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5. Contemporary Management of Severe Symptomatic Aortic Stenosis

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Iung, Bernard, Bax, Jeroen, De Bonis, Michele, Delgado, Victoria, Haude, Michael, Hindricks, Gerhard, Maggioni, Aldo P., Pierard, Luc, Popescu, Bogdan A., Prendergast, Bernard, Price, Susanna, Rosenhek, Raphael, Ruschitzka, Frank, Vahanian, Alec, Wendler, Olaf, Windecker, Stephan, Mekhaldi, Souad, Lemaitre, Katell, Authier, Sébastien, Laroche, Cécile, Abdelhamid, Magdy, Apor, Astrid, Bajraktari, Gani, Beleslin, Branko, Bogachev-Prokophiev, Alexander, Demarco, Daniela Cassar, Pasquet, Agnes, Dogan, Sait Mesut, Erglis, Andrejs, Evangelista, Arturo, Goda, Artan, Ihlemann, Nikolaj, Ince, Huseyin, Katsaros, Andreas, Linhartova, Katerina, Mascherbauer, Julia, Mirrakhimov, Erkin, Mizariene, Vaida, Rahman-Haley, Shelley, Ribeiras, Regina, Samadov, Fuad, Saraste, Antti, Simkova, Iveta, Kostovska, Elizabeta Srbinovska, Tomkiewicz-Pajak, Lidia, Tribouilloy, Christophe, Zera, Eliverta, Metalla, Mimoza, Shirka, Ervina, Dado, Elona, Bica, Loreta, Aleksi, Jorida, Knuti, Gerti, Gjyli, Lidra, Pjeci, Rudina, Shuperka, Eritinka, Lleshi, Erviola, Rustemaj, Joana, Qordja, Marsjon, Gina, Mirald, Husi, Senada, Basic, Daniel, Steringer-Mascherbauer, Regina, Huber, Charlotte, Ebner, Christian, Sigmund, Elisabeth, Ploechl, Andrea, Sturmberger, Thomas, Eder, Veronica, Koppler, Tanja, Heger, Maria, Kammerlander, Andreas, Duca, Franz, Binder, Christina, Koschutnik, Matthias, Perschy, Leonard, Puskas, Lisa, Ho, Chen-Yu, Aliyev, Farid, Guluzada, Vugar, Imanov, Galib, Ibrahimov, Firdovsi, Abbasaliyev, Abbasali, Ahmedov, Tahir, Muslumova, Fargana, Babayev, Jamil, Rustamova, Yasmin, Jahangirov, Tofig, Samadov, Rauf, Museyibov, Muxtar, Isayev, Elnur, Musayev, Oktay, Xalilov, Shahin, Huseynov, Saleh, Yuzbashova, Madina, Zamanov, Vuqar, Mammadov, Vusal, Van Camp, Gery, Penicka, Martin, Batjoens, Hedwig, Debonnaire, Philippe, Dendooven, Daniel, Knecht, Sebastien, Duytschaever, Mattias, Vandekerckhove, Yves, Missault, Luc, Muyldermans, Luc, Tavernier, René, De Grande, Tineke, Coussement, Patrick, DeTroyer, Joyce, Derycker, Katrien, De Jaegher, Kelly, Bondue, Antoine, Beauloye, Christophe, Goffinet, Céline, Mirica, Daniela Corina, Eynden, Frédéric Vanden, Van de Borne, Philippe, Van Frachen, Béatrice, Vancraeynest, David, Vanoverschelde, Jean Louis, Pierard, Sophie, Malanca, Mihaela, Sinnaeve, Florence, Tahon, Séverine, De Clippel, Marie, Gayet, Frederic, Loiseau, Jacques, Van de Veire, Nico, Moerman, Veronique, Willems, Anne-Marie, Cosyns, Bernard, Droogmans, Steven, Motoc, Andreea, Kerkhove, Dirk, Plein, Daniele, Roosens, Bram, Weytjens, Caroline, Lancellotti, Patrizio, Dulgheru, Elena Raluca, Parenicova, Ilona, Bedanova, Helena, Tousek, Frantisek, Sindelarova, Stepanka, Canadyova, Julia, Taborsky, Milos, Ostransky, Jiri, Ivona simkova, Vicha, Marek, Jelinek, Libor, Opavska, Irena, Homza, Miroslav, Kvrayola, Miriam, Brat, Radim, Mrozek, Dan, Lichnerova, Eva, Docekalova, Iveta, Zarybnicka, Marta, Peskova, Marketa, Roucka, Patrik, Stastna, Vlasta, Vondrackova, Dagmar Jungwirtova, Hornig, Alfred, Niznansky, Matus, Branny, Marian, Vodzinska, Alexandra, Dorda, Miloslav, Snkouril, Libor, Kluz, Krystyna, Kypusova, Jana, Nezvalova, Radka, Olsen, Niels Thue, Ali, Hosam Hasan, Taha, Salma, Hassan, Mohamed, Afifi, Ahmed, Kabil, Hamza, Mady, Amr, Ebaid, Hany, Ahmed, Yasser, Nour, Mohammad, Talaat, Islam, Sayed, CairoMaiy El, Mostafa, Ahmad Elsayed, Sadek, CairoYasser, Eltobgi, CairoSherif, Bakhoum, Sameh, Doss, Ramy, Sheashea, Mahmoud, Elasry, Abd Allah, Fouad, Ahmed, Baraka, Mahmoud, Samir, Sameh, Roshdy, Alaa, AbdelRazek, Yasmin, Abd Rabou, Mostafa M., Abobakr, Ahmed, Moaaz, Moemen, Mokhtar, Mohamed, Ashry, Mohamed, Elkhashab, Khaled, Ghareeb, Haytham Soliman, Kamal, Mostafa, AbdelRazek, Gomaa, Farag, GizaNabil, Elbarbary, Giza:Ahmed, Wahib, Evette, Kazamel, Ghada, Kamal, Diaa, Tantawy, Mahmoud, Alansary, Adel, Yahia, Mohammed, Mahmoud, Raouf, El Banna, Tamer, Atef, Mohamed, Nasr, Gamela, Ahmed, Salah, El Hefny, Ehab E., Saifelyazal, Islam, El Ghany, Mostafa Abd, El Rahman El Hadary, Abd, Khairy, Ahmed, Lommi, Jyri, Laine, Mika, Kylmala, Minna, Kankanen, Katja, Turpeinen, Anu, Hartikainen, Juha, Kujanen, Lari, Airaksinen, Juhani, Vasankari, Tuija, Szymanski, Catherine, Bohbot, Yohann, Gun, Mesut, Rousseaux, Justine, Biere, Loic, Mateus, Victor, Audonnet, Martin, Rautureau, Jérémy, Cornet, Charles, Sorbets, Emmanuel, Mear, BourgesKarine, Issa, Adi, Jobic, Yannick, Le Ven, Florent, Pouliquen, Marie-Claire, Gilard, Martine, Ohanessian, Alice, Farhat, Ali, Vlase, Alina, Said, Fkhar, Lasgi, Caroline, Sanchez, Carlos, Breil, Romain, Peignon, Marc, Elkaim, Jean-Philippe, Jan-Blin, Virginie, BertrandM'Ban, Sylvain Ropars, Bardet, Hélène, Sawadogo, Samuel, Muschoot, Aurélie, Tchatchoua, Dieudonné, Elhadad, Simon, Maubert, Aline, Lazizi, Tahar, Ourghi, Kais, Bonnet, Philippe, Menager-Gangloff, Clarisse, Gafsi, Sofiene, Mansouri, Djidjiga, Aboyans, Victor, Magne, Julien, Martins, Elie, Karm, Sarah, Mohty, Dania, Briday, Guillaume, David, Amandine, Marechaux, Sylvestre, Le Goffic, Caroline, Binda, Camille, Menet, Aymeric, Delelis, Francois, Ringlé, Anne, Castel, Anne-Laure, Appert, Ludovic, Tristram, Domitille, Trouillet, Camille, Nacer, Yasmine, Ngoy, Lucas, Habib, MarseilleGilbert, Thuny, Franck, Haentjens, Julie, Cautela, Jennifer, Lavoute, Cécile, Robin, Floriane, Armangau, Pauline, Vergeylen, Ugo, Sanhadji, Khalil, Abdallah, Nessim Hamed, Kerzazi, Hassan, Perianu, Mariana, Plurien, François, Oueslati, Chaker, Debauchez, Mathieu, Monin, Jean-Luc, Konstantinos, Zannis, Berrebi, Alain, Dibie, Alain, Lansac, Emmanuel, Veugeois, Aurélie, Diakov, Christelle, Caussin, Christophe, Czitrom, Daniel, Salvi, Suzanna, Amabile, Nicolas, Dervanian, Patrice, Lejeune, Stéphanie, Bagdadi, Imane, Mokrane, Yemmi, Rouault, Gilles, Abalea, Jerome, Leledy, Marion, Horen, Patrice, Donal, Erwan, Bosseau, Christian, Paven, Elise, Galli, Elena, Collette, Edouard, Urien, Jean-Marie, Bridonneau, Valentin, Gervais, Renaud, Bauer, Fabrice, Chopra, Houzefa, Charbonnier, Arthur, Attias, David, Dahouathi, Nesrine, Khounlaboud, Moukda, Daudin, Magalie, Thebault, Christophe, Hamon, Cécile, Couffon, Philippe, Bellot, Catherine, Vomscheid, Maelle, Bernard, Anne, Dion, Fanny, Naudin, Djedjiga, Mouzouri, Mohammed, Rudelin, Mathilde, Berenfeld, Alain, Vanzwaelmen, Thibault, Alloui, Tarik, Radovikj, Marija Gjerakaroska, Jordanova, Slavica, Scholtz, Werner, Liberda-Knoke, Eva, Wiemer, Melanie, Mugge, Andreas, Nickenig, Georg, Sinning, Jan-Malte, Sedaghat, Alexander, Heintzen, Matthias, Ballof, Jan, Frenk, Daniel, Hambrecht, Rainer, Wienbergen, Harm, Seidel, Annemarie, Osteresch, Rico, Kramer, Kirsten, Ziemann, Janna, Schulze, Ramona, Fehske, Wolfgang, Eifler, Clarissa, Wafaisade, Bahram, Kuhn, Andreas, Fischer, Sören, Lichtenberg, Lutz, Brunold, Mareike, Simons, Judith, Balling, Doris, Buck, Thomas, Plicht, Bjoern, Schols, Wolfgang, Ebelt, Henning, Chamieh, Marwan, Anacker, Jelena, Rassaf, Tienush, Janosi, Alexander, Lind, Alexander, Lortz, Julia, Lüdike, Peter, Kahlert, Philipp, Rittger, Harald, Eichinger, Gabriele, Kuhls, Britta, Felix, Stephan B., Lehnert, Kristin, Pedersen, Ann-Louise, Dorr, Marcus, Empen, Klaus, Kaczmarek, Sabine, Busch, Mathias, Baly, Mohammed, Er, Fikret, Duman, Erkan, Gabriel, Linda, Weinbrenner, Christof, Bauersachs, Johann, Wider, Julian, Kempf, Tibor, Bohm, Michael, Schulze, Paul-Christian, Poerner, C. Tudor, Möbius-Winkler, Sven, Lenk, Karsten, Heitkamp, Kerstin, Franz, Marcus, Krauspe, Sabine, Schumacher, Burghard, Windmuller, Volker, Kurwitz, Sarah, Thiele, Holger, Kurz, Thomas, Meyer-Saraei, Roza, Akin, Ibrahim, Fastner, Christian, Lossnitzer, Dirk, Hoffmann, Ursula, Borggrefe, Martin, Baumann, Stefan, Kircher, Brigitte, Foellinger, Claudia, Dietz, Heike, Schieffer, Bernhard, Niroomand, Feraydoon, Mudra, Harald, Maier, Lars, Camboni, Daniele, Birner, Christoph, Debl, Kurt, Paulus, Michael, Seither, Benedikt, El