Risultati per: Il dolore neuropatico: review

Circulation, Volume 150, Issue Suppl_1, Page A4138662-A4138662, November 12, 2024. Background:While mineralocorticoid antagonists (MRA) reduce mortality in patients developing heart failure post myocardial infarction (MI), it is unclear whether they are beneficial in an unselected post-MI population.Aims:Using a systematic review and meta-analysis, we aim to determine the effect of MRA treatment versus no MRA treatment on all-cause mortality in unselected post-MI patients from randomized data, simultaneously with the presentation of the largest randomized controlled trial on the topic, the CLEAR SYNERGY trial.Methods/Approach:We completed a systematic review of all randomized controlled trials comparing MRA treatment to no MRA treatment in post-MI patients. We will perform our primary analysis using fixed effects with the Peto odds ratio method and use random effects as a sensitivity analysis. The primary outcome will be all-cause mortality, and secondary outcomes will include cardiovascular mortality, new or worsening heart failure, recurrent myocardial infarction and stroke.Results/Data:Our systematic review of Pubmed, Embase, and CENTRAL from inception until April 30, 2024, yielded 456 records. A total of 11,199 participants from 11 randomized clinical trials will be included in addition to the late-breaking CLEAR SYNERGY trial. The CLEAR SYNERGY trial is a 2 x 2 factorial randomized controlled trial of low-dose colchicine 0.5mg daily versus placebo and spironolactone 25mg daily versus placebo in 7,062 post-MI patients who were within 72h of the index percutaneous coronary intervention. The results of the spironolactone factorial will be presented in the fall of 2024 with an expected median follow-up of 3.5 years. As the investigators of the CLEAR SYNERGY trial, we will combine our data with the other 11 trials for a total of 12 trials and 18,261 participants.Conclusions:CLEAR SYNERGY is the largest randomized controlled trial with the longest follow-up of spironolactone in the post-MI population. Our meta-analysis will provide updated effect estimates of post-MI MRA treatment, leveraging the late-breaking CLEAR SYNERGY data to reflect the totality of the evidence.

Circulation, Volume 150, Issue Suppl_1, Page A4140224-A4140224, November 12, 2024. Background:In recent years, there has been a rise in the adoption of conservative approaches to managing patent ductus arteriosus (PDA) in preterm infants. Systematic appraisal of the clinical evidence supporting this approach is essential for guiding recommendations in clinical guidelines.Methods:A comprehensive search of MEDLINE (PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov, spanning from inception to April 2024, was conducted to identify all relevant randomized controlled trials (RCTs) that evaluated conservative management of patent ductus arteriosus (PDA) in preterm infants. Conservative management was defined as approximately ≤25% open-label pharmacological treatment with ibuprofen, indomethacin, or paracetamol and/or ligation/endovascular closure. Our primary outcomes were the risk of all-cause mortality and bronchopulmonary dysplasia. We used RevMan 5.4 to pool risk ratios (RRs) under a random-effects model, ensuring a rigorous and reliable analysis.Results:Our review included 6 RCTs. There was no difference in the risk of mortality (RR 0.83; 95% CI: 0.64-1.08, I2= 0%) and BPD (RR 0.89; 95% CI: 0.76-1.03, I2= 22%) between the conservative management and active treatment groups. The rates of necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, sepsis, pulmonary hemorrhage, and the need for surgical ligation or transcatheter occlusion were similar between the two groups.Conclusions:The meta-analysis showed no difference in the risk of all-cause mortality, BPD, or other clinical outcomes between a strategy of conservative management compared to active treatment. These findings support a conservative approach for the management of PDA in preterm infants. Future studies should focus on cost-effectiveness analyses between the two approaches and investigate important subgroups, such as extremely preterm births.

