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Showing 161–180 of 2058 publications.
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Vettori, Laura; Tran, Hien A.; Mahmodi, Hadi; Filipe, Elysse C.; Wyllie, Kaitlin; Liu Chung Ming, Clara; Cox, Thomas R.; Tipper, Joanne L.; Kabakova, Irina V.; Rnjak-Kovacina, Jelena; Gentile, CarmineSilk fibroin (SF) is a natural protein extracted from Bombyx mori silkworm thread. From its common use in the textile industry, it emerged as a biomaterial with promising biochemical and mechanical properties for applications in the field of tissue engineering and regenerative medicine. In this study, we evaluate for the first time the effects of SF on cardiac bioink formulations containing cardiac spheroids (CSs). First, we evaluate if the SF addition plays a role in the structural and elastic properties of hydrogels containing alginate (Alg) and gelatin (Gel). Then, we test the printability and durability of bioprinted SF-containing hydrogels. Finally, we evaluate whether the addition of SF controls cell viability and function of CSs in Alg-Gel hydrogels. Our findings show that the addition of 1% (w/v) SF to Alg-Gel hydrogels makes them more elastic without affecting cell viability. However, fractional shortening (FS%) of CSs in SF-Alg-Gel hydrogels increases without affecting their contraction frequency, suggesting an improvement in contractile function in the 3D cultures. Altogether, our findings support a promising pathway to bioengineer bioinks containing SF for cardiac applications, with the ability to control mechanical and cellular features in cardiac bioinks. 2024 The Author(s). Published by IOP Publishing Ltd.
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Reid, Michael Anthony[No abstract available]
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White, Liam; Kirwan, Morwenna; Christie, Vita; Hurst, Lauren; Gwynne, Kylie G.This systematic review and meta-analysis evaluated the combined effects of clinician-led and community-based group exercise interventions on a range of health outcomes in adults with type 2 diabetes mellitus. Our literature search spanned Medline, Scopus, PubMed, Embase, and CINAHL databases, focusing on peer-reviewed studies published between January 2003 and January 2023. We included studies involving participants aged 18 years and older and articles published in English, resulting in a dataset of eight studies with 938 participants. Spanning eight peer-reviewed studies with 938 participants, the analysis focused on the interventions impact on glycemic control, physical fitness, and anthropometric and hematological measurements. Outcomes related to physical fitness, assessed through the six-minute walk test, the 30 s sit-to-stand test, and the chair sit-and-reach test, were extracted from five studies, all of which reported improvements. Anthropometric outcomes from seven studies highlighted positive changes in waist circumference and diastolic blood pressure; however, measures such as body mass index, systolic blood pressure, weight, and resting heart rate did not exhibit significant changes. Hematological outcomes, reviewed in four studies, showed significant improvements in fasting blood glucose, triglycerides, and total cholesterol, with glycemic control evidenced by reductions in HbA1c levels, yet LDL and HDL cholesterol levels remained unaffected. Ten of the fifteen outcome measures assessed showed significant enhancement, indicating that the intervention strategies implemented may offer substantial health benefits for managing key type 2 diabetes mellitus-related health parameters. These findings in combination with further research, could inform the refinement of physical activity guidelines for individuals with type 2 diabetes mellitus, advocating for supervised group exercise in community settings. 2024 by the authors.
