/pdf/2021-esc-guidelines-for-the-diagnosis-and-treatment-of-acute-4pqhe8c49t.pdf

2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.

/pdf/2021-esc-guidelines-on-cardiovascular-disease-prevention-in-14ygu7kat1.pdf

2021 ESC Guidelines on cardiovascular disease prevention in clinical practice

Document Reviewers: Rudolf A. de Boer (CPG Review Coordinator) (Netherlands), P. Christian Schulze (CPG Review Coordinator) (Germany), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Elena Arbelo (Spain), Riccardo Asteggiano (Italy), Johann Bauersachs (Germany), Antoni Bayes‐Genis (Spain), Michael A. Borger (Germany), Werner Budts (Belgium), Maja Cikes (Croatia), Kevin Damman (Netherlands), Victoria Delgado (Netherlands), Paul Dendale (Belgium), Polychronis Dilaveris (Greece), Heinz Drexel (Austria), Justin Ezekowitz (Canada), Volkmar Falk (Germany), Laurent Fauchier (France), Gerasimos Filippatos (Greece), Alan Fraser (United Kingdom), Norbert Frey (Germany), Chris P. Gale (United Kingdom), Finn Gustafsson (Denmark), Julie Harris (United Kingdom), Bernard Iung (France), Stefan Janssens (Belgium), Mariell Jessup (United States of America), Aleksandra Konradi (Russia), Dipak Kotecha (United Kingdom), Ekaterini Lambrinou (Cyprus), Patrizio Lancellotti (Belgium), Ulf Landmesser (Germany), Christophe Leclercq (France), Basil S. Lewis (Israel), Francisco Leyva (United Kingdom), AleVs Linhart (Czech Republic), Maja‐Lisa Løchen (Norway), Lars H. Lund (Sweden), Donna Mancini (United States of America), Josep Masip (Spain), Davor Milicic (Croatia), Christian Mueller (Switzerland), Holger Nef (Germany), Jens‐Cosedis Nielsen (Denmark), Lis Neubeck (United Kingdom), Michel Noutsias (Germany), Steffen E. Petersen (United Kingdom), Anna Sonia Petronio (Italy), Piotr Ponikowski (Poland), Eva Prescott (Denmark), Amina Rakisheva (Kazakhstan), Dimitrios J. Richter (Greece), Evgeny Schlyakhto (Russia), Petar Seferovic (Serbia), Michele Senni (Italy), Marta Sitges (Spain), Miguel Sousa‐Uva (Portugal), Carlo G. Tocchetti (Italy), Rhian M. Touyz (United Kingdom), Carsten Tschoepe (Germany), Johannes Waltenberger (Germany/Switzerland)

/pdf/2021-esc-guidelines-for-the-diagnosis-and-treatment-of-acute-1wzjkcdn.pdf

2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

The present article summarizes the main novelties in the recently published cardiovascular disease prevention guidelines of the European Society of Cardiology (ESC), comparing them with the previous recommendations and examining both their positive aspects and those that may be controversial. In addition, we comment on their applicability to routine clinical practice, taking into account the socioeconomic characteristics of Spain. We do not seek to contradict the recommendations, drafted by experts in the field of cardiovascular prevention, but to analyze and explain their possible implications in our country. At the suggestion of the Guidelines Committee of the Spanish Society of Cardiology (SEC) and the coordinators assigned to this document, a group of expert cardiologists was selected to thoroughly review the new guidelines.

2016 ESC guidelines on cardiovascular disease prevention in clinical practice

/pdf/2021-esc-guidelines-on-cardiovascular-disease-prevention-in-2qb5vb8va1.pdf

Aims:

We investigated the relationship between clinically assessed left ventricular ejection fraction (LVEF) and survival in a large, heterogeneous clinical cohort.
Methods and results:

Physician-reported LVEF on 403 977 echocardiograms from 203 135 patients were linked to all-cause mortality using electronic health records (1998–2018) from US regional healthcare system. Cox proportional hazards regression was used for analyses while adjusting for many patient characteristics including age, sex, and relevant comorbidities. A dataset including 45 531 echocardiograms and 35 976 patients from New Zealand was used to provide independent validation of analyses. During follow-up of the US cohort, 46 258 (23%) patients who had undergone 108 578 (27%) echocardiograms died. Overall, adjusted hazard ratios (HR) for mortality showed a u-shaped relationship for LVEF with a nadir of risk at an LVEF of 60–65%, a HR of 1.71 [95% confidence interval (CI) 1.64–1.77] when ≥70% and a HR of 1.73 (95% CI 1.66–1.80) at LVEF of 35–40%. Similar relationships with a nadir at 60–65% were observed in the validation dataset as well as for each age group and both sexes. The results were similar after further adjustments for conditions associated with an elevated LVEF, including mitral regurgitation, increased wall thickness, and anaemia and when restricted to patients reported to have heart failure at the time of the echocardiogram.
Conclusion:

Deviation of LVEF from 60% to 65% is associated with poorer survival regardless of age, sex, or other relevant comorbidities such as heart failure. These results may herald the recognition of a new phenotype characterized by supra-normal LVEF.

