stratified according to absolute, height-indexed, and body surface area (BSA)-indexed aortic dimensions. Fatal thoracic aortic dissections (ICD-10-AM Code I71) were identified via linkage with the National Death Index. A total of 524 994 individuals were assessed, comprising patients with normal aortic dimensions (n = 460 992), mild dilation (n = 53 402), moderate dilation (n = 10 029), and severe dilation (n = 572). A total of 274 992 (52.4%) were males, with a median age of 64 years and a median follow-up time of 6.9 years. Eight hundred and ninety-nine fatal aortic dissections occurred (normal diameter = 610, mildly dilated aorta = 215, moderately dilated = 53, and severely dilated = 21). Using normal aortas as the reference population, odds of fatal dissection increased with aortic diameter [mild = odds ratio (OR) 3.05, 95% confidence interval (CI) 2.61-3.56; moderate = OR 4.0, 95% CI 3.02-5.30; severe = OR 28.72, 95% CI 18.44-44.72]. Due to the much larger number of patients without severe aortic dilation, 97.7% of fatal aortic dissections occurred in non-severely dilated aortas. Following sensitivity analysis, severe aortic dilation was responsible for at most 24.4% of fatal aortic dissections. The results were robust for absolute, height-indexed, or BSA-indexed aortic measurements. Conclusion: Although severe aortic dilatation is associated with a near-30-fold increase in fatal dissections, severely dilated aortas are implicated in only 2.3-24.4% of fatal dissections. This highlights the 'aortic paradox' and limitations of current guidelines. Future studies should seek to refine risk predictors in patients without severe aortic dilation. 2024 The Author(s).
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Fono, Margaret Apolima; Rambaldini, Boe; Christie, Vita; Gwynne, Kylie G.Objectives and importance of study: In the public service context, codesign is novel and ever-expanding. Co-design brings together decision-makers and people impacted by a problem to unpack the problem and design solutions together. Government agencies are increasingly adopting co-design to understand and meet the unique needs of priority populations. While the literature illustrates a progressive uptake of co-design in service delivery, there is little evidence of co-design in policy development. We propose a qualitative study protocol to explore and synthesise the evidence (literary, experiential and theoretical) of co-design in public policy. This can inform a framework to guide policymakers who co-design health policy with Aboriginal and Torres Strait Islander people. Methods: The study design is informed by a critical qualitative approach that comprises five successive stages. The study commences with the set-up of a co-design brains trust (CBT), comprising people with lived experience of being Aboriginal and Torres Strait Islander who have either co-designed with public agencies and/or have health policymaking expertise (stage 1) The brains trust will play a key role in guiding the protocols methodology, data collection, reporting and co-designing a Version 1 framework to guide policymakers in co-designing health policy with Aboriginal and Torres Strait Islander people (the framework). Two realist evaluations will explore codesign in health policy settings to understand how co-design works for whom, under what circumstances, and how (stages 2 and 3) The findings of the realist evaluations will guide the CBT in developing the framework (stage 4). A process evaluation of the CBT setup and framework development will assess the degree to which the CBT achieved its intended objectives (stage 5). Conclusion: The proposed study will produce much-needed evidence to guide policymakers to share decision-making power and privilege the voices of Aboriginal and Torres Strait Islander people when co-designing health policy. Learnings from this translational research will be shared via the CBT, academic papers, conference presentations and policy briefings. 2024 Fono et al.
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Cartland, Si; Patil, Manisha S.; Kelland, Elaina; Le, Natalie; Boccanfuso, Lauren M.; Stanley, Christopher P.; Cholan, Pradeep Manuneedhi; Dona, Malathi S.I.; Patrick, Ralph; McGrath, Jordan P.; Su, Qian Peter; Alwis, Imala D.; Ganss, Ruth; Powell, Joseph E.; Harvey, Richard P.; Pinto, Alexander Ruvantha; Griffith, Thomas Scott; Loa, Jacky; Aitken, Sarah Joy; Robinson, David A.; Patel, Sanjay; Kavurma, Mary M.Reversal of ischemia is mediated by neo-angiogenesis requiring endothelial cell (EC) and pericyte interactions to form stable microvascular networks. We describe an unrecognized role for tumor necrosis factorrelated apoptosis-inducing ligand (TRAIL) in potentiating neo-angiogenesis and vessel stabilization. We show that the endothelium is a major source of TRAIL in the healthy circulation compromised in peripheral artery disease (PAD). EC deletion of TRAIL in vivo or in vitro inhibited neo-angiogenesis, pericyte recruitment, and vessel stabilization, resulting in reduced lower-limb blood perfusion with ischemia. Activation of the TRAIL receptor (TRAIL-R) restored blood perfusion and stable blood vessel networks in mice. Proof-of-concept studies showed that Conatumumab, an agonistic TRAIL-R2 antibody, promoted vascular sprouts from explanted patient arteries. Single-cell RNA sequencing revealed heparin-binding EGF-like growth factor in mediating EC-pericyte communications dependent on TRAIL. These studies highlight unique TRAIL-dependent mechanisms mediating neo-angiogenesis and vessel stabilization and the potential of repurposing TRAIL-R2 agonists to stimulate stable and functional microvessel networks to treat ischemia in PAD. 2024 American Association for the Advancement of Science. All rights reserved.
