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1. Development of Automated Neural Network Prediction for Echocardiographic Left ventricular Ejection Fraction

Author

Zhang, Yuting, Liu, Boyang, Bunting, Karina V., Brind, David, Thorley, Alexander, Karwath, Andreas, Lu, Wenqi, Zhou, Diwei, Wang, Xiaoxia, Mobley, Alastair R., Tica, Otilia, Gkoutos, Georgios, Kotecha, Dipak, and Duan, Jinming

Subjects
Computer Science - Computer Vision and Pattern Recognition
Abstract

The echocardiographic measurement of left ventricular ejection fraction (LVEF) is fundamental to the diagnosis and classification of patients with heart failure (HF). In order to quantify LVEF automatically and accurately, this paper proposes a new pipeline method based on deep neural networks and ensemble learning. Within the pipeline, an Atrous Convolutional Neural Network (ACNN) was first trained to segment the left ventricle (LV), before employing the area-length formulation based on the ellipsoid single-plane model to calculate LVEF values. This formulation required inputs of LV area, derived from segmentation using an improved Jeffrey's method, as well as LV length, derived from a novel ensemble learning model. To further improve the pipeline's accuracy, an automated peak detection algorithm was used to identify end-diastolic and end-systolic frames, avoiding issues with human error. Subsequently, single-beat LVEF values were averaged across all cardiac cycles to obtain the final LVEF. This method was developed and internally validated in an open-source dataset containing 10,030 echocardiograms. The Pearson's correlation coefficient was 0.83 for LVEF prediction compared to expert human analysis (p<0.001), with a subsequent area under the receiver operator curve (AUROC) of 0.98 (95% confidence interval 0.97 to 0.99) for categorisation of HF with reduced ejection (HFrEF; LVEF<40%). In an external dataset with 200 echocardiograms, this method achieved an AUC of 0.90 (95% confidence interval 0.88 to 0.91) for HFrEF assessment. This study demonstrates that an automated neural network-based calculation of LVEF is comparable to expert clinicians performing time-consuming, frame-by-frame manual evaluation of cardiac systolic function., Comment: Accepted to Frontiers in Medicine

Published
2024

4. Fourier-Net+: Leveraging Band-Limited Representation for Efficient 3D Medical Image Registration

Author

Jia, Xi, Thorley, Alexander, Gomez, Alberto, Lu, Wenqi, Kotecha, Dipak, and Duan, Jinming

Subjects
Electrical Engineering and Systems Science - Image and Video Processing, Computer Science - Computer Vision and Pattern Recognition
Abstract

U-Net style networks are commonly utilized in unsupervised image registration to predict dense displacement fields, which for high-resolution volumetric image data is a resource-intensive and time-consuming task. To tackle this challenge, we first propose Fourier-Net, which replaces the costly U-Net style expansive path with a parameter-free model-driven decoder. Instead of directly predicting a full-resolution displacement field, our Fourier-Net learns a low-dimensional representation of the displacement field in the band-limited Fourier domain which our model-driven decoder converts to a full-resolution displacement field in the spatial domain. Expanding upon Fourier-Net, we then introduce Fourier-Net+, which additionally takes the band-limited spatial representation of the images as input and further reduces the number of convolutional layers in the U-Net style network's contracting path. Finally, to enhance the registration performance, we propose a cascaded version of Fourier-Net+. We evaluate our proposed methods on three datasets, on which our proposed Fourier-Net and its variants achieve comparable results with current state-of-the art methods, while exhibiting faster inference speeds, lower memory footprint, and fewer multiply-add operations. With such small computational cost, our Fourier-Net+ enables the efficient training of large-scale 3D registration on low-VRAM GPUs. Our code is publicly available at \url{https://github.com/xi-jia/Fourier-Net}., Comment: Under review. arXiv admin note: text overlap with arXiv:2211.16342

Published
2023

6. Nesterov Accelerated ADMM for Fast Diffeomorphic Image Registration

Author

Thorley, Alexander, Jia, Xi, Chang, Hyung Jin, Liu, Boyang, Bunting, Karina, Stoll, Victoria, de Marvao, Antonio, O'Regan, Declan P., Gkoutos, Georgios, Kotecha, Dipak, and Duan, Jinming

Subjects
Computer Science - Computer Vision and Pattern Recognition, Mathematics - Dynamical Systems
Abstract