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Krskova, Hana; Baumann, Chris; Breyer, Yvonne AlexandraPurpose: This research seeks to extend previous research into student discipline and competitiveness, at the macro or national level, to the micro or individual level. The role of factors with the potential to impact individual competitiveness, namely the expectations of the mother and the father, the importance of school discipline played in primary and secondary schools, and past participation in sport and music were examined. Design/methodology/approach: Data from a sample of current university students and recent graduates representing Western (the United States) and Asian regions (South Korea and China) were analysed using multiple regressions to establish the explanatory power of independent variables in the competitiveness model, including testing for moderation effects of country of birth. Results: The study found that personal discipline is significantly associated with individual competitiveness. The importance placed on discipline in primary schools was found to predict individual competitiveness as were parents expectations, yet with nuances in terms of maternal and paternal expectations. Surprisingly, neither participation in music nor discipline at secondary school was found to significantly associate with individual competitiveness. At the same time, the study did find moderating effects of country of birth and the number of years students played sport in predicting competitiveness. Originality/value: Guided by the Ecological Systems Theory and the notion of the Pygmalion effect, we develop a framework of factors that shape an individual's competitiveness. The results make several theoretical contributions by establishing new drivers of individual competitiveness, and as such illuminating the importance of discipline during schooling and how parental expectations drive performance. Implications for employers, educational institutions, and parents are outlined and directions for further research are offered. 2024 The Authors
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Savarese, Gianluigi; Lindberg, Felix; Christodorescu, Ruxandra Maria; Ferrini, Marc; Kler, Thomas; Toutoutzas, Konstantinos; Dattilo, G.; Bay-Gen, Antoni; Moura, Brenda; Amir, Offer; Petrie, Mark Colquhoun; Seferovic, Petar M.; Chioncel, O. Dragomir; Metra, Marco; Coats, Andrew J.S.; Rosano, Giuseppe Massimo ClaudioAims: Recent guidelines recommend four core drug classes (reninangiotensin system inhibitor/angiotensin receptorneprilysin inhibitor [RASi/ARNi], beta-blocker, mineralocorticoid receptor antagonist [MRA], and sodiumglucose cotransporter 2 inhibitor [SGLT2i]) for the pharmacological management of heart failure (HF) with reduced ejection fraction (HFrEF). We assessed physicians' perceived (i) comfort with implementing the recent HFrEF guideline recommendations; (ii) status of guideline-directed medical therapy (GDMT) implementation; (iii) use of different GDMT sequencing strategies; and (iv) barriers and strategies for achieving implementation. Methods and results: A 26-question survey was disseminated via bulletin, e-mail and social channels directed to physicians with an interest in HF. Of 432 respondents representing 91 countries, 36% were female, 52% were aged <50 years, and 90% mainly practiced in cardiology (30% HF). Overall comfort with implementing quadruple therapy was high (87%). Only 12% estimated that >90% of patients with HFrEF without contraindications received quadruple therapy. The time required to initiate quadruple therapy was estimated at 12 weeks by 34% of respondents, 1 month by 36%, 3 months by 24%, and ?6 months by 6%. The average respondent favoured traditional drug sequencing strategies (RASi/ARNi with/followed by beta-blocker, and then MRA with/followed by SGLT2i) over simultaneous initiation or SGLT2i-first sequences. The most frequently perceived clinical barriers to implementation were hypotension (70%), creatinine increase (47%), hyperkalaemia (45%) and patient adherence (42%). Conclusions: Although comfort with implementing all four core drug classes in patients with HFrEF was high among physicians, a majority estimated implementation of GDMT in HFrEF to be low. We identified several important perceived clinical and non-clinical barriers that can be targeted to improve implementation. 