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Background: We previously conducted a single-profile discrete choice experiment to elicit preferences of adolescents around HPV vaccine communication, finding that only half of participants made variable choices (non-uniform respondents) from which preferences were elicited. In this paper we provide a framework to evaluate post-choice certainty information to elicit preferences even among respondents who uniformly accepted (serial demanders) or refused (serial non-demanders) hypothetical vaccination scenarios. Methods: During an in-class online questionnaire among 1458 French adolescents aged 13–15 years old, we collected certainty levels (0–10) after decisions on nine hypothetical scenarios, including four vaccination attributes: information on vaccine-preventable disease type, on vaccine safety, on potential for indirect protection and on vaccine coverage. We developed a vaccine eagerness scale (ranging from −10 to 10), by combining information on the binary decision (accept vs. refuse the hypothetical vaccine) and the decision certainty level. We used random effects linear regressions to evaluate attributes’ impact on vaccine eagerness. Sensitivity analyses were performed taking into account low response quality, assessed as invariant certainty and low response time. Results: Attributes’ impact on decision certainty were similar between serial demanders (N = 659) and non-uniform respondents (N = 711): mentioning a positive benefit-risk balance significantly decreased certainty to accept (coefficient −0.93), while information on 80% coverage in other countries (+0.33) and potential for disease elimination (+0.09) increased it. Among serial non-demanders, significant attribute impacts were observed only after exclusion of low-quality responses (N = 31): a potential for disease elimination (coefficient: +0.24) and 80% coverage in other countries (+0.42) significantly increased certainty of refusing vaccination. Combining decision and certainty into a vaccine eagerness indicator allowed analysing preferences in the full sample, including “hesitant” respondents, who were sensitive to the content of the vaccination profile. Conclusion: Choice certainty informs on respondents’ preferences in single-profile discrete-choice experiments, in particular among those with uniform responses.

Background The 2023 Duke–International Society for Cardiovascular Diseases (ISCVID) criteria for infective endocarditis (IE) were proposed as an updated diagnostic classification of IE. Using an open prospective multicenter cohort of patients treated for IE, we compared the performance of these new criteria to that of the 2000 Modified Duke and 2015 European Society of Cardiology (ESC) criteria. Methods Cases of patients treated for IE between January 2017 and October 2022 were adjudicated as certain IE or not. Each case was also categorized as either definite or possible/rejected within each classification. Sensitivity, specificity, and accuracy were estimated with 95% confidence intervals. Results Of the 1194 patients analyzed (mean age, 66.1 years; 71.2% males), 414 (34.7%) had a prosthetic valve and 284 (23.8%) had a cardiac implanted electronic device (CIED); 946 (79.2%) were adjudicated as certain IE; 978 (81.9%), 997 (83.5%), and 1057 (88.5%) were classified as definite IE in the 2000 modified Duke, 2015 ESC, and 2023 Duke–ISCVID criteria, respectively. The sensitivity of each set of criteria was 93.2% (95% confidence interval [CI], 91.6–94.8), 95.0% (95% CI, 93.7–96.4), and 97.6% (95% CI, 96.6–98.6), respectively (P <.001 for all 2-by-2 comparisons). Corresponding specificity rates were 61.3% (95% CI, 55.2–67.4), 60.5% (95% CI, 54.4–66.6), and 46.0% (95% CI, 39.8–52.2), respectively. In patients without CIED, sensitivity rates were 94.8% (95% CI, 93.2–96.4), 96.5% (95% CI, 95.1–97.8), and 97.7% (95% CI, 96.6–98.8); specificity rates were 59.0% (95% CI, 51.6–66.3), 56.6% (95% CI, 49.3–64.0), and 53.8% (95% CI, 46.3–61.2), respectively. Conclusions Overall, the 2023 Duke–ISCVID criteria had a significantly higher sensitivity but a significantly lower specificity compared with older criteria. This decreased specificity was mainly attributable to patients with CIED. [ABSTRACT FROM AUTHOR]

