Safety and Real-World Effectiveness in the Transition from Alteplase to Tenecteplase for Stroke Treatment.

Background: Tenecteplase has been shown to be non-inferior to alteplase for the treatment of acute ischemic stroke within 4.5 hours of stroke onset. While not formally approved by regulatory authorities, many jurisdictions have transitioned to using tenecteplase for routine stroke treatment because it is simpler to use and has cost advantages.

Individualized Electronic Patient-Reported Outcome Measures As a Communication Aid in Outpatient Cardiology Care: A Study Protocol.

Patient-reported outcomes measures (PROMs) quantify patients' perspectives about their health and well-being, their functioning (emotional, physical, mental, and social), and their health-related quality-of-life. The Alberta Provincial Project for Outcomes Assessment (APPROACH) developed an ePROM clinical report that includes 4 validated PROM instruments (Seattle Angina Questionnaire, 7-item version [SAQ-7], Patient Health Questionnaire, 2-item and 9-item [PHQ-2 & PHQ-9], Medical Outcomes Study Social Support Survey [MOS SSS], EuroQol Group 5-level assessment [EQ-5D-5L] and the Self-Care of Coronary Heart Disease Inventory). The primary objective of this study is to evaluate the feasibility, acceptability, and efficacy of the APPROACH ePROM clinician report as an adjunct to the care of patients with established coronary artery disease.

Women's Improvements in Cardiorespiratory Fitness Following Cardiac Rehabilitation Differ by Body Mass Index Category.

Background: Improving women's cardiovascular outcomes requires optimizing cardiorespiratory fitness (CRF), as higher CRF predicts improved mortality in people with cardiovascular disease (CVD). As such, increasing CRF is a key goal of cardiac rehabilitation (CR). This study assesses the potential influence of body habitus, assessed by body mass index (BMI), on improvements in CRF in women with CVD.

Continuation vs Withdrawal of Beta-Blockers and Outcomes After Myocardial Infarction With Preserved Left Ventricular Function.

Background: The role of routine beta-blocker (BB) use after uncomplicated acute myocardial infarction (AMI) treated with contemporary therapies is not well established.

Objectives: The authors conducted a retrospective cohort study using linked registry and administrative data to evaluate whether early BB discontinuation (a prescription ending within 180 days of discharge) is associated with clinical outcomes.

Methods: We included patients who survived at least 180 days after AMI from 2008 to 2017 with new BB prescription and left ventricular ejection fraction ≥50%.

Hospital and Physician Variability in Revascularization Decisions and Outcomes for Patients With 3-Vessel and Left Main Coronary Artery Disease: A Population-Based Cohort Study.

Background: Hospital- and physician-level variation for selection of percutaneous coronary intervention versus coronary artery bypass grafting (CABG) for patients with coronary artery disease has been associated with outcome differences. However, most studies excluded patients treated medically.

Methods And Results: From 2010 to 2019, adults with 3-vessel or left main coronary artery disease at 3 hospitals (A, B, C) in Alberta, Canada, were categorized by treatment with medical therapy, percutaneous coronary intervention, or CABG.

APPROACH e-PROM system: a user-centered development and evaluation of an electronic patient-reported outcomes measurement system for management of coronary artery disease.

Background: Coronary artery disease (CAD) confers increased risks of premature mortality, non-fatal morbidity, and significant impairment in functional status and health-related quality of life. Routine administration of electronic patient-reported outcome measures (PROMs) and its real time delivery to care providers is known to have the potential to inform routine cardiac care and to improve quality of care and patient outcomes. This study describes a user-centered development and evaluation of the Alberta Provincial Project for Outcomes Assessment (APPROACH) electronic Patient Reported Outcomes Measurement (e-PROM) system.

Assessing agreement between population-level administrative pharmaceutical databases and patient-reported medication dispensation in cardiac rehabilitation patients.

