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The article discusses the ARISE-HF trial, which aimed to evaluate the safety and efficacy of a novel aldose reductase inhibitor (AT-001) in patients with diabetic cardiomyopathy (DbCM) and stage B heart failure (HF). DbCM is a complication of type 2 diabetes mellitus (T2DM) that can lead to structural and functional abnormalities in the heart. The study found that AT-001 did not significantly improve exercise capacity compared to placebo, but there was a potential benefit in patients not receiving other cardioprotective drugs. However, further research is needed to confirm these findings and determine the clinical role of AT-001 in combination with other therapies. [Extracted from the article]

This article discusses the role of anti-obesity drugs in heart failure, specifically focusing on heart failure with preserved ejection fraction (HFpEF). Obesity is a significant risk factor for cardiovascular diseases, including HFpEF, and is associated with unfavorable clinical characteristics and worse symptoms. The pathophysiology of obesity-related HFpEF involves impaired left ventricular function, oxidative stress, inflammation, and adipose tissue dysfunction. The article also explores the potential benefits of anti-obesity drugs in improving outcomes for patients with HFpEF. However, the use of these drugs in heart failure with reduced ejection fraction (HFrEF) is less clear, and further research is needed to determine their efficacy and safety in this population. [Extracted from the article]

Purpose of Review: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are gaining importance due to their effects on cardiovascular parameters. This review discusses the findings of dedicated cardiovascular outcome trials of GLP-1RAs and summarizes their utility to help clinicians understand their role in cardiovascular disease. Recent Findings: Patients with diabetes mellitus are at an increased risk of cardiovascular disease. Cardiovascular outcome trials have shown GLP-1RAs decrease the primary composite outcome of the first occurrence of major adverse cardiovascular events (MACE) in patients with diabetes. Additionally, select GLP-1RAs have also shown improved cardiovascular outcomes in patients without diabetes who are either overweight (BMI ≥ 27), or obese (BMI ≥ 30). There have also been encouraging results in patients with heart failure with preserved ejection fraction. Summary: There is increasing evidence showing GLP-1RAs are beneficial across the cardiometabolic spectrum of disease. Implementation of these therapeutics into clinical practice is important to improve cardiovascular risk. [ABSTRACT FROM AUTHOR]

Purpose of Review: End stage kidney disease can be a slow process and it may be challenging to achieve required follow-up for sufficient events. Therefore, a surrogate kidney endpoint, such as estimated glomerular filtration rate (eGFR) slope maybe attractive to assess the kidney in cardiovascular trials, especially heart failure (HF). Recent Findings: eGFR slope can generate informative results in a shorter follow-up period, has decreased risk of type-2 error, and is less sensitive to eGFR shifts compared with other surrogate kidney endpoints (eGFR decline≥40% or doubling creatinine). However, eGFR slope has its limitations with acute effects, heterogeneity in slope calculation/reporting, and deviations from linearity. Summary: eGFR slope is a kidney endpoint which may be well-suited for HF trials. Cross-collaborated guideline recommendations are needed to optimize the use of eGFR slope as a kidney endpoint in patients with HF. [ABSTRACT FROM AUTHOR]

Given the substantial burden of chronic kidney disease associated with type 2 diabetes, an aggressive approach to treatment is required. Despite the benefits of guideline-directed therapy, there remains a high residual risk of continuing progression of chronic kidney disease and of cardiovascular events. Historically, a linear approach to pharmacologic management of chronic kidney disease has been used, in which drugs are added, then adjusted, optimized, or stopped in a stepwise manner based on their efficacy, toxicity, effects on a patient's quality of life, and cost. However, there are disadvantages to this approach, which may result in missing a window of opportunity to slow chronic kidney disease progression. Instead, a pillar approach has been proposed to enable earlier treatment that simultaneously targets multiple pathways involved in disease progression. Combination therapy in patients with chronic kidney disease associated with type 2 diabetes is being investigated in several clinical trials. In this article, we discuss current treatment options for patients with chronic kidney disease associated with type 2 diabetes and provide a rationale for tailored combinations of therapies with complementary mechanisms of action to optimize therapy using a pillar-based treatment strategy. [This article includes a plain language summary as an additional file]. [ABSTRACT FROM AUTHOR]

Aim: The RESHAPE‐HF2 trial is designed to assess the efficacy and safety of the MitraClip device system for the treatment of clinically important functional mitral regurgitation (FMR) in patients with heart failure (HF). This report describes the baseline characteristics of patients enrolled in the RESHAPE‐HF2 trial compared to those enrolled in the COAPT and MITRA‐FR trials. Methods and results: The RESHAPE‐HF2 study is an investigator‐initiated, prospective, randomized, multicentre trial including patients with symptomatic HF, a left ventricular ejection fraction (LVEF) between 20% and 50% with moderate‐to‐severe or severe FMR, for whom isolated mitral valve surgery was not recommended. Patients were randomized 1:1 to a strategy of delivering or withholding MitraClip. Of 506 patients randomized, the mean age of the patients was 70 ± 10 years, and 99 of them (20%) were women. The median EuroSCORE II was 5.3 (2.8–9.0) and median plasma N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) was 2745 (1407–5385) pg/ml. Most patients were prescribed beta‐blockers (96%), diuretics (96%), angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor–neprilysin inhibitors (82%) and mineralocorticoid receptor antagonists (82%). The use of sodium–glucose cotransporter 2 inhibitors was rare (7%). Cardiac resynchronization therapy (CRT) devices had been previously implanted in 29% of patients. Mean LVEF, left ventricular end‐diastolic volume and effective regurgitant orifice area (EROA) were 31 ± 8%, 211 ± 76 ml and 0.25 ± 0.08 cm2, respectively, whereas 44% of patients had mitral regurgitation severity of grade 4+. Compared to patients enrolled in COAPT and MITRA‐FR, those enrolled in RESHAPE‐HF2 were less likely to have mitral regurgitation grade 4+ and, on average, HAD lower EROA, and plasma NT‐proBNP and higher estimated glomerular filtration rate, but otherwise had similar age, comorbidities, CRT therapy and LVEF. Conclusion: Patients enrolled in RESHAPE‐HF2 represent a third distinct population where MitraClip was tested in, that is one mainly comprising of patients with moderate‐to‐severe FMR instead of only severe FMR, as enrolled in the COAPT and MITRA‐FR trials. The results of RESHAPE‐HF2 will provide crucial insights regarding broader application of the transcatheter edge‐to‐edge repair procedure in clinical practice. [ABSTRACT FROM AUTHOR]