Deterministic approaches using iterative optimisation have been historically successful in diffeomorphic image registration (DiffIR). Although these approaches are highly accurate, they typically carry a significant computational burden. Recent developments in stochastic approaches based on deep learning have achieved sub-second runtimes for DiffIR with competitive registration accuracy, offering a fast alternative to conventional iterative methods. In this paper, we attempt to reduce this difference in speed whilst retaining the performance advantage of iterative approaches in DiffIR. We first propose a simple iterative scheme that functionally composes intermediate non-stationary velocity fields to handle large deformations in images whilst guaranteeing diffeomorphisms in the resultant deformation. We then propose a convex optimisation model that uses a regularisation term of arbitrary order to impose smoothness on these velocity fields and solve this model with a fast algorithm that combines Nesterov gradient descent and the alternating direction method of multipliers (ADMM). Finally, we leverage the computational power of GPU to implement this accelerated ADMM solver on a 3D cardiac MRI dataset, further reducing runtime to less than 2 seconds. In addition to producing strictly diffeomorphic deformations, our methods outperform both state-of-the-art deep learning-based and iterative DiffIR approaches in terms of dice and Hausdorff scores, with speed approaching the inference time of deep learning-based methods., Comment: Accepted to MICCAI 2021

Published
2021

7. Efficacy of decentralised home-based antihypertensive treatment in older adults with multimorbidity and polypharmacy (ATEMPT): an open-label randomised controlled pilot trial

Author

Majert, Jeannette, Nazarzadeh, Milad, Ramakrishnan, Rema, Bidel, Zeinab, Hedgecott, Deborah, Perez-Crespillo, Abel, Turpie, Wendy, Akhtar, Naseem, Allison, Moira, Rao, Shishir, Gudgin, Bernard, McAuley, Melanie, A'Court, Christine, Billot, Laurent, Kotecha, Dipak, Potter, John, and Rahimi, Kazem

Published
2024
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10. Development of automated neural network prediction for echocardiographic left ventricular ejection fraction

Author

Zhang, Yuting, primary, Liu, Boyang, additional, Bunting, Karina V., additional, Brind, David, additional, Thorley, Alexander, additional, Karwath, Andreas, additional, Lu, Wenqi, additional, Zhou, Diwei, additional, Wang, Xiaoxia, additional, Mobley, Alastair R., additional, Tica, Otilia, additional, Gkoutos, Georgios V., additional, Kotecha, Dipak, additional, and Duan, Jinming, additional

Published
2024
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11. CODE-EHR best-practice framework for the use of structured electronic health-care records in clinical research

Author

Kotecha, Dipak, Asselbergs, Folkert W, Achenbach, Stephan, Anker, Stefan D, Atar, Dan, Baigent, Colin, Banerjee, Amitava, Beger, Birgit, Brobert, Gunnar, Casadei, Barbara, Ceccarelli, Cinzia, Cowie, Martin R, Crea, Filippo, Cronin, Maureen, Denaxas, Spiros, Derix, Andrea, Fitzsimons, Donna, Fredriksson, Martin, Gale, Chris P, Gkoutos, Georgios V, Goettsch, Wim, Hemingway, Harry, Ingvar, Martin, Jonas, Adrian, Kazmierski, Robert, Løgstrup, Susanne, Lumbers, R Thomas, Lüscher, Thomas F, McGreavy, Paul, Piña, Ileana L, Roessig, Lothar, Steinbeisser, Carl, Sundgren, Mats, Tyl, Benoît, Thiel, Ghislaine van, Bochove, Kees van, Vardas, Panos E, Villanueva, Tiago, Vrana, Marilena, Weber, Wim, Weidinger, Franz, Windecker, Stephan, Wood, Angela, and Grobbee, Diederick E

Published
2022
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13. Design and deployment of the STEEER-AF trial to evaluate and improve guideline adherence: a cluster-randomized trial by the European Society of Cardiology and European Heart Rhythm Association.

Author

Sterliński, Maciej, Bunting, Karina V, Boriani, Giuseppe, Boveda, Serge, Guasch, Eduard, Mont, Lluís, Rajappan, Kim, Sommer, Philipp, Mehta, Samir, Sun, Yongzhong, Gale, Chris P, Deutekom, Colinda van, Gelder, Isabelle C Van, Kotecha, Dipak, and Team, STEEER-AF Trial

Abstract

Aims The aim is to describe the rationale, design, delivery, and baseline characteristics of the Stroke prevention and rhythm control Treatment: Evaluation of an Educational programme of the European society of cardiology in a cluster-Randomized trial in patients with Atrial Fibrillation (STEEER-AF) trial. Methods and results STEEER-AF is a pragmatic trial designed to objectively and robustly determine whether guidelines are adhered to in routine practice and evaluate a targeted educational programme for healthcare professionals. Seventy centres were randomized in six countries (France, Germany, Italy, Poland, Spain, and UK; 2022–23). The STEEER-AF centres recruited 1732 patients with a diagnosis of atrial fibrillation (AF), with a mean age of 68.9 years (SD 11.7), CHA2DS2-VASc score of 3.2 (SD 1.8), and 647 (37%) women. Eight hundred and forty-three patients (49%) were in AF at enrolment and 760 (44%) in sinus rhythm. Oral anticoagulant therapy was prescribed in 1543 patients (89%), with the majority receiving direct oral anticoagulants (1378; 89%). Previous cardioversion, antiarrhythmic drug therapy, or ablation was recorded in 836 patients (48.3%). Five hundred fifty-one patients (31.8%) were currently receiving an antiarrhythmic drug, and 446 (25.8%) were scheduled to receive a future cardioversion or ablation. The educational programme engaged 195 healthcare professionals across centres randomized to the intervention group, consisting of bespoke interactive online learning and reinforcement activities, supported by national expert trainers. Conclusion The STEEER-AF trial was successfully deployed across six European countries to investigate guideline adherence in real-world practice and evaluate if a structured educational programme for healthcare professionals can improve patient-level care. Clinical Trial Registration Clinicaltrials.gov , NCT04396418. [ABSTRACT FROM AUTHOR]

