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Journal Cover European Heart Journal - Quality of Care and Clinical Outcomes
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   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 2058-5225 - ISSN (Online) 2058-1742
   Published by Oxford University Press Homepage  [372 journals]
  • Normal coronary angiography: blessing or curse'
    • Authors: Tavella R; Beltrame J.
      Abstract: This editorial refers to ‘Changes in symptoms of anxiety and depression following diagnostic angiography: a prospective cohort study’, by T.A. Hanssen et al., on page 106.
      PubDate: Thu, 15 Mar 2018 00:00:00 GMT
  • Movement is medicine: the Scandinavian way
    • Authors: Warriner D; Mandrola J.
      Abstract: This editorial refers to ‘Survival and incidence of cardiovascular diseases in participants in a long-distance ski race (Vasaloppet, Sweden) compared with the background population’, by U. Hållmarker et al., on page 91.
      PubDate: Thu, 01 Mar 2018 00:00:00 GMT
  • Thromboembolisms related to post-operative electrical cardioversions for
           atrial fibrillation in patients with surgical aortic valve replacement
    • Authors: Kiviniemi T; Malmberg M, Biancari F, et al.
      Abstract: AimsPost-operative atrial fibrillation (POAF) is a frequent complication after open-heart surgery, and cardioversions (CV) are commonly performed to restore sinus rhythm. However, little data exists on thrombo-embolic risk related to early post-operative CV and on the recurrence of POAF after CV. CAREAVR study sought to assess the rate of strokes, transient ischaemic attacks (TIA), and mortality shortly after POAF-triggered CV in patients who underwent isolated surgical aortic valve replacement (SAVR) with a bioprosthesis.Methods and resultsAltogether 721 patients underwent isolated SAVR with a bioprosthesis at four Finnish university hospitals. During post-operative hospitalization, after patients with prior chronic AF were excluded, 309/634 (48.7%) of patients had at least one episode of POAF [median time (interquartile range) 3 (3) days], and an electrical CV was performed in 113/309 (36.6%) of them. The length of hospital stay was not affected by CV. At 30 days follow-up, the rate of stroke, TIA or mortality was higher in those AF patients who underwent CV vs. those who did not (9.7% vs. 3.6%, P = 0.04, respectively; adjusted hazard ratio 2.63, 95% confidence interval 1.00–6.92, P = 0.05). Similar proportion of patients in both groups were in AF rhythm at discharge (32.7% vs. 35.7%, P = 0.18); and at 3 months (25.0% vs. 23.6%, P = 0.40), respectively.ConclusionIn this real-world population of patients undergoing isolated SAVR, the rate of POAF was nearly 50%. One-third of these patients underwent an electrical CV, and they exhibited over two-fold risk for thromboembolisms and mortality. Cardioversion did not affect the short-term prevalence of AF.
      PubDate: Tue, 30 Jan 2018 00:00:00 GMT
  • Survival and incidence of cardiovascular diseases in participants in a
           long-distance ski race (Vasaloppet, Sweden) compared with the background
    • Authors: Hållmarker U; Lindbäck J, Michaëlsson K, et al.
      Abstract: AimsWe studied the relationship between taking part in a long-distance ski race and incidence of cardiovascular diseases (CVDs) to address the hypothesis that lifestyle lowers the incidence.Methods and resultsA cohort of 399 630 subjects in Sweden, half were skiers in the world’s largest ski race, and half were non-skiers. Non-skiers were frequency matched for sex, age, and year of race. Individuals with severe diseases were excluded. The endpoints were death, myocardial infarction, or stroke. The subjects were followed up for a maximum of 21.8 years and median of 9.8 years. We identified 9399 death, myocardial infarction, or stroke events among non-skiers and 4784 among the Vasaloppet skiers. The adjusted hazard ratios (HRs) comparing skiers and non-skiers were 0.52 [95% confidence interval (CI) 0.49–0.54] for all-cause mortality, 0.56 (95% CI 0.52–0.60) for myocardial infarction and 0.63 (95% CI 0.58–0.67) for stroke and for all three outcomes 0.56 (95% CI 0.54–0.58). The results were consistent across subgroups: age, sex, family status, education, and race year. For skiers, a doubling of race time was associated with a higher age-adjusted risk of 19%, and male skiers had a doubled risk than female skiers, with a HR 2.06 (95% CI 1.89–2.41). The outcome analyses revealed no differences in risk of atrial fibrillation between skiers and non-skiers.ConclusionThis large cohort study provides additional support for the hypothesis that individuals with high level of physical activity representing a healthy lifestyle, as evident by their participation in a long-distance ski race, have a lower risk of CVD or death.