Summary: Obesity is a worsening public health epidemic that remains challenging to manage. Obesity substantially increases the risk of cardiovascular diseases and presents a significant financial burden on the healthcare system. Digital health interventions, specifically telemedicine, may offer an attractive and viable solution for managing obesity. During the COVID‐19 pandemic, the need for a safer alternative to in‐person visits led to the increased popularity of telemedicine. Multiple studies have tested the efficacy of telemedicine modalities, including digital coaching via videoconferencing sessions, e‐health monitoring using wearable devices, and asynchronous forms of communication such as online chatrooms with counselors. In this review, we discuss the available evidence for telemedicine interventions in managing obesity, review current challenges and barriers to using telemedicine, and outline future directions to optimize the management of patients with obesity using telemedicine. [ABSTRACT FROM AUTHOR]

Heart failure (HF) affects more than 60 million individuals globally. Empagliflozin is currently approved for type 2 diabetes and chronic HF. Clinical trials have demonstrated that empagliflozin reduces the composite end point of hospitalizations for HF and mortality and improves the quality of life irrespective of left ventricular ejection fraction. Empagliflozin is a once-daily medication with minimal drug–drug interactions and does not require titration. Empagliflozin causes mild weight loss and does not significantly reduce blood pressure. Empagliflozin acts as an enabler for other HF drugs by reducing the risk of hyperkalemia. Empagliflozin is also beneficial for chronic kidney disease which exists commonly with HF. This review outlines the pharmacokinetics, pharmacodynamics, safety, and efficacy of empagliflozin in HF across various sub-groups and settings. Empagliflozin is a one-daily medication and is an effective glucose-lowering drug for the treatment of diabetes. In recent years, researchers and medical professionals have discovered that empagliflozin may also be used to treat some cardiovascular conditions. Numerous people suffer from myocardial infarction ('heart attack') each year. According to several clinical trials, empagliflozin may slow the course of myocardial infarction and improve clinical outcomes and quality of life. Additionally, empagliflozin does not result in a substantial decrease in blood pressure and can also lead to mild weight loss. Therefore, empagliflozin shows potential as a useful medication for the treatment of myocardial infarction, especially in individuals with diabetes and impaired kidney function. Article highlights Pharmacokinetics & metabolism Empagliflozin is a once-daily medication and does not require titration, unlike other heart failure (HF) medications. There are currently no reports of suspected drug–drug interactions involving empagliflozin. Pharmacodynamics Empagliflozin induces a natriuretic effect, improves myocardial ischemia-reperfusion injury, and reduces infarct size. Pharmacodynamics Empagliflozin causes mild weight loss, acts as an enabler for other HF drugs by reducing the risk of hyperkalemia, and has been linked to a rise in mean left ventricular ejection fraction. Empagliflozin is also beneficial for chronic kidney disease that frequently coexists with HF. Clinical efficacy Empagliflozin reduces the risk of cardiovascular mortality and hospitalization for HF regardless of the baseline systolic blood pressure, the spectrum of HF risk, type 2 diabetes status, background diuretic use, and baseline ejection fraction status. [ABSTRACT FROM AUTHOR]

Cardiac wasting, or the loss of heart muscle, has been observed in late stages of chronic diseases and in severely malnourished patients with anorexia nervosa. The main mechanisms responsible for cardiac wasting include disrupted cardiomyocyte ultrastructure, fibrosis, and proteolysis. Cardiac wasting can occur due to various reasons such as increased levels of inflammatory cytokines, tissue hypoxia, volume overload, and chemical stress. Studies have found evidence of cardiac wasting in patients with cancer, which may lead to cardiac dysfunction resembling heart failure. Reduced left ventricular mass has been associated with reduced physical functioning status and increased all-cause mortality in cancer patients. The pathophysiological mechanism behind cancer-associated cardiac wasting involves a metabolic imbalance leading to increased catabolic shifts in cardiac tissue. Cardiac wasting may also be influenced by physical inactivity and skeletal muscle loss. Screening for both muscular and cardiac wasting is important in cancer patients. Plasma biomarkers such as high-sensitivity troponin and BNP/NT-proBNP may be useful in predicting cardiac cachexia. Exercise has shown potential in stimulating cardiac regeneration and reversing cancer-mediated cardiac atrophy. Further research is needed to prevent and reverse cancer-related cardiac wasting and to identify its stages and development in cancer patients. [Extracted from the article]

