1,721,437 research outputs found
Reply: The Barcelona Bio-HF Calculator: A Contemporary Web-Based Heart Failure Risk Score
No full textSex- and gender‑specific precision medicine for chronic coronary syndromes: challenges and opportunities
Full text linkN/
The European society of cardiology ACCA-EAPCI registry on ST elevation myocardial infarction: A new Registry to evaluate the treatment of STEMI across Europe and the Mediterranean countries is discussed
No full textThe main objective of this study is to describe the demographic, clinical,
and biological characteristics of patients with STEMI admitted to
a representative setting of cardiology centres in ESC-member countries
in Europe.
Other objectives are to assess management patterns and in particular
the current use of reperfusion therapies and to evaluate how recommendations
of most recent STEMI European guidelines regarding reperfusion
therapies and adjunctive pharmacological and non-pharmacological treatments
are adopted in clinical practice and how their application can impact
on patients’ outcomes. Information on the reasons why evidencebased
treatments are not utilized will be collected.
An interesting objective will be to evaluate the organization of
STEMI management across Europe and Mediterranean countries specifically
regarding the diagnostic and admission process and treatment
pathways. The registry will validate the prognostic predictors of inhospital
and 1-year outcomes. In particular, patients with
Cardiopulmonary resuscitation and/or cardiogenic shock, who still
present a high mortality rate despite reperfusion therapy. A 1-year
follow-up will be performed to assess long-term event rate and adherence
to secondary prevention measures
Real-world data on new users of atypical antipsychotics: characterisation, prescription patterns, healthcare costs and early cardio-metabolic occurrences from a large Italian database
No full textPurpose: To describe new users of atypical antipsychotics (APs) in terms of sociodemographic characteristics, cardio-metabolic risk profile, prescription patterns, healthcare costs and cardio-metabolic events over the 24 months after treatment initiation. Methods: Atypical AP new users were selected from the ReS database and grouped into three: patients already affected by cardio-metabolic diseases (group A), patients without these clinical conditions but with predisposing conditions (group B) and patients without cardio-metabolic diseases and predisposing conditions (group C). Annual prescription patterns and healthcare costs were analysed. Subjects of groups B and C were matched with controls to compare the occurrences of cardio-metabolic events over 24 months. Results: Thirty-two thousand thirty-four new users of atypical APs were selected (median age 69). The 22.3% had cardio-metabolic diseases, 14.8% had predisposing conditions and 62.9% had none of these. The 99.3% received monotherapy. The mean annual cost per patient was €2785, and the median cost was €1108. After 24 months, a cardio-metabolic event occurred in 11.5% of group B vs. 8.7% of the controls (p < .01), and in 5.0% of group C vs. 2.1% of the controls (p < .01). Conclusion: Patients treated with atypical AP were on average old and, in a non-negligible amount, with cardio-metabolic disease or predisposing conditions. New users of atypical APs showed a significantly higher likelihood to develop a cardio-metabolic event early after treatment initiation. Keywords: Administrative data; Atypical antipsychotic; Cardio-metabolic risk; Italy; Real-world evidence
Appropriateness of Prescriptions of Recommended Treatments in Organisation for Economic Co-operation and Development Health Systems: Findings Based on the Long-Term Registry of the European Society of Cardiology on Heart Failure
No full textAbstractObjectiveThis observational study aimed to identify clinical variables and health system characteristics associated with incomplete guideline application in drug treatment of patients with chronic heart failure (HF) across 15 countries.MethodsThree data sets were used: European Society of Cardiology Heart Failure Registry, Organisation for Economic Co-operation and Development’s Health System Characteristics Survey, and Organisation for Economic Co-operation and Development Health Statistics 2013. Patient and country variables were examined by multilevel, multiple logistic regression. The study population consisted of ambulatory patients with chronic HF and reduced ejection fraction. Inappropriateness of prescription of pharmacological treatments was defined as patients not prescribed at least one of the two recommended treatments (angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers and beta-blockers) or treated with both medications but at suboptimal dosage and in absence of documented contraindication/intolerance.ResultsOf 4605 patients, 1097 (23.8%) received inappropriate drug prescriptions with a large variation within and across countries, with 18.5% of the total variability accounted for by between-country health structure characteristics. Patient-level characteristics such as having mitral regurgitation (odds ratio 1.4; 95% confidence interval 1.1–1.7) was significantly associated with inappropriate prescription of recommended drugs, whereas chronic obstructive pulmonary disease (odds ratio 0.7; 95% confidence interval 0.5–0.9) was associated with more appropriate prescriptions. Among the country-level variables, incentives or obligation to comply with guidelines increased the probability of prescription appropriateness.ConclusionsCombining clinical variables with health system characteristics is a promising exercise to explain the appropriateness of recommended drug prescriptions. Such an understanding can help decision makers to design more effective policies to improve adherence to guidelines, improve health care outcomes, and potentially reduce costs
[Diabetes mellitus and atrial fibrillation: evidence of a pathophysiological, clinical and epidemiological association beyond the thromboembolic risk]
No full textA large number of studies have linked diabetes mellitus (DM) to the development of cardiovascular disease. However, the association between DM and arrhythmic disease of the heart is less well recognized by the cardiology community. Mostly, the focus is the increased thromboembolic risk that the presence of DM confers to patients with atrial fibrillation (AF). However, recent evidence points toward an increased prevalence of AF in patients with diabetes. This association seems to be reinforced by the presence of additional comorbidities such as hypertension and insulin-resistance. Moreover, different pathophysiological mechanisms support this association. Notably the link between AF and DM is bidirectional: not only patients with DM are more vulnerable to develop AF but also patients with new-onset AF have an increased risk of DM. Herein, the epidemiological findings and pathophysiological mechanisms linking AF and DM will be reviewed in order to increase the knowledge on this association and improve the clinical and therapeutic approach
Patient, hospital and country-level risk factors of all-cause mortality among patients with chronic heart failure: Prospective international cohort study
Full text linkBackground
Although many studies have described patient-level risk factors for outcomes in heart failure (HF), health care structural determinants remain largely unexplored. This research reports patient-, hospital- and country-level characteristics associated with 1-year all-cause mortality among patients with chronic HF, and investigates geographic and hospital variation in mortality.
