Open Heart

ObjectiveTo compare the NHS Health Check Programme with the Polypill Prevention Programme in the primary prevention of heart attacks and strokes. DesignUse of published data and methodology to produce flow charts of the two programmes to determine screening performance and heart attacks and strokes prevented. SettingThe UK population. InterventionThe NHS Health Check Programme using a QRisk score on people aged 40-74 to select those eligible for a statin is compared with the Polypill Prevention programme in people aged 50 or more to select people for a combination of a statin and 3 low dose blood pressure lowering agents. In both programmes people had no history of heart attack or stroke. Main outcome measuresIn 1000 people the number of heart attacks and strokes prevented in the two programmes. ResultsAssuming 100% uptake and adherence to the screening protocol, in every 1000 persons, the NHS Health Check Programme would prevent 287 cases of a heart attack or stroke in individuals who would gain on average about 4 years of life without a heart attack or stroke, the precise gain depending on the extent of treatment for those with raised blood pressure, and 136 would be prescribed statins with no benefit. The corresponding figures for the Polypill Prevention Programme are 316 individuals who would, on average, gain 8 years of life without a heart attack or stroke with 260 prescribed the polypill with no benefit. Based on published estimates of uptake and adherence to of the NHS Health Check programme, only 24 cases per 1000 are currently benefitting instead of 287. This result could be achieved in the Polypill Prevention Programme with just 8% (24/316) of the eligible population taking part. ConclusionsThe Polypill Prevention Programme is by design simpler with the potential of preventing many more heart attacks and strokes; even an uptake of 40% would represent a 5-fold greater preventive effect than the NHS Health Check Programme.

BackgroundAlthough morbidity and mortality from COVID-19 have been widely reported, the indirect effects of the pandemic beyond 2020 on other major diseases and health service activity have not been well described. MethodsAnalyses used national administrative electronic hospital records in England, Scotland and Wales for 2016-2021. Admissions and procedures during the pandemic (2020-2021) related to six major cardiovascular conditions (acute coronary syndrome, heart failure, stroke/transient ischaemic attack, peripheral arterial disease, aortic aneurysm, and venous thromboembolism) were compared to the annual average in the pre-pandemic period (2016-2019). Differences were assessed by time period and urgency of care. ResultsIn 2020, there were 31,064 (-6%) fewer hospital admissions (14,506 [-4%] fewer emergencies, 16,560 [-23%] fewer elective admissions) compared to 2016-2019 for the six major cardiovascular diseases combined. The proportional reduction in admissions was similar in all three countries. Overall, hospital admissions returned to pre-pandemic levels in 2021. Elective admissions remained substantially below expected levels for almost all conditions in all three countries (-10,996 [-15%] fewer admissions). However, these reductions were offset by higher than expected total emergency admissions (+25,878 [+6%] higher admissions), notably for heart failure and stroke in England, and for venous thromboembolism in all three countries. Analyses for procedures showed similar temporal variations to admissions. ConclusionThis study highlights increasing emergency cardiovascular admissions as a result of the pandemic, in the context of a substantial and sustained reduction in elective admissions and procedures. This is likely to increase further the demands on cardiovascular services over the coming years. Key QuestionWhat is the impact in 2020 and 2021 of the COVID-19 pandemic on hospital admissions and procedures for six major cardiovascular diseases in England, Scotland and Wales? Key FindingIn 2020, there were 6% fewer hospital admissions (emergency: -4%, elective: -23%) compared to 2016-2019 for six major cardiovascular diseases, across three UK countries. Overall, admissions returned to pre-pandemic levels in 2021, but elective admissions remained below expected levels. Take-home MessageThere was increasing emergency cardiovascular admissions as a result of the pandemic, with substantial and sustained reduction in elective admissions and procedures. This is likely to increase further the demands on cardiovascular services over the coming years.