      PubDate: Tue, 30 Jan 2018 00:00:00 GMT
  • Do patient-reported outcome measures speak for all patient subgroups: is
           everyone included'
    • Authors: Rathod K; Wragg A.
      Abstract: This editorial refers to ‘Does routinely collected patient-reported outcome data represent the actual case-mix of elective coronary revascularization patients'’, by S. Oinasmaa et al., on page 113.
      PubDate: Mon, 29 Jan 2018 00:00:00 GMT
  • Systematic review of the cost-effectiveness of transcatheter interventions
           for valvular heart disease
    • Authors: Gialama F; Prezerakos P, Apostolopoulos V, et al.
      Abstract: Transcatheter aortic valve implantation (TAVI) and transcatheter mitral valve repair (TMVR) are increasingly used for managing patients with valvular heart disease to whom surgery presents a high-risk. As these are costly procedures, a systematic review of studies concerned with their economic assessment was undertaken. The search was performed in PubMed and the Cochrane Library and followed recommended methodological steps. Studies were screened and their data were retrieved and were synthesized using a narrative approach. Twenty-four, good to high quality, evaluations were identified, representing different viewpoints, modelling techniques and willingness-to-pay thresholds. Studies show that in high-risk patients with symptomatic aortic stenosis, TAVI may be cost-effective compared with medical management (MM) across many health care settings. In contrast, studies of TAVI compared with surgical aortic valve replacement (SAVR) yield conflicting and inconclusive results. The limited data available show that TMVR may also be cost-effective relative to MM in mitral valve disease. Existing evidence indicates that transcatheter techniques may be cost-effective options, relative to MM, in high-risk patients with valvular disease. Nonetheless, more research is needed to establish their economic value further, to investigate the drives of cost-effectiveness, and to evaluate surgical with transcatheter techniques in aortic valvular disease.
      PubDate: Tue, 09 Jan 2018 00:00:00 GMT
  • Hospitalized elderly patients for acute pericarditis deserve more clinical
           attention and a closer follow-up monitoring
    • Authors: Chhabra L; Spodick D.
      Abstract: This editorial refers to ‘Trends in acute pericarditis hospitalizations and outcomes among the elderly in the USA, 1999--2012’, by P Mody et al., on page 98.
      PubDate: Thu, 21 Dec 2017 00:00:00 GMT
  • The association of invasive treatment with health status outcomes in
           patients with non-ST-elevation myocardial infarction and pre-infarct
    • Authors: Alturkmani H; Qintar M, Patel K, et al.
      Abstract: Heterogeneity in preventing major adverse cardiac events has been shown to occur in non-ST-elevation myocardial infarction (NSTEMI), with greater benefit with invasive management in patients having higher TIMI risk scores.1 It is unknown whether there is heterogeneity in the effect of invasive management on health status outcomes. We hypothesized that the use of invasive treatment for patients with pre-infarct angina (PIA), which has been shown to predict better clinical outcomes,2 would be associated with better health status outcomes. To address this gap in knowledge, we leveraged two prospective, multi-centre, US acute myocardial infarction cohort studies.
      PubDate: Mon, 27 Nov 2017 00:00:00 GMT
  • Cost-effectiveness of colchicine treatment on post-operative atrial
           fibrillation events in patients of major cardiac surgery
    • Authors: Barman M; Tantawy M, Sopher M, et al.
