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8. Gamification and its Potential for Better Engagement in the Management of Heart Failure or Quality of Care Registries: A Viewpoint.

Author

Shakoor, Abdul, Mohansingh, Chanu, van der Boon, Robert M.A., Brugts, Jasper J., and Schaap, Jeroen

Abstract

Over the past decade, gamification, an umbrella term that refers to tools that engage and motivate participants through the use of game design elements (e.g., challenges and rewards) in a non-gaming context, has emerged as a promising approach in the management of chronic diseases. Specifically, it has been demonstrated to be effective in the education of both patients as well as healthcare professionals on medication adherence, risk reduction, patient self-care, and rehabilitation. There is some evidence suggesting that gamification might have similar benefits for heart failure (HF) patients and their health care professionals. This is of specific interest since HF is a chronic disease associated with a severely compromised long-term prognosis and subsequent high health care resource utilization. However, more robust research is needed to confirm these findings and determine the optimal method, as well as barriers, to the implementation of gamification in the working process of health care professionals or treatment adherence to patients specifically in the setting of HF. This viewpoint explores the literature concerning HF and gamification and aims to identify its various potentials in the management of HF patients. [ABSTRACT FROM AUTHOR]

Published
2025
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9. Safety of the oral factor XIa inhibitor asundexian compared with apixaban in patients with atrial fibrillation (PACIFIC-AF): a multicentre, randomised, double-blind, double-dummy, dose-finding phase 2 study

Author

Auer, Johann, Hubauer, Martin, Pandzic, Sead, Preishuber, Eva, Primus-Grabscheit, Carina, Reitgruber, Dietmar, Schmalzer, Florian, Adlbrecht, Christopher, Schober, Andreas, Hajos, Johannes, Keil, Christoph, Schratter, Alexandra, Frick, Matthias, Benda, Magdalena Anna, Mächler, Maximilian, Mutschlechner, Beatrix, Saely, Christoph, Sprenger, Lukas, Lichtenauer, Michael, Eber, Miriam, Hoppe, Uta, Kolbitsch, Tobias, Jirak, Peter Michael, Mirna, Moritz, Schönbauer, Robert, Bergler-Klein, Jutta, Hengstenberg, Christian, Stojkovic, Stefan, Scherr, Daniel, Manninger-Wünscher, Martin, Rohrer, Ursula, Stühlinger, Markus, Schgoer, Wilfried, Schwarzl, Jana, Pürerfellner, Helmut, Derndorfer, Michael, Ebner, Christian, Eder, Veronika, Kollias, Georgios, Sturmberger, Thomas, Sieghartsleitner, Stefan, Vijgen, Johan, Koopman, Peter, Dujardin, Karl, Anné, Wim, De Ceuninck, Michel, Tavernier, Rene, Duytschaever, Mattias, Knecht, Sébastien, Missault, Luc, Vandekerckhove, Yves, Rossenbacker, Tom, Ector, Bavo, Charlier, Filip, Debruyne, Philippe, Dewilde, Willem, Janssens, Luc, Roosen, John, Vankelecom, Bart, Heidbuchel, Hein, Delesie, Michiel, Vervoort, Gert, Rombouts, Hans, Vanassche, Thomas, Engelen, Matthias, Verhamme, Peter, Willems, Rik, Constance, Christian, Pranno, Nicolas, Cox, Jafna, Bata, Iqbal, Macle, Laurent, Aguilar, Martin, Tourigny, Julia Cadrin, Dubuc, Marc, Dyrda, Katia, Guerra, Peter, Khairy, Paul, Mondésert, Blandine, Rivard, Léna, Roy, Denis, Tadros, Rafik, Talajic, Mario, Thibault, Bernard, Nault, Isabelle, Blier, Louis, Champagne, Jean, Molin, Franck, O'Hara, Gilles, Philippon, François, Plourde, Benoit, Sarrazin, Jean-François, Steinberg, Christian, Coufal, Zdenek, Balazsik, David, Mikulica, Michal, Zapeca, Jakub, Cermak, Ondrej, Drasnar, Tomas, Falc, Matej, Hornof, Josef, Racz, Blazej, Weissova, Danica, Linkova, Hana, Paskova, Eva, Petr, Robert, Sirakova, Andrea, Kettner, Jiri, Benak, Ales, Holek, Martin, Podpera, Ivo, Podperova, Monika, Vancura, Vlastimil, Jandik, Tomas, Smid, Jiri, Dedek, Vratislav, Banik, Jan, Durdil, Vaclav, Hnat, Tomas, Lellouche, Nicolas, Rouffiac, Ségolène, Taldir, Guillaume, Bridonneau, Valentin, Couffon, Philippe, Daudin, Magalie, Hamon, Cécile, Lacaze, Jonathan, Quentin, Anne, Thebault, Christophe, Boiffard, Emmanuel, Billon, Olivier, Miette, Fabien, Pouliquen, Hervé, Turlotte, Guillaume, Gorka, Hervé, Albert, Franck, Bayle, Sandrine, Bensaid, Reda, Dasoveanu, Madalina, Demichili, Thibaud, Dutoiu, Teodora, Khalil, Cliff, Loghin, Caterina, Range, Grégoire, Roussel, Laurent, Socié, Pierre, Thuaire, Christophe, Extramiana, Fabrice, Algalarrondo, Vincent, Boughanmi, Haten, El Mansour, Noreddine, Mohammad, Usman, Sellier, Romain, Elbaz, Meyer, Laperche, Clémence, Maury, Philippe, Kiss, Robert, Borsanyi, Tunde, Gingl, Zoltan, Polgar, Balaza, Benczur, Bela, Bodor, Alexandra, Hepp, Tamas, Malati, Eva, Nagy, Laszlo, Erdei, Norbert, Kapus, Jozsef, Kapus, Katalin, Toth, Brigitta, Matoltsy, Andras, Kiss, Tunde, Merkely, Bela, Herczeg, Szilvia, Kiss, Orsolya, Sallo, Zoltan, Toth, Kalman, Habon, Tamas, Rabai, Miklos, Totsimon, Kinga, Zilahi, Zsolt, Bencze, Gabriella, Santa, Janos, Aradi, Daniel, Kelemen, Barbara, Bolognese, Leonardo, Nesti, Martina, Notarstefano, Pasquale Giovanni, D'Orazio, Simona, Cosmi, Franco, Becattini, Cecilia, Agnelli, Giancarlo, Broccatelli, Belinda, Mosconi, Maria Giulia, Paciaroni, Maurizio, Urbini, Chiara, Parato, Vito Maurizio, Notaristefani, Camilla, Scarano, Michele, Ameri, Pietro, Ghigliotti, Giorgio, Guglielmi, Giulia, Lotti, Roberta, Merlo, Andrea Carlo, Muiesan, Maria Lorenza, Abondio, Andrea, Berasi, Caterina, Mattiuzzo, Elena, Mutti, Claudio, Salvetti, Massimo, Pignatelli, Pasquale, Menichelli, Danilo, Pastori, Daniele, Tamiya, Eiji, Matsumoto, Takahiro, Takabe, Tomosato, Yamamoto, Shoichi, Yamashita, Haruyo, Higashiue, Shinichi, Furuya, Onichi, Hiramatsu, Norihiko, Kasuga, Kensuke, Kojima, Saburo, Komooka, Masatoshi, Kuroyanagi, Satoshi, Matsuura, Makoto, Takemoto, Tetsushi, Yamamoto, Shuji, Saito, Katusmi, Abe, Takuro, Ishida, Issei, Iwanami, Yuji, Kataoka, Shohei, Moriyama, Tetsu, Murohashi, Akira, Sasaki, Akihito, Nakamura, Yuichiro, Ueno, Tetsuya, Shimane, Akira, Hamana, Tomoyo, Ichibori, Hirotoshi, Inoue, Tomohiro, Itoh, Mitsuaki, Iwane, Seigo, Kawai, Hiroya, Kokawa, Tatsuya, Masumoto, Akiko, Matsuo, Koki, Miyata, Taishi, Nakano, Shinsuke, Oishi, Shogo, Onishi, Tetsuari, Sawada, Takahiro, Saito, Takayuki, Shoda, Mitsuhiko, Takahashi, Nobuyuki, Takaya, Tomofumi, Taniguchi, Yasuyo, Tsukamoto, Shota, Tsukishiro, Yasue, Tsukiyama, Yoshiro, Tsunamoto, Hiroshi, Uzu, Kenzo, Yamamoto, Hiroyuki, Yamamoto, Tetsuya, Yokoi, Kiminobu, Yoshida, Chiaki, Watanabe, Nobuhiro, Betsuyaku, Tetsuo, Adachi, Kumiko, Awane, Kouichi, Goto, Daisuke, Sakakibara, Mamoru, Watanabe, Masashi, Ueno, Hideki, Hiroe, Yoshitaka, Matsuo, Koshi, Ayata, Kenji, Fukuda, Ko, Hata, Yoshiki, Hashimoto, Katsushi, Matsumi, Hiroaki, Nikaido, Akira, Okamoto, Shuichi, Sime, Iveta, Stirna, Valters, Reinholde, Ilze, Hansone, Silvija, Kozlovska, Anita, Romanova, Janina, Klincare, Dace, Pontaga, Natalja, Dirmans, Igors, Kalnins, Artis, Upite, Dana, Gersamija, Arcils, Teleznikovs, Arturs, Rozkova, Nadezda, Safro, Jelena, Anguera Camós, Ignasi, Domenico Dallaglio, Paolo, Salguero Bodes, Rafael, Arnbas, Fernando, Borrego, Luis, Marco, Alvaro, Jimenez, Javier Ramos, Gómez-Doblas, Juan José, Pérez Cabeza, Alejandro, Ferreira Gonzålez, Ignacio, Limeres Freire, Javier, Lopez Grau, Merce, Viñolas Prat, Xavier, Moreno Weidmann, Zoraida, Guerra Ramos, Jose Maria, Alonso Martin, Maria Concepcion, Campos Garcia, Bieito, Mogro Carranza, Javier Mauricio, Mendez Zurita, Francisco Javier, Rodriguez Font, Enrique, Gonzales Matos, Carlos Eduardo, García Hernando, Víctor, Lindholm, Carl-Johan, Thulin, Jörgen, Wallén, Håkan, Hagwall, Kristina, Eliasson, Ken, Lundvall, Martin, Olsson, Jens, Kjellman, Björn, Lind, Markus, Johansson, Lars, Svedberg, Niclas, Berglund, Stefan, Söderberg, Julia, Zedigh, Christer, Mooe, Thomas, Axelsson, Mattias, Binsell, Emil, Huber, Daniel, Müller, Christian, Danier, Isabelle, Kühne, Michael, Okamura, Bernhard, Schoepfer, Hadrien, Simmen, Cornelia, Reichlin, Tobias, Chollet, Laurève, Lam, Anna, Wittmer, Severin, Rickli, Hans, Gall, Christian, Hametner, Greta, Intorp, Stephanie, Luescher, Daniel, Haegeli, Laurent, Berg, Jan Christopher, Ebrahimi, Ramin, Auricchio, Angelo, Crljenica, Carmela, Moccetti, Tizziano, Monti, Cristina, Pasotti, Elena, Petrova, Iveta, Rossi, Mariagrazia, Mach, François, Namdar, Mehdi, de Groot, Joris, Proost, Virginnio, Neefs, Joline, Linz, Dominik, van Stipdonk, Twan, den Uijl, Dennis, Alings, Marco, Schaap, Jeroen, Segers, Dolf, Wouters, Noemi, Bartels, Louis, Tieleman, Robert, Pisters, Ron, de Vries, Tim, Selig, Jaap, Kuijper, Aaf, Bot, Pieter, Keijzers, Mitran, Verdel, Gerardus, Tukkie, Raymond, van den Bos, Ewout, Kauer, Floris, Oemrawsingh, Rohit, Stevenhagen, Jeroen, van Es, Jan, Lip, Gregory, Gupta, Dhiraj, Kotalczyk, Agnieszka, Gunstone, Anthony, Brixey, Richard David, Gorog, Diana, Dinarvand, Danial, Gue, Ying, Kanji, Rahim, Memtsas, Vassilios, Senior, Roxy, Bioh, Gabriel, Wong, Yuk-Ki, Child, Nick, Piccini, Jonathan P, Caso, Valeria, Connolly, Stuart J, Fox, Keith A A, Oldgren, Jonas, Jones, W Schuyler, Gorog, Diana A, Durdil, Václav, Viethen, Thomas, Neumann, Christoph, Mundl, Hardi, and Patel, Manesh R

Published
2022
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10. Baseline Tumor Size Is an Independent Prognostic Factor for Overall Survival in Patients with Melanoma Treated with Pembrolizumab