Mokhtari, Nour Eddine, Oner, Alper, Caglayan, Evren, Sherif, Mohammed, Yucel, Seyrani, Custodis, Florian, Schwinger, Robert, Vorpahl, Marc, Seyfarth, Melchior, Nover, Ina, Koehler, Till, Christiani, Sarah, Sanchez, David Calvo, Schanze, Barbel, Sigusch, Holger, Salman, Athir, Hancock, Jane, Chambers, John, Demetrescue, Camelia, Prendergast, Claire, Dalby, Miles, Smith, Robert, Rogers, Paula, Riley, Cheryl, Tousoulis, Dimitris, Kanakakis, Ioannis, Spargias, Konstantinos, Lampropoulos, Konstantinos, Panagiotis, Tolis, Koutsoukis, Athanasios, Michalis, Lampros, Goudevenos, Ioannis, Bellos, Vasileios, Papafaklis, Michail, Lakkas, Lampros, Hahalis, George, Makris, Athanasios, Karvounis, Haralampos, Kamperidis, Vasileios, Ninios, Vlasis, Sachpekidis, Vasileios, Rouskas, Pavlos, Poulimenos, Leonidas, Charalampidis, Georgios, Hamodraka, Eftihia, Manolis, Athanasios, Kiss, Robert Gabor, Borsanyi, Tunde, Jarai, Zoltan, Zsary, Andras, Bartha, Elektra, Kosztin, Annamaria, Doronina, Alexandra, Kovacs, Attila, Imre, Barabas Janos, Chao, Chun, Benke, Kalman, Karoczkai, Istvan, Keltai, Kati, Förchécz, Zsolt, Pozsonyi, Zoltán, Jenei, Zsigmond, Patthy, Adam, Sallai, Laszlo, Majoros, Zsuzsanna, Pál, Tamás, Bencze, Jusztina, Sagi, Ildiko, Molnar, Andrea, Kurczina, Anita, Kolodzey, Gabor, Edes, Istvan, Szatmari, Valeria, Zajacz, Zsuzsanna, Cziraki, Attila, Nemeth, Adam, Faludi, Reka, Vegh, Laszlone, Jebelovszki, Eva, Lupkovics, Geza Karoly, Kovacs, Zsofia, Horvath, Andras, Berisha, Gezim, Ibrahimi, Pranvera, Percuku, Luan, Arapova, Rano, Laahunova, Elmira, Neronova, Kseniia, Zhakypova, Zarema, Naizabekova, Gulira, Muratova, Gulnazik, Sime, Iveta, Sorokins, Nikolajs, Kamzola, Ginta, Cgojeva-Sproge, Irina, Rancane, Gita, Valentinaviciene, Ramune, Rudiene, Laima, Raugaliene, Rasa, Bardzilauske, Aiste, Jonkaitiene, Regina, Petrauskaite, Jurate, Bieseviciene, Monika, Verseckaite, Raimonda, Zvirblyte, Ruta, Kalibatiene, Danute, Radauskaite, Greta, Janaviciute-Matuzeviciene, Gabija, Jancauskaite, Dovile, Balkute, Deimile, Maneikyte, Juste, Mileryte, Ingrida, Vaisvilaite, Monika, Gedvilaite, Lina, Biliukas, Mykolas, Karpaviciene, Vaiva, Xuereb, Robert George, Pllaha, Elton, Djaberi, Roxana, Komor, Klaudiusz, Gorgon-Komor, Agnieszka, Loranc, Beata, Myszor, Jaroslaw, Mizia-Stec, Katarzyna, Berger-Kucza, Adrianna, Mizia, Magdalena, Polak, Mateusz, Bogacki, Piotr, Podolec, Piotr, Komar, Monika, Sedziwy, Ewa, Sliwiak, Dorota, Sobien, Bartosz, Rog, Beata, Hlawaty, Marta, Gancarczyk, Urszula, Libiszewska, Natasza, Sorysz, Danuta, Gackowski, Andrzej, Cieply, Malgorzata, Misiuda, Agnieszka, Racibor, Franciszek, Nytko, Anna, Widenka, Kazimierz, Kolowca, Maciej, Bak, Janusz, Curzytek, Andrzej, Regulski, Mateusz, Kamela, Malgorzata, Wisniowski, Mateusz, Hryniewiecki, Tomasz, Szymanski, Piotr, Rozewicz, Monika, Grabowski, Maciej, Duchnowski, Piotr, Budaj, Andrzej, Zaborska, Beata, Pilichowska-Paskiet, Ewa, Sikora-Frac, Malgorzata, Slomski, Tomasz, Joao, Isabel, Cruz, Ines, Pereira, Hélder, Cale, Rita, Marques, Ana, Pereira, Ana Rita, Morais, Carlos, Freitas, Antonio, Roque, David, Antunes, Nuno, Pereira, Antonio Costeira, Vieira, Catarina, Salome, Nuno, Martins, Juliana, Campos, Isabel, Cardoso, Goncalo, Silva, Claudia, Oliveira, Afonso, Goncalves, Mariana, Martins, Rui, Quintal, Nuno, Mendes, Bruno, Silva, Joseline, Ferreira, Joao, Milner, James, Alves, Patricia, Marinho, Vera, Gago, Paula, Amado, Jose, Bispo, Joao, Bento, Dina, Machado, 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Olga, Tsechanovich, Valeriy, Medvedev, Igor, Lepilin, Michail, Nemchenko, PenzaEvgenii, Karnahin, Vadim, Safina, Vasilya, Slastin, Yaroslav, Gilfanova, Venera, Gorbunov, Roman, Jakubov, Ramis, Fazylova, Aigul, Poteev, Mansur, Vazetdinova, Laysan, Tarasova, Indira, Irgaliyev, Rishat, Moiseeva, Olga, Gordeev, Mikhail, Irtyuga, Olga, Moiseeva, Raisa, Ostanina, Nina, Zverev, Dmitry, Murtazalieva, Patimat, Kuznetsov, Dmitry, Skurativa, Mariya, Polyaeva, Larisa, Mihaiilov, Kirill, Obrenovic-Kircanski, Biljana, Putnik, Svetozar, Simic, Dragan, Petrovic, Milan, Nikolic, Natasa Markovic, Jovovic, Ljiljana, Ostric, Dimitra Kalimanovska, Brajovic, Milan, Manojlovic, Milica Dekleva, Novakovic, Vladimir, Zamaklar-Trifunovic, Danijela, Orbovic, Bojana, Petrovic, Olga, Boricic-Kostic, Marija, Andjelkovic, Kristina, Milanov, Marko, Despotovic-Nikolic, Maja, Budisavljevic, Sreten, Veljkovic, Sanja, Cvetinovic, Nataša, Lepojevic, Daniijela, Todorovic, Aleksandra, Nikolic, Aleksandra, Borzanovic, Branislava, Trkulja, Ljiljana, Tomic, Slobodan, Vukovic, Milan, Milosavljevic, Jelica, Milanovic, Mirjana, Stakic, Vladan, Cvetkovic, Aleksandra, Milutinovic, Suzana, Bozic, Olivera, Miladinovic, Miodrag, Nikolic, Zoran, Despotovic, Dinka, Jovanovic, Dimitrije, Stojsic-Milosavljevic, Anastazija, Ilic, Aleksandra, Sladojevic, Mirjana, Susak, Stamenko, Maletin, Srdjan, Pavlovic, Salvo, Kuzmanovic, Vladimir, Ivanovic, Nikola, Dejanovic, Jovana, Ruzicic, Dusan, Drajic, Dragana, Cvetanovic, Danijel, Mirkovic, Marija, Omoran, Jon, Margoczy, Roman, Sedminova, Katarina, Reptova, Adriana, Baranova, Eva, Valkovicova, Tatiana, Valocik, Gabriel, Kurecko, Marian, Vachalcova, Marianna, Kollarova, Alzbeta, Studencan, Martin, Alusik, Daniel, Kozlej, Marek, Macakova, Jana, Moral, Sergio, Cladellas, Merce, Luiso, Daniele, Calvo, Alicia, Palet, Jordi, Carballo, Juli, Tura, Gisela Teixido, Maldonado, Giuliana, Gutierrez, Laura, Gonzalez-Alujas, Teresa, Jose Fernando, Rodriguez Palomares, Villalva, Nicolas, Molina-Mora, Ma Jose, Paton, Ramon Rubio, Martinez Diaz, Juan Jose, Ruiz, Pablo Ramos, Valle, Alfonso, Rodriguez, Ana, Alania, Edgardo, Galcera, Emilio, Seller, Julia, Valenzuela, Gonzalo de la Morena, Espin, Daniel Saura, Garcia, Dolores Espinosa, Oliva Sandoval, Maria Jose, Gonzalez, Josefa, Navarro, Miguel Garcia, Perez-Martinez, Maria Teresa, Ortega Trujillo, Jose Ramon, Gallego, Irene Menduina, San Roman, Daniel, Perez Nogales, Eliu David, Medina, Olga, Montiel Quintero, Rodolfo Antonio, Bujanda Morun, Pablo Felipe, Perez, Marta Lopez, Huaripata, Jimmy Plasencia, Morales Gonzalez, Juan Jose, Nelson, Veronica Quevedo, Zamorano, Jose Luis, Gomez, Ariana Gonzalez, Fraile, Alfonso, Alberca, Maria Teresa, Martin, Joaquin Alonso, Fernandez-Golfin, Covadonga, Ramos, Javier, Jimenez, Sergio Hernandez, Mitroi, Cristina, Sanchez Fernandez, Pedro L., Diaz-Pelaez, Elena, Garde, Beatriz, Caballero, Luis, Garcia, Fermin Martinez, Cambronero, Francisco, Castro, Noelia, Castro, Antonio, De La Rosa, Alejandro, Gallego, Pastora, Mendez, Irene, Villegas, David Villagomez, Correa, Manuel Gonzalez, Calvo, Roman, Florian, Francisco, Paya, Rafael, Esteban, Esther, Buendia, Francisco, Cubillos, Andrés, Fernandez, Carmen, Cárdenas, Juan Pablo, Pérez-Boscá, José Leandro, Vano, Joan, Belchi, Joaquina, Iglesia-Carreno, Cristina, Iglesias, Francisco Calvo, Escudero-Gonzalez, Aida, Zapateria-Lucea, Sergio, Duarte, Juan Sterling, Perez-Davila, Lara, Cobas-Paz, Rafael, Besada-Montenegro, Rosario, Fontao-Romeo, Maribel, Lopez-Rodriguez, Elena, Paredes-Galan, Emilio, Caneiro-Queija, Berenice, Gonzalez, Alba Guitian, Bozkurt, Abdi, Demir, Serafettin, Unlu, Durmus, Cagliyan, Caglar Emre, Ikikardes, Muslum Firat, Tangalay, Mustafa, Kuloglu, Osman, Ozer, Necla, Canpolat, Ugur, Kemaloglu, Melek Didem, Demirtas, Abdullah Orhan, Akgün, Didar Elif, Avci, Eyup, Taylan, Gokay, Yilmaztepe, Mustafa Adem, Ucar, Fatih Mehmet, Altay, Servet, Gurdogan, Muhammet, Gudul, Naile Eris, Aktas, Mujdat, Buyuklu, Mutlu, Degirmenci, Husnu, Turan, Mehmet Salih, Mert, Kadir Ugur, Mert, Gurbet Ozge, Dural, Muhammet, Arslan, Sukru, Sayar, Nurten, Kanar, Batur, Sadic, Beste Ozben, Sahin, Ahmet Anil, Buyuk, Ahmet, Kilicarslan, Onur, Bostan, Cem, Yildirim, Tarik, Yildirim, Seda Elcim, Cosansu, Kahraman, Varim, Perihan, Ilguz, Ersin, Demirbag, Recep, Yesilay, Asuman, Cirit, Abdullah, Tusun, Eyyup, Erkus, Emre, Sayin, Muhammet Rasit, Kazaz, Zeynep, Kul, Selim, Karabag, Turgut, Kalayci, Belma, Eugène, Marc, and Bax, Jeroen J.