Published
2024
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14. Longer and better lives for patients with atrial fibrillation: the 9th AFNET/EHRA consensus conference

Author

Linz, Dominik, primary, Andrade, Jason G, additional, Arbelo, Elena, additional, Boriani, Giuseppe, additional, Breithardt, Guenter, additional, Camm, A John, additional, Caso, Valeria, additional, Nielsen, Jens Cosedis, additional, De Melis, Mirko, additional, De Potter, Tom, additional, Dichtl, Wolfgang, additional, Diederichsen, Søren Zoega, additional, Dobrev, Dobromir, additional, Doll, Nicolas, additional, Duncker, David, additional, Dworatzek, Elke, additional, Eckardt, Lars, additional, Eisert, Christoph, additional, Fabritz, Larissa, additional, Farkowski, Michal, additional, Filgueiras-Rama, David, additional, Goette, Andreas, additional, Guasch, Eduard, additional, Hack, Guido, additional, Hatem, Stéphane, additional, Haeusler, Karl Georg, additional, Healey, Jeff S, additional, Heidbuechel, Hein, additional, Hijazi, Ziad, additional, Hofmeister, Lucas H, additional, Hove-Madsen, Leif, additional, Huebner, Thomas, additional, Kääb, Stefan, additional, Kotecha, Dipak, additional, Malaczynska-Rajpold, Katarzyna, additional, Merino, José Luis, additional, Metzner, Andreas, additional, Mont, Lluís, additional, Ng, Ghulam Andre, additional, Oeff, Michael, additional, Parwani, Abdul Shokor, additional, Puererfellner, Helmut, additional, Ravens, Ursula, additional, Rienstra, Michiel, additional, Sanders, Prashanthan, additional, Scherr, Daniel, additional, Schnabel, Renate, additional, Schotten, Ulrich, additional, Sohns, Christian, additional, Steinbeck, Gerhard, additional, Steven, Daniel, additional, Toennis, Tobias, additional, Tzeis, Stylianos, additional, van Gelder, Isabelle C, additional, van Leerdam, Roderick H, additional, Vernooy, Kevin, additional, Wadhwa, Manish, additional, Wakili, Reza, additional, Willems, Stephan, additional, Witt, Henning, additional, Zeemering, Stef, additional, and Kirchhof, Paulus, additional

Published
2024
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15. Redefining β-blocker response in heart failure patients with sinus rhythm and atrial fibrillation: a machine learning cluster analysis

Author

Karwath, Andreas, Bunting, Karina V, Gill, Simrat K, Tica, Otilia, Pendleton, Samantha, Aziz, Furqan, Barsky, Andrey D, Chernbumroong, Saisakul, Duan, Jinming, Mobley, Alastair R, Cardoso, Victor Roth, Slater, Karin, Williams, John A, Bruce, Emma-Jane, Wang, Xiaoxia, Flather, Marcus D, Coats, Andrew J S, Gkoutos, Georgios V, and Kotecha, Dipak

Published
2021
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17. Consumer wearable devices for evaluation of heart rate control using digoxin versus beta-blockers: the RATE-AF randomized trial

Author

Gill, Simrat K., Barsky, Andrey, Guan, Xin, Bunting, Karina V., Karwath, Andreas, Tica, Otilia, Stanbury, Mary, Haynes, Sandra, Folarin, Amos, Dobson, Richard, Kurps, Julia, Asselbergs, Folkert W., Grobbee, Diederick E., Camm, A. John, Eijkemans, Marinus J. C., Gkoutos, Georgios V., and Kotecha, Dipak