Background: Pharmacoepidemiology has emerged as a crucial field in evaluating the use and effects of medications in large populations to ensure their safe and effective use. This study aimed to assess the agreement of cardiac medication use between a provincial medication database, the Pharmaceutical Information Network (PIN), and reconciled medication data from confirmation through patient interviews for patients referred to cardiac rehabilitation.

Methods: The study included data from patients referred to the TotalCardiology Rehabilitation CR program, and medication data was available in both TotalCardiology Rehabilitation charts and PIN.

Mortality Benefits of Cardiac Rehabilitation in Coronary Artery Disease Are Mediated by Comprehensive Risk Factor Modification: A Retrospective Cohort Study.

Background: Cardiac rehabilitation (CR) is a multicomponent intervention to reduce adverse outcomes from coronary artery disease, but its mechanisms are not fully understood. The aims of this study were to examine the impact of CR on survival and cardiovascular risk factors, and to determine potential mediators between CR attendance and reduced mortality.

Methods And Results: A retrospective mediation analysis was conducted among 11 196 patients referred to a 12-week CR program following an acute coronary syndrome event between 2009 and 2019.

Association between sodium-glucose cotransporter-2 inhibitors and arrhythmic outcomes in patients with diabetes and pre-existing atrial fibrillation.

Aims: Prior studies suggest that sodium-glucose cotransporter-2 inhibitors (SGLT2is) may decrease the incidence of atrial fibrillation (AF). However, it is unknown whether SGLT2i can attenuate the disease course of AF among patients with pre-existing AF and Type II diabetes mellitus (DM). In this study, our objective was to examine the association between SGLT2i prescription and arrhythmic outcomes among patients with DM and pre-existing AF.

Response shift in coronary artery disease.

Purpose: Patients with coronary artery disease (CAD) experience significant angina symptoms and lifestyle changes. Revascularization procedures can result in better patient-reported outcomes (PROs) than optimal medical therapy (OMT) alone. This study evaluates the impact of response shift (RS) on changes in PROs of patients with CAD across treatment strategies.

Unsupervised item response theory models for assessing sample heterogeneity in patient-reported outcomes measures.

Purpose: Unsupervised item-response theory (IRT) models such as polytomous IRT based on recursive partitioning (IRTrees) and mixture IRT (MixIRT) models can be used to assess differential item functioning (DIF) in patient-reported outcome measures (PROMs) when the covariates associated with DIF are unknown a priori. This study examines the consistency of results for IRTrees and MixIRT models.

Methods: Data were from 4478 individuals in the Alberta Provincial Project on Outcome Assessment in Coronary Heart Disease registry who received cardiac angiography in Alberta, Canada, and completed the Hospital Anxiety and Depression Scale (HADS) depression subscale items.

Left atrium 4D-flow segmentation with high-resolution contrast-enhanced magnetic resonance angiography.

Background: Atrial fibrillation (AF) leads to intracardiac thrombus and an associated risk of stroke. Phase-contrast cardiovascular magnetic resonance (CMR) with flow-encoding in all three spatial directions (4D-flow) provides a time-resolved 3D volume image with 3D blood velocity, which brings individual hemodynamic information affecting thrombus formation. As the resolution and contrast of 4D-flow are limited, we proposed a semi-automated 4D-flow segmentation method for the left atrium (LA) using a standard-of-care contrast-enhanced magnetic resonance angiography (CE-MRA) and registration technique.

Optimal medical therapy improves outcomes in patients with diabetes mellitus and acute myocardial infarction.

Aims: We aimed to explored the association between the use of optimal medical therapy (OMT) in patients with myocardial infarction (AMI) and diabetes mellitus (DM) and clinical outcomes.

Methods: Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome (BleeMACS) is an international registry that enrolled participants with acute coronary syndrome followed up for at least 1 year across 15 centers from 2003 to 2014. Baseline characteristics and endpoints were analyzed.

An evaluation of the role of the exercise training dose for changes in exercise capacity following a standard cardiac rehabilitation program.

Background: To retrospectively characterize and compare the dose of exercise training (ET) within a large cohort of patients demonstrating different levels of improvement in exercise capacity following a cardiac rehabilitation (CR) program.