Published
2021
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14. Clinical outcomes at medium-term follow-up of COVID-19.

Author

Barbara, Jessica-Marie, Gatt, Jessica, Xuereb, Rachel-Anne, Tabone Adami, Nicholas, Darmanin, Jessica, Erasmi, Renee, Xuereb, Robert G., Barbara, Christopher, and Stephen, Fava

Abstract

Background: The long coronavirus disease 2019 (COVID-19) syndrome is defined as persistent physical, cognitive and/or psychological symptoms that continue for more than 12 weeks following the acute illness. Methods: In all, 2,646 patients were randomly selected from all individuals who were diagnosed with COVID-19. They were interviewed so as to assess the persistence of symptoms and health-related quality of life. Blood investigations were also taken. Results: The median (interquartile range (IQR)) age was 44 (31-55) years and 48.6% were males. Five per cent had been hospitalised. Follow-up was for a median of 142 days (IQR: 128-161). Twenty-two per cent of the participants claimed that they were feeling worse than they felt before COVID-19. The most common symptoms were anosmia, ageusia, fatigue, shortness of breath, headaches and myalgia. The Short Form-36 questionnaire revealed that 16.4% felt that they were somewhat worse than in the previous year and that hospitalised patients fared worse in all domains except for role-emotional. New-onset diabetes was similar to the rate of undiagnosed diabetes in the background population. Hospitalised patients had significantly higher liver transaminases, fasting plasma glucose, glycated haemoglobin, uric acid, red cell distribution width, mean platelet volume, triglyceride levels and troponin levels but lower estimated glomerular filtration rate and high-density lipoprotein-cholesterol at follow-up. Discussion: A significant proportion of patients were symptomatic at a median follow-up of 142 days and felt worse than 1 year previously. Hospitalised patients had more biochemical and haematological abnormalities compared to non-hospitalised ones, suggesting ongoing inflammation in subjects who were more severely affected by the disease. [ABSTRACT FROM AUTHOR]

Published
2022
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15. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS) : The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC)

Author

Konstantinides, Stavros V., Meyer, Guy, Bueno, Hector, Galié, Nazzareno, Gibbs, J. Simon R., Ageno, Walter, Agewall, Stefan, Almeida, Ana G., Andreotti, Felicita, Barbato, Emanuele, Baumbach, Andreas, Beygui, Farzin, Carlsen, Jørn, De Carlo, Marco, Delcroix, Marion, Subias, Pilar Escribano, Gaine, Sean, Goldhaber, Samuel Z., Gopalan, Deepa, Habib, Gilbert, Jenkins, David, Kjellström, Barbro, Lainscak, Mitja, Lee, Geraldine, Le Gal, Grégoire, Messas, Emmanuel, Morais, Joao, Piepoli, Massimo Francesco, Price, Susanna, Salvi, Aldo, Sanchez, Olivier, Stortecky, Stefan, Thielmann, Matthias, Noordegraaf, Anton Vonk, Becattini, Cecilia, Bueno, Héctor, Geersing, Geert Jan, Harjola, Veli Pekka, Huisman, Menno V., Humbert, Marc, Jennings, Catriona Sian, Jiménez, David, Kucher, Nils, Lang, Irene Marthe, Lankeit, Mareike, Lorusso, Roberto, Mazzolai, Lucia, Meneveau, Nicolas, Áinle, Fionnuala Ní, Prandoni, Paolo, Pruszczyk, Piotr, Righini, Marc, Torbicki, Adam, Van Belle, Eric, Zamorano, José Luis, Windecker, Stephan, Aboyans, Victor, Baigent, Colin, Collet, Jean Philippe, Dean, Veronica, Delgado, Victoria, Fitzsimons, Donna, Gale, Chris P., Grobbee, Diederick E., Hindricks, Gerhard, Iung, Bernard, Jüni, Peter, Katus, Hugo A., Landmesser, Ulf, Leclercq, Christophe, Lettino, Maddalena, Lewis, Basil S., Merkely, Bela, Mueller, Christian, Petersen, Steffen E., Petronio, Anna Sonia, Richter, Dimitrios J., Roffi, Marco, Shlyakhto, Evgeny, Simpson, Iain A., Sousa-Uva, Miguel, Touyz, Rhian M., Hammoudi, Naima, Hayrapetyan, Hamlet, Mascherbauer, Julia, Ibrahimov, Firdovsi, Polonetsky, Oleg, Lancellotti, Patrizio, Tokmakova, Mariya, Skoric, Bosko, Michaloliakos, Ioannis, Hutyra, Martin, Mellemkjaer, Søren, Mansour, Mostafa, Reinmets, Julia, Jääskeläinen, Pertti, Angoulvant, Denis, Bauersachs, Johann, Giannakoulas, George, Zima, Endre, Vizza, Carmine Dario, Sugraliyev, Akhmetzhan, Bytyçi, Ibadete, Maca, Aija, Ereminiene, Egle, Huijnen, Steve, Xuereb, Robert, Diaconu, Nadejda, Bulatovic, Nebojsa, Asfalou, Ilyasse, Bosevski, Marijan, Halvorsen, Sigrun, Sobkowicz, Bozena, Ferreira, Daniel, Petris, Antoniu Octavian, Moiseeva, Olga, Zavatta, Marco, Obradovic, Slobodan, Šimkova, Iveta, Radsel, Peter, Ibanez, Borja, Wikström, Gerhard, Aujesky, Drahomir, Kaymaz, Cihangir, Parkhomenko, Alexander, and Pepke-Zaba, Joanna