Circulation, Volume 150, Issue Suppl_1, Page A4135791-A4135791, November 12, 2024. Background:While non-vitamin K antagonist oral anticoagulants (NOACs) are more effective than single antiplatelets (mostly low-dose aspirin) at reducing stroke risk in patients with atrial fibrillation (AF), differences in bleeding risk between NOACs and single-dose antiplatelets across various populations remain unclear.Aim:We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing bleeding outcomes of NOACs versus single antiplatelet therapy.Methods:We searched MEDLINE, EMBASE, and CENTRAL to June 2024 for RCTs that compared NOAC (therapeutic doses used for stroke prevention in AF patients) versus single antiplatelet therapy for a treatment duration of ≥3 months. For the meta-analyses, we used fixed-effects models and reported results as summary risk ratios (RRs). We used Risk of Bias 2 and GRADE to assess the quality and certainty of the evidence.Results:Eight RCTs with 26,194 participants were included. Mean follow-up time was 18 (±13) months. NOACs included in the studies were apixaban (4 studies), rivaroxaban (2 studies), and dabigatran (2 studies). All studies used low-dose aspirin as the comparator. When compared to aspirin, NOACs had a higher risk of major bleeding (326/13107 [2.5%] vs. 239/13087 [1.8%] events; RR 1.36 95% CI 1.15-1.60, I2=52%, 8 trials; high certainty) (Figure A), gastrointestinal bleeding (104/8803 [1.2%] vs. 74/8788 [0.8%] events; RR 1.39; 95%CI, 1.04-1.87; I2=0%; 5 trials; high certainty), and clinically relevant non-major bleeding (318/10397 [3.1%] vs. 230/10395 [2.2%] events; RR 1.38; 95%CI, 1.17-1.63; I2=16%; 5 trials; high certainty). There was no difference in the risk of intracranial hemorrhage (88/13107 [0.7%] vs. 84/13087 [0.6%] events; RR 1.04, 95%CI 0.78-1.41; I2=48%; 9 trials; high certainty) (Figure B) nor fatal bleeding (22/12412 [0.2%] vs. 28/12392 [0.2%] events; RR 0.78; 95%CI, 0.45-1.36; I2=8%; 6 trials; high certainty).Conclusion:When compared to aspirin, NOACs are associated with an increased risk of major bleeding and clinically relevant non-major bleeding, but not intracranial hemorrhage. These data are important to inform patients about the risks of antithrombotic treatment.

Circulation, Volume 150, Issue Suppl_1, Page A4144136-A4144136, November 12, 2024. Background:Elevated fasting serum triglyceride (TG) levels are linked to an increased risk of cardiovascular disease. Olezarsen is an inhibitor of apolipoprotein C3 (apo-C3) production with a potential to decrease TG levels and thereby, reduce the risk of cardiovascular disease.Research Question:Is olezarsen efficacious and safe in reducing the TG levels?Aim:This meta-analysis aims to evaluate the efficacy and safety of olezarsen in patients with hypertriglyceridemia.Methods:A literature search was carried out on Medline, Embase, Google Scholar, Cochrane CENTRAL, Scopus, and clinicaltrials.gov. Only randomized controlled trials (RCTs), including adult patients with hypertriglyceridemia and treated with olezarsen, were included. The primary outcome assessed was the mean change in the level of TG, whereas the secondary outcomes were changes in the apo-C3, apo-B48, and non-HDL cholesterol levels at the end of the 6-month follow-up period. Various adverse events were also assessed. Review Manager 5.4 was used to calculate standardized mean differences (SMD) with 95% confidence intervals (95% CIs) using a random effects model.Results:Three RCTs involving 334 patients in total, with 248 receiving olezarsen and 86 receiving placebo, were included. The analysis revealed that at the end of the follow up period, there was a significant change in the levels of TG (SMD -52.04, 95%CI: -64.55 to -39.52; p

Circulation, Volume 150, Issue Suppl_1, Page A4125679-A4125679, November 12, 2024. Introduction:Gender minority (GM; e.g., transgender, non-binary) adults have a higher prevalence of cardiovascular disease (CVD) than their cisgender (i.e., non-transgender) counterparts. Physical activity (PA) is associated with a lower risk of CVD and all-cause mortality. Compared to cisgender adults, GM adults face unique challenges (e.g., discrimination, lack of safe spaces) to meeting aerobic and muscle-strengthening PA recommendations, which may negatively impact their overall health and well-being. There is also limited evidence on factors associated with lower PA among GM adults.Goal:To understand differences in the prevalence of PA between GM and cisgender adults and to identify factors associated with PA among GM adults.Methods:Following the PRISMA guidelines, we performed a comprehensive search using five databases (PubMed, Embase, Web of Since, CINAHL, and Scopus). We included peer-reviewed, English-language, quantitative empirical studies focused on PA among GM adults published between 2004 and 2024. We excluded qualitative studies, reviews, editorials, conference abstracts, and grey literature. We performed quality appraisal using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies.Results:A total of 5,163 articles were retrieved and 24 met inclusion criteria. The included studies had a low to moderate risk of bias. Methodological weaknesses of the included studies were an overreliance on self-reported PA with no objective assessment using accelerometry, use of non-validated PA measures, and limited assessment of muscle-strengthening PA. Most studies (n = 15) reported lower aerobic and muscle-strengthening PA among GM adults compared to their cisgender counterparts. Two studies found that GM adults with higher perceived psychological stress reported lower PA. One study found that GM adults who were on gender-affirming hormone therapy reported higher PA than GM adults who were not.Conclusions:Findings highlight that GM adults report lower aerobic and muscle-strengthening PA than cisgender adults. There is a need for more comprehensive research to understand these disparities and their impact on GM adults’ cardiovascular health. This systematic review can inform future research and the development of tailored interventions to increase PA among GM adults.