Author

Joseph, Richard W, Elassaiss-Schaap, Jeroen, Kefford, Richard, Hwu, Wen-Jen, Wolchok, Jedd D, Joshua, Anthony M, Ribas, Antoni, Hodi, F Stephen, Hamid, Omid, Robert, Caroline, Daud, Adil, Dronca, Roxana, Hersey, Peter, Weber, Jeffrey S, Patnaik, Amita, de Alwis, Dinesh P, Perrone, Andrea, Zhang, Jin, Kang, S Peter, Ebbinghaus, Scot, Anderson, Keaven M, and Gangadhar, Tara C

Subjects
Cancer, Clinical Research, Oncology and Carcinogenesis, Oncology & Carcinogenesis
Abstract

Purpose: The purpose of this study was to assess the association of baseline tumor size (BTS) with other baseline clinical factors and outcomes in pembrolizumab-treated patients with advanced melanoma in KEYNOTE-001 (NCT01295827).Experimental Design: BTS was quantified by adding the sum of the longest dimensions of all measurable baseline target lesions. BTS as a dichotomous and continuous variable was evaluated with other baseline factors using logistic regression for objective response rate (ORR) and Cox regression for overall survival (OS). Nominal P values with no multiplicity adjustment describe the strength of observed associations.Results: Per central review by RECIST v1.1, 583 of 655 patients had baseline measurable disease and were included in this post hoc analysis. Median BTS was 10.2 cm (range, 1-89.5). Larger median BTS was associated with Eastern Cooperative Oncology Group performance status 1, elevated lactate dehydrogenase (LDH), stage M1c disease, and liver metastases (with or without any other sites; all P ≤ 0.001). In univariate analyses, BTS below the median was associated with higher ORR (44% vs. 23%; P < 0.001) and improved OS (HR, 0.38; P < 0.001). In multivariate analyses, BTS below the median remained an independent prognostic marker of OS (P < 0.001) but not ORR. In 459 patients with available tumor programmed death ligand 1 (PD-L1) expression, BTS below the median and PD-L1-positive tumors were independently associated with higher ORR and longer OS.Conclusions: BTS is associated with many other baseline clinical factors but is also independently prognostic of survival in pembrolizumab-treated patients with advanced melanoma. Clin Cancer Res; 24(20); 4960-7. ©2018 AACR See related commentary by Warner and Postow, p. 4915.

Published
2018

11. Contemporary guideline‐directed medical therapy in de novo, chronic, and worsening heart failure patients: First data from the TITRATE‐HF study

Author

Malgie, Jishnu, primary, Wilde, Mariëlle I., additional, Clephas, Pascal R.D., additional, Emans, Mireille E., additional, Koudstaal, Stefan, additional, Schaap, Jeroen, additional, Mosterd, Arend, additional, van Ramshorst, Jan, additional, Wardeh, Alexander J., additional, van Wijk, Sandra, additional, van den Heuvel, Mieke, additional, Wierda, Eric, additional, Borleffs, C. Jan Willem, additional, Saraber, Colette, additional, Beeres, Saskia L.M.A., additional, van Kimmenade, Roland, additional, Jansen Klomp, Wouter, additional, Denham, Robert, additional, da Fonseca, Carlos A., additional, Klip, IJsbrand T., additional, Manintveld, Olivier C., additional, van der Boon, Robert M.A., additional, van Ofwegen, Clara E.E., additional, Yilmaz, Ayten, additional, Pisters, Ron, additional, Linssen, Gerard C.M., additional, Faber, Nikola, additional, van Heerebeek, Loek, additional, van de Swaluw, Julio E.C., additional, Bouhuijzen, Lex J., additional, Post, Marco C., additional, Kuijper, Aaf F.M., additional, Wu, Ka wai, additional, van Beek, Eugène A., additional, Hesselink, Tim, additional, Kleijn, Lennaert, additional, Kurvers, Maurice J.M., additional, Tio, René A., additional, Langerveld, Jorina, additional, van Dalen, Bas M., additional, van Eck, J.W. Martijn, additional, Handoko, M. Louis, additional, Hermans, Walter R.M., additional, Koornstra‐Wortel, Hetty J.J., additional, Szymanski, Mariusz K., additional, Rooker, Dennis, additional, Tandjung, Kenneth, additional, Eijsbouts, Sabine C.M., additional, Asselbergs, Folkert W., additional, van der Meer, Peter, additional, Brunner‐La Rocca, Hans‐Peter, additional, de Boer, Rudolf A., additional, and Brugts, Jasper J., additional

Published
2024
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14. Efficacy and safety of low‐dose digoxin in patients with heart failure. Rationale and design of the DECISION trial.

Author

van Veldhuisen, Dirk J., Rienstra, Michiel, Mosterd, Arend, Alings, A. Marco, van Asselt, Antoinette D.J., Bouvy, Marcel L, Tijssen, Jan G.P., Schaap, Jeroen, van der Wall, Ernst E., Voors, Adriaan A., Boorsma, Eva M., Lok, Dirk J.A., Crijns, Harry J.G.M., Schut, Astrid, Vijver, Marlene A.T., Voordes, Geert H.D., de Vos, Agaath H., Maas‐Soer, Ester L., Smit, Nicoline W., and Touw, Daan J.

Subjects
VENTRICULAR ejection fraction, DIGOXIN, HEART failure patients, ATRIAL fibrillation, HEART failure
Abstract

Aims: Digoxin is the oldest drug in cardiovascular (CV) medicine, and one trial conducted >25 years ago showed a reduction in heart failure (HF) hospitalizations but no effect on mortality. However, later studies suggested that the dose of digoxin used in that trial (and other studies) may have been too high. The DECISION (Digoxin Evaluation in Chronic heart failure: Investigational Study In Outpatients in the Netherlands) trial will examine the efficacy and safety of low‐dose digoxin in HF patients with reduced or mildly reduced left ventricular ejection fraction (LVEF) with a background of contemporary HF treatment. Methods: The DECISION trial is a randomized, double‐blind, parallel‐group, placebo‐controlled event‐driven outcome trial which will investigate the efficacy and safety of low‐dose digoxin in patients with chronic HF and LVEF <50%. Both patients with sinus rhythm and atrial fibrillation will be enrolled and will be randomized (1:1) to low‐dose digoxin or matching placebo. To maintain a target serum digoxin concentration of 0.5–0.9 ng/ml, dose adjustments are made throughout follow‐up based on serum digoxin measurements with dummy values for the placebo group. The primary endpoint is a composite of CV mortality and total HF hospitalizations or total urgent hospital visits for worsening HF, and all endpoints are adjudicated blindly by a Clinical Event Committee. The estimated sample size was 982 patients who will be followed for a median of 3 years, and in December 2023 enrolment was completed after 1002 patients. Conclusions: The DECISION trial will provide important evidence regarding the effect of (low‐dose) digoxin on CV mortality and total HF hospitalizations and urgent hospital visits when added to contemporary HF treatment of patients with reduced or mildly reduced LVEF. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT03783429. [ABSTRACT FROM AUTHOR]

Published
2024
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16. Contemporary guideline-directed medical therapy in de novo, chronic, and worsening heart failure patients: First data from the TITRATE-HF study

Author

Team Medisch, Circulatory Health, Malgie, Jishnu, Wilde, Mariëlle I, Clephas, Pascal R D, Emans, Mireille E, Koudstaal, Stefan, Schaap, Jeroen, Mosterd, Arend, van Ramshorst, Jan, Wardeh, Alexander J, van Wijk, Sandra, van den Heuvel, Mieke, Wierda, Eric, Borleffs, C Jan Willem, Saraber, Colette, Beeres, Saskia L M A, van Kimmenade, Roland, Jansen Klomp, Wouter, Denham, Robert, da Fonseca, Carlos A, Klip, IJsbrand T, Manintveld, Olivier C, van der Boon, Robert M A, van Ofwegen, Clara E E, Yilmaz, Ayten, Pisters, Ron, Linssen, Gerard C M, Faber, Nikola, van Heerebeek, Loek, van de Swaluw, Julio E C, Bouhuijzen, Lex J, Post, Marco C, Kuijper, Aaf F M, Wu, Ka Wai, van Beek, Eugène A, Hesselink, Tim, Kleijn, Lennaert, Kurvers, Maurice J M, Tio, René A, Langerveld, Jorina, van Dalen, Bas M, van Eck, J W Martijn, Handoko, M Louis, Hermans, Walter R M, Koornstra-Wortel, Hetty J J, Szymanski, Mariusz K, Rooker, Dennis, Tandjung, Kenneth, Eijsbouts, Sabine C M, Asselbergs, Folkert W, van der Meer, Peter, Brunner-La Rocca, Hans-Peter, de Boer, Rudolf A, Brugts, Jasper J, Team Medisch, Circulatory Health, Malgie, Jishnu, Wilde, Mariëlle I, Clephas, Pascal R D, Emans, Mireille E, Koudstaal, Stefan, Schaap, Jeroen, Mosterd, Arend, van Ramshorst, Jan, Wardeh, Alexander J, van Wijk, Sandra, van den Heuvel, Mieke, Wierda, Eric, Borleffs, C Jan Willem, Saraber, Colette, Beeres, Saskia L M A, van Kimmenade, Roland, Jansen Klomp, Wouter, Denham, Robert, da Fonseca, Carlos A, Klip, IJsbrand T, Manintveld, Olivier C, van der Boon, Robert M A, van Ofwegen, Clara E E, Yilmaz, Ayten, Pisters, Ron, Linssen, Gerard C M, Faber, Nikola, van Heerebeek, Loek, van de Swaluw, Julio E C, Bouhuijzen, Lex J, Post, Marco C, Kuijper, Aaf F M, Wu, Ka Wai, van Beek, Eugène A, Hesselink, Tim, Kleijn, Lennaert, Kurvers, Maurice J M, Tio, René A, Langerveld, Jorina, van Dalen, Bas M, van Eck, J W Martijn, Handoko, M Louis, Hermans, Walter R M, Koornstra-Wortel, Hetty J J, Szymanski, Mariusz K, Rooker, Dennis, Tandjung, Kenneth, Eijsbouts, Sabine C M, Asselbergs, Folkert W, van der Meer, Peter, Brunner-La Rocca, Hans-Peter, de Boer, Rudolf A, and Brugts, Jasper J

Published
2024

17. Contemporary guideline-directed medical therapy in de novo, chronic, and worsening heart failure patients:First data from the TITRATE-HF study

Author

Malgie, Jishnu, Wilde, Mariëlle I., Clephas, Pascal R.D., Emans, Mireille E., Koudstaal, Stefan, Schaap, Jeroen, Mosterd, Arend, van Ramshorst, Jan, Wardeh, Alexander J., van Wijk, Sandra, van den Heuvel, Mieke, Wierda, Eric, Borleffs, C. Jan Willem, Saraber, Colette, Beeres, Saskia L.M.A., van Kimmenade, Roland, Jansen Klomp, Wouter, Denham, Robert, da Fonseca, Carlos A., Klip, IJsbrand T., Manintveld, Olivier C., van der Boon, Robert M.A., van Ofwegen, Clara E.E., Yilmaz, Ayten, Pisters, Ron, Linssen, Gerard C.M., Faber, Nikola, van Heerebeek, Loek, van de Swaluw, Julio E.C., Bouhuijzen, Lex J., Post, Marco C., Kuijper, Aaf F.M., Wu, Ka wai, van Beek, Eugène A., Hesselink, Tim, Kleijn, Lennaert, Kurvers, Maurice J.M., Tio, René A., Langerveld, Jorina, van Dalen, Bas M., van Eck, J. W.Martijn, Handoko, M. Louis, Hermans, Walter R.M., Koornstra-Wortel, Hetty J.J., Szymanski, Mariusz K., Rooker, Dennis, Tandjung, Kenneth, Eijsbouts, Sabine C.M., Asselbergs, Folkert W., van der Meer, Peter, Brunner-La Rocca, Hans Peter, de Boer, Rudolf A., Brugts, Jasper J., Malgie, Jishnu, Wilde, Mariëlle I., Clephas, Pascal R.D., Emans, Mireille E., Koudstaal, Stefan, Schaap, Jeroen, Mosterd, Arend, van Ramshorst, Jan, Wardeh, Alexander J., van Wijk, Sandra, van den Heuvel, Mieke, Wierda, Eric, Borleffs, C. Jan Willem, Saraber, Colette, Beeres, Saskia L.M.A., van Kimmenade, Roland, Jansen Klomp, Wouter, Denham, Robert, da Fonseca, Carlos A., Klip, IJsbrand T., Manintveld, Olivier C., van der Boon, Robert M.A., van Ofwegen, Clara E.E., Yilmaz, Ayten, Pisters, Ron, Linssen, Gerard C.M., Faber, Nikola, van Heerebeek, Loek, van de Swaluw, Julio E.C., Bouhuijzen, Lex J., Post, Marco C., Kuijper, Aaf F.M., Wu, Ka wai, van Beek, Eugène A., Hesselink, Tim, Kleijn, Lennaert, Kurvers, Maurice J.M., Tio, René A., Langerveld, Jorina, van Dalen, Bas M., van Eck, J. W.Martijn, Handoko, M. Louis, Hermans, Walter R.M., Koornstra-Wortel, Hetty J.J., Szymanski, Mariusz K., Rooker, Dennis, Tandjung, Kenneth, Eijsbouts, Sabine C.M., Asselbergs, Folkert W., van der Meer, Peter, Brunner-La Rocca, Hans Peter, de Boer, Rudolf A., and Brugts, Jasper J.