Subjects
thrombolysis, pulmonary embolism, treatment, diagnosis, education, venous thromboembolism, biomarkers, heart failure, shock, Embolectomy, Guidelines, dyspnoea, right ventricle, humanities, Anticoagulation, Pregnancy, Venous thrombosis, Journal Article, echocardiography, Cardiology and Cardiovascular Medicine, health care economics and organizations, Risk assessment
Abstract

Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in proposing the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

Published
2020

16. European society of cardiology

Author

Timmis, Adam, Townsend, Nick, Gale, Chris P., Torbica, Aleksandra, Lettino, Maddalena, Petersen, Steffen E., Mossialos, Elias A., Maggioni, Aldo P., Kazakiewicz, Dzianis, May, Heidi T, De Smedt, Delphine, Flather, Marcus, Zuhlke, Liesl, Beltrame, John F., Huculeci, Radu, Tavazzi, Luigi, Hindricks, Gerhard, Bax, Jeroen, Casadei, Barbara, Achenbach, Stephan, Wright, Lucy, Vardas, Panos, Mimoza, Lezha, Artan, Goda, Aurel, Demiraj, Chettibi, Mohammed, Hammoudi, Naima, Sisakian, Hamayak, Pepoyan, Sergey, Metzler, Bernhard, Siostrzonek, Peter, Weidinger, Franz, Jahangirov, Tofig, Aliyev, Farid, Rustamova, Yasmin, Manak, Nikolay, Mrochak, Aliaksandr, Lancellotti, Patrizio, Pasquet, Agnès, Claeys, Marc, Kušljugić, Zumreta, Dizdarević Hudić, Larisa, Smajić, Elnur, Tokmakova, Mariya Petkova, Gatzov, Plamen Marinov, Milicic, Davor, Bergovec, Mijo, Christou, Christos, Moustra, Hera Heracleous, Christodoulides, Theodoros, Linhart, Ales, Taborsky, Milos, Hansen, Henrik Steen, Holmvang, Lene, Kristensen, Steen Dalby, Abdelhamid, Magdy, Shokry, Khaled, Kampus, Priit, Viigimaa, Margus, Ryödi, Essi, Niemelä, Matti, Rissanen, Tuomas T., Le Heuzey, Jean-Yves, Gilard, Martine, Aladashvili, A., Gamkrelidze, A., Kereselidze, Maia, Zeiher, A., Katus, H., Bestehorn, K., Tsioufis, Costas, Goudevenos, John, Csanádi, Zoltán, Becker, Dávid, Tóth, Kálmán, Jóna Hrafnkelsdóttir, Þórdís, Crowley, James, Kearney, Peter, Dalton, Barbra, Zahger, Doron, Wolak, Arik, Gabrielli, Domenico, Indolfi, Ciro, Urbinati, Stefano, Imantayeva, Gulnara, Berkinbayev, Salim, Bajraktari, Gani, Ahmeti, Artan, Berisha, Gezim, Erkin, Mirrakhimov, Saamay, Abilova, Erglis, Andrejs, Bajare, Iveta, Jegere, Sanda, Mohammed, Malek, Sarkis, Antoine, Saadeh, Georges, Zvirblyte, Ruta, Sakalyte, Gintare, Slapikas, Rimvydas, Ellafi, Khaled, El Ghamari, Fathi, Banu, Cristiana, Beissel, Jean, Felice, Tiziana, Buttigieg, Sandra C, Xuereb, Robert G., Popovici, Mihail, Boskovic, Aneta, Rabrenovic, Miroslav, Ztot, Samir, Abir-khalil, Saadia, van Rossum, A. C., Mulder, B. J. M., Elsendoorn, M. W., Srbinovska-Kostovska, Elizabeta, Kostov, Jorgo, Marjan, Bosevski, Steigen, Terje, Mjølstad, Ole Christian, Ponikowski, Piotr, Witkowski, Adam, Jankowski, Piotr, Gil, Victor Machado, Mimoso, Jorge, Baptista, Sérgio, Vinereanu, Dragos, Chioncel, Ovidiu, Popescu, Bogdan A., Shlyakhto, Evgeny, Oganov, Raphael, Foscoli, Marina, Zavatta, Marco, Dikic, Ana Djordjevic, Beleslin, Branko, Radovanovic, Mina Radosavljevic, Hlivák, Peter, Hatala, Robert, Kaliská, Gabriela, Kenda, Miran, Fras, Zlatko, Anguita, Manuel, Cequier, Ángel, Muñiz, Javier, James, Stefan, Johansson, Bengt, Platonov, Pyotr, Zellweger, Michael Johannes, Pedrazzini, Giovanni B., Carballo, David, Shebli, Hussam Eddin, Kabbani, Samer, Abid, Leila, Addad, Faouzi, Bozkurt, Engin, Kayıkçıoğlu, Meral, Erol, Mustafa Kemal, Kovalenko, Volodymyr, Nesukay, Elena, Wragg, Andrew, Ludman, Peter, Ray, Simon, Kurbanov, Ravshanbek, Boateng, Dennis, Daval, Ghislain, De Benito Rubio, Víctor, Sebastiao, David, De Courtelary, Paola Thellung, Bardinet, Isabel, Cardiology, ACS - Heart failure & arrhythmias, APH - Personalized Medicine, and APH - Aging & Later Life

Subjects
Male, medicine.medical_specialty, Mortality • morbidity, Health infrastructure, Cardiology, Disease, 030204 cardiovascular system & hematology, European Society of Cardiology, 03 medical and health sciences, 0302 clinical medicine, CARDIOVASCULAR DISEASE, EUROPEAN SOCIETY OF CARDIOLOGY, HEALTH INFRASTRUCTURE, MORBIDITY, MORTALITY, RISK FACTORS, SERVICE PROVISION, STATISTICS, Interquartile range, Internal medicine, Statistics, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Service provision, Mortality, Disease burden, business.industry, medicine.disease, Cardiovascular disease, Obesity, Europe, Years of potential life lost, Risk factors, Cardiovascular Diseases, Hypertension, Income, Female, Population Risk, Morbidity, Cardiology and Cardiovascular Medicine, business, Body mass index
Abstract

Aims The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. Methods and results In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5–23.1%] vs. 15.7% (IQR 14.5–21.1%)}, diabetes [7.7% (IQR 7.1–10.1%) vs. 5.6% (IQR 4.8–7.0%)], and among males smoking [43.8% (IQR 37.4–48.0%) vs. 26.0% (IQR 20.9–31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0–10.8) vs. 16.7% (IQR 13.9–19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655–8115)] compared with high-income [2235 (IQR 1896–3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. Conclusion A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest.

Published
2020

17. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD).

Author

Rydén, Lars, Grant, Peter J., Anker, Stefan D., Berne, Christian, Cosentino, Francesco, Danchin, Nicolas, Deaton, Christi, Escaned, Javier, Hammes, Hans-Peter, Huikuri, Heikki, Marre, Michel, Marx, Nikolaus, Mellbin, Linda, Ostergren, Jan, Patrono, Carlo, Seferovic, Petar, Uva, Miguel Sousa, Taskinen, Marja-Riita, Tendera, Michal, Tuomilehto, Jaakko, Valensi, Paul, Zamorano, Jose Luis, Zamorano, Jose Luis, Achenbach, Stephan, Baumgartner, Helmut, Bax, Jeroen J., Bueno, Héctor, Dean, Veronica, Deaton, Christi, Erol, Çetin, Fagard, Robert, Ferrari, Roberto, Hasdai, David, Hoes, Arno W., Kirchhof, Paulus, Knuuti, Juhani, Kolh, Philippe, Lancellotti, Patrizio, Linhart, Ales, Nihoyannopoulos, Petros, Piepoli, Massimo F., Ponikowski, Piotr, Sirnes, Per Anton, Tamargo, Juan Luis, Tendera, Michal, Torbicki, Adam, Wijns, William, Windecker, Stephan, De Backer, Guy, Sirnes, Per Anton, Ezquerra, Eduardo Alegria, Avogaro, Angelo, Badimon, Lina, Baranova, Elena, Baumgartner, Helmut, Betteridge, John, Ceriello, Antonio, Fagard, Robert, Funck-Brentano, Christian, Gulba, Dietrich C., Hasdai, David, Hoes, Arno W., Kjekshus, John K., Knuuti, Juhani, Kolh, Philippe, Lev, Eli, Mueller, Christian, Neyses, Ludwig, Nilsson, Peter M., Perk, Joep, Ponikowski, Piotr, Reiner, Željko, Sattar, Naveed, Schächinger, Volker, Scheen, André, Schirmer, Henrik, Strömberg, Anna, Sudzhaeva, Svetlana, Tamargo, Juan Luis, Viigimaa, Margus, Vlachopoulos, Charalambos, and Xuereb, Robert G.

Published
2013
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19. CYP2C19*2 genetic polymorphism and incidence of in-stent restenosis in patients on clopidogrel: a matched case-control study.

Author

Osama, Sara, Wirth, Francesca, Zahra, Graziella, Barbara, Christopher, Xuereb, Robert G., Camilleri, Liberato, and Azzopardi, Lilian M.

