Electronic Devices Research Articles

Crystallite size and phase purity in Pb1-xSrxTiO3 ferroelectric perovskites for biomedical applications via controlled sintering

ABSTRACT Lead strontium titanate (Pb1-xSrx)TiO3 (PST) is a ferroelectric perovskite material with tunable properties, including Curie temperature, spontaneous polarization, and high dielectric permittivity, making it promising for advanced biomedical applications, such as biosensors, bioimaging, and light-activated therapeutics. This study investigates the effect of varying sintering temperatures on the crystallite size and phase purity of PST, aiming to optimize its performance for biomedical devices. PbCO3, SrCO3, and TiO2 powders were processed via ball milling for 58 hours, followed by sintering at temperatures ranging from 500°C to 1100°C. Laser diffraction particle size analysis and X-ray diffraction (XRD) were used to assess the particle size and crystal phase transformations. The results demonstrate that higher sintering temperatures improve the PST phase composition, reducing impurities and enhancing crystallite growth. The most significant crystal growth was observed at 900°C, while the optimal phase purity and crystallite size (91.5 nm) were achieved at 1100°C, producing 100% single-phase PST. These findings emphasize the critical role of sintering temperature in tailoring PST’s properties, enhancing its suitability for electronic and microelectronic biomedical devices. Controlled sintering in perovskite materials opens new pathways for their application in medical diagnostics and therapeutic technologies.

Carbon nanostructures for high-frequency line-filtering supercapacitors

Supercapacitors (SCs) are considered one of the front-runner energy storage devices for future electronic and automobile device applications. Even though their high-power densities, fast charge/discharge, and long cycling stabilities make them promising for future applications, their charge-discharge takes place below 1 Hz, a major issue for using them as capacitors for line filtering applications. Therefore, developing ultrafast electrochemical supercapacitors with alternating current (AC) line filtering functions has gained research attention to replace conventional aluminum electrolytic capacitors (AEC). Most available SCs possess resistive features rather than capacitive at 120 Hz because of the electrode geometry and configurations, which is a bottleneck in the research of line-filtering SCs. Addressing this challenge could be possible by developing novel electrode materials using hybrid nanostructures to meet the critical requirements for line filtering functions. This mini-review focuses on the advancement and challenges of carbon nanostructure-based electrode materials for AC line filtering applications and the future directions of this growing research area.

Experiences from the European Region: case studies and scenarios to inform ways forward in digital health

Abstract Member States in the WHO European Region face similar challenges when it comes to strengthening their HIS and implementing digital health solutions. From WHO/Europe’s work with its Member States, several important preconditions have become apparent for successful and sustainable digital transformation. Firstly, the importance of recognising that implementing digital tools is not a one-off investment, but that this takes a long-term vision including long-term budgeting. Having business continuity plans also is a key element of sustainable implementation of digital tools, that is often not adequately addressed in practice. Secondly, the importance of comprehensive strategic planning. Implementing digital tools is not only about software and hardware, but also about people and processes. Here it is also crucial for policymakers to understand that, to be able to harvest the benefits of data that are gathered by means of digital tools, resources for data processing and analysis also need to be made available. Last but not least, an important precondition for successful digital transformation is stakeholder involvement. Often, new software is developed without adequately involving the end-user, resulting in for example apps that do not meet patients’ needs. Or in electronic health record systems that are not user-friendly for the healthcare staff that need to enter the data, with incomplete and low quality information as a consequence. Stakeholder involvement is essential in strategic planning for digital health as well. Think for example about standardization and accreditation agencies, and institutes that will be secondary users of data for statistics and research. In this presentation, several case studies from across the European Region will be presented, illustrating how digital transformation in health can be successfully and sustainably implemented.

Large scale public health system transformation: Germany

Abstract The COVID-19 pandemic was a stress test for public health services in Germany. Decision making was complex (party lengthy and inconsistent) due to the divided responsibilities within the federal system. Some improvements on the public health system were already enacted during the pandemic. A “pandemic radar” was established to bundle up relevant infectious disease indicators with indicators of health services use. The national electronic notification and information system for infectious diseases was extended. Digital improvements were made in the public health offices. Laboratory capacity was strengthened, so was inter-science modelling to forecast pathogen spread. A nation-wide collaborative mechanism, the cloverleaf system, was introduced between regions to avoid the overburdening of hospitals. It is now established for times of excess need for inpatient services. In 2020, a 4 billion euros investment program, the “Pact of Public Health Services”, was adopted to strengthen and modernize the German public health service institutions. The pact is implemented until 2026. The human resources component is the largest. Further priorities include digitalization, improvement of the infrastructure (of designated ports and airports) for the implementation of the International Health Regulations, research and the creation of agile and resilient public health structures. Outputs so far include the establishment of more than 4800 new public health positions, the appointment of new professorships for public health services, the initiation of several research projects, and the roll-out of more than 300 digitalization projects. A new federal institute for prevention is planned. It aims to foster networking between public health services, strengthen health communication, data use, and evidence for public health services. In this process, WHO advised the federal ministry e.g. on behavioral insights; heat health action; prevention on noncommunicable diseases and others. Many public health actors have provided opinions. However, consensus building on how Germany can overcome fragmentation in public health is ongoing.

