Risultati per: Passo 12. Ripulire in modo mirato le cartelle cliniche degli assisiti

Iniziativa benefica high-tech mercoledì in Vaticano

Introduction
Despite the availability of a safe and effective measles vaccine in Ethiopia, the country has experienced recurrent and significant measles outbreaks, with a nearly fivefold increase in confirmed cases from 2021 to 2023. The WHO has identified being unvaccinated against measles as a major factor driving this resurgence of cases and deaths. Consequently, this study aimed to apply robust machine learning algorithms to predict the key factors contributing to measles vaccination dropout.

Methods
This study utilised data from the 2016 Ethiopian Demographic and Health Survey to evaluate measles vaccination dropout. Eight supervised machine learning algorithms were implemented: eXtreme Gradient Boosting (XGBoost), Random Forest, Gradient Boosting, Support Vector Machine, Decision Tree, Naïve Bayes, K-Nearest Neighbours and Logistic Regression. Data preprocessing and model development were performed using R language V.4.2.1. The predictive models were evaluated using accuracy, precision, recall, F1-score and area under the curve (AUC). Unlike previous studies, this research utilised Shapley values to interpret individual predictions made by the top-performing machine learning model.

Results
The XGBoost algorithm surpassed all classifiers in predicting measles vaccination dropout (Accuracy and AUC values of 73.9% and 0.813, respectively). The Shapley Beeswarm plot displayed how each feature influenced the best model’s predictions. The model predicted that the younger mother’s age, religion-Jehovah/Adventist, husband with no and mother with primary education, unemployment of the mother, residence in the Oromia and Somali regions, large family size and older paternal age have a strong positive impact on the measles vaccination dropout.

Conclusion
The measles dropout rate in the country exceeded the recommended threshold of

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Circulation, Volume 150, Issue Suppl_1, Page A4145890-A4145890, November 12, 2024. Background:Catheter ablation (CA) is a well-established treatment for atrial fibrillation (AF). The most popular current methods of CA include radiofrequency ablation (RFA) and cryoablation (CRYO) which are thermal methods of ablation known to affect the autonomic nervous system through ablation of cardiac ganglionated plexi (GP). Pulsed[SC1] -field ablation (PFA) is a newer method of CA with demonstrated efficacy that preferentially affects cardiac cells and spares surrounding structures such as GP through irreversible electroporation which does not lead to chronic fibrosis like RFA or CRYO. Elevations in the marker the marker P terminal force (PTF) have been associated with AF/stroke and have been known to correlate with atrial fibrosis, and higher PTF after cryoablation for patients with paroxysmal AF has been associated with an increased risk of recurrence. The differences in P-wave parameters pre and post PFA have not been studied.Objective:To investigate the differences in P-wave parameters after PFA and compare them to CRYO.Methods:We identified 40 patients who underwent PFA (20 patients) or CRYO (20 patients) for paroxysmal AF and compared P-wave parameters including duration and amplitude in leads aVF, V1 and the PTF calculated as the duration x amplitude of the terminal negative component of the P-wave in V1. Data were obtained from 12-lead electrocardiograms obtained pre and post ablation.Results:The mean age of patients in our study was 61 with 75% male and 33% on antiarrythmics. We noticed a significant reduction in PTF for patients who underwent CRYO (54 mVmS at baseline compared to 36.8 mVmS after CRYO, p = 0.04) and no significant reduction in PTF for patients who underwent PFA (46 mVmS at baseline compared to 38 mVmS after PFA, p = 0.27). There was also a significant increase in HR after CRYO (65 bpm at baseline compared to 78 bpm after CRYO, p=0.01) and no significant change in HR after PFA (61 bpm at baseline compared with 60 bpm after PFA, p=0.8). There was no statistical difference in both groups looking at aVF or total V1 duration or amplitude pre and post ablation.Conclusions:CRYO leads to a significant change in PTF after ablation while PFA does not, consistent with the notion that PFA does not lead to fibrosis and PTF is not a useful marker for measuring risk of recurrence of AF post PFA.