BackgroundCardiometabolic morbidity and medications, specifically Angiotensin Converting Enzyme inhibitors (ACEi) and Angiotensin Receptor Blockers (ARBs), have been linked with adverse outcomes from coronavirus disease 2019 (COVID-19). This study aims to investigate factors associated with COVID-19 positivity for the first 669 UK Biobank participants; compared with individuals who tested negative, and with the untested, presumed negative, rest of the population. MethodsWe studied 1,474 participants from the UK Biobank who had been tested for COVID-19. Given UK testing policy, this implies a hospital setting, suggesting at least moderate to severe symptoms. We considered the following exposures: age, sex, ethnicity, body mass index (BMI), diabetes, hypertension, hypercholesterolaemia, ACEi/ARB use, prior myocardial infarction (MI), and smoking. We undertook comparisons between: 1) COVID-19 positive and COVID-19 tested negative participants; and 2) COVID-19 tested positive and the remaining participants (tested negative plus untested, n=501,837). Logistic regression models were used to investigate univariate and mutually adjusted associations. ResultsAmong participants tested for COVID-19, non-white ethnicity, male sex, and greater BMI were independently associated with COVID-19 positive result. Non-white ethnicity, male sex, greater BMI, diabetes, hypertension, prior MI, and smoking were independently associated with COVID-19 positivity compared to the remining cohort (test negatives plus untested). However, similar associations were observed when comparing those who tested negative for COVID-19 with the untested cohort; suggesting that these factors associate with general hospitalisation rather than specifically with COVID-19. ConclusionsAmong participants tested for COVID-19 with presumed moderate to severe symptoms in a hospital setting, non-white ethnicity, male sex, and higher BMI are associated with a positive result. Other cardiometabolic morbidities confer increased risk of hospitalisation, without specificity for COVID-19. Notably, ACE/ARB use did not associate with COVID-19 status.

BackgroundCardiac rehabilitation (CR) uptake for heart failure (HF) in the UK remains low at around 15%, with evidence of disparities based on sex, ethnicity, socioeconomic status, availability of staffing and financial constraints. We analysed data from the Pumping Marvellous Foundation online home CR programme to understand who accesses this service and whether inequities persist, to help guide strategies to achieve equitable rehabilitation delivery. MethodsThe PMF online home CR platform was launched in August 2024 along with an educational booklet available for order (at no cost) by HF or CR teams. We analysed anonymised data (n=673) of registrants from August 2024 to July 2025. Variables analysed included demographics, ethnicity, deprivation index, HF type based on ejection fraction, referral source, time since diagnosis and prior CR participation. We also analysed CR booklet orders and assessed correlation with HF admissions as per national HF audit data. Descriptive statistics summarised distributions. Results673 participants (median age 62 years; IQR 18 to 90 years, 12% aged >76 years) registered for the online CR classes from August 2024 to July 2025. The majority (63%) were women, and 6% were from minority ethnic communities. 35% of registrants had either mildly reduced (HFmrEF) or preserved (HFpEF) ejection fraction. 30% of referrals were from HF or CR teams, 29% obtained information via social media, and around 25% obtained information directly from PMF groups. There were also direct referrals from GPs (4%) and around 10% obtained referral information via Google search or YouTube. Analysis of the time since HF diagnosis demonstrated late entry to CR: 343 (51%) registered >12 months post-diagnosis, 88 (13%) within 3 months, and 130 (19%) within 6 to 12 months. Only 38 (6%) reported any prior CR participation. We also correlated CR booklet orders from hospitals with National HF Audit HF admissions. Within the limitations of the spread of the scatter, there was a general positive relationship: hospitals with more HF admissions tended to order more booklets. 33% of registrants came from the top 20 most deprived cities in England. ConclusionsBy providing free lifetime access to online cardiac rehabilitation, widening the access of cardiac rehab to more women and people without access to standard cardiac rehabilitation (due to staffing, cost constraints, accessibility issues) and reaching areas with socio-economic deprivation, the PMF online cardiac rehab platform can help to increase CR uptake and reduce the inequity in access to CR in the UK.

