BACKGROUND Significant gaps in guideline-directed medical therapy(GDMT)for heart failure(HF)stem from shortages of cardiologists and advanced HF providers,as well as a lack of optimal HF management knowledge among hos...BACKGROUND Significant gaps in guideline-directed medical therapy(GDMT)for heart failure(HF)stem from shortages of cardiologists and advanced HF providers,as well as a lack of optimal HF management knowledge among hospitalists.This study compared the impact of optimal medical therapy in HF(OMT-HF)certification on GDMT implementation and patient outcomes between an intervention group(IG)of hospitalists and a standard-of-care comparison group(SOC-CG).METHODS This study was implemented from November 2022 to May 2023.Hospitalized car-diology patients with HF and left ventricular ejection fraction≤40%were rando-mized to IG or SOC-CG.Exclusion criteria included patients in cardiogenic shock,unable to consent,or at high risk.Follow-up was at 30 days post-discharge.Diffe-rences between groups were analyzed using Fisher’s exact test for categorical va-riables and Wilcoxon rank-sum or unpaired t-test for continuous variables.Chan-ges in Minnesota Living with Heart Failure Questionnaire(MLWHFQ)scores were evaluated using a paired t-test.RESULTS IG patients had lower readmission rates[9(42.85%)vs 11(17.46%),P=0.03]and a decreased trend in mortality 30-day post discharge.IG patients also showed greater mean improvements in total(-27.03±24.59 vs-5.85±23.52,P<0.001),physical(-13.8±12.3 vs-2.71±11.16,P<0.001)and emotional(-4.76±8.10 vs-1.42±5.98)dimensions on the MLWHFQ compared to SOC-CG,however,change in emotional dimension did not reach statistical significance.CONCLUSION Hospitalist OMT-HF certification may lead to better 30-day outcomes in hospitalized HF patients including quality of life,mortality and readmission rates.Larger prospective studies are warranted to validate these findings.展开更多
Currently,the improvement in AI is mainly related to deep learning techniques that are employed for the classification,identification,and quantification of patterns in clinical images.The deep learning models show mor...Currently,the improvement in AI is mainly related to deep learning techniques that are employed for the classification,identification,and quantification of patterns in clinical images.The deep learning models show more remarkable performance than the traditional methods for medical image processing tasks,such as skin cancer,colorectal cancer,brain tumour,cardiac disease,Breast cancer(BrC),and a few more.The manual diagnosis of medical issues always requires an expert and is also expensive.Therefore,developing some computer diagnosis techniques based on deep learning is essential.Breast cancer is the most frequently diagnosed cancer in females with a rapidly growing percentage.It is estimated that patients with BrC will rise to 70%in the next 20 years.If diagnosed at a later stage,the survival rate of patients with BrC is shallow.Hence,early detection is essential,increasing the survival rate to 50%.A new framework for BrC classification is presented that utilises deep learning and feature optimization.The significant steps of the presented framework include(i)hybrid contrast enhancement of acquired images,(ii)data augmentation to facilitate better learning of the Convolutional Neural Network(CNN)model,(iii)a pre‐trained ResNet‐101 model is utilised and modified according to selected dataset classes,(iv)deep transfer learning based model training for feature extraction,(v)the fusion of features using the proposed highly corrected function‐controlled canonical correlation analysis approach,and(vi)optimal feature selection using the modified Satin Bowerbird Optimization controlled Newton Raphson algorithm that finally classified using 10 machine learning classifiers.The experiments of the proposed framework have been carried out using the most critical and publicly available dataset,such as CBISDDSM,and obtained the best accuracy of 94.5%along with improved computation time.The comparison depicts that the presented method surpasses the current state‐ofthe‐art approaches.展开更多
Background Many studies have indicated that medical therapy and percutaneous coronary intervention have similar effects in terms of the long-term prognosis of patients with stable coronary artery disease. This study i...Background Many studies have indicated that medical therapy and percutaneous coronary intervention have similar effects in terms of the long-term prognosis of patients with stable coronary artery disease. This study investigated the effects of optimal medical therapy （OMT） and revascularization-plus-OMT in elderly patients with high-risk angina. Methods In this prospective non-randomized study, 241 consecutive high-risk elderly male patients （65-92 years of age） with angiographically confirmed multivessel disease were enrolled in the registry from January 2004 to April 2005. Of these, 98 patients underwent OMT and 143 underwent revascularization therapy plus OMT. Results After 6.5 years of follow-up, we found that the rate of long-term cardiac mortality was significantly higher in patients who under- went OMT than in those who underwent revascularization （6.5-year unadjusted mortality rate, 14.3% for OMT vs. 7.0% for revascularization patients; log-rank P = 0.04）. However, the overall risks of major adverse cardiac cerebrovascular events （MACCE） were similar among all patients （6.5-year unadjusted mortality rate, 29.6% for OMT vs. 27.3% for revascularization patients; log-rank P = 0.67）. Conclusions OMT was associated with an increase in cardiac death but a similar 6.5-year risk of MACCE compared with revascularization in high-risk elderly male patients with coronary multivessel disease.展开更多