Abstract

The cytochrome P450 2C19*2 (CYP2C19*2) genetic polymorphism is associated with reduced clopidogrel bioactivation, increasing the risk of atherothrombotic complications after percutaneous coronary intervention (PCI). In-stent restenosis (ISR) is a complication that limits the long-term prognosis of PCI. The aim was to investigate the association between presence of the CYP2C19*2 allele and ISR within one-year after PCI in patients prescribed dual antiplatelet therapy with aspirin and clopidogrel. Sixty patients with angiographically-confirmed drug eluting stent (DES)-ISR within 12 months post-PCI when on DAPT with aspirin and clopidogrel were retrospectively identified (Cases). Another 60 patients with no documented ISR post-PCI in the study period (Controls) were case-matched for age, gender, ethnicity, diabetes mellitus and estimated glomerular filtration rate value, and were invited for CYP2C19*2 genotyping. The association between presence of the CYP2C19*2 allele and ISR was analysed using the Fisher's exact test and binary logistic regression. Twenty-six (43.3%) cases and 5 (8.3%) controls were carriers of one or two CYP2C19*2 alleles. As to non-carrier status of the CYP2C19*2 allele, 34 (56.7%) cases and 55 (91.7%) controls were identified. The association between CYP2C19*2 carrier status and DES-ISR within one-year post-PCI was statistically significant (p<0.001) in both the univariate and multivariate analysis. The proportion of patients who were carriers of one or two CYP2C19*2 alleles who presented with DES-ISR within one-year post-PCI while on clopidogrel was significantly higher compared to patients with no documented ISR. [ABSTRACT FROM AUTHOR]

Published
2022
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22. European Society of Cardiology: Cardiovascular Disease Statistics 2017

Author

Timmis, Adam, Townsend, Nick, Gale, Chris, Grobbee, Rick, Maniadakis, Nikos, Flather, Marcus, Wilkins, Elizabeth, Wright, Lucy, Vos, Rimke, Bax, Jeroen, Blum, Maxim, Logstrup, Susanne, Pinto, Fausto J., Vardas, Panos, Goda, Artan, Demiraj, Aurel F, Weidinger, Franz, Metzler, Bernard, Ibrahimov, Firdovsi, Pasquet, Agnes A, Claeys, Marc, Thorton, Yolanda, Kusljugic, Zumreta, Smajic, Elnur, Velchev, Vasil, Ivanov, Nikolay, Antoniades, Loizos, Agathangelou, Petros, Táborský, Miloš, Gerdes, Christian, Viigima, Margus, Juhani, Pietila Mikko, Juilliere, Yves, Cattan, Simon, Aladashvili, Alexander, Hamm, Christian, Kuck, Karl-Heinz, Papoutsis, Konstantinos, Bestehorn, Kurt, Foussas, Stefanos, Giannoulidou, Georgia, Varounis, Christos, Kallikazaros, Ioannis, Kiss, Robert Gabor, Czétényi, Tunde, Becker, Dávid, Gudnason, Thorarinn, Kearney, Peter, McDonald, Kenneth, Rozenman, Yoseph, Ziv, Batia, Bolognese, Leonardo, Luciolli, Paola, Boriani, Giuseppe, Berkinbayev, Salim, Rakisheva, Amina, Mirrakhimov, Erkin, Erglis, Andrejs, Jegere, Sandra, Marinskis, Germanas, Beissel, Jean, Marchal, Nathalie, Kedev, Sasko, Xuereb, Robert G, Tilney, Terence, Felice, Tiziana, Popovici, Mihail, Mulder, Barbara, Simoons, Maarten, Elsendoorn, Moniek, Steigen, Terje K, Atar, Dan, Kalarus, Zbigniew, Tendera, Michal, Cardoso, Jose Silva, Ribeiro, José, Mateus, Cristina, Tatu-Chitoiu, Gabriel, Seferovic, Petar, Beleslin, Branko, Simkova, Iveta, Durcikova, Petra, Belicova, Veronica, Fras, Zlatko, Radelj, Sasa, Gonzalez Juanatey, Jose Ramon, Legendre, Sharon, Braunschweig, Frieder, Kaufmann, Urs Philipp, Rudiger-Sturchler, Marjam, Tokgozoglu, Lale, Unver, Ahmet, Kovalenko, Volodymir, Nesukay, Elena, Naum, Anastasia, de Courtelary, Paola Thellung, Martin, Stephan, Sebastiao, David, Ghislain, Daval, Bardinet, Isabel, and Repositório da Universidade de Lisboa

Subjects
medicine.medical_specialty, Inequality, media_common.quotation_subject, Health infrastructure, Disease, 030204 cardiovascular system & hematology, European Society of Cardiology, 03 medical and health sciences, 0302 clinical medicine, Economic indicator, Internal medicine, Health care, Statistics, medicine, Cardiovascular disease, Morbidity, Mortality, Risk factors, Service provision, Cardiology and Cardiovascular Medicine, 030212 general & internal medicine, Disease burden, Cause of death, media_common, business.industry, medicine.disease, Obesity, Years of potential life lost, Cardiology, business
Abstract

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com., Aims: The European Society of Cardiology (ESC) Atlas has been compiled by the European Heart Agency to document cardiovascular disease (CVD) statistics of the 56 ESC member countries. A major aim of this 2017 data presentation has been to compare high-income and middle-income ESC member countries to identify inequalities in disease burden, outcomes, and service provision. Methods and results: The Atlas utilizes a variety of data sources, including the World Health Organization, the Institute for Health Metrics and Evaluation, and the World Bank to document risk factors, prevalence, and mortality of cardiovascular disease and national economic indicators. It also includes novel ESC-sponsored survey data of health infrastructure and cardiovascular service provision provided by the national societies of the ESC member countries. Data presentation is descriptive with no attempt to attach statistical significance to differences observed in stratified analyses. Important differences were identified between the high-income and middle-income member countries of the ESC with regard to CVD risk factors, disease incidence, and mortality. For both women and men, the age-standardized prevalence of hypertension was lower in high-income countries (18% and 27%) compared with middle-income countries (24% and 30%). Smoking prevalence in men (not women) was also lower (26% vs. 41%) and together these inequalities are likely to have contributed to the higher CVD mortality in middle-income countries. Declines in CVD mortality have seen cancer becoming a more common cause of death in a number of high-income member countries, but in middle-income countries declines in CVD mortality have been less consistent where CVD remains the leading cause of death. Inequalities in CVD mortality are emphasized by the smaller contribution they make to potential years of life lost in high-income countries compared with middle-income countries both for women (13% vs. 23%) and men (20% vs. 27%). The downward mortality trends for CVD may, however, be threatened by the emerging obesity epidemic that is seeing rates of diabetes increasing across all the ESC member countries. Survey data from the National Cardiac Societies showed that rates of cardiac catheterization and coronary artery bypass surgery, as well as the number of specialist centres required to deliver them, were greatest in the high-income member countries of the ESC. The Atlas confirmed that these ESC member countries, where the facilities for the contemporary treatment of coronary disease were best developed, were often those in which declines in coronary mortality have been most pronounced. Economic resources were not the only driver for delivery of equitable cardiovascular health care, as some middle-income ESC member countries reported rates for interventional procedures and device implantations that matched or exceeded the rates in wealthier member countries. Conclusion: In documenting national CVD statistics, the Atlas provides valuable insights into the inequalities in risk factors, health care delivery, and outcomes of CVD across the ESC member countries. The availability of these data will underpin the ESC’s ambitious mission ‘to reduce the burden of cardiovascular disease’ not only in its member countries but also in nation states around the world.

Published
2018

23. Did the introduction of high-sensitivity Troponin T for the assessment of suspected acute coronary syndrome in Malta result in reduction of hospitalization time? A retrospective review

Author

Chilmeran, Ahmed, Alwatari, Yahya, Zintilis, Stuart, and Xuereb, Robert

Subjects
Myocardial infarction -- Treatment, Peptides -- Therapeutic use, Troponin I, macromolecular substances, Acute diseases -- Malta, Myocardial infarction -- Malta, musculoskeletal system
Abstract

Aims: Troponins I and T are biomarkers used for diagnosing myocardial infarction. The recently developed high-sensitivity Troponin T assay can detect levels as low as 3 ng/L which gives the advantage of rapid diagnosis of acute coronary syndrome (ACS) allowing earlier intervention and theoretically earlier discharge. The aim of the study was to audit the hospital practice and its adherence to international guidelines in using Troponin for diagnosing ACS, and to assess the average hospital admission length when using Troponin T compared to the older Troponin I. Methodology: A retrospective study that included all patients who had Troponin T taken between January 1st and January 31st, 2016 at Mater Dei Hospital (MDH), comparing them to patients who had Troponin I taken between November 1st and November 30th, 2015. Results: Data collection yielded a total of 1,032 patients in the Troponin T group and 1,004 patients in the Troponin I group. The average length of stay when using Troponin T was 5.53 days whereas the average length of stay when using Troponin I was 8.29 days. Data analysis of those patients also showed that the average time interval between the first and second Troponin was in the region of 9 hours, which is not what the current guidelines recommend. Conclusion: The use of the new highly sensitive Troponin T resulted in an average reduction in hospitalization time of 2.76 days per patient at MDH. Adherence to the “0/3 hours” guideline of the second Troponin is highly recommended., peer-reviewed

Published
2018

24. Antiplatelet and anticoagulant therapy for non-ST-elevation acute coronary syndromes in a general hospital

Author

Mason, Giorgia, Wirth, Francesca, Cignarella, Andrea, Xuereb, Robert G., and Azzopardi, Lilian M.

