Publications

INTRODUCTION: Heart failure (HF) with reduced ejection fraction (HFrEF) has been defined by varying ejection fraction (EF) criteria in clinical trials, leading to differences in quantifying treatment effects. AREAS COVERED: The definitions of HFrEF in randomized controlled trials from 2010 until 2020 were collected. The EF ranges were clustered into very low (<30%), low (30-39%) and mildly reduced (40-49%) stratified by intervention. A time series regression analysis was performed. A total of 3052 articles were screened and 706 were included. Interventions included were pharmacologic (37%), device therapy (10%), and a combination of programs, procedural, and laboratory testing (53%). Regarding EF cutoffs, 41% of the studies utilized <40% while 26% used <35%. About 31% did not have a clearly defined EF. Between 2010 and 2020, studies with HFrEF ranges 30-39% have significantly decreased (p value < 0.001 for trend), but those which included very low EF (<30%) and mildly reduced EF (40-49%) have remained the same. EXPERT OPINION: EF definitions across clinical trials in HFrEF varied widely. Defining the specific target HF population phenotype when designing trials or in patient treatment is important as various beneficial effects of different heart failure treatment modalities can be modified or even attenuated across the spectrum of EF.

Introduction: Obesity has been linked to atrial fibrillation (AF) burden and severity, and epidemiological studies suggest that AF is more prevalent in whites than Asian or Afro-Caribbean populations. We aimed to investigate whether obesity mediates associations with AF in Europe and Asia using patient-level data comparisons of two cohort studies. Hypothesis: We therefore hypothesized that the difference in the distribution of BMI and WC can partially explain the ethnic differences in AF incidence Methods: Using Korean National Health Insurance Service’s Health Screening (NHIS-HealS) and U.K. Biobank data, we included 401,206 Korean and 477,926 British aged 40-70 years without previous AF who received check-ups. The incidence and risk of AF were evaluated regarding different body mass index (BMI) values. Results: The obese proportion(BMI ≥ 30.0 kg/m 2 , 2.8% vs. 24.3%, P &lt; 0.001) was higher in the U.K. than the Korean. In the Korean and U.K. cohort, the age- and sex-adjusted incidence rates of AF were 3.52 and 3.95 per 1,000 person-years among overweight individuals (BMI, 25 to &lt;30 kg/m 2 ), and 4.97 and 6.54 per 1,000 person-years among obese individuals, respectively. Compared to Koreans, the risk of AF was higher in the British population, with adjusted hazard ratios of 1.11 (95% confidence interval [CI], 1.04-1.19) and 1.16 (95% CI, 1.11-1.22) in overweight participants and 1.69 (95% CI, 1.57-1.83) and 1.45 (95% CI, 1.30-1.62) in obese participants, respectively ( P for interaction &lt; 0.05). Conclusions: Obesity was associated with AF in both populations. British subjects had a greater incidence of AF related to the high proportion of obese individuals, but the risk of AF was also increased when separating participants into overweight and obese categories.

Newly diagnosed cardiovascular complications following ICH (i.e. stroke-heart syndrome) were common and associated with a significantly worsened 5-year prognosis.

These findings may aid physicians and patients in making informed decisions when considering a switch between apixaban and rivaroxaban.

The burden of CCD in patients with T1DM is substantial and significantly associated with increased hospital mortality and high healthcare expenditures.