Abstract

Aims: Despite clear guideline recommendations for initiating four drug classes in all patients with heart failure (HF) with reduced ejection fraction (HFrEF) and the availability of rapid titration schemes, information on real-world implementation lags behind. Closely following the 2021 ESC HF guidelines and 2023 focused update, the TITRATE-HF study started to prospectively investigate the use, sequencing, and titration of guideline-directed medical therapy (GDMT) in HF patients, including the identification of implementation barriers. Methods and results: TITRATE-HF is an ongoing long-term HF registry conducted in the Netherlands. Overall, 4288 patients from 48 hospitals were included. Among these patients, 1732 presented with de novo, 2240 with chronic, and 316 with worsening HF. The median age was 71 years (interquartile range [IQR] 63–78), 29% were female, and median ejection fraction was 35% (IQR 25–40). In total, 44% of chronic and worsening HFrEF patients were prescribed quadruple therapy. However, only 1% of HFrEF patients achieved target dose for all drug classes. In addition, quadruple therapy was more often prescribed to patients treated in a dedicated HF outpatient clinic as compared to a general cardiology outpatient clinic. In each GDMT drug class, 19% to 36% of non-use in HFrEF patients was related to side-effects, intolerances, or contraindications. In the de novo HF cohort, 49% of patients already used one or more GDMT drug classes for other indications than HF. Conclusion: This first analysis of the TITRATE-HF study reports relatively high use of GDMT in a contemporary HF cohort, while still showing room for improvement regarding quadruple therapy. Importantly, the use and dose of GDMT were suboptimal, with the reasons often remaining unclear. This underscores the urgency for further optimization of GDMT and implementation strategies within HF management.

Published
2024

18. RELEASE-HF study:a protocol for an observational, registry-based study on the effectiveness of telemedicine in heart failure in the Netherlands

Author

van Eijk, Jorna, Luijken, Kim, Jaarsma, Tiny, Reitsma, Johannes B., Schuit, Ewoud, Frederix, Geert W.J., Derks, Lineke, Schaap, Jeroen, Rutten, Frans H., Brugts, Jasper, de Boer, Rudolf A., Asselbergs, Folkert W., Trappenburg, Jaap C.A., van Eijk, Jorna, Luijken, Kim, Jaarsma, Tiny, Reitsma, Johannes B., Schuit, Ewoud, Frederix, Geert W.J., Derks, Lineke, Schaap, Jeroen, Rutten, Frans H., Brugts, Jasper, de Boer, Rudolf A., Asselbergs, Folkert W., and Trappenburg, Jaap C.A.

Abstract

Introduction:Meta-analyses show postive effects of telemedicine in heart failure (HF) management on hospitalisation, mortality and costs. However, these effects are heterogeneous due to variation in the included HF population, the telemedicine components and the quality of the comparator usual care. Still, telemedicine is gaining acceptance in HF management. The current nationwide study aims to identify (1) in which subgroup(s) of patients with HF telemedicine is (cost-)effective and (2) which components of telemedicine are most (cost-) effective. Methods and analysis:The RELEASE-HF ('REsponsible roLl-out of E-heAlth through Systematic Evaluation -Heart Failure') study is a multicentre, observational, registry-based cohort study that plans to enrol 6480 patients with HF using data from the HF registry facilitated by the Netherlands Heart Registration. Collected data include patient characteristics, treatment information and clinical outcomes, and are measured at HF diagnosis and at 6 and 12 months afterwards. The components of telemedicine are described at the hospital level based on closed-ended interviews with clinicians and at the patient level based on additional data extracted from electronic health records and telemedicine-generated data. The costs of telemedicine are calculated using registration data and interviews with clinicians and finance department staff. To overcome missing data, additional national databases will be linked to the HF registry if feasible. Heterogeneity of the effects of offering telemedicine compared with not offering on days alive without unplanned hospitalisations in 1 year is assessed across predefined patient characteristics using exploratory stratified analyses. The effects of telemedicine components are assessed by fitting separate models for component contrasts. Ethics and dissemination:The study has been approved by the Medical Ethics Committee 2021 of the University Me

Published
2024

19. Guideline implementation, drug sequencing, and quality of care in heart failure:design and rationale of TITRATE-HF

Author

Clephas, Pascal R.D., Malgie, Jishnu, Schaap, Jeroen, Koudstaal, Stefan, Emans, Mireille, Linssen, Gerard C.M., de Boer, Grytsje A., van Heerebeek, Loek, Borleffs, C. Jan Willem, Manintveld, Olivier C., van Empel, Vanessa, van Wijk, Sandra, van den Heuvel, Mieke, da Fonseca, Carlos, Damman, Kevin, van Ramshorst, Jan, van Kimmenade, Roland, van de Ven, Arjen R.T., Tio, René A., van Veghel, Dennis, Asselbergs, Folkert W., de Boer, Rudolf A., van der Meer, Peter, Greene, Stephen J., Brunner-La Rocca, Hans Peter, Brugts, Jasper J., Clephas, Pascal R.D., Malgie, Jishnu, Schaap, Jeroen, Koudstaal, Stefan, Emans, Mireille, Linssen, Gerard C.M., de Boer, Grytsje A., van Heerebeek, Loek, Borleffs, C. Jan Willem, Manintveld, Olivier C., van Empel, Vanessa, van Wijk, Sandra, van den Heuvel, Mieke, da Fonseca, Carlos, Damman, Kevin, van Ramshorst, Jan, van Kimmenade, Roland, van de Ven, Arjen R.T., Tio, René A., van Veghel, Dennis, Asselbergs, Folkert W., de Boer, Rudolf A., van der Meer, Peter, Greene, Stephen J., Brunner-La Rocca, Hans Peter, and Brugts, Jasper J.

Abstract

Aims: Current heart failure (HF) guidelines recommend to prescribe four drug classes in patients with HF with reduced ejection fraction (HFrEF). A clear challenge exists to adequately implement guideline-directed medical therapy (GDMT) regarding the sequencing of drugs and timely reaching target dose. It is largely unknown how the paradigm shift from a serial and sequential approach for drug therapy to early parallel application of the four drug classes will be executed in daily clinical practice, as well as the reason clinicians may not adhere to new guidelines. We present the design and rationale for the real-world TITRATE-HF study, which aims to assess sequencing strategies for GDMT initiation, dose titration patterns (order and speed), intolerance for GDMT, barriers for implementation, and long-term outcomes in patients with de novo, chronic, and worsening HF. Methods and results: A total of 4000 patients with HFrEF, HF with mildly reduced ejection fraction, and HF with improved ejection fraction will be enrolled in >40 Dutch centres with a follow-up of at least 3 years. Data collection will include demographics, physical examination and vital parameters, electrocardiogram, laboratory measurements, echocardiogram, medication, and quality of life. Detailed information on titration steps will be collected for the four GDMT drug classes. Information will include date, primary reason for change, and potential intolerances. The primary clinical endpoints are HF-related hospitalizations, HF-related urgent visits with a need for intravenous diuretics, all-cause mortality, and cardiovascular mortality. Conclusions: TITRATE-HF is a real-world multicentre longitudinal registry that will provide unique information on contemporary GDMT implementation, sequencing strategies (order and speed), and prognosis in de novo, worsening, and chronic HF patients.

Published
2024

20. Embedding routine health care data in clinical trials:with great power comes great responsibility

Author

Handoko, M. Louis, de Man, Frances S., Brugts, Jasper J., van der Meer, Peter, Rhodius-Meester, Hanneke F.M., Schaap, Jeroen, van de Kamp, H. J.Rik, Houterman, Saskia, van Veghel, Dennis, Uijl, Alicia, Asselbergs, Folkert W., Handoko, M. Louis, de Man, Frances S., Brugts, Jasper J., van der Meer, Peter, Rhodius-Meester, Hanneke F.M., Schaap, Jeroen, van de Kamp, H. J.Rik, Houterman, Saskia, van Veghel, Dennis, Uijl, Alicia, and Asselbergs, Folkert W.

Abstract

Randomised clinical trials (RCTs) are vital for medical progress. Unfortunately, ‘traditional’ RCTs are expensive and inherently slow. Moreover, their generalisability has been questioned. There is considerable overlap in routine health care data (RHCD) and trial-specific data. Therefore, integration of RHCD in an RCT has great potential, as it would reduce the effort and costs required to collect data, thereby overcoming some of the major downsides of a traditional RCT. However, use of RHCD comes with other challenges, such as privacy issues, as well as technical and practical barriers. Here, we give a current overview of related initiatives on national cardiovascular registries (Netherlands Heart Registration, Heart4Data), showcasing the interrelationships between and the relevance of the different registries for the practicing physician. We then discuss the benefits and limitations of RHCD use in the setting of a pragmatic RCT from a cardiovascular perspective, illustrated by a case study in heart failure.

Published
2024

21. The different risk of new-onset, chronic, worsening, and advanced heart failure:A systematic review and meta-regression analysis

Author

Shakoor, Abdul, Abou Kamar, Sabrina, Malgie, Jishnu, Kardys, Isabella, Schaap, Jeroen, de Boer, Rudolf A., van Mieghem, Nicolas M., van der Boon, Robert M.A., Brugts, Jasper J., Shakoor, Abdul, Abou Kamar, Sabrina, Malgie, Jishnu, Kardys, Isabella, Schaap, Jeroen, de Boer, Rudolf A., van Mieghem, Nicolas M., van der Boon, Robert M.A., and Brugts, Jasper J.

Abstract

Aims: Heart failure (HF) is a chronic and progressive syndrome associated with a poor prognosis. While it may seem intuitive that the risk of adverse outcomes varies across the different stages of HF, an overview of these risks is lacking. This study aims to determine the risk of all-cause mortality and HF hospitalizations associated with new-onset HF, chronic HF (CHF), worsening HF (WHF), and advanced HF. Methods and results: We performed a systematic review of observational studies from 2012 to 2022 using five different databases. The primary outcomes were 30-day and 1-year all-cause mortality, as well as 1-year HF hospitalization. Studies were pooled using random effects meta-analysis, and mixed-effects meta-regression was used to compare the different HF groups. Among the 15 759 studies screened, 66 were included representing 862 046 HF patients. Pooled 30-day mortality rates did not reveal a significant distinction between hospital-admitted patients, with rates of 10.13% for new-onset HF and 8.11% for WHF (p = 0.10). However, the 1-year mortality risk differed and increased stepwise from CHF to advanced HF, with a rate of 8.47% (95% confidence interval [CI] 7.24–9.89) for CHF, 21.15% (95% CI 17.78–24.95) for new-onset HF, 26.84% (95% CI 23.74–30.19) for WHF, and 29.74% (95% CI 24.15–36.10) for advanced HF. Readmission rates for HF at 1 year followed a similar trend. Conclusions: Our meta-analysis of observational studies confirms the different risk for adverse outcomes across the distinct HF stages. Moreover, it emphasizes the negative prognostic value of WHF as the first progressive stage from CHF towards advanced HF.