Circulation, Volume 150, Issue Suppl_1, Page A4146402-A4146402, November 12, 2024. Background:Previous clinical trials demonstrated the efficacy of beta-blockers (BB) after myocardial infarction (MI). However, the effects and safety of BB in patients with chronic obstructive pulmonary disease(COPD) after MI remain a mystery. Therefore, we conducted a systematic review and meta-analysis evaluating beta-blocker use after MI in patients with COPD.Methods:We performed a systematic review and meta-analysis of observational studies that included patients with COPD who received BB after an episode of MI. We searched through Pubmed, Cochrane, and Embase databases. Our primary efficacy outcome was (1) all-cause mortality, and our safety outcome was (2) COPD-related and respiratory adverse events. In our secondary analysis, we evaluated all-cause mortality in patients with a prior history of heart failure (HF). Statistical analysis was done using R Studio 4.3.2.Results:A total of 6 studies were included, encompassing 41840 patients, of whom 16561 (39.5%) were in the beta-blocker group. Most of the participants were male (65%) and the mean follow-up was 5.1 years. In the pooled analysis, all-cause mortality was significantly lower in the BB group (HR 0.81; 95% CI 0.66, 0.98; p = 0.03, Fig 1A). Our secondary analysis in the HF subgroup also showed a significant risk reduction in all-cause mortality(HR 0.80; 95% CI 0.66, 0.97; p = 0.02, Fig 1B.) Regarding COPD-related and respiratory adverse events, the analysis demonstrated a significantly lower incidence in the BB group (HR 0.79; 95% CI 0.74, 0.83; p

Circulation, Volume 150, Issue Suppl_1, Page A4148117-A4148117, November 12, 2024. Background:Tricuspid regurgitation (TR) is a prevalent disease in the population and is usually progressive. Most patients are treated with conservative management due to the risk involving transcatheter tricuspid valve replacement (TTVR) and surgical tricuspid valve replacement (STVR). The TRI-SCORE was developed to evaluate the severity of patients with TR and their risk of undergoing a correction procedure. However, there is still controversy regarding the cutoff value of the score. Therefore, we aim to perform a systematic review and meta-analysis comparing the cutoffs ≥6 with =6 with

Circulation, Volume 150, Issue Suppl_1, Page A4144674-A4144674, November 12, 2024. Introduction:While right ventricular pacing (RVP) is the conventional temporary pacing modality used for transcatheter aortic valve replacement (TAVR), this approach possesses inherent risks and procedural challenges. We aim to assess and compare safety and efficacy of left ventricular pacing (LVP) and RVP during TAVR and balloon aortic valvuloplasty (BAV).Methods:Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted in four databases from inception to December 15th, 2023. We included observational studies and clinical trials comparing LVP with RVP during TAVR and BAV procedures. The risk ratio (RR) with a 95% confidence interval (CI) was used to compare dichotomous outcomes, while continuous outcomes were reported in form of mean difference (MD).Results:Five studies involving 830 patients with RVP and 1577 with LVP were included. Short-term mortality was significantly higher in the RVP group (RR 2.32, 95% CI: [1.37-3.93], P = 0.002), as was the incidence of cardiac tamponade (RR 2.19, 95% CI: [1.11-4.32], P = 0.02). Subgroup analysis of the TAVR studies only revealed similar trends with higher short-term mortality in the RVP group (RR 1.99, 95% CI: [1.13-3.51], P-value = 0.02). LVP demonstrated shorter hospital stays (MD = 1.34 d, 95% CI: [0.90, 1.78], P