Subjects
Prescriptions, ACUTE CORONARY SYNDROMES, Acute diseases, CLINICAL-PRACTICE GUIDELINES, pharmacological therapy, Anticoagulants -- Therapeutic use, Hospitals -- Case management services, Pharmacist and patient
Abstract

Aim: To audit compliance with the 2011 European Society of Cardiology (ESC) guidelines for prescribing antiplatelet and anticoagulant therapy in patients diagnosed with non-ST-elevation acute coronary syndromes (NSTE-ACS). Methods: Five-month audit at Cardiac Catheterisation Suite, Mater Dei Hospital, Malta. A data collection form for inpatients diagnosed with NSTE-ACS was developed, psychometrically evaluated and completed for each patient by the investigator. Comparative analysis to assess whether these patients were being managed according to the guidelines was undertaken. Results: 165 patients were recruited; 73% were male, 37% were between 66 and 75 years and 44% were active smokers. The most common risk factors for cardiovascular disease in these patients were hypertension (27%), dyslipidemia and obesity (both 16%). 41% of the patients underwent a percutaneous coronary intervention, either ad hoc (34%) or elective (7%). Compliance to guidelines for prescription of aspirin and clopidogrel 300mg loading dose was 95% and 88% respectively. Compliance to guidelines for prescription of aspirin and clopidogrel 75mg daily maintenance dose was 97% and 96% respectively. Compliance to guidelines for prescription of proton pump inhibitors (PPIs) in patients receiving dual antiplatelet therapy (DAPT) was only 19%; 81% of the patients were prescribed omeprazole against guideline recommendations. Compliance to guidelines for prescription of anticoagulation therapy was 95% with respect to prescription of heparin treatment in combination with DAPT. Compliance to guidelines for prescription of enoxaparin was 81%. Compliance to guidelines for other antiplatelet and anticoagulant drugs recommended in the guidelines, including ticagrelor, prasugrel, glycoprotein IIb/IIIa receptor antagonists, fondaparinux and bivalirudin, was not measured. Conclusions: Prescription of antiplatelet and anticoagulant therapy for NSTE-ACS in Malta is predominantly in accordance with ESC guidelines. Alternative antiplatelet and anticoagulant drugs and PPIs should be included in the Maltese hospital formulary to improve NSTE-ACS management in line with guideline recommendations., peer-reviewed

Published
2014

25. Relationship of Hyperglycaemia, Hypoglycaemia, and Glucose Variability to Atherosclerotic Disease in Type 2 Diabetes.

Author

Magri, Caroline Jane, Mintoff, Dillon, Camilleri, Liberato, Xuereb, Robert G., Galea, Joseph, and Fava, Stephen

Subjects
HYPERGLYCEMIA, HYPOGLYCEMIA, GLUCOSE, ATHEROSCLEROSIS, TYPE 2 diabetes, CEREBROVASCULAR disease
Abstract

Objective. Type 2 diabetes mellitus (T2DM) is known to be associated with increased cardiovascular risk. The aim of this study was therefore to investigate the independent effects of hyperglycaemia, hypoglycaemia, and glucose variability on microvascular and macrovascular disease in T2DM. Methods. Subjects with T2DM of <10 years duration and on stable antiglycaemic treatment underwent carotid intima-media thickness (CIMT), ankle-brachial index (ABI), albumin-creatinine ratio (ACR), and HbA1c measurement, as well as 72-hour continuous glucose monitoring. Macrovascular disease was defined as one or more of the following: history of ischaemic heart disease (IHD), cerebrovascular accident (CVA), ABI < 0.9, or abnormal CIMT. Results. The study population comprised 121 subjects with T2DM (89 males : 32 females). The mean age was 62.6 years, and the mean DM duration was 3.7 years. Macrovascular disease was present in 71 patients (58.7%). In multivariate logistic regression analysis, body surface area (BSA) (OR 18.88 (95% CI 2.20–156.69), p=0.006) and duration of blood glucose (BG) < 3.9 mmol/L (OR 1.12 (95% CI 1.014–1.228), p=0.024) were independent predictors of macrovascular disease. BSA (OR 12.6 (95% CI 1.70–93.54), p=0.013) and duration of BG < 3.9 mmol/L (OR 1.09 (95% CI 1.003–1.187), p=0.041) were independent predictors of abnormal CIMT. Area under the curve for BG > 7.8 mmol/L (β = 15.83, p=0.005) was the sole independent predictor of albuminuria in generalised linear regression. Conclusions. This study demonstrates that hypoglycaemia is associated with the occurrence of atherosclerotic disease while hyperglycaemia is associated with microvascular disease in a Caucasian population with T2DM of recent duration. [ABSTRACT FROM AUTHOR]

Published
2018
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26. CYP2C19 genetic polymorphisms in Maltese patients on clopidogrel therapy.

Author

Wirth, Francesca, Zahra, Graziella, Xuereb, Robert G., Barbara, Christopher, Camilleri, Liberato, Fenech, Albert, and Azzopardi, Lilian M.

Subjects
GENETIC polymorphisms, DRUG metabolism, GENE frequency, ALLELES, GENOTYPES
Abstract

Introduction and Aims: The CYP2C19 enzyme is involved in the metabolism of various therapeutically-important drugs including clopidogrel. The aims were to determine CYP2C19 *2 and *17 variant allele frequencies and CYP2C19 genotype distribution in a cohort of Maltese patients on clopidogrel and to compare observed frequencies of the CYP2C19 *2 allele and *2/*2 genotype in this cohort to other populations bordering the Mediterranean Sea. Methods: CYP2C19 genotyping in a cohort of Maltese patients on clopidogrel was performed using TaqMan? Drug Metabolism Genotyping Assays. Frequencies of the CYP2C19 *2 and *17 variant alleles and six genotypes (*1/*1, *1/*2, *2/*2, *1/*17, *17/*17, *2/*17) were determined. Observed frequencies of the *2 allele and *2/*2 genotype were compared to fourteen populations bordering the Mediterranean Sea. Results: Frequency of the CYP2C19 *2 and *17 allele in the 244 Maltese patients genotyped was 12.3% and 15.4% respectively. CYP2C19 genotype distribution was: *1/*1 (52.1%), *1/*17 (22.5%), *1/*2 (18.0%), 2/*17 (6.6%), *17/*17 (0.8%) and *2/*2 (0). There was no statistically significant difference in *2 allele frequency between the Maltese cohort and all fourteen populations bordering the Mediterranean Sea. Conclusions: This study reports the frequency of CYP2C19 *2 and *17 variant alleles in a cohort of Maltese patients treated with clopidogrel. The high percentage of patients genotyped as carriers of the *2 (25%) or *17 (23%) variant alleles indicates that CYP2C19 genotyping could be used to guide clinicians in the individualisation of antiplatelet therapy. [ABSTRACT FROM AUTHOR]

Published
2018

27. Atrial fibrillation : a common arrhythmia with possible dire consequences

Author

Xuereb, Robert G., robert.g.xuereb@um.edu.mt, and robert.g.xuereb@um.edu.mt

Subjects
cardiovascular system, cardiovascular diseases, Atrial fibrillation
Abstract

The diagnosis of atrial fibrillation (AF) is clinched on the electrocardiogram with the finding of fine baseline oscillations, absent P waves and irregular ventricular rhythm.1 It is the most common type of arrhythmia requiring medical care, with a prevalence of 1-2%.2 More than half of AF episodes are detected by continuous ambulatory ECG monitoring. Although uncommon in the younger age groups, less than 0.5% in 40-50 year olds, it affects 5-15% of the population by the age of 80 years., peer-reviewed

Published
2010

28. ‘Twiddling’ of the pacemaker resulting in lead dislodgement

Author

Cassar DeMarco, Daniela and Xuereb, Robert G.

Subjects
Cardiac pacemakers -- Implantation, Cardiac pacemakers -- Complications -- Case studies, Cardiac pacemakers -- Complications -- Malta
Abstract

Twiddler’s syndrome is a rare condition in which patient manipulation of the pulse generator within its pocket may result in coiling of the lead and lead dislodgement, thereby causing pacemaker malfunction. Retraction of the electrode may cause phrenic nerve stimulation resulting in diaphragmatic stimulation and a sensation of abdominal pulsations. As the leads are further wrapped around the generator, rhythmic arm twitching may occur as a result of pacing of the brachial plexus.1 Twiddler’s syndrome was first described by Bayliss et al in 1968 as a complication of pacemaker implantation.2 It has also been reported with implantable cardioverter-defibrillators (ICDs)3 and cardiac resynchronisation therapy (CRT).4 This is a case report of an elderly lady with Twiddler’s syndrome resulting in pacemaker malfunction secondary to lead retraction, who emphatically denied any manipulation of her device. She subsequently underwent lead repositioning and appropriate counselling., peer-reviewed

Published
2009

30. Transcatheter device closure of atrial septal defect and patent foramen ovale in Malta

Author

Grech, Victor E., Aquilina, Oscar, Felice, Herbert, Fenech, Albert, Xuereb, Robert G., Xuereb, Mariosa, Tilney, Terrence, Aquilina, Josanne, Vella, Norbert, Galea Debono, Anthony, and DeGiovanni, Joseph V.