Abstract

Consumer-grade wearable technology has the potential to support clinical research and patient management. Here, we report results from the RATE-AF trial wearables study, which was designed to compare heart rate in older, multimorbid patients with permanent atrial fibrillation and heart failure who were randomized to treatment with either digoxin or beta-blockers. Heart rate (n= 143,379,796) and physical activity (n= 23,704,307) intervals were obtained from 53 participants (mean age 75.6 years (s.d. 8.4), 40% women) using a wrist-worn wearable linked to a smartphone for 20 weeks. Heart rates in participants treated with digoxin versus beta-blockers were not significantly different (regression coefficient 1.22 (95% confidence interval (CI) −2.82 to 5.27; P= 0.55); adjusted 0.66 (95% CI −3.45 to 4.77; P= 0.75)). No difference in heart rate was observed between the two groups of patients after accounting for physical activity (P= 0.74) or patients with high activity levels (≥30,000 steps per week; P= 0.97). Using a convolutional neural network designed to account for missing data, we found that wearable device data could predict New York Heart Association functional class 5 months after baseline assessment similarly to standard clinical measures of electrocardiographic heart rate and 6-minute walk test (F1 score 0.56 (95% CI 0.41 to 0.70) versus 0.55 (95% CI 0.41 to 0.68); P= 0.88 for comparison). The results of this study indicate that digoxin and beta-blockers have equivalent effects on heart rate in atrial fibrillation at rest and on exertion, and suggest that dynamic monitoring of individuals with arrhythmia using wearable technology could be an alternative to in-person assessment. ClinicalTrials.gov identifier: NCT02391337.

Published
2024
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18. Antithrombotic management and outcomes of patients with atrial fibrillation treated with NOACs early at the time of market introduction: Main results from the PREFER in AF Prolongation Registry

Author

Renda, Giulia, Pecen, Ladislav, Patti, Giuseppe, Ricci, Fabrizio, Kotecha, Dipak, Siller-Matula, Jolanta M., Schnabel, Renate B., Wachter, Rolf, Sellal, Jean-Marc, Rohla, Miklos, Lucerna, Markus, Huber, Kurt, Verheugt, Freek W. A., Zamorano, Jose Luis, Brüggenjürgen, Bernd, Darius, Harald, Duytschaever, Mattias, Le Heuzey, Jean-Yves, Schilling, Richard J., Kirchhof, Paulus, and De Caterina, Raffaele

Published
2021
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23. Impact of Renal Impairment on Beta-Blocker Efficacy in Patients With Heart Failure

Author

Kotecha, Dipak, Gill, Simrat K., Flather, Marcus D., Holmes, Jane, Packer, Milton, Rosano, Giuseppe, Böhm, Michael, McMurray, John J.V., Wikstrand, John, Anker, Stefan D., van Veldhuisen, Dirk J., Manzano, Luis, von Lueder, Thomas G., Rigby, Alan S., Andersson, Bert, Kjekshus, John, Wedel, Hans, Ruschitzka, Frank, Cleland, John G.F., Damman, Kevin, Redon, Josep, and Coats, Andrew J.S.

Published
2019
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25. Nesterov Accelerated ADMM for Fast Diffeomorphic Image Registration

Author

Thorley, Alexander, primary, Jia, Xi, additional, Chang, Hyung Jin, additional, Liu, Boyang, additional, Bunting, Karina, additional, Stoll, Victoria, additional, de Marvao, Antonio, additional, O’Regan, Declan P., additional, Gkoutos, Georgios, additional, Kotecha, Dipak, additional, and Duan, Jinming, additional

Published
2021
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26. Evaluation of pulse wave analysis to assess coronary artery disease

Author

Kotecha, Dipak and Kotecha, Dipak

Subjects
616.1
Abstract

Conventional risk factors for cardiovascular disease, such as age, gender, hyperlipidaemia and hypertension are useful clinical markers of coronary artery disease (CAD) in asymptomatic patients or those without a prior history of atherosclerosis. In patients referred for a cardiology opinion, modification of risk factors by lifestyle changes and cardiac medications as well as confounding co-morbidities limit the value of these markers. Patients are often referred for diagnostic coronary angiography to determine the presence and severity of CAD, stratify the risk of future events and determine appropriate management. Despite the use of a variety of tests to best identify those requiring angiography, up to half of all patients referred do not have significant disease. Pulse wave analysis (PWA) is a novel method to derive indices of central (aortic) blood pressure and arterial stiffness. Pressure waveforms are obtained non-invasively from the radial artery using a simple tonometry method and have been shown to correlate with clinical outcomes and cardiovascular events in selected populations. This thesis will explore, for the first time, the clinical potential for PWA as a non-invasive marker of CAD in an unselected contemporary cohort of patients referred for elective coronary angiography. The main hypotheses tested are first that PWA is a suitable tool for clinical use, including those with cardiac and non-cardiac co-morbidities and second that abnormalities of PWA are independent predictors of the presence and severity of CAD. Data have been derived from a prospective, protocol-driven, multi-centre cohort of 550 patients recruited from 2006-8. Results suggest that PWA has a useful clinical role in stratifying the risk of coronary disease. PWA variables were independent of conventional blood pressure measurement and superior to baseline risk factors, biomarkers and other non-invasive tests.