Circulation, Volume 150, Issue Suppl_1, Page A4143622-A4143622, November 12, 2024. Introduction:Obesity-related heart failure in patients is often associated with high symptom burden. However, no treatments have been proven to specifically target obesity-related heart failure with preserved ejection fraction (HfpEF).Objective:The objective of this study is to evaluate the efficacy of semaglutide in patients with obesity and HfpEF.Methods:The study was by the PRISMA guidelines. Studies reporting endpoints of semaglutide in patients with obesity and HfpEF were included. The outcomes included percentage weight change and adjudicated heart failure events. Both random and common effects models were used for the data analysis. The random intercept logistic regression model was used to compute the proportions, and the Peto method was used to compute the odds ratios. A p-value ≤ 0.05 was considered significant.Results:In total, three studies with 1463 patients with obesity and HfpEF were included in the study. The mean age of the patients was 68.8 ± 3.47 years. 50.7% of the patients were females. Patients who received Semaglutide had statistically higher odds of 10% weight reduction (OR 6.35; 1.54-26.21; p

Circulation, Volume 150, Issue Suppl_1, Page A4148133-A4148133, November 12, 2024. Background:Left ventricular assist devices (LVADs) are crucial for the management of advanced heart failure patients acting, both as a bridge to heart transplant or destination therapy. Existing studies revealed mixed results on the impact of pre-implant left ventricular end-diastolic diameter (LVEDD) on post-LVAD mortality. Some studies found smaller LVEDD increases mortality, while others revealed no significant impact. Due to the limited evidence, this meta-analysis aims to determine the association between pre-LVEDD and post-LVAD implantation mortality through a systematic review and meta-analysis.Method:We systematically reviewed articles until May 2024 examining the association between pre-implant LVEDD and post-LVAD implantation mortality using PubMed, Google Scholar, Embase, and Scopus. A random effects model was used to calculate the pooled adjusted odds ratio (aOR). We used I2statistics to determine the heterogeneity of studies. Leave-one-out sensitivity analysis was done to evaluate each study’s effect on the overall estimate, with statistical significance set at p

Circulation, Volume 150, Issue Suppl_1, Page A4147717-A4147717, November 12, 2024. Background:SGLT2 inhibitors have demonstrated efficacy in reducing cardiovascular death and hospitalization and are recommended as first-line therapy for hear failure (HF) in adults due to acquired heart diseases. Our study aimed to assess the safety, tolerability, and outcomes of HF patients with adult congenital heart disease (ACHD) treated with SGLT2 inhibitors.Methods:We conducted a comprehensive search of three major databases—PubMed, Scopus, and Embase—and collected articles on the use of SGLT2 inhibitors for HF in ACHD patients who were already receiving angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), angiotensin receptor neprilysin inhibitors (ARNI), beta-blockers (BB), and mineralocorticoid antagonists (MRA). We excluded articles related to acute decompensated HF and HF with preserved ejection fraction. The primary outcome was the change in NYHA functional class (FC). Secondary outcomes included changes in B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) levels, as well as body weight. Additionally, we evaluated the safety and tolerability of SGLT2 inhibitors in ACHD HF patients. A pooled effect size was calculated based on mean differences (MD) or log odds ratio (LogOR).Results:Our meta-analysis included 9 studies with a total of 287 patients aged 19 to 67 (median 37.5 years) (Table). When SGLT2 inhibitors were added to combined therapies, they significantly improved NYHA FC (LogOR: 1.3, 95% CI: 0.37–2.23, p=0.01) (Figure 1A), decreased NT-proBNP (MD -0.43, 95% CI -0.70 to -0.16, p=0.00) (Figure 1B), were associated with a reduction in systolic blood pressure (MD = -0.32, 95% CI: -0.51 to 0.14, p=0.00) (Figure 1C), and led to an elevation of creatinine (Cr) levels (MD = 0.18, 95% CI -0.0 to 0.36, p=0.06) (Figure 1D). Only 4 patients experienced urinary tract infections (UTIs), and none had hypoglycemia or ketoacidosis.Conclusion:Our meta-analysis demonstrates that SGLT2 inhibitors improve NYHA FC, decrease NT-proBNP, and are well-tolerated with safety features similar to adult HF clinical trials when added to combination HF therapies including ACEI/ARB/ARNI, BB and MRA. Future prospective studies are needed to assess long-term clinical outcomes in ACHD patients with HF.

