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Recognising and addressing social determinants of health: an important step toward centring equity in cardiovascular care. 认识并解决健康的社会决定因素:实现心血管护理公平中心化的重要一步。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 Epub Date: 2024-02-16 DOI: 10.1007/s12471-024-01857-9
Bigina N R Ginos, Maryam Kavousi
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引用次数: 0
Diverging from the traditional RCT paradigm. 偏离传统的 RCT 范式。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 Epub Date: 2024-02-22 DOI: 10.1007/s12471-024-01858-8
Pim van der Harst
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引用次数: 0
Embedding routine health care data in clinical trials: with great power comes great responsibility. 将常规医疗数据纳入临床试验:权力越大,责任越大。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 Epub Date: 2024-01-15 DOI: 10.1007/s12471-023-01837-5
M Louis Handoko, Frances S de Man, Jasper J Brugts, Peter van der Meer, Hanneke F M Rhodius-Meester, Jeroen Schaap, H J Rik van de Kamp, Saskia Houterman, Dennis van Veghel, Alicia Uijl, Folkert W Asselbergs

Randomised clinical trials (RCTs) are vital for medical progress. Unfortunately, 'traditional' RCTs are expensive and inherently slow. Moreover, their generalisability has been questioned. There is considerable overlap in routine health care data (RHCD) and trial-specific data. Therefore, integration of RHCD in an RCT has great potential, as it would reduce the effort and costs required to collect data, thereby overcoming some of the major downsides of a traditional RCT. However, use of RHCD comes with other challenges, such as privacy issues, as well as technical and practical barriers. Here, we give a current overview of related initiatives on national cardiovascular registries (Netherlands Heart Registration, Heart4Data), showcasing the interrelationships between and the relevance of the different registries for the practicing physician. We then discuss the benefits and limitations of RHCD use in the setting of a pragmatic RCT from a cardiovascular perspective, illustrated by a case study in heart failure.

随机临床试验(RCT)对医学进步至关重要。遗憾的是,"传统 "的 RCT 费用高昂,而且速度缓慢。此外,它们的普遍性也受到质疑。常规医疗保健数据(RHCD)与特定试验数据有相当大的重叠。因此,将 RHCD 纳入 RCT 具有很大的潜力,因为它可以减少收集数据所需的工作量和成本,从而克服传统 RCT 的一些主要缺点。然而,RHCD 的使用也面临其他挑战,如隐私问题以及技术和实际障碍。在此,我们将概述国家心血管登记处(荷兰心脏登记处、Heart4Data)的相关举措,展示不同登记处之间的相互关系以及对执业医师的意义。然后,我们从心血管角度出发,通过心力衰竭的案例研究,讨论了在务实的 RCT 环境中使用 RHCD 的好处和局限性。
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引用次数: 0
Aneurysm or diverticulum? You better look twice—Two rare faces of hypertrophic cardiomyopathy 动脉瘤还是憩室?最好多看两眼-肥厚型心肌病的两种罕见表现
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-22 DOI: 10.1007/s12471-023-01852-6
Silvio Quick, Karim Ibrahim, Akram Youssef, Lorena Payo-Anez
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引用次数: 0
Routine transthoracic echocardiography in ischaemic stroke or transient ischaemic attack of undetermined cause: a prospective multicentre study. 常规经胸超声心动图在缺血性卒中或不明原因的短暂性缺血性发作中的应用:一项前瞻性多中心研究。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-01 Epub Date: 2023-10-23 DOI: 10.1007/s12471-023-01819-7
Gerlinde van der Maten, Matthijs F L Meijs, Jorik R Timmer, Paul J A M Brouwers, Clemens von Birgelen, Jonathan M Coutinho, Berto J Bouma, Henk Kerkhoff, Anne Mijn Helming, Julia H van Tuijl, Nicolet A van der Meer, Ritu Saxena, Corné Ebink, Job van der Palen, Heleen M den Hertog

Background: Guidelines recommend routine transthoracic echocardiography (TTE) after ischaemic stroke or transient ischaemic attack of undetermined cause; yet, only limited scientific evidence exists. Therefore, we aimed to determine in these patients the prevalence of TTE-detected major cardiac sources of embolism (CSE), which are abnormalities leading to therapeutic changes.

Methods: Six Dutch hospitals conducted a prospective observational study that enrolled patients with ischaemic stroke or transient ischaemic attack of undetermined cause. Patients underwent TTE after comprehensive diagnostic evaluation on stroke units, including blood chemistry, 12-lead electrocardiogram (ECG), ≥ 24 h continuous ECG monitoring, brain imaging and cervical artery imaging. Primary outcome measure was the proportion of patients with TTE-detected major CSE.

Results: From March 2018 to October 2020, 1084 patients, aged 66.6 ± 12.5 years, were enrolled; 456 (42.1%) patients were female and 869 (80.2%) had ischaemic stroke. TTE detected major CSE in only 11 (1.0%) patients. Ten (90.9%) of these patients also had major ECG abnormalities (previous infarction, major repolarisation abnormalities, or previously unknown left bundle branch block) that would have warranted TTE assessment regardless of stroke evaluation. Such ECG abnormalities were present in 11.1% of the total study population. A single patient (0.1%) showed a major CSE despite having no ECG abnormality.

