Publications by authors named "Robert Klempfner"
Background: Aortic valve replacement (AVR) is considered one of the most potent disease-modifying procedures among patients with severe aortic stenosis (sAS). Accordingly, we have witnessed a consistent increase in the procedure rates in recent years. Nevertheless, the elderly population, particularly octogenarians, remains relatively undertreated.
View Article and Find Full Text PDFBackground: Age and sex can be estimated using artificial intelligence on the basis of various sources. The aims of this study were to test whether convolutional neural networks could be trained to estimate age and predict sex using standard transthoracic echocardiography and to evaluate the prognostic implications.
Methods: The algorithm was trained on 76,342 patients, validated in 22,825 patients, and tested in 20,960 patients.
Article Synopsis
- Cardiac rehabilitation programs often focus on aerobic fitness, neglecting muscle strength; this study aimed to assess the effects of a remote strength training program (RCR-ST) on cardiac rehab outcomes.
- In a randomized study with 50 patients, one group used a targeted resistance training app while a control group received standard care, with assessments conducted at the start and after 16 weeks.
- The RCR-ST group showed significant gains in muscle endurance and functional performance, along with heightened engagement and self-reported health improvements, highlighting the effectiveness of integrating strength training into cardiac rehabilitation.
Background: We aimed to assess in a prospective multicenter study the quality of echocardiographic exams performed by inexperienced users guided by a new artificial intelligence software and evaluate their suitability for diagnostic interpretation of basic cardiac pathology and quantitative analysis of cardiac chamber and function.
Methods: The software (UltraSight, Ltd) was embedded into a handheld imaging device (Lumify; Philips). Six nurses and 3 medical residents, who underwent minimal training, scanned 240 patients (61±16 years; 63% with cardiac pathology) in 10 standard views.
Article Synopsis
- Current guidelines recommend implantable cardioverter-defibrillators (ICDs) for all patients with symptomatic heart failure and low left ventricular ejection fraction, but many may not benefit from them.
- The study evaluated the feasibility of using the MADIT-II-based Risk Stratification Score (MRSS) to differentiate patients and gauge their likely survival benefits from ICDs.
- Results indicated that among 2,177 patients, different MRSS risk groups had varying survival benefits from ICDs, suggesting that this score can help identify who might actually benefit from prophylactic ICD implantation.
Management of acute COPD exacerbations in the internal medicine departments in Israel-a national survey.
Front Med (Lausanne)
August 2023
Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Acute exacerbations of COPD (AECOPD) drastically affect the clinical course of the disease. We aimed to evaluate the treatment of AECOPD in the internal medicine departments in Israel, nationwide.
View Article and Find Full Text PDFAdvances in Technology Promote Patient-Centered Care in Cardiac Rehabilitation.
Cardiol Rev
February 2025
Patient-centered health care (PCC) is a framework of clinical care focused on the patient's individual health care needs. In particular, it emphasizes the development of a partnership between the patient, physician, and healthcare workers to actively involve and empower the patient in their health care decisions. Additionally, PCC goals include ensuring access to care, emotional support, engaging patient support systems, physical comfort, and continuity of care.
View Article and Find Full Text PDFEffect of sodium glucose cotransporter 2 inhibitors on atrial tachy-arrhythmia burden in patients with cardiac implantable electronic devices.
J Cardiovasc Electrophysiol
August 2023
Article Synopsis
- - The study investigates the impact of sodium glucose cotransporter 2 inhibitors (SGLT2i) on atrial tachyarrhythmias (ATA) in patients with cardiac implantable electronic devices (CIEDs), revealing a notable reduction in ATA hospitalizations linked to SGLT2i use.
- - Analyzing data from 13,888 patients over 24,442 years of follow-up, results show a 22% decrease in ATA risk and all-cause mortality among SGLT2i users, particularly in heart failure patients, but no significant effect on ventricular tachyarrhythmias (VTA).