Published
2024

22. Embedding routine health care data in clinical trials: with great power comes great responsibility

Author

Cardiometabolic Health, Handoko, M Louis, de Man, Frances S, Brugts, Jasper J, van der Meer, Peter, Rhodius-Meester, Hanneke F M, Schaap, Jeroen, van de Kamp, H J Rik, Houterman, Saskia, van Veghel, Dennis, Uijl, Alicia, Asselbergs, Folkert W, Cardiometabolic Health, Handoko, M Louis, de Man, Frances S, Brugts, Jasper J, van der Meer, Peter, Rhodius-Meester, Hanneke F M, Schaap, Jeroen, van de Kamp, H J Rik, Houterman, Saskia, van Veghel, Dennis, Uijl, Alicia, and Asselbergs, Folkert W

Published
2024

24. 1-Year Outcomes of Delayed Versus Immediate Intervention in Patients With Transient ST-Segment Elevation Myocardial Infarction

Author

Janssens, Gladys N., van der Hoeven, Nina W., Lemkes, Jorrit S., Everaars, Henk, van de Ven, Peter M., Marques, Koen M.J., Nap, Alexander, van Leeuwen, Maarten A.H., Appelman, Yolande, Knaapen, Paul, Verouden, Niels J.W., Allaart, Cornelis P., Brinckman, Stijn L., Saraber, Colette E., Plomp, Koos J., Timmer, Jorik R., Kedhi, Elvin, Hermanides, Renicus S., Meuwissen, Martijn, Schaap, Jeroen, van der Weerdt, Arno P., van Rossum, Albert C., Nijveldt, Robin, and van Royen, Niels

Published
2019
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25. RELEASE-HF study: a protocol for an observational, registry-based study on the effectiveness of telemedicine in heart failure in the Netherlands

Author

van Eijk, Jorna, primary, Luijken, Kim, additional, Jaarsma, Tiny, additional, Reitsma, Johannes B, additional, Schuit, Ewoud, additional, Frederix, Geert W J, additional, Derks, Lineke, additional, Schaap, Jeroen, additional, Rutten, Frans H, additional, Brugts, Jasper, additional, de Boer, Rudolf A, additional, Asselbergs, Folkert W, additional, and Trappenburg, Jaap C A, additional

Published
2024
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26. Guideline implementation, drug sequencing, and quality of care in heart failure: design and rationale of TITRATE‐HF

Author

Clephas, Pascal R. D., primary, Malgie, Jishnu, additional, Schaap, Jeroen, additional, Koudstaal, Stefan, additional, Emans, Mireille, additional, Linssen, Gerard C. M., additional, de Boer, Grytsje A., additional, van Heerebeek, Loek, additional, Borleffs, C. Jan Willem, additional, Manintveld, Olivier C., additional, van Empel, Vanessa, additional, van Wijk, Sandra, additional, van den Heuvel, Mieke, additional, da Fonseca, Carlos, additional, Damman, Kevin, additional, van Ramshorst, Jan, additional, van Kimmenade, Roland, additional, van de Ven, Arjen R. T., additional, Tio, René A., additional, van Veghel, Dennis, additional, Asselbergs, Folkert W., additional, de Boer, Rudolf A., additional, van der Meer, Peter, additional, Greene, Stephen J., additional, Brunner‐La Rocca, Hans‐Peter, additional, and Brugts, Jasper J., additional

Published
2023
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27. Safety and tumor responses with lambrolizumab (anti-PD-1) in melanoma.

Author

Hamid, Omid, Robert, Caroline, Daud, Adil, Hodi, F Stephen, Hwu, Wen-Jen, Kefford, Richard, Wolchok, Jedd D, Hersey, Peter, Joseph, Richard W, Weber, Jeffrey S, Dronca, Roxana, Gangadhar, Tara C, Patnaik, Amita, Zarour, Hassane, Joshua, Anthony M, Gergich, Kevin, Elassaiss-Schaap, Jeroen, Algazi, Alain, Mateus, Christine, Boasberg, Peter, Tumeh, Paul C, Chmielowski, Bartosz, Ebbinghaus, Scot W, Li, Xiaoyun Nicole, Kang, S Peter, and Ribas, Antoni

Subjects
Humans, Melanoma, Brain Neoplasms, Skin Neoplasms, Antineoplastic Agents, Antibodies, Monoclonal, Drug Administration Schedule, Dose-Response Relationship, Drug, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Antibodies, Monoclonal, Humanized, Programmed Cell Death 1 Receptor, Human Genome, Genetics, Clinical Research, Patient Safety, Clinical Trials and Supportive Activities, Cancer, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundThe programmed death 1 (PD-1) receptor is a negative regulator of T-cell effector mechanisms that limits immune responses against cancer. We tested the anti-PD-1 antibody lambrolizumab (previously known as MK-3475) in patients with advanced melanoma.MethodsWe administered lambrolizumab intravenously at a dose of 10 mg per kilogram of body weight every 2 or 3 weeks or 2 mg per kilogram every 3 weeks in patients with advanced melanoma, both those who had received prior treatment with the immune checkpoint inhibitor ipilimumab and those who had not. Tumor responses were assessed every 12 weeks.ResultsA total of 135 patients with advanced melanoma were treated. Common adverse events attributed to treatment were fatigue, rash, pruritus, and diarrhea; most of the adverse events were low grade. The confirmed response rate across all dose cohorts, evaluated by central radiologic review according to the Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1, was 38% (95% confidence interval [CI], 25 to 44), with the highest confirmed response rate observed in the cohort that received 10 mg per kilogram every 2 weeks (52%; 95% CI, 38 to 66). The response rate did not differ significantly between patients who had received prior ipilimumab treatment and those who had not (confirmed response rate, 38% [95% CI, 23 to 55] and 37% [95% CI, 26 to 49], respectively). Responses were durable in the majority of patients (median follow-up, 11 months among patients who had a response); 81% of the patients who had a response (42 of 52) were still receiving treatment at the time of analysis in March 2013. The overall median progression-free survival among the 135 patients was longer than 7 months.ConclusionsIn patients with advanced melanoma, including those who had had disease progression while they had been receiving ipilimumab, treatment with lambrolizumab resulted in a high rate of sustained tumor regression, with mainly grade 1 or 2 toxic effects. (Funded by Merck Sharp and Dohme; ClinicalTrials.gov number, NCT01295827.).

Published
2013

31. The different risk of new‐onset, chronic, worsening, and advanced heart failure: A systematic review and meta‐regression analysis.

Author

Shakoor, Abdul, Abou Kamar, Sabrina, Malgie, Jishnu, Kardys, Isabella, Schaap, Jeroen, de Boer, Rudolf A., van Mieghem, Nicolas M., van der Boon, Robert M.A., and Brugts, Jasper J.

Subjects
HEART failure, PROGNOSIS, MORTALITY, DEATH rate, SCIENTIFIC observation, CONFIDENCE intervals
Abstract

Aims: Heart failure (HF) is a chronic and progressive syndrome associated with a poor prognosis. While it may seem intuitive that the risk of adverse outcomes varies across the different stages of HF, an overview of these risks is lacking. This study aims to determine the risk of all‐cause mortality and HF hospitalizations associated with new‐onset HF, chronic HF (CHF), worsening HF (WHF), and advanced HF. Methods and results: We performed a systematic review of observational studies from 2012 to 2022 using five different databases. The primary outcomes were 30‐day and 1‐year all‐cause mortality, as well as 1‐year HF hospitalization. Studies were pooled using random effects meta‐analysis, and mixed‐effects meta‐regression was used to compare the different HF groups. Among the 15 759 studies screened, 66 were included representing 862 046 HF patients. Pooled 30‐day mortality rates did not reveal a significant distinction between hospital‐admitted patients, with rates of 10.13% for new‐onset HF and 8.11% for WHF (p = 0.10). However, the 1‐year mortality risk differed and increased stepwise from CHF to advanced HF, with a rate of 8.47% (95% confidence interval [CI] 7.24–9.89) for CHF, 21.15% (95% CI 17.78–24.95) for new‐onset HF, 26.84% (95% CI 23.74–30.19) for WHF, and 29.74% (95% CI 24.15–36.10) for advanced HF. Readmission rates for HF at 1 year followed a similar trend. Conclusions: Our meta‐analysis of observational studies confirms the different risk for adverse outcomes across the distinct HF stages. Moreover, it emphasizes the negative prognostic value of WHF as the first progressive stage from CHF towards advanced HF. [ABSTRACT FROM AUTHOR]

Published
2024
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32. Guideline implementation, drug sequencing, and quality of care in heart failure: design and rationale of TITRATE‐HF.

Author

Clephas, Pascal R. D., Malgie, Jishnu, Schaap, Jeroen, Koudstaal, Stefan, Emans, Mireille, Linssen, Gerard C. M., de Boer, Grytsje A., van Heerebeek, Loek, Borleffs, C. Jan Willem, Manintveld, Olivier C., van Empel, Vanessa, van Wijk, Sandra, van den Heuvel, Mieke, da Fonseca, Carlos, Damman, Kevin, van Ramshorst, Jan, van Kimmenade, Roland, van de Ven, Arjen R. T., Tio, René A., and van Veghel, Dennis

Subjects
HEART failure, DESIGN failures, DRUG therapy, VENTRICULAR ejection fraction, DIURETICS, DRUGS
Abstract

Aims: Current heart failure (HF) guidelines recommend to prescribe four drug classes in patients with HF with reduced ejection fraction (HFrEF). A clear challenge exists to adequately implement guideline‐directed medical therapy (GDMT) regarding the sequencing of drugs and timely reaching target dose. It is largely unknown how the paradigm shift from a serial and sequential approach for drug therapy to early parallel application of the four drug classes will be executed in daily clinical practice, as well as the reason clinicians may not adhere to new guidelines. We present the design and rationale for the real‐world TITRATE‐HF study, which aims to assess sequencing strategies for GDMT initiation, dose titration patterns (order and speed), intolerance for GDMT, barriers for implementation, and long‐term outcomes in patients with de novo, chronic, and worsening HF. Methods and results: A total of 4000 patients with HFrEF, HF with mildly reduced ejection fraction, and HF with improved ejection fraction will be enrolled in >40 Dutch centres with a follow‐up of at least 3 years. Data collection will include demographics, physical examination and vital parameters, electrocardiogram, laboratory measurements, echocardiogram, medication, and quality of life. Detailed information on titration steps will be collected for the four GDMT drug classes. Information will include date, primary reason for change, and potential intolerances. The primary clinical endpoints are HF‐related hospitalizations, HF‐related urgent visits with a need for intravenous diuretics, all‐cause mortality, and cardiovascular mortality. Conclusions: TITRATE‐HF is a real‐world multicentre longitudinal registry that will provide unique information on contemporary GDMT implementation, sequencing strategies (order and speed), and prognosis in de novo, worsening, and chronic HF patients. [ABSTRACT FROM AUTHOR]

Published
2024
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34. Figure S1 from Baseline Tumor Size Is an Independent Prognostic Factor for Overall Survival in Patients with Melanoma Treated with Pembrolizumab

Author

Joseph, Richard W., primary, Elassaiss-Schaap, Jeroen, primary, Kefford, Richard, primary, Hwu, Wen-Jen, primary, Wolchok, Jedd D., primary, Joshua, Anthony M., primary, Ribas, Antoni, primary, Hodi, F. Stephen, primary, Hamid, Omid, primary, Robert, Caroline, primary, Daud, Adil, primary, Dronca, Roxana, primary, Hersey, Peter, primary, Weber, Jeffrey S., primary, Patnaik, Amita, primary, de Alwis, Dinesh P., primary, Perrone, Andrea, primary, Zhang, Jin, primary, Kang, S. Peter, primary, Ebbinghaus, Scot, primary, Anderson, Keaven M., primary, and Gangadhar, Tara C., primary

Published
2023
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35. Table S1 from Baseline Tumor Size Is an Independent Prognostic Factor for Overall Survival in Patients with Melanoma Treated with Pembrolizumab

Author

Joseph, Richard W., primary, Elassaiss-Schaap, Jeroen, primary, Kefford, Richard, primary, Hwu, Wen-Jen, primary, Wolchok, Jedd D., primary, Joshua, Anthony M., primary, Ribas, Antoni, primary, Hodi, F. Stephen, primary, Hamid, Omid, primary, Robert, Caroline, primary, Daud, Adil, primary, Dronca, Roxana, primary, Hersey, Peter, primary, Weber, Jeffrey S., primary, Patnaik, Amita, primary, de Alwis, Dinesh P., primary, Perrone, Andrea, primary, Zhang, Jin, primary, Kang, S. Peter, primary, Ebbinghaus, Scot, primary, Anderson, Keaven M., primary, and Gangadhar, Tara C., primary

Published
2023
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36. Figure Legends from Baseline Tumor Size Is an Independent Prognostic Factor for Overall Survival in Patients with Melanoma Treated with Pembrolizumab

Author

Joseph, Richard W., primary, Elassaiss-Schaap, Jeroen, primary, Kefford, Richard, primary, Hwu, Wen-Jen, primary, Wolchok, Jedd D., primary, Joshua, Anthony M., primary, Ribas, Antoni, primary, Hodi, F. Stephen, primary, Hamid, Omid, primary, Robert, Caroline, primary, Daud, Adil, primary, Dronca, Roxana, primary, Hersey, Peter, primary, Weber, Jeffrey S., primary, Patnaik, Amita, primary, de Alwis, Dinesh P., primary, Perrone, Andrea, primary, Zhang, Jin, primary, Kang, S. Peter, primary, Ebbinghaus, Scot, primary, Anderson, Keaven M., primary, and Gangadhar, Tara C., primary

Published
2023
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37. Figure S1 from Phase I Study of Pembrolizumab (MK-3475; Anti–PD-1 Monoclonal Antibody) in Patients with Advanced Solid Tumors

Author

Patnaik, Amita, primary, Kang, S. Peter, primary, Rasco, Drew, primary, Papadopoulos, Kyriakos P., primary, Elassaiss-Schaap, Jeroen, primary, Beeram, Muralidhar, primary, Drengler, Ronald, primary, Chen, Cong, primary, Smith, Lon, primary, Espino, Guillermo, primary, Gergich, Kevin, primary, Delgado, Liliana, primary, Daud, Adil, primary, Lindia, Jill A., primary, Li, Xiaoyun Nicole, primary, Pierce, Robert H., primary, Yearley, Jennifer H., primary, Wu, Dianna, primary, Laterza, Omar, primary, Lehnert, Manfred, primary, Iannone, Robert, primary, and Tolcher, Anthony W., primary

