Publications

Compared to PCI, exercise-based CR associated with significantly lower odds of 18-month all-cause mortality, rehospitalization, and cardiovascular morbidity in patients with CCS, whilst combining PCI and exercise-based CR associated with lower incident heart failure only.

Among patients undergoing TAVI, those with amyloidosis are at a higher risk of adverse events, particularly HF, and have an increased risk of pacemaker implantation and stroke in the long-term.

Abstract Background and Aims The OPTIMAS trial showed that early initiation of direct oral anticoagulant (DOAC) after acute ischaemic stroke (IS) related to atrial fibrillation is non-inferior to delayed initiation. Patients with chronic kidney disease (CKD) are at increased risk of IS and intracerebral haemorrhage, so the safety and efficacy of early DOAC in those with CKD is of interest. Method OPTIMAS was a randomised, parallel-group, open-label trial with blinded outcome assessment. Participants were randomised 1:1 to early (within 4 days of onset) or delayed (at day 7–14) DOAC initiation. The primary outcome was a composite outcome of recurrent IS, symptomatic intracranial haemorrhage (sICH) and systemic arterial embolism. Secondary outcomes included the individual components of the primary outcome and all-cause mortality. CKD was defined as a history of known CKD and collected systematically. We fitted mixed effects logistic regression models with interaction terms between CKD and treatment group. Results We included 3601 patients (mean age 78.0 ± 9.9 years, 45.3% female), 543 with CKD. For the primary outcome, there was no difference between early and delayed DOAC initiation in either the normal kidney function group (OR 1.01, 95% CI 0.67 to 1.51), or the CKD group (OR 0.90, 95% CI 0.36 to 2.25), interaction P = 0.822. Similarly, for the secondary outcomes we detected no modification of the treatment effect according to CKD (interaction p-values 0.637, 0.386 and 0.107 for IS, sICH and all-cause mortality respectively). Conclusion Compared to delayed initiation of DOAC, we found no evidence of increased efficacy nor risk of harm from early DOAC initiation after acute ischaemic stroke for those with AF and CKD. OPTIMAS is registered with ClinicalTrials.gov (NCT03759938) and funded by the British Heart Foundation.

New cardiac-related hospital readmissions within 30 days after ischemic stroke occur in 2.4% of patients, with elective admission and cancer being a strong predictor of readmissions.

<h3>Background &amp; Aim</h3> Large curated datasets of clinical echocardiographic measurements with associated interpretation are scarce. Due to standardised echocardiographic protocols and diverse patient populations, the UK offers a unique opportunity to link echocardiographic data to study patient outcomes through nationwide records of primary care visits, hospitalisations, and mortality. <h3>Our aims were to</h3> 1) Develop a toolkit for the extraction and anonymisation of clinical echocardiographic data and 2) Implement the toolkit in the first NHS Trust to demonstrate feasibility. <h3>Methods</h3> The data were collected under the ‘EchoVision’ project – an expanding resource of echocardiographic data (UK HRA approval 251473). Customisation of database queries were undertaken by Philips (Koninklijke Philips N.V, Netherlands) staff with input from the first author. Data (measurements, standardised interpretive phrases and free-text comments) from consecutive clinical echocardiograms, undertaken at an NHS Trust and reported upon within Philips Intellispace Cardiovascular system, were extracted using the built-in ‘Advanced Analytics’ functionality in date-ranged portions using the customised queries. Individual extract files (.csv) were formatted in Microsoft Excel using a ‘Visual Basic for Applications’ script to get a rectangular dataset, before being merged and processed in RStudio (v2023.09.1) using R (v4.2.1). Scans from patients with an age &lt;18 years or missing age were excluded. After creating the unique study identifier for each scan via a one-way hash function (https://www.quickhash-gui.org/), protected health information was removed. Subsequently, the data were transferred to the research team, and stored on secure severs with password protected access by the study research staff. <h3>Results</h3> Standard operating procedures and training materials were written for the use of Philips software and for data anonymisation (the ‘toolkit’). Data from n=19100 echocardiograms performed in 2022 were extracted, with n=291 exclusions leaving n=18809 scans. The median age was 68 [interquartile range 26] years – the age distribution is shown in figure 1. Female patients comprised n=8324 scans (44.3%), males n=10108 (53.7%) and n=377 (2.0%) had their sex unrecorded. ‘Transthoracic’ scan type represented n=18475 (98.2%), with the remainder being transoesophageal (n=190), stress (n=82), bubble (n=58), and intracardiac (n=4). The number of echocardiograms performed per month varied from n=1314 in April to n=1841 in November (figure 2). <h3>Conclusions</h3> The NED-UK pilot study demonstrates the ability to develop a functional toolkit for the extraction and anonymisation of clinical echocardiographic report data and the feasibility of large-scale extraction of echocardiographic data. Future aims should be focused on expanding NED-UK to become a multi-site multi-vendor resource for clinical research with the potential for predicting cardiovascular risk across diverse patient populations. <h3>Conflict of Interest</h3> None

