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Circulation, Volume 146, Issue Suppl_1, Page A11873-A11873, November 8, 2022. Background:Hyponatremia, defined as a serum sodium (Na) level
Circulation, Volume 146, Issue Suppl_1, Page A14167-A14167, November 8, 2022. Introduction:Recently, there has been a dramatic surge of interest in leadless pacemakers (LP). Although benefits of LP versus transvenous pacemakers (TVP) have been reported in small institutional and some registry-based studies, the systematic comparison and pooling of data remain limited. Therefore, we sought to meta-analyze the safety and benefit of leadless pacemakers over conventional transvenous pacemaker systems.Method:We followed PRISMA guidelines to conduct the study. The study protocol has been registered in the PROSPERO (CRD42022325376). Databases were searched for published literature from inception to April 12, 2022. Comparative studies on TVP with LP reporting device-related, cardiac, vascular, thoracic complications, and infection were included. Studies were analyzed using RevMan 5.4.1 with odds ratios (OR) to assess overall complications, device dislodgement, reintervention, and other complications. The I-squared (I2) test was used to assess the heterogeneity.ResultTotal 879 studies were imported from databases. After the removal of 265 duplicates, 614 papers were screened for eligibility. Among 41 papers screened for full text, 17 meet the inclusion criteria. There were 50% lower odds of overall complications in the LP group (OR 0.50, 95% CI 0.32 to 0.78; n = 20825). Similarly, 73% lower odds of device dislodgment (OR 0.27, 95% CI 0.14 to 0.50; n = 6897), 46% lower odds of re-intervention (OR 0.54, 95% CI 0.45 to 0.64; n= 17009), 87% lower odds of pneumothorax (OR 0.13, 95% CI 0.03 to 0.57; n = 4261), however 2.08 higher odds of pericardial effusion (OR 2.08, 95% CI 1.04 to 4.16; n = 4842) observed in LP group.ConclusionMeta-analysis of observational studies suggests that LP demonstrates a more favorable complication profile than TVP, although with higher rates of pericardial effusion. However, patient selection was not uniform between studies, and inferences remain limited.
Circulation, Volume 146, Issue Suppl_1, Page A12367-A12367, November 8, 2022. Introduction:In recent years, the “obesity paradox” has been shown in studies demonstrating better outcomes in overweight and obese patients undergoing percutaneous or surgical cardiovascular procedures. This study compares the effect of body-mass index (BMI) on outcomes in patients undergoing transcatheter aortic valve replacement (TAVR).Methods:A comprehensive systematic search was conducted in PubMed, Web of Science, and Cochrane library for relevant studies. Studies were included if they had categories for BMI (normal-weight, overweight, and obese) and reported the outcomes of TAVR in each group. Random-effects using STATA was performed for the meta-analysis.Results:34 studies with 96,093 patients were included in our study. Overweight and obese patients had a significantly lower rate of 1-year all-cause mortality, long-term all-cause mortality and moderate to severe aortic regurgitation compared to normal-weight patients (Figure 1). Incidence of 30-day myocardial infarction was lower in overweight patients, and 1-year stroke incidence was significantly lower in obese patients compared with normal cases. In contrast, permanent pacemaker implantation was more observed in overweight and obese patients. There was no significant difference in outcomes in underweight patients compared to normal-weight ones except for a higher rate of major vascular complications in underweight cases.Conclusions:Our analysis showed improved outcomes in terms of all-cause mortality and aortic regurgitation in overweight and obese patients undergoing TAVR compared to normal-weight patients.