Objective To analyze the current usage of optimal medical therapy （OMT）, influencing factors, and the predictive value of OMT for all-cause mortality in coronary artery disease （CAD） patients with different subgro...Objective To analyze the current usage of optimal medical therapy （OMT）, influencing factors, and the predictive value of OMT for all-cause mortality in coronary artery disease （CAD） patients with different subgroups. Methods A total of 3176 CAD patients confirmed by coronary angiography were included. OMT was defined as the combination of anti-platelet drugs, statins, beta blockers, and angiotensin converting enzyme inhibitors or angiotensin receptor blockers. Factors for OMT and its prognostic value were analyzed in CAD patients across different subgroups. Results Out of 3176 patients, only 39.8% （n = 1265） were on OMT at discharge. Factors associated with OMT at discharge were pre-admission OMT and discharge department. All-cause mortality occurred in 6.8% （n = 217） of patients. Multivariate analyses indicated that OMT was significantly associated with reduced all-cause mortality （HR： 0.65, 95% CI： 0.45~0.95; P = 0.025）. Sub-group analyses indicate that male acute coronary syndrome （ACS） patients were more likely to receive survival benefits with OMT at discharge. The positive impact of OMT at discharge was more apparent after 24 months, regardless of revascularization therapy. Four-drug combination of OMT was superior to 3-drug combination therapy in ACS patients but not in stable patients. Conclusions OMT was asso- ciated with significant improvement in survival in patients with CAD. The positive impact of OMT was distinct in the CAD patients with different characteristics.展开更多
China＇s Rural Cooperative Medical System collapsed alongside communal farming at the end of the Maoist period in 1976, leaving most farmers vulnerable[1]. In rural areas, where 80% of people have been without health ...China＇s Rural Cooperative Medical System collapsed alongside communal farming at the end of the Maoist period in 1976, leaving most farmers vulnerable[1]. In rural areas, where 80% of people have been without health insurance of any kind, illness has emerged as a leading cause of poverty[24]. To address the poor state of health care among the rural population, in 2003 the Chinese government launched the New Rural Cooperative Medical System （NCMS）,展开更多
Background Percutaneous coronary intervention （PCI） is indicated for angina with coronary stenosis. However, PCI for asymptomatic coronary stenosis remains controversial. We prospectively followed a group of patient...Background Percutaneous coronary intervention （PCI） is indicated for angina with coronary stenosis. However, PCI for asymptomatic coronary stenosis remains controversial. We prospectively followed a group of patients for four years who underwent coronary computed tomography angiography （CCTA） for major adverse cardiac events （MACE）. We hypothesized that the results of this trial would reliably reflect the natural outcome of the coronary disease. Methods Consecutive patients who underwent CCTA from June 2008 to May 2009 were selected. Those who could not be reached by telephone, had significant angina, had CT images that were not interpretable, or poor kidney and left ventricular （LV） function were excluded. The patients were divided into five groups： group A normal CCTA without stenosis, group B mild stenosis （1%-49%）, group C moderate stenosis （50%-74%）, group D severe stenosis （≥75%） and they were treated with optimal medical therapy （OMT） or PCI. The group E had PCI before the CCTA examination. The patients were then followed for MACE after different treatments. MACE included acute myocardial infarction （MI）, heart failure （HF） and death. Results The patient population consisted of 419 patients. The follow-up time was （51±5） months. The age was （60±31） years. Male made up 67.78% of the population （n=284）. A total of 51 cases of MACE occurred including 25 MI, eight HF and 18 all-cause deaths. There was no MACE in group A. Although MACE occurred in two patients in group B, they were not attributed to cardiac death. We further compared the MACE in groups C-E and no significant difference was found （P 〉0.05）. However, a difference was detected among patients with unstable angina pectods （UAP）, stable angina pectoris （SAP）, re-hospitalization, and cerebrovascular events from groups A-E （P 〈0.05）. The plaque scores were used to predict MACE. The scores progressively increased significantly with lesion severity （P 〈0.05）. Receiver operating curve （ROC） was performed to determine the sensitivity and specificity in predicting MACE. Our scores predicted MI with area of 0.76, predicted HF with area of 0.77, and predicted death with area of 0.70. Conclusions Normal and mild lesions had very few events. With increased stenosis the MACE rate increased progressively. PCI did not significantly reduce the MACE in comparison with OMT in asymptomatic patients. Furthermore, UAP, re-hospitalization, and re-PCI were sianificantlv increased in patients who were treated with PCI.展开更多
基金Supported by Houston Methodist DeBakey Heart and Vascular Center Grant.
