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The efficacy of patient empowerment has been emphasized recently by the EPIC-HF trial.40 Patient education can reinforce the partnership between health professionals and patients (i.e. patient-care partner approach). Randomized controlled trials (RCTs) have established the efficacy of several therapies to improve both symptoms and outcomes for patients with heart failure and reduced left ventricular ejection fraction (HFrEF). More recently, the OFICA Study,7 which included >1600 patients hospitalized with HF in 170 French centres on a single day, found that discharge medications were rarely at optimal dosage and remained largely unchanged following discharge.8 The result is that a large proportion of patients with HFrEF does not receive cardinal HF treatments or is prescribed suboptimal doses.9-11 Recently, the CHAMP-HF registry showed that only 1% of patients with HFrEF was treated, simultaneously, with target dose of ACE-I/ARB/ARNI, beta-blocker, and MRA.9 Reasons for not prescribing, or not up-titrating guideline-recommended medications might be many, but when audited, they are commonly not reported or clearly stated. They may furthermore operate through ambulatory IV diuretics infusion.34 Despite their usefulness, the use of HF clinics is suboptimal, possibly due to lack of capacity, geographical considerations, and funding issues.35 Ambulatory disease management programmes DMP, usually providing care outside of hospitals, have been shown to reduce the risk of both all-cause mortality and HF-related hospital readmission by approximately 30%36 and are now formally recommended in 2021 ESC guidelines on HF. [Extracted from the article]

Background and aims: Complex aortic atheroma (CAA) is a common cause of acute brain ischemia (BI), including ischemic stroke (IS) and transient ischemic attack (TIA), and is associated with recurrence. The CHA2DS2‐VASc score is a useful tool for predicting stroke in patients with atrial fibrillation (AF), and can also predict cardiovascular events in other populations, including non‐AF populations. The ADAM‐C score is a new risk score for predicting the diagnostic yield of transesophageal echocardiography (TEE) after BI. We aimed to evaluate the ability of CHA2DS2‐VASc and ADAM‐C scores to predict CAA after BI. Methods: This prospective, multicenter, observational study included 1479 patients aged over 18 years who were hospitalized for BI. CAA was defined as the presence of one or more of the following criteria: thrombus, ulcerated plaque, or plaque thickening ≥ 4 mm. Results: CAA was diagnosed in 216 patients (14.6%). CHA2DS2‐VASc and ADAM‐C scores were significantly higher in the CAA group versus the non‐CAA group (P <.0001 for both). The CHA2DS2‐VASc and ADAM‐C scores appear to be good predictors of CAA (AUC 0.699 [0.635, 0.761] and 0.759 [0.702, 0.814], respectively). The sensitivity, specificity, predictive positive value (PPV), and negative predictive value (NPV) of the scores for detecting CAA were 94%, 22%, 17%, and 96%, respectively, for a CHA2DS2‐VASc score < 2, and 90%, 46%, 22%, and 96%, respectively, for an ADAM‐C score < 3 Conclusions: CHA2DS2‐VASc and ADAM‐C scores are able to predict CAA after BI. CHA2DS2‐VASc < 2 and ADAM‐C < 3 both have an interesting NPV of 96%. [ABSTRACT FROM AUTHOR]

Background and aim: The clinical utility of transesophageal echocardiography (TEE) after brain ischemia (BI) remains a matter of debate. We aimed to evaluate the clinical impact of TEE and to build a score that could help physicians to identify which patients should better benefit from TEE. Methods: This prospective, multicenter, observational study included patients over 18 years old, hospitalized for BI. TEE findings were judged discriminant if the results showed important information leading to major changes in the management of patients. Most patients with patent foramen ovale were excluded. Variables independently associated with a discriminant TEE were used to build the prediction model. Results: Of the entire population (1479 patients), 255 patients (17%) were classified in the discriminant TEE group. Five parameters were selected as predictors of a discriminant TEE. Accordingly, the ADAM-C score could be calculated as follows: Score = 4 (if age ≥60) + 2 (if diabetes) + 2 (if aortic stenosis from any degrees) + 1 (if multi-territory stroke) + 2 (if history of coronary artery disease). At a threshold lower than 3, the sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of detecting discriminant TEE were 88% (95% CI 85-90), 44% (95% CI 41-47), 21% (95% CI 19-27), and 95% (95% CI 94-97), respectively. Conclusion: A simple score based on clinical and transthoracic echocardiographic parameters can help physicians to identify patients who might not benefit from TEE. Indeed, a score lower than 3 has an interesting NPV of 95% (95% CI 94-97). [ABSTRACT FROM AUTHOR]