Circulation, Volume 146, Issue Suppl_1, Page A323-A323, November 8, 2022. Global prevalence of cardiopulmonary resuscitation and automated external defibrillator training: a systematic review and meta-analysisAim:Sudden cardiac arrest exerts a large disease burden, which may be mitigated by bystander cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED). The global prevalence and distribution of laypersons trained in these skills are poorly understood. We aimed to estimate the global prevalence of CPR and AED training, and identify their determinants.Method:We searched Medline, Embase and Cochrane Library from inception to October 24th, 2021, for cross-sectional studies reporting the prevalence of CPR or AED training from representative samples of laypersons. Prevalences were pooled using random effects models. We examined varying definitions of being identified as CPR-trained, namely CPR-V (valid training within 2-years), CPR-E (ever been trained). Subgroup analysis and meta-regression were used to examine determinants of interest.Results:28 studies were included, representing 53,397 laypersons. Among national studies, the prevalence of CPR-V training was 10.02% (95% CI 6.60 to 14.05), prevalence of CPR-E training was 39.64% (95%CI 29.11 to 50.67), and prevalence of AED training was 15.70% (95% CI 10.17 to 22.18). Subgroup analysis revealed differences in prevalences between continents,with prevalence highest in Oceania and lowest in Asia (p
Circulation, Volume 146, Issue Suppl_1, Page A15577-A15577, November 8, 2022. Introduction:Despite the increasing rate of hypertensive emergency (elevated blood pressure with acute target organ damage) presentations in the emergency department (ED), subsequent morbidity and mortality data to support clinical decision making remains scarce. We aim to study the prevalence and prognosis of hypertensive emergencies and hypertension mediated organ damage (HMOD) in patients presenting to the ED.Methods:PubMed and Scopus were queried from their inception through the mid of November 2021. Studies were included if they reported the prevalence or prognosis of hypertensive emergencies in patients presenting to the ED. Data from each study was arcsine-transformed and pooled using a random-effects model.Results:Fourteen studies (n = 4370 patients) were included in our analysis. Pooled analysis demonstrates that the prevalence of hypertensive emergencies was 0.5% (95% CI: 0.40 – 0.60) in patients presenting to ED. Ischemic stroke 28.1% (95% CI: 18.7 – 38.6), was the most prevalent HMOD, followed by pulmonary edema/acute heart failure 24.1%, (95% CI: 19.0 – 29.7, hemorrhagic stroke 14.6%, (95% CI: 9.9 – 20.0), acute coronary syndrome 10.8%, (95% CI: 7.3 – 14.8), renal failure 8.0%, (95% CI: 2.9 – 15.5), subarachnoid hemorrhage 6.9%, (95% CI: 3.9 – 10.7), encephalopathy 6.1%, (95% CI: 1.9 – 12.4), and the least prevalent was aortic dissection 1.8%, (95% CI: 1.1 – 2.8) (Figure). Mortality rate among patients admitted to the hospital due to hypertensive emergency was 9.9% (CI: 1.4 – 24.6).Conclusions:Our findings demonstrate substantial morbidity and mortality amongst patients presenting to the ED with hypertensive emergency. Results of studies may help clinicians identify organs at highest risk of damage in patients with hypertensive emergency, aiding the work-up and therefore helping curb the burden of this disease.
Circulation, Volume 146, Issue Suppl_1, Page A11149-A11149, November 8, 2022. Background:the practice of pretreatment with oral P2Y12inhibitors in ST-Elevation Myocardial Infarction (STEMI) remains common; however, its association with improved cardiovascular outcomes is unclear, since no large RCT has addressed this issue.Hypothesis:We aimed to evaluate the association of oral P2Y12 inhibitor pretreatment in STEMI patients with cardiovascular and bleeding outcomes.Methods:PubMed, MEDLINE, Embase, Cochrane, Scopus, Web of Science were systematically searched for studies that compared pretreatment with P2Y12versus no pretreatment in STEMI, and reported efficacy and safety outcomes. A meta-analysis using a fixed and random effects model was used to calculated outcomes of interest. Heterogeneity was assessed with I2statistics.Results:A total of 3 RCTs and 14 observational studies assigning 91,771 patients to either pretreatment (65,598 patients) or no pretreatment (26,171 patients) were included. Follow-up ranged from 7 days to 19 months. The P2Y12inhibitors included clopidogrel, prasugrel and ticagrelor. At 30 days, P2Y12pretreatment was associate with lower 30-day mortality (risk ratio [RR], 0.71; 95% CI, 0.56-0.91; p=0.006; I2=75%), stent thrombosis (RR, 0.33; 95% CI, 0.12-0.95; p=0.04; I2=83%), and major bleeding (RR, 0.81; 95% CI, 0.74-0.90; p
Circulation, Volume 146, Issue Suppl_1, Page A11962-A11962, November 8, 2022. Introduction:The cardiopulmonary exercise testing (CPET) has been proved to be a good tool in prognostic stratification of HFrEF and HFpEF, but its value in cardiac amyloidosis (CA) is uncertain. With the increasing knowledge and clinical suspicion toward CA, the growing prevalence of the disease, and the current availability of disease-modifying drugs, prognostic stratification is becoming fundamental to optimise the cost-effectiveness of treatment, patient follow-up and management.Hypothesis:We investigate the association of VO2max and VE/VCO2 slope with prognosis in patients with CA.Methods:We performed a systematic review following the PRISMA guidelines. Electronic databases (MEDLINE, Biomed Central, and Cochrane Library) were searched for clinical trials performing CPET for prognostication in transthyretin and light-chain CA patients. Studies reporting Hazard Ratio (HR) for mortality and VO2 max or VE/VCO2 slope (1-unit increase) were further selected for quantitative analysis. After logarithmic transformation, HRs were pooled using a random-effect model.Results:Five studies were selected for qualitative analysis and 3 for the quantitative analysis. A total of 233 patients were included in the meta-analysis, 127 (55%) with transthyretin and 106 (45%) with light-chain CA. Mean VO2 max in each trial was consistently depressed, ranging from a mean of 14.5 ± 4.5 mL/kg/min to 15.2 ± 10 mL/kg/min. On the other side, the VE/VCO2 slope ranged from a mean of 30 ± 3.0% to 41.3 ± 9.7%. Our pooled analysis shows that VO2 max (pooled HR 0.89, 95%CI 0.84-0.94) and VE/VCO2 slope (pooled HR 1.04, 95%CI 1.01-1.07) are significantly associated with the risk of death in CA patients, with no significant statistical heterogeneity for both analyses.Conclusions:CPET is a valuable tool for prognostic stratification in CA, identifying patients at increased risk of death. Large prospective clinical trials are needed to confirm this exploratory finding.