Background: Public and clinical attention to postural orthostatic tachycardia syndrome (POTS) has increased, particularly since the COVID-19 pandemic. We quantified changes in United Kingdom Google search interest and examined whether searches increasingly used diagnostic and self-assessment language. Methods: We extracted monthly Google Trends relative search volume (RSV; 0-100) for the Health-category search term 'Pots syndrome' in the United Kingdom from January 2004 through July 2026. Five extraction attempts were made; two returned complete, identical monthly series and were retained. Prespecified eras were summarised and an exploratory interrupted time-series model at March 2020 used ordinary least squares with Newey-West heteroskedasticity and autocorrelation consistent standard errors (12 lags). Comparator searches included conventional orthostatic diagnoses, POTS diagnostic terms, associated conditions and YouTube searches. Results: The primary series comprised 271 complete months. Mean RSV increased from 18.6 during 2015-2019 to 64.8 during 2022-2023 (3.49-fold) and remained 50.6 during January 2024-July 2026 (2.73-fold above baseline). Search interest peaked in October 2022 (RSV 100); July 2026 RSV was 57. The interrupted time-series model estimated an immediate March 2020 level increase of 21.8 points (95% CI 2.8-40.7; p=0.024), while the slope change was not statistically supported (0.069 points/month, 95% CI 0.299 to 0.438; p=0.713). Searches for 'POTS symptoms', 'POTS test' and 'POTS heart rate' increased more steeply than the general term, although low baseline volumes made fold changes unstable. Conclusions: UK Google search interest in POTS rose before 2020, increased sharply after the pandemic began, and remained substantially above its prepandemic baseline. The results demonstrate a sustained change in public attention, not disease incidence or social-media causation. The growth of symptom- and testing-oriented searches is compatible with increased diagnostic self-investigation and warrants linkage to referral, diagnosis and social-media exposure data.

Background: Given around 50% of people with heart failure have a degree of iron deficiency, guidelines recommend screening. It is uncertain to what extent this is done in primary care and whether testing is equitable. Aim: To report the proportion of people with incident heart failure who undergo a ferritin test within 12 months. Design and setting: Retrospective primary care cohort study using Clinical Practice Research Datalink Aurum data, between 2016 and 2021. Methods: We report the proportion of adults with an incident diagnosis of heart failure who received a ferritin test within 12 months. Multivariable logistic regression was used to examine the odds of testing based on key demographic covariates and co-morbidities. Results: Among 105,749 individuals with an incident diagnosis of heart failure (mean age 71.6 years, SD 14.3), only 35,688 (33.7%) received a ferritin test within the subsequent year. Increasing age (odds ratio 1.25 per 10-year increase, 95% CI: 1.24-1.27), female sex (male sex OR 0.86, 0.84-0.89) and Asian ethnicity (OR 1.70, 1.59-1.80) were all associated with increased odds of testing as were diagnoses of coeliac disease (OR 1.86, 1.58-2.21), type 1 diabetes (OR 1.82, 1.51-2.19) and cirrhosis (OR 1.64, 1.43-1.87). There was geographic variation in testing, even in adjusted analyses. Conclusion: In a large primary care dataset, two thirds of people with incident heart failure did not receive a ferritin test for iron deficiency within a year of diagnosis demonstrating a gap in current practice and an opportunity for improvements in service delivery.

Aims: Iron deficiency is common among people with heart failure and associated with morbidity and mortality. While intravenous iron improves clinical outcomes, oral iron continues to be prescribed in routine practice despite limited evidence of benefit. Methods: We completed a retrospective primary care cohort study (2016 to 2021) to investigate the proportion of people with an incident diagnosis of heart failure who had iron deficiency identified (defined as ferritin <100 micrograms/L) and subsequently received a first prescription for oral iron within 12 months. Multivariable logistic regression was used to report the odds ratio (OR) of receiving oral iron in relation to key demographic covariates and co-morbidities. Results: Among 105,749 people with an incident diagnosis of heart failure, 35,688 underwent a ferritin test within the first year of whom 11,237 had iron deficiency and no prior prescription for oral iron. Of these, 2,734 (24.3%) were subsequently prescribed oral iron. Increasing age (OR per 10-year increase 1.14, 95%CI: 1.10-1.19), Asian ethnicity (1.33, 1.08-1.64), cirrhosis (2.01, 1.29-3.14) and diabetes (1.36, 1.24-1.49) were associated with increased odds of receiving oral iron. Among 1,357 (49.6%) people who had their ferritin level re-tested, the median change was 26 micrograms/L (interquartile range 7 to 61) among people who were prescribed oral iron compared to 4 micrograms/L (IQR -9 to 34) among people not prescribed oral iron. Conclusions: One in four individuals with heart failure and low ferritin received oral iron replacement, despite this not being recommended in international guidelines. Treatment could be improved and standardised in primary care.