Methods: A total of 2310 patients who completed a 12-week, center-based, guidelines-informed CR program between January 2018 and December 2019 were included in the analysis. Peak metabolic equivalents (MET) were determined pre- and post-CR during which total duration (ET time) and intensity [percent of heart rate peak (%HR)] of supervised ET were also obtained.

Preferences of Patients With Chronic Kidney Disease for Invasive Versus Conservative Treatment of Acute Coronary Syndrome: A Discrete Choice Experiment.

Background Patients with chronic kidney disease (CKD) can experience acute coronary syndromes (ACS) with high morbidity and mortality. Early invasive management of ACS is recommended for most high-risk patients; however, choosing between an early invasive versus conservative management approach may be influenced by the unique risk of kidney failure for patients with CKD. Methods and Results This discrete choice experiment measured the preferences of patients with CKD for future cardiovascular events versus acute kidney injury and kidney failure following invasive heart procedures for ACS.

Effect of Multifactorial Risk Factor Interventions on Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Evidence supports the benefit of managing atrial fibrillation (AF) specific risk factors in secondary prevention of AF. However, a comprehensive summary of the effect of multifactorial risk factor interventions on outcomes of patients with AF over long-term is lacking. We searched MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL databases from inception to October 2021 for both randomized controlled trials (RCT) and observational studies comparing multifactorial risk factor interventions to usual care in patients with AF.

Cardiorespiratory fitness estimations and their ability to predict all-cause mortality in patients with cardiovascular disease.

Background: In cardiac rehabilitation programs, cardiorespiratory fitness is commonly estimated (eCRF) from the maximum workload achieved on a graded exercise test. This study compared four well-established eCRF equations in their ability to predict mortality in patients with cardiovascular disease (CVD).

Methods: A total of 7269 individuals with CVD were studied (81% male; age 59.

High-density mapping improves detection of conduction gaps after pulmonary vein isolation ablation with a circular mapping catheter.

Background: High-density (HD) mapping of the pulmonary vein (PVs) has been hypothesized to improve the detection of conduction gaps in the radiofrequency ablation lesions set after pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF). We aimed to compare the incidence of gaps after PVI with a standard 20-pole circumferential mapping catheter (CMC-20) and an HD mapping catheter (HD Grid).

Methods: This prospective study included patients scheduled for high-power short-duration PVI.

Systematic Review of Patient Decision Aids for Stroke Prevention Therapy in Atrial Fibrillation Management.

Background: Atrial Fibrillation (AF) is a major cause of stroke. Oral anticoagulation can reduce the risk of AF-associated stroke by 65% but it remains underused. Stroke prevention therapy in patients with AF has been considered a good target for shared decision making with patient decision aids as it is a long-term, preference-sensitive decision with known risk-benefit trade-offs.

Machine learning prediction of atrial fibrillation in cardiovascular patients using cardiac magnetic resonance and electronic health information.

Background: Atrial fibrillation (AF) is a commonly encountered cardiac arrhythmia associated with morbidity and substantial healthcare costs. While patients with cardiovascular disease experience the greatest risk of new-onset AF, no risk model has been developed to predict AF occurrence in this population. We hypothesized that a patient-specific model could be delivered using cardiovascular magnetic resonance (CMR) disease phenotyping, contextual patient health information, and machine learning.

Long-Term Maintenance of Cardiorespiratory Fitness Gains After Cardiac Rehabilitation Reduces Mortality Risk in Patients With Multimorbidity.

Purpose: The objective of this study was to characterize the impact of multimorbidity and cardiorespiratory fitness (CRF) on mortality in patients completing cardiac rehabilitation (CR).

Methods: This cohort study included data from patients with a history of cardiovascular disease (CVD) completing a 12-wk CR program between January 1996 and March 2016, with follow-up through March 2017. Patients were stratified by the presence of multimorbidity, which was defined as having a diagnosis of ≥2 noncommunicable diseases (NCDs).