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Moonen, Avalon; Celermajer, David S.; Ng, Martin K.C.; Strange, G. A.; Playford, David A.; Stewart, S.Aims We set out to explore associations between a mitral-specific cardiac damage score (m-CDS) and survival outcomes in mitral regurgitation (MR) and compare the performance of the m-CDS and an aortic-specific CDS (a-CDS) in patients with MR within the large National Echo Database of Australia. Methods Among 620 831 unique adults investigated with echocardiography, there were 17 658 individuals (3.1%) with moderate or greater functional MR (aged 7613 years, 51% female) who met inclusion criteria. A randomly selected cohort of 5000 of these patients was used to test seven different CDS models for prediction of subsequent all-cause mortality during an average 3.8-year follow-up. The best-performing CDS model in the derivation cohort was then applied to a validation cohort of the remaining 12 658 individuals (aged 7613 years, 51% female). Results The best-performing m-CDS model stratified the full cohort into Stage 0: control (1046 patients, 8%); Stage 1: left atrial damage (3416 patients, 27%); Stage 2: left ventricular damage (3352 patients, 26%); Stage 3: right ventricular damage (1551 patients, 12%) and Stage 4: pulmonary hypertension (3293 patients, 26%). Increasing m-CDS stage was consistently and incrementally associated with both all-cause and cardiovascular mortality at 1 year, 5 years and all-time and remained so after adjustment for increasing age and severity of MR, with a ~35% increase in mortality for each increase in CDS stage (p<0.001). Conclusion A m-CDS was robustly and incrementally associated with short-, medium- and long-term risk of all-cause and cardiovascular mortality in patients with functional MR in this large registry study. Author(s) (or their employer(s)) 2024.
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Adamopoulos, Stamatis N.; Bonios, Michael J.; Ben-Gal, Tuvia; Gustafsson, Finn; Abdelhamid, Magdy A.; Adamo, Marianna; Bay-Gen, Antoni; Bm, Michael; Chioncel, O. Dragomir; Cohen-Solal, Alain; Damman, Kevin; Di Nora, Concetta; Hashmani, Shahrukh; Hill, Loreena Michelle; Jaarsma, Tiny; Jankowska, Ewa Anita; Lopatin, Yuri M.; Masetti, Marco; Mehra, M. R.; Mili?i?, Davor; Moura, Brenda; Mullens, Wilfried; Nalbantgil, Sanem; Panagiotou, Chrysoula; PIEPOLI, MASSIMO Francesco; Rakisheva, Amina G.; Risti?, Arsen D.; Rivinius, Rasmus; Savarese, Gianluigi; Thum, Thomas; Tocchetti, Carlo G.; Tops, Laurens F.; van Laake, Linda Wilhelmina; Volterrani, Maurizio; Seferovic, Petar M.; Coats, Andrew J.S.; Metra, Marco; Rosano, Giuseppe Massimo ClaudioRight heart failure (RHF) following implantation of a left ventricular assist device (LVAD) is a common and potentially serious condition with a wide spectrum of clinical presentations with an unfavourable effect on patient outcomes. Clinical scores that predict the occurrence of right ventricular (RV) failure have included multiple clinical, biochemical, imaging and haemodynamic parameters. However, unless the right ventricle is overtly dysfunctional with end-organ involvement, prediction of RHF post-LVAD implantation is, in most cases, difficult and inaccurate. For these reasons optimization of RV function in every patient is a reasonable practice aiming at preparing the right ventricle for a new and challenging haemodynamic environment after LVAD implantation. To this end, the institution of diuretics, inotropes and even temporary mechanical circulatory support may improve RV function, thereby preparing it for a better adaptation post-LVAD implantation. Furthermore, meticulous management of patients during the perioperative and immediate postoperative period should facilitate identification of RV failure refractory to medication. When RHF occurs late during chronic LVAD support, this is associated with worse long-term outcomes. Careful monitoring of RV function and characterization of the origination deficit should therefore continue throughout the patient's entire follow-up. Despite the useful information provided by the echocardiogram with respect to RV function, right heart catheterization frequently offers additional support for the assessment and optimization of RV function in LVAD-supported patients. In any patient candidate for LVAD therapy, evaluation and treatment of RV function and failure should be assessed in a multidimensional and multidisciplinary manner. 2024 European Society of Cardiology.