Background and aimsEvidence of the impact of frailty on oral anticoagulant (OAC) prescription in older people with atrial fibrillation (AF) is conflicting. This study aimed to examine the prevalence of frailty in hospitalised older patients with AF and its relationship with OAC prescription during admission. The secondary aim was to examine the association between frailty and rate/rhythm control medication prescriptions. MethodsThis retrospective observational study included adults aged [&ge;]65 with AF admitted to six hospitals in Australia in 2022. Frailty was defined by a Frailty Index [&ge;]0.25. Logistic regression models were applied to examine the association between frailty and the prescriptions of OAC, rate-control and rhythm-control drugs during hospitalisation. Results are presented as odds ratios and 95% confidence intervals (CI). ResultsThere were 685 patients, with a mean age of 82.6(SD 8.3), 49.8% female and 42.8% identified as frail. Overall, 75.6% were prescribed OAC (67.9% in the frail versus 81.4% in the non-frail, p<0.001), 37.7% received rate-control drugs (42.0% in the frail versus 34.4% in the non-frail, p=0.044), 27.3% received rhythm-control drugs (22.9% in the frail versus 30.6% in the non-frail, p=0.024). The adjusted odds ratios of frailty on prescriptions were 0.58 (95% CI 0.39-0.86) for OAC, 1.75 (95%CI 1.22-2.52) for rate-control drugs, and 0.83 (95%CI 0.55-1.24) for rhythm-control drugs. ConclusionsThe study revealed a high prevalence of frailty in older inpatients with AF. Frailty was associated with reduced likelihood of prescription of OAC during admission and increased likelihood of prescribing rate-control medications, with no independent impact on rhythm-control therapy. Further studies are needed to understand these prescribing patterns.

Background: Atrial high-rate episodes (AHRE) detected by cardiac implantable electronic devices (CIEDs) are associated with increased thromboembolic risk, yet their clinical significance and optimal anticoagulation strategy remain uncertain, particularly in the absence of electrocardiogram (ECG)-confirmed atrial fibrillation. Methods: We conducted a nationwide cross-sectional survey of UK clinicians involved in CIED follow-up. The survey assessed anticoagulation decision-making in AHRE, including episode-duration thresholds, cumulative burden, CHA2DS2-VA use, additional ECG monitoring, and anticoagulant choice. Only responses from UK-based consultant clinicians were included and analysed descriptively. Results: A total of 51 responses were received; 38 met the inclusion criteria and were analysed. Most respondents (86.8%) reported having reviewed AHRE alerts within the preceding six months, indicating that AHRE are commonly encountered in clinical practice. A [&ge;]24-hour episode was the most common threshold for anticoagulation (44.7%), although many clinicians reported lower thresholds or individualised approaches. Nearly half (44.7%) did not consider cumulative AHRE burden in decision-making. CHA2DS2-VA thresholds also varied, most commonly [&ge;]2 or [&ge;]1. Additional ECG monitoring was infrequently performed. Direct oral anticoagulants were universally preferred, with apixaban the most commonly selected agent (73.7%). Conclusion: There is substantial variation in UK clinical practice regarding anticoagulation for AHRE, reflecting ongoing uncertainty and lack of clear guidance. These findings highlight the need for evidence-based thresholds to support consistent and informed clinical decision-making.

Importance: Autistic people have increased risks of cardiometabolic conditions and premature mortality; however, no studies specifically assess risks of major ischaemic events in the autistic population. Objective: To determine whether autistic people are at increased risk of major ischaemic events after accounting for known risk factors. Design: A retrospective matched cohort study from 1/1/1990 to 31/12/2019. Cox regression models accounting for matching factors, sociodemographic characteristics, intellectual disability, and cardiovascular risk factors were employed. Setting: This population-based study leveraged lifetime primary and secondary care electronic health records from the Clinical Practice Research Datalink and Hospital Episode Statistics, as well as sociodemographic, ethnicity, and death registration data from the Office of National Statistics. Participants: 23,612 autistic people were matched 1:5 on birth year (+/-2 years), general practitioner practice ID, and gender to 118,060 non-autistic people. Autistic people were defined as those with a clinical autism diagnosis recorded during the study period. Patients missing Indices of Multiple Deprivation and ethnicity data, and an end date prior to their CPRD start date were excluded along with their matched set. Exposure: Clinical diagnosis of autism. Secondary exposures included health conditions associated with cardiovascular disease with some additional conditions relevant to autism. Main Outcome and Measures: Time to first major ischaemic event (any of myocardial infarction, angina, other ischaemic heart disease, ischaemic stroke, and transient ischaemic attacks). Results: Autistic people had a greater risk of a major ischaemic event in the study period in the minimally adjusted Model 1 (HR 1.19; 95% CI: 1.00, 1.42) as well as for autistic females even after accounting for risk factors (adjusted HR 1.71; 95% CI: 1.10, 2.67). There was also evidence that several cardiometabolic risk factors had a higher prevalence among the autistic group such as severe mental illness, dyslipidaemia, and obesity (all P<0.001). Conclusions and Relevance: Autistic people have an increased risk of major ischaemic events and need improved cardiometabolic risk management. This risk remained in autistic women after adjusting for cardiometabolic and sociodemographic factors. As cardiovascular disease is a primary cause of death globally, research is needed to better understand the mechanism that drives this association.

