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Current Heart Failure Reports Oct 2023This systematic review aims to summarise clustering studies in heart failure (HF) and guide future clinical trial design and implementation in routine clinical practice. (Review)
Review
REVIEW PURPOSE
This systematic review aims to summarise clustering studies in heart failure (HF) and guide future clinical trial design and implementation in routine clinical practice.
FINDINGS
34 studies were identified (n = 19 in HF with preserved ejection fraction (HFpEF)). There was significant heterogeneity invariables and techniques used. However, 149/165 described clusters could be assigned to one of nine phenotypes: 1) young, low comorbidity burden; 2) metabolic; 3) cardio-renal; 4) atrial fibrillation (AF); 5) elderly female AF; 6) hypertensive-comorbidity; 7) ischaemic-male; 8) valvular disease; and 9) devices. There was room for improvement on important methodological topics for all clustering studies such as external validation and transparency of the modelling process. The large overlap between the phenotypes of the clustering studies shows that clustering is a robust approach for discovering clinically distinct phenotypes. However, future studies should invest in a phenotype model that can be implemented in routine clinical practice and future clinical trial design. HF = heart failure, EF = ejection fraction, HFpEF = heart failure with preserved ejection fraction, HFrEF = heart failure with reduced ejection fraction, CKD = chronic kidney disease, AF = atrial fibrillation, IHD = ischaemic heart disease, CAD = coronary artery disease, ICD = implantable cardioverter-defibrillator, CRT = cardiac resynchronization therapy, NT-proBNP = N-terminal pro b-type natriuretic peptide, BMI = Body Mass Index, COPD = Chronic obstructive pulmonary disease.
PubMed: 37477803
DOI: 10.1007/s11897-023-00615-z -
Circulation. Arrhythmia and... Feb 2017Patients with heart failure and reduced ejection fraction are at increased risk of malignant ventricular arrhythmias. Implantable cardioverter-defibrillator (ICD) is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Patients with heart failure and reduced ejection fraction are at increased risk of malignant ventricular arrhythmias. Implantable cardioverter-defibrillator (ICD) is recommended to prevent sudden cardiac death in some of these patients. Sleep-disordered breathing (SDB) is highly prevalent in this population and may impact arrhythmogenicity. We performed a systematic review and meta-analysis of prospective studies that assessed the impact of SDB on ICD therapy.
METHODS AND RESULTS
Relevant prospective studies were identified in the Ovid MEDLINE, EMBASE, and Google Scholar databases. Weighted risk ratios of the association between SDB and appropriate ICD therapies were estimated using random effects meta-analysis. Nine prospective cohort studies (n=1274) were included in this analysis. SDB was present in 52% of the participants. SDB was associated with a 55% higher risk of appropriate ICD therapies (45% versus 28%; risk ratio, 1.55; 95% confidence interval, 1.32-1.83). In a subgroup analysis based on the subtypes of SDB, the risk was higher in both central (risk ratio, 1.50; 95% confidence interval, 1.11-2.02) and obstructive (risk ratio, 1.43; 95% confidence interval, 1.01-2.03) sleep apnea.
CONCLUSIONS
SDB is associated with an increased risk of appropriate ICD therapy in patients with heart failure and reduced ejection fraction.