Methods and findings
We included 9,277 patients with chronic HF enrolled between May 2011 and November 2017 in the prospective cohort study European Society of Cardiology Heart Failure Long Term registry across 142 hospitals, located in 22 countries. Mean age of the selected outpatients was 65 years (sd 13.2) and 28% were female. The all-cause 1-year mortality rate per 100 person-years was 7.1 (95% confidence interval (CI) 6.6–7.7), and varied between countries (median 6.8, IQR 5.6–11.2) and hospitals (median 7.8, IQR 5.2–12.4). Mortality was associated with age (incidence rate ratio 1.03, 95% CI 1.02–1.04), diabetes mellitus (1.37, 1.15–1.63), peripheral artery disease (1.56, 1.27–1.92), New York Heart Association class III/IV (1.91, 1.60–2.30), treatment with angiotensin-converting enzyme inhibitor and angiotensin receptor antagonists (0.71, 0.57–0.87) and HF clinic (0.64, 0.46–0.89). No other hospital-level characteristics, and no country-level healthcare characteristics were associated with 1-year mortality, with case-mix standardised variance between countries being very low (1.83e-06) and higher for hospitals (0.372).
Conclusions
All-cause mortality at 1 year among outpatients with chronic HF varies between countries and hospitals, and is associated with patient characteristics and the availability of hospital HF clinics. After full adjustment for clinical, hospital and country variables, between-country variance was negligible while between-hospital variance was evident
Contemporary stroke prevention strategies in 11 096 European patients with atrial fibrillation: a report from the EURObservational Research Programme on Atrial Fibrillation (EORP-AF) Long-Term General Registry
Full text linkAIMS: Contemporary data regarding atrial fibrillation (AF) management and current use of oral anticoagulants (OACs) for stroke prevention are needed.
METHODS AND RESULTS: The EURObservational Research Programme on AF (EORP-AF) Long-Term General Registry analysed consecutive AF patients presenting to cardiologists in 250 centres from 27 European countries. From 2013 to 2016, 11 096 patients were enrolled (40.7% female; mean age 69 ± 11 years). At discharge, OACs were used in 9379 patients (84.9%), with non-vitamin K antagonists (NOACs) accounting for 40.9% of OACs. Antiplatelet therapy alone was used by 20% of patients, while no antithrombotic treatment was prescribed in 6.4%. On multivariable analysis, age, hypertension, previous ischaemic stroke, symptomatic AF and planned cardioversion or ablation were independent predictors of OAC use, whereas lone AF, previous haemorrhagic events, chronic kidney disease and admission for acute coronary syndrome (ACS) or non-cardiovascular causes independently predicted OAC non-use. Regarding the OAC type, coronary artery disease, history of heart failure, or valvular heart disease, planned cardioversion and non-AF reasons for admission independently predicted the use of vitamin K antagonists (VKAs). Wide variability among the European regions was observed in the use of NOACs, independently from other clinical factors.
CONCLUSION: The EORP-AF Long-Term General Registry provides a full picture of contemporary use of OAC in European AF patients. The overall rate of OACs use was generally high (84.9%), and a series of factors were associated with the prescription of OAC. A significant geographical heterogeneity in prescription of NOACs vs. VKAs was evident
Health-related quality of life and healthcare costs of symptoms and cardiovascular disease events in patients with atrial fibrillation: a longitudinal analysis of 27 countries from the EURObservational Research Programme on Atrial Fibrillation general long-term registry
Full text linkAims: We examine the effects of symptoms and cardiovascular disease (CVD) events on health-related quality of life (HRQOL) and healthcare costs in a European population with atrial fibrillation (AF). Methods and results: In the EURObservational Research Programme on AF long-term general registry, AF patients from 250 centres in 27 European countries were enrolled and followed for 2 years. We used fixed effects models to estimate the association of symptoms and CVD events on HRQOL and annual healthcare costs. We found significant decrements in HRQOL in AF patients in whom ST-segment elevation myocardial infarction (STEMI) [−0.075 (95% confidence interval −0.144, −0.006)], angina or non-ST-elevation myocardial infarction (NSTEMI) [−0.037 (−0.071, −0.003)], new-onset/worsening heart failure [−0.064 (−0.088, −0.039)], bleeding events [−0.031 (−0.059, −0.003)], thromboembolic events [−0.071 (−0.115, −0.027)], mild symptoms [0.037 (−0.048, −0.026)], or severe/disabling symptoms [−0.090 (−0.108, −0.072)] occurred during the follow-up. During follow-up, annual healthcare costs were associated with an increase of €11 718 (€8497, €14 939) in patients with STEMI, €5823 (€4757, €6889) in patients with angina/NSTEMI, €3689 (€3219, €4158) in patients with new-onset or worsening heart failure, €3792 (€3315, €4270) in patients with bleeding events, and €3182 (€2483, €3881) in patients with thromboembolic events, compared with AF patients without these events. Healthcare costs were primarily driven by inpatient costs. There were no significant differences in HRQOL or healthcare resource use between EU regions or by sex. Conclusion: Symptoms and CVD events are associated with a high burden on AF patients and healthcare systems throughout Europe
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