<b>Objective</b> Anticoagulation management in patients with atrial fibrillation (AF) and impaired renal function is challenging. This study aimed to evaluate anticoagulation prescription patterns in relation to renal function and to describe 2-year clinical outcomes among dabigatran users. <b>Methods</b> Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF) is an international, prospective, and observational study program involving patients with newly diagnosed AF at risk for stroke. Prescription patterns were assessed by creatinine clearance (CrCl) at enrollment. Dabigatran users were followed for 2 years. Clinical outcomes were standardized for stroke and bleeding risk, based on CHA ₂ DS ₂ -VASc and HAS-BLED scores, with missing values imputed. <b>Results</b> Baseline CrCl values were available for 12,056 of 15,308 eligible patients (79%). With declining renal function, prescriptions increased for vitamin K antagonists (VKAs) and decreased for dabigatran (30-47% and 34-12%, respectively). The prescription of other non-vitamin K antagonists remained similar across CrCl groups (14-19%). In 4,873 dabigatran users, standardized stroke rates were low across all CrCl groups; 0.58/100 patient-years (95% confidence interval [CI]: 0.30-0.90) in CrCl ≥80 mL/min, 0.85 (95% CI: 0.48-1.21) in CrCl 50 to 79 mL/min, and 0.33 (95% CI: 0.06-1.11) in CrCl 30 to 49 mL/min. Similarly, major bleeding rates were low and numerically increased with declining renal function (0.68/100 patient-years, 95% CI: 0.39-1.03; 0.92, 95% CI: 0.58-1.32; and 1.26, 95% CI: 0.66-1.97, respectively). <b>Conclusion</b> In patients with AF, VKA prescriptions increased and dabigatran prescriptions decreased with declining renal function. Rates of stroke and major bleeding in dabigatran patients remained low across the categories of renal impairment.

The patients are the first to be informed of the rhythm anomaly, leading to the urgency of increasing the patients' AF self-management. Furthermore, HCPs need to update themselves about mHealth devices use in clinical practice. Nevertheless, these are promising instruments in specific populations, such as post-stroke patients, to promote an early arrhythmia diagnosis in the post-ablation/cardioversion period, allowing checks on the efficacy of the treatment or intervention.