Aims: Patients who experience hospitalizations due to heart failure (HF) face a significant risk of readmission and mortality. Our objective was to evaluate whether the risk of hospitalization and mortality following discharge from HF hospitalization differed based on adherence to the outpatient follow‐up (FU) protocol comprising an appointment with a general practitioner (GP) within 15 days, a cardiologist within 2 months or both (termed combined FU). Methods and results: We studied all adults admitted for a first HF hospitalization from 2016 to 2020 in France's Grand Est region. Association between adherence to outpatient FU and outcomes were assessed with time‐dependent survival analysis model. Among 67 476 admitted patients (mean age 80.3 ± 11.3 years, 53% women), 62 156 patients (92.2%) were discharged alive and followed for 723 (317–1276) days. Combined FU within 2 months was used in 21.1% of patients, with lower rates among >85 years, women, and those with higher comorbidity levels (p < 0.0001 for all). Combined FU was associated with a lower 1‐year death or rehospitalization (adjusted hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.88–0.94, p < 0.0001) mostly related to lower mortality (adjusted HR 0.65, 95% CI 0.62–0.68, p < 0.0001) whereas HF readmission was higher (adjusted HR 1.19, 95% CI 1.15–1.24, p < 0.0001). When analysing components of combined FU separately, 1‐year mortality was more related to cardiologist FU (HR 0.65, 95% CI 0.62–0.67, p < 0.0001), than GP FU (HR 0.87, 95% CI 0.85–0.90, p < 0.0001). Conclusion: Combined FU is carried out in a minority of patients following HF hospitalization, yet it is linked to a substantial reduction in 1‐year mortality, albeit at the expense of an increase in HF hospitalizations. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES This observational study aimed to evaluate Association pour l'Etude et la Prévention de l'Endocardite Infectieuse (AEPEI) surgery score predictive performance in comparison to general (EuroSCORE I, II) and specific (De Feo, PALSUSE) surgical risk scores for infective endocarditis (IE). METHODS The study included patients who underwent surgery for IE during the acute phase at Bichat University Hospital (Paris, France) between 1 January 2006 and 31 December 2016 and at Nancy University Hospital (Nancy, France) between 1 January 2009 and 31 December 2019. Patients with IE complicating percutaneous aortic valve implantations or implantable intra-cardiac devices were excluded. Discrimination and calibration were assessed using receiver operating characteristic curve analysis, calibration curves and the Hosmer–Lemeshow test. RESULTS In-hospital mortality rates were 18% at Bichat and 16% at Nancy. Discrimination was high for all risk scores at Bichat (area under the receiver operating characteristic curve = 0.77 for EuroSCORE I, 0.78 for EuroSCORE II, 0.76 for De Feo score, 0.72 for PALSUSE and 0.73 for AEPEI with 95% confidence interval ranging from 0.67 to 0.83), but lower at Nancy (0.56 for EuroSCORE I, 0.65 for EuroSCORE II, 0.63 for De Feo score, 0.67 for PALSUSE and 0.66 for AEPEI score with 95% confidence interval ranging from 0.47 to 0.75). With Brier score, all scores were adequately calibrated in both populations between 0.129 (De Feo) and 0.135 (PALSUSE) for Bichat and between 0.128 (De Feo) and 0.135 (EuroSCORE I) for Nancy. With the Hosmer–Lemeshow test, the AEPEI score exhibited the best calibration (observed/predicted ratio 1.058 in Bichat, 1.087 in Nancy). CONCLUSIONS This surgical score external validation in 2 large independent populations demonstrated that the AEPEI surgical score had the best predictive performance compared to other prognosis scores. It could be helpful in clinical practice to assist the endocarditis team in decision-making. [ABSTRACT FROM AUTHOR]

Objective To summarize findings from qualitative studies on factors associated with smoking cessation among adolescents and young adults. Data sources We searched Pubmed, Psychinfo, CINAHL, Embase, Web of Science, and SCOPUS databases, as well as reference lists, for peer-reviewed articles published in English or French between January 1, 2000, and November 18, 2020. We used keywords such as adolescents, determinants, cessation, smoking, and qualitative methods. Study selection Of 1724 records identified, we included 39 articles that used qualitative or mixed methods, targeted adolescents and young adults aged 10–24, and aimed to identify factors associated with smoking cessation or smoking reduction. Data extraction Two authors independently extracted the data using a standardized form. We assessed study quality using the National Institute for Health and Care Excellence checklist for qualitative studies. Data synthesis We used an aggregative meta-synthesis approach and identified 39 conceptually distinct factors associated with smoking cessation. We grouped them into two categories: (1) environmental factors [tobacco control policies, pro-smoking norms, smoking cessation services and interventions, influence of friends and family], and (2) individual attributes (psychological characteristics, attitudes, pre-quitting