Circulation, Volume 150, Issue Suppl_1, Page A4147647-A4147647, November 12, 2024. Background and Objectives:Yoga may be a promising form of mind-body rehabilitation for patients with long term illness. Digitally delivered yoga increases access to participation but has not previously been evaluated in the heart failure population. The aim of this study was to examine the effects of tele-yoga on cognition, sleep, health-related quality of life and exercise capacity in persons with heart failure.Methods:The Tele-yoga study (ClinicalTrials.gov, ID: NCT 03703609) was a parallel two-arm randomised controlled trial (RCT) with 1:1 distribution to an intervention and control group. Study participants were randomised to tele-yoga including live-streamed group-yoga for 60 minutes twice weekly during 12 weeks and yoga individually for 10 minutes/day using an app, or to a control group receiving individual exercise advice. Cognition (Montreal Cognitive Assessment: MoCA), sleep (minimal insomnia symptom scale; MISS), health-related quality of life (EQ-5D VAS) and sub-maximal exercise capacity (6 minute walk test; 6MWT) were assessed at baseline, after 3 and 6 months. Linear mixed model with random intercept for patients as the random effect and group-time interaction along with age was taken as the fixed effects to analyse outcomes.Results:A total of 311 participants were included (tele-yoga n=156 and active controls n=155), mean age 66 years, 70% men. Adherence to the group yoga was very good. The linear mixed models showed a significant change in cognition, health-related quality of life and exercise capacity favouring the tele-yoga group. No significant differences between the groups were seen regarding sleep. When analysing the fixed effects of all outcomes, age, group assignment and time-points interaction had significant effects on EQ-5D VAS score, 6MWT distance and MoCA scores. For EQ-5D VAS the tele-yoga group performed significantly better than the control group at 3 months, but not at 6 months. For the 6MWT distance, the tele-yoga group performed better than the control group at 3 months, but not at 6 months. The tele-yoga group had significantly higher MoCA scores than the control group at both 3 and 6 months.Conclusion:This adequately powered RCT showed that digitally delivered mind-body training in the format of group and individual yoga during 12 weeks lead to an improvement in cognition, quality of life and exercise capacity at the end of the intervention. The effect was sustained for cognition also after 6 months.

Circulation, Volume 150, Issue Suppl_1, Page A4144574-A4144574, November 12, 2024. Background:According to the American Cancer Society, there are currently over 18 million adult cancer survivors in the US, and by 2030, that figure is estimated to rise to over 22 million. While this is positive, more and more survivors are now at risk for cardiovascular disease (CVD).Hypothesis:This meta-analysis aims to evaluate the association between cancer survivors and cardiovascular event.Methods:A systematic search was conducted in electronic databases from inception until March 2024 using appropriate Mesh terms for ‘Cancer’, and ‘cardiovascular risk’. Pooled risk ratios (RR) with their corresponding 95% confidence intervals (CI) were calculated using random effects models. A p-value of

Circulation, Volume 150, Issue Suppl_1, Page A4143384-A4143384, November 12, 2024. Introduction:ST elevation myocardial infarction (STEMI) is associated with a persistent high global mortality rate. Early diagnosis and treatment are essential to improve cardiac outcomes. Wearables may play a key role as promising technology in this clinical scenario.Methods:70 consecutive patients were referred to coronary angiography (cath) due to typical chest pain and STEMI standard 12-lead ECG tracing. At cathlab, 4-electrodes-12-leads-wearable-smartphone-based-ECG-System(AngelUS®) tracing was performed. ECG tracings interpretations were compared between the 2 groups by independent cardiologists blinded to ECGs and then correlated with cath findings. The Cohen κ statistic was used to measure agreement between the 2 groups.Results:Both cardiologists agreed to include 70 standard ECG tracing and 70 AngelUS® ECG tracing as STEMI. Both cardiologists agreed to exclude 70 standard ECG tracing and 70 AngelUS® ECG tracing as absence of STEMI, showing a perfect agreement with Cohen’s k:1. Correlations with coronary angiography were also performed showing total agreement with both ECG diagnostics.Conclusion:In 70 consecutive patients with typical symptoms and STEMI, standard ECG and the AngelUS®4-Electrodes-12-Leads-Wearable-Smartphone-Based-ECG showed clinical agreement. Correlations with coronary angiography were also performed, showing clinical equivalence between both ECG diagnostics. Analysis of AngelUS® ECG tracing compared to standard ECG is ongoing, extending our investigation into the utility of this technology in preoperative ECGs.