- - The findings suggest that SGLT2i can significantly lower ATA and mortality
Aims: Cardiac rehabilitation is an essential component of secondary prevention consistently unexploited by most eligible patients. Accordingly, the remote cardiac rehabilitation program (RCRP) was developed to create optimal conditions for remote instruction and supervision for patients to enable successful completion of the program.
Methods: This study comprised 306 patients with established coronary heart disease who underwent a 6-month RCRP.
Home-Based Cardiac Rehabilitation Among Patients Unwilling to Participate in Hospital-Based Programs.
J Cardiopulm Rehabil Prev
January 2024
Purpose: Asynchronous home-based cardiac rehabilitation (HBCR) is a viable alternative to center-based cardiac rehabilitation (CBCR). However, to achieve significant functional improvement, a high level of adherence and activity must be achieved. The effectiveness of HBCR among patients who actively avoid CBCR has not been effectively investigated.
View Article and Find Full Text PDFArticle Synopsis
- * Patients with baseline AF (2% of the total) tended to be older, predominantly male, and had more comorbidities, while male sex, age, obesity, and heart-related issues were identified as strong predictors of AF.
- * Among those without baseline AF, 85 new cases were identified during follow-up, with age, heart failure, and congenital heart disease being significant risk factors; the CHARGE-AF risk score proved to be a better predictor of AF than the CHADS-VAS
Understanding patients' survival probability as well as the factors affecting it constitute a significant concern for researchers and practitioners, in particular for patients with severe chronic illnesses such as congestive heart failure (CHF). CHF is a clinical syndrome characterized by comorbidities and adverse medical events. Risk stratification to identify patients most likely to die shortly after hospital discharge can improve the quality of care by better allocating organizational resources and personalized interventions.
View Article and Find Full Text PDFArticle Synopsis
- LDL-C lowering is essential for preventing atherosclerotic disease progression in post-acute coronary syndrome (ACS) patients, but managing LDL-C remains difficult in clinical settings.
- The ACS EuroPath III project aimed to enhance LDL-C management by gathering data from healthcare providers and patients through surveys, identifying key improvement areas, and creating actionable solutions for better treatment practices.
- Five areas needing improvement were pinpointed, including issues with discharge treatment, guideline knowledge, and patient concerns; top solutions proposed included a standardized discharge letter and a treatment algorithm for better LDL-C management.
Article Synopsis
- * It involved 92 patients, with 84 undergoing DT; all successfully terminated induced ventricular fibrillation without complications, and follow-ups showed no inappropriate shocks or lead malfunctions.
- * The results indicated that while DT posed no complications, it did not yield any clinically significant findings for patient management.
The First National Program of Remote Cardiac Rehabilitation in Israel-Goal Achievements, Adherence, and Responsiveness in Older Adult Patients: Retrospective Analysis.
JMIR Cardio
November 2022
Background: Remote cardiac rehabilitation (RCR) after myocardial infarction is an innovative Israeli national program in the field of telecardiology. RCR is included in the Israeli health coverage for all citizens. It is generally accepted that telemedicine programs better apply to younger patients because it is thought that they are more technologically literate than are older patients.
View Article and Find Full Text PDFArticle Synopsis
- A nationwide study in Israel investigated the impact of the COVID-19 pandemic on admissions and outcomes for patients with non-ST-segment myocardial infarction (NSTEMI) over an 8-week period.
- Results showed that 56% of NSTEMI patients were admitted during the pandemic compared to 44% in the same period two years prior, with no significant differences in demographics between the two groups.
- Despite a longer time from symptom onset to hospital admission during the pandemic, in-hospital mortality rates and 30-day mortality rates were similar across both time periods, indicating that care quality for NSTEMI may not have been adversely affected.
Blood lipid levels and treatment following an acute coronary syndrome or coronary intervention - Journey from hospital to cardiac rehabilitation.
Int J Cardiol Cardiovasc Risk Prev
December 2022
Article Synopsis
- Many patients with coronary artery disease struggle to reach recommended LDL cholesterol levels, but cardiac rehabilitation (CR) programs can help improve adherence to treatments.