Introduction: Atrioventricular node (AVN) ablation after pacemaker implantation is a rate control option for patients with symptomatic atrial fibrillation (AF) when rhythm control with anti-arrhythmic drug therapy and/or ablation with pulmonary vein i

Gestational complications are associated with worse long-term cardiovascular outcomes. There is a clear call to action required to improve the longitudinal management of gestational complications to improve women's long-term health.

Abstract Background We examined the associations between family income and educational attainment with incident atrial fibrillation (AF), myocardial infarction (MI), stroke and cardiovascular (CV) death among patients with newly‐diagnosed heart failure (HF). Methods In a nationwide Danish registry of HF patients diagnosed between 2008 and 2018, we established a cohort for each outcome. When examining AF, MI and stroke, respectively, patients with a history of these outcomes at diagnosis of HF were excluded. We used cause‐specific proportional hazard models to estimate hazard ratios for tertile groups of family income and three levels of educational attainment. Results Among 27,947 AF‐free patients, we found no association between income or education and incident AF. Among 27,309 MI‐free patients, we found that lower income (hazard ratio 1.28 [95% CI 1.11–1.48] and 1.11 [0.96–1.28] for lower and medium vs. higher income) and education (1.23 [1.04–1.45] and 1.15 [0.97–1.36] for lower and medium vs. higher education) were associated with MI. Among 36,801 stroke‐free patients, lower income was associated with stroke (1.38 [1.23–1.56] and 1.27 [1.12–1.44] for lower and medium vs. higher income) but not education. Lower income (1.56 [1.46–1.67] and 1.32 [1.23–1.42] for lower and medium vs. higher income) and education (1.20 [1.11–1.29] and 1.07 [0.99–1.15] for lower and medium vs. higher education) were associated with CV death. Conclusions In patients with newly‐diagnosed HF, lower family income was associated with higher rates of acute MI, stroke and cardiovascular death. Lower educational attainment was associated with higher rates of acute MI and cardiovascular death. There was no evidence of associations between income and education with incident AF.