smoking behavior, nicotine dependence symptoms, and other substances use). We developed a synthetic framework that captured the factors identified, the links that connect them, and their associations with smoking cessation. Conclusions This qualitative synthesis offers new insights on factors related to smoking cessation services, interventions, and attitudes about cessation (embarrassment when using cessation services) not reported in quantitative reviews, supplementing limited evidence for developing cessation programs for young persons who smoke. Implications Using an aggregative meta-synthesis approach, this study identified 39 conceptually distinct factors grouped into two categories: Environmental factors and individual attributes. These findings highlight the importance of considering both environmental and individual factors when developing smoking cessation programs for young persons who smoke. The study also sheds light on self-conscious emotions towards cessation, such as embarrassment when using cessation services, which are often overlooked in quantitative reviews. Overall, this study has important implications for developing effective smoking cessation interventions and policies that address the complex factors influencing smoking behavior among young persons. [ABSTRACT FROM AUTHOR]

Aims: We aimed to identify prognostic individual factors in patients with first acute heart failure (HF) hospitalization, considering both death and readmission as part of the natural history of HF. Methods and results: We used data from the observational, prospective, multicentre EPICAL2 cohort study from which we selected incident cases of acute HF alive at discharge. We relied on an illness‐death model to identify prognostic factors on first readmission and on mortality before and after readmission. In 451 patients hospitalized for first acute HF, we observed within the year after discharge, 23 (5.1%) deaths before readmission and 270 (59.9%) first readmissions, of which 60 (22.2%) were followed by death of any cause. First, among patient characteristics, only Charlson index ≥ 8 was associated with first readmission [adjusted hazard ratio (aHR) = 1.6, 95% confidence interval (CI) (1.1–2.3), P = 0.011]. Second, Charlson index ≥ 8 [aHR = 4.2, 95% CI (1.2–14.8), P = 0.025], low blood pressure (BP) [aHR = 12.2, 95% CI (1.9–79.6), P = 0.009], high BP [aHR = 6.9, 95% CI (1.3–36.4), P = 0.023], and prescription of recommended dual or triple HF therapy at index discharge [aHR = 0.2, 95% CI (0.1–0.7), P = 0.014] were associated with mortality before any readmission. Third, Charlson index ≥ 8 [aHR = 2.4, 95% CI (1.1–5.6), P = 0.037] and the time to first readmission (per 30 days additional) [aHR = 1.2; 95% CI (1.1–1.4), P = 0.007] were associated with mortality after readmission. Conclusions: Regardless of the prognostic state considered, we showed that comorbidities are of critical prognostic value in a real‐world cohort of incident HF cases. This argues in favour of multidisciplinary care in HF. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) typically occurs in patients with underlying cardiac conditions (UCC). Little is known about IE in patients without UCC. We aimed to describe the clinical, microbiological and imaging characteristics, management, and in-hospital mortality of IE patients without UCC. We analysed the data of patients with definite IE included in an observatory between 1st January 2009 and 31st December 2019. We described patients without UCC compared to those with UCC. Of 1502 IE patients, 475 (31.6%) had no UCC. They were younger (median 64.0 [19.0–101.0] vs. 70.0 [18.0–104.0] years, p <.001), more often on chronic haemodialysis (5.5% vs. 2.7%, p =.008), and had more often malignancy (22.5% vs. 17.3%, p =.017), immune deficiency (10.3% vs. 6.4%, p =.008), and an indwelling central venous line (14.5% vs. 7.0%, p <.001). They more often developed cerebral complications (34.7% vs. 27.5%, p =.004) and extracerebral embolism (48.6% vs. 36.1%, p <.001). Causative microorganisms were less often coagulase negative staphylococci (5.9% vs. 10.8%, p =.002) or enterococci (10.3% vs. 15.0%, p =.014) and more often group D streptococci (14.1% vs. 10.0%, p =.020). Vegetations were more common (92.8% vs. 77.0%, p <.001) and larger (14.0 [1.0–87.0], vs. 12.0 [0.5–60.0] mm, p =.002). They had more valve perforation or valve regurgitation (67.4% vs. 53.0%, p <.001) and underwent valve surgery more often (53.5% vs. 36.3%, p <.001). In-hospital mortality did not significantly differ between groups. Patients with IE and no UCC were younger than those with UCC, had specific comorbidities and portals of entry, and a more severe disease course. [ABSTRACT FROM AUTHOR]