Published
2023
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38. Supplementary Tables S1-2, Figure 1 from Phase I Study of Pembrolizumab (MK-3475; Anti–PD-1 Monoclonal Antibody) in Patients with Advanced Solid Tumors

Author

Patnaik, Amita, primary, Kang, S. Peter, primary, Rasco, Drew, primary, Papadopoulos, Kyriakos P., primary, Elassaiss-Schaap, Jeroen, primary, Beeram, Muralidhar, primary, Drengler, Ronald, primary, Chen, Cong, primary, Smith, Lon, primary, Espino, Guillermo, primary, Gergich, Kevin, primary, Delgado, Liliana, primary, Daud, Adil, primary, Lindia, Jill A., primary, Li, Xiaoyun Nicole, primary, Pierce, Robert H., primary, Yearley, Jennifer H., primary, Wu, Dianna, primary, Laterza, Omar, primary, Lehnert, Manfred, primary, Iannone, Robert, primary, and Tolcher, Anthony W., primary

Published
2023
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39. Anti-programmed-death-receptor-1 treatment with pembrolizumab in ipilimumab-refractory advanced melanoma: a randomised dose-comparison cohort of a phase 1 trial

Author

Robert, Caroline, Ribas, Antoni, Wolchok, Jedd D, Hodi, F Stephen, Hamid, Omid, Kefford, Richard, Weber, Jeffrey S, Joshua, Anthony M, Hwu, Wen-Jen, Gangadhar, Tara C, Patnaik, Amita, Dronca, Roxana, Zarour, Hassane, Joseph, Richard W, Boasberg, Peter, Chmielowski, Bartosz, Mateus, Christine, Postow, Michael A, Gergich, Kevin, Elassaiss-Schaap, Jeroen, Li, Xiaoyun Nicole, Iannone, Robert, Ebbinghaus, Scot W, Kang, S Peter, and Daud, Adil

Published
2014
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42. Safety of the oral factor XIa inhibitor asundexian compared with apixaban in patients with atrial fibrillation (PACIFIC-AF): a multicentre, randomised, double-blind, double-dummy, dose-finding phase 2 study

Author

Piccini, Jonathan P, primary, Caso, Valeria, additional, Connolly, Stuart J, additional, Fox, Keith A A, additional, Oldgren, Jonas, additional, Jones, W Schuyler, additional, Gorog, Diana A, additional, Durdil, Václav, additional, Viethen, Thomas, additional, Neumann, Christoph, additional, Mundl, Hardi, additional, Patel, Manesh R, additional, Auer, Johann, additional, Hubauer, Martin, additional, Pandzic, Sead, additional, Preishuber, Eva, additional, Primus-Grabscheit, Carina, additional, Reitgruber, Dietmar, additional, Schmalzer, Florian, additional, Adlbrecht, Christopher, additional, Schober, Andreas, additional, Hajos, Johannes, additional, Keil, Christoph, additional, Schratter, Alexandra, additional, Frick, Matthias, additional, Benda, Magdalena Anna, additional, Mächler, Maximilian, additional, Mutschlechner, Beatrix, additional, Saely, Christoph, additional, Sprenger, Lukas, additional, Lichtenauer, Michael, additional, Eber, Miriam, additional, Hoppe, Uta, additional, Kolbitsch, Tobias, additional, Jirak, Peter Michael, additional, Mirna, Moritz, additional, Schönbauer, Robert, additional, Bergler-Klein, Jutta, additional, Hengstenberg, Christian, additional, Stojkovic, Stefan, additional, Scherr, Daniel, additional, Manninger-Wünscher, Martin, additional, Rohrer, Ursula, additional, Stühlinger, Markus, additional, Schgoer, Wilfried, additional, Schwarzl, Jana, additional, Pürerfellner, Helmut, additional, Derndorfer, Michael, additional, Ebner, Christian, additional, Eder, Veronika, additional, Kollias, Georgios, additional, Sturmberger, Thomas, additional, Sieghartsleitner, Stefan, additional, Vijgen, Johan, additional, Koopman, Peter, additional, Dujardin, Karl, additional, Anné, Wim, additional, De Ceuninck, Michel, additional, Tavernier, Rene, additional, Duytschaever, Mattias, additional, Knecht, Sébastien, additional, Missault, Luc, additional, Vandekerckhove, Yves, additional, Rossenbacker, Tom, additional, Ector, Bavo, additional, Charlier, Filip, additional, Debruyne, Philippe, additional, Dewilde, Willem, additional, Janssens, Luc, additional, Roosen, John, additional, Vankelecom, Bart, additional, Heidbuchel, Hein, additional, Delesie, Michiel, additional, Vervoort, Gert, additional, Rombouts, Hans, additional, Vanassche, Thomas, additional, Engelen, Matthias, additional, Verhamme, Peter, additional, Willems, Rik, additional, Constance, Christian, additional, Pranno, Nicolas, additional, Cox, Jafna, additional, Bata, Iqbal, additional, Macle, Laurent, additional, Aguilar, Martin, additional, Tourigny, Julia Cadrin, additional, Dubuc, Marc, additional, Dyrda, Katia, additional, Guerra, Peter, additional, Khairy, Paul, additional, Mondésert, Blandine, additional, Rivard, Léna, additional, Roy, Denis, additional, Tadros, Rafik, additional, Talajic, Mario, additional, Thibault, Bernard, additional, Nault, Isabelle, additional, Blier, Louis, additional, Champagne, Jean, additional, Molin, Franck, additional, O'Hara, Gilles, additional, Philippon, François, additional, Plourde, Benoit, additional, Sarrazin, Jean-François, additional, Steinberg, Christian, additional, Coufal, Zdenek, additional, Balazsik, David, additional, Mikulica, Michal, additional, Zapeca, Jakub, additional, Cermak, Ondrej, additional, Drasnar, Tomas, additional, Falc, Matej, additional, Hornof, Josef, additional, Racz, Blazej, additional, Weissova, Danica, additional, Linkova, Hana, additional, Paskova, Eva, additional, Petr, Robert, additional, Sirakova, Andrea, additional, Kettner, Jiri, additional, Benak, Ales, additional, Holek, Martin, additional, Podpera, Ivo, additional, Podperova, Monika, additional, Vancura, Vlastimil, additional, Jandik, Tomas, additional, Smid, Jiri, additional, Dedek, Vratislav, additional, Banik, Jan, additional, Durdil, Vaclav, additional, Hnat, Tomas, additional, Lellouche, Nicolas, additional, Rouffiac, Ségolène, additional, Taldir, Guillaume, additional, Bridonneau, Valentin, additional, Couffon, Philippe, additional, Daudin, Magalie, additional, Hamon, Cécile, additional, Lacaze, Jonathan, additional, Quentin, Anne, additional, Thebault, Christophe, additional, Boiffard, Emmanuel, additional, Billon, Olivier, additional, Miette, Fabien, additional, Pouliquen, Hervé, additional, Turlotte, Guillaume, additional, Gorka, Hervé, additional, Albert, Franck, additional, Bayle, Sandrine, additional, Bensaid, Reda, additional, Dasoveanu, Madalina, additional, Demichili, Thibaud, additional, Dutoiu, Teodora, additional, Khalil, Cliff, additional, Loghin, Caterina, additional, Range, Grégoire, additional, Roussel, Laurent, additional, Socié, Pierre, additional, Thuaire, Christophe, additional, Extramiana, Fabrice, additional, Algalarrondo, Vincent, additional, Boughanmi, Haten, additional, El Mansour, Noreddine, additional, Mohammad, Usman, additional, Sellier, Romain, additional, Elbaz, Meyer, additional, Laperche, Clémence, additional, Maury, Philippe, additional, Kiss, Robert, additional, Borsanyi, Tunde, additional, Gingl, Zoltan, additional, Polgar, Balaza, additional, Benczur, Bela, additional, Bodor, Alexandra, additional, Hepp, Tamas, additional, Malati, Eva, additional, Nagy, Laszlo, additional, Erdei, Norbert, additional, Kapus, Jozsef, additional, Kapus, Katalin, additional, Toth, Brigitta, additional, Matoltsy, Andras, additional, Kiss, Tunde, additional, Merkely, Bela, additional, Herczeg, Szilvia, additional, Kiss, Orsolya, additional, Sallo, Zoltan, additional, Toth, Kalman, additional, Habon, Tamas, additional, Rabai, Miklos, additional, Totsimon, Kinga, additional, Zilahi, Zsolt, additional, Bencze, Gabriella, additional, Santa, Janos, additional, Aradi, Daniel, additional, Kelemen, Barbara, additional, Bolognese, Leonardo, additional, Nesti, Martina, additional, Notarstefano, Pasquale Giovanni, additional, D'Orazio, Simona, additional, Cosmi, Franco, additional, Becattini, Cecilia, additional, Agnelli, Giancarlo, additional, Broccatelli, Belinda, additional, Mosconi, Maria Giulia, additional, Paciaroni, Maurizio, additional, Urbini, Chiara, additional, Parato, Vito Maurizio, additional, Notaristefani, Camilla, additional, Scarano, Michele, additional, Ameri, Pietro, additional, Ghigliotti, Giorgio, additional, Guglielmi, Giulia, additional, Lotti, Roberta, additional, Merlo, Andrea Carlo, additional, Muiesan, Maria Lorenza, additional, Abondio, Andrea, additional, Berasi, Caterina, additional, Mattiuzzo, Elena, additional, Mutti, Claudio, additional, Salvetti, Massimo, additional, Pignatelli, Pasquale, additional, Menichelli, Danilo, additional, Pastori, Daniele, additional, Tamiya, Eiji, additional, Matsumoto, Takahiro, additional, Takabe, Tomosato, additional, Yamamoto, Shoichi, additional, Yamashita, Haruyo, additional, Higashiue, Shinichi, additional, Furuya, Onichi, additional, Hiramatsu, Norihiko, additional, Kasuga, Kensuke, additional, Kojima, Saburo, additional, Komooka, Masatoshi, additional, Kuroyanagi, Satoshi, additional, Matsuura, Makoto, additional, Takemoto, Tetsushi, additional, Yamamoto, Shuji, additional, Saito, Katusmi, additional, Abe, Takuro, additional, Ishida, Issei, additional, Iwanami, Yuji, additional, Kataoka, Shohei, additional, Moriyama, Tetsu, additional, Murohashi, Akira, additional, Sasaki, Akihito, additional, Nakamura, Yuichiro, additional, Ueno, Tetsuya, additional, Shimane, Akira, additional, Hamana, Tomoyo, additional, Ichibori, Hirotoshi, additional, Inoue, Tomohiro, additional, Itoh, Mitsuaki, additional, Iwane, Seigo, additional, Kawai, Hiroya, additional, Kokawa, Tatsuya, additional, Masumoto, Akiko, additional, Matsuo, Koki, additional, Miyata, Taishi, additional, Nakano, Shinsuke, additional, Oishi, Shogo, additional, Onishi, Tetsuari, additional, Sawada, Takahiro, additional, Saito, Takayuki, additional, Shoda, Mitsuhiko, additional, Takahashi, Nobuyuki, additional, Takaya, Tomofumi, additional, Taniguchi, Yasuyo, additional, Tsukamoto, Shota, additional, Tsukishiro, Yasue, additional, Tsukiyama, Yoshiro, additional, Tsunamoto, Hiroshi, additional, Uzu, Kenzo, additional, Yamamoto, Hiroyuki, additional, Yamamoto, Tetsuya, additional, Yokoi, Kiminobu, additional, Yoshida, Chiaki, additional, Watanabe, Nobuhiro, additional, Betsuyaku, Tetsuo, additional, Adachi, Kumiko, additional, Awane, Kouichi, additional, Goto, Daisuke, additional, Sakakibara, Mamoru, additional, Watanabe, Masashi, additional, Ueno, Hideki, additional, Hiroe, Yoshitaka, additional, Matsuo, Koshi, additional, Ayata, Kenji, additional, Fukuda, Ko, additional, Hata, Yoshiki, additional, Hashimoto, Katsushi, additional, Matsumi, Hiroaki, additional, Nikaido, Akira, additional, Okamoto, Shuichi, additional, Sime, Iveta, additional, Stirna, Valters, additional, Reinholde, Ilze, additional, Hansone, Silvija, additional, Kozlovska, Anita, additional, Romanova, Janina, additional, Klincare, Dace, additional, Pontaga, Natalja, additional, Dirmans, Igors, additional, Kalnins, Artis, additional, Upite, Dana, additional, Gersamija, Arcils, additional, Teleznikovs, Arturs, additional, Rozkova, Nadezda, additional, Safro, Jelena, additional, Anguera Camós, Ignasi, additional, Domenico Dallaglio, Paolo, additional, Salguero Bodes, Rafael, additional, Arnbas, Fernando, additional, Borrego, Luis, additional, Marco, Alvaro, additional, Jimenez, Javier Ramos, additional, Gómez-Doblas, Juan José, additional, Pérez Cabeza, Alejandro, additional, Ferreira Gonzålez, Ignacio, additional, Limeres Freire, Javier, additional, Lopez Grau, Merce, additional, Viñolas Prat, Xavier, additional, Moreno Weidmann, Zoraida, additional, Guerra Ramos, Jose Maria, additional, Alonso Martin, Maria Concepcion, additional, Campos Garcia, Bieito, additional, Mogro Carranza, Javier Mauricio, additional, Mendez Zurita, Francisco Javier, additional, Rodriguez Font, Enrique, additional, Gonzales Matos, Carlos Eduardo, additional, García Hernando, Víctor, additional, Lindholm, Carl-Johan, additional, Thulin, Jörgen, additional, Wallén, Håkan, additional, Hagwall, Kristina, additional, Eliasson, Ken, additional, Lundvall, Martin, additional, Olsson, Jens, additional, Kjellman, Björn, additional, Lind, Markus, additional, Johansson, Lars, additional, Svedberg, Niclas, additional, Berglund, Stefan, additional, Söderberg, Julia, additional, Zedigh, Christer, additional, Mooe, Thomas, additional, Axelsson, Mattias, additional, Binsell, Emil, additional, Huber, Daniel, additional, Müller, Christian, additional, Danier, Isabelle, additional, Kühne, Michael, additional, Okamura, Bernhard, additional, Schoepfer, Hadrien, additional, Simmen, Cornelia, additional, Reichlin, Tobias, additional, Chollet, Laurève, additional, Lam, Anna, additional, Wittmer, Severin, additional, Rickli, Hans, additional, Gall, Christian, additional, Hametner, Greta, additional, Intorp, Stephanie, additional, Luescher, Daniel, additional, Haegeli, Laurent, additional, Berg, Jan Christopher, additional, Ebrahimi, Ramin, additional, Auricchio, Angelo, additional, Crljenica, Carmela, additional, Moccetti, Tizziano, additional, Monti, Cristina, additional, Pasotti, Elena, additional, Petrova, Iveta, additional, Rossi, Mariagrazia, additional, Mach, François, additional, Namdar, Mehdi, additional, de Groot, Joris, additional, Proost, Virginnio, additional, Neefs, Joline, additional, Linz, Dominik, additional, van Stipdonk, Twan, additional, den Uijl, Dennis, additional, Alings, Marco, additional, Schaap, Jeroen, additional, Segers, Dolf, additional, Wouters, Noemi, additional, Bartels, Louis, additional, Tieleman, Robert, additional, Pisters, Ron, additional, de Vries, Tim, additional, Selig, Jaap, additional, Kuijper, Aaf, additional, Bot, Pieter, additional, Keijzers, Mitran, additional, Verdel, Gerardus, additional, Tukkie, Raymond, additional, van den Bos, Ewout, additional, Kauer, Floris, additional, Oemrawsingh, Rohit, additional, Stevenhagen, Jeroen, additional, van Es, Jan, additional, Lip, Gregory, additional, Gupta, Dhiraj, additional, Kotalczyk, Agnieszka, additional, Gunstone, Anthony, additional, Brixey, Richard David, additional, Gorog, Diana, additional, Dinarvand, Danial, additional, Gue, Ying, additional, Kanji, Rahim, additional, Memtsas, Vassilios, additional, Senior, Roxy, additional, Bioh, Gabriel, additional, Wong, Yuk-Ki, additional, and Child, Nick, additional