Circulation, Volume 150, Issue Suppl_1, Page A4138277-A4138277, November 12, 2024. Background:Bleeding risk is a major concern for patients receiving transcatheter aortic valve implantation (TAVI) due to heparin use. In recent studies, Heparin antagonists, such as protamine, have shown potential in mitigating this complication. We aim to evaluate its potential role in reducing the risk of bleeding in patients post-TAVI.MethodsOn March 18, 2024, related articles were searched in the following databases: PubMed, Embase, Scopus, Web of Science, Cochrane Library, Wiley Library, VHL, Google Scholar, and clinicaltrials.gov. The inclusion criteria consisted of studies that reported the use of protamine in patients who underwent TAVI, with the aim of reducing bleeding risk compared to administering a placebo or no treatment. Our primary outcomes included major bleeding, life-threatening bleeding, the need for blood transfusion, the 30-day mortality rate, and any events of stroke or transient ischemic attack (TIA). The effect size was calculated using the odds ratio with a 95% confidence interval. Meta-analysis was conducted based on random-effect model using Revman.ResultsOut of the 14,705 articles we obtained, only 5 papers were included. One was a randomized controlled trial; the remaining 4 were observational cohorts with control groups. These studies comprised a total of 3,502 patients. Protamine significantly reduced major bleeding (OR 0.44, 95% CI 0.29-0.69, p = 0.0003, I2= 37%), especially with full-dose administration (1 mg/100 U UFH) compared to partial-dose administration (0.5 mg/100 U UFH) (OR 0.38, 95% CI 0.25-0.58, p < 0.00001, I2= 0%). Similarly, protamine significantly reduced life-threatening bleeding (OR 0.37, 95% CI 0.20-0.67, p = 0.001, I2= 4%), particularly with full-dose usage compared to partial-dose (OR 0.37, 95% CI 0.18-0.73, p = 0.004, I2= 0%). However, no significant difference was observed in the need for blood transfusion (OR 0.75, 95% CI 0.46-1.24, p = 0.27, I2= 33%), stroke/TIA risk (OR 0.82, 95% CI 0.41-1.61, p = 0.56, I2= 49%), or 30-day mortality (OR 0.93, 95% CI 0.62-1.39, p = 0.73, I2= 0%).ConclusionsThe use of protamine appears to significantly reduce major and life-threatening bleeding. The need for blood transfusion, risk of stroke or TIA, and 30-day mortality did not show significant differences. These findings suggest that protamine may be an effective intervention for reducing bleeding complications post-TAVI. However, large randomized controlled trials are needed to validate these findings.

Circulation, Volume 150, Issue Suppl_1, Page A4131409-A4131409, November 12, 2024. Angiotensin Receptor Nephrilysin Inhibitors (ARNi) have been established as a beneficial medication in patients with heart failure (HF). This class of medications has been shown to decrease HF hospitalizations and has been included as one of the pillars in guideline directed medical therapy. Recently, left ventricular (LV) global longitudinal strain (GLS) measurements on echocardiograms have become more common and provide a more precise measurement of LV function than ejection fraction. GLS is now being used as a more intricate way of monitoring improvement in the function of the myocardium, especially in patients with heart failure. This meta-analysis was conducted to determine if treatment with ARNi in HF patients significantly improves myocardial functioning measured by LV GLS.A meta-analysis of 9 studies including observational studies and randomized controlled trials found in a Pubmed search was performed and included patients with heart failure who were initiated on an ARNi for guideline directed medical therapy and had LV GLS measurements taken on an echocardiogram before and after ARNi initiation. The study included patients with heart failure with reduced ejection fraction. Studies were excluded if the patient population did not have a diagnosis of HF and if LV GLS measurements were not available before and after treatment with ARNi. This analysis was performed to determine if initiation of ARNi in patients with HF led to a significant improvement in LV GLS on echocardiography and therefore a significant improvement in myocardial function.There were 9 studies included in the analysis and 879 patients with HF who were treated with ARNi or a control. The change in LV GLS at the conclusion of the study period was measured in both treatment and control groups and the mean difference between the two groups was -1.61 with a 95% confidence interval of (-2.23, -0.98) (p