ObjectiveThe aim of this study is to understand stakeholder experiences of cardiovascular disease (CVD) diagnosis to support the development of technological solutions that meet current needs. Specifically, we aimed to identify challenges faced by stakeholders in the process of diagnosis of CVD; to identify discrepancies between patient and clinician experiences of CVD diagnosis, and to make recommendations for the requirements of future health technology solutions intended to improve CVD diagnosis. DesignThe qualitative data was obtained using semi-structured focus groups and 1-1 interviews. ParticipantsUK-based individuals (N = 32) with lived experience of diagnosis of CVD (n = 23) and clinicians with experience in diagnosing CVD (n = 9). ResultsThematic analysis of focus groups and interview transcripts produced four key themes related to challenges contributing to delayed or inaccurate diagnosis of CVD: Symptom Interpretation, Patient Characteristics, Patient-Clinician Interactions, and Systemic Challenges. Sub-themes from each theme are discussed in depth. ConclusionsChallenges related to time and communication were greatest for both stakeholder groups, however there were differences in other areas, for example patient experiences highlighted difficulties with the psychological aspects of diagnosis and interpreting ambiguous symptoms, while clinicians emphasised the role of individual patient differences and the lack of rapport in contributing to delays or inaccurate diagnosis. Key takeaways from this qualitative study were summarised into a table of considerations to highlight key areas that require prioritisation for future research aiming to improve the efficiency and accuracy of CVD diagnosis using digital technologies.

Inhibitors of the Renin-Angiotensin-Aldosterone System (RAAS) notably Angiotensin-Converting Enzyme inhibitors (ACEi) or Angiotensin Receptor Blockers (ARB) have been scrutinised in hypertensive patients hospitalised with coronavirus disease 2019 (COVID-19) following some initial data they might adversely affect prognosis. With an increasing number of COVID-19 cases worldwide and the likelihood of a "second wave" of infection it is imperative to better understand the impact RAAS inhibitor use in antihypertensive covid positive hospitalised patients. A systematic review and meta-analysis of ACEi or ARB in patients admitted with COVID-19 was conducted. PubMed and Embase were searched and six studies were included in the meta-analysis. Pooled analysis demonstrated that 18.3% of the patients admitted with COVID-19 were prescribed ACEi/ARBs (0.183, CI 0.129 to 0.238, p<0.001). The use of RAAS inhibitors did not show any association with critical events (Pooled OR 0.833 CI 0.605 to 1.148, p=0.264) or death (Pooled OR 0.650, CI 0.356 to 1.187, p=0.161). In conclusion, our meta-analysis including critical events and mortality data on patients prescribed ACEi/ARB and hospitalised with COVID-19, found no evidence to associate ACEi/ARB with death or adverse events.