Conclusions: This multicentre cross-sectional study in patients who-after workup on contemporary stroke units-were diagnosed with ischaemic stroke or transient ischaemic attack of undetermined cause found TTE-detected major CSE in only 1% of all patients. Most of these patients also had major ECG abnormalities. These findings question the value of routine TTE assessment in this clinical setting.

背景:指南建议在缺血性中风或不明原因的短暂性缺血性发作后进行常规经胸超声心动图(TTE);然而,只有有限的科学证据存在。因此,我们旨在确定这些患者经胸超声心动图检测的主要心脏栓塞源(CSE)的患病率,这些栓塞是导致治疗变化的异常。方法:六家荷兰医院进行了一项前瞻性观察性研究,纳入了不明原因的缺血性中风或短暂性缺血性发作患者。患者在对卒中单位进行综合诊断评估后,包括血液化学、12导联心电图(ECG)、≥ 24 h连续心电图监测、大脑成像和颈动脉成像。主要结果指标是经胸超声心动图检测出主要CSE的患者比例。结果:从2018年3月到2020年10月,1084名患者,年龄66.6岁 ± 12.5岁,入组;456名(42.1%)患者为女性,869名(80.2%)患者为缺血性中风。TTE仅在11例(1.0%)患者中检测到严重CSE。这些患者中有10名(90.9%)也有严重的心电图异常(既往梗死、严重再极化异常或既往未知的左束支传导阻滞),无论卒中评估如何,都需要进行经胸超声心动图评估。此类心电图异常出现在总研究人群的11.1%中。尽管没有心电图异常,但有一名患者(0.1%)表现出严重的CSE。结论:这项多中心横断面研究针对在当代卒中单元检查后被诊断为缺血性卒中或不明原因的短暂性脑缺血发作的患者,发现经胸超声心动图仅在1%的患者中检测到主要CSE。这些患者中的大多数也有严重的心电图异常。这些发现对常规经胸超声心动图评估在这种临床环境中的价值提出了质疑。
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引用次数: 0
Welcome from the new editor-in-chief. 新任主编致欢迎辞
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-01 DOI: 10.1007/s12471-024-01855-x
Pim van der Harst
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引用次数: 0
Treatment of elderly patients with non-ST-elevation myocardial infarction: the nationwide POPular age registry. 老年非ST段抬高型心肌梗死患者的治疗:全国POPular年龄登记。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-01 Epub Date: 2023-09-28 DOI: 10.1007/s12471-023-01812-0
Marieke E Gimbel, Dean R P P Chan Pin Yin, Wout W A van den Broek, Renicus S Hermanides, Floris Kauer, Annerieke H Tavenier, Dirk Schellings, Stijn L Brinckman, Salem H K The, Martin G Stoel, Ton A C M Heestermans, Saman Rasoul, Mireille E Emans, Machiel van de Wetering, Paul F M M van Bergen, Ronald Walhout, Debby Nicastia, Ismail Aksoy, Arnoud van 't Hof, Paul Knaapen, Cees-Joost Botman, Anho Liem, Cornelis de Nooijer, Joyce Peper, Johannes C Kelder, Jurriën M Ten Berg

Objective: We describe the current treatment of elderly patients with non-ST-elevation myocardial infarction (NSTEMI) enrolled in a national registry.

Methods: The POPular AGE registry is a prospective, multicentre study of patients ≥ 75 years of age presenting with NSTEMI, performed in the Netherlands. Management was at the discretion of the treating physician. Cardiovascular events consisted of cardiovascular death, myocardial infarction and ischaemic stroke. Bleeding was classified according to the Bleeding Academic Research Consortium (BARC) criteria.

Results: A total of 646 patients were enrolled between August 2016 and May 2018. Median age was 81 (IQR 77-84) years and 58% were male. Overall, 75% underwent coronary angiography, 40% percutaneous coronary intervention, and 11% coronary artery bypass grafting, while 49.8% received pharmacological therapy only. At discharge, dual antiplatelet therapy (aspirin and P2Y12 inhibitor) was prescribed to 56.7%, and 27.4% received oral anticoagulation plus at least one antiplatelet agent. At 1‑year follow-up, cardiovascular death, myocardial infarction or stroke had occurred in 13.6% and major bleeding (BARC 3 and 5) in 3.9% of patients. The risk of both cardiovascular events and major bleeding was highest during the 1st month. However, cardiovascular risk was three times as high as bleeding risk in this elderly population, both after 1 month and after 1 year.

Conclusions: In this national registry of elderly patients with NSTEMI, the majority are treated according to current European Society of Cardiology guidelines. Both the cardiovascular and bleeding risk are highest during the 1st month after NSTEMI. However, the cardiovascular risk was three times as high as the bleeding risk.