2024 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Savarese, Gianluigi; Lindberg, Felix; Cannata, Antonio; Chioncel, O. Dragomir; Stolfo, Davide; Musella, Francesca; Tomasoni, Daniela; Abdelhamid, Magdy A.; Banerjee, Debasish; Bay-Gen, Antoni; Berthelot, Emmanuelle; Braunschweig, Frieder; Coats, Andrew J.S.; Girerd, Nicolas; Jankowska, Ewa Anita; Hill, Loreena Michelle; Lain?ak, Mitja; Lopatin, Yuri M.; Lund, Lars H.; Maggioni, Aldo Pietro; Moura, Brenda; Rakisheva, Amina; Ray, Robin; Seferovic, Petar M.; Skouri, Hadi N.; Vitale, Cristiana A.; Volterrani, Maurizio; Metra, Marco; Rosano, Giuseppe Massimo ClaudioGuideline-directed medical therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF) reduces morbidity and mortality, but its implementation is often poor in daily clinical practice. Barriers to implementation include clinical and organizational factors that might contribute to clinical inertia, i.e. avoidance/delay of recommended treatment initiation/optimization. The spectrum of strategies that might be applied to foster GDMT implementation is wide, and involves the organizational set-up of heart failure care pathways, tailored drug initiation/optimization strategies increasing the chance of successful implementation, digital tools/telehealth interventions, educational activities and strategies targeting patient/physician awareness, and use of quality registries. This scientific statement by the Heart Failure Association of the ESC provides an overview of the current state of GDMT implementation in HFrEF, clinical and organizational barriers to implementation, and aims at suggesting a comprehensive framework on how to overcome clinical inertia and ultimately improve implementation of GDMT in HFrEF based on up-to-date evidence. 2024 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Zhang, Wei; Chen, Yi; Hu, Leixiao; Xia, Jiahui; Ye, Xiaofei; Cheng, Yibang; Wang, Ying; Guo, Qianhui; Li, Yan; Lowres, Nicole; Freedman, Ben; Wang, Jiguang; Wang, J. G.; Zhang, W.; Chen, Y.; Miao, Chaoying; Freedman, B.; Li, Y.; Wang, Dian; Huang, Qifang; Sheng, Changsheng; Barnett, K.; Shao, S.; Xu, S. K.; Lei, L.; Zhang, Dongyan; Chen, Y. L.; Hu, L. X.; Xia, J. H.; Ye, X. F.; Cheng, Y. B.; Wang, Y.; Guo, Q. H.; Lu, C.; Li, Zhuoyan; Wang, Yiqun; Zhou, Y. H.; Yan, Y. Q.; Ye, Xiaofei; Zhuang, K. L.; Shen, Y. X.; Le, J. Y.; Lu, Y. Y.; Zhang, W. T.; Tan, Q.; Han, F.; Sui, R.; Liu, X. Y.Hypertension and atrial fibrillation are closely related. However, hypertension is already prevalent in young adults, but atrial fibrillation usually occurs in the elderly. In the present analysis, we investigated incident atrial fibrillation in relation to new-onset hypertension in an elderly Chinese population. Our study participants were elderly (?65 years) hypertensive residents, recruited from community health centers in the urban Shanghai (n = 4161). Previous and new-onset hypertension were defined as the use of antihypertensive medication or elevated systolic/diastolic blood pressure (?140/90 mmHg), respectively, at entry and during follow-up on ? 2 consecutive clinic visits. Atrial fibrillation was detected by a 30-s single-lead electrocardiography (ECG, AliveCor Heart Monitor) and further evaluated with a regular 12-lead ECG. During a median of 2.1 years follow-up, the incidence rate of atrial fibrillation was 7.60 per 1000 person-years in all study participants; it was significantly higher in patients with new-onset hypertension (n = 368) than those with previous hypertension (n = 3793, 15.76 vs. 6.77 per 1000 person-years, P = 0.02). After adjustment for confounding factors, the hazard ratio for the incidence of atrial fibrillation was 2.21 (95% confidence interval 1.154.23, P = 0.02) in patients with new-onset hypertension versus those with previous hypertension. The association was even stronger in those aged ? 75 years (hazard ratio 2.70, 95% confidence interval 1.116.56, P = 0.03). In patients with previous hypertension, curvilinear association (P for non-linear trend = 0.04) was observed between duration of hypertension and the risk of incident atrial fibrillation, with a higher risk in short- and long-term than mid-term duration of hypertension. Our study showed a significant association between new-onset hypertension and the incidence of atrial fibrillation in elderly Chinese. (Figure presented.). The Author(s), under exclusive licence to The Japanese Society of Hypertension 2024.