Published
2010
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30. Systematic review of the incidence and clinical risk predictors of atrial fibrillation and permanent pacemaker implantation for bradycardia in Fabry disease

Author

Vijapurapu, Ravi, primary, Roy, Ashwin, additional, Demetriades, Polyvios, additional, Warfield, Adrian, additional, Hughes, Derralynn A, additional, Moon, James, additional, Woolfson, Peter, additional, de Bono, Joseph, additional, Geberhiwot, Tarekegn, additional, Kotecha, Dipak, additional, and Steeds, Richard Paul, additional

Published
2023
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31. Guía ESC 2021 sobre estimulación cardiaca y terapia de resincronización

Author

Glikson, Michael, Nielsen, Jens Cosedis, Kronborg, Mads Brix, Michowitz, Yoav, Auricchio, Angelo, Barbash, Israel Moshe, Barrabés, José A., Boriani, Giuseppe, Braunschweig, Frieder, Brignole, Michele, Burri, Haran, Coats, Andrew J.S., Deharo, Jean-Claude, Delgado, Victoria, Diller, Gerhard-Paul, Israel, Carsten W., Keren, Andre, Knops, Reinoud E., Kotecha, Dipak, Leclercq, Christophe, Merkely, Bela, Starck, Christoph, Thylén, Ingela, and Tolosana, José María

Published
2022
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34. ANTIHYPERTENSIVE TREATMENT EVALUATION IN A MULTIMORBIDITY AND POLYPHARMACY TRIAL (ATEMPT): A RANDOMISED CONTROLLED TRIAL

Author

Rahimi, Kazem, primary, Majert, Jeannette, additional, Nazarzadeh, Milad, additional, Ramakrishnan, Rema, additional, Bidel, Zeinab, additional, Hedgecott, Debbie, additional, Perez-Crespillo, Abel, additional, Turpie, Wendy, additional, Akhtar, Naseem, additional, Allison, Moira, additional, Court, Christine A., additional, Billot, Laurent, additional, Kotecha, Dipak, additional, and Potter, John, additional

Published
2023
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39. Systematic approach to outcome assessment from coded electronic healthcare records in the DaRe2THINK NHS-embedded randomized trial

Author

Wang, Xiaoxia, Mobley, Alastair R, Tica, Otilia, Okoth, Kelvin, Ghosh, Rebecca E, Myles, Puja, Williams, Tim, Haynes, Sandra, Nirantharakumar, Krishnarajah, Shukla, David, Kotecha, Dipak, Beatty, Susan, Mehta, Samir, Breeze, Sophie, Lancaster, Karen, Fordyce, Stuart, Allen, Naomi, Calvert, Melanie, Denniston, Alastair, Gkoutos, George, Jayawardana, Sahan, Ball, Simon, Baigent, Colin, Brocklehurst, Peter, Lester, Will, McManus, Richard, Seri, Stefano, Valentine, Janet, Camm, A John, Moore, Dame Julie, Rogers, Amy, Stanbury, Mary, Flather, Marcus, Walker, Suzy, and Wang, Duolao

Abstract

Aims Improving the efficiency of clinical trials is key to their continued importance in directing evidence-based patient care. Digital innovations, in particular the use of electronic healthcare records (EHRs), allow for large-scale screening and follow up of participants. However, it is critical these developments are accompanied by robust and transparent methods that can support high-quality and high clinical value research. Methods and results The DaRe2THINK trial includes a series of novel processes, including nationwide pseudonymized pre screening of the primary-care EHR across England, digital enrolment, remote e-consent, and ‘no-visit’ follow up by linking all primary- and secondary-care health data with patient-reported outcomes. DaRe2THINK is a pragmatic, healthcare-embedded randomized trial testing whether earlier use of direct oral anticoagulants in patients with prior or current atrial fibrillation can prevent thromboembolic events and cognitive decline (www.birmingham.ac.uk/dare2think). This study outlines the systematic approach and methodology employed to define patient information and outcome events. This includes transparency on all medical code lists and phenotypes used in the trial across a variety of national data sources, including Clinical Practice Research Datalink Aurum (primary care), Hospital Episode Statistics (secondary care), and the Office for National Statistics (mortality). Conclusion Co-designed by a patient and public involvement team, DaRe2THINK presents an opportunity to transform the approach to randomized trials in the setting of routine healthcare, providing high-quality evidence generation in populations representative of the community at risk.

Published
2022

42. Blood pressure-lowering treatment for the prevention of cardiovascular events in patients with atrial fibrillation: An individual participant data meta-analysis

Author

Pinho-Gomes, Ana-Catarina, Azevedo, Luis, Copland, Emma, Canoy, Dexter, Nazarzadeh, Milad, Ramakrishnan, Rema, Berge, Eivind, Sundström, Johan, Kotecha, Dipak, Woodward, Mark, Teo, Koon, Davis, Barry R., Chalmers, John, Pepine, Carl J., and Rahimi, Kazem

Subjects
Stroke (Disease) -- Risk factors -- Prevention, Atrial fibrillation -- Complications and side effects, Antihypertensive drugs -- Usage, Heart failure -- Risk factors -- Prevention, Biological sciences
Abstract