- A study tracked 1,015 patients at different stages of their medical care and found that LDL levels improved from 57% to 63% below 70 mg/dL after 3 months in the CR program, despite high doses of statins being widely prescribed.
- The findings highlight a treatment gap where many patients still do not meet lipid goals, suggesting a need for stronger lipid-lowering therapies and better adherence to treatment regimens.
Objectives: Despite documented benefits and physicians' recommendations to participate in cardiac rehabilitation (CR) programs, the average dropout rate remains between 12-56%. This study's goal was to demonstrate that using personalized interventions can significantly increase patient adherence.
Method: Ninety-five patients (ages 18-90) eligible for the CR program were randomly recruited and received personalized interventions using the Well-Beat system.
Article Synopsis
- Patients presenting with acute ileitis or colitis have a low risk (4.7%) of being diagnosed with inflammatory bowel diseases (IBD) within 9 years after an emergency department visit.
- Younger patients (average age 28) and those with diarrhea as a symptom were more likely to develop IBD compared to older, non-IBD patients.
- Key predictors for future IBD diagnosis included age, imaging results showing colitis or enteritis, and a history of diarrhea reported in the emergency department.
Background: Contemporary data on the independent association of severe tricuspid regurgitation (TR) with excess mortality are needed. The aims of this study were to describe contemporary outcomes of patients with severe TR and to identify outcome modifiers.
Methods: Consecutive echocardiographic reports linked to clinical data from the largest medical center in Israel (2007-2019) were reviewed.
Background: The CHA2DS2-VASC score is used to assess the risk of cerebrovascular accident (CVA) in patients with atrial fibrillation (AF) or atrial flutter (AFL).
Objectives: We aimed to determine whether this score can determine the risk of CVA during the first year after hospitalization, in patients without known AF/AFL.
Design: Single-center retrospective cohort.
The Clinical SYNTAX score predicts survival better than the SYNTAX score in coronary revascularization.
J Thorac Cardiovasc Surg
January 2024
Article Synopsis
- The SYNTAX trial demonstrated the SYNTAX score (SS) as a key tool for developing personalized revascularization strategies for patients with complex coronary disease, while the newer Clinical SYNTAX score (CSS) incorporates additional patient health factors for better prognosis assessment.
- This study, part of the MULTICAD registry in Israel, followed 585 patients over five years, analyzing their outcomes based on SS, CSS, and the type of revascularization they received (PCI or CABG).
- Findings indicated that patients with a CSS of 27 or higher had a lower survival rate, particularly those undergoing PCI, which showed a significantly higher 5-year mortality rate (32.2%) compared to those
Article Synopsis
- * Among the 2,202 patients with moderate AS studied, the five-year death rate was significantly higher (46%) compared to those without moderate AS (18%).
- * The risk of death from moderate AS is influenced by factors like age and ejection fraction, particularly affecting patients under 80 years and those with lower heart function.
Disease evolution and risk-based disease trajectories in congestive heart failure patients.
J Biomed Inform
January 2022
Congestive Heart Failure (CHF) is among the most prevalent chronic diseases worldwide, and is commonly associated with comorbidities and complex health conditions. Consequently, CHF patients are typically hospitalized frequently, and are at a high risk of premature death. Early detection of an envisaged patient disease trajectory is crucial for precision medicine.
View Article and Find Full Text PDFArticle Synopsis
- The study compared outcomes of ACS patients using prasugrel vs. ticagrelor during in-hospital percutaneous coronary interventions.
- Among 7,233 patients, 1,126 received prasugrel and 817 received ticagrelor, analyzed separately for different types of ACS.
- Results showed prasugrel led to better 30-day re-hospitalization and lower complication rates in STEMI patients, while outcomes in NSTE-ACS patients were similar regardless of the medication used.
- In conclusion, prasugrel is associated with better results for STEMI patients compared to ticagrelor but not for those with NSTE-ACS.