Circulation, Volume 146, Issue Suppl_1, Page A15605-A15605, November 8, 2022. Introduction:Cardiologists face an increased risk of medical professional liability (MPL) claims compared to physicians overall throughout their careers. Simultaneously, male physicians are over twice as likely to encounter medicolegal litigation than female physicians. Understanding the distribution of MPL claims across cardiologist demographics is vital to identify high risk areas and improve quality of patient care. Thus, we aimed to characterize current literature on the inclusion of demographic data in medicolegal cases against cardiologists.Methods:Searches were performed in the PubMed database. An initial search using a combination of the terms “cardiologist,” “cardiology,” “cardiac,” and “malpractice” yielded 802 results. Studies were screened by title and abstract for 1) relevance and 2) acquisition of data from a legal or insurance database. Data was manually extracted from eligible studies and categorized into 18 legal and demographic fields.Results:After applying eligibility criteria, 21 studies were analyzed. Comparison of key variables revealed an underrepresentation of cardiologist demographic data compared to patient data (Table 1). While two-thirds of medicolegal studies in cardiology described patient gender, no studies included gender of the defending cardiologist. Similarly, though two-thirds of studies mentioned patient age, none included cardiologist age. There was no mention of patient or cardiologist race in any of the 21 studies reviewed.Conclusion:In conclusion, knowledge of gender- and race-specific litigation patterns against cardiologists is absent from literature. Despite descriptions of patient characteristics, current studies on the medicolegal landscape of cardiology ignore key cardiologist variables. Incorporating demographics of prosecuted cardiologists could help elucidate the role of gender and race in medicolegal cases, minimize litigation risk, and enhance patient care outcomes.
Circulation, Volume 146, Issue Suppl_1, Page A14901-A14901, November 8, 2022. IntroductionAlthough immune checkpoint inhibitors (ICI) have reshaped the treatment landscape for cancer patients, they carry potential risk for the development of cardiovascular adverse events (CVAEs).ObjectivesWe attempted to identify risk factors for CVAEs in cancer patients receiving ICI.MethodsTwo investigators (C.H.H. and Y.C.) independently reviewed Medline, PubMed, and Embase from inception to May 20, 2022 to identify high quality studies. We included randomized controlled trials, prospective or retrospective cohorts that reported the risks factors for any new onset or worsening CVAEs, including cardiomyopathy, arrhythmia, heart failure, acute coronary syndrome, myocarditis, and pericarditis, in cancer patients receiving ICI. Two investigators (E.A. and M.A.) independently extracted data from included studies. Any discrepancy was resolved through discussion with senior reviewers (K.Y.C and M.N.). We performed random-effects meta-analyses on risk factors for CVAEs after the initiation of ICI. We used I-statistics (I2) to quantify the statistical heterogeneity.Results12 observational studies involving 21,912 patients (CVAEs=2,897) of any cancers were included for final qualitative and quantitative analyses. 11 covariates, including age, gender, body mass index, ever-smoking history, hypertension, type II diabetes, coronary artery disease (CAD), congestive heart failure, chronic kidney disease (CKD), chronic obstructive pulmonary disease, and stroke, were available for the meta-analyses. Our meta-analyses (Table 1) demonstrated that male gender, hypertension, CAD, and CKD were associated with increased odds for the development of CVAEs in patients taking ICI.ConclusionsIn conclusion, male gender, hypertension, CAD, and CKD were identified as significant risk factors for CVAEs in patients taking ICI. Evidence supports a strategy of proper optimization of risk factors before, during, and after the ICI treatment.
Circulation, Volume 146, Issue Suppl_1, Page A11793-A11793, November 8, 2022. Background:The risk of fatal and recurrent cardiovascular complications in Hypertrophic Cardiomyopathy (HCM) warrant data to identify the rate, causes and predictors of readmission on a large scale. We conducted the first-ever meta-analysis to evaluate the pooled rate of short-term and long-term readmissions after index HCM admissions.Methods:PubMed/Medline, EMBASE and SCOPUS databases were systematically reviewed to find studies through May 2022 reporting rates and causes of readmission following index HCM admissions. Random effects models were used to estimate pooled rates and causes of readmissions and I2statistics were used to report inter-study heterogeneity.Results:This meta-analysis included 17860 index HCM admissions (Mean age: 46-67 years, median follow up duration: 321.6 days, Female 53.11%) from 17 studies, which revealed a 14.8% [95% CI 12.2%-17.4%, I2=96%] pooled rate of readmission(Fig. 1). Studies published from China (23.5% vs. 10.5%) had a higher readmission rate than the USA(Fig. 2). The long-term readmission rate was highest within 1-3 years (26.6%) and in patients who underwent alcohol septal ablation procedure (10% vs 7.6%) compared to those who underwent surgical myectomy(Fig. 3). The readmission rate was higher in cohorts with smaller sample sizes (19.2% vs 10.2%) (n1000). Among the readmission events, congestive heart failure, and acute decompensated heart failure were the leading causes of readmission, accounting for up to 66% of the readmission cases [95%CI 32.5%-100.4%, p
Circulation, Volume 146, Issue Suppl_1, Page A14099-A14099, November 8, 2022. Introduction:Speckle tracking echocardiography (STE) can be an useful tool for detecting early and subtle myocardial changes in patients with systemic lupus erythematosus (SLE)Hypothesis:The present study aimed to perform systemic review and meta-analysis of the studies based on the assessment of the left ventricular (LV) systolic function with LV ejection fraction (LVEF) and LV global longitudinal strain (LV GLS).Methods:Data were analysed according to an established protocol of the Cochrane Collaboration steps and meta-analysisResults:A total of 850 papers were collected, of those 10 papers including 174 442 SLE patients and 45 608 723 controls with heart failure, also 20 papers including 1121 SLE patients and 1010 controls with measured LVEF and 9 papers including 462 patients and 356 controls with measured LV GLS were selected. Studies have shown, that patients with SLE were characterized with higher prevalence of heart failure as compared to controls (Fig1). Patients with SLE exhibited lower levels of LVEF as compared to controls too (Fig.1), some included studies have shown that the difference in terms of LVEF between groups is not always significant. LV GLS was more deteriorated in SLE patients as compared to controls (Fig.2a, 2b), moreover some studies showed significant association between deteriorated LV GLS and cardiovascular events.Conclusions:Patients with SLE are characterized with high prevalence of heart failure. LV systolic function as measured by LVEF and LV GLS is significantly more affected in SLE patients. Data suggest that LV GLS may improve risk-stratification in patients with SLE.
Circulation, Volume 146, Issue Suppl_1, Page A10564-A10564, November 8, 2022. Objectives:To investigate the utility of AngioVac-assisted vegetation debulking (AVD) in right sided infective endocarditis (RSIE)Background:AngioVac is a vacuum-based device that was approved in 2014 for the percutaneous removal of undesirable materials from the intravascular system. Although there are multiple reports on the use of the AngioVac device to aspirate right-sided heart chamber thrombi, data on its use to treat RSIE is limited.Methods:We performed a comprehensive literature search for studies that evaluated the utility of AVD. The primary outcomes of our study were the procedural success, defined as the ability of AngioVac to produce residual vegetation size
Circulation, Volume 146, Issue Suppl_1, Page A14285-A14285, November 8, 2022. Introduction:Contemporary literature reveals a range of cardiac complications in patients who receive the percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).Hypothesis:This study compared the adverse cardiac outcomes and procedural/technical success rates between the patients groups of in-stent (IS) CTO PCI and de novo CTO PCI.Methods:This systematic review and meta-analysis compared odds for primary (all-cause mortality, MACE, cardiac death post PCI, stroke) and secondary (bleeding requiring blood transfusion, ischemia-driven target-vessel revascularization, PCI procedural success, PCI technical success, and target-vessel MI) endpoints between 2,734 patients who received PCI for IS CTO and 17,808 for de novo CTO. Odds ratios for outcome variables were calculated within 95% confidence intervals (CIs) via the Mantel-Haenszel method. The pooled analysis was undertaken for observational (retrospective/prospective) single- and multi-centered studies published between January 2005 and December 2021.Results:We found 57% higher, 166% higher, 129% higher, and 57% lower odds for MACE (OR: 1.57, 95% CI 1.31, 1.89,p
Introduction
Sub-Saharan Africa (SSA) region harbours the highest burden of HIV infections in the world. Agricultural work has been reported as one of the occupations with a high prevalence of HIV. Farm workers generally have poor access to health services, which prevents them from receiving proper HIV prevention and care. Furthermore, poor policies and policy implementation, and lack of workplace programmes increases farm workers’ vulnerability to HIV infection. Thus, the aim of this study is to conduct a systematic review to assess HIV prevention and treatment services and national policies governing access to healthcare services by farm workers in SSA.