Background: Recent evidence suggests that acetazolamide may be beneficial as an adjunctive diuretic therapy in patients with acute decompensated heart failure (HF). We aim to pool all the studies conducted until now and provide updated evidence regarding the role of acetazolamide as adjunctive diuretic in patients with acute decompensated HF. Methods: PubMed/Medline, Cochrane Library, and Scopus were searched from inception until July 2023, for randomized and nonrandomized studies evaluating acetazolamide as add-on diuretic in patients with acute decompensated HF. Data about natriuresis, urine output, decongestion, and the clinical signs of congestion were extracted, pooled, and analyzed. Data were pooled using a random effects model. Results were presented as risk ratios (RRs), odds ratios (ORs), or weighted mean differences (WMD) with 95% confidence intervals (95% CIs). Certainty of evidence was assessed using the grading of recommendation, assessment, development, and evaluation (GRADE) approach. A P value of < 0.05 was considered significant in all cases. Results: A total of 5 studies (n = 684 patients) were included with a median follow-up time of 3 months. Pooled analysis demonstrated significantly increased natriuresis (MD 55.07, 95% CI 35.1–77.04, P < 0.00001; I2 = 54%; moderate certainty), urine output (MD 1.04, 95% CI 0.10–1.97, P = 0.03; I2 = 79%; moderate certainty) and decongestion [odds ratio (OR) 1.62, 95% CI 1.14–2.31, P = 0.007; I2 = 0%; high certainty] in the acetazolamide group, as compared with controls. There was no significant difference in ascites (RR 0.56, 95% CI 0.23–1.36, P = 0.20; I2 = 0%; low certainty), edema (RR 1.02, 95% CI 0.52–2.0, P = 0.95; I2 = 45%; very low certainty), raised jugular venous pressure (JVP) (RR 0.86, 95% CI 0.63–1.17, P = 0.35; I2 = 0%; low certainty), and pulmonary rales (RR 0.82, 95% CI 0.44–1.51, P = 0.52; I2 = 25%; low certainty) between the two groups. Conclusions: Acetazolamide as an adjunctive diuretic significantly improves global surrogate endpoints for decongestion therapy but not all individual signs and symptoms of volume overload. Systematic Review Registration: This systematic review was prospectively registered on the PROSPERO (https://www.crd.york.ac.uk/PROSPERO/), registration number CRD498330. [ABSTRACT FROM AUTHOR]

This article discusses the challenges and effectiveness of early post-discharge follow-up for patients hospitalized with heart failure (HF). While guidelines recommend early follow-up visits after discharge, the evidence supporting their effectiveness is limited. A study from France found that combined follow-up with a general practitioner and cardiologist was associated with a lower risk of death or rehospitalization, but a higher risk of HF readmission. The article emphasizes the importance of optimizing guideline-directed medical therapy (GDMT) during these visits and initiating GDMT prior to discharge to improve outcomes for HF patients. However, the article acknowledges the limitations of the study and the need for further research in this area. [Extracted from the article]

The article discusses the underutilization of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF). It highlights the findings of the CHAMP-HF registry, which revealed that many eligible patients did not receive GDMT. The article explores various reasons for this, including patient out-of-pocket costs, poor tolerability, patient preference, and clinical inertia. The authors present the results of the HELP-HF registry, which examined the reasons for non-prescription or non-titration of GDMT. However, the study faced limitations due to missing data and the subjective nature of reasons provided. The article emphasizes the need for definitive data to understand the barriers to GDMT utilization and improve patient care. [Extracted from the article]

Aims: The therapeutic mechanism of sodium–glucose cotransporter 2 inhibitors (SGLT2i) on left cardiac remodelling in patients with heart failure with reduced ejection fraction (HFrEF) is not well‐established. This study meta‐analysed the impact of SGLT2i on left cardiac structure and function in patients with HFrEF. Methods and results: Online databases were queried up to April 2023 for trials reporting indicators of left cardiac structure and function in patients with HFrEF treated with SGLT2i. Data from studies were pooled using a random‐effects model to derive weighted mean differences (WMDs) and 95% confidence intervals (CIs). Six trials were included (n = 555). Compared with control, SGLT2i significantly improved left ventricular end‐diastolic volume (LVEDV; WMD: −17.07 ml [−23.84, −10.31]; p < 0.001), LVEDV index (WMD: −5.62 ml/m2 [−10.28, −0.97]; p = 0.02), left ventricular end‐systolic volume (LVESV; WMD: −15.63 ml [−26.15, −5.12]; p = 0.004), LVESV index (WMD: −6.90 ml/m2 [−10.68, −3.11]; p = 0.001), left ventricular ejection fraction (WMD: 2.71% [0.70, 4.72]; p = 0.008), and left atrial volume index (WMD: −2.19 ml/m2 [−4.26, −0.11]; p = 0.04) in patients with HFrEF. SGLT2i use was associated with a non‐significant trend towards a reduction in left ventricular mass index (WMD: −6.25 g/m2 [−12.79, 0.28]; p = 0.06). No significant impact on left ventricular global longitudinal strain was noted (WMD: 0.21% [−0.25, 0.67]; p = 0.38). Conclusions: Sodium–glucose cotransporter 2 inhibitors improve cardiac structure and function in patients with HFrEF. [ABSTRACT FROM AUTHOR]

Aims: The relationship between accelerometry data and changes in Kansas City Cardiomyopathy Questionnaire‐Physical Limitation Score (KCCQ‐PLS) or 6 min walk test (6MWT) is not well understood. Methods and results: VITALITY‐HFpEF accelerometry substudy (n = 69) data were assessed at baseline and 24 weeks. Ordinal logistic regression models were used to assess the association between accelerometry activity and deterioration, improved, or unchanged KCCQ‐PLS (≥8.33 and ≤ −4.17 points) and 6MWT (≥32 vs. ≤ −32 m). KCCQ‐PLS score deteriorated in 16 patients, improved in 34, and was unchanged in 19. 6MWT deteriorated in 8 patients, improved in 21, and was unchanged in 19. Mean accelerometer wear was 21.4 (±2.1) h/day. Changes in hours active from baseline to 24 weeks were not significantly different among patients who exhibited deterioration, improvement, or no change in KCCQ‐PLS [odds ratio (OR) 0.91, 95% confidence interval (CI) 0.71–1.18; P = 0.48] or 6MWT (OR 1.21, 95% CI 0.91–1.60; P = 0.18). Similar lack of association was observed for other accelerometry metrics and change in KCCQ and 6MWT. These findings were unaffected when KCCQ and 6MWT were examined as continuous variables. Conclusions: Accelerometer‐based activity measures did not correlate with subjective or objective standard measures of health status and functional capacity in heart failure with preserved ejection fraction. Further investigation of their relationships to clinical outcomes is required. [ABSTRACT FROM AUTHOR]