文摘BACKGROUND Significant gaps in guideline-directed medical therapy(GDMT)for heart failure(HF)stem from shortages of cardiologists and advanced HF providers,as well as a lack of optimal HF management knowledge among hospitalists.This study compared the impact of optimal medical therapy in HF(OMT-HF)certification on GDMT implementation and patient outcomes between an intervention group(IG)of hospitalists and a standard-of-care comparison group(SOC-CG).METHODS This study was implemented from November 2022 to May 2023.Hospitalized car-diology patients with HF and left ventricular ejection fraction≤40%were rando-mized to IG or SOC-CG.Exclusion criteria included patients in cardiogenic shock,unable to consent,or at high risk.Follow-up was at 30 days post-discharge.Diffe-rences between groups were analyzed using Fisher’s exact test for categorical va-riables and Wilcoxon rank-sum or unpaired t-test for continuous variables.Chan-ges in Minnesota Living with Heart Failure Questionnaire(MLWHFQ)scores were evaluated using a paired t-test.RESULTS IG patients had lower readmission rates[9(42.85%)vs 11(17.46%),P=0.03]and a decreased trend in mortality 30-day post discharge.IG patients also showed greater mean improvements in total(-27.03±24.59 vs-5.85±23.52,P<0.001),physical(-13.8±12.3 vs-2.71±11.16,P<0.001)and emotional(-4.76±8.10 vs-1.42±5.98)dimensions on the MLWHFQ compared to SOC-CG,however,change in emotional dimension did not reach statistical significance.CONCLUSION Hospitalist OMT-HF certification may lead to better 30-day outcomes in hospitalized HF patients including quality of life,mortality and readmission rates.Larger prospective studies are warranted to validate these findings.
基金Supporting Project number(PNURSP2023R410)Princess Nourah bint Abdulrahman University,Riyadh,Saudi Arabia.supported by MRC,UK(MC_PC_17171)+9 种基金Royal Society,UK(RP202G0230)BHF,UK(AA/18/3/34220)Hope Foundation for Cancer Research,UK(RM60G0680)GCRF,UK(P202PF11)Sino‐UK Industrial Fund,UK(RP202G0289)LIAS,UK(P202ED10,P202RE969)Data Science Enhancement Fund,UK(P202RE237)Fight for Sight,UK(24NN201)Sino‐UK Education Fund,UK(OP202006)BBSRC,UK(RM32G0178B8).The funding of this work was provided by Princess Nourah bint Abdulrahman University Researchers Supporting Project number(PNURSP2023R410),Princess Nourah bint Abdulrahman University,Riyadh,Saudi Arabia.
文摘Currently,the improvement in AI is mainly related to deep learning techniques that are employed for the classification,identification,and quantification of patterns in clinical images.The deep learning models show more remarkable performance than the traditional methods for medical image processing tasks,such as skin cancer,colorectal cancer,brain tumour,cardiac disease,Breast cancer(BrC),and a few more.The manual diagnosis of medical issues always requires an expert and is also expensive.Therefore,developing some computer diagnosis techniques based on deep learning is essential.Breast cancer is the most frequently diagnosed cancer in females with a rapidly growing percentage.It is estimated that patients with BrC will rise to 70%in the next 20 years.If diagnosed at a later stage,the survival rate of patients with BrC is shallow.Hence,early detection is essential,increasing the survival rate to 50%.A new framework for BrC classification is presented that utilises deep learning and feature optimization.The significant steps of the presented framework include(i)hybrid contrast enhancement of acquired images,(ii)data augmentation to facilitate better learning of the Convolutional Neural Network(CNN)model,(iii)a pre‐trained ResNet‐101 model is utilised and modified according to selected dataset classes,(iv)deep transfer learning based model training for feature extraction,(v)the fusion of features using the proposed highly corrected function‐controlled canonical correlation analysis approach,and(vi)optimal feature selection using the modified Satin Bowerbird Optimization controlled Newton Raphson algorithm that finally classified using 10 machine learning classifiers.The experiments of the proposed framework have been carried out using the most critical and publicly available dataset,such as CBISDDSM,and obtained the best accuracy of 94.5%along with improved computation time.The comparison depicts that the presented method surpasses the current state‐ofthe‐art approaches.
基金This study was supported by the grant from the National Natural Science Foundation of China （No. 81100160, 81470504）. The authors declare no conflicts of interest.