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2022
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43. CCTA for Improved Assessment of Patients with Acute Chest Pain and Non-Conclusive Elevated High-Sensitivity Troponins

Author

Arslan, Murat, primary, Schaap, Jeroen, additional, Van Gorsel, Bart, additional, Aubanell, Anton, additional, Budde, Ricardo P.J., additional, Hirsch, Alexander, additional, Smulders, Martijn W., additional, Mihl, Casper, additional, Damman, Peter, additional, Sliwicka, Olga, additional, Habets, Jesse, additional, Dubois, Eric A., additional, and Dedic, Admir, additional

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2022
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44. Risk, Clinical Course, and Outcome of Ischemic Stroke in Patients Hospitalized With COVID-19: A Multicenter Cohort Study

Author

Sluis, Wouter M., primary, Linschoten, Marijke, additional, Buijs, Julie E., additional, Biesbroek, J. Matthijs, additional, den Hertog, Heleen M., additional, Ribbers, Tessa, additional, Nieuwkamp, Dennis J., additional, van Houwelingen, Reinier C., additional, Dias, Andreas, additional, van Uden, Ingeborg W.M., additional, Kerklaan, Joost P., additional, Bienfait, H. Paul, additional, Vermeer, Sarah E., additional, de Jong, Sonja W., additional, Ali, Mariam, additional, Wermer, Marieke J.H., additional, de Graaf, Marieke T., additional, Brouwers, Paul J.A.M., additional, Asselbergs, Folkert W., additional, Kappelle, L. Jaap, additional, van der Worp, H. Bart, additional, Algra, Annemijn M., additional, Donders, Richard C.J.M., additional, Pruissen, D. Martijn O., additional, Kuijper, Aaf F.M., additional, van Ofwegen-Hanekamp, Clara E.E., additional, Hermanides, Rik S., additional, Haerkens-Arends, Hortence E., additional, Anthonio, Rutger L., additional, Emans, Mireille E., additional, Tio, René A., additional, ten Berg, Jur M., additional, Groenemeijer, Björn E., additional, Pisters, Ron, additional, van der Zee, P. Marc, additional, Siebelink, Hans-Marc J., additional, Verschure, Derk O., additional, Meijs, Matthijs F.L., additional, Schut, Astrid, additional, Tieleman, Robert G., additional, Hermans-van Ast, Wanda, additional, Schaap, Jeroen, additional, Jewbali, Lucia S., additional, Smits, Peter C., additional, van der Harst, Pim, additional, van Smeden, Maarten, additional, and van Gilst, Wiek H., additional

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2021
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46. Coronary CT angiography for improved assessment of patients with acute chest pain and low-range positive high-sensitivity troponins: study protocol for a prospective, observational, multicentre study (COURSE trial)

Author

Arslan, Murat, primary, Schaap, Jeroen, additional, Van Gorsel, Bart, additional, Budde, Ricardo PJ, additional, Bekkers, Sebastiaan CAM, additional, Van Cauteren, Yvonne JM, additional, Damman, Peter, additional, Habets, Jesse, additional, Dubois, Eric A, additional, and Dedic, Admir, additional

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2021
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48. Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Author