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Chami, Jason; Nicholson, Calum; Baker, David William; Cordina, Rachael Louise; Strange, G. A.; Celermajer, David S.Background: In order to manage a class of diseases as broad as congenital heart disease (CHD), multiple manually generated classification systems defining CHDs as mild, moderate and severe have been developed and used to good effect. As databases have grown, however, such manual complexity scoring has become infeasible. Though past attempts have been made to determine CHD complexity algorithmically using a list of diagnoses alone, missing data and lack of procedural information have been significant limitations. Methods: We built an algorithm that can stratify the complexity of patients with CHD by integrating their diagnoses with a list of their previous procedures. Specific procedures which address a missing diagnosis or imply a certain operative status were used to supplement the diagnosis list. To verify this algorithm, CHD specialists manually checked the classification of 100 children and 100 adults across four hospitals in Australia. Results: Our algorithm was 99.5% accurate in the manually checked cohort (100% in children and 99% in adults) and was able to automatically classify more than 90% of a cohort of over 24,000 CHD patients, including 92.5% of children (vs 84.4% without procedures, p < 0.0001) and 91.1% of adults (vs 70.4% without procedures; p < 0.0001). Conclusions: CHD complexity scoring is significantly improved by access to procedural history and can be automatically calculated with high accuracy. 2024 The Author(s)
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Cross, Cara; Christie, Vita; Holt, Leanne; Rambaldini, Boe; Ward, Katrina D.; Skinner, John C.; Henson, Connie; McCowen, Debbie; Benrimoj, Shalom I.; Dineen-Griffin, Sarah; Gwynne, Kylie G.Background. In Australia, medications can be prescribed by medical practitioners, dentists, nurses, and dispensed by pharmacists. Until recently, pharmacists have been limited to prescribing Schedule 2 and 3 medications, and optometrists, podiatrists, and nurse practitioners can prescribe medications under their scope of practice in some areas of Australia. Recently, the New South Wales (NSW) Government initiated a trial where approved pharmacists in NSW and Australian Capital Territory have an expanded scope of practice to prescribe further medications for urinary tract infections, dermatology conditions (mild to moderate atopic dermatitis, herpes zoster (shingles), impetigo, and mild plaque psoriasis), and resupply of contraceptives. This protocol is for a sub-study of the larger research trial and will explore the perspectives of Aboriginal and Torres Strait Islander peoples and communities including clinicians, healthcare services, and community members about the expanded scope of pharmacists practice. Methods and analysis. Yarning circles (group) and individual yarns (semi-structured interviews) will be conducted with leaders, clinicians working with Aboriginal and Torres Strait Islander peoples (general practitioners, nurses, Aboriginal health workers, community pharmacists), Aboriginal Elders, and community members to understand perspectives of the risks, benefits, opportunities, and issues associated with pharmacists prescribing for these specific conditions. Ethics approval was obtained through the Aboriginal Health and Medical Research Council of NSW. Conclusion. The findings of this sub-study will clarify Aboriginal and Torres Strait Islander peoples unique perspectives, including perception of risks and opportunities. 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
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Zhao, Emma; Lowres, Nicole; Bloomfield, Jacqueline G.; Weddell, Joseph; Tofler, Geoffrey H.; Gallagher, Robyn D.Background: Cognitive impairment (CI) is common in patients with acute coronary syndrome (ACS) but is often undetected and may affect recovery and secondary prevention uptake. Nurses play a crucial role providing care for patients with ACS and promoting secondary prevention. Aim: This study aimed to explore current nursing practices and barriers regarding CI screening in patients with ACS. Methods: Cardiac nurses were recruited from three metropolitan teaching hospitals and two professional associations in Australia and undertook a 38-question purpose-built survey. Results: A total of 95 nurses participated (mean age 3813 years; 78% [n=74] female): 69 were registered nurses, and 48% had received CI training. Only 16% of nurses in our sample reported that they regularly screen for CI, and 