Establishing Minimal Clinically Important Difference for PROMIS Physical Function Improvement After Revascularization for Peripheral Artery Disease.

Objective: Patients with peripheral arterial disease (PAD) undergo revascularization to improve physical function, yet meaningful improvement has not been defined. This study aims to define a threshold for improvement in patient-reported physical function (PROMIS-PF) and establish factors predictive of improvement following lower extremity revascularization.

Methods: This study is a single-center retrospective cohort analysis of adults undergoing elective revascularization for PAD 2016-2023 who had PROMIS-PF scores.

Catheter ablation of atrial fibrillation in patients with heart failure: Insights from the NCDR atrial fibrillation ablation registry.

Background: Catheter ablation (CA) for atrial fibrillation (AF) is a widely used treatment strategy in patients with and without heart failure (HF).

Objective: To evaluate patient characteristics, ablation strategies, and complications of CA for AF by HF status.

Methods: We conducted a retrospective analysis of patients undergoing CA between 2016 and 2022 from the National Cardiovascular Data Registry.

Geographic and clinical patterns of left atrial appendage occlusion utilization across the United States.

Background: Left Atrial Appendage Occlusion (LAAO) has become a more common procedure designed to reduce stroke risk in patients who are intolerant of systemic anticoagulation. The speed of adoption and broader application to patients outside of the narrow trial patients motivates an assessment to understand whether specific operator characteristics affect procedural volume.

Methods: Using US CMS and Open Payments datasets, we explored LAAO procedural volumes, including temporal and geographical trends.

Fat, fib, and forgetfulness: The interplay between adiposity, atrial fibrillation, and dementia.

Atrial Fibrillation, dementia, and obesity are prevalent and interconnected pathologic states with significant morbidity and mortality and increasing global incidence. This review examines the current literature regarding the known and hypothesized relationships between these three conditions, their risk factors, and treatment strategies. We aim to highlight a stepwise and potentially causative interplay between them.

Variability in implantable cardioverter-defibrillator battery longevity.

Background: Implantable cardioverter-defibrillator (ICD) battery longevity impacts the need for generator replacement, with the accompanying risk of complications and cost.

Objective: We sought to identify factors associated with ICD battery longevity and compare manufacturers.

Methods: We used a nationwide, multicenter remote monitoring dataset (PaceMate) to evaluate ICDs implanted between 2003 and 2023, assessing time from implant to replacement interval (RI).

Explainable artificial intelligence for stroke risk stratification in atrial fibrillation.

Current risk stratification tools can limit the optimal implementation of new and emerging therapies for patients with heart rhythm disorders. For example, stroke prevention treatments have outpaced means for stroke risk stratification for patients with atrial fibrillation (AF). Artificial intelligence (AI) techniques have shown promise for improving various tasks in cardiovascular medicine.

Correlation between mobile and 12-lead ECG among patients loading with intravenous sotalol: A PEAKS substudy.

Background: Electrocardiographic monitoring is performed during sotalol loading, primarily to assess QTc. Continuous telemetry increases resource utilization, generating interest in streamlining QTc monitoring through mobile technologies.

Objective: Assess feasibility and outcomes of mobile electrocardiogram (ECG) monitoring during intravenous sotalol loading.

Sotalol Dosing and Outcomes Among Patients Undergoing Intravenous Loading for Atrial Arrhythmias-A PEAKS Registry Substudy.

Background: Sotalol is used for the maintenance of sinus rhythm among patients with atrial fibrillation. However, there is discretion regarding dosing of chronic therapy, and the target oral dose dictates infusion doses for intravenous sotalol loading. To date, use and outcomes by dose are not well-described.

Atrial Fibrillation as a Predictor of Age-Related Macular Degeneration.

Background: Aging of the population has resulted in more patients living with atrial fibrillation (AF) and age-related macular degeneration (AMD). AF is associated with macro- and micro-thromboembolism, microvascular dysfunction, and system inflammation. Organ systems sensitive to the long-term systemic and vascular disease associations of AF will likely develop dysfunction over time.

Preparatory Program for Students Underrepresented in Medicine Promotes Self-Efficacy in the Medical School Application Process: Novel Insights from a Qualitative Analysis.

Background: The current US physician workforce does not reflect the diversity of the patient population it serves. While programs have been designed to support learners underrepresented in medicine, evidence of their efficacy is lacking.

Methods: We designed, implemented, and assessed a medical school admissions preparatory program (MAPP) for premedical students from underrepresented backgrounds, as defined by race, gender identity, and/or socioeconomic status.

Effectiveness of shared decision making strategies for stroke prevention among patients with atrial fibrillation: cluster randomized controlled trial.