Teerlink, John R., Diaz, Rafael, Felker, G. Michael, McMurray, John J.V., Metra, Marco, Solomon, Scott D., Adams, Kirkwood F., Anand, Inder, Arias‐Mendoza, Alexandra, Biering‐Sørensen, Tor, Böhm, Michael, Bonderman, Diana, Cleland, John G.F., Corbalan, Ramon, Crespo‐Leiro, Maria G., Dahlström, Ulf, Echeverria Correa, Luis E., Fang, James C., Filippatos, Gerasimos, Fonseca, Cândida, Goncalvesova, Eva, Goudev, Assen R., Howlett, Jonathan G., Lanfear, David E., Lund, Mayanna, Macdonald, Peter, Mareev, Vyacheslav, Momomura, Shin‐ichi, O'Meara, Eileen, Parkhomenko, Alexander, Ponikowski, Piotr, Ramires, Felix J. A., Serpytis, Pranas, Sliwa, Karen, Spinar, Jindrich, Suter, Thomas M., Tomcsanyi, Janos, Vandekerckhove, Hans, Vinereanu, Dragos, Voors, Adriaan A., Yilmaz, Mehmet B., Zannad, Faiez, Sharpsten, Lucie, Legg, Jason C., Abbasi, Siddique A., Varin, Claire, Malik, Fady I., Kurtz, Christopher E., Besada, Diego Alejandro, Majul, Claudio Rodolfo, Bruno, Marco Raul Litvak, Sassone, Sonia, Avaca, Horacio Alberto, Rasmussen, Mariela, Aiub, Jorge Roberto, Hominal, Miguel Angel, Perna, Eduardo, Duran, Ruben Omar Garcia, Schiavi, Lilia, Marquez, Lilia Luz Lobo, Vilamajo, Oscar Alberto Gomez, Mackinnon, Ignacio, Fuente, Ricardo Alfonso Leon, Montana, Oscar Romano, Novaretto, Leonardo, Guerrero, Rodolfo Andres Ahuad, Brasca, Daniela Garcia, Prado, Aldo, Garrido, Marcelo Alejandro, Luquez, Hugo, Martinez, Diego Felipe, Nicolosi, Liliana, Parody, Maria Leonor, Zaidman, Cesar, Berra, Fernando Colombo, Ibañez, Julio, Zapata, Gerardo, Caccavo, Alberto, Colque, Roberto, Diez, Mirta, Poy, Carlos, Salomone, Oscar Alejandro, Vogel, Daniel, Bordonava, Anselmo Paulino, Fernandez, Alberto, French, John, Atherton, John, Hamilton, Andrew, Begg, Alistair, Abhayaratna, Walter, Judkins, Christopher, De Pasquale, Carmine, McKenzie, Scott, Amerena, John, Szto, Gregory, Kearney, Leighton, Zimmet, Hendrik, Sverdlov, Aaron, Beltrame, John, Korczyk, Dariusz, Sindone, Andrew, Moertl, Deddo, Huber, Kurt, Huelsmann, Martin, Ablasser, Klemens, Ebner, Christian, Siostrzonek, Peter, Drexel, Heinz, Poelzl, Gerhard, Dujardin, Karl, Dupont, Matthias, Buysschaert, Ian, Lancellotti, Patrizio, Droogne, Walter, Chouchane, Iman, Silveira, Fabio, Rassi, Salvador, Reis, Gilmar, Filho, Pedro Pimentel, Simoes, Marcus Vinicius, Braga, Joao Carlos, Giorgeto, Flavio Eduardo, Ferraz, Almir, Jaeger, Cristiano Pederneiras, Saraiva, Jose Francisco, Tognon, Alexandre, Cardoso, Juliano, Greco, Oswaldo, Paiva, Maria Sanali, Paolino, Bruno, Filho, Otavio Coelho, Maia, Lilia Nigro, Silva, Rodrigo, Canesin, Manoel, Rossi, Paulo Roberto Ferreira, Fortes, Jose Augusto Ribas, Cerci, Rodrigo Julio, Manenti, Euler Roberto Fernandes, Leaes, Paulo Ernesto, Silva Neto, Luis Beck, Souza, Weimar Kunz Barroso, Bacal, Fernando, Chaves, Renato, Ramires, Felix, Vidotti, Maria Helena, Barros e Silva, Pedro Gabriel Melo, Piegas, Leopoldo Soares, Todorov, Georgi, Tzekova, Maria, Goudev, Assen, Mincheva, Valentina, Vasilev, Ivaylo, Tisheva‐ Gospodinova, Snezhanka, Petrov, Ivo, Postadzhiyan, Arman, Velikov, Chavdar, Dimov, Bojidar, Constance, Christian, Phaneuf, Denis‐Carl, Mielniczuk, Lisa, Pandey, A Shekhar, Senaratne, Manohara, Zieroth, Shelley, Savard, Daniel, Stewart, Robert, Huynh, Thao, Giannetti, Nadia, Moe, Gordon, Bourgeois, Ronald, Ezekowitz, Justin, Hartleib, Michael, Sussex, Bruce, Babapulle, Mohan, Chehayeb, Raja, Gaudet, Daniel, McKelvie, Robert, Nguyen, Viviane, Roth, Sherryn, Gupta, Milan, Pesant, Yves, Rupka, Dennis, Bhargava, Rakesh, Costa‐Vitali, Atilio, Proulx, Guy, Vega, Mario, Potthoff, Sergio, Cid, Maria Cristina Schnettler, Sepulveda, Alex Mauricio Villablanca, Zanetti, Fernando Tomas Lanas, Gajardo, Victor Areli Saavedra, Kindel, Carlos Conejeros, Jofre, Christian Paolo Pincetti, Segarra, Jorge Leonardo Cobos, Venegas, Manuel Eduardo Rodriguez, Hidalgo, Mario Yanez, Jalaf, Margarita Gertrudis Vejar, Li, Weimin, Zhang, Jinguo, Fu, Xin, Zhang, Xuelian, Li, Dongye, Wang, Zhifang, Qu, Yanling, Zheng, Zhe, Tang, Huifang, Yang, Ping, Zhang, Yuhui, Zheng, Yang, Mi, Yafei, Huang, He, Bu, Peili, Chen, Guoqin, Chen, Jiyan, Han, Yajun, Li, Zhangquan, Ma, Shumei, Yang, Xuming, Yuan, Zuyi, Dong, Yugang, Li, Zhaoping, Mahemuti, Ailiman, Niu, Wentang, Yang, Zhenyu, Zhang, Yuqing, Sun, Yuemin, Wu, Weiheng, Liu, Feng, Yan, Jing, Li, Yinjun, Wang, Yi, Zhang, Shouyan, Zhou, Changyong, Cui, Hanbin, Li, Jianjun, Li, Tianfa, Han, Qinghua, Wei, Yu, Correa, Luis Eduardo Echeverria, Mendoza, Jose Luis Accini, Jattin, Fernando Manzur, Osorio, Wilder Castaño, Luengas, Carlos Alberto, Arroyo, Julian Alonso Coronel, Corredor, Miguel Alfredo Moncada, Giraldo, Clara Ines Saldarriaga, Lopez, Rodrigo Botero, Salazar, Dora Ines Molina, Triana, Miguel Urina, Lopez, Luis Horacio Atehortua, Rojas, Pastor Olaya, Pelaez, Sebastian Velez, Pareja, Monica Lopez, Bonfanti, Alberto Cadena, Polasek, Rostislav, Monhart, Zdenek, Sochor, Karel, Motovska, Zuzana, Belohlavek, Jan, Busak, Ladislav, Krupicka, Jiri, Tyl, Petr, Jerabek, Ondrej, Podpera, Ivo, Skrobakova, Janka, Peterka, Karel, Spacek, Rudolf, Cech, Vladimir, Kellnerova, Ivana, Nechvatal, Libor, Pozdisek, Zbynek, Houra, Marek, Kryza, Radim, Machova, Vilma, Cepelak, Michal, Stepek, David, Zeman, Kamil, Klimsa, Zdenek, Koleckar, Pavel, Schee, Alexandr, Spinarova, Lenka, Coufal, Zdenek, Jeppesen, Jorgen, Vraa, Soren, Wiggers, Henrik, Nyvad, Ole, Nielsen, Tonny, Kaiser‐Nielsen, Peter, Videbaek, Lars, Galinier, Michel, Lefebvre, Jean‐Marie, Tartiere, Jean‐Michel, De Geeter, Guillaume, Roubille, Francois, Ricci, Jean Etienne, Salvat, Muriel, Gueffet, Jean‐Pierre, Decoulx, Eric, Berdague, Philippe, Jondeau, Guillaume, Ovize, Michel, Groote, Pascal De, Donal, Erwan, Isnard, Richard, Sabatier, Rémi, Trochu, Jean Noel, Damy, Thibaud, Georges, Jean‐Louis, Rosamel, Yann, Picard, François, Aboyans, Victor, Laperche, Thierry, Mitrovic, Veselin, Taggeselle, Jens, Störk, Stefan, Ebelt, Henning, Genth‐Zotz, Sabine, Rassaf, Tienush, Duengen, Hans‐Dirk, Mittag, Marcus, Menck, Niels, Zeymer, Uwe, Haehling, Stephan, Boehm, Michael, Frankenstein, Lutz, Killat, Holger, Bourhaial, Hakima, Beug, Daniel, Horacek, Thomas, Pfister, Roman, Sandri, Marcus, Westenfeld, Ralf, Kadel, Christoph, Karvounis, Haralambos, Patsilinakos, Sotirios, Mantas, Ioannis, Karavidas, Apostolos, Giamouzis, Grigorios, Tsioufis, Konstantinos, Naka, Katerina, Tziakas, Dimitrios, Parissis, John, Styliadis, Ioannis, Barbetseas, Ioannis, Manolis, Athanasios, Kochiadakis, George, Herczeg, Bela, Nagy, Laszlo, Nyolczas, Noemi, Toth, Kalman, Merkely, Bela, Laszlo, Zoltan, Mark, Laszlo, Szakal, Imre, Papp, Andras, Bezzegh, Katalin, Lakatos, Ferenc, Hajko, Erik, Papp, Aniko, Forster, Tamas, Lupkovics, Geza, Mohacsi, Attila, Salamon, Csaba, Aradi, Daniel, Andreka, Peter, Szasz, Gyula, Zilahi, Zsolt, Kazinczy, Rita, Margonato, Alberto, Agostoni, Piergiuseppe, Fucili, Alessandro, Piovaccari, Giancarlo, Senni, Michele, Carluccio, Erberto, Bilato, Claudio, Frigerio, Maria, Indolfi, Ciro, Sinagra, Gianfranco, Brunetti, Natale Daniele, Perna, Gianpiero, Pini, Daniela, Volterrani, Maurizio, Leonardi, Sergio, Mortara, Andrea, Friz, Hernan Emilio Francisco Polo, Rossini, Roberta, Tocchetti, Carlo Gabriele, Vincenzi, Antonella, Cavallini, Claudio, Floresta, Agata Marina, Zaca, Valerio, Giudici, Vittorio, Villani, Giovanni Quinto, Higashino, Yorihiko, Oishi, Shogo, Wada, Atsuyuki, Fukuzawa, Shigeru, Onoue, Kenji, Koike, Akihiro, Koizumi, Tomomi, Masuda, Seigo, Mitsuo, Kazuhisa, Takahashi, Natsuki, Takenaka, Takashi, Tanabe, Jun, Watanabe, Naoki, Yoshida, Takeshi, Amano, Tetsuya, Ishikawa, Masahiro, Kida, Keisuke, Kubota, Toru, Nakamura, Kentaro, Sakamoto, Tomohiro, Shimomura, Mitsuhiro, Yuge, Masaru, Doi, Masayuki, Domae, Hiroshi, Ebato, Mio, Fujii, Kenshi, Fujiwara, Wakaya, Gohara, Seiichiro, Hata, Yoshiki, Kanda, Junji, Kitaoka, Hiroaki, Matsumoto, Takashi, Michishita, Ichiro, Miura, Shinichiro, Miyazaki, Tetsuro, Nakamura, Akihiro, Ogawa, Tomohiro, Okumura, Takahiro, Okumura, Yasuo, Sakai, Tetsuo, Sato, Yukihito, Shimizu, Wataru, Sugino, Hiroshi, Suzuki, Masahiro, Takagi, Atsutoshi, Takaishi, Hiroshi, Tanaka, Takahiro, Terasaki, Toshiro, Tsujimoto, Mitsuru, Ueda, Yasunori, Ujino, Keiji, Usui, Makoto, Yamamoto, Mitsutaka, Yoshikawa, Masaki, Ando, Kenji, Asakura, Masanori, Asano, Hiroshi, Fujii, Shigeru, Hara, Hisao, Inomata, Takayuki, Isshiki, Takaaki, Kadokami, Toshiaki, Kai, Hisashi, Kasai, Toshio, Kawamitsu, Katsunori, Kawasaki, Tomohiro, Koga, Tokushi, Komiyama, Nobuyuki, Maejima, Yasuhiro, Manita, Mamoru, Miyamoto, Nobuhide, Node, Koichi, Numaguchi, Kotaro, Sakata, Yasushi, Serikawa, Takeshi, Takama, Noriaki, Tatebe, Shunsuke, Ueno, Hideki, Hidaka, Takayuki, Hiroi, Shitoshi, Iseki, Harukazu, Ito, Hiroshi, Kajinami, Kouji, Kawakami, Hideo, Momiyama, Yukihiko, Mori, Masuki, Morita, Yukiko, Okishige, Kaoru, Sakagami, Satoru, Takeishi, Yasuchika, Terasawa, Akihiro, Utsu, Noriaki, Badariene, Jolita, Celutkiene, Jelena, Slapikas, Rimvydas, Jarasuniene, Dalia, Castillo, Armando Garcia, De los Rios Ibarra, Manuel Odin, Lopez, Gabriel Arturo Ramos, Llamas, Edmundo Alfredo Bayram, Esperon, Guillermo Antonio Llamas, Vazquez, Eduardo Salcido, Gonzalez, Ricardo Garcia, Leon, Jose Luis Arenas, Gonzalez, Salvador Leon, Mendoza, Maria Alexandra Arias, Rodriguez, Alicia Contreras, Machado, Gustavo Francisco Mendez, Salazar, Melchor Alpizar, Ruiz, Alberto Esteban Bazzoni, Flores, Ana Maria De Leon, Carrasco, Jose Alfredo Pagola, Araiza, Raul Reyes, Römer, Tjeerd, Remmen, Johannes, Van Eck, Jacob, Elvan, Arif, Smilde, Tom, Voors, Adriaan, Wal, Ruud, Schaap, Jeroen, Sluis, Aize, Linssen, Gerardus, Magro, Michael, Willems, Frank, Hal, John, Zwaan, Coenraad, Beelen, Driek, Boswijk, Dirk, Hermans, Walter, Van Kesteren, Henricus, Scott, Russell, Hart, Hamish, Lund, Marianne, Szczasny, Marcin, Blicharski, Tomasz, Kafara, Mariusz, Stankiewicz, Anna, Skonieczny, Grzegorz, Zabowka, Maciej, Kania, Grzegorz, Kopaczewski, Jerzy, Pawlowicz, Lidia, Spyra, Janusz, Wlodarczyk, Aleksander, Sciborski, Ryszard, Balsam, Pawel, Drozdz, Jaroslaw, Sobkowicz, Bozena, Konieczynska, Malgorzata, Lelonek, Malgorzata, Bednarkiewicz, Zbigniew, Trebacz, Jaroslaw, Jankowski, Piotr, Sidor, Mateusz, Berkowski, Piotr, Chmielak, Zbigniew, Lenartowska, Lucyna, Nessler, Jadwiga, Straburzynska‐Migaj, Ewa, Kalarus, Zbigniew, Kowalski, Robert, Kalecinska‐Krystkiewicz, Ewa, Gola, Zbigniew, Pijanowski, Zbigniew, Wozakowska‐Kaplon, Beata, Cymerman, Krzysztof, Rynkiewicz, Andrzej, Miekus, Pawel, Monteiro, Pedro, Sarmento, Pedro Morais, Almeida, Filipa, Duarte, Tatiana, Fonseca, Candida, Oliveira, Luis, Santos, Luis, Brito, Dulce, Stanciulescu, Gabriela, Spiridon, Marilena Renata, Militaru, Constantin, Podoleanu, Cristian Gheorghe, Zdrenghea, Dumitru, Popescu, Mircea Ioachim, Macarie, Cezar‐Eugen, Giuca, Alina, Mitu, Florin, Voicu, Olga‐Cristina, Dorobantu, Maria, Lighezan, Daniel, Stamate, Sorin, Bykov, Alexander, Kobalava, Zhanna, Zrazhevskiy, Konstantin, Semenova, Irina, Vishnevsky, Alexander, Shutemova, Elena, Tereschenko, Sergey, Shvarts, Yury, Barbarash, Olga, Lukyanov, Yury, Voevoda, Mikhail, Dovgolis, Svetlana, Dronov, Dmitry, Goloshchekin, Boris, Sitnikova, Maria, Ezhov, Marat, Tarasov, Nikolay, Kotelnikov, Mikhail, Kostenko, Viktor, Solovev, Oleg, Goncharov, Ivan, Myasnikov, Roman, Rafalskiy, Vladimir, Ryabov, Vyacheslav, Kosmacheva, Elena, Motylev, Igor, Nosov, Vladimir, Osipova, Irina, Salukhov, Vladimir, Belenkiy, Dmitriy, Bolshakova, Olga, Pimenov, Leonid, Shilkina, Nataliya, Kulibaba, Elena, Repin, Alexey, Timofeev, Alexander, Mitrokhin, Vladislav, Sherenkov, Alexander, Arbolishvili, Georgy, Antalik, Lubomir, Dzupina, Andrej, Fulop, Peter, Majercak, Ivan, Gonsorcik, Jozef, Vinanska, Daniela, Lenner, Egon, Lukacova, Jana, Margoczy, Roman, Smik, Rudolf, Stevlik, Jan, Uhliar, Rudolf, Burgess, Lesley, Badat, Aysha, Klug, Eric, Van Zyl, Louis, Abelson, Mark, Moodley, Rajendran, Tsabedze, Nqoba, Fourie, Nyda, Bonet, Luis Almenar, Prado, Jose Maria Arizon, Oliveira Soares, Manue Martinez‐Selles D, Villota, Julio Eduardo Nuñez, Leiro, Maria Generosa Crespo, Juanatey, Jose Ramon Gonzalez, Figal, Domingo Andres Pascual, Palomas, Juan Luis Bonilla, Perez, Sonia Mirabet, Jimenez, Juan Francisco Delgado, Padron, Antonio Lara, Diaz, Victor Alfonso Jimenez, Cubero, Javier Segovia, Paya, Vicente Eduardo Climent, Mayoral, Alejandro Recio, Fuente Galan, Luis, Doblas, Juan Jose Gomez, Freire, Ramon Bover, Peiro, Maria Teresa Blasco, Molina, Beatriz Diaz, Martinez, Laura Jordan, Vilchez, Francisco Gonzalez, Boman, Kurt, Karlstrom, Patric, Berglund, Stefan, Szabo, Barna, Peterson, Magnus, Wodlin, Peter, Lindholm, Carl‐Johan, Moccetti, Tiziano, Mueller, Christian, Suter, Thomas, Hullin, Roger, Meyer, Philippe, Noll, Georg, Yigit, Zerrin, Turgut, Okan Onur, Bekar, Lutfu, Sahin, Tayfun, Koldas, Zehra Lale, Celik, Ahmet, Cavusoglu, Yuksel, Demir, Mesut, Onrat, Ersel, Duzenli, Mehmet, Cosansu, Kahraman, Muderrisoglu, Ibrahim Haldun, Tuncer, Mustafa, Badak, Ozer, Nalbantgil, Sanem, Kirma, Cevat, Okuyan, Ertugrul, Guray, Umit, Prokhorov, Oleksandr, Karpenko, Oleksandr, Vakaliuk, Igor, Yagensky, Andriy, Kracz, Igor, Stanislavchuk, Mykola, Kulynych, Oleksii, Rishko, Mykola, Stets, Roman, Tseluyko, Vira, Mishchenko, Larysa, Rudenko, Leonid, Rudyk, Iurii, Alieksieieva, Liudmyla, Korzh, Oleksii, Mostovoy, Yuriy, Parkhomenko, Oleksandr, Rasputina, Lesya, Voronkov, Leonid, Lymar, Yurii, Vasilyeva, Larysa, Keeling, Philip, Barr, Craig, Wong, Kenneth, Price, Dallas, Skaria, Binoy, Clark, Andrew, Chandrasekaran, Badrinathan, Trevelyan, Jasper, Gordon, Brian, Donnelly, Patrick, Glover, Jason, Ryding, Alisdair, Weir, Robin, Lang, Chim, Roy, Debashis, Adhya, Shaumik, Clifford, Piers, Ludman, Andrew, Kalra, Paul, Lynch, Mary, Mahmood, Shahid, Al Mohammad, Abdallah, Asubiaro, Joshua, Elmahi, Einas, Muthumala, Amal, Taylor, Justin, Gupta, Dinesh, Nadar, Venkatesh, Henderson, David, Zolty, Ronald, Sauer, Andrew, Adams, Kirkwood, Chandra, Lokesh, Jaffrani, Naseem, Grewal, Gurinder, Mancini, Donna, McLean, Dalton, Vasallo, Javier, Gottlieb, Stephen, Joseph, Susan, Barua, Rajat, Gorodeski, Eiran, Mouhaffel, Asad, Chung, Eugene, Desai, Pratik, Portnay, Edward, Rama, Bhola, Shandling, Adrian, Stahl, Llyod, Heilman, Karl, Jacob, Binu, Londono, Juan, Almousalli, Omar, Ashcom, Thomas, Bauerlein, Eugene Joseph, Koo, Charles, McGrew, Frank, Rajagopalan, Navin, Robinson, Shawn, Schultz, David, Starling, Randall, Ambardekar, Amrut, Bhagwat, Ravi, Boehmer, John, Bouza, Manuel, Farris, Neil, Feitell, Scott, Ganji, Jagadeesh, Geltman, Edward, Javier, Julian, Morrow, John Andrew, Pianko, Leonard, Smart, Frank, Adler, Alexander, Brinkley, Douglas, Cardona, Jose, Coletti, Andrew, Harris, John, Hunter, Vernon, Krantz, Mori, Lang, Christopher, Lovell, Charles, Murray, David, Pillutla, Priya, Shah, Amit, Bogaev, Roberta, Dauber, Ira, Franchi, Francesco, Fremont, Richard, Hart, Terence, Hattler, Brack, Janik, Matthew, Khalife, Wissam, Malhotra, Sanjay, Mamdani, Shafiq, Nelson, William, Orgera, Marisa, Ortiz, Aurelio, Rahko, Peter, Rennyson, Stephen, Shin, Jooyoung, Tsao, Lana, Uretsky, Barry, Wahid, Faisal, Wilkett, Matt, Amanullah, Aman, Baker, Mathue, Berk, Martin, Boccalandro, Fernando, Cruz, Kimberly, Doyle, Timothy, Gianfagna, Robert, Jones, Alonzo, King, Anthony, Lepor, Norman, Martinez‐Castrillon, Melvin, Pham, Michael, Radin, Michael, Radojevic, Joseph, Ramanathan, Kodangudi, Schmalfuss, Carsten, Schnitzler, Robert, Shah, Keyur, Takata, Theodore, Bertolet, Barry, Bostick, Brian, Civitello, Andrew, Collins, John, Dib, Nabil, Fang, James, Gilmore, Richard, Gray, Wayne, Grazette, Luanda, Haddad, Tariq, Hearne, Steven, Janmohamed, Munir, Katz, Richard, Kazemi, Navid, Llerena, Sara, Lohr, Nicole, Marzouka, George, Mignone, John, Ooi, Henry, Paszczuk, Anna, Pickett, Christopher, Sampognaro, Gregory, Sawyer, Douglas, Shayani, Steven, Treasure, Charles, Vaz, Garth, Vijay, Nampalli, Williams, Celeste, Yeoman, Gary, Zhang, Lily, Aaronson, Keith, Abo‐Auda, Wael, Alharethi, Rami, Anderson, William, Ariani, Mehrdad, Banerji, Sourin, Baweja, Paramdeep, Carson, Peter, Eberly, Arthur, Elliott, James, Fernando, Ronald, Fisher, Daniel, Forman, Steven, Gabriel, George, Gogia, Harinder, Hametz, Craig, Houston, Brian, Ibrahim, Hassan, Jadbabaie, Farid, Kassiotis, Christos, Krishnamoorthy, Arun, Kwan, Michael, Lupovitch, Steven, Macias, Leonardo, Malik, Adnan, Martinez, Luis, Miyamoto, Michael, Mody, Freny, Patel, Devesh, Peart, Brenda, Pisani, Barbara, Ramos, Mark, Rivero, Mariel, Shah, Anil, Sharma, Mukesh, Sichrovsky, Tina, Simon, Marc, Singh, Deovrat, Tallet, Julio, Vaccari, Christopher, Villoch, Mario, Wheeler, Matthew, Yousuf, Kabir, Abadier, Rafik, Abdullah, Shuaib, Arora, Raveen, Aslam, Shamaila, Buynak, Robert, Chang, David, Contreras, Johanna, Halpern, Stephen, Handel, Franklin, Heitner, John, Herzog, William, Jackson, Bruce, Kao, John, Kondo, Nicholas, Koren, Michael, LeWinter, Martin, Martindale, Jeffrey, Martinez‐Arraras, Joaquin, Olsen, Stephanie, Piatek, Marek, Ranadive, Nandkishore, Randall, William, Rao, Sunder, Rawitscher, David, Rider, James, Sokos, George, Strader, J Russell, Sulemanjee, Nasir, Tahirkheli, Naeem, Trichon, Benjamin, Vanhecke, Thomas, Whellan, David, Abuannadi, Mohammad, Aggarwala, Gaurav, Ahmad, Saad, Artis, Andre, Cheirif, Jorge, Cotarlan, Vladimir, Cox, Jeremy, Eaton, Charles, Florea, Viorel, Frank, Theodore, Friedman, Keith, Ganeshram, Vedampattu, Gass, Alan, Gemignani, Anthony, Hasni, Syed, Hedgepeth, Chester, Itchhaporia, Dipti, Kaluski, Edo, Karim, Amin, Kono, Alan, Lader, Ellis, Lakshminarayanan, Batlagundu, Lewis, Neil, Malhotra, Vinay, Mayer, Nolan, Mohapatra, Robert, Nair, Nandini, O'Brien, Terrence, Pauwaa, Sunil, Rowan, Christopher, Saxena, Sanjeev, Seto, Arnold, Shah, Nishant, Singh, Pradeep, Skopicki, Hal, Stoddard, Marcus, and Sweitzer, Nancy