Intermittent Flow Control Schemes for Heat Stress Mitigation in Lactating Sows on a Floor Cooling Pad

The Purdue hog cooling pad has previously been demonstrated to mitigate heat stress in lactating sows by conductively transferring heat from a sow to cool water running through an integral heat exchanger. Coolant effectiveness, which describes how much heat is removed per volume of water flushed through the cooling pad, is used to compare the operation under varying conditions. Past studies have indicated that the intermittent flow of cooling water achieves a greater coolant effectiveness than continuous flow operational schemes. An electronic control system was implemented with the current cooling pad design to allow for the automated control of a solenoid valve to create the intermittent flow conditions. All testing was performed using 18 ± 1 °C inlet water. Potential control schemes were categorized into two groups, temporal and temperature threshold. The temporal schemes opened the solenoid for 30 s, enough time to flush the entire contents of the cooling coils, before closing for 3, 6, or 9 min. The temperature threshold control schemes utilized feedback from thermal probes embedded beneath the surface of the cooling pad to open the solenoid for 30 s, when a maximum surface temperature was detected. Trigger temperatures of 28.0, 29.5, or 31.0 °C were used. The temperature threshold control schemes achieved greater heat transfer rates (348, 383, 268 W) compared to the temporal control schemes (324, 128, 84 W). The cooling effectiveness for all control schemes ranged from 46.6 to 64.7 kJ/L. The tested intermittent flow control schemes in this study achieved greater cooling effectiveness than continuous flow systems from previous studies (time: 51 kJ/L; temperature: 61 kJ/L; steady: 5.8 kJ/L), although the temporal control schemes exhibited lower heat transfer rates (time: 180 W; temperature: 330 W; steady: 305 W).

Prevalence of E-Cigarettes in Children and Adolescents: A Failure of Public Health Prevention

The rising prevalence of e-cigarette use among children and adolescents poses a significant challenge to public health prevention efforts. As these electronic nicotine delivery systems gain popularity among youth, concerns about the health impacts and long-term consequences have escalated. In this article, we delve into the concerning trends of e-cigarette use among the younger population, exploring the factors driving this phenomenon and evaluating the failures in current public health prevention strategies. By examining the regulatory gaps in e-cigarette marketing to the youth and proposing interventions to combat this growing issue, we aim to shed light on the urgent need for stronger policies and enforcement mechanisms to protect the health and well-being of our youth.

Comparison of machine learning and traditional methods for prediction of adverse clinical events after percutaneous coronary intervention

Abstract Background Accurate prediction of clinical outcomes following percutaneous coronary intervention (PCI) is essential for mitigating risk and periprocedural planning. Traditional risk models have demonstrated modest predictive value. Machine learning (ML) models offer an alternative risk stratification that may provide improved predictive accuracy. We performed a systematic review and meta-analysis comparing ML models and traditional risk scores for prediction of clinical outcomes after PCI. Methods This study was reported according to PRISMA guidelines. PubMed, EMBASE, Web of Science and Cochrane databases were searched until 1st November, 2023 for studies comparing ML models with traditional statistical methods for event prediction after PCI. The primary outcome was comparative discrimination measured by C-statistics with 95% confidence intervals between ML models and traditional methods in estimating the risk of all-cause mortality, major bleeding and the composite outcome major adverse cardiovascular events (MACE). Results Thirty-four models were included across 13 observational studies (4105916 patients). The summary C-statistic all ML models across all clinical endpoints was 0.81 (95% CI, 0.78-0.85), compared to traditional methods 0.79 (95% CI, 0.74-0.85). The difference in C-statistic was 0.02 (95% CI, 0.002-0.04, p=0.56). Of included studies, only 1 model was externally validated and 10 models were calibrated. Conclusion ML models did not outperform traditional risk scores in the discrimination of all-cause mortality, major bleeding or MACE following PCI. While integration of ML algorithms into electronic healthcare systems may improve periprocedural risk stratification, immediate implementation in the clinical setting remains uncertain. Further research is required to overcome methodological and validation limitations.