文摘Background Many studies have indicated that medical therapy and percutaneous coronary intervention have similar effects in terms of the long-term prognosis of patients with stable coronary artery disease. This study investigated the effects of optimal medical therapy （OMT） and revascularization-plus-OMT in elderly patients with high-risk angina. Methods In this prospective non-randomized study, 241 consecutive high-risk elderly male patients （65-92 years of age） with angiographically confirmed multivessel disease were enrolled in the registry from January 2004 to April 2005. Of these, 98 patients underwent OMT and 143 underwent revascularization therapy plus OMT. Results After 6.5 years of follow-up, we found that the rate of long-term cardiac mortality was significantly higher in patients who under- went OMT than in those who underwent revascularization （6.5-year unadjusted mortality rate, 14.3% for OMT vs. 7.0% for revascularization patients; log-rank P = 0.04）. However, the overall risks of major adverse cardiac cerebrovascular events （MACCE） were similar among all patients （6.5-year unadjusted mortality rate, 29.6% for OMT vs. 27.3% for revascularization patients; log-rank P = 0.67）. Conclusions OMT was associated with an increase in cardiac death but a similar 6.5-year risk of MACCE compared with revascularization in high-risk elderly male patients with coronary multivessel disease.
文摘Objective To analyze the current usage of optimal medical therapy （OMT）, influencing factors, and the predictive value of OMT for all-cause mortality in coronary artery disease （CAD） patients with different subgroups. Methods A total of 3176 CAD patients confirmed by coronary angiography were included. OMT was defined as the combination of anti-platelet drugs, statins, beta blockers, and angiotensin converting enzyme inhibitors or angiotensin receptor blockers. Factors for OMT and its prognostic value were analyzed in CAD patients across different subgroups. Results Out of 3176 patients, only 39.8% （n = 1265） were on OMT at discharge. Factors associated with OMT at discharge were pre-admission OMT and discharge department. All-cause mortality occurred in 6.8% （n = 217） of patients. Multivariate analyses indicated that OMT was significantly associated with reduced all-cause mortality （HR： 0.65, 95% CI： 0.45~0.95; P = 0.025）. Sub-group analyses indicate that male acute coronary syndrome （ACS） patients were more likely to receive survival benefits with OMT at discharge. The positive impact of OMT at discharge was more apparent after 24 months, regardless of revascularization therapy. Four-drug combination of OMT was superior to 3-drug combination therapy in ACS patients but not in stable patients. Conclusions OMT was asso- ciated with significant improvement in survival in patients with CAD. The positive impact of OMT was distinct in the CAD patients with different characteristics.
文摘China＇s Rural Cooperative Medical System collapsed alongside communal farming at the end of the Maoist period in 1976, leaving most farmers vulnerable[1]. In rural areas, where 80% of people have been without health insurance of any kind, illness has emerged as a leading cause of poverty[24]. To address the poor state of health care among the rural population, in 2003 the Chinese government launched the New Rural Cooperative Medical System （NCMS）,
文摘Background Percutaneous coronary intervention （PCI） is indicated for angina with coronary stenosis. However, PCI for asymptomatic coronary stenosis remains controversial. We prospectively followed a group of patients for four years who underwent coronary computed tomography angiography （CCTA） for major adverse cardiac events （MACE）. We hypothesized that the results of this trial would reliably reflect the natural outcome of the coronary disease. Methods Consecutive patients who underwent CCTA from June 2008 to May 2009 were selected. Those who could not be reached by telephone, had significant angina, had CT images that were not interpretable, or poor kidney and left ventricular （LV） function were excluded. The patients were divided into five groups： group A normal CCTA without stenosis, group B mild stenosis （1%-49%）, group C moderate stenosis （50%-74%）, group D severe stenosis （≥75%） and they were treated with optimal medical therapy （OMT） or PCI. The group E had PCI before the CCTA examination. The patients were then followed for MACE after different treatments. MACE included acute myocardial infarction （MI）, heart failure （HF） and death. Results The patient population consisted of 419 patients. The follow-up time was （51±5） months. The age was （60±31） years. Male made up 67.78% of the population （n=284）. A total of 51 cases of MACE occurred including 25 MI, eight HF and 18 all-cause deaths. There was no MACE in group A. Although MACE occurred in two patients in group B, they were not attributed to cardiac death. We further compared the MACE in groups C-E and no significant difference was found （P 〉0.05）. However, a difference was detected among patients with unstable angina pectods （UAP）, stable angina pectoris （SAP）, re-hospitalization, and cerebrovascular events from groups A-E （P 〈0.05）. The plaque scores were used to predict MACE. The scores progressively increased significantly with lesion severity （P 〈0.05）. Receiver operating curve （ROC） was performed to determine the sensitivity and specificity in predicting MACE. Our scores predicted MI with area of 0.76, predicted HF with area of 0.77, and predicted death with area of 0.70. Conclusions Normal and mild lesions had very few events. With increased stenosis the MACE rate increased progressively. PCI did not significantly reduce the MACE in comparison with OMT in asymptomatic patients. Furthermore, UAP, re-hospitalization, and re-PCI were sianificantlv increased in patients who were treated with PCI.