      Abstract: AimsPost-operative atrial fibrillation (POAF) occurs in 20–50% of patients amid post-operative stay after Cardiac Surgery. We intend to determine whether colchicine therapy in patients undergoing cardiac surgery is a cost-effective strategy for prevention of POAF. To undertake cost utility analysis and calculate incremental cost utility ratio (ICUR) for colchicine therapy in these subgroup of patients.Methods and results Design Decision tree model to calculate the ICUR comparing two treatment strategies in patients undergoing cardiac surgery. One wherein patients received colchicine along with usual care and second where they received placebo or just usual care. Cost utility analysis was undertaken using relevant data from the systematic review and meta-analysis of the available randomized controlled trials till June 2016 and mean cost calculations from validated available sources across various jurisdictions.ResultsColchicine treatment based on mean costs for life expectancy calculated at 10 years’ post-surgery using recommended discounting rates of 3.5% was € 17544.80 cheaper per quality-adjusted life-year (QALY) gained. The incremental cost is negative and the incremental effect (QALY) is positive (South East quadrant), Hence the intervention of colchicine treatment is unequivocally cost-effective, meaning it is dominant and achieves better outcomes at a lower cost.ConclusionOur findings provide a benchmark for current and future analyses relating to effectiveness of colchicine on POAF events after cardiac surgery. Currently, there are few reports that provide cutting edge estimates of the higher expenses associated with POAF. Future analyses should likewise explore the impact of added costs from using pharmacologic efforts to prevent and treat POAF after cardiac surgery.
      PubDate: Tue, 07 Nov 2017 00:00:00 GMT
  • Trends in acute pericarditis hospitalizations and outcomes among the
           elderly in the USA, 1999–2012
    • Authors: Mody P; Bikdeli B, Wang Y, et al.
      Abstract: AimsThe elderly are at risk of pericarditis from conditions such as malignancy, renal disease, and after cardiac surgery. However, the burden of pericarditis and, especially, the long-term outcomes associated with pericarditis have not been described before among the elderly.Methods and resultsWe examined hospitalization rates; in-hospital, 30-day, and 1-year all-cause mortality rates; all-cause 30-day readmission rates; length of stay and health care expenditure for Medicare beneficiaries aged 65 years or older with a principal discharge diagnosis of pericarditis from 1999 to 2012. A total of 45 504 hospitalizations were identified. The hospitalization rate for pericarditis remained stable at 26 per 100 000 person-years across the study period and was consistently higher among men and the oldest old. The adjusted all-cause 30-day mortality rates decreased from 7.6% [95% confidence interval (CI) 6.9–8.2] in 1999 to 5.7% (95% CI 4.5–7.1) in 2012 and all-cause 1-year mortality rates decreased from 19.7% (95% CI 18.8–20.8) in 1999 to 17.3% (95% CI 15.3–20) in 2011 respectively. The 30-day all-cause readmission rate remained unchanged at 18% across the study period. The length of stay ranged from a mean of 5.8 days in 1999 to 5.5 days in 2012. The consumer price index adjusted cost per hospitalization increased from $8404 in 1999 to $9982 in 2012.ConclusionThe hospitalization rate for acute pericarditis has remained unchanged among older adults. Although mortality rates associated with pericarditis have improved, hospitalization for pericarditis continues to signal a high risk of dying within a year.
      PubDate: Thu, 02 Nov 2017 00:00:00 GMT
  • Changes in symptoms of anxiety and depression following diagnostic
           angiography: a prospective cohort study
    • Authors: Hanssen T; Iqbal A, Forsdahl S, et al.
      Abstract: AimsCoronary angiography is the gold standard diagnostic test for coronary artery disease (CAD), and the diagnostic results can have an immediate effect on symptoms. The aim of this study was to explore the long-term impact of diagnostic angiography on symptoms of anxiety and depression in a group of patients without previous CAD.Methods and resultsThe prospective cohort study included 459 consecutive patients undergoing invasive angiography and was approved by the regional board of ethics. Data were collected at baseline and after 6 and 12 months using self-reports. Symptoms of anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS). The sample population had a mean age of 62 years and included 197 (43%) women. Fifty-three percent had hypertension, and 17% had diabetes. The diagnostic results indicated that 41% of patients had normal vessels; 21% had wall changes; and 38% had obstructive stenosis. No significant difference was found between the diagnostic groups at baseline regarding the levels of anxiety or depression. After 6 months, participants with obstructive stenosis had significantly lower levels of anxiety than those without obstructive stenosis. Improvements were observed in all groups over time in both HADS subscale scores; the largest improvement occurred in patients with obstructive stenosis.ConclusionThis study demonstrates that patients with normal coronary arteries or minimal coronary disease/non-obstructive coronary disease do not seem to obtain the same benefit from the receipt of information about their coronary status in terms of anxiety and depression as patients with significant obstructive stenosis.
