Publications

We developed a prediction model for the 1-year risk of AF. Application of the model in routine clinical settings is necessary to determine the possibility of predicting AF risk among patients with HF more accurately and if so, to quantify the clinical effects of implementing the model in practice.

Prescribers' compliance to approved indications were high. However, 1/3 of DOAC prescriptions were inconsistent with approved dosing. Dosing deviation was associated with an increase in adverse clinical outcomes.

In patients with coexisting AF and HF, digoxin was associated with significantly higher risks of all-cause mortality, cardiovascular mortality, and heart failure hospitalization compared to beta-blocker.

Hypertension is a significant global health challenge, contributing substantially to morbidity and mortality through its association with various cardiovascular diseases. Traditional approaches to hypertension risk prediction, which rely on broad epidemiological data and common risk factors, often fail to account for individual variability, highlighting the need for advanced data-driven methodologies. This review examines the role of Artificial Intelligence (AI) and Machine Learning (ML) in enhancing the prediction of hypertension risk by incorporating a range of data sources, including clinical, lifestyle, and genetic factors. Despite promising developments, challenges such as data standardisation, the need for high-quality datasets, model explainability, and class imbalance in medical data persist. The integration of wearable technologies, alongside the potential of emerging technologies in healthcare such as digital twins, presents significant opportunities in personalising care through the dynamic modelling of individual health profiles. This review synthesises current methodologies, identifies existing gaps, and highlights the transformative potential of AI-driven, personalised hypertension prevention and management, emphasising the importance of addressing issues of reproducibility and transparency to facilitate clinical adoption.

The importance of integrated care for complex, multiple long term conditions was acknowledged before the COVID pandemic but remained a challenge. The pandemic and consequent development of Long COVID required rapid adaptation of health services to address the population's needs, requiring service redesigns including integrated care. This Delphi consensus study was conducted in the UK and found similar integrated care priorities for Long COVID and complex, multiple long term conditions, provided by 480 patients and health care providers, with an 80% consensus rate. The resultant recommendations were based on more than 1400 responses from survey participants and were supported by patients, health care professionals, and by patient charities. Participants identified the need to allocate resources to: support integrated care, provide access to care and treatments that work, provide diagnostic procedures that support the personalization of treatment in an integrated care environment, and enable structural consultation between primary and specialist care settings including physical and mental health care. Based on the findings we propose a model for delivering integrated care by a multidisciplinary team to people with complex multisystem conditions. These recommendations can inform improvements to integrated care for complex, multiple long term conditions and Long COVID at international level.

The higher risks of AF and IS according to an increment of BMI and WC were most apparent among the young ages. The association between obesity measurements and IS was not significantly above the midlife. Weight management in the young and integrated risk factor management in the elderly are warranted.

Abstract: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and a major risk factor for stroke. The number of patients with AF is predicted to increase in the next few decades. AF has also negative impact on quality of life as well as it significantly increases the risk of cardiovascular disease and overall mortality. Because the stroke is a pivotal outcome of AF, its prevention with the use of anticoagulation therapy constitutes an important component of AF management. The decision on oral anticoagulants' prescription should be based on appropriate risk stratification to allow for comprehensive assessment of benefit/hazard ratio of stroke and bleeding along with patients' preference. Several risk scores for stroke and bleeding as well as for stroke and systemic embolism have been developed, mainly in patients on vitamin K antagonists. AF guidelines stress the need for repetitive evaluation of thromboembolic and bleeding risks to tailor optimal AF management. Indeed, risk is not a static “one off” process and it should be adjusted for dynamic nature of risk factors. However, most risk scores are calculated according to baseline characteristics of patients, but the older the patients get, the more comorbidities they acquire, which influences stroke risk significantly. Hence, the default management of every patient with AF should include a regular reassessment of stroke and bleeding risk factors.