BackgroundHeart valve disease can result in high morbidity and impairment of quality of life (QOL) both before and after intervention. However, there are few descriptions of the QOL of people with heart valve disease across the disease course. AimsWe aimed to describe the QOL of people living with heart valve disease through qualitative interviews. MethodsSemi-structured interviews were conducted in people with heart valve disease, their family members, and clinical experts. A simple thematic analysis was used to summarise their perceptions of QOL. ResultsWe interviewed 34 people with heart valve disease: seven with aortic stenosis, seven with rheumatic heart disease involving the mitral valve, nine with mitral regurgitation, and 11 with valve replacement/repair (mean age 66, 56% female). Three family members and five clinical experts were also interviewed. A key contributor to QOL was fatigue: most participants experienced fatigue, even mild fatigue impaired QOL directly, and severe fatigue had devastating effects on quality of life. Physical limitations impaired QOL due to the loss of normal activity rather than objective physical limitation. Symptoms of heart valve disease impaired QOL directly, but the indirect effects of valve disease inspiring worry that reduced confidence and activity led to greater impairment. ConclusionsFatigue both before and after valve intervention is a contributor to QOL and requires further assessment. Research is recommended into whether fatigue is a specific enough symptom to warrant valvular intervention in heart valve disease.

BACKGROUNDThe social media site Twitter has been widely embraced in medical circles for its ability to connect individuals and support rapid information sharing. Critics say that the messages shared may not accurately reflect what was said and that sharing meeting content could devalue conferences themselves. It is unclear how it is used at SSIEM and what value it may bring. METHODSTwitters tweetdeck software was used to find all tweets containing the conference hashtag #SSIEM2018. All tweets were reviewed to identify the author, see what had been shared and count replies, likes and retweets. Authors were grouped by professional background and tweet content was broken down by type of material shared and theme. RESULTS122 relevant tweets were sent during the fortnight at the beginning of September 2018, creating over 400,000 impressions. There were a further 73 replies with approximately 13 engagements (likes, replies or retweets) per tweet. 36 people wrote tweets (rate: 3.4 per person [1-33]). One quarter of the tweets shared poster content and over one third of tweets related to Phenylketonuria materials. 50 of the tweets were produced by just two accounts, both intended to provide information to patients and their families. DISCUSSIONTweets where no hashtag was used cannot be identified and restrictions within Twitter prevent certain analyses on tweet data greater than 30 days old. However, Twitter uptake within metabolic medicine is significantly behind other specialities where conference tweets can exceed 20,000. Information shared is typically intended for patients rather than other health professionals; this suggests a different uptake to more mainstream specialities. Presenting teams should be aware that their work may be received directly by patients and families and consider how best to present their messages for all who may receive them.

BackgroundThe Covid-19 pandemic has affected human behaviour and burdened health systems and has thus had an impact on other health outcomes. ObjectiveThis paper studies whether there was a decrease in cardiac surgery operations in Greece during the first wave of the Covid-19 pandemic. Data and MethodsWe used data from 7 major hospitals that geographically cover about half the country and more than half the population, including a mix of public, private, military and childrens hospitals. We used a difference-in-differences econometric approach to compare trends in cardiac surgery before and after the pandemic in 2020, to the same months in 2019, controlling for seasonality and unemployment, and using hospital fixed effects. ResultsWe found that during the first wave of the pandemic and the associated lockdown, there were 35-56% fewer cardiac surgery operations compared to what we would have expected in the absence of the pandemic. ConclusionsThere was a steep decline in Cardiac surgery operations in Greece during the first wave of the Covid-19 pandemic. Possible reasons may include people not seeking medical attention to avoid the risk of catching Covid-19; fewer referrals; and working from home, thus not being exposed to a stressful work environment or commute.

Introduction: Shared medical appointments (SMAs) are medical visits where multiple individuals are seen together in a group setting. For patients with inherited cardiovascular disease, where multiple family members often require ongoing cardiac care and screening, family SMAs may be particularly valuable as a tool to facilitate family communication and comprehension of their condition. This research aimed to identify patient perspectives on the potential benefits and challenges of family SMAs in comparison to an existing individual clinic model. Methods: Qualitative semi-structured interviews were conducted with adult family representatives. Each family had at least one family member seen at the adult and pediatric inherited cardiovascular disease clinics. Interview recordings were transcribed verbatim and inductively coded using a content analysis approach. Results: Sixteen families were interviewed in this study. The mean age of the family representative interviewed was 43.4 years ({+/-} 9.3 SD), and they were followed at Stanford Health Care for a mean of 7.3 years ({+/-} 4.2 SD). 81.2% (13/16) of families said they would find family SMAs beneficial. For interested families who consented to recorded interviews (n=12), benefits and challenges fell into two major categories: care quality and access and logistics. Interested families thought family SMAs would provide an added care quality benefit by increasing understanding among adults, children, and providers (83.3%, 10/12). Six of twelve participants interested in having family SMA visits felt there would be logistical/access-based benefits to this new model (50%, 6/12). Families also identified possible challenges with this model, such as less individualized care, potential privacy concerns, and concerns regarding the smoothness of the clinic process in coordinating a family SMA. Conclusion: The majority of families believed a family SMA model would provide added benefit to families with inherited cardiovascular disease, but requires thoughtful implementation and should be tailored to families? unique needs.