Abstract Background Stroke prevention is central to the management of patients with atrial fibrillation (AF) but the impact of NOACs on stroke severity from a nationwide perspective, and the impact of changes in antithrombotic regimen following an ischaemic stroke on subsequent clinical events is unceratin. The aims of the present study were as follows: (i) to describe the temporal trends in OAC use between 2012-2018, and the relationship to stroke severity at presentation; (ii) to describe antithrombotic therapy prescribing patterns following an ischaemic stroke, and the impact of post-stroke thromboprophylaxis on outcomes; and (iii) to assess the impact of changing OAC strategy in AF patients on a NOAC presenting with an ischaemic stroke. Methods From 2007 to 2018, a total of 63,365 patients were identified from the “National Health Insurance Research Database (NHIRD)” in Taiwan. The stroke prevention strategy before and after ischemic stroke and its association to stroke severity was analysed. Subsequent clinical events after ischaemic stroke included recurrent ischaemic stroke, intracranial haemorrhage (ICH), major bleeding, all-cause mortality and composite outcomes. Results The temporal trend disclosed that the overall OAC prescription rate was rising, with warfarin used declining and NOACs use increasing, which was associated with a gradual decline of moderate-severe and severe strokes. The post-stroke antithrombotic strategy was variable. Compared to NOACs post-stroke, there was a significant increase in ischaemic stroke and mortality in non-anticoagulated (adjusted hazard ratios [aHRs] 1.804 and 3.441, respectively) and antiplatelet users (aHRs 1.785 and 1.483, respectively). Warfarin use post-stroke was associated with a significantly incresaed risk of major bleeding compared to NOACs (aHR 2.839). Non-anticoagulated and antiplatelet users were associated with higher risks of both composite outcomes compared to NOAC. Among 769 patients who received NOACs before stroke and continued NOAC post-stroke, there was a higher risk of ischaemic stroke and composite outcomes with no difference in major bleeding, mortality or ICH if patients were changed to a different NOAC post-stroke. Conclusions In this nationwide cohort study, increasing use of NOACs was associated with a decline of moderate-severe and severe strokes. Compared to NOACs, non-anticoagulation and antiplatelet use were associated with a significant increase in ischaemic stroke, mortality, and the composite outcome with no significant differences in bleeding events. There was no significant difference of ischemic stroke, mortaltiy, and ICH between post-stroke warfarin and NOAC use but warfarin was associated with a significantly increased risk of major bleeding. A change of NOAC types after ischemic stroke was associated with a two-fold higher risk of ischaemic stroke and the composite outcomes.

The blood level of lipids, apolipoproteins, and lipid ratios are important predictors of some chronic diseases. However, their association with cardiometabolic multimorbidity (CMM) is less known. We evaluated a wide range of lipid profiles and lipid ratios, including low-density lipoprotein-cholesterol (LDL-C), very-low-density lipoprotein-cholesterol (VLDL-C), high-density lipoprotein-cholesterol (HDL-C), and apoA1 and B, as well triglyceride and total cholesterol with risk of incident CMM. In 1728 men aged 52.5 ± 5.2 years from the Kuopio Ischaemic Heart Disease were included in this study. We defined CMM as coexisting of two or more of stroke, type 2 diabetes mellitus (T2D), coronary heart disease (CHD). A Cox proportional hazard regression method was applied to evaluate the risk of CMM against the exposures. During the mean follow-up of 22.4 years, 335 men suffered from CMM conditions. Higher serum triglyceride and VLDL concentrations were associated with a higher risk of coexisting T2D-CHD (HRs 1.99 (95% CI, 1.12-3.53) and HRs 1.79 (95% CI, 1.04-3.11), respectively. Whereas higher HDL was associated with lower incident [HRs 0.49 (95% CI, 0.40-1.00)]. The HRs for coexisting T2D-CHD was 2.02 (95% CI, 1.01-3.07) for total cholesterol/HDL-C, 1.85 (95% CI, 1.04-3.29) for triglyceride/HDL-C, 1.69 (95% CI, 1.01-2.31) for Non-HDL-C/HDL-C, and 1.89 (95% CI, 1.03-2.46) for apoB/apoA1. In contrast, serum LDL-C/apoB ratios were inversely associated with the risk of coexisting T2D-CHD [HRs 0.50 (95% CI, 0.28-0.90)]. No associations were observed between our exposures and other CMM conditions. In conclusion, elevated triglyceride, VLDL-C, total cholesterol/HDL-C, TG/HDL-C, apoB/apoA1 as well as lower LDL-C/apoB were independently associated with the higher risk of T2D-CHD coexistence.

In patients with CHA2DS2-VASc score 2, OAC was used in 81% including 68% with NOAC. In patient with CHA2DS2-VASc score = 1, OAC was used in 53% including 19% with NOAC. Variables associated with NOAC treatment were high CHA2D2-VASc score (OR 2.33; CI 95% 2.10-2.59), history of hypertension (OR=3.73; CI 95% 3.03-4.60), malignancy (OR=1.60; CI 95% 1.18-2.17), major bleeding (OR= 23.36; CI 95% 3.51-155.66), and minor bleeding (OR=7.39; CI 95% 1.08-50.77). Variable associated with warfarin treatment were female, high HAS-BLED score, diabetes mellitus, heart failure, cardioversion, CKD, ESRD.