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To develop a suite of quality indicators (QIs) for the management of patients with ventricular arrhythmias (VA) and the prevention of sudden cardiac death (SCD). The Working Group comprised experts in heart rhythm management including Task Force members of the 2022 European Society of Cardiology (ESC) Clinical Practice Guidelines for the management of patients with VA and the prevention of SCD, members of the European Heart Rhythm Association, international experts, and a patient representative. We followed the ESC methodology for QI development, which involves (i) the identification of the key domains of care for the management of patients with VA and the prevention of SCD by constructing a conceptual framework of care, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified-Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. We identified eight domains of care for the management of patients with VA and the prevention of SCD: (i) structural framework, (ii) screening and diagnosis, (iii) risk stratification, (iv) patient education and lifestyle modification, (v) pharmacological treatment, (vi) device therapy, (vii) catheter ablation, and (viii) outcomes, which included 17 main and 4 secondary QIs across these domains. Following a standardized methodology, we developed 21 QIs for the management of patients with VA and the prevention of SCD. The implementation of these QIs will improve the care and outcomes of patients with VA and contribute to the prevention of SCD.

QC 20221212

Objective: To determine whether a multicomponent intervention based on physical activity with technological support and nutritional counselling prevents mobility disability in older adults with physical frailty and sarcopenia. Design: Evaluator blinded, randomised controlled trial. Setting: 16 clinical sites across 11 European countries, January 2016 to 31 October 2019. Participants: 1519 community dwelling men and women aged 70 years or older with physical frailty and sarcopenia, operationalised as the co-occurrence of low functional status, defined as a short physical performance battery (SPPB) score of 3 to 9, low appendicular lean mass, and ability to independently walk 400 m. 760 participants were randomised to a multicomponent intervention and 759 received education on healthy ageing (controls). Interventions: The multicomponent intervention comprised moderate intensity physical activity twice weekly at a centre and up to four times weekly at home. Actimetry data were used to tailor the intervention. Participants also received personalised nutritional counselling. Control participants received education on healthy ageing once a month. Interventions and follow-up lasted for up to 36 months. Main outcome measures: The primary outcome was mobility disability (inability to independently walk 400 m in <15 minutes). Persistent mobility disability (inability to walk 400 m on two consecutive occasions) and changes from baseline to 24 and 36 months in physical performance, muscle strength, and appendicular lean mass were analysed as pre-planned secondary outcomes. Primary comparisons were conducted in participants with baseline SPPB scores of 3–7 (n=1205). Those with SPPB scores of 8 or 9 (n=314) were analysed separately for exploratory purposes. Results: Mean age of the 1519 participants (1088 women) was 78.9 (standard deviation 5.8) years. The average follow-up was 26.4 (SD 9.5) months. Among participants with SPPB scores of 3–7, mobility disability occur