Background Randomised evidence on the efficacy of blood pressure (BP)-lowering treatment to reduce cardiovascular risk in patients with atrial fibrillation (AF) is limited. Therefore, this study aimed to compare the effects of BP-lowering drugs in patients with and without AF at baseline. Methods and findings The study was based on the resource provided by the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC), in which individual participant data (IPD) were extracted from trials with over 1,000 patient-years of follow-up in each arm, and that had randomly assigned patients to different classes of BP-lowering drugs, BP-lowering drugs versus placebo, or more versus less intensive BP-lowering regimens. For this study, only trials that had collected information on AF status at baseline were included. The effects of BP-lowering treatment on a composite endpoint of major cardiovascular events (stroke, ischaemic heart disease or heart failure) according to AF status at baseline were estimated using fixed-effect one-stage IPD meta-analyses based on Cox proportional hazards models stratified by trial. Furthermore, to assess whether the associations between the intensity of BP reduction and cardiovascular outcomes are similar in those with and without AF at baseline, we used a meta-regression. From the full BPLTTC database, 28 trials (145,653 participants) were excluded because AF status at baseline was uncertain or unavailable. A total of 22 trials were included with 188,570 patients, of whom 13,266 (7%) had AF at baseline. Risk of bias assessment showed that 20 trials were at low risk of bias and 2 trials at moderate risk. Meta-regression showed that relative risk reductions were proportional to trial-level intensity of BP lowering in patients with and without AF at baseline. Over 4.5 years of median follow-up, a 5-mm Hg systolic BP (SBP) reduction lowered the risk of major cardiovascular events both in patients with AF (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.83 to 1.00) and in patients without AF at baseline (HR 0.91, 95% CI 0.88 to 0.93), with no difference between subgroups. There was no evidence for heterogeneity of treatment effects by baseline SBP or drug class in patients with AF at baseline. The findings of this study need to be interpreted in light of its potential limitations, such as the limited number of trials, limitation in ascertaining AF cases due to the nature of the arrhythmia and measuring BP in patients with AF. Conclusions In this meta-analysis, we found that BP-lowering treatment reduces the risk of major cardiovascular events similarly in individuals with and without AF. Pharmacological BP lowering for prevention of cardiovascular events should be recommended in patients with AF., Author(s): Ana-Catarina Pinho-Gomes 1, Luis Azevedo 2, Emma Copland 3, Dexter Canoy 3,4, Milad Nazarzadeh 3, Rema Ramakrishnan 3, Eivind Berge 5,6, Johan Sundström 7, Dipak Kotecha 8, Mark Woodward [...]

Published
2021
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43. Real world evidence: Perspectives from a European Society of Cardiology Cardiovascular Round Table with contribution from the European Medicines Agency

Author

Szymański, Piotr, primary, Weidinger, Franz, additional, Lordereau-Richard, Isabelle, additional, Himmelmann, Anders, additional, Arca, Marcello, additional, Chaves, Jose, additional, Lee, Charles, additional, Jonker, Carla, additional, Kotecha, Dipak, additional, O'Kelly, James, additional, Plueschke, Kelly, additional, Ryś, Andrzej, additional, Segec, Andrej, additional, Wallentin, Lars, additional, Veltrop, Rogier, additional, and James, Stefan, additional

Published
2023
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49. Contributors