/pdf/routinely-reported-ejection-fraction-and-mortality-in-w59k9hxv29.pdf

Routinely reported ejection fraction and mortality in clinical practice: where does the nadir of risk lie?

IntroductionWe applied machine learning (ML) to routine bloods, then to advanced haematology data from a full blood count (rawFBC) plus biochemistry, to build predictive models for heart failure, which were then used at population scale. MethodsRoutine blood results from 8,031 patients with heart failure, with equal number of controls, were used in ML training and testing datasets (Split 80:20). NT-proBNP was used for diagnostic comparison. rawFBC metadata was used in a dataset of 698 patients, 314 of whom had heart failure, to train and test ML models (Split 70:30) from rawFBC, rawFBC plus biochemistry and routine bloods. The rawFBC model was used to predict heart failure in a validation dataset of 69,492 FBCs (2.3% heart failure prevalence). ResultsHeart failure was predicted from rawFBC and biochemistry versus rawFBC AUROC 0.93 versus 0.91, 95% CI -0.023 to 0.048, P = 0.5, and predicted from routine bloods and NT-proBNP, AUROC 0.87 versus 0.81, 95% CI 0.004 to 0.097, P = 0.03. In the validation cohort heart failure was predicted from rawFBC with AUROC 0.83, 95% CI 0.83 to 0.84, P View larger version (30K): org.highwire.dtl.DTLVardef@c289d0org.highwire.dtl.DTLVardef@1e5d1bforg.highwire.dtl.DTLVardef@12d7b93org.highwire.dtl.DTLVardef@10c2e0c_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 2.C_FLOATNO Receiver operator curves comparing ECLIPSE models C_FIG ConclusionHeart failure can be predicted from routine bloods with accuracy equivalent to NT-proBNP. Predictive features included markers of erythropoiesis, with therapeutic monitoring implications.

/pdf/machine-learning-applied-to-routine-blood-tests-and-clinical-20kx4pe9bw.pdf

Machine Learning Applied to Routine Blood Tests and Clinical Metadata to Identify and Classify Heart failure

Predicting CRT Response Using Machine Learning Analysis of Pre-Implant ECG Data

IntroductionTicagrelor is widely considered superior to clopidogrel however a pharmacogenetic substudy of PLATO indicated that the majority of this difference is due to genetic nonresponders to clopidogrel. We evaluated patient outcomes following genotyping for CYP2C19 in a propensity matched acute coronary syndrome cohort treated with either clopidogrel, ticagrelor or aspirin monotherapy. MethodsICD10 coding identified 6,985 acute coronary syndrome patients at Waitemat[a] District Health Board over a five year period (2012-2016). Ticagrelor was subsidised by The Pharmaceutical Management Agency of New Zealand in July 2013. Patients were genotyped for CYP2C19 *2, *3 and *17 alleles using the Nanosphere Verigene analyser and treatment was tailored accordingly. Logistic regression and nearest neighbour propensity matching was employed in a 1:3 fashion with each treatment group to balance patient characteristics. ResultsA total of 146 patients were genotyped and compared with 438 matched patients taking either clopidogrel, ticagrelor or aspirin monotherapy. Post July 2013 clopidogrel was prescribed more often in responders than in those without genotype information (68 vs 39%, {chi}2 9, 95% CI 4 to 34, p=0.003). Conversely, ticagrelor was used more frequently in clopidogrel nonresponders. Mortality with personalised treatment was equivalent to ticagrelor (HR 0.8, 95% CI 0.3 to 1.8) but higher in those treated with clopidogrel (HR 2.3, 95 % CI 1 to 5.3). Readmissions with ACS were higher in nonresponders treated with clopidogrel versus those treated with genotype appropriate dual antiplatelet therapy (HR 3.9, 95% CI 0.8 to 18, p =0.03). ConclusionPersonalised antiplatelet management was equivalent to ticagrelor with respect to all-cause mortality and ACS readmissions. It also led to more appropriate use of both clopidogrel and ticagrelor and potential cost savings.

/pdf/a-propensity-matched-nested-case-control-study-of-acute-1bobt6sk53.pdf

A Propensity-Matched Nested Case-Control Study of Acute Coronary Syndrome Patients Genotyped for CYP2C19

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Papers

Routinely reported ejection fraction and mortality in clinical practice: where does the nadir of risk lie?

Machine Learning Applied to Routine Blood Tests and Clinical Metadata to Identify and Classify Heart failure

Predicting CRT Response Using Machine Learning Analysis of Pre-Implant ECG Data

A Propensity-Matched Nested Case-Control Study of Acute Coronary Syndrome Patients Genotyped for CYP2C19