      PubDate: Wed, 25 Oct 2017 00:00:00 GMT
  • Does routinely collected patient-reported outcome data represent the
           actual case-mix of elective coronary revascularization patients'
    • Authors: Oinasmaa S; Heiskanen J, Hartikainen J, et al.
      Abstract: AimsPatient-reported outcomes (PROs) are valuable for effectiveness evaluation, but it is unknown whether the patient views obtained represent the actual case mix. We studied the representativeness of the responses obtained to a routinely administered health-related quality of life (HRQoL) questionnaire in a cardiology unit.Methods and resultsElective coronary artery bypass grafting (CABG; n = 404) and percutaneous coronary intervention (PCI; n = 738) patients operated during June 2012 to August 2014 in the Heart Center, Kuopio University Hospital. The characteristics of the patients with a baseline (n = 260 and 290 for CABG and PCI, respectively) or both baseline and follow-up HRQoL measurements (n = 203 and 189 for CABG and PCI, respectively) were compared with those who did not respond (n = 144 and 448 for CABG and PCI). Baseline questionnaires were less likely obtained from older CABG patients (odds ratio 0.51, 95% confidence interval 0.28–0.91) and those with more severe disease (0.20, 0.05–0.79). Among PCI patients, women (0.64, 0.45–0.91), smokers (0.74, 0.53–1.04), and those with more severe disease (0.26, 0.13–0.52) or more hospital days were underrepresented.ConclusionRoutinely collected PROs in cardiac patients may be biased towards younger and healthier patients. This needs to be recognized when evaluating the representativeness of such data. The routine collection of these data should be adequately resourced.
      PubDate: Fri, 13 Oct 2017 00:00:00 GMT
  • Neurological effects of proprotein convertase subtilisin/kexin type 9
           inhibitors: direct comparisons
    • Authors: Bajaj N; Patel N, Kalra R, et al.
      Abstract: AimsProprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors considerably alter the lipid profile. We sought to examine the rates of ischaemic stroke and neurocognitive deficits in patients treated with and without PCSK9 inhibitors.Methods and resultsRandomized controlled trials (RCTs) reporting rates of ischaemic stroke and neurocognitive deficits in patients using PCSK9 inhibitors were identified. Standard meta-analysis techniques were used to compare these outcomes among patients treated with and without PCSK9 inhibitors and the two US Food and Drug Administration-approved PCSK9 inhibitors, evolocumab and alirocumab. The results were presented in terms of risk ratio (RR) with 95% confidence intervals (CIs). Sixteen RCTs with 39 104 patients were included. Evolocumab was used in six RCTs with 33 450 patients, whereas alirocumab was used in 10 RCTs with 5654 patients. We observed a significantly lower risk of ischaemic stroke among those treated with PCSK9 inhibitors (RR 0.77, 95% CI 0.64–0.93) when compared with those without. We did not observe any difference in the risk of neurocognitive deficits between the aforementioned groups (RR 1.11, 95% CI 0.93–1.32). The lower stroke risk in the PCSK9 inhibitors group was driven by evolocumab studies. We observed no difference in the risk of neurocognitive deficits among evolocumab and alirocumab when compared with no PCSK9 inhibitors group.ConclusionTreatment with PCSK9 inhibitors significantly lowers the risk of ischaemic stroke, without any increased risk of neurocognitive deficits. PCSK9 inhibitors are neuroprotective due to the decrease in ischaemic-mediated neurovascular events and should be considered cognitively innocuous medications.
      PubDate: Fri, 06 Oct 2017 00:00:00 GMT
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