23% reported that they never screen; however, 59% believed screening should be part of everyday practice. Nurses mostly screened when ward policy required admission/daily cognitive screening (34%) or when they suspected cognitive problems or decline (39%). Nurses in acute settings (vs non-acute) were nine times more likely to screen when adjusting for confounders. The typically used screening instruments assessed delirium/confusion and dementia but not milder CI. Common barriers to screening included communication difficulties, patients too unstable/unwell, time constraints requiring clinical care prioritisation, and being unaware of patients normal cognition status. Conclusions: Screening practices for CI in the context of ACS were found to be suboptimal, with only 16% of nurses in our sample reporting regularly screening. The most used methods focus on screening for delirium. Given current practice, many CI cases will be missed, especially mild CI, which will negatively affect secondary prevention efforts. Further research is required to identify appropriate methods to implement routine screening within the nursing clinical workflow and establish a suitable screening tool. 2024 The Author(s)
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Seferovic, Petar M.; Paulus, Walter J.S.; Rosano, Giuseppe Massimo Claudio; Polovina, Marija M.; Petrie, Mark Colquhoun; Jhund, Pardeep S.; Tsche, Carsten; Sattar, Naveed A.; PIEPOLI, MASSIMO Francesco; Papp, Zolt; Standl, Eberhard; Mamas, Mamas Andreas; Valensi, Paul Elie; Linhart, Ale; Lali?, Neboja Mali?; Ceriello, Antonio; Doehner, Wolfram; Risti?, Arsen D.; Milinkovi?, Ivan; Seferovic, Jelena P.; Cosentino, Francesco; Metra, Marco; Coats, Andrew J.S.The association between type 2 diabetes mellitus (T2DM) and heart failure (HF) has been firmly established; however, the entity of diabetic myocardial disorder (previously called diabetic cardiomyopathy) remains a matter of debate. Diabetic myocardial disorder was originally described as the occurrence of myocardial structural/functional abnormalities associated with T2DM in the absence of coronary heart disease, hypertension and/or obesity. However, supporting evidence has been derived from experimental and small clinical studies. Only a minority of T2DM patients are recognized as having this condition in the absence of contributing factors, thereby limiting its clinical utility. Therefore, this concept is increasingly being viewed along the evolving HF trajectory, where patients with T2DM and asymptomatic structural/functional cardiac abnormalities could be considered as having pre-HF. The importance of recognizing this stage has gained interest due to the potential for current treatments to halt or delay the progression to overt HF in some patients. This document is an expert consensus statement of the Heart Failure Association of the ESC and the ESC Working Group on Myocardial & Pericardial Diseases. It summarizes contemporary understanding of the association between T2DM and HF and discuses current knowledge and uncertainties about diabetic myocardial disorder that deserve future research. It also proposes a new definition, whereby diabetic myocardial disorder is defined as systolic and/or diastolic myocardial dysfunction in the presence of diabetes. Diabetes is rarely exclusively responsible for myocardial dysfunction, but usually acts in association with obesity, arterial hypertension, chronic kidney disease and/or coronary artery disease, causing additive myocardial impairment. 2024 European Society of Cardiology.
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Hibbitt, Katie; Brimicombe, James David; Cowie, Martin R.; Dymond, Andrew; Freedman, Ben; Griffin, Simon J.; Hobbs, FD Richard; Linden, Hannah Clair; Lip, Gregory Y.H.; Mant, Jonathan W.F.; McManus, R. J.; Pandiaraja, Madhumitha; Williams, Kate M.; Charlton, Peter H.Aims Single-lead electrocardiograms (ECGs) can be recorded using widely available devices such as smartwatches and handheld ECG recorders. Such devices have been approved for atrial fibrillation (AF) detection. However, little evidence exists on the reliability of single-lead ECG interpretation. We aimed to assess the level of agreement on detection of AF by independent cardiologists interpreting single-lead ECGs and to identify factors influencing agreement.Methods and results In a population-based AF screening study, adults aged ?65 years old recorded four single-lead ECGs per day for 14 weeks using a handheld ECG recorder. Electrocardiograms showing signs of possible AF were identified by a nurse, aided by an automated algorithm. These were reviewed by two independent cardiologists who assigned participant- and ECG-level diagnoses. Inter-rater reliability of AF diagnosis was calculated using linear weighted Cohens kappa (?