Aim: The association of standard 12-lead electrocardiogram (ECG) markers with benefits of the primary prophylactic implantable cardioverter-defibrillator (ICD) has not been determined in the contemporary era. We analysed traditional and novel ECG variables in a large prospective, controlled primary prophylactic ICD population to assess the predictive value of ECG in terms of ICD benefit. Methods and results: Electrocardiograms from 1477 ICD patients and 700 control patients (EU-CERT-ICD; non-randomized, controlled, prospective multicentre study; ClinicalTrials.gov Identifier: NCT02064192), who met ICD implantation criteria but did not receive the device, were analysed. The primary outcome was all-cause mortality. In ICD patients, the co-primary outcome of first appropriate shock was used. Mean follow-up time was 2.4 ± 1.1 years to death and 2.3 ± 1.2 years to the first appropriate shock. Pathological Q waves were associated with decreased mortality in ICD patients [hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.35–0.84; P < 0.01] and patients with pathological Q waves had significantly more benefit from ICD (HR 0.44, 95% CI 0.21–0.93; P = 0.03). QTc interval increase taken as a continuous variable was associated with both mortality and appropriate shock incidence, but commonly used cut-off values, were not statistically significantly associated with either of the outcomes. Conclusion: Pathological Q waves were a strong ECG predictor of ICD benefit in primary prophylactic ICD patients. Excess mortality among Q wave patients seems to be due to arrhythmic death which can be prevented by ICD., EU-CERT-ICD The EU-CERT-ICD Study Investigators: Elena Arbelo, MD, Axel Bauer MD, Frieder Braunschweig MD PhD, Josep Brugada MD, PhD, David Conen MD, Iwona Cygankiewicz MD, Michael Dommasch MD, Christian Eick, MD, Panagiota Flevari MD, Tim Friede PhD, Jan Galuszka MD, Jim Hansen MD, Robert Hatala MD, Markus Harden PhD, Katerina Hnatkova PhD, Heikki V. Huikuri MD, Juhani M. Junttila, MD PhD, Stefan Kääb MD, Gabriela Kaliska MD, Jaroslaw D. Kasprzak MD, Andreas Katsimardos MD, Milan Kozak MD, Tomasz Kuczejko MD, Andrzej Lubinski MD, Jozef Martinek PhD, Béla Merkely MD, PhD, Tomáš Novotný MD, Marek Malik PhD MD, Peter Perge MD, Burkert Pieske MD, Pyotr Platonov MD PhD, Pawel Ptaczyński, MD, Dariusz Qavoq MD, L. Rotkvić, MD, Zoltan Sallo MD, Simon Schlögl MD, Georg Schmidt MD, Moritz Sinner, MD, Rajeeva Sritharan MSc, Stefan Stefanow MD, Christian Sticherling MD PhD, Jesper Hastrup Svendsen MD DMSc, Martin Svetlosak MD, Janko Szavits-Nossan MD, Milos Taborsky MD, Anton Tuinenburg, MD, Bert Vandenberk MD, Marc A. Vos PhD, Rik Willems MD PhD, Stefan N Willich MD PhD, Christian Wolpert MD, Markus Zabel MD, Ante Anic, MD, Zoran Bakotic MD, Steffen Behrens MD, Dieter Bimmel MD, Sandro Brusich MD, Rüdiger Dissmann MD, Gerian Grönefeld, MD, Przemyzlav Guzik MD, Svetoslav Iovev MD, Zrinka Jurisic MD, Thomas Klingenheben, MD, Nikola Pavlović MD, Joachim Seegers MD, Robert H.G. Schwinger MD, Tchavdar Shalganov MD, Vassil Traykov MD, Vasil Velchev MD.

Fragmented QRS (fQRS) is an electrocardiographic (ECG) marker of myocardial conduction abnormality, characterized by additional notches in the QRS complex. The presence of fQRS has been associated with an increased risk of all-cause mortality and arrhythmia in patients with cardiovascular disease. However, current binary visual analysis is prone to intra- and inter-observer variability and different definitions are problematic in clinical practice. Therefore, objective quantification of fQRS is needed and could further improve risk stratification of these patients. We present an automated method for fQRS detection and quantification. First, a novel robust QRS complex segmentation strategy is proposed, which combines multi-lead information and excludes abnormal heartbeats automatically. Afterwards extracted features, based on variational mode decomposition (VMD), phase-rectified signal averaging (PRSA) and the number of baseline-crossings of the ECG, were used to train a machine learning classifier (Support Vector Machine) to discriminate fragmented from non-fragmented ECG-traces using multi-center data and combining different fQRS criteria used in clinical settings. The best model was trained on the combination of two independent previously annotated datasets and, compared to these visual fQRS annotations, achieved Kappa scores of 0.68 and 0.44, respectively. We also show that the algorithm might be used in both regular sinus rhythm and irregular beats during atrial fibrillation. These results demonstrate that the proposed approach could be relevant for clinical practice by objectively assessing and quantifying fQRS. The study sets the path for further clinical application of the developed automated fQRS algorithm.

Objective To determine whether a multicomponent intervention based on physical activity with technological support and nutritional counselling prevents mobility disability in older adults with physical frailty and sarcopenia. Design Evaluator blinded, randomised controlled trial. Setting 16 clinical sites across 11 European countries, January 2016 to 31 October 2019. Participants 1519 community dwelling men and women aged 70 years or older with physical frailty and sarcopenia, operationalised as the co-occurrence of low functional status, defined as a short physical performance battery (SPPB) score of 3 to 9, low appendicular lean mass, and ability to independently walk 400 m. 760 participants were randomised to a multicomponent intervention and 759 received education on healthy ageing (controls). Interventions The multicomponent intervention comprised moderate intensity physical activity twice weekly at a centre and up to four times weekly at home. Actimetry data were used to tailor the intervention. Participants also received personalised nutritional counselling. Control participants received education on healthy ageing once a month. Interventions and follow-up lasted for up to 36 months. Main outcome measures The primary outcome was mobility disability (inability to independently walk 400 m in <15 minutes). Persistent mobility disability (inability to walk 400 m on two consecutive occasions) and changes from baseline to 24 and 36 months in physical performance, muscle strength, and appendicular lean mass were analysed as pre-planned secondary outcomes. Primary comparisons were conducted in participants with baseline SPPB scores of 3-7 (n=1205). Those with SPPB scores of 8 or 9 (n=314) were analysed separately for exploratory purposes. Results Mean age of the 1519 participants (1088 women) was 78.9 (standard deviation 5.8) years. The average follow-up was 26.4 (SD 9.5) months. Among participants with SPPB scores of 3-7, mobility disability occurred in 283/605 (