The article discusses the lack of research output and physician-scientists from developing countries, highlighting the challenges of funding, infrastructure, and mentorship. It emphasizes the importance of structured research training for medical students and early career physicians, advocating for research teaching to be integrated into medical curricula. The Research Council of Pakistan (RCOP) is presented as an example of an organization that aims to train future leaders in academic medicine by providing research workshops and mentorship opportunities. The article also mentions the positive impact of online workshops during the pandemic, which increased participation and publication rates among medical students, particularly women. The RCOP model is suggested as a potential solution to overcome the shortage of physician-scientists in developing countries and promote international collaborations. [Extracted from the article]

An effective low-cost nano NiO-In2O3 electrode material for oxygen evolution (OER) is presented. Electrochemical studies uncovered electrocatalytic recital in Ascorbic Acid, Hydrogen Peroxide (H2O2), and ethanol. The cubic crystal structure of NiO-In2O3 was revealed by XRD. FT-IR, FE-SEM and HR-TEM studies exploit the structure and morphology of NiO-In2O3. Electrochemistry of NiO-In2O3 uncovered high current density (900mA/cm²) at substantially low overpotential (230mV), realizing its OER recital. On top, high mass activity and turnover frequency by NiO-In2O3 comprehend improved electrical and semiconductive properties in H2O2. The NiO-In2O3 durability beyond 90 hours was estimated by chronopotentiometry (CP). The Impedance analysis (EIS) revealed low charge transfer resistance and high exchange current density. Given electrocatalytic studies, we found a direct relationship between NiO-In2O3 nanocomposite and the degradation of H2O2 compared to its counterparts. Hence, this strategy can be an alternative and potential source of hydrogen and oxygen production at commercial scale. [ABSTRACT FROM AUTHOR]

Background and Aims Whereas a beneficial effect of intravenous ferric carboxymaltose (FCM) on symptoms and exercise capacity among patients with iron deficiency and heart failure (HF) has been consistently demonstrated, the effects of treatment on clinical events remain the subject of research. This meta-analysis aimed to characterize the effects of FCM therapy on hospitalizations and mortality. Methods Patient-level data from randomized, placebo-controlled FCM trials including adults with HF and iron deficiency with ≥52 weeks follow-up were analysed. The co-primary efficacy endpoints were (i) composite of total/recurrent cardiovascular hospitalizations and cardiovascular death and (ii) composite of total HF hospitalizations and cardiovascular death, through 52 weeks. Key secondary endpoints included individual composite endpoint components. Event rates were analysed using a negative binomial model. Treatment-emergent adverse events were also examined. Results Three FCM trials with a total of 4501 patients were included. Ferric carboxymaltose was associated with a significantly reduced risk of co-primary endpoint 1 (rate ratio 0.86; 95% confidence interval 0.75–0.98; P =.029; Cochran Q : 0.008), with a trend towards a reduction of co-primary endpoint 2 (rate ratio 0.87; 95% confidence interval 0.75–1.01; P =.076; Cochran Q : 0.024). Treatment effects appeared to result from reduced hospitalization rates, not improved survival. Treatment appeared to have a good safety profile and was well tolerated. Conclusions In iron-deficient patients with HF with reduced left ventricular ejection fraction, intravenous FCM was associated with significantly reduced risk of hospital admissions for HF and cardiovascular causes, with no apparent effect on mortality. [ABSTRACT FROM AUTHOR]

Endpoint adjudication (EA) is a common feature of contemporary randomized controlled trials (RCTs) in cardiovascular medicine. Endpoint adjudication refers to a process wherein a group of expert reviewers, known as the clinical endpoint committee (CEC), verify potential endpoints identified by site investigators. Events that are determined by the CEC to meet pre-specified trial definitions are then utilized for analysis. The rationale behind the use of EA is that it may lessen the potential misclassification of clinical events, thereby reducing statistical noise and bias. However, it has been questioned whether this is universally true, especially given that EA significantly increases the time, effort, and resources required to conduct a trial. Herein, we compare the summary estimates obtained using adjudicated vs. non-adjudicated site designated endpoints in major cardiovascular RCTs in which both were reported. Based on these data, we lay out a framework to determine which trials may warrant EA and where it may be redundant. The value of EA is likely greater when cardiovascular trials have nuanced primary endpoints, endpoint definitions that align poorly with practice, sub-optimal data completeness, greater operator variability, and lack of blinding. EA may not be needed if the primary endpoint is all-cause death or all-cause hospitalization. In contrast, EA is likely merited for more nuanced endpoints such as myocardial infarction, bleeding, worsening heart failure as an outpatient, unstable angina, or transient ischaemic attack. A risk-based approach to adjudication can potentially allow compromise between costs and accuracy. This would involve adjudication of a small proportion of events, with further adjudication done if inconsistencies are detected. [ABSTRACT FROM AUTHOR]

Background: Multiple randomized controlled trials (RCTs) have compared the success of antero-lateral vs. antero-posterior electrode position for cardioversion of atrial fibrillation (AF). However, due to small sample size and conflicting results of these RCTs, the optimal electrode positioning for successful cardioversion remains uncertain. Methods: A systematic search of MEDLINE and EMBASE was conducted. Outcomes of interest included overall success of cardioversion with restoration of sinus rhythm, 1st shock success, 2nd shock success, mean shock energy required for successful cardioversion, mean number of shocks required for successful cardioversion, success of cardioversion at high energy (> 150 J) and success of cardioversion at low energy (< 150 J). Mantel–Haenszel risk ratios (RR) with 95% confidence intervals were calculated using random-effects model. Results: A total of 14 RCTs comprising 2445 patients were included. There was no statistically significant difference between two cardioversion approaches in the overall success of cardioversion (RR 1.02; 95% CI [0.97–1.06]; p = 0.43), first shock success (RR 1.14; 95% CI [0.99–1.32]), second shock success (RR 1.08; 95% CI [0.94–1.23]), mean shock energy required (mean difference 6.49; 95% CI [-17.33–30.31], success at high energy > 150 J (RR 1.02; 95% CI [0.92–1.14] and success at low energy < 150 J (RR 1.09; 95% CI [0.97–1.22]). Conclusions: This meta-analysis of RCTs shows no significant difference in the success of cardioversion between antero-lateral vs. antero-posterior electrode position for cardioversion of AF. Large well-conducted and adequately powered randomized clinical trials are needed to definitively address this question. [ABSTRACT FROM AUTHOR]