Circulation, Volume 150, Issue Suppl_1, Page A4122290-A4122290, November 12, 2024. Background:Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated to reduce the risk of hospitalizations from heart failure and cardiovascular mortality. However, SGLT2i therapy’s potential effects on the risks of dementia and Parkinson’s disease are not well established, with conflicting results based on observational studies.Objective:We sought to evaluate the association between SGLT2i and the risk of dementia and Parkinson’s disease in patients with type 2 diabetes mellitus (T2DM), heart failure, or chronic kidney disease.Methods:We performed a systematic literature search on PubMed, Scopus, and Clinicaltrial.gov for relevant randomized controlled trials (RCTs) from inception until March 2024 without any language restrictions. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using a random-effect model.Results:A total of 12 RCTs with 74, 442 patients (40784 in the SGLT2i group and 33658 in the control group) were included in the analysis. The mean age of patients in SGLT2i and control was 65.3 and 65.2 years respectively. The mean follow-up duration was 2.9 years. Pooled analysis showed that there is no significant association between SGLT2i and the risk of dementia (OR, 1.37 (95%CI: 0.70-2.69),P=0.36, I2=0%), dementia Alzheimer’s type (OR, 2.62 (95%CI: 0.47-14.49),P=0.27, I2=0), vascular dementia (OR, O.52 (95%CI: 0.09-2.98),P=0.46, I2=0%), and Parkinson’s disease (OR, 0.75 (95%CI: 0.25-2.25),P=0.61, I2=0%) was comparable between SGLT2i and control groups.Conclusion:Our study suggest that there is no significant association between SGLT2i and the risk of dementia, its subtypes, and Parkinson’s disease. Further large-power randomized trials are needed to strengthen the understanding of neuropsychiatric beneficial effects of SGLT2i.

Circulation, Volume 150, Issue Suppl_1, Page A4119992-A4119992, November 12, 2024. Introduction:Chest pain is a common cause for presentation to the emergency department (ED). Identifying patients at increased risk of adverse cardiovascular outcomes may help guide testing.Aims:We sought to determine if deep learning enabled 12-lead electrocardiogram (ECG) analysis may improve prediction of adverse cardiovascular outcomes of ED patients presenting with chest pain compared to conventional approaches.Methods:A pretrained convolutional neural network was applied to derive numerical representations of the index ECG waveforms from patients presenting to the Brigham and Women’s Hospital (BWH) ED with chest pain. We trained a neural network model (‘CP-AI’) to predict 30-day major adverse cardiovascular events (MACE) defined as myocardial infarction (MI), pulmonary embolism (PE), aortic dissection (AD), or mortality using age, sex, cardiac biomarkers (troponin and d-dimer), and the numerical ECG representations as inputs (Figure 1). In a holdout sample of Massachusetts General Hospital (MGH) ED patients, we compared the performance of the CP-AI model to alternative models fit on (1) demographics (‘Age and Sex’) (2) demographics + cardiac biomarkers (‘Biomarker Model’), and (3) demographics + numerical ECG representations (‘ECG Model’).Results:The BWH derivation sample included 18,811 individuals (51% female, mean age 65 ± 16 years). The MGH validation sample included 14,476 individuals (45% female, mean age 65 ± 15 years). The CP-AI model significantly outperformed the comparison models for prediction of 30-day MACE with an area under the receiver operating characteristic curve (AUROC) of 0.82 [95% CI 0.81-0.83] (Figure 1). CP-AI also significantly outperformed the comparison models for classification of the 30-day MACE components including MI (AUROC 0.91 [95% CI 0.90-0.92]), PE (AUROC 0.74 [95% CI 0.72-0.76]), and mortality (AUROC 0.86 [95% CI 0.85-0.87]), but not aortic dissection (0.71 [95% CI 0.68-0.75]).Conclusions:The integration of deep learning ECG analysis with conventional assessment improved prediction of adverse cardiovascular of ED patients presenting with chest pain.