Objective: To evaluate the effectiveness of multiple decision aid strategies in promoting high quality shared decision making for prevention of stroke in patients with non-valvular atrial fibrillation.

Design: Cluster randomized controlled trial.

Setting: Six academic medical centers in the United States.

Stroke-bleeding risk score pairings within individuals in the outcomes registry for better informed treatment of atrial fibrillation (ORBIT-AF) registry.

Background: Decisions about stroke prevention strategies in atrial fibrillation (AF) typically balance thromboembolism reduction against increased bleeding from oral anticoagulation therapy (OAC). When determining eligibility for OAC, guidelines recommend calculation of thromboembolic event rates using a validated score such as CHA2DS2-VASc. In contrast, routine calculation of bleeding scores is not recommended, in part because many patient factors associated with an increased risk of bleeding are associated with an even larger increased risk of ischemic stroke.

Symptoms Burden as a Clinical Outcomes Assessment in Heart Failure Patients With Atrial Fibrillation.

Background: Safe and effective pharmacologic therapy for atrial fibrillation (AF) in heart failure (HF) is an unmet need. In AF clinical trials, the standard primary endpoint of time to first symptomatic AF event (TTFSE) has several disadvantages, which could theoretically be overcome by measurement of AF-specific symptoms burden during an entire follow-up period.

Objectives: The authors sought to develop and validate a method of measuring symptom burden of AF in a HF population.

Performance of off-the-shelf machine learning architectures and biases in low left ventricular ejection fraction detection.

Background: Artificial intelligence-machine learning (AI-ML) has demonstrated the ability to extract clinically useful information from electrocardiograms (ECGs) not available using traditional interpretation methods. There exists an extensive body of AI-ML research in fields outside of cardiology including several open-source AI-ML architectures that can be translated to new problems in an "off-the-shelf" manner.

Objective: We sought to address the limited investigation of which if any of these off-the-shelf architectures could be useful in ECG analysis as well as how and when these AI-ML approaches fail.

Left atrial functional changes associated with repeated catheter ablations for atrial fibrillation.

Introduction: The impact of repeated atrial fibrillation (AF) ablations on left atrial (LA) mechanical function remains uncertain, with limited long-term follow-up data.

Methods: This retrospective study involved 108 AF patients who underwent two catheter ablations with cardiac magnetic resonance imaging (MRI) done before and 3 months after each of the ablations from 2010 to 2021. The rate of change in peak longitudinal atrial strain (PLAS) assessed LA function.

Real-Time Ambulatory ECG Does Not Expedite Care.

Background: Ambulatory ECG (AECG) monitoring is pivotal to the diagnosis of arrhythmias and can be performed with near "real-time" notification of abnormalities. There are limited data on the relative benefit of real-time monitoring compared with traditional Holter monitoring.

Methods And Results: This is a retrospective observational analysis of University of Utah Health patients who underwent ambulatory ECG studies from 2010 to 2022.

Design and rationale of a pragmatic randomized clinical trial of early dronedarone versus usual care to change and improve outcomes in persons with first-detected atrial fibrillation - the CHANGE AFIB study.

Background: While there are several completed clinical trials that address treatment strategies in patients with symptomatic and recurrent atrial fibrillation (AF), there are no randomized clinical trials that address first-line rhythm control of new-onset AF. Recent data suggest that early initiation of rhythm control within 1 year can improve outcomes.

Methods: In this open-label pragmatic clinical trial nested within the Get with The Guidelines Atrial Fibrillation registry, approximately 3,000 patients with first-detected AF will be enrolled at approximately 200 sites.

Discordant Treatment Goals for Patients With Atrial Fibrillation and Clinical Trials Metrics.

Background: Most clinical trials define successful atrial fibrillation (AF) treatment as no AF episodes longer than 30 seconds. Yet, there has been minimal study of how patients define successful treatment and whether their perspectives align with trial outcomes.

Objectives: Survey patients with AF to identify: 1) what aspect of AF is most important to address (frequency, duration, or severity of AF episodes); 2) what AF burden would be considered acceptable to consider treatment successful; and 3) to establish patient preferences for successful treatment thresholds for a validated patient-reported outcome (PRO) score.

Atrial Fibrillation and Heart Failure With Reduced Ejection Fraction: New Assessment of an Old Problem.

Atrial fibrillation (AF) and heart failure (HF)-specifically, heart failure with reduced ejection fraction (HFrEF)-often coexist, and each contributes to the propagation of the other. This relationship extends from the mechanistic and physiological to clinical syndromes, quality of life, and long-term cardiovascular outcomes. The risk factors for AF and HF overlap and create a critical opportunity to prevent adverse outcomes among patients at greatest risk for either condition.