Publications

All patients were informed about the nature and purpose of the study, and the protocol was approved by the Ethics Committee of Hospital General Universitario Morales Meseguer (reference: EST:20/16). This is an observational study focusing on 'real life' practice and therefore all treatments and follow-up will be performed in accordance to the routine clinical practice with no specific interventions or visits. The results of our study will be disseminated by presentations at national and international meetings, and publications in peer-reviewed journals.

<h3>Introduction</h3> Obesity can adversely impact efficacy and safety of AF ablation. NHS England have recently proposed restricting ablation in obese AF patients to those who demonstrate &gt;10% reduction in body weight. The feasibility of this degree of weight reduction in a tertiary NHS AF clinic, and its impact on efficacy and safety of AF ablation has not been reported. <h3>Methods</h3> Consecutive AF patients with BMI&gt;30 seen in an arrhythmia clinic were given advice to follow the 5:2 diet while on the waiting list for AF ablation. The diet involved calorie restriction to &lt;600kCal/ day for 2 days a week, with no restrictions on the other 5 days. Patients were asked to maintain a daily weight diary. The outcomes assessed were weight loss achieved, and the recurrence of AF or atrial tachycardia following ablation. <h3>Results</h3> 58 patients (mean age was 65.2 [±9.7] years, 50% males, 64% persistent AF) with a mean baseline weight of 109.1 (±16.8) kgs, BMI of 36.7 (±4.1) were prescribed the 5:2 diet. Following a median of 5.3 (IQR 1.7-15.1) months, a mean weight loss of 8.1 (±7.5) kg was observed prior to AF ablation, p&lt;0.001 compared to baseline. Weight loss of &gt;10%, 3-10% and &lt;3% was observed in 16 (27.6%), 26 (44.8%), and 16 (27.6%) patients respectively, with weight loss of 17.9± 5.4 kgs, 6.8 ± 1.9 kgs, and 0.4 ± 2.8 kgs (P&lt;0.001). Two procedural complications (pulmonary oedema) occurred in the entire cohort - both in group 3 (P=0.15). Over a mean follow up period of 17.3 (±13.7) months, 38/58 (65.3%) were free of AF/AT recurrence; no differences were observed between the groups, p=0.095 (Figure 1). <h3>Conclusions</h3> Weight loss of &gt;3% body weight can be achieved in the majority of patients seen in a tertiary AF clinic with a simple dietary advice, although weight reduction of greater than 10% is seen in only a minority. Modern AF ablation practice results in encouraging procedural safety as well as medium-term arrhythmia free survival rates in this traditionally difficult population, with no influence observed in our cohort of significant weight reduction. Whether this is because of advanced arrhythmia substrate by the time patients are referred for ablation is unclear. <h3>Conflict of Interest</h3> None

Data suggest that coronavirus disease 2019 (COVID-19) results in a prothrombotic state leading to arterial and venous thromboses. Vaccination, novel antiviral drugs, and emerging variants have changed the course of the disease in many ways; however, their effects on the incidence of thrombotic events and the efficacy of preventative antithrombotic agents have not been yet evaluated. A systematic search was conducted to identify studies reported on the incidence of thrombotic events based on vaccination status, use of novel antiviral drugs, and emerging viral variants. Similarly, we screened the ongoing/published randomized trials of preventative antithrombotic therapy in any COVID-19 population to assess whether subgroup-specific results were reported based on any of these variants. Upon searching a total of 3,451 records, only one entry fulfilled the inclusion criteria of our systematic review, which was a self-controlled case series on 29,121,633 vaccinated individuals, the incidence rate ratio of thrombotic complication after breakthrough infection was 13.86 (95% confidence interval [CI]: 12.76-15.05) compared with 1.10 (95% CI: 1.02-1.18) during the 28-day postvaccination. In conclusion, although the mortality benefit of mass vaccination and the early promising results of the new antiviral therapies are well known, we were unable to find clinical evidence on whether vaccination, the use of novel antiviral agents, and emerging viral variants have affected the incidence rate of thrombotic events or impacted the efficacy of prophylactic antithrombotic therapy in patients with COVID-19. Analyses from existing trials and large-scale registries can provide interim knowledge and any findings of relevance should be incorporated in the design of future trials.

AF was significantly associated with higher risks of stroke and mortality. TET2 mutation and increased IL-1β were independent risk factors of AF in patients with JAK2^V617F-positive MPN.

Patients with AF who have bleeding events have an increased risk for subsequent death and stroke and systemic embolism. These patients should be identified as vulnerable clinically complex patients and require a holistic approach to their AF management.