This study aimed to evaluate the types, frequency, severity, and contributing factors of medication errors associated with anticoagulants in a tertiary care hospital in Saudi Arabia, with particular focus on identifying patterns across different anticoagulant types and patient characteristics. A retrospective cohort study was conducted analyzing 630 anticoagulant-related medication errors reported between January 2021 and December 2023 at the Armed Forces Hospital Southern Region. Data were extracted from the hospitals electronic reporting systems (Datix and Intervention systems). Errors were classified according to type, subtype, severity (using the NCC MERP index), and contributing factors. Statistical analyses included descriptive statistics and logistic regression to identify associations between patient characteristics and error patterns. A total of 650 medication errors were reported during the study period. Prescribing errors were the most prevalent type (72.4%), with incorrect dosing being the predominant subtype (61.3%). Enoxaparin was associated with the highest number of errors (51.2%), followed by apixaban (25.2%) and warfarin (18.2%). The majority of errors (91.4%) were classified as category B (reached the patient but caused no harm). Elderly patients (70-84 years) experienced the highest frequency of errors, with a significant association between advanced age and error severity (OR 1.42 per decade increase, 95% CI: 1.28-1.57, p<0.001). Lack of knowledge (39.7%) and monitoring failure (33.4%) were identified as the primary contributing factors, with distinct patterns observed across different anticoagulants and error types. Anticoagulant-related medication errors remain a significant patient safety concern, with prescribing errors and incorrect dosing being particularly prevalent. Targeted interventions addressing knowledge gaps, monitoring processes, and the unique challenges of anticoagulant management in elderly patients are needed to enhance medication safety and improve patient outcomes.

BackgroundHigher rates of venous and arterial thromboembolism have been noted in coronavirus disease-2019 (COVID-19). There has been limited research on the impact of anticoagulant and antiplatelet choice in COVID-19. MethodsThis was a single-centre retrospective cohort study of 933 patients with COVID-19 infection presenting between 01/02/2020 and 31/05/2020. Survival time at 90 days post-diagnosis and thromboembolism development were the measured outcomes. ResultsOf 933 total patients, mean age was 68 years and 54.4% were male. 297 (31.8%) did not survive at 90 days. A Cox proportional hazards model analysis found no statistically significant relationship between anticoagulant or antiplatelet choice and survival (p<0.05). 57 (6.3%) developed thromboembolism. Antiplatelet choice was not shown to have a statistically significant relationship with thromboembolism development. Warfarin and direct oral anticoagulant (DOAC) use did not have a statistically significant impact on thromboembolism development (p<0.05). Therapeutic low-molecular-weight heparin (LMWH) use was associated with increased thromboembolism risk (Odds ratio = 14.327, 95% CI 1.904 - 107.811, p = 0.010). ConclusionsAntiplatelet choice was shown to have no impact on survival or thromboembolism development in COVID-19. Anticoagulant choice did not impact survival or thromboembolism development, aside from LMWH. Therapeutic LMWH use was associated with increased risk of thromboembolism. However, it should be noted that the sample size for patients using therapeutic LMWH was small (n=4), and there may be confounding variables affecting both LMWH use and thromboembolism development. These findings should be repeated with a larger sample of patients using therapeutic LMWH with additional adjustment for cofounding variables.