<inf>w</inf>). Out of 2141 participants and 162 515 ECGs, only 1843 ECGs from 185 participants were reviewed by both cardiologists. Agreement was moderate: ?<inf>w</inf> = 0.48 (95% confidence interval, 0.370.58) at participant level and ?<inf>w</inf> = 0.58 (0.530.62) at ECG level. At participant level, agreement was associated with the number of adequate-quality ECGs recorded, with higher agreement in participants who recorded at least 67 adequate-quality ECGs. At ECG level, agreement was associated with ECG quality and whether ECGs exhibited algorithm-identified possible AF.Conclusion Inter-rater reliability of AF diagnosis from single-lead ECGs was found to be moderate in older adults. Strategies to improve reliability might include participant and cardiologist training and designing AF detection programmes to obtain sufficient ECGs for reliable diagnoses. The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Schnabel, Renate B.; Engler, Daniel; Freedman, Ben[No abstract available]
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Ashok, Deepu; Singh, Jasneil; Jiang, Shouyuan; Waterhouse, Anna; Bilek, Marcela M.M.Microfluidic systems have become integral for lab-on-a-chip and organ-on-a-chip applications across numerous disciplines. These systems, typically fabricated using polydimethylsiloxane (PDMS) chips on glass substrates, lack the bioactivity required for such applications. To overcome this, biomolecules are immobilized using either oxygen (O<inf>2</inf>) plasma treatment or chemical reagents like amino silanes. However, O<inf>2</inf> plasma treatments are unstable and cannot covalently immobilize biomolecules, while wet-chemistry approaches are toxic, time-consuming, and expensive. A novel microfluidic platform that combines two plasma surface treatments: Plasma-activated coating (PAC) and atmospheric pressure plasma jet (APPJ), to enable reagent-free covalent immobilization of biomolecules is described here. These surface treatments, unlike O<inf>2</inf> plasma, covalently immobilized fibronectin on PDMS and glass, and significantly improved endothelial cell attachment and proliferation. By combining PAC and APPJ, a hybrid microfluidic platform with equivalent bond strength to standard O<inf>2</inf> plasma devices, but with significantly enhanced endothelial cell growth in and artery-on-a-chip model, is developed. This platform is also amenable to high-shear applications such as coronary shear, with endothelial cells aligning with flow, as seen in human arteries. By providing reagent-free covalent immobilization of biomolecules within a microfluidic system, this technology has the potential to radically improve organ-on-a-chip development as well as lab-on-a-chip systems, point-of-care diagnostics, and sensors. 2024 The Authors. Advanced Functional Materials published by Wiley-VCH GmbH.
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Gosbell, Sally E.; Ayer, Julian Ganesh J.; Lubans, David Revalds; Coombes, Jeff S.; Maiorana, Andrew John; Morris, Norman R.; Tran, Derek L.; Cordina, Rachael LouisePhysical activity participation is critical for optimal physical, psychological, and cognitive health in children and adults living with congenital heart disease (CHD). Majority of the general population are not sufficiently active, and with the added psychological, physical, and socioeconomic barriers faced by individuals with CHD, it is unsurprising that many people living with CHD do not meet the recommendations for physical activity either. The aim of this review is to outline lifelong physical activity barriers faced by individuals living with CHD and provide age-appropriate strategies that can be used to ensure the development of long-term positive physical activity behaviours. Barriers to physical activity include safety fears, lack of encouragement, low exercise self-efficacy, body image concerns, limited education, socioeconomic status, reduced access to resources, and cardiac diagnosis and severity. These barriers are multifaceted and often begin in early childhood and continue to develop well into adulthood. Therefore, it is important for children to participate in physical activity from early stages of life as it has been shown to improve cardiorespiratory fitness, muscular endurance, and quality of life. Current literature demonstrates that participation in physical activity and higher intensity exercise after appropriate screening is safe and should be encouraged rather than dissuaded in people born with a congenital heart condition. 2024