Circulation, Volume 150, Issue Suppl_1, Page A4142374-A4142374, November 12, 2024. Background:Out-of-hospital cardiac arrest (OHCA) typically results in low survival rates and undesirable neurological outcome. There is a significant correlation between mean arterial pressure (MAP) levels after the return of spontaneous circulation (ROSC) and the outcomes of OHCA patients, yet the optimal blood pressure target remains unclear. This study explores how achieved blood pressure within the initial 12 hours after ROSC impacts the clinical outcomes of OHCA patients.Methods:We conducted a retrospective analysis of patients who experienced OHCA and achieved ROSC. Patients were divided into three tertiles based on the distribution of patient numbers, with each tertile defined as follows: MAP < 80 mmHg, 80 mmHg ≤ MAP < 95 mmHg, and MAP ≥ 95 mmHg. MAP levels were measured within the first 12 hours. Mortality and cerebral performance category (CPC) were utilized in the study to assess the clinical outcomes at 30 days post-OHCA event.Results:A total of 231 non-traumatic OHCA patients who survived for 12 hours after ROSC were enrolled. Among the three tertiles (n = 77 in each), significant difference in mortality and CPC score were found between tertile 1 and the remaining two tertiles, but no notable difference were observed between tertile 2 and 3. Higher MAP level, specifically target MAP ≥ 80 mmHg (hazard ratio [HR]: 0.960, 95% confidence interval [CI]: 0.949-0.971, P < 0.001) was associated with lower 30-day mortality. Additionally, a higher MAP level with target MAP ≥ 80 mmHg within the first 12 hours was correlated with better neurological outcomes (odd ratio [OR]: 0.370, 95% CI: 0.147-0.935, P = 0.035).Conclusions:MAP levels within the initial 12 hours after ROSC is a practical predictor of 30-day mortality and neurological outcomes among OHCA patients. Maintaining MAP levels above 80mmHg exhibits strong correlation with short-term outcomes improvement in the early post-arrest period.

Circulation, Volume 150, Issue Suppl_1, Page A4141318-A4141318, November 12, 2024. Background:Though echocardiography is the cornerstone of cardiac function assessment in specialized practice, there is a lack of point-of-care tools for immediate evaluation of left ventricular ejection fraction (LVEF) in current practice facilitating the early identification of patients at risk for heart failure who may benefit from further echocardiographic evaluation.Aims:To develop and validate artificial intelligence (AI) models to identify reduced LVEF from a single 12-lead ECG using a smartphone application.Methods:We sourced all ECGs and transthoracic echocardiograms (TTEs) recorded between 2011 and 2021. ECGs were paired with TTEs conducted within a 24-hour window and were randomly divided into the model development dataset (50%) and validation dataset (50%). Two AI-ECG models were created: one to detect LVEF ≤40% and another for LVEF