ObjectivesCoronavirus Disease 2019 (COVID-19) is a rapidly expanding global pandemic resulting in significant morbidity and mortality. COVID-19 patients may present with acute myocardial infarction (AMI). The aim of this study is to conduct detailed analysis on patients with AMI and COVID-19. MethodsWe included all patients admitted with AMI and actively known or found to be COVID-19 positive by PCR between the 4th February 2020 and the 11th June 2020 in the State of Qatar. Patients were divided into ST-elevation myocardial infarction (STEMI) and Non-STE (NSTEMI). ResultsThere were 68 patients (67 men and 1 woman) admitted between the 4th of February 2020 and the 11th of June 2020 with AMI and COVID-19. The mean age was 49.1{+/-}9 years, 46 patients had STEMI and 22 had NSTEMI. 38% had diabetes mellitus, 31% had hypertension, 16% were smokers, 13% had dyslipidemia, and 14.7% had prior cardiovascular disease. Chest pain and dyspnea were the presenting symptoms in 90% and 12% of patients, respectively. Fever (15%) and cough (15%) were the most common COVID-19 symptoms, while the majority had no viral symptoms. Thirty-nine (33 STEMI and 6 NSTEMI) patients underwent coronary angiography, 38 of them had significant coronary disease. In-hospital MACE was low; 1 patient developed stroke and 2 died. ConclusionContrary to previous small reports, in-hospital adverse events were low in this largest cohort of COVID-19 patients presenting with AMI. We hypothesize patients demographics and profile including younger age contributed to these findings. Further studies are required to confirm this observation. Key questionsO_ST_ABSWhat is already known on this subject?C_ST_ABSO_LICOVID-19 patients may present with acute myocardial infarction (AMI). C_LI What might this study add?O_LIContrary to previous small reports, most COVID-19 patients presenting with AMI have significant obstructive coronary artery disease and favorable in-hospital outcome. C_LI How might this impact on clinical practice?O_LICOVID-19 patients presenting with AMI should be treated according to the standard practice. C_LI

BackgroundBystander cardiopulmonary resuscitation (CPR) plays a significant role in survival from out-of-hospital cardiac arrest (OHCA). This study aimed to assess whether bystander CPR differed by patient sex among bystander-witnessed arrests. MethodsData on all OHCAs attended by New South Wales (NSW) paramedics between January 2017 and December 2019 was obtained from the NSW Public Health Risks and Outcomes Registry (PHROR). This observational study was restricted to bystander-witnessed cases with presumed medical aetiology. OHCA from arrests in aged care, medical facilities, and cases with an advance care directive (do-not-resuscitate) were excluded. Multivariate logistic regression was used to examine the association of patient sex with bystander CPR. Secondary outcomes were OHCA recognition, bystander AED applied, initial shockable rhythm, and survival outcomes. ResultsAmong the 4,491 bystander-witnessed cases, females were less likely to receive bystander CPR in both private residential (Adjusted Odds ratio [AOR]: 0.82, 95%CI: 0.70-0.95) and public locations (AOR: 0.58, 95%CI:0.39-0.88). Recognition of OHCA in the emergency call was lower for females, particularly in those who arrested in public locations (84.6% vs 91.6%-males, p=0.002) and it partially explained the association of sex with bystander CPR ([~]44%). There was no significant difference in OHCA recognition by sex for arrests in private residential locations (p=0.2). Females had lower rates of bystander AED use (4.8% vs 9.6%, p<0.001) however, after adjustment for arrest location and other covariates, this relationship was attenuated and no longer significant (AOR: 0.83, 95%CI: 0.60-1.12). Females were significantly less likely to record an initial shockable rhythm (AOR: 0.52, 95%CI: 0.44-0.61). Although females had greater odds of event survival (AOR: 1.34, 95%CI: 1.15 - 1.56), there was no sex difference in survival to hospital discharge (AOR: 0.96, 95%CI: 0.77-1.19). ConclusionOHCA recognition and bystander CPR provision differs by patient sex in NSW. Given their importance to patient outcomes, research is needed to understand why this difference occurs and to raise awareness of this issue to the public. CLINICAL PERSPECTIVEO_ST_ABSWhat is new?C_ST_ABSO_LIFemale OHCA patients in New South Wales, Australia were less likely to receive bystander CPR, irrespective of arrest location. C_LIO_LIIn public locations, recognition of OHCA during the emergency call was lower in women and this partly explained the observed sex difference in bystander CPR provision. C_LI What are the clinical implications?O_LIPublic education campaigns and training programs that address bystander response should consider sex differences as a potential barrier to bystander CPR in OHCA C_LIO_LIFuture research that examines reasons for lower rates of bystander response in women and ways of addressing this barrier could help address sex disparities in the future. C_LI