Circulation, Volume 150, Issue Suppl_1, Page A4142104-A4142104, November 12, 2024. Objective:This systematic review and meta-analysis aimed to compare the incidence of ischemic stroke and Transient ischemic attack (TIA) post-transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in intermediate or high surgical risk patients with aortic stenosis, as this assessment may influence the choice of intervention.Methods:In accordance with PRISMA guidelines, we conducted a comprehensive search of PubMed, Google Scholar, and Cochrane CENTRAL databases from inception to December 2023 to identify trials and observational studies comparing the incidence of stroke and TIA after 30 days and 1-year post-TAVR vs SAVR from their inception through December 2023. Odds ratios (ORs) with 95% confidence intervals (CIs) for each study, employing a random-effects model for data synthesis irrespective of heterogeneity, were utilized as measures of outcomes. Heterogeneity was assessed using I2 statistics. All statistical analyses were conducted using Review Manager (Rev Man, Version 5.4; The Cochrane Collaboration, Copenhagen, Denmark).Results:After screening of 4549 articles, eight randomized controlled trial studies consisting of 5 randomized controlled trials and three observational studies with a total of 6879 patients were included in this meta-analysis; six studies comparing 30-day stroke incidence, no significant difference was found between TAVR and SAVR (OR 0.83, 95% CI 0.59 to 1.17, p=0.30, I2 3%). Seven studies showed that TAVR patients had a similar 1-year stroke risk to SAVR patients (OR 0.92, 95% CI 0.64 to 1.33, p=0.67, I2 52%). In the TIA case, there was no evidence of a significant difference between TAVR and SAVR in the risk of having a transient ischemic attack within 30 days following surgery (OR 0.93, 95% CI 0.24 to 3.63, p=0.92, I2 52%), although There was a greater 1-year risk of having a transient ischemic attack in the TAVR group compared to the SAVR group, OR 1.15 (95% CI 0.72 to 1.82, p=0.56, I2 0%), however, this was not a statistically significant difference.Conclusion:Our meta-analysis showed no significant differences in either ischemic stroke or TIA occurrences within 30 days and 1-year post TAVR and post SAVR in intermediate or high surgical risk patients.

Circulation, Volume 150, Issue Suppl_1, Page A4146753-A4146753, November 12, 2024. Background:The role of digital health interventions (DHI) in addition to usual care (UC) in patients discharged after an acute coronary syndrome (ACS) remains uncertain.Hypothesis:DHI improves medication adherence, and systolic blood pressure (BP) control and reduces mortality in patients after an ACS.Purpose:To ascertain the efficacy of adding DHI to UC in patients discharged after an ACS through a systematic review and meta-analysis.Methods:We systematically searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) comparing DHI plus UC versus UC alone in patients discharged after an ACS. We pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for binary and continuous outcomes, respectively. Our outcomes of interest were medication adherence (as per the studies’ definitions), all-cause mortality, and systolic BP. Statistical analyses were performed using R software version 4.4.0.Results:We included 22 RCTs comprising 20,587 patients, of whom 14,079 (68.4%) were randomized to DHI + UC. The mean age was 59.5 years and 58.5% were male. About 15% had diabetes mellitus at baseline while 54% had hypertension. In the pooled analysis, DHI plus UC significantly increased medication adherence (RR 1.06; 95% CI 1.01 to 1.13; p=0.03; Fig. 1) and reduced systolic BP (MD -3.16 mmHg; 95% CI -5.53 to -0.79; p

Circulation, Volume 150, Issue Suppl_1, Page A4136358-A4136358, November 12, 2024. Background:Electrocardiography (ECG) stands as the gold standard for the evaluation of cardiac arrhythmias. Recent smartwatches aim to promptly detect rhythm abnormalities enhancing user experience. However, the accuracy of these devices remains controversial. Our purpose was to perform a systematic review and meta-analysis evaluating the diagnostic performance of the Apple Watch electrocardiogram in detecting atrial fibrillation (AF).Methods:The literature search was conducted on PubMed, Embase, and Cochrane through April, 2024 for studies comparing the diagnostic accuracy of Apple Watch to standard 12 Lead ECG. Statistical analysis was performed using R Software version 4.4.0. Pooled analyses of sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were determined along with their 95% confidence intervals (CI). The quality of studies was analyzed using the QUADAS-2 tool.Results:The meta-analysis included 11 studies comprising 13,490 participants. Their mean age was 62.56 ± 3.92 years and 28% of the population were females. The pooled sensitivity and specificity of Apple Watch for detecting AF was 94.8% (95% CI 91.7 – 96.8%) and 95% (95% CI 88.6 – 97.8%) respectively. The AUC was 0.96 (95% CI 0.92 – 0.97; Figure 1). Sensitivity analysis for heterogeneity revealed no significant change in values for sensitivity 94.8% (95% CI 91.7-96.8%) and specificity 94.9% (95% CI 88.6-97.8%). The studies had a low risk of bias in Index test and reference standard domains, but a high risk of bias in patient selection and Flow and timing domains.Conclusion:The Apple Watch ECG shows a high accuracy in detecting atrial fibrillation, providing a convenient and timely option for such patients.