Circulation, Volume 150, Issue Suppl_1, Page A4141704-A4141704, November 12, 2024. Background:The multiple electrodes needed to generate a 12-lead electrocardiogram (12L ECG) limits its use to traditional health care settings. An innovative credit-card sized unit (HeartBeam, Santa Clara, CA, USA) when placed on the chest without cables captures a vectorcardiogram (VCG). A personalized transformation matrix (PTM) then converts the signals into a 12L ECG.Objective:This is the first quantitative (standard intervals and amplitudes) and qualitative (rhythm diagnosis) accuracy assessment of a synthesized 12L ECG (Syn 12L) compared to a simultaneously recorded standard 12L ECG (Std 12L) on patients in sinus rhythm (SR) or in a non-life-threatening arrhythmia.Methods:The 80 patients, who were enrolled at a single center (Dedinje Cardiovascular Research Institute, Belgrade, Serbia), first underwent recording of a Std 12L and VCG to create a unique PTM, which was used to create the Syn 12L from the VCG. Then a simultaneous Std 12L and VCG were recorded. The quantitative endpoint was the calculated difference (mean and standard deviation [SD]) between the Syn 12L and Std 12L in a series of intervals (RR, PQ, QJ, and QT) and amplitudes (P wave, R wave, and T wave). For the qualitative endpoint, 2 blinded electrophysiology physicians (EP) classified the Syn 12L and Std 12L arrhythmia status.Results:Of the 80 patients, 41 were in SR and 39 in another rhythm (3:SR with PACs, 5:SR with PVCs, 1:SR with pre-excitation, 16:atrial fibrillation, 3:atrial flutter, 2:atrial pacing, and 9:ventricular pacing). The interval and amplitude differences are listed in the table. Rhythm classification by the blinded EPs demonstrated a sensitivity of 94.9% (95% CI: 82.7-99.4%) and specificity of 100% (95% CI: 91.4-100%) compared to Std 12L.Conclusion:In this first study comparing the performance of a 12L ECG created from a credit card sized VCG recorder, the 12L Syn demonstrated clinically equivalent interval and amplitude accuracy and excellent agreement in arrhythmia classification when compared to a simultaneously recorded 12L Std. This approach holds significant promise, potentially permitting patients to obtain a 12L ECG outside of a health care setting with a compact, easy to use device.

Circulation, Volume 150, Issue Suppl_1, Page A4124370-A4124370, November 12, 2024. Background:Dual antiplatelet therapy (DAPT) is well established as standard of care following percutaneous coronary intervention (PCI). Recent trials have shown a potential benefit in the reduction of hemorrhagic events with a shorter course of DAPT. However, the optimal duration of DAPT following PCI remains unclear.Question:Is 1 month of DAPT followed by P2Y12 inhibitor monotherapy superior to the standard 12-month DAPT regimen in terms of cardiovascular outcomes in patients post-PCI?Methods:Medline, PubMed, and Cochrane Central Register of Controlled Trials databases were searched for randomized clinical trials (RCTs) comparing 1-month vs. 12-months of DAPT followed by P2Y12 inhibitor monotherapy post-PCI. The outcomes of interest were cardiovascular death, myocardial infarction, and major bleeding. We used R version 4.1.2 (The R Foundation, 2021) to pool the data using a random-effects model. Heterogeneity was assessed with I2.Results:We included three RCTs reporting data from 22,413 patients, of whom 11,180 (49.8%) were treated with 1-month of DAPT, followed by P2Y12 inhibitor monotherapy. Follow-up ranged from 12 months to 24 months. The incidence of all-cause death (RR 1.20; 95% CI 0.95-1.51; p=0.12) and myocardial infarction (RR 0.86; 95% CI 0.71-1.05; p=0.14) were not significantly different between the groups. However, major bleeding (RR 0.51; 95% CI 0.26-0.99; p=0.048) was significantly reduced with a short course of DAPT followed by P2Y12 inhibitor monotherapy, as compared with standard 12 months of DAPT.Conclusion:Following PCI, a transition from DAPT to P2Y12 inhibitor monotherapy at 1-month is associated with a significant reduction in major bleeding as compared with standard DAPT for 12-months, with no significant change in the incidence of all-cause mortality or myocardial infarction.