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Grobbee, Diederick E.; Filippatos, Gerasimos S.; Desai, Nihar R.; Coats, Andrew J.S.; Pinto, Fausto J.; Rosano, Giuseppe Massimo Claudio; Cleland, John G.F.; Kammerer, Jennifer; Ramez-De-Arellano, AntonioPatients with heart failure (HF), particularly those with impaired renal function receiving reninangiotensinaldosterone system inhibitors (RAASis), are at risk of hyperkalaemia; when hyperkalaemia is severe, this can have serious clinical consequences. The incidence, prevalence, and risk factors for hyperkalaemia reported in randomized trials of RAASis may not reflect clinical practice due to exclusion of patients with elevated serum potassium (sK+) or severe renal impairment: information on patients managed in routine clinical care is important to understanding the actual burden of hyperkalaemia. This paper reviews the available clinical epidemiology data on hyperkalaemia in HF and considers areas requiring further research. Observational studies published since 2017 that focused on hyperkalaemia, included patients with HF, and had ?1000 participants were considered. Hyperkalaemia occurrence in HF varied widely from 7% to 39% depending on the setting, HF severity, follow-up length, and concomitant medications. Rates were lowest in patients with newly diagnosed HF and highest in patients with greater disease severity; comorbidities, such as chronic kidney disease and diabetes, and RAASi use, reflected commonly identified risk factors for hyperkalaemia in patients with HF. Hyperkalaemia was most often mild; however, from the limited data available, persistence of mild hyperkalaemia was associated with an increased risk of mortality and major adverse cardiovascular events. There were also limited data available on the progression of hyperkalaemia. Recurrence was common, occurring in one-quarter to two-fifths of hyperkalaemia cases. Despite HF guidelines recommending close monitoring of sK+, 5593% of patients did not receive appropriate testing before or after initiation of RAASi or in follow-up to moderate/severe hyperkalaemia detection. Many of the observational studies were retrospective and from a single country. There is a need for international, prospective, longitudinal, observational studies, such as the CARE-HK in HF study (NCT04864795), to understand hyperkalaemia's prevalence, incidence, and severity; to identify and characterize cases that persist, progress, and recur; to highlight the importance of sK+ monitoring when using RAASi; and to assess the impact of newer HF therapies and potassium binders in clinical practice. Data from both clinical trials and observational studies with adjustments for confounding variables will be needed to assess the contribution of hyperkalaemia to clinical outcomes. 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Rosano, Giuseppe Massimo Claudio; Stolfo, Davide; Anderson, Lisa J.; Abdelhamid, Magdy A.; Adamo, Marianna; Bauersachs, Johann; Bay-Gen, Antoni; Bm, Michael; Chioncel, O. Dragomir; Filippatos, Gerasimos S.; Hill, Loreena Michelle; Lain?ak, Mitja; Lambrinou, Ekaterini; Maas, Angela H.E.M.(Angela); Massouh, Angela; Moura, Brenda; Petrie, Mark Colquhoun; Rakisheva, Amina G.; Ray, Robin; Savarese, Gianluigi; Skouri, Hadi N.; van Linthout, Sophie A.; Vitale, Cristiana A.; Volterrani, Maurizio; Metra, Marco; Coats, Andrew J.S.Despite the progress in the care of individuals with heart failure (HF), important sex disparities in knowledge and management remain, covering all the aspects of the syndrome, from aetiology and pathophysiology to treatment. Important distinctions in phenotypic presentation are widely known, but the mechanisms behind these differences are only partially defined. The impact of sex-specific conditions in the predisposition to HF has gained progressive interest in the HF community. Under-recruitment of women in large randomized clinical trials has continued in the more recent studies despite epidemiological data no longer reporting any substantial difference in the lifetime risk and prognosis between sexes. Target dose of medications and criteria for device eligibility are derived from studies with a large predominance of men, whereas specific information in women is lacking. The present scientific statement encompasses the whole scenario of available evidence on sex-disparities in HF and aims to define the most challenging and urgent residual gaps in the evidence for the scientific and clinical HF communities. 2024 European Society of Cardiology.