Coronavirus disease 2019 (COVID-19) is associated with mortality risk in heart failure (HF) patients.1 In order to curb the spread of the virus, the UK government announced a national lockdown in March 2020. Whilst there is data2-6 regarding the prognosis of HF patients hospitalised with COVID-19, the impact of lockdown upon in incidence of hospitalisation, is unknown. Our single centre, retrospective observational study was undertaken in a British university hospital to analyse the effect of lockdown upon COVID-19 hospitalisations amongst HF patients and the predictors of risk. We collated data regarding co-morbidities (Charlson Co-morbidity Index- CCI),7 the Rockwood clinical frailty score (CFS), clinical features, blood results, HF treatments and 30-day mortality. We identified 1097 HF patients from our existing HF registry with HF hospitalisation in 2018 and 2019. Fifty out of 801 (6.2%) surviving HF patients required hospitalisation because of COVID-19 from March to November 2020 (COVID group); 24 patients (3.1%) during the first lockdown (March-June 2020) and 26 (3.5%) in the post-lockdown period (July-November 2020); P = .7. In comparison to patients not hospitalised with COVID-19 (no-COVID group), the COVID group had a significantly higher prevalence of co-morbidities (Table 1) – hypertension (P < .001), diabetes (P = .005), ischaemic heart disease (P = .01) and increased body mass index (P = .04). This data is in line with other studies.1, 4, 8, 9 CCI was also significantly higher in the COVID group (6.5 ± 1.5 vs no-COVID group 5.7 ± 1; P < .001). The COVID group was frailer (Rockwood CFS in COVID group 6.5 ± 1.5 vs. 6.1 ± 1.1 in no-COVID group; P = .02). HF patients hospitalised with COVID had a longer hospital stay than for HF (median 14.5 days vs 8 days; P < .001) and 30-day mortality was 52%. 15.6 (±14.8) Median 14.5 (3-57) 8.6 8 (1-43) Table 2 illustrates mortality predictors. Whilst the incidence of diabetes, hypertension and frailty was significantly higher amongst the group that died within 30 days, multivariate regression analysis demonstrated that only diabetes (OR 3.82;95% CI 1.13 to 12.95; P = .03) and Rockwood Frailty Score ≥6 (OR 6.5306; 95% CI: 1.8958 to 22.4961; P = .003), were independent predictors of mortality. Our study showed a similar incidence of COVID-19 hospitalisation pre- and post-lockdown amongst HF patients. This is the first study of its kind and demonstrates some important results. Mainly that the incidence of HF COVID-19 hospitalisation was 3.1%, this was similar to the overall incidence during the first wave in England (3.5%).10 It can only be surmised that HF patients have been taking adequate shielding precautions in view of media reports of higher risk of complications amongst patients with cardiovascular co-morbidities. It is also possible that the anxiety felt by HF patients and their reluctance to attend hospital may also have resulted in reduced hospitalisations because of COVID-19.11 30-day mortality because of COVID-19 hospitalisation was high (54%) in our HF cohort, comparable to other studies.4, 8, 9 Study limitations include the single centre, retrospective observational design and relatively small number of COVID-19 hospitalisations in this cohort. In conclusion, our data suggest that lockdown did not seemingly affect the incidence of amongst patients from our HF registry. Co-morbidity and frailty scores should be incorporated during the initial clinical assessment to aid risk prediction for 30-day mortality. The authors declared no conflict of interest. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Abstract Background Remnant cholesterol (RC) have been suggested as a significant mediator of atherosclerotic cardiovascular diseases. However, the relationship between RC with cause-specific mortality in long-term remained uncertain. This study aimed to investigate the association between time-weighted RC and cause-specific mortality outcomes. Methods This retrospective population-based study enrolled patients attending family medicine clinics in Hong Kong between 1 st January 2000, to 31 st December 2003 with at least three RC testing results during follow-up. The time-weighted RC was calculated by the products of the sums of two consecutive measurements and the time interval divided by the total time. The primary outcomes were all-cause mortality and cause-specific mortality outcomes. Cox regression and marginal effective plots were applied to identify associations between time-weighted RC and mortality. Results A cohort of 75,342 patients (39.69% males, mean age: 61.3 years old) with at least three valid RC test were included. During up to 19 years of follow-up, in the multivariate model adjusted for demographics, comorbidities, medications, and time-weighted laboratory results, time-weighted RC was associated with all-cause mortality (Hazard ratio [HR]: 1.41; 95% Confidence Interval [CI]: 1.35-1.48) but not RC (HR: 0.99; 95% CI: 0.89-1.10). Time-weighted RC was also associated with increased risks of cardiovascular-related mortality (HR: 1.40; 95% CI: 1.27-1.54), cancer-related mortality (HR: 1.59; 95% CI: 1.43-1.77), and respiratory-related mortality (HR: 1.33; 95% CI: 1.20-1.47). The exploratory analysis of the cause of death demonstrated that time-weighted RC was associated with Ischaemic heart disease, cerebrovascular-related and pneumonia. Conclusions Time-weighted RC was independently associated with all-cause mortality and cause-specific mortality outcomes amongst the general population.

Exercise-based cardiac rehabilitation prescribed for people following a stroke associated with significantly lower odds of major adverse cardiovascular events at 2 years, compared to usual care.

In a European AF patients' cohort, a pure rate control strategy was associated with a higher risk for adverse events at 1-year follow-up, and partially adjusted analysis suggested that rate control independently increased the risk for all-cause death. A fully adjusted propensity score matched analysis found that this association was no longer statistically significant, suggesting an important role of comorbidities in determining the higher risk for all-cause death.

The COOL-AF risk scores may be an easy tool to identify Asian patients with AF at risk for death and major bleeding and performs better in Asian than in European patients with AF. (Clinical Survey on the Stroke Prevention in Atrial Fibrillation in Asia [AF-Registry]; NCT04807049).

A small number of clinical variables identify a subset of patients with HF-PEF, but without AF, at elevated risk of stroke.

Premature cardiac aging is evident in SAs and may contribute to high cardiovascular morbidity in this ethnic group, compared to ACs.