Early recurrence of atrial fibrillation (ERAF) after catheter-ablation (CA) can be a transient phenomenon due to inflammation, or a harbinger of late AF recurrence due to CA lesion (re)conduction. We studied the relationship between ERAF and the 3-month CA lesions integrity. Forty one consecutive AF patients who underwent a pulmonary vein isolation (PVI), roof line (RL) and mitral isthmus line (MIL) CA were enrolled. At 3 months all patients underwent invasive assessment of the lesion set integrity irrespective of ERAF. The PVI, RL and MIL ablation was successful in 100.0%, 95.1% and 82.9% patients, respectively. At the 3-month remapping, a gap in PVI-lesion(s), RL or MIL was identified in 61.0%, 31.7% and 36.6% patients, respectively. Patients with (n = 17, 41.5%) compared to those without ERAF (n = 24) had a significantly higher rate of any PV-reconnection (88.2% vs. 41.7%), the right PV(s)-reconnection (82.5% vs. 29.2%) and the RL gap (52.9% vs. 16.7%), as well as a higher number of reconnected right PVI-segments, all p < 0.05. On multivariate analysis, only the number of reconnected right PVI-segments was associated with ERAF (OR 4.26, p = 0.004). The ERAF following PVI + RL + MIL ablation was significantly related to 3-month PV-reconnections and the presence of RL gaps.

Abstract Background There are uncertainties about diabetes mellitus and the incidences of conduction disturbances regarding their different locations (sinus node disease [SND], atrio-ventricular block located above the His bundle or of infra-Hisian location) and their possible relation to the type of diabetes. We investigated whether diabetes confers higher relative rates of conduction disturbances, and whether this may depend on the type 1 (T1DM) or type 2 (T2DM) of diabetes mellitus. Methods All patients aged ≥18 seen in French hospitals in 2013 with at least 5 years of follow-up were identified and categorized by their diabetes status. A total of 77,499 patients with T1DM (age 60.9±18.3, 52% male) and 506,937 patients with T2DM (age 67.1±14.6, 54% male) were identified. They were matched 1:1 on age and sex with patients with no diabetes and followed over a mean period of 4.3±2.1 years (median 5.3, interquartile 2.8-5.8 years). We calculated incidence rates, incidence rate ratios and adjusted hazard ratios in patients with T1DM and T2DM (compared to age- and sex-matched controls with no diabetes) for the different types of conduction disturbances and for the need of treatment with cardiac implantable electronic device (CIED) such as pacemakers or implantable cardioverter defibrillators (ICD). Hazard ratios were adjusted for comorbidities known or suggested to be directly or indirectly associated with conduction disturbances and for those associated with a high mortality rate and less likely to reach high age with development of conduction disturbances or the need of CIED during follow-up. Results During 3,271,832 million person-years of follow-up, 126,217 patients with new-onset conduction disturbances or CIED implantation were identified. The incidence rates of conduction disturbances were higher in T1DM and T2DM patients than in control patients with no diabetes. This was seen for all-types of conduction disturbances: SND, atrioventricular block, left bundle branch block and right bundle branch block. Treatment with CIEDs were also more frequent in T1DM or T2DM patients than in control patients with no diabetes (see table). The independent associations of T1DM and T2DM with atrioventricular block, right or left bundle branch block and CIED implantation persisted in the multivariable analyses (adjusted HRs ranging from to 1.11 to 1.44, all p&amp;lt;0.0001). Conclusion In this large nationwide study, T1DM and T2DM were both associated with a higher rate of conduction disturbances and CIED implantations compared with age- and sex-matched controls. T1DM and T2DM remained independently associated with AV block after adjustment on comorbidities known to be positively or inversely associated with SND, atrioventricular block or CIED implantation. This also included a higher incidence or left and right bundle branch block, suggesting that the mechanism may not only be related to the influences of the autonomic nervous system or to the use of bradycardic agents.

Low SES was associated with poorer outcomes when AF was present. These findings may imply that health-care professionals and policy interventions should focus on the promotion of AF-education and management among patients with AF and low SES.

When using data reflecting contemporary clinical practice, our observations suggested that 1 year after a diagnosis of AF, anticoagulated patients with aortic or mitral valvular heart disease had dissimilar risk of thromboembolism and major bleeding complications. Specifically, patients with aortic stenosis or mitral stenosis were high-risk subgroups. This observation may guide clinicians regarding intensity of clinical follow-up.