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Giskes, Katrina; Lowres, Nicole; Orchard, Jessica Joan; Hyun, Karice K.; Hespe, Charlotte Mary; Freedman, BenBackground: Atrial fibrillation (AF) is associated with stroke. Major changes to AF management recommendations in 20162018 advised that: 1. Stroke risk be estimated using the CHA<inf>2</inf>DS<inf>2</inf>-VA score; 2. Antiplatelet agents (APAs) do not effectively mitigate stroke risk; 3. Anticoagulation is prioritised above bleeding risk among high-risk patients; and 4. Non-vitamin K oral anticoagulants (NOACs) are used as first-line anticoagulants. Aim: To examine trends in stroke risk management among high-risk patients with non-valvular AF in Australia between 20112019. Method: De-identified data of patients were obtained from 164 separate general practices. Data included information on patient demographics, diagnoses, health risk factors and recent prescriptions. Patients with a diagnosis of non-valvular AF were identified and stroke risk was calculated by CHA<inf>2</inf>DS<inf>2</inf>-VA score. High risk patients (i.e. CHA<inf>2</inf>D<inf>S</inf>2-VA ? 2) were categorised as being managed by oral anticoagulants (OACs, i.e., warfarin or NOACs), APAs only, or neither (i.e., no OACs or APAs) and time trends in prescribing were examined. Multivariate analyses examined the characteristics of patients receiving the guideline recommended OAC management. Results: Data were available for 337,964 patients; 8696 (2.6 %) had AF. Most patients with AF (85.8 %, n = 7116) had high stroke risk. The proportion of high-risk patients managed on OACs increased from 56.7 % in 2011 to 73.7 % in 2019, while the proportion prescribed APAs declined from 31.1 % to 14.0 %. Those receiving neither treatment remained steady (around 12 %). Overall, 26.3 % of patients were inadequately anticoagulated at the end of the study period. There were no age or gender differences in receiving the guideline-recommended therapy, and patients with comorbidities associated with increased stroke risk were more likely to receive OAC therapy. Conclusions: Stroke risk management among patients with AF has improved between 20112019, however there is still scope for further gains as many high-risk patients remain inadequately anticoagulated. Better stroke risk assessment by clinicians coupled with addressing practitioner concerns about bleeding risk may improve management of high-risk patients. 2024 The Authors
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Giskes, Katrina; Lowres, Nicole; Hespe, Charlotte Mary; Freedman, BenAtrial fibrillation heightens the risk of stroke. Current guidelines emphasise assessing stroke risk and promptly initiating oral anticoagulants for high-risk patients. Management should also include regular reviews to ensure medication adherence and persistence. 2024 Medicine Today Pty Ltd. All rights reserved.
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Goh, Tiffany; Gao, Lingzi; Singh, Jasneil; Totaro, Richard J.; Carey, Ruaidhri; Yang, Kevin; Cartwright, Bruce Lloyd; Dennis, Mark R.; Ju, Lining Arnold; Waterhouse, AnnaUse of extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure remains complicated by blood clot formation (thrombosis), triggered by biomaterial surfaces and flow conditions. Thrombosis may result in ECMO circuit changes, cause red blood cell hemolysis, and thromboembolic events. Medical device thrombosis is potentiated by the interplay between biomaterial properties, hemodynamic flow conditions and patient pathology, however, the contribution and importance of these factors are poorly understood because many in vitro models lack the capability to customize material and flow conditions to investigate thrombosis under clinically relevant medical device conditions. Therefore, an ECMO thrombosis-on-a-chip model is developed that enables highly customizable biomaterial and flow combinations to evaluate ECMO thrombosis in real-time with low blood volume. It is observed that low flow rates, decelerating conditions, and flow stasis significantly increased platelet adhesion, correlating with clinical thrombus formation. For the first time, it is found that tubing material, polyvinyl chloride, caused increased platelet P-selectin activation compared to connector material, polycarbonate. This ECMO thrombosis-on-a-chip model can be used to guide ECMO operation, inform medical device design, investigate embolism, occlusion and platelet activation mechanisms, and develop anti-thrombotic biomaterials to ultimately reduce medical device thrombosis, anti-thrombotic drug use and therefore bleeding complications, leading to safer blood-contacting medical devices. 2024 The Author(s). Advanced Science published by Wiley-VCH GmbH.