Subjects
Foramen Ovale, Patent -- Malta, Atrial septal defects -- Treatment, Cerebrovascular disease -- Malta, Heart valve prosthesis
Abstract

Significant atrial septal defects (ASD) are closed, surgically or through a transcatheter device, in order to avoid pulmonary hypertension in late life. A patent foramen ovale (PFO) may need to be closed because of transient shunt reversal resulting in transient ischaemic events or stroke. We report the Maltese experience to date in transcatheter closure of these defects. A total of 46 ASDs and 51 PFOs have been successfully closed at our unit (total 97), with very low complication rates, rates that compare very favourably with results from larger international centres., peer-reviewed

Published
2008

31. The long and winding road: the management of Acute Coronary Syndromes in Malta

Author

Xuereb, Robert G. and Xuereb, Mariosa

Subjects
education, Myocardial infarction -- Prevention, Coronary heart disease -- Treatment -- Malta, Catheterization
Abstract

The treatment of acute coronary syndromes in Malta has been revolutionized over the past decade by the introduction of the catheterization laboratory. With the set-up of on-call cardiac invasive teams for primary percutaneous coronary interventions in ST-elevation myocardial infarction, Malta may be counted among the elite cardiac centres. The recent completion of numerous multicentre international clinical trials has led to an upheaval in the strategy and armamentarium for the treatment of acute coronary syndromes., peer-reviewed

Published
2003

32. Female gender and cardiovascular disease.

Author

Xuereb, Rachel, Magri, Caroline J., Xuereb, Sara, Xuereb, Mariosa, Zammit Mangion, Marion, and Xuereb, Robert G.

Abstract

The article discusses the symptomatology, diagnostic modalities and therapeutic strategies for cardiovascular diseases in women. Topics covered include diagnostic modalities used in the investigation of chest pain including exercise testing, biochemical markers and functional imaging, treatment options including revascularization, antiplatelet agents and coronary artery bypass grafting and gender differences diagnosis, preventive and therapeutic management.

Published
2016
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33. Coronary artery spasm : role in acute myocardial ischaemia

Author

Xuereb, Robert G. and Xuereb, Mariosa

Subjects
Myocardial infarction, Coronary heart disease -- Treatment, Coronary heart disease -- Pathophysiology, cardiovascular diseases
Abstract

Coronary artery spasm is an accepted cause of transient myocardial ischaemia in patients with variant angina. The electrocardiographic abnormality, ST segment elevation, which is a hallmark of this syndrome, resembles that seen experimentally when the animal coronary artery is ligated and clinically, when the human coronary artery is totally occluded by a balloon angioplasty catheter. Coronary artery spasm is defined as a severe localized constriction sufficiently profound to cause transient total or sub-total occlusion of an epicardial coronary artery resulting in myocardial ischaemia. Coronary artery spasm has also been suggested to play an important role in the pathophysiology of myocardial ischaemia throughout the wide clinical spectrum of coronary artery disease including effort angina, unstable angina, acute myocardial infarction and sudden death., peer-reviewed

Published
1992

34. Peripartum cardiomyopathy.

Author

Grixti, Sarah, Magri, Caroline J., Xuereb, Robert, and Fava, Stephen

Abstract

Peripartum cardiomyopathy is a form of dilated cardiomyopathy of indeterminate aetiology occurring in late pregnancy or the months following delivery. This article reviews current knowledge of its pathophysiology, therapeutic strategies and prognosis, as well as new treatments and future directions. [ABSTRACT FROM AUTHOR]

Published
2015
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35. Coronary chronic total occlusions and percutaneous coronary intervention.

Author

Magri, Caroline J., Carlino, Mauro, and Xuereb, Robert G.

Abstract

The article discusses coronary chronic total occlusions, which occur in a third of patients with coronary artery disease whereas percutaneous coronary intervention (PCI) is attempted in a minority. The benefits of PCIs for chronic total occlusion including recanalization of chronic total occlusions leading to symptomatic benefit up to 6 years following the procedure are described. Some of the limitations of PCI for chronic total occlusions are highlighted. INSET: KEY POINTS.

Published
2013
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36. Stress echocardiography vs nuclear stress imaging in clinical cardiology.

Author

Magri, Caroline J. and Xuereb, Robert G.

Abstract

Stress echocardiography and nuclear stress imaging are important non-invasive tools in clinical cardiology. This review discusses the uses, strengths and limitations of these imaging modalities and looks at whether stress echocardiography can actually replace nuclear stress imaging. [ABSTRACT FROM AUTHOR]

Published
2012

37. Peroxisome proliferatoractivated receptor-&ggr; and the endothelium: implications in cardiovascular disease.

Author

Magri, Caroline Jane, Gatt, Noel, Xuereb, Robert G, and Fava, Stephen

Subjects
PEROXISOME proliferator-activated receptors, ENDOTHELIUM, CARDIOVASCULAR diseases, TRANSCRIPTION factors, LIPID metabolism, ROSIGLITAZONE, NEOVASCULARIZATION, THROMBOSIS
Abstract

Peroxisome proliferator-activated receptors-&ggr; (PPAR&ggr;s) are ligand-activated transcription factors that play a crucial regulatory role in the transcription of a large number of genes involved in lipid metabolism and inflammation. In addition to physiological ligands, synthetic ligands (the thiazoledinediones) have been developed. In spite of the much publicized adverse cardiovascular effects of one such thiazoledinedione (rosiglitazone), PPAR&ggr; activation may have beneficial cardiovascular effects. In this article we review the effects of PPAR&ggr; activation on the endothelium with special emphasis on the possible implications in cardiovascular disease. We discuss its possible role in inflammation, vasomotor function, thrombosis, angiogenesis, vascular aging and vascular rhythm. We also briefly review the clinical implications of these lines of research. INSETS: Beneficial cardiovascular effects of endothelial peroxisome proli;Key issues. [ABSTRACT FROM AUTHOR]

Published
2011
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38. A 69-year-old woman presenting with shortness of breath.

Author

Xuereb, Rachel, Xuereb, Sara, and Xuereb, Robert

Subjects
DYSPNEA, CONGENITAL heart disease, SYNCOPE, HEART disease complications, HEART disease diagnosis, LEFT heart ventricle, ECHOCARDIOGRAPHY, CARDIAC catheterization, HEART ventricles, DIVERTICULUM, HEART physiology, HEART diseases, DISEASE complications
Published
2020
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41. 'Twiddling' of the Pacemaker Resulting in Lead Dislodgement.

Author

DeMarco, Daniela Cassar and Xuereb, Robert G.

Subjects
*MEDICAL equipment, *SIGNAL generators, *IMPLANTABLE cardioverter-defibrillators, CARDIAC pacemaker complications
Abstract

Twiddler's syndrome is a rare condition in which patient manipulation of the pulse generator within its pocket may result in coiling of the lead and lead dislodgement, thereby causing pacemaker malfunction. Retraction of the electrode may cause phrenic nerve stimulation resulting in diaphragmatic stimulation and a sensation of abdominal pulsations. As the leads are further wrapped around the generator, rhythmic arm twitching may occur as a result of pacing of the brachial plexus. Twiddler's syndrome was first described by Bayliss et al in 1968 as a complication of pacemaker implantation. It has also been reported with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronisation therapy (CRT). This is a case report of an elderly lady with Twiddler's syndrome resulting in pacemaker malfunction secondary to lead retraction, who emphatically denied any manipulation of her device. She subsequently underwent lead repositioning and appropriate counselling. [ABSTRACT FROM AUTHOR]

Published
2009

43. Heart failure in Europe: Guideline‐directed medical therapy use and decision making in chronic and acute, pre‐existing and de novo, heart failure with reduced, mildly reduced, and preserved ejection fraction – the ESC EORP Heart Failure III Registry.

Author

Lund, Lars H., Crespo‐Leiro, Maria Generosa, Laroche, Cécile, Zaliaduonyte, Diana, Saad, Aly M., Fonseca, Candida, Čelutkienė, Jelena, Zdravkovic, Marija, Bielecka‐Dabrowa, Agata M., Agostoni, Piergiuseppe, Xuereb, Robert G., Neronova, Kseniya V., Lelonek, Malgorzata, Cavusoglu, Yuksel, Gellen, Barnabas, Abdelhamid, Magdy, Hammoudi, Naima, Anker, Stefan D., Chioncel, Ovidiu, and Filippatos, Gerasimos

Subjects
*MINERALOCORTICOID receptors, *VENTRICULAR ejection fraction, *HEART failure, *EMERGENCY medical services, *HOSPITAL emergency services
Abstract

Aims Methods and results Conclusion We analysed baseline characteristics and guideline‐directed medical therapy (GDMT) use and decisions in the European Society of Cardiology (ESC) Heart Failure (HF) III Registry.Between 1 November 2018 and 31 December 2020, 10 162 patients with acute HF (AHF, 39%, age 70 [62–79], 36% women) or outpatient visit for HF (61%, age 66 [58–75], 33% women), with HF with reduced (HFrEF, 57%), mildly reduced (HFmrEF, 17%) or preserved (HFpEF, 26%) ejection fraction were enrolled from 220 centres in 41 European or ESC‐affiliated countries. With AHF, 97% were hospitalized, 2.2% received intravenous treatment in the emergency department, and 0.9% received intravenous treatment in an outpatient clinic. AHF was seen by most by a general cardiologist (51%) and outpatient HF most by a HF specialist (48%). A majority had been hospitalized for HF before, but 26% of AHF and 6.1% of outpatient HF had de novo HF. Baseline use, initiation and discontinuation of GDMT varied according to AHF versus outpatient HF, de novo versus pre‐existing HF, and by ejection fraction. After the AHF event or outpatient HF visit, use of any renin–angiotensin system inhibitor, angiotensin receptor–neprilysin inhibitor, beta‐blocker, mineralocorticoid receptor antagonist and loop diuretics was 89%, 29%, 92%, 78%, and 85% in HFrEF; 89%, 9.7%, 90%, 64%, and 81% in HFmrEF; and 77%, 3.1%, 80%, 48%, and 80% in HFpEF.Use and initiation of GDMT was high in cardiology centres in Europe, compared to previous reports from cohorts and registries including more primary care and general medicine and regions more local or outside of Europe and ESC‐affiliated countries. [ABSTRACT FROM AUTHOR]

Published
2024
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46. Sleep measures and cardiovascular disease in type 2 diabetes mellitus.