A study published in the European Journal of Heart Failure examined the association between a diabetes-specific heart failure risk score (WATCH-DM) and the presence of subclinical cardiomyopathy in individuals with diabetes. The study included 150 adults with diabetes and found that those with high WATCH-DM scores had a significantly greater prevalence of diabetic cardiomyopathy (DbCM) compared to those with low scores. The study suggests that the WATCH-DM risk score may be a useful tool for identifying individuals with diabetes who are at high risk of developing heart failure. However, the study has limitations, such as a small sample size and the inability to establish causality. The study was supported by a research grant and the authors have disclosed potential conflicts of interest. [Extracted from the article]

Heart failure (HF) is a heterogeneous syndrome affecting more than 60 million individuals globally. Despite recent advancements in understanding of the pathophysiology of HF, many issues remain including residual risk despite therapy, understanding the pathophysiology and phenotypes of patients with HF and preserved ejection fraction, and the challenges related to integrating a large amount of disparate information available for risk stratification and management of these patients. Risk prediction algorithms based on artificial intelligence (AI) may have superior predictive ability compared to traditional methods in certain instances. AI algorithms can play a pivotal role in the evolution of HF care by facilitating clinical decision making to overcome various challenges such as allocation of treatment to patients who are at highest risk or are more likely to benefit from therapies, prediction of adverse outcomes, and early identification of patients with subclinical disease or worsening HF. With the ability to integrate and synthesize large amounts of data with multidimensional interactions, AI algorithms can supply information with which physicians can improve their ability to make timely and better decisions. In this review, we provide an overview of the AI algorithms that have been developed for establishing early diagnosis of HF, phenotyping HF with preserved ejection fraction, and stratifying HF disease severity. This review also discusses the challenges in clinical deployment of AI algorithms in HF, and the potential path forward for developing future novel learning‐based algorithms to improve HF care. [ABSTRACT FROM AUTHOR]

This study presents the perspectives of the travel industry stakeholders, namely travellers, potential tourists, hospitality businesses, and travel agents. There is little literature available that covers the perspectives of all these stakeholders. The study tries to understand the preference of travellers, problems faced by them, the response of hospitality businesses on reviews posted by travellers, and the viewpoint of travel agents. A purposive sampling technique was used to select respondents for semi-structured interviews. A total of seven semi-structured interviews were conducted online to understand better the perspectives on the study topic. Thematic analysis was applied to the interview data and several themes related to each stakeholder emerged. The main themes include online presence, travellers' preference, hospitality businesses' response, and social media interaction. Travellers usually expect neat and clean rooms, washrooms, comfortable beds, and food. They expect services in accordance to the fee they pay. Hospitality businesses have dedicated staff to respond to every comment they receive. More positive reviews increase the chances of guest inflow and vice versa. There are no websites in Pakistan to review the travel agents' services, however, they are reviewed mostly on social media pages. These travel agents provide a one-stop solution to their guests and have to be very vigilant in addressing any inconvenience voiced by their customers. This research provides insights to all the stakeholders involved in the industry and gives valuable pointers to improve their services. [ABSTRACT FROM AUTHOR]

This article discusses the prevalence and implications of albuminuria in transthyretin cardiac amyloidosis (ATTR-CA), a condition that is often under-recognized as a cause of heart failure. The study found that almost half of the patients with ATTR-CA had albuminuria, which is associated with an increased risk of mortality. The findings suggest that albuminuria can be a useful risk marker in patients with ATTR-CA and should be considered in clinical practice and trials. Further research is needed to understand the mechanisms behind kidney involvement in ATTR-CA and to explore potential treatments for albuminuria in these patients. [Extracted from the article]

Aims: Iron deficiency is common in patients with heart failure (HF) and reduced ejection fraction (HFrEF) and is associated with a poor prognosis. Whether intravenous iron replacement improves recurrent HF hospitalizations and cardiovascular mortality of these patients is uncertain although several trials were conducted. Moreover, none of the trials were powered to assess the effect of intravenous iron in clinically important subgroups. Therefore, we conducted a Bayesian analysis to derive precise estimates of the effect of intravenous iron replacement on recurrent HF hospitalizations and cardiovascular mortality in iron‐deficient HFrEF patients using consistent subgroup definitions across trials. Methods and results: Individual participant data were used from the FAIR‐HF (n = 459), CONFIRM‐HF (n = 304) and AFFIRM‐AHF (n = 1108) trials. These data were re‐analysed following as closely as possible the approach taken in the analyses of IRONMAN (n = 1137), for which study level data were used. Definitions of outcomes and subgroups from the FAIR‐HF, CONFIRM‐HF and AFFIRM‐AHF were matched with those used in IRONMAN. The primary endpoint was recurrent HF hospitalizations and cardiovascular mortality. The analysis of recurrent events was based on rate ratios (RR) derived from the Lin‐Wei‐Yang‐Ying model, and the data were pooled using Bayesian random‐effects meta‐analysis. Compared with placebo, intravenous iron significantly reduced the rates of recurrent HF hospitalizations and cardiovascular mortality (RR 0.73, 95% credible interval [CI] 0.48–0.99; between‐trial heterogeneity tau = 0.16). The pooled treatment effects did not provide evidence for any differential effects for subgroups based on sex (ratio of rate ratios [RRR] 1.49 [95% CI 0.95–2.37], age <69.4 vs. ≥69.4 years) (RRR 0.68 [0.40–1.15]), ischaemic versus non‐ischaemic aetiology of HF (RRR 0.73 [0.42–1.33]), transferrin saturation <20% vs. ≥20% (RRR 0.75 [0.40–1.34]), estimated glomerular filtration rate ≤60 versus >60 ml/min/1.73 m2 (RRR 0.97 [0.56–1.68]), haemoglobin <11.8 versus ≥11.8 (RRR 0.95 [0.53–1.60]), ferritin <35 versus ≥35 μg/L (RRR 1.26 [0.72–2.48]) and New York Heart Association class II versus III/IV (RRR 0.91 [0.54–1.56]). Conclusions: Treatment of iron‐deficient HFrEF patients with intravenous iron – namely with ferric carboxymaltose or ferric derisomaltose – results in significant reduction in recurrent HF hospitalizations and cardiovascular mortality. Results were nominally consistent across the subgroups studied, but for several of these subgroups uncertainty remains present. [ABSTRACT FROM AUTHOR]