Circulation, Volume 150, Issue Suppl_1, Page A4147011-A4147011, November 12, 2024. Introduction:Guidelines recommend dual antiplatelet therapy (DAPT) for 12 months following percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). However, prolonged DAPT may increase bleeding risk. Monotherapy with the potent P2Y12 inhibitor ticagrelor after short DAPT offers a promising strategy to balance thrombotic and bleeding risks.Objective:To compare outcomes of short DAPT (≤3 months) followed by ticagrelor monotherapy until 12 months vs. 12-month DAPT in patients undergoing PCI for ACS.Methods:We systematically searched PubMed, Scopus, and Cochrane Central databases for studies comparing short DAPT followed by ticagrelor monotherapy vs. 12-month DAPT following PCI. Outcomes of interest included net adverse clinical events (NACE), major adverse cardiovascular/cerebrovascular events (MACCE), and any bleeding at 12 months post-PCI. Statistical analysis was done using R software. Random effects models were used to generate risk ratios (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I2statistics. Analysis followed the PRISMA guideline.Results:The systematic review identified 4 randomized controlled trials including 5,293 patients. Ticagrelor monotherapy was used in 2,667 (50.38%) patients. At 12 months, NACE (RR 0.81; 95%CI 0.57-1.14; p=0.227; I2=45%), MACCE (RR 1.11; 95%CI 0.86-1.42; p=0.415; I2=3%), and any bleeding (RR 0.68; 95%CI 0.46-1.01; p=0.055; I2=34%) were comparable between the two groups.Conclusion:After PCI for STEMI, short DAPT for ≤3 months followed by ticagrelor monotherapy was non-inferior to 12-month DAPT in terms of NACE, MACCE, and bleeding. Ticagrelor monotherapy following short DAPT may be considered for STEMI patients after PCI.

Circulation, Volume 150, Issue Suppl_1, Page A4143156-A4143156, November 12, 2024. Introduction:Specific markers on the sinus rhythm ECG are independently associated with increased risk of sudden cardiac death (SCD) with several published ECG risk scores. However due to distinctive activation of the heart, ventricular-paced (VP) ECGs are typically excluded from these studies, especially in the general population.Hypothesis:Markers on the VP ECG can predict risk of SCD in the general population.Methods:We conducted a case-control analysis in an ongoing community-based study of SCD in the Northwestern US (catchment population ~ 1 million; 2002-2020). SCD cases were included if they were aged ≥18 years, had archived ECGs performed prior to and unrelated to SCD that demonstrated continuous ventricular pacing. Control participants with identical ECG selection criteria and no history of ventricular arrhythmias or cardiac arrest were recruited from the same geographical area. Individuals with biventricular pacing and fusion rhythm were excluded. The ECG markers analyzed included QRS duration, QT, QTc, JTc, Tpeak-end, and heart rate.Results:Among 104 cases and 36 controls meeting criteria, VP SCD cases exhibited significantly longer QRS duration (median 172 ms, interquartile range [IQR] 157-192 vs. 161 ms, IQR 144-172, p=0.02), QTc (median 521 ms, IQR 495-560 vs. 511 ms, IQR 483-529 ms, p=0.001), and Tpeak-end interval (median 113 ms, IQR 97-124 vs. 99 ms, IQR 84-111, p=0.02) than VP controls. The highest quartile of QRS duration, QTc, and Tpeak-end were associated with 3.9, 7.6, and 5.2-fold higher odds of SCA, respectively, compared to the lowest quartiles. After performing multivariable regression analysis with demographic factors and comorbidities, QRS duration and Tpeak-end remained independent predictors of SCA (Figure).Conclusion:Our findings suggest that specific markers from ventricular paced ECGs are also associated with SCD. Further investigation is warranted to validate these results in other populations and to explore the implications for SCD risk stratification in the previously neglected sub-group of individuals with ventricular-paced rhythms.