Abstract Objective The objective of this systematic review and meta-analysis was to assess sarcopenia and its components as prognostic factors in patients with heart failure (HF). Methods From inception to December 2022, a systematic literature search was carried out utilizing PubMed, Web of Science, Scopus, and Cochrane Library databases. A meta-analysis employing a random-effects model was performed to assess the pooled effects. Results The systematic review and meta-analysis included 32 and 18 longitudinal studies, respectively. The prediction of 1- to 2-year all-cause mortality in sarcopenia was not statistically significant (hazard ratio (HR): 1.35, 95% CI 0.76–2.38, I 2 = 54%, P = 0.31). The lowest combined quartile and quantile of the population were used to define low handgrip strength that showed identical results (HR: 1.24, 95% CI 0.94–1.62, I 2 = 0%, P = 0.13). Low L3-L4 psoas muscle mass (HR: 2.20, 95% CI 1.26–3.83, I 2 = 87%, P &lt; 0.01) and slow gait speed (HR: 1.45, 95% CI 1.20–1.74, I 2 = 0%, P &lt; 0.01) were significant contributors to all-cause mortality risk. Additionally, a 0.1 m/s increase in gait speed demonstrated a significant reduction of all-cause mortality (HR: 0.77, 95% CI 0.66–0.90, I2 = 60%, P &lt; 0.01). Our narrative synthesis also described appendicular lean mass (ALM) and short physical performance battery (SPPB) scores as significant prognostic factors. Conclusions Compared to patients with higher overall functional performance, those with HF and low ALM, low psoas muscle mass, low SPPB, and slow gait speed are at an increased risk of all-cause mortality. Early prevention and/or treatment of lower limb physical function deterioration may be an essential strategy to reduce the risk of premature death in HF. Graphical abstract

In this cohort of Asian patients with first-ever ischaemic stroke, optimal management according to the ABC_stroke pathway was associated with a reduction in the risk of adverse outcomes.

Atrial fibrillation (AF) is the most common arrhythmia conferring a fivefold increased risk of stroke. Stroke prevention is the cornerstone of management of patients with AF. Asians have a generally higher incidence of AF-related risks of stroke and bleeding (particularly intracranial bleeding), compared with non-Asians. Despite the well-documented efficacy and relative safety of oral anticoagulation for stroke prevention among Asians, the suboptimal use of oral anticoagulation remains common. The current narrative review aims to provide a summary of the available evidence on stroke prevention among patients with AF focused on the Asia region, regarding stroke and bleeding risk evaluation, the performance of oral anticoagulation, and current use of thromboprophylaxis.

Both prehospital stroke scales and ML models demonstrated varying accuracies in predicting LVO. Despite ML potential for improved LVO detection in the prehospital setting, application remains limited by the absence of prospective external validation, limited sample sizes, and lack of real-world performance data in a prehospital setting.

Although the projected decline in age-standardized DALYs of modifiable cardiovascular risk factors suggest improved management of CVDs, crude DALYs will continue to rise due to population growth and aging.

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Abstract Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia that affects 60 million people worldwide. Limited evidence on AF management exists from low- and middle-income countries and none from Sri Lanka. We aimed to investigate the existing AF care pathway and patients’ perception on AF management to identify barriers and enablers for optimal AF care in Northern Province, Sri Lanka. Methods: A rapid evaluation was undertaken with use of qualitative methods. Local healthcare providers (HCPs) mapped the intended pathway of care for AF patients which was then explored and annotated through 12 iterative sessions with additional HCPs. Topics of inefficiencies identified from the finalised map were used to guide focus group discussions (FGDs) with AF patients. AF patients who were attending the anticoagulation clinic at the only tertiary hospital in Northern Province were recruited and invited to participate using purposive sampling. The topic guide was developed in collaboration with local clinicians and qualitative experts. FGDs were conducted in the native Tamil language and all sessions were recorded, transcribed verbatim and thematically analysed using a deductive approach. Results: The mapped pathway revealed inefficiencies in referral, diagnosis and ongoing management. These were explored through three FGDs conducted with 25 AF patients aged 25 to 70 years. Two key themes that contributed to and resulted in delays in accessing care and ongoing management were health seeking behaviours and atomistic healthcare structures. Four cross-cutting sub-themes identified were decision making, paternalistic approach to care, cost impacts and lifestyle impacts. These are discussed across 10 unique categories with consideration of the local context. Conclusions: Strengthening primary healthcare services, improving public health literacy regarding AF and building patient autonomy whilst understanding the importance of their daily life and family involvement may be advantageous in tackling the inefficiencies in the current AF care pathway in Sri Lanka.