Author

Abdel-Wahab, Omar, primary, Abrahm, Janet L., additional, Adams, Sharon, additional, Adewoye, Adeboye H., additional, Allen, Carl, additional, Ambinder, Richard F., additional, Anasetti, Claudio, additional, Anastasi, John, additional, Anderson, Julia A., additional, Antin, Joseph H., additional, Antony, Aśok C., additional, Araten, David J., additional, Armand, Philippe, additional, Armstrong, Gillian, additional, Armstrong, Scott A., additional, Arnold, Donald M., additional, Artz, Andrew S., additional, Awan, Farrukh T., additional, Baglin, Trevor P., additional, Benson, Don M., additional, Benz, Edward J., additional, Berliner, Nancy, additional, Bhagat, Govind, additional, Bhardwaj, Nina, additional, Bhatia, Ravi, additional, Bhatia, Smita, additional, Bhatt, Mihir D., additional, Bhatt, Vijaya Raj, additional, Bitan, Menachem, additional, Blinderman, Craig D., additional, Bollard, Catherine M., additional, Braun, Benjamin S., additional, Brenner, Malcolm K., additional, Brittenham, Gary M., additional, Brodsky, Robert A., additional, Brown, Myles, additional, Broxmeyer, Hal E., additional, Brummel-Ziedins, Kathleen, additional, Brunner, Andrew M., additional, Buadi, Francis K., additional, Burkhardt, Birgit, additional, Burns, Melissa, additional, Byrd, John C., additional, Caimi, Paolo F., additional, Caligiuri, Michael A., additional, Canavan, Michelle, additional, Cantor, Alan B., additional, Carcao, Manuel, additional, Carroll, Michael C., additional, Carty, Shannon A., additional, Castillo, Jorge J., additional, Chan, Anthony K.C., additional, Chapin, John, additional, Chiu, April, additional, Chute, John P., additional, Clark, David B., additional, Coates, Thomas D., additional, Cogle, Christopher R., additional, Connell, Nathan T., additional, Cooke, Elizabeth, additional, Cooley, Sarah, additional, Corradini, Paolo, additional, Creager, Mark A., additional, Creger, Richard J., additional, Cromwell, Caroline, additional, Crowther, Mark A., additional, Cushing, Melissa M., additional, Cutler, Corey, additional, Dang, Chi V., additional, Danial, Nika N., additional, Dave, Sandeep S., additional, DeCaprio, James A., additional, Dinauer, Mary C., additional, Dinner, Shira, additional, Diz-Küçükkaya, Reyhan, additional, Dodd, Roger Y., additional, Donato, Michele L., additional, Dorshkind, Kenneth, additional, Dotti, Gianpietro, additional, Dror, Yigal, additional, Dunleavy, Kieron, additional, Dvorak, Christopher C., additional, Ebert, Benjamin L., additional, Eck, Michael J., additional, Eikelboom, John W., additional, Epperla, Narendranath, additional, Ershler, William B., additional, Evans, William E., additional, Faderl, Stefan, additional, Ferrara, James L.M., additional, Filipovich, Alexandra Hult, additional, Fischer, Martin, additional, Fredenburgh, James C., additional, Friedman, Kenneth D., additional, Fuchs, Ephraim, additional, Fuller, Stephen J., additional, Gailani, David, additional, Galipeau, Jacques, additional, Gallagher, Patrick G., additional, Ganapathi, Karthik A., additional, Gardner, Lawrence B., additional, Gee, Adrian P., additional, Gerson, Stanton L., additional, Gertz, Morie A., additional, Giardina, Patricia J., additional, Gibson, Christopher J., additional, Golan, Karin, additional, Golub, Todd R., additional, Gonzales, Matthew J., additional, Gotlib, Jason, additional, Gottschalk, Stephen, additional, Grant, Marianne A., additional, Graubert, Timothy A., additional, Gregg, Xylina T., additional, Gribben, John G., additional, Gross, Dawn M., additional, Gruber, Tanja A., additional, Guitart, Joan, additional, Gurbuxani, Sandeep, additional, Gur-Cohen, Shiri, additional, Gutierrez, Alejandro, additional, Hamadani, Mehdi, additional, Hari, Parameswaran N., additional, Hartwig, John H., additional, Hayman, Suzanne R., additional, Hayward, Catherine P.M., additional, Hebbel, Robert P., additional, Heslop, Helen E., additional, Hillis, Christopher, additional, Hillyer, Christopher D., additional, Ho, Karin, additional, Hockenbery, David M., additional, Hoffman, Ronald, additional, Hogg, Kerstin E., additional, Holtan, Shernan G., additional, Horny, Hans-Peter, additional, Hsu, Yen-Michael S., additional, Hunter, Zachary R., additional, Huntington, James A., additional, Iancu-Rubin, Camelia, additional, Iqbal, Ali, additional, Isenman, David E., additional, Israels, Sara J., additional, Italiano, Joseph E., additional, Jaffe, Elaine S., additional, Jaffer, Iqbal H., additional, Jagannath, Sundar, additional, Jäger, Ulrich, additional, Jain, Nitin, additional, James, Paula, additional, Jeha, Sima, additional, Jordan, Michael B., additional, Josephson, Cassandra D., additional, Jung, Moonjung, additional, Kager, Leo, additional, Kambayashi, Taku, additional, Kanakry, Jennifer A., additional, Kantarjian, Hagop M., additional, Kaplan, Jason, additional, Karafin, Matthew S., additional, Karsan, Aly, additional, Kaufman, Randal J., additional, Kaufman, Richard M., additional, Keller, Frank G., additional, Kelly, Kara M., additional, Kessler, Craig M., additional, Key, Nigel S., additional, Keyzner, Alla, additional, Khandoga, Alexander G., additional, Khanna-Gupta, Arati, additional, Khatib-Massalha, Eman, additional, Klein, Harvey G., additional, Knoechel, Birgit, additional, Kollet, Orit, additional, Konkle, Barbara