Subjects
R1
Abstract

Aims:\ud The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials.\ud \ud Methods and Results:\ud Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure

Published
2020

49. Undetectable High-Sensitivity Troponin T as a Gatekeeper for Coronary Computed Tomography Angiography in Patients Suspected of Acute Coronary Syndrome

Author

Arslan, Murat, Schaap, Jeroen, Rood, Pleunie P.M., Nieman, Koen, Budde, Ricardo P.J., Van Dalen, Bas M., Attrach, Mohamed, Dubois, Eric A., Dedic, Admir, Arslan, Murat, Schaap, Jeroen, Rood, Pleunie P.M., Nieman, Koen, Budde, Ricardo P.J., Van Dalen, Bas M., Attrach, Mohamed, Dubois, Eric A., and Dedic, Admir

Abstract

Objectives: The aim of this study was to characterize the safety and efficiency of a strategy employing the limit of detection (LoD) of high-sensitivity troponin T (hs-TnT) as a gatekeeper for coronary computed tomography angiography (CCTA) in suspected acute coronary syndrome (ACS) patients in the emergency department (ED). Methods: We included suspected ACS patients who underwent CCTA and were evaluated with hs-TnT. Patients were categorized as below the LoD and at or above the LoD. The primary outcome was 30-day major adverse cardiac events (MACEs), defined as all-cause mortality, ACS, or coronary revascularization. Results: The study population consisted of 177 patients (mean age 55 ± 10 years, 50.3% women), and 16 (9.0%) patients reached the primary outcome. None of the patients died, while 13 had an adjudicated diagnosis of ACS, and 3 underwent elective coronary revascularization. There were 77 patients (44%) with an hs-TnT value below the LoD (MACEs; n = 1 [1.3%]) and 100 (56%) with at or above the LoD levels (MACEs; n = 15 [15%]). None of 67 patients with an hs-TnT value below the LoD and <50% stenosis on CCTA experienced MACEs. Out of the 10 patients with an hs-TnT value below the LoD and ≥50% stenosis on CCTA, 1 patient underwent elective percutaneous coronary revascularization. In patients with an hs-TnT value at or above the LoD, 74 patients had <50% stenosis on CCTA, and 2 patients (3%) were diagnosed with myocardial infarction without obstructive coronary artery disease confirmed on invasive angiography. Thirteen (50%) patients with an hs-TnT value at or above the LoD and ≥50% stenosis on CCTA experienced MACEs (11 ACS and 2 elective percutaneous coronary revascularizations). Conclusion: Our findings support that implementing the LoD of hs-TnT as a gatekeeper may reduce the need for CCTA in suspected ACS patients in the ED.

Published
2021

50. Coronary CT angiography for improved assessment of patients with acute chest pain and low-range positive high-sensitivity troponins:Study protocol for a prospective, observational, multicentre study (COURSE trial)

Author

Arslan, Murat, Schaap, Jeroen, Van Gorsel, Bart, Budde, Ricardo P.J., Bekkers, Sebastiaan C.A.M., Van Cauteren, Yvonne J.M., Damman, Peter, Habets, Jesse, Dubois, Eric A., Dedic, Admir, Arslan, Murat, Schaap, Jeroen, Van Gorsel, Bart, Budde, Ricardo P.J., Bekkers, Sebastiaan C.A.M., Van Cauteren, Yvonne J.M., Damman, Peter, Habets, Jesse, Dubois, Eric A., and Dedic, Admir

Abstract

Introduction Current evaluation of patients suspected of a non-ST-elevation acute coronary syndrome (NSTE-ACS) involves the use of algorithms that incorporate clinical information, electrocardiogram (ECG) and high-sensitivity cardiac troponins (hs-troponins). While primarily designed to rule out NSTE-ACS safely, these algorithms can also be used for rule in of NSTE-ACS in some patients. Still, in a substantial number of patients, these algorithms do not provide a conclusive work-up. These patients often present with an atypical clinical profile and low-range positive hs-troponin values without a characteristic rise or fall pattern. They represent a heterogeneous group of patients with various underlying conditions; only a fraction (30%-40%) will eventually be diagnosed with a myocardial infarction. Uncertainty exists about the optimal diagnostic strategy and their management depends on the clinical perspective of the treating physician ranging from direct discharge to admission for invasive coronary angiography. Coronary CT angiography (CCTA) is a non-invasive test that has been shown to be safe, fast and reliable in the evaluation of coronary artery disease. In this study, we will determine the usefulness of CCTA in patients with acute chest pain and low-range positive hs-troponin values. Methods and analysis A prospective, double-blind, observational, multicentre study conducted in the Netherlands. Patients aged 30-80 years presenting to the emergency department with acute chest pain and a suspicion of NSTE-ACS, a normal or non-diagnostic ECG and low-range positive hs-troponins will be scheduled to undergo CCTA. The primary outcome is the diagnostic accuracy of CCTA for the diagnosis of NSTE-ACS at discharge, in terms of sensitivity and negative predictive value. Ethics and dissemination This study was approved by the Medical Research Ethics Committee of Erasmus Medical Center in Rotterdam, the Netherlands (registration number MEC-2017-506). Written informed co

Published
2021

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