Conventional randomized controlled trials (RCTs) can be expensive, time intensive, and complex to conduct. Trial recruitment, participation, and data collection can burden participants and research personnel. In the past two decades, there have been rapid technological advances and an exponential growth in digitized healthcare data. Embedding RCTs, including cardiovascular outcome trials, into electronic health record systems or registries may streamline screening, consent, randomization, follow-up visits, and outcome adjudication. Moreover, wearable sensors (i.e. health and fitness trackers) provide an opportunity to collect data on cardiovascular health and risk factors in unprecedented detail and scale, while growing internet connectivity supports the collection of patient-reported outcomes. There is a pressing need to develop robust mechanisms that facilitate data capture from diverse databases and guidance to standardize data definitions. Importantly, the data collection infrastructure should be reusable to support multiple cardiovascular RCTs over time. Systems, processes, and policies will need to have sufficient flexibility to allow interoperability between different sources of data acquisition. Clinical research guidelines, ethics oversight, and regulatory requirements also need to evolve. This review highlights recent progress towards the use of routinely generated data to conduct RCTs and discusses potential solutions for ongoing barriers. There is a particular focus on methods to utilize routinely generated data for trials while complying with regional data protection laws. The discussion is supported with examples of cardiovascular outcome trials that have successfully leveraged the electronic health record, web-enabled devices or administrative databases to conduct randomized trials. [ABSTRACT FROM AUTHOR]

The efficient degradation of organic effluent is always desirable when using advanced photocatalysts with enhanced activity under visible light. Nickel-doped indium oxide (Ni-In2O3) is synthesized via a hydrothermal route as well as its composites with reduced graphene oxide (rGO). Facile synthesis and composite formation methods lead to a well-defined morphology of fabricated nanocomposite at low temperatures. The bandgap energy of indium oxide lies in the range of 3.00–4.30 eV. Its high light absorption capacity, high stability, and non-toxicity make it a choice as a photocatalyst that is active under visible light. The transition metal Ni-doping changes the indium oxide's chemical, optical, and physicochemical properties. The Ni-In2O3 and rGO composites improved the charge transport and reduced the charge recombination. The phase analysis of the developed photocatalysts was performed using X-ray diffraction (XRD), and the morphological and structural properties were observed using advanced microscopic techniques (SEM and TEM), while UV-vis and FTIR spectroscopic techniques were used to confirm the structure and optical and chemical properties. The electrochemical properties of the photocatalysts were investigated using cyclic voltammetry (CV), linear sweep voltammetry (LSV), and electrochemical impedance spectroscopy (EIS), and the charge-transfer properties of the obtained photocatalysts and the mechanism of the photocatalytic degradation mechanism of methylene blue, a common dye used in the dyeing industry, were determined. [ABSTRACT FROM AUTHOR]

Despite significant therapeutic advancements in heart failure with reduced ejection fraction (HFrEF), the residual risk of all-cause mortality and hospitalizations remains high among patients with HFrEF. Vericiguat is a novel oral soluble guanylate cyclase (sGC) stimulator which was approved by the US Food and Drug administration (FDA) in January 2021 for use in patients with symptomatic chronic HF and an ejection fraction less than 45% following a hospitalization for HF or the need for outpatient intravenous diuretics. We provide a concise review of the pharmacology, clinical efficacy, and tolerability of vericiguat in HFrEF. We also discuss the role of vericiguat in current clinical practice. Vericiguat reduces the risk of cardiovascular mortality or HF hospitalizations by an absolute event-rate reduction of 4.2 events per 100 patient-years with a number needed to treat of 24 patients, on a background of guideline-directed medical therapy. Almost 90% of the patients with HFrEF were adherent to the 10 mg dose of vericiguat in the VICTORIA trial with a favorable tolerability and safety profile. Considering the high residual risk that persists in HFrEF, vericiguat has a role to improve outcomes among patients with worsening HFrEF. [ABSTRACT FROM AUTHOR]

Contamination set off by highly toxic metal ions and dyes is a big threat to the environment and living beings. Various industries like metal plating, mining, pesticides, battery manufacturing, and dyeing release metal ions and toxic dyes directly into the water. It is necessary to remove these toxic substances from the environment. Molecular imprinting technology (MIT) got a lot of attention in the last two decades because of several advantages over conventional adsorption technologies. Molecularly imprinted polymers (MIPs) are compatible with natural antibodies having the highest selectivity due to specific recognition sites for the template molecules. Selectivity is the major advantage of MIP, any targeted heavy metal ions and dyes can be separated efficiently. Various polymerization procedures can be used for the MIP preparation started by self-assembled monomers surrounding the molecules of the template because of the “monomer functional groups and template” interchange. Various studies have been made for the removal of metal ions and dyes from water and excellent results have been attained. Continuous research developments are being done for real applications of MIPs to remove toxic environmental substances that are not only harmful to humans and other organisms but also disturb the ecological balance. This review represents the development of current MIPs, advantages as well as disadvantages exhibited from various angles to complete a roadmap towards industrial and commercial use of MIPs. [ABSTRACT FROM AUTHOR]