Prognostic value of soluble urokinase plasminogen activator receptor (suPAR) in patients admitted with acute heart failure

Abstract Introduction The inflammatory marker, soluble urokinase plasminogen activator receptor (suPAR), has emerged as a promising prognostic biomarker of heart failure (HF). Higher levels of suPAR in plasma are indicative of hospital readmissions and mortality. Currently little is known about suPAR-values upon admission in patients with acute heart failure (AHF). Purpose This study investigates the prevalence of elevated suPAR and prognostic value in patients hospitalized with AHF. Methods In this prospective cohort study, all patients ≥ 18 years old admitted at the Emergency Department at a large University Hospital in Denmark, were consecutively included from March 10, 2020, to March 31, 2022. The follow-up period was 365 days. The biomarker suPAR was measured in all patients upon admission (median time from admission to suPAR measurement was two hours (IQR 3: 3,9-6,9)). Patient data was extracted from the electronic patient record system, and a cardiologist adjudicated whether the patients had AHF. Patients were stratified according to validated cut-off values of suPAR above or below 6 ng/mL. Kaplan-Meier survival analysis and Cox Regression were used to assess the association between suPAR levels and one-year mortality outcomes. Results A total of 408 (5%) AHF patients, from a total population of 6,715, were included in the study. 40 patients were excluded due to missing suPAR-values and the final analysis comprised of 368 AHF patients. Among AHF patients upon admission, the mean suPAR value was 6.2 ng/mL (standard deviation [SD] = 4.8 ng/mL), and non-AHF patients had a mean value of 4.5 ng/mL (SD = 3.1 ng/mL). A suPAR level above 6 ng/mL was significantly associated with mortality (figure 1), log-rank test p-value < 0.0001. Furthermore, Cox regression analysis demonstrated that elevated suPAR levels were independently associated with increased risk of mortality with a hazard ratio (HR): 2.09 (95% CI: 1.59-2.90), p-value < 0.001 after adjusting for potential confounders: age, sex, atrial fibrillation, Chronic Obstructive Pulmonary Disease, and Creatinine levels. Conclusion The inflammatory biomarker suPAR measured upon hospital admission in AHF patients is significantly associated with one-year mortality in patients admitted with AHF. The potential of suPAR as a valuable prognostic marker in AHF is offering clinicians a tool to identify high-risk patients and tailor management strategies, accordingly, thereby improving patient outcomes.Figure 1 - 1 year mortality

Electronic nudges to increase influenza vaccination in patients with chronic kidney disease: a prespecified analysis of NUDGE-FLU-CHRONIC

Abstract Background Annual influenza vaccination is recommended for individuals with chronic kidney disease (CKD); however, guideline adherence is suboptimal potentially related to lack of awareness of vaccine availability and effectiveness. Purpose This prespecified analysis of the NUDGE-FLU-CHRONIC trial investigated the effectiveness of digital behavioral nudges on influenza vaccine uptake based on the presence or absence of CKD. Methods NUDGE-FLU-CHRONIC was a randomized, nationwide trial, conducted during the 2023/2024 influenza season including younger and middle-aged (18-64 years) Danish citizens with chronic illnesses (making them eligible for the free Danish vaccine program). Participants were randomized in a ratio of 2.45:1:1:1:1:1:1 to receive either usual care (no letter) or one of six different letter-based nudges, delivered via the governmental electronic letter system on September 26, 2023. Baseline and outcome data were obtained with the Danish nationwide registers. Primary endpoint was receipt of an influenza vaccine no later than January 1, 2024. Results A total of 299,881 individuals were randomized in NUDGE-FLU-CHRONIC trial, among them, 15,208 (5.1%) had a history of CKD. Participants with CKD had a median age was 53.1 years (IQR, 42.2-59.6) and 46.0% were female. During follow-up, 43.7% of participants with CKD were vaccinated compared with 35.8% of participants without CKD (p<0.001). Any letter was highly effective in increasing influenza vaccination in the overall population but was slightly less effective in those with a history of CKD (p for interaction = 0.005). In participants with CKD, any letter increased vaccination by 25% versus no letter (46.3% vs. 37.1%; difference, 9.3 percentage points; 99.29%CI, 6.9-11.6; RR, 1.25; 99.29%CI, 1.18-1.33). In participants without CKD, any letter increased vaccination by 43% (39.2% vs. 27.4%; difference, 11.8 percentage points; 99.29%CI, 11.3-12.3; RR, 1.43; 99.29%CI, 1.41-1.45). Similar patterns were observed when assessing each intervention letter individually (Figure 1). Effectiveness of any letter vs. usual care was consistent across CKD subgroups, except for concomitant diabetes vs no diabetes (Figure 2). There was no observed effect modification by CKD duration (p for interaction = 0.78) or by estimated glomerular filtration rate (p for interaction = 0.78) modelled continuously for any letter vs. usual care. Conclusion In this prespecified analysis from the nationwide NUDGE-FLU-CHRONIC trial, only approximately 1 in 3 younger and middle-aged adults with CKD received influenza vaccination. Digital nudge letters emphasizing the importance of annual influenza vaccination significantly boosted rates of vaccination across a broad range of individuals with CKD.Figure 1Figure 2

Obstructive hydrocephalus due to developmental venous anomalies: a pediatric imaging case series.

Developmental venous anomalies are a rare cause of obstructive hydrocephalus in the pediatric population. In this study, we present the most extensive case series of DVA-induced obstructive hydrocephalus in the pediatric population. We thoroughly describe the imