Risultati per: Studio REDUCE-IT e appropriatezza prescrittiva degli acidi grassi omega-3

Circulation, Volume 150, Issue Suppl_1, Page A4136330-A4136330, November 12, 2024. Introduction:Accurate assessment of pacing thresholds during permanent pacemaker implantation is critical to ensure device function and longevity. A few reports have described rate-related threshold variability during MicraTMleadless pacemaker (Medtronic Inc, Minneapolis, MN) procedures. Postulated mechanisms for this phenomenon include variable myocardial contact or micro-dislodgment, and inflammation-induced phase IV block. In this case series, we demonstrate the use of adenosine to induce transient heart block for accurate threshold assessment in patients with tachycardia during leadless pacemaker placement.Cases:A 69-year-old male with a history of atrial flutter presented with complete atrioventricular (AV) block requiring emergent transvenous pacing. A Micra placement was performed. During the procedure, the patient was tachycardic in rapid atrial flutter despite multiple doses of metoprolol. It was noted that with rapid pacing from the pacemaker at 120 pulses per minute (ppm) the threshold was ≤1V at 0.24 ms. An adequate “tug-test” was performed and at least 2 of 4 tines were noted to be fixated based on fluoroscopic motion. To confirm the capture threshold before final deployment, 12 mg of adenosine was given to induce heart block. However, at a rate of 60 ppm, there was no ventricular capture at 3V at 0.24ms. The device was repositioned and repeat threshold testing with adenosine at 60 ppm was 0.38V at 0.24ms. Pacing parameters were assessed the next day and remained stable.Similarly, a 75-year-old female with ischemic cardiomyopathy was admitted with new atrial fibrillation (AF). She then developed pauses prompting Micra placement. During initial threshold testing, she was in rapid AF despite receiving multiple doses of metoprolol. Heart block was induced with 12mg adenosine to assess the threshold at a lower pacing rate of 60 ppm. The capture threshold achieved was 0.5V at 0.24ms.Discussion:Nusbickel et al., Yoshiyama et al., and Sano et al. have reported rate dependent discrepancies in capture thresholds after Micra implantation. Our cases highlight the importance of capture threshold assessment at lower pacing rates during implantation. In patients who are tachycardic at the time of the procedure, adenosine may be useful to more reliably assess device capture threshold and determine the need for repositioning.

Circulation, Volume 150, Issue Suppl_1, Page A4140072-A4140072, November 12, 2024. Introduction:Icosapent ethyl (IE), an ethyl ester derivative of eicosapentanoic acid (EPA), and omega-3 acid ethyl esters, an ethyl ester derivative of both EPA and docosahexaenoic acid (DHA), are approved as adjunct to statin therapy for reducing MACE in patients with elevated triglyceride levels. There are concerns regarding atrial fibrillation (AF) risk associated with IE. This study aims to assess the incidence of AF while receiving IE versus omega-3-acid ethyl esters (DHA/EPA), both alongside baseline statin therapy.Methods:In this retrospective cohort study, we used data from the Merative MarketScan Commercial Claims and Medicare Supplemental Databases (2013-2021). Adult patients on statin therapy who initiated either IE or DHA/EPA were identified using outpatient dispensing records. Patients with an AF diagnosis during the one-year baseline period were excluded. Patients were followed for up to two years to assess the incidence of AF. Censoring occurred if there was treatment discontinuation, switching between treatments, end of enrollment, or end of the study. Patients experiencing events or being censored within the first 30 days were also excluded. Propensity score matching was used to create comparable groups, with exact matching on time periods (2013-2015, 2016-2018, and 2019-2021). Using Cox proportional hazard regression model, we calculated hazards ratio of the onset of AF for IE versus DHA/EPA.Results:The analytic cohort consisted of 17,638 matched pairs. Patients in both groups had a median age of 56 years. Male patients accounted for a 65.7% of the IE group and 64.5% of the DHA/EPA group. Baseline cardiovascular risk factors were well matched between both groups. The 2-year cumulative incidence of AF for IE and DHA/EPA groups were 5.322% and 3.994%, respectively, resulting in a HR of 1.257 [95% CI,1.159-1.364], p=0.0032. (Figure 1)Conclusions:IE is associated with a higher risk of AF compared to DHA/EPA combined products, indicating the need for careful risk-benefit discussion between clinicians and patients considering IE therapy.

Circulation, Volume 150, Issue Suppl_1, Page A4141774-A4141774, November 12, 2024. Background:Numerous studies evaluating the effects of consumption of omega-3 fatty acids (ω3FAs) and omega-6 fatty acids (ω6FAs) on the prevention of cardiovascular disease (CVD) have yielded inconsistent results. In addition, the association between ω3FAs/ω6FAs and CVD has been suggested to vary with the daily intake levels of fatty acids among individuals. On the other hand, the longitudinal associations between plasma ω3FAs/ω6FAs and arterial stiffness, which is a predictor of CVD, have not been well elucidated.Hypothesis:We hypothesized that plasma ω3FAs are associated with the suppression of age-related increases in arterial stiffness, whereas plasma ω6FAs are associated with an increase in arterial stiffness.Aims:The objective of this study is to fill the existing research gap by investigating the longitudinal association between plasma ω3FAs/ω6FAs and arterial stiffness in a Japanese people, known for their higher intake of marine products.Methods:This prospective observational study included 2520 healthy Japanese participants (mean age:43.1±8.7y, men:83.1%) who underwent repeated annual health check-ups from 2008 to 2013. Participants with a history of CVD or treatment for CVD risk factors were excluded. Arterial stiffness was evaluated by brachial-ankle pulse wave velocity (baPWV), and plasma ω3FAs [docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)]/ω6FAs [arachidonic acid (AA), dihomo-gamma-linolenic acid (DGLA)] were evaluated by gas chromatography. The longitudinal association between plasma ω3FAs/ω6FAs and baPWV was evaluated by a linear mixed model adjusted for conventional CVD risk factors.Results:During a median follow-up of 5 years (IQR 4-5 years), 11034 baPWV measurements were performed. The linear mix model adjusted for conventional CVD risk factors revealed that both higher plasma AA and DGLA levels were significantly associated with an increase in baPWV (1SD increase in AA; β=12±3, 1SD increase in DGLA; β=14±3, both P

Circulation, Volume 150, Issue Suppl_1, Page A4138953-A4138953, November 12, 2024. Background:Oral inflammation is thought to affect systemic atherosclerosis, but the mechanisms are unclear. Tumor necrosis factor-alpha (TNF-α) is an inflammatory cytokine that has been implicated in coronary plaque rupture as well as periodontitis by mediating periodontal destruction and inflammation. Blood levels of the omega-3 fatty acids have been inversely associated with systemic inflammation and coronary plaque volume, but their impact on oral inflammation requires further study.Objective:To examine the relationship between salivary levels of TNF-α, plasma levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and coronary plaque.Methods:Salivary TNF-α was measured in gingival crevicular fluid in 199 patients with clinical coronary artery disease on statin therapy. Fatty, fibrous and noncalcified coronary plaque volumes were measured using coronary CT angiography. The plasma omega-3 fatty acid index was the sum of EPA and DHA of total plasma fatty acids. Linear regression estimated the association between TNF-α, omega-3 fatty acid index and coronary plaque volumes.Results:Mean age was 62.7±7.5 years; mean LDL-C was 78.2±28.9 mg/dL, and median triglyceride was 119 [80.5,165.0] mg/dL. Higher salivary TNF-α was independently associated with a lower plasma omega-3 fatty acid index (Table 1). Moreover, higher salivary TNF-α was independently associated with higher fatty, fibrous, and noncalcified plaque volumes after adjustment for age, sex, BMI, triglyceride, LDL-C, diabetes status, diastolic blood pressure, albumin-to-creatinine ratio, and estimated glomerular filtration rate (Table 2).Conclusions:The inverse relationship between salivary TNF-α and the plasma omega-3 fatty acid index and direct relationship with fatty plaque suggests that maintaining high blood levels of omega-3 fatty acids may be beneficial in lowering oral inflammation and amount of fatty plaque, thus, potentially decreasing risk for acute coronary syndromes.

Circulation, Volume 150, Issue Suppl_1, Page A4144426-A4144426, November 12, 2024. Introduction:Intensive blood pressure (BP) control is associated with a significant reduction in the risk of heart failure (HF) or all-cause death. However, the extent to which intensive BP control-associated HF risk reduction is mediated by changes in subclinical markers of cardiovascular (CV) disease (CVD) and stage B HF is not well-characterized.Methods:Participants of the Systolic Blood Pressure Intervention Trial (SPRINT) with hypertension and available data on subclinical CVD markers at baseline and follow-up (1- or 2-year visit) were included. The key subclinical markers of CVD analyzed included chronic myocardial injury (assessed by high-sensitivity cardiac troponin I [hs-cTnI]), neurohormonal stress (assessed by N-terminal pro-B-type natriuretic peptide [NT-proBNP]), left ventricular (LV) mass (assessed by electrocardiogram Cornell voltage [CV]), and arterial stiffness (assessed by estimated pulse wave velocity [ePWV]). A counterfactual framework was used to assess the effects of the exposure and mediator on key outcomes, including 1) HF / all-cause death; 2) atherosclerotic CVD (ASCVD), including nonfatal myocardial infarction, nonfatal stroke, or CV death.Results:The present study included 8,872 participants (35% women, 31% Black). Over the 3.3-year median follow-up, there were 333 (3.8%) HF / all-cause death events and 200 (2.3%) ASCVD events. Reductions in neurohormonal stress and LV mass mediated up to 15% of the reduction in risk of HF / all-cause death with intensive BP control (Table). In contrast, treatment-related changes in chronic myocardial injury and arterial stiffness did not mediate the benefits of intensive BP reduction on HF / all-cause death risk. Furthermore, changes in any subclinical CVD markers did not mediate the effect of intensive BP control on ASCVD risk (Table).Conclusions:In this post-hoc analysis of SPRINT, improvements in neurohormonal stress and LV mass, as identified by surrogate markers of hs-cTnI and CV, were important mediators of the beneficial effects of intensive BP control in reducing the risk of HF / all-cause death. Mediators of the effect of intensive vs. standard BP control for reducing HF / all-cause death differ from those for ASCVD.

Circulation, Volume 150, Issue Suppl_1, Page A4119941-A4119941, November 12, 2024. Backgrounds:Randomized controlled trials (RCTs) have demonstrated benefits of marine omega-3 polyunsaturated fatty acids (omega-3 FA) supplementation for the prevention of coronary heart disease (CHD). However, it has not been clear which individuals would benefit the most from the supplementation. We sought to predict the individual treatment effect of omega-3 FA supplementation on CHD prevention and to develop an omega-3 effect score to stratify individuals according to their expected benefit from the supplementation.Methods:Among the 25,871 randomized participants without history of CVD in the VITamin D and OmegA-3 TriaL (VITAL), we applied machine-learning (ML) approaches to predict individual treatment effect of omega-3 FA supplementation on 5-year CHD risk (a composite of myocardial infarction, coronary revascularization, and CHD death) using 11 covariates pre-specified in the VITAL trial protocol. A 10-fold cross-validation was used and held-out test dataset was used for the evaluation. An omega-3 effect score was developed such that each covariate contributed linearly, and utility of the score was further evaluated by transportability analysis using the National Health and Nutrition Examination Survey (NHANES) data as the target population.Results:Omega-3 FA intervention led to absolute 0.48% [SE: 0.20] reduction in CHD in the total population. ML algorithms effectively stratified participants by their expected benefit according to individual factors; decreased CHD risk was observed in those with quintile 1 and 2 of the expected benefit (absolute CHD risk reduction %: 1.30 % [0.55] and 1.32 % [0.51] in quintile 1 and 2, respectively). Race, diabetes, and fish intake most contributed to the omega-3 effect score. CHD incidence rates per 1000 person-year were 5.5 [0.44] if treated and 8.5 [0.55] if not treated (35.3% reduction) in individuals with the score ≥11 (upper 40th percentile), and 3.9% [0.31] if treated and 3.4% [0.55] if not treated (14.7% increase) in those with the score

Circulation, Volume 150, Issue Suppl_1, Page A4144881-A4144881, November 12, 2024. Introduction:Metabolic equivalents (METs), a measure of energy use during a specified exercise intensity, and volume of oxygen consumed (VO2) are key measurements in cardiopulmonary exercise tests (CPETs). METs are traditionally converted to VO2 via multiplying METs by 3.5 ml/kg/min when VO2 data is not available, due to the fact that the latter requires more-expensive, accurate measurements of volume of inspired and expired oxygen and CO2. However, it is unclear which populations have significant variation between peak METs and peak VO2.Research Question:In a general cardiology population, do older women have a weaker relationship between peak METs and peak VO2?Methods:We present a retrospective study analyzing the relationship of peak METs and peak VO2 achieved on a CPET. Patients presenting to the cardiology clinic who received a CPET from 2017-2022 were included. Patients with severe valvular dysfunction, congenital heart disease, prior coronary artery bypass grafting, or ejection fraction < 50% were removed to limit confounding. A Spearman correlation coefficient was calculated for the whole sample comparing peak METs and peak VO2. Subsequently, a subgroup of women age 65 or greater were compared to the general sample by a fisher’s z transformation.Results:1907 patients were included. There was a strong positive correlation between peak VO2 and peak METs in the whole sample (r(1860) = 0.914), p

Circulation, Volume 150, Issue Suppl_1, Page A4147395-A4147395, November 12, 2024. Background:Peanuts, a heart-healthy staple due to their high polyphenolic antioxidant content, contain a substantial amnount of omega 6 fatty acids. An excess of the Omega-6 polyunsaturated fatty acids (PUFAs), up regulates the body’s inflammatory pathways.The n-6 PUFA-derived lipid mediators trigger inflammation, platelet aggregation, and vasoconstriction. Omega 3 fatty acids in foods such as salmon or avocado, inhibit inflammation and platelet aggregation while enhancing vasodilation. Over consumption of omega 6 fatty acids by more than the 5-10% daily recommendation can lead to inflammatory conditions like myositis, as seen in this case presentation.Case Presentation:A 70-year-old Caucasian male presented to his primary care clinic for worsening bilateral lower extremity myalgias for the past few months. His medical history includes hypertension, non-insulin- dependent type 2 diabetes, and hyperlipidemia. He denied any trauma, strenuous exercise, myocardial infarction, or mechanical falls. His home medications were aspirin, low-dose Crestor, Pioglitazone, Janumet, and Farxiga. Radiographic imaging of the lower extremities was unremarkable. He had elevated creatinine kinase (CK) levels from 2018-2022, ranging from 300-500’s. A trial withholding the statin (Crestor), was initiated to check for improvement, but serum creatinine levels remained high. His muscle biopsy was unrevealing as well. During an office visit in 2022, the patient incidentally stated he had been eating a one-pound bag of shelled peanuts daily for the lat 4 years to improve his health. He was advised to eliminate peanuts for a month and have a follow up CK level testing.Results:The creatinine kinase levels between 2018-2022 revealed a baseline elevation until May 2022 when the patient returned for an office visit after abstaining from peanuts for a month. His CK levels not only normalized in May 2022, but also coincided with resolution of his myalgias. These results reveal the association between over consumption of omega 6 fatty acids as a trigger for myositis.Conclusion:The patient was educated on the detrimental health effects from over consumption of omega 6 fatty acids and the importance of moderation in the diet. This case illustrates the link between omega-6 fatty acid as a precursor to inflammatory disease. The patient’s peanut consumption being the culprit of his myositis also highlights the importance of good history taking and exploring diet as a conduit to disease management.

Circulation, Volume 150, Issue Suppl_1, Page A4144382-A4144382, November 12, 2024. Background:Left atrial fibrosis has been shown to be associated with atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). The optimal way to target atrial fibrosis has not been determined still.Purpose:The aim of this study is to determine whether left atrial fibrosis, as detected by late gadolinium enhancement MRI (LGE-MRI), should be covered, encircled, or both, in addition to PVI, to improve ablation success in patients with persistent AF.Methods:We conducted an analysis of DECAAF II participants who were randomized to the PVI plus MRI-guided atrial fibrosis ablation arm. These patients underwent late-gadolinium enhancement MRI (LGE-MRI) before and after AF ablation. Left atrial ablation lesions were collected from intra-procedural electro-anatomical maps and were superposed on 3D left atrial MRI images of fibrosis. We divided the patients into three groups based on whether atrial fibrosis was covered, encircled, or both. After ablation, patients were instructed to provide single-lead smartphone-based ECG strips once daily and following symptoms based on which AF burden and recurrence after ablation was assessed. Uni- and multivariable regression models were developed to assess the association of the technique used with time-to-atrial arrhythmia recurrence.Results:393 patients were included in our analyses. At baseline, patients were similar in comorbidity burden, age, sex, and left atrial volume. However, baseline fibrosis was different amongst the groups (19% vs 18% vs 20%; p-value=0.02). LA volume decrease was higher when atrial fibrosis was both encircled and covered simultaneously (31 mm3 vs 21 mm3 vs 23 mm3; p= 0.006). The primary outcome of atrial arrhythmia recurrence was similar among all the groups as shown in figure A (p=0.17). Even after controlling for possible confounders such as age, body mass index, sex, comorbidities, left atrial volume index, and baseline fibrosis, the technique used to target atrial fibrosis was not associated with recurrence (p=0.07). Moreover, AF burden in the follow-up period was not different across the patient groups as shown in figure B (p=0.63).Conclusion:Among patients with persistent AF, neither covering nor encircling atrial fibrosis in addition to PVI affected atrial arrhythmia recurrence after catheter ablation. More studies should be done to optimize atrial fibrosis targeting and modification.

Circulation, Volume 150, Issue Suppl_1, Page A4137009-A4137009, November 12, 2024. Background:The Danish German Cardiogenic Shock trial (DanGer Shock) recently showed a reduction in all-cause mortality when treating selected patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock with a microaxial flow pump (mAFP). Whether there is an age-related differential survival benefit is unknown.Objective:To assess the influence of age on 180-day all-cause mortality in patients with STEMI and cardiogenic shock randomized in DanGer Shock.Methods:In DanGer Shock (an open-label, international, multicenter trial), 355 adult patients (aged ≥18 years with no upper age limit) with STEMI and cardiogenic shock were included and randomized to a mAFP (Impella CP) plus standard care or standard care alone. Patients were stratified in quartiles according to age, and logistic regression analyses were used to assess mortality according to age quartiles, and to evaluate whether age modified the treatment effect of the mAFP.Results:From lowest to highest quartile, patients’ ages ranged from 31-59, 60-69, 70-76, and 77-92, respectively. There were no differences in blood pressure, lactate level, left ventricular ejection fraction and shock severity across age groups. However, the proportion of females (41%) and the prevalence of hypertension (64%) was higher in patients aged ≥77 years (highest quartile), while more patients aged