Participants enrolled in cardiovascular disease (CVD) randomized controlled trials are not often representative of the population living with the disease. Older adults, children, women, Black, Indigenous and People of Color, and people living in low- and middle-income countries are typically under-enrolled in trials relative to disease distribution. Treatment effect estimates of CVD therapies have been largely derived from trial evidence generated in White men without complex comorbidities, limiting the generalizability of evidence. This review highlights barriers and facilitators of trial enrollment, temporal trends, and the rationale for representativeness. It proposes strategies to increase representativeness in CVD trials, including trial designs that minimize the research burden on participants, inclusive recruitment practices and eligibility criteria, diversification of clinical trial leadership, and research capacity-building in under-represented regions. Implementation of such strategies could generate better and more generalizable evidence to reduce knowledge gaps and position the cardiovascular trial enterprise as a vehicle to counter existing healthcare inequalities. [ABSTRACT FROM AUTHOR]

Terminal units' modification is an effective strategy for designing efficient un-fused nonfullerene acceptors (UF-NFAs) with enhanced power conversion efficiency (PCE). Nowadays, researchers are focused on designing new UF-NFAs that enhance the PCE of organic solar cells. In this line, efforts are being made to design new UF-NFAs for possible application on organic solar cells (OSCs). By doing terminal unit modification of the Cl-4F molecule, we have designed a new series of UF-NFA (ETPJ-1–ETPJ-4). Density functional theory (DFT) and time-dependent density functional theory (TD-DFT) at the B3LYP/6-311G(d , p) level have been employed for the computation of various geometric and photovoltaic aspects. Energies of highest occupied molecular orbitals (HOMO) and lowest unoccupied molecular orbitals (LUMO) with their band gap suggested that ETPJ-1–ETPJ-4 are effective contributors to the design of the efficient active layer of OSCs. Red-shift (near IR) in the absorption spectrum with easy excitation of exciton has been noted in ETPJ-1–ETPJ-4. Enhanced open circuit voltage with high fill factor percentage (FF%) was also noted for designed systems. Further, the PCE values of the ETPJ-1–ETPJ-4 are better than the reference molecule. So, we recommended a novel kind of unfused nonfullerene acceptors (NFAs) with unique S–O noncovalent interaction for possible application in OSCs. [ABSTRACT FROM AUTHOR]

Pulmonary arterial pressures are often used as surrogates for intravascular blood volume. However, the relationship between pressure and volume remains controversial. To contextualize and provide concrete examples and impact on clinical management, we report two cases of heart failure (one in heart failure with reduced ejection fraction and one in heart failure with preserved ejection fraction) where pressure‐based measurements did not accurately represent the intravascular status and affected clinical management. [ABSTRACT FROM AUTHOR]

Aims: Baseline body mass index (BMI) and weight loss promoted by sodium–glucose cotransporter 2 inhibitors may impact outcomes in patients with heart failure with reduced ejection fraction (HFrEF). We assessed in the EMPEROR‐Reduced population treated with empagliflozin versus placebo the relationship between baseline BMI, weight loss and effects on the primary (time to first hospitalization for heart failure [HHF] or cardiovascular death) and key secondary outcomes. Methods and results: We categorized patients according to their baseline BMI: <20 kg/m2 (n = 180); 20 to <25 kg/m2 (n = 1038); 25 to <30 kg/m2 (n = 1345); 30 to <35 kg/m2 (n = 774) and ≥35 kg/m2 (n = 393). The treatment effect of empagliflozin on the primary outcome was consistent across all BMI categories (hazard ratios in subgroups 0.66–0.88, interaction trend p = 0.32), as was the effect on total (first plus recurrent) HHF (interaction trend p = 0.31). Empagliflozin reduced the rate of estimated glomerular filtration rate decline consistently across the BMI categories (interaction trend p = 0.67). Overall, incidence rates of any or serious adverse events were comparable between the treatment groups across all BMI categories. A total of 313 (17.4%) patients treated with empagliflozin experienced a weight loss of more than 5% at week 52 versus 230 (12.8%) in placebo. When analysed separately within each treatment group, presence of weight loss was similarly associated with an increased risk of all‐cause mortality. Conclusion: The benefits of empagliflozin versus placebo were consistently present across all BMI categories in HFrEF patients. Weight loss was associated with higher risk of all‐cause mortality, regardless of treatment group. [ABSTRACT FROM AUTHOR]

Introduction: Bibliometric studies can help guide researchers and funding bodies toward fields where more research activity is warranted. Bibliometric analyses have previously been published in many specialties and sub-specialties. Our literature search did not show a bibliometric analysis on pericardial diseases. We performed a bibliometric analysis of the top 100 cited manuscripts on pericardial diseases to identify knowledge. Material and methods: Bibliometric analysis is a quantitative method to assess research performance and analyze publication trends. Web of Science was searched in April 2020 to identify the top 100 cited manuscripts in pericardial diseases. Results: Twenty-six out of the top 100 cited manuscripts were published between 2000 and 2009. These manuscripts were cited on average189 times (range: 110–743) since publication. Only two manuscripts were cited > 500 times. Among the top-ten cited manuscripts, there were 6 original articles, 1 case series, and 3 review articles. Of the 3 review articles, 2 were society guidelines. 90% of the authors had written just 1 manuscript. There were ten manuscripts with women as first authors with a significant association between gender of the first and corresponding author (odds ratio = 44, p < 0.001). Only 20% of manuscripts were funded. Most publications came from institutions in the United States (n = 40), Italy (n = 10), and Spain (n = 5). Conclusions: Our study provides an insight into the characteristics and quality of the highly cited literature in the field of pericardial diseases. This can be used to guide further research in the field of pericardial diseases. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a complex, multifactorial and heterogeneous syndrome with substantial mortality and morbidity. Over the last few decades, numerous attempts have been made to develop targeted therapies that may attenuate the known pathophysiological pathways responsible for causing the progression of HF. However, therapies developed with this objective have sometimes failed to show benefit. The pathophysiological construct of HF with numerous aetiologies suggests that interventions with broad mechanisms of action which simultaneously target more than one pathway maybe more effective in improving the outcomes of patients with HF. Indeed, current therapeutics with clinical benefits in HF have targeted a wider range of intermediate phenotypes. Despite extensive scientific breakthroughs in HF research recently, questions persist regarding the ideal therapeutic targets which may help achieve maximum benefit. In this review, we evaluate the mechanism of action of current therapeutic strategies, the pathophysiological pathways they target and highlight remaining knowledge gaps regarding the mode of action of these interventions. [ABSTRACT FROM AUTHOR]