A., additional, Kontoyiannis, Dimitrios P., additional, Koreth, John, additional, Koretzky, Gary A., additional, Kotecha, Dipak, additional, Kremyanskaya, Marina, additional, Kumari, Anju, additional, Kuzel, Timothy M., additional, Küppers, Ralf, additional, Lacy, Martha Q., additional, Ladas, Elana, additional, Landier, Wendy, additional, Lapid, Kfir, additional, Lapidot, Tsvee, additional, Larson, Peter J., additional, Levi, Marcel, additional, Lewis, Russell E., additional, Liebman, Howard A., additional, Lillicrap, David, additional, Lim, Wendy, additional, Lin, Judith C., additional, Lindblad, Robert, additional, Lip, Gregory Y.H., additional, Little, Jane A., additional, Lohr, Jens G., additional, López, José A., additional, Luscinskas, Francis W., additional, Maciejewski, Jaroslaw P., additional, Majhail, Navneet S., additional, Manches, Olivier, additional, Mandle, Robert J., additional, Mann, Kenneth G., additional, Manno, Catherine S., additional, Marcogliese, Andrea N., additional, Mariani, Guglielmo, additional, Marincola, Francesco M., additional, Mascarenhas, John, additional, Massberg, Steffen, additional, McEver, Rodger P., additional, McGrath, Emer, additional, McKinney, Matthew S., additional, Mehta, Rohtesh S., additional, Mentzer, William C., additional, Merlini, Giampaolo, additional, Merryman, Reid, additional, Michel, Marc, additional, Migliaccio, Anna Rita, additional, Miller, Jeffrey S., additional, Mims, Martha P., additional, Mondoro, Traci Heath, additional, Moorehead, Paul, additional, Muniz, Luciana R., additional, Munshi, Nikhil C., additional, Najfeld, Vesna, additional, Nayak, Lalitha, additional, Nazy, Ishac, additional, Neff, Anne T., additional, Ness, Paul M., additional, Notarangelo, Luigi D., additional, O'Brien, Sarah H., additional, O'Connor, Owen A., additional, O'Donnell, Martin, additional, Olson, Amanda, additional, Orkin, Stuart H., additional, Pai, Menaka, additional, Pai, Sung-Yun, additional, Paidas, Michael, additional, Panch, Sandhya R., additional, Pande, Reena L., additional, Papayannopoulou, Thalia, additional, Parikh, Rahul, additional, Petersdorf, Effie W., additional, Peterson, Shane E., additional, Pittaluga, Stefania, additional, Ponce, Doris M., additional, Popolo, Laura, additional, Prchal, Josef T., additional, Pui, Ching-Hon, additional, Puigserver, Pere, additional, Rak, Janusz, additional, Ramos, Carlos A., additional, Rand, Jacob H., additional, Rand, Margaret L., additional, Rao, Dinesh S., additional, Ravandi, Farhad, additional, Rawlings, David J., additional, Reddy, Pavan, additional, Reding, Mark T., additional, Reiter, Andreas, additional, Rice, Lawrence, additional, Riese, Matthew J., additional, Ritchey, Arthur Kim, additional, Roberts, David J., additional, Roman, Elizabeth, additional, Rooney, Cliona M., additional, Rosen, Steven T., additional, Rosenthal, David S., additional, Rossmann, Marlies P., additional, Rot, Antal, additional, Rowley, Scott D., additional, Rubnitz, Jeffrey E., additional, Rydz, Natalia, additional, Salama, Mohamed E., additional, Sauk, Steven, additional, Saunthararajah, Yogen, additional, Savage, William, additional, Scadden, David, additional, Schaefer, Kristen G., additional, Schiffman, Fred, additional, Schneidewend, Robert, additional, Schrier, Stanley L., additional, Schuchman, Edward H., additional, Scullion, Bridget Fowler, additional, Selvaggi, Kathy J., additional, Senoo, Keitaro, additional, Shaheen, Montaser, additional, Shaz, Beth H., additional, Shelburne, Samuel A., additional, Shpall, Elizabeth J., additional, Shurin, Susan B., additional, Siegal, Deborah, additional, Silberstein, Leslie E., additional, Silberstein, Lev, additional, Silverstein, Roy L., additional, Sloan, Steven R., additional, Smith, Franklin O., additional, Smith, James W., additional, Smith, Katy, additional, Steensma, David P., additional, Steinberg, Martin H., additional, Stock, Wendy, additional, Storry, Jill R., additional, Stramer, Susan L., additional, Strauss, Ronald G., additional, Stroncek, David F., additional, Taylor, Justin, additional, Thota, Swapna, additional, Treon, Steven P., additional, Tulpule, Anil, additional, Valdes, Roberto Ferro, additional, Valent, Peter, additional, Vedantham, Suresh, additional, Vercellotti, Gregory M., additional, Verneris, Michael R., additional, Vichinsky, Elliott P., additional, von Andrian, Ulrich H., additional, Vose, Julie M., additional, Wagner, Andrew J., additional, Wang, Ena, additional, Wang, Jia-huai, additional, Warkentin, Theodore E., additional, Wasserstein, Melissa P., additional, Webster, Ann, additional, Weisdorf, Daniel J., additional, Weitz, Jeffrey I., additional, Westhoff, Connie M., additional, Wheeler, Allison P., additional, Widick, Page, additional, Wiley, James S., additional, William, Basem M., additional, Williams, David A., additional, Wilson, Wyndham H., additional, Wolfe, Joanne, additional, Wolgast, Lucia R., additional, Wood, Deborah, additional, Wu, Jennifer, additional, Yahalom, Joachim, additional, Yee, Donald L., additional, Younes, Anas, additional, Young, Neal S., additional, and Zeller, Michelle P., additional

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2018
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