Methods and analysis
Our systematic review will include studies published from January 1990 to December 2021 within SSA countries. We will use a sensitive search strategy for electronic bibliographic databases and grey literature sources. Databases will include PubMed, CINAHL, Cochrane library, African Index Medicus and Scopus. The main outcomes to be reported will be HIV policy for farmworkers, availability of HIV prevention service(s), availability of treatment and support to farmworkers who are living with HIV, presence of referral structures for farmworkers through the health system and follow-up services for farmworkers who are on antiretroviral therapy. We will synthesise the main characteristics of included studies and use summary measures to describe study characteristics. In a situation where data are not sufficiently homogeneous to perform a quantitative synthesis, we will conduct a narrative synthesis. We will explore themes and relationships between included studies for qualitative data.
Ethics and dissemination
The study will use publicly available data and ethics exemption has been obtained from Human Research Ethics Committees, Faculty of Medicine & Health Sciences, Stellenbosch University. The results of this study will be disseminated through peer-reviewed journals, conference presentations and seminars.
PROSPERO registration number
CRD42021277528.
Introduction
Endovascular aneurysm repair (EVAR) has a marked short-term advantage over open surgical repair in managing abdominal aortic aneurysms (AAA); however, this benefit is lost in the long term. The current trend towards stratified medicine has given rise to diverse prognostic prediction models and scoring systems for EVAR. These models could act as decision support tools that employ patient and operative factors, to improve long-term outcomes. Past literature evaluated and compared model performance for predicting one outcome, for example, mortality. None were deemed competent for clinical application. The proposed study will use a scoping review approach to capture literature on prognostic modelling in EVAR for all predictable outcomes. The results are anticipated to inform future research, identify knowledge gaps, and assist in determining the potential of models for clinical use.
Methods and analysis
The proposed study will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping Reviews as a framework for conducting the review. PubMed Central, Embase and Cochrane Library will be searched and screened for peer-reviewed studies on prognostic modelling for EVAR, published between 2000 and 2022. No limits exist on predictor variables used and outcomes predicted by the model for inclusion, provided they apply to AAA patients managed with EVAR. Data will be abstracted using a charting form based on the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies guidelines and PRISMA guidelines for systematic reviews. The Prediction model Risk of Bias Assessment Tool and the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis checklist will be used to critically appraise included studies.
Ethics and dissemination
Since scoping reviews cover secondary data from published literature, ethical approval is not required. The findings will be disseminated via peer-reviewed publications and presentations at key conferences.
Introduction
Health agencies and community organisations play a crucial role in disseminating information to the public about COVID-19 risks and events, providing instructions on how to change behaviour to mitigate those risks, motivating compliance with health directives and addressing false information. Social media platforms are a critical tool in risk communication, providing a medium for rapid transmission of messages as well as providing the opportunity for engagement and immediate feedback. Access to health information, services and support are especially important for marginalised and underserved (‘equity-deserving’) populations who are disproportionately affected by COVID-19. This scoping review aims to review the breadth and depth of the academic and grey literature on equity-informed social media risk communication tools to provide guidance on promising practices and principles for reaching equity-deserving populations through social media.
Methods and analysis
Arksey and O’Malley’s (2005) framework guided the identification of the research question; identification and selection of relevant studies from electronic databases and hand-searches of discipline-specific journals; extraction and charting of the data; and collating and reporting of findings. The results of the screening process will be reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis-Scoping Review guidelines.
Findings
We will identify reported facilitators and barriers to the development of risk communications that target equity-deserving communities. We will also identify recommendations for equity-informed risk communication for COVID-19.
Ethics and dissemination
This study does not require ethics approval. We intend to disseminate the results through publication in an open-access peer-reviewed journal, conference presentations, lay summaries (eg, checklists) for health organisations and messages to be shared through social media.