Circulation, Volume 150, Issue Suppl_1, Page A4136462-A4136462, November 12, 2024. Background:Coronary Artery Calcium (CAC) scoring is critical in assessing Atherosclerotic Cardiovascular Disease (ASCVD) risk. Despite its utility, many primary care physicians lack confidence and familiarity with its application. Significant racial disparities in CAC scoring utilization have been observed, potentially affecting patient outcomes.Hypothesis:We hypothesized that a short targeted educational intervention would enhance physicians’ confidence, knowledge, and utilization of CAC scoring and awareness of racial disparities.Methods:A pre- and post-intervention study (Image 1) was conducted among 39 physicians at the University of Louisville. The intervention included a 20-minute educational session on CAC scoring and racial disparities. A video summarizing the ACC2018 guidelines for prevention and cholesterol treatment was provided. A summary of key points for clinical practice was given. The ASCVD plus calculator app was provided. Data were collected using a structured questionnaire before and after the intervention. Viewing time and engagement were recorded. Descriptive and inferential statistics analyzed the data.Results:The average correct physician responses increased from a mean of 59.5% pre-intervention to 92.0% post-intervention. Post-intervention, the number of physicians who felt confident or very confident in CAC testing increased from 17.9% to 94.8%. Additionally, 33 out of 39 physicians (84.6%) reported likely to use CAC testing more frequently. Correct responses on racial disparities improved from 59% pre-intervention to 92.0% post-intervention. (Image 2). The average viewing time was 28 minutes. Time spent on the questionnaires was 14 min pre and 12 min post.Conclusion:Our targeted educational intervention significantly enhanced physicians’ knowledge and confidence in CAC scoring for ASCVD risk assessment and raised awareness about racial disparities, promoting more equitable practices.

Circulation, Volume 150, Issue Suppl_1, Page A4147960-A4147960, November 12, 2024. Introduction:Blood pressure targets for the elderly are still controversial, there is a lack of certainty about the benefit and safety of targeting ≤ 130mmHg systolic blood pressure. Evaluate the benefit in important cardiovascular outcomes and safety in elderly patients of a blood pressure control ≤ 130mmHg compared to standard of care.Methods:The research was performed in PubMed, EMBASE, Scielo, LILACS, and Cochrane Central Register of Controlled Trials (CENTRAL) from January 1st, 2013 to May 1st, 2023. Randomized controlled trials that were published between January 1st, 2013 and May 1st, 2023 that included hypertensive patients over 60 years old which reported major adverse cardiovascular outcomes (MACE) or all-cause mortality, cardiovascular mortality and safety outcomes were selected. The data extraction was performed independently by two investigators following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A meta-analysis was performed using a fixed-effect model. The results were reported as the pooled results using risk ratio (RR) and a confidence interval (CI) of 95%.Results:The 4 trials included a number of 16,834 patients, the mean age was over 65 years, there was a good balance between genders, 13.3% of patients had cardiovascular disease, 10.9% diabetes, and 15.5% chronic kidney disease. The mean achieved blood pressure was roughly under 130mmHg, only one study was over (135mmHg) and the mean follow-up time was over 32 months. The intensive therapy decreased the outcomes for mortality (RR = 0.75, 95% CI 0.64 – 0.87, p