Contains fulltext : 235276.pdf (Publisher’s version ) (Open Access), AIMS: This study was performed to develop and externally validate prediction models for appropriate implantable cardioverter-defibrillator (ICD) shock and mortality to identify subgroups with insufficient benefit from ICD implantation. METHODS AND RESULTS: We recruited patients scheduled for primary prevention ICD implantation and reduced left ventricular function. Bootstrapping-based Cox proportional hazards and Fine and Gray competing risk models with likely candidate predictors were developed for all-cause mortality and appropriate ICD shock, respectively. Between 2014 and 2018, we included 1441 consecutive patients in the development and 1450 patients in the validation cohort. During a median follow-up of 2.4 (IQR 2.1-2.8) years, 109 (7.6%) patients received appropriate ICD shock and 193 (13.4%) died in the development cohort. During a median follow-up of 2.7 (IQR 2.0-3.4) years, 105 (7.2%) received appropriate ICD shock and 223 (15.4%) died in the validation cohort. Selected predictors of appropriate ICD shock were gender, NSVT, ACE/ARB use, atrial fibrillation history, Aldosterone-antagonist use, Digoxin use, eGFR, (N)OAC use, and peripheral vascular disease. Selected predictors of all-cause mortality were age, diuretic use, sodium, NT-pro-BNP, and ACE/ARB use. C-statistic was 0.61 and 0.60 at respectively internal and external validation for appropriate ICD shock and 0.74 at both internal and external validation for mortality. CONCLUSION: Although this cohort study was specifically designed to develop prediction models, risk stratification still remains challenging and no large group with insufficient benefit of ICD implantation was found. However, the prediction models have some clinical utility as we present several scenarios where ICD implantation might be postponed.

Background: Most of relevant studies for a systematic review are identified via electronic searches of biomedical databases, of which MEDLINE is arguably the most important. As search strategies may vary in complexity and yield, we aimed to assess MEDLINE search strategies regarding their recall, precision, and coverage in a sample of Cochrane Reviews in occupational medicine.Methods: Overall, we replicated and analysed search strategies of 42 Cochrane Reviews published between 2001 and 2017. Results: We found a median precision of 1.5% and a median recall of 83% which may act as benchmarks for a MEDLINE search strategy in systematic reviews in occupational medicine.Conclusion: These benchmarks for reviews in occupational medicine may help to find a balance between recall and precision of search strategies. They will be helpful for researchers to plan their work load required for reviews., Hintergrund: Die meisten relevanten Studien für einen systematischen Review werden über die elektronische Suche in biomedizinischen Datenbanken identifiziert, von denen MEDLINE wohl eine der wichtigsten ist. Da die Komplexität und das Ergebnis von Suchstrategien variieren können, wollten wir die MEDLINE-Suchstrategien in einer Stichprobe von Cochrane Reviews aus dem Bereich der Arbeitsmedizin hinsichtlich Recall, Precision und Coverage bewerten.Methoden: Insgesamt haben wir die Suchstrategien von 42 Cochrane Reviews, welche zwischen 2001 und 2017 veröffentlicht wurden, repliziert und analysiert.Ergebnisse: Wir fanden eine mediane Precision von 1,5% und einen medianen Recall von 83%, die als Benchmark für eine MEDLINE-Suchstrategie in systematischen Übersichtsarbeiten in der Arbeitsmedizin dienen können.Schlussfolgerung: Diese Benchmarks für Reviews in der Arbeitsmedizin können dazu beitragen, ein Gleichgewicht zwischen Recall und Precision von Suchstrategien zu finden. Sie können außerdem hilfreich sein, um den Arbeitsaufwand für systematische Reviews zu planen.