目的:我们介绍目前在国家注册的老年非ST段抬高型心肌梗死(NSTEMI)患者的治疗方法。方法:POPular AGE登记是一项前瞻性、多中心研究,研究对象为≥ 75岁,患有NSTEMI,在荷兰演出。管理由主治医师自行决定。心血管事件包括心血管死亡、心肌梗死和缺血性中风。根据出血学术研究联合会(BARC)标准对出血进行分类。结果:2016年8月至2018年5月,共有646名患者入选。中位年龄为81岁(IQR 77-84),58%为男性。总的来说,75%的患者接受了冠状动脉造影,40%的患者接受经皮冠状动脉介入治疗,11%的患者接受冠状动脉搭桥术,而49.8%的患者仅接受药物治疗。出院时,56.7%的患者接受了双重抗血小板治疗(阿司匹林和P2Y12抑制剂),27.4%的患者接受口服抗凝和至少一种抗血小板药物。在一年的随访中,13.6%的患者发生心血管死亡、心肌梗死或中风,3.9%的患者出现大出血(BARC3和5)。第一个月发生心血管事件和大出血的风险最高。然而,无论是在1个月后还是1年后,该老年人群的心血管风险都是出血风险的三倍。NSTEMI后1个月心血管和出血风险最高。然而,心血管风险是出血风险的三倍。
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引用次数: 0
Older patients with non-ST-elevation myocardial infarction: which treatment strategies do we currently use? 非 ST 段抬高型心肌梗死老年患者:我们目前采用哪些治疗策略?
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-01 Epub Date: 2024-01-03 DOI: 10.1007/s12471-023-01842-8
Kirsten Boerlage-van Dijk
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引用次数: 0
Geriatric cardiology in one's own backyard? 在自家后院开展老年心脏病学研究?
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-01 Epub Date: 2023-12-19 DOI: 10.1007/s12471-023-01841-9
Martin E W Hemels, Gerard J Blauw
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引用次数: 0
Impact of geriatric co-management on outcomes in hospitalised cardiology patients aged 85 and over. 老年病学共同管理对 85 岁及以上住院心脏病患者疗效的影响。
IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-01 Epub Date: 2023-08-31 DOI: 10.1007/s12471-023-01806-y
Renee C M A Raijmann, Huiberdina L Koek, Marielle H Emmelot-Vonk, Joost G E Swaving, Willem R P Agema, Angèle P M Kerckhoffs, Carolina J P W Keijsers

Objective: Cardiovascular disease and frailty are common among the population aged 85+. We hypothesised these patients might benefit from geriatric co-management, as has been shown in other frail patient populations. However, there is limited evidence supporting geriatric co-management in older, hospitalised cardiology patients.

Methods: A retrospective cohort study was performed in a large teaching hospital in the Netherlands. We compared patients aged 85 and over admitted to the cardiology ward before (control group) and after the implementation of standard geriatric co-management (intervention group). Data on readmission, mortality, length of stay, number of consultations, delirium, and falls were analysed.

Results: The data of 1163 patients were analysed (n = 542 control, n = 621 intervention). In the intervention group, 251 patients did not receive the intervention because of logistic reasons or the treating physician's decision. Baseline characteristics were comparable in the intervention and control groups. Patients in the intervention group had a shorter length of stay (-1 day, p = 0.01) and were more often discharged to a geriatric rehabilitation facility (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.10-3.54, p = 0.02) compared with the control patients. Other outcomes were not significantly different between the groups.

Conclusions: After implementation of standard geriatric co-management for hospitalised cardiology patients aged 85 and over, the length of hospital stay shortened and the number of patients discharged to a geriatric rehabilitation facility increased. The adherence to geriatric team recommendations was high. Geriatric co-management would appear to optimise care for older hospitalised patients with cardiac disease.

目的:心血管疾病和体弱在 85 岁以上的人群中很常见。我们假设这些患者可能会从老年病学共同管理中获益,这一点已在其他体弱患者群体中得到证实。然而,支持对住院的老年心脏病患者进行老年病学共同管理的证据却很有限:方法:我们在荷兰一家大型教学医院进行了一项回顾性队列研究。我们对心脏科病房 85 岁及以上的住院患者在实施标准老年病共同管理之前(对照组)和之后(干预组)的情况进行了比较。我们对再入院、死亡率、住院时间、就诊次数、谵妄和跌倒等数据进行了分析:结果:分析了 1163 名患者的数据(对照组 542 人,干预组 621 人)。在干预组中,251 名患者因后勤原因或主治医生的决定而未接受干预。干预组和对照组的基线特征相当。与对照组患者相比,干预组患者的住院时间更短(-1 天,p = 0.01),更常出院到老年康复机构(几率比 [OR] 1.97,95% 置信区间 [CI] 1.10-3.54,p = 0.02)。两组患者的其他结果无明显差异:结论:对85岁及以上的住院心脏病患者实施标准的老年病共同管理后,住院时间缩短了,出院到老年康复机构的患者人数增加了。老年病小组建议的遵守率很高。老年病学共同管理似乎可以优化对住院老年心脏病患者的护理。
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引用次数: 0
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Netherlands Heart Journal
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