Circulation, Volume 150, Issue Suppl_1, Page A4125939-A4125939, November 12, 2024. Background:Prophylactic steroids are often used to reduce the systemic inflammatory response to cardiopulmonary bypass in infants undergoing heart surgery. The STRESS trial found that the likelihood of a worse outcome did not differ between infants randomized to methylprednisolone vs placebo in a risk-adjusted primary analysis (adjusted odds ratio [OR], 0.86; 95% CI, 0.71 to 1.05; P=0.14). However, secondary unadjusted analyses showed possible benefits with methylprednisolone. We re-analyzed the STRESS trial using Bayesian analytics to assess probability of benefit with methylprednisolone.Methods:We used a covariate-adjusted proportional odds model using the original STRESS trial model covariates and primary outcome (a ranked composite of death, transplant, major complications and post-op length of stay). We assessed effect thresholds from OR 0.6 to 1.25 (OR 1 conveys harm). We assumed a neutral probability of benefit vs harm with weak prior belief (SD of the normal prior distribution = 0.425). In sensitivity analyses, we evaluated pessimistic (5%-30% prior likelihood of benefit), neutral and optimistic (70%-95% prior likelihood of benefit) prior beliefs, and controlled strength of prior belief as weak (SD = 0.425), moderate (SD = 0.215) and strong (SD = 0.135). We compared posterior distribution of the OR under these priors with the reference results under the vague prior distribution. Analyses consisted of 10 Markov Chain Monte Carlo simulations each consisting of 2000 iterations with a 1000 iteration burn-in to ensure proper posterior convergence.Results:In primary analysis, the posterior probability of benefit from methylprednisolone was 92% and the probability of harm was 8%. The mean absolute benefit was 12%. In sensitivity analyses, the probability of benefit was ≥ 79% for all informative priors except the most pessimistic (Table/Figure).Conclusion:In Bayesian re-analysis of the STRESS trial, probability of benefit with prophylactic methylprednisolone is high and harm is unlikely. Assessing probability of benefit or harm may be more informative than frequentist analytics relying on a p-value threshold. Another advantage is the ability to consider a range of prior evidence.

Circulation, Volume 150, Issue Suppl_1, Page A4144226-A4144226, November 12, 2024. Background and Objectives:Neonatal cardiac surgery requires careful consideration of cardiopulmonary bypass (CPB) priming fluid composition due to small blood volume and immature physiology. This study investigated the impact of allogeneic stored red blood cells (RBCs) processed using an autotransfusion system in CPB priming fluid for neonates.Materials and Methods:We compared perioperative parameters, inflammatory mediators, coagulation indicators, vasoactive-inotropic score (VIS), and clinical outcomes between neonates receiving unwashed (n=56) and washed (n=45) RBCs in CPB priming fluid. Regression models were used to assess the independent association between RBC washing and patient outcomes.Results:The autotransfusion system improved stored RBC quality. The washed group showed higher peak hematocrit (P < 0.01) and hemoglobin levels (P = 0.04) during CPB, an increased oxygen delivery index during rewarming (P < 0.05), and lower postoperative lactate levels and VIS (P < 0.05).Inflammatory (IL-6, IL-8, IL-10) and coagulation parameters (DD, FIB, FDP) fluctuated compared to baseline but did not significantly differ between groups. The washed group had a lower incidence of hyperlactacidemia and delayed sternal closure at CPB weaning.Conclusions:Adding washed allogeneic stored RBCs to neonatal CPB priming fluid reduced postoperative lactate elevation and VIS without early improvement in the inflammatory and coagulation systems.

Introduction
Evidence suggests that sedentary behaviour (SB) and physical activity (PA) are important indicators of well-being and quality of life in older adults (OAs). However, OAs are the least active and highly sedentary of all the age groups. The present study intends to examine the feasibility of a wearable gadget to remind users to break sitting time (by standing up and moving more), coupled with a brief health coaching session, pamphlet and reminder messages to decrease SB and improve PA.

Methods and analysis
This study will employ a multi-methods approach that generates quantitative data from questionnaires and qualitative data from semi-structured interviews following OAs’ involvement in the study. This intervention will be informed by the socio-ecological model (SEM) and the habit formation model. The quantitative and qualitative data will be analysed separately and then integrated for interpretation and reporting, which will assist our knowledge of the feasibility of the programme.

Ethics and dissemination
Ethical approval for this study has been obtained from Swansea University (NM_ 2023 6667 6123). Informed consent will be obtained from participants. The findings of the study will be disseminated to the scientific community through conference presentations and scientific publications. The findings of the current study will determine the suitability of a future effectiveness trial.

Trial registration number
NCT06407557.

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