Topics: Death, Sudden, Cardiac; Defibrillators, Implantable; Heart Failure; Humans; Risk Factors; Sleep Apnea Syndromes; Stroke Volume
PubMed: 28213507
DOI: 10.1161/CIRCEP.116.004609 -
World Journal of Cardiology May 2017Implantable cardioverter defibrillator (ICD) programming involves several parameters. In recent years antitachycardia pacing (ATP) has gained an increasing importance in... (Review)
Review
Implantable cardioverter defibrillator (ICD) programming involves several parameters. In recent years antitachycardia pacing (ATP) has gained an increasing importance in the treatment of ventricular arrhythmias, whether slow or fast. It reduces the number of unnecessary and inappropriate shocks and improves both patient's quality of life and device longevity. There is no clear indication regarding the type of ATP to be used, except for the treatment of fast ventricular tachycardias (188 bpm-250 bpm) where it has been shown a greater efficacy and safety of burst compared to ramp; 8 impulses in each sequence of ATP appears to be the best programming option in this setting. Beyond ATP use, excellent clinical results were obtained with programming standardization following these principles: extended detection time in ventricular fibrillation (VF) zone; supraventricular discrimination criteria up to 200 bpm; first shock in VF zone at the maximum energy in order to reduce the risk of multiple shocks. The MADIT-RIT trial and some observational registries have also recently demonstrated that programming with a widespread use of ATP, higher cut-off rates or delayed intervention reduces the number of inappropriate and unnecessary therapies and improves the survival of patients during mid-term follow-up.
PubMed: 28603590
DOI: 10.4330/wjc.v9.i5.429 -
The Cochrane Database of Systematic... Nov 2017Atrial fibrillation increases stroke risk and adversely affects cardiovascular haemodynamics. Electrical cardioversion may, by restoring sinus rhythm, improve... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Atrial fibrillation increases stroke risk and adversely affects cardiovascular haemodynamics. Electrical cardioversion may, by restoring sinus rhythm, improve cardiovascular haemodynamics, reduce the risk of stroke, and obviate the need for long-term anticoagulation.
OBJECTIVES
To assess the effects of electrical cardioversion of atrial fibrillation or flutter on the risk of thromboembolic events, strokes and mortality (primary outcomes), the rate of cognitive decline, quality of life, the use of anticoagulants and the risk of re-hospitalisation (secondary outcomes) in adults (>18 years).
SEARCH METHODS
We searched the Cochrane CENTRAL Register of Controlled Trials (1967 to May 2004), MEDLINE (1966 to May 2004), Embase (1980 to May 2004), CINAHL (1982 to May 2004), proceedings of the American College of Cardiology (published in Journal of the American College of Cardiology 1983 to 2003), www.trialscentral.org, www.controlled-trials.com and reference lists of articles. We hand-searched the indexes of the Proceedings of the British Cardiac Society published in British Heart Journal (1980 to 1995) and in Heart (1995 to 2002); proceedings of the European Congress of Cardiology and meetings of the Joint Working Groups of the European Society of Cardiology (published in European Heart Journal 1983-2003); scientific sessions of the American Heart Association (published in Circulation 1990-2003). Personal contact was made with experts.
SELECTION CRITERIA
Randomised controlled trial or controlled clinical trials of electrical cardioversion plus 'usual care' versus 'usual care' only, where 'usual care' included any combination of anticoagulants, antiplatelet drugs and drugs for 'rate control'. We excluded trials which used pharmacological cardioversion as the first intervention, and trials of new onset atrial fibrillation after cardiac surgery. There were no language restrictions.
DATA COLLECTION AND ANALYSIS
For dichotomous data, odds ratios were calculated; and for continuous data, the weighted mean difference was calculated.
MAIN RESULTS
We found three completed trials of electrical cardioversion (rhythm control) versus rate control, recruiting a total of 927 participants (Hot Cafe; RACE; STAF) and one ongoing trial (J-RHYTHM). There was no difference in mortality between the two strategies (OR 0.83; CI 0.48 to 1.43). There was a trend towards more strokes in the rhythm control group (OR 1.9; 95% CI 0.99 to 3.64). At follow up, three domains of quality of life (physical functioning, physical role function and vitality) were significantly better in the rhythm control group (RACE 2002; STAF 2003).
AUTHORS' CONCLUSIONS
Electrical cardioversion (rhythm control) led to a non-significant increase in stroke risk but improved three domains of quality of life.
Topics: Adult; Atrial Fibrillation; Atrial Flutter; Electric Countershock; Humans; Randomized Controlled Trials as Topic
PubMed: 29140555
DOI: 10.1002/14651858.CD002903.pub3 -
Resuscitation Jun 2011The most popular method of training in basic life support and AED use remains instructor-led training courses. This systematic review examines the evidence for different... (Review)
Review
INTRODUCTION
The most popular method of training in basic life support and AED use remains instructor-led training courses. This systematic review examines the evidence for different training methods of basic life support providers (laypersons and healthcare providers) using standard instructor-led courses as comparators, to assess whether alternative method of training can lead to effective skill acquisition, skill retention and actual performance whilst using the AED.
METHOD
OVID Medline (including Medline 1950-November 2010; EMBASE 1988-November 2010) was searched using "training" OR "teaching" OR "education" as text words. Search was then combined by using AND "AED" OR "automatic external defibrillator" as MESH words. Additionally, the American Heart Association Endnote library was searched with the terms "AED" and "automatic external defibrillator". Resuscitation journal was hand searched for relevant articles.
RESULTS
285 articles were identified. After duplicates were removed, 172 references were reviewed for relevance. From this 22 papers were scrutinized and 18 were included. All were manikin studies. Four LOE 1 studies, seven LOE 2 studies and three LOE 4 studies were supportive of alternative AED training methods. One LOE 2 study was neutral. Three LOE 1 studies provided opposing evidence.
CONCLUSION
There is good evidence to support alternative methods of AED training including lay instructors, self directed learning and brief training. There is also evidence to support that no training is needed but even brief training can improve speed of shock delivery and electrode pad placement. Features of AED can have an impact on its use and further research should be directed to making devices user-friendly and robust to untrained layperson.
Topics: Clinical Competence; Defibrillators; Health Personnel; Humans
PubMed: 21458137
DOI: 10.1016/j.resuscitation.2011.02.035 -
Current Cardiology Reviews 2022Implantable cardioverter defibrillators are used to prevent sudden cardiac death. The subcutaneous implantable cardioverter-defibrillator was newly developed to overcome... (Meta-Analysis)
Meta-Analysis
BACKGROUND/OBJECTIVES
Implantable cardioverter defibrillators are used to prevent sudden cardiac death. The subcutaneous implantable cardioverter-defibrillator was newly developed to overcome the limitations of the conventional implantable cardioverter defibrillator-transvenous device. The subcutaneous implantable cardioverter defibrillator is indicated for young patients with heart disease, congenital heart defects, and poor venous access, who have an indication for implantable cardioverter defibrillator without the need for anti-bradycardic stimulation. We aimed to compare the efficacy and complications of subcutaneous with transvenous implantable cardioverter- defibrillator devices.
METHODOLOGY
A systematic review was conducted using different databases. The inclusion criteria were observational and clinical randomized trials with no language limits and no publication date limit that compared subcutaneous with transvenous implantable cardioverter-defibrillators. The selected patients were aged > 18 years with complex ventricular arrhythmia.
RESULTS
Five studies involving 2111 patients who underwent implantable cardioverter defibrillator implantation were included. The most frequent complication in the subcutaneous device group was infection, followed by hematoma formation and electrode migration. For the transvenous device, the most frequent complications were electrode migration and infection. Regarding efficacy, the total rates of appropriate shocks were 9.04% and 20.47% in the subcutaneous and transvenous device groups, respectively, whereas inappropriate shocks to the subcutaneous and transvenous device groups were 11,3% and 10,7%, respectively.
CONCLUSION
When compared to the transvenous device, the subcutaneous device had lower complication rates owing to lead migration and less inappropriate shocks due to supraventricular tachycardia; nevertheless, infection rates and improper shocks due to T wave oversensing were comparable for both devices CRD42021251569.
Topics: Arrhythmias, Cardiac; Death, Sudden, Cardiac; Defibrillators, Implantable; Electrocardiography; Humans; Tachycardia, Supraventricular; Treatment Outcome
PubMed: 34879809
DOI: 10.2174/1573403X17666211208100151 -
BMJ (Clinical Research Ed.) Dec 2008To synthesise the literature on the effects of fish oil-docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)-on mortality and arrhythmias and to explore dose... (Review)
Review
OBJECTIVE
To synthesise the literature on the effects of fish oil-docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)-on mortality and arrhythmias and to explore dose response and formulation effects.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Medline, Embase, the Cochrane Library, PubMed, CINAHL, IPA, Web of Science, Scopus, Pascal, Allied and Complementary Medicine, Academic OneFile, ProQuest Dissertations and Theses, Evidence-Based Complementary Medicine, and LILACS. Studies reviewed Randomised controlled trials of fish oil as dietary supplements in humans.
DATA EXTRACTION
The primary outcomes of interest were the arrhythmic end points of appropriate implantable cardiac defibrillator intervention and sudden cardiac death. The secondary outcomes were all cause mortality and death from cardiac causes. Subgroup analyses included the effect of formulations of EPA and DHA on death from cardiac causes and effects of fish oil in patients with coronary artery disease or myocardial infarction.
DATA SYNTHESIS
12 studies totalling 32 779 patients met the inclusion criteria. A neutral effect was reported in three studies (n=1148) for appropriate implantable cardiac defibrillator intervention (odds ratio 0.90, 95% confidence interval 0.55 to 1.46) and in six studies (n=31 111) for sudden cardiac death (0.81, 0.52 to 1.25). 11 studies (n=32 439 and n=32 519) provided data on the effects of fish oil on all cause mortality (0.92, 0.82 to 1.03) and a reduction in deaths from cardiac causes (0.80, 0.69 to 0.92). The dose-response relation for DHA and EPA on reduction in deaths from cardiac causes was not significant.
CONCLUSIONS
Fish oil supplementation was associated with a significant reduction in deaths from cardiac causes but had no effect on arrhythmias or all cause mortality. Evidence to recommend an optimal formulation of EPA or DHA to reduce these outcomes is insufficient. Fish oils are a heterogeneous product, and the optimal formulations for DHA and EPA remain unclear.
Topics: Arrhythmias, Cardiac; Dietary Supplements; Docosahexaenoic Acids; Eicosapentaenoic Acid; Fish Oils; Humans; Randomized Controlled Trials as Topic
PubMed: 19106137
DOI: 10.1136/bmj.a2931 -
Frontiers in Public Health 2023The coronavirus disease of 2019 (COVID-19) pandemic, directly and indirectly, affected the emergency medical care system and resulted in worse out-of-hospital cardiac... (Meta-Analysis)
Meta-Analysis Review
The coronavirus disease of 2019 (COVID-19) pandemic, directly and indirectly, affected the emergency medical care system and resulted in worse out-of-hospital cardiac arrest (OHCA) outcomes and epidemiological features compared with those before the pandemic. This review compares the regional and temporal features of OHCA prognosis and epidemiological characteristics. Various databases were searched to compare the OHCA outcomes and epidemiological characteristics during the COVID-19 pandemic with before the pandemic. During the COVID-19 pandemic, survival and favorable neurological outcome rates were significantly lower than before. Survival to hospitalization, return of spontaneous circulation, endotracheal intubation, and use of an automated external defibrillator (AED) decreased significantly, whereas the use of a supraglottic airway device, the incidence of cardiac arrest at home, and response time of emergency medical service (EMS) increased significantly. Bystander CPR, unwitnessed cardiac arrest, EMS transfer time, use of mechanical CPR, and in-hospital target temperature management did not differ significantly. A subgroup analysis of the studies that included only the first wave with those that included the subsequent waves revealed the overall outcomes in which the epidemiological features of OHCA exhibited similar patterns. No significant regional differences between the OHCA survival rates in Asia before and during the pandemic were observed, although other variables varied by region. The COVID-19 pandemic altered the epidemiologic characteristics, survival rates, and neurological prognosis of OHCA patients. : PROSPERO (CRD42022339435).
Topics: Humans; Cardiopulmonary Resuscitation; Pandemics; COVID-19; Out-of-Hospital Cardiac Arrest; Emergency Medical Services
PubMed: 37234770
DOI: 10.3389/fpubh.2023.1180511 -
The International Journal of Angiology... Mar 2022This study aimed to figure out the incidence and predictors of pacemaker-induced cardiomyopathy (PICM) in patients with right ventricular (RV) pacing. We systematically... (Review)
Review
This study aimed to figure out the incidence and predictors of pacemaker-induced cardiomyopathy (PICM) in patients with right ventricular (RV) pacing. We systematically searched in PubMed on March 18, 2020, for English language abstract and full-article journals, using the following criteria: pacemaker induced cardiomyopathy AND right ventricular AND pacemaker AND patients AND human NOT implantable cardioverter defibrillator NOT ICD NOT animal. Four studies were included in this review after filtering 35 studies through year of publication and abstract selection. The average PICM incidence from 1,365 patients included from the four studies was 10.7 to 13.7%. One study stated that preimplantation left ventricular ejection fraction (LVEF) was the predictor for the development of PICM. Three studies mentioned that RV pacing burden was the predictor for the development of PICM. However, the percentage differ in three studies: ≥20, >40, and 60%. In addition, one of the studies also included interventricular dyssynchrony as another predictor. The incidence of PICM in patients with RV pacing ranged from 10.7 to 13.7%. Preimplantation LVEF, interventricular dyssynchrony, and burden of RV pacing are reported as the predictors for the development of PICM in patients with RV pacing.
PubMed: 35221847
DOI: 10.1055/s-0041-1735206 -
Annals of Noninvasive Electrocardiology... Sep 2023Double sequential external defibrillation (DSED) and vector-change defibrillation (VCD) have been suggested to enhance clinical outcomes for patients with ventricular... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVE
Double sequential external defibrillation (DSED) and vector-change defibrillation (VCD) have been suggested to enhance clinical outcomes for patients with ventricular fibrillation (VF) refractory of standard defibrillation (SD). Therefore, this network meta-analysis aims to evaluate the comparative efficacy of DSED, VCD, and SD for refractory VF.
METHODS
A systematic review and network meta-analysis synthesizing randomized controlled trials (RCTs) and comparative observational studies retrieved from PubMed, EMBASE, WOS, SCOPUS, and Cochrane through November 15th, 2022. R software netmeta and netrank package (R version 4.2.0) and meta-insight software were used to pool dichotomous outcomes using odds ratio (OR) presented with the corresponding confidence interval (CI). Our protocol was prospectively published in PROSPERO with ID: CRD42022378533.
RESULTS
We included seven studies with a total of 1632 participants. DSED was similar to SD in survival to hospital discharge (OR: 1.14 with 95% CI [0.55, 2.83]), favorable neurological outcome (modified Rankin scale ≤2 or cerebral performance category ≤2) (OR: 1.35 with 95% CI [0.46, 3.99]), and return of spontaneous circulation (ROSC) (OR: 0.81 with 95% CI [0.43; 1.5]). In addition, VCD was similar to SD in survival to hospital discharge (OR: 1.12 with 95% CI [0.27, 4.57]), favorable neurological outcome (OR: 1.01 with 95% CI [0.18, 5.75]), and ROSC (OR: 0.88 with 95% CI [0.24; 3.15]).
CONCLUSION
Double sequential external defibrillation and VCD were not associated with enhanced outcomes in patients with refractory VF out-of-hospital cardiac arrest, compared to SD. However, the current evidence is still inconclusive, warranting further large-scale RCTs.
Topics: Humans; Electric Countershock; Ventricular Fibrillation; Out-of-Hospital Cardiac Arrest; Network Meta-Analysis; Electrocardiography; Cardiopulmonary Resuscitation
PubMed: 37482919
DOI: 10.1111/anec.13075