Herein, hydrothermal fabrication of CdO-g-C3N4 photocatalyst for a substantially better photocatalytic recital in water splitting is presented. The XRD analysis confirms the cubic phase of CdO-g-C3N4, whereas FTIR and UV-VIS studies revealed the presence of respective groups and a median band gap energy (2.55 eV) of the photocatalyst, respectively, which further enhanced its photo-electrochemical (PEC) properties. The SEM displays the oblong structures of g-C3N4 sheets and nano rod-like morphology of CdO and CdO-g-C3N4, respectively. The HR-TEM exhibits morphology & orientation of the grains and substantiates the polycrystal-line nature of CdO-g-C3N4 nanocomposite. The photocatalytic water-splitting concert is evaluated by PEC experiments under 1 SUN visible light irradiation. Linear sweep voltammetry (LSV), chronoamperometry (CA), and electrochemical impedance spectroscopy (EIS) comprehend the CdO-g-C3N4 as a hydrogen evolution photocatalyst. A photocurrent density beyond ≥5 mA/cm2 is recorded from CdO-g-C3N4, which is 5–6 folds greater than pure CdO and g-C3N4. The efficient separation and transfer of charges allocated to CdO-g-C3N4 and fabricating heterojunctions between g-C3N4 and CdO suppresses the unfavorable electron-hole pairs recombination process. Thus, it recesses charge transfer resistance, augmenting enhanced photocatalytic performance under 1 SUN irradiation. [ABSTRACT FROM AUTHOR]

Background Individuals with diabetes have a high frailty burden and increased risk of heart failure (HF). In this study, we evaluated the association of baseline and longitudinal changes in frailty with risk of HF and its subtypes: HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction (HFrEF). Methods Participants (age: 45–76 years) of the Look AHEAD trial without prevalent HF were included. The frailty index (FI) was used to assess frailty burden using a 35-variable deficit model. The association between baseline and longitudinal changes (1- and 4-year follow-up) in FI with risk of overall HF, HFpEF (ejection fraction [EF] ≥ 50%), and HFrEF (EF < 50%) independent of other risk factors and cardiorespiratory fitness was assessed using adjusted Cox models. Results The study included 5 100 participants with type 2 diabetes mellitus, of which 257 developed HF. In adjusted analysis, higher frailty burden was significantly associated with a greater risk of overall HF. Among HF subtypes, higher baseline FI was significantly associated with risk of HFpEF (hazard ratio [HR] [95% CI] per 1- SD higher FI: 1.37 [1.15–1.63]) but not HFrEF (HR [95% CI]: 1.19 [0.96–1.46]) after adjustment for potential confounders, including traditional HF risk factors. Among participants with repeat measures of FI at 1- and 4-year follow-up, an increase in frailty burden was associated with a higher risk of HFpEF (HR [95% CI] per 1- SD increase in FI at 4 years: 1.78 [1.35–2.34]) but not HFrEF after adjustment for other confounders. Conclusions Among individuals with type 2 diabetes mellitus, higher baseline frailty and worsening frailty burden over time were independently associated with higher risk of HF, particularly HFpEF after adjustment for other confounders. [ABSTRACT FROM AUTHOR]

Purpose: Most centers performing catheter ablation (CA) of atrial fibrillation (AF) admit the patients for an overnight hospital stay to monitor for post-procedure complications, but the clinical benefits of this overnight hospital admission policy have not been carefully investigated. We hypothesized that same-day discharge strategy is safe and feasible in patients with AF undergoing CA. Methods: A systematic review of studies comparing the safety of same-day discharge vs hospital admission for AF patients undergoing CA was conducted in PubMed/MEDLINE, Embase, Scopus, and Web of Science. No randomized controlled trials met the inclusion criteria; therefore, observational cohort studies were included. Mantel–Haenszel risk ratios were calculated and I2 statistics were reported for heterogeneity assessment. Results: A total of 8 observational studies with 10,102 patients were included. There were no statistically significant differences between same-day discharge vs hospital admission in all studied outcomes including post-discharge 30-day hospital visits (RR: 0.90; 95% CI: 0.40–2.02; p = 0.81), post-discharge vascular/bleeding complications (RR: 0.93; 95% CI: 0.46–1.88; p = 0.85), post-discharge stroke/transient ischemic attack/thromboembolism (RR: 0.70; 95% CI: 0.23–2.20; p = 0.55), and post-discharge recurrent arrhythmias (RR: 0.81; 95% CI: 0.60–1.09; p = 0.1). Conclusion: In carefully selected AF patients undergoing CA, same-day discharge strategy is feasible and safe. There are no significant differences in post-discharge 30-day hospital visits, post-discharge vascular complications, and other safety outcomes. Randomized trials are needed to validate these hypothesis-generating findings. [ABSTRACT FROM AUTHOR]