Author

Magri, Caroline J., Xuereb, Sara, Xuereb, Rachel-Anne, Xuereb, Robert G., Fava, Stephen, and Galea, Joseph

Subjects
*CARDIOVASCULAR diseases risk factors, *NONPARAMETRIC statistics, *STATISTICS, *CAROTID intima-media thickness, *CONFIDENCE intervals, *CROSS-sectional method, *MULTIVARIATE analysis, *SELF-evaluation, *ACTIGRAPHY, *MANN Whitney U Test, *TYPE 2 diabetes, *SLEEP disorders, *RISK assessment, *T-test (Statistics), *PEARSON correlation (Statistics), *QUESTIONNAIRES, *MENTAL depression, *DESCRIPTIVE statistics, *BODY mass index, *DATA analysis software, *DATA analysis, *PSYCHOLOGICAL stress, *DISEASE complications
Abstract

Objective The objective of this study was to assess whether poor sleep is independently associated with cardiovascular disease in people with type 2 diabetes mellitus (T2DM). Methods A cross-sectional study was performed in subjects with T2DM aged between 40 and 80 years. Sleep assessment was achieved by actigraphy and Pittsburgh Sleep Quality Index (PSQI) score. Results The study population comprised 108 subjects with T2DM. The mean age was 64.9 years, the median diabetes duration was 6 years and 73.1% were men. No association was shown between sleep parameters as assessed by actigraphy and T2DM-associated micro- and macrovascular complications. However, sleep quality as assessed by PSQI was significantly associated with macrovascular disease in univariate analysis. Multivariate logistic regression analysis showed red blood cell distribution width (RDW) (odds ratio (OR) 1.79, p=0.018) and good sleep quality (OR 0.35, p=0.017) to be independently associated. Binary logistic regression analysis revealed that body mass index (BMI) (OR 1.11, p=0.024), RDW (OR 1.95, p=0.007) and Center for Epidemiologic Studies Depression score (OR 1.06, p=0.012] were independently associated with abnormal carotid intima-media thickness (CIMT). Conclusions Poor sleep quality and higher RDW levels are associated with macrovascular disease in a T2DM population. Increased BMI as well as depression also appear to have an independent role in subclinical atherosclerosis, as assessed by CIMT. [ABSTRACT FROM AUTHOR]

Published
2023
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47. Letter to the editor: Are we missing pancreatic exocrine insufficiency in 'at-risk' groups?

Author

Kapembwa, Moses Silungwe, Fleming, Simon Charles, Batman, Philip Anthony, Griffin, George Edward, Magri, Caroline J., Xuereb, Sara, Xuereb, Rachel-Anne, Xuereb, Robert G., Fava, Stephen, and Galea, Joseph

Subjects
*FECAL analysis, *PATIENT compliance, *DIFFERENTIAL diagnosis, *AT-risk people, *HIV-positive persons, *HIV enteropathy, *DIAGNOSTIC errors, *EXOCRINE pancreatic insufficiency, *PHYSICIAN practice patterns, *PROTEOLYTIC enzymes, *AMINO acids, *ALCOHOLISM, *MEDICAL screening, *BIOMARKERS, *DISEASE risk factors
Published
2024
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48. Write a Scientific Paper (WASP): Past and anticipated trends in cardiology service requirements at Mater Dei Hospital, Malta.

Author

Grech, Victor, Aquilina, Oscar, Cassar, Andrew, and Xuereb, Robert

Subjects
*RESEARCH papers (Students), *CARDIOLOGY, *MEDICAL care, *HEALTH planning, *DATA protection, *DOCUMENTATION, *HEALTH facilities, *MEDICAL writing, *STATISTICS, *DEPARTMENTS, *ACQUISITION of data
Abstract

Introduction: The requirement for medical services fluctuates. This study was carried out in order to attempt to extrapolate the service requirements for various cardiology services at Mater Dei Hospital, Malta over the coming five years, based on service demands from previous years.Methods: Past annual data was obtained from hospital records for various services (to 2017). Linear regression was carried out using a bespoke Excel™ spreadsheet in order to extrapolate possible services requirements up to 2022.Results: All services are expected to increase, with forecasts ranging between 41 and 354%, depending on services being considered.Discussion: It is easy to "get on with it" and perform the work required at the workplace but this study has shown that it is equally important to anticipate demands lest lack of planning leads to long and important waiting lists for critical diagnostics and treatments. Health care provision requirements are increasing worldwide. Even using conservative estimates and in the absence of the creation of new services, the demands for extant services are likely to continue to grow. Unless medium term plans are made for hardware, software, physical space and staffing, and the funding thereof, waiting lists for investigations in this speciality are bound to rise. This may be mitigated by novel treatments but since these cannot be predicted, it would be safer and wiser to plan ahead lest we are overwhelmed. This paper has also shown how WASP (Write a Scientific Paper) precepts can be applied to elegantly study a problem and write up a paper. [ABSTRACT FROM AUTHOR]

Published
2019
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49. Recurrent swimming-induced pulmonary oedema (SIPE) in a triathlete.

Author

Bonello Spiteri, Danica, Debono, Ritienne, Micallef-Stafrace, Kirill, and Xuereb, Robert G.

Subjects
*PULMONARY edema, *COUGH, *DYSPNEA, *SPUTUM, *SWIMMING, *TRIATHLON, *DISEASE relapse, *DIAGNOSIS
Abstract

A 37-year-old male triathlete presented with two episodes of acute onset of severe dyspnoea, cough and expectoration of pink frothy sputum during the swimming stage of two different races. On both occasions he was still able to continue the bike segment of the race but at a slower pace and symptoms improved spontaneously once he reached the shore and rested. All investigations conducted were normal leading to the diagnosis of swimming-induced pulmonary oedema. [ABSTRACT FROM AUTHOR]

Published
2011

50. Six Months After the Patients Stayed Home: A Nationwide Study of Cardiac Mortality and Readmissions Following the First Wave of the COVID-19 Pandemic in Malta.

Author

Grech N, Xuereb RA, Xuereb RG, and Caruana M

Abstract

Background The first COVID-19 wave resulted in a significant decline in acute cardiac admissions (ACAs) and delays to hospital presentation in Malta, as well as an excess of out-of-hospital cardiac arrests. The aim was to investigate the impact of the observed delays in presentation in 2020 on mortality and cardiac readmissions at six months. Methods All ACAs between 28th February and 30th April 2020 (first wave of COVID-19 in Malta) were included, and the corresponding 2019 period was used as a control. ACA was defined as an unplanned admission of an adult (aged ≥16 years) under the care of a cardiologist. Outcomes over the six months following the index ACA included death, cardiac readmission, and planned cardiac intervention at discharge. The term 'death' referred to all-cause mortality. Cardiac readmissions referred to unplanned admissions for acute cardiac pathology following the index ACA. During sub-analyses, ACAs were divided into acute coronary syndrome (ACS) and non-ACS. A first analysis compared the frequency of deaths, cardiac readmissions, and planned interventions between the 2019 and 2020 cohorts. A second analysis investigated differences in six-month survival and freedom from readmission between the two cohorts. Both analyses were followed by a sub-analysis. Results There were 330 ACAs among the 2019 cohort and 220 in 2020. There were no significant differences between the 2019 and 2020 cohorts in all-cause mortality (2019, 8.8% vs 2020, 8.2%, p=0.466) and Kaplan-Meier survival estimates at a six-month follow-up (2019, 169.06 days (95% CI 164.95-173.17) vs 2020, 168.27 days (95% CI 162.82-173.72), p=0.836), including subgroup analysis for non-ACS (2019, 168.52 days (95% CI 163.08-173.96) vs 168.11 days (95% CI 160.93-175.30), p=0.952) and ACS patients (169.81 days (95% CI 163.54-176.09) in 2019 vs 168.45 days (95% CI 160.17-176.73) in 2020, p=0.739). A significantly higher number of patients from the 2019 cohort (75/319, 23.5%) required readmission compared to 2020 (32/212; 15.1%) (p=0.02). Similarly, there was shorter freedom from cardiac readmission among 2019 patients (mean 150.98 days (95% CI 144.63-157.33)) compared to 2020 patients (mean 158.66 days (95% CI 151.58-165.74, p=0.024). During sub-analysis, the difference in freedom from readmission was significant only for non-ACS patients (mean of 145.45 days (95% CI 136.58-154.32) in 2019 vs 158.92 days (95% CI 149.19-168.64) in 2020, p=0.018). Analysis of cardiac interventions during the six months post-index ACA discharge showed significantly more planned cardiac interventions in 2019 (52/319; 16.3%) compared to 2020 (20/212; 9.4%) (p=0.027). Conclusions A delay in presentation of ACAs during COVID-19 in Malta resulted in lower readmission rates and increased freedom from readmissions, with no excess in all-cause mortality at a six-month follow-up. The reasons for the optimistic outcomes of patients admitted during the first wave of COVID-19 may be multifactorial. Reasons may include ongoing fear of hospital presentation, a more holistic approach to patients' in-hospital care during 2020 aimed at reducing further hospital contact post-discharge, and a selection bias secondary to an excess of out-of-hospital cardiac arrests during the initial wave of COVID-19. Further studies will be required to truly assess the collateral impact of non-COVID-19-related illness. Public education on cardiovascular health is vital and must be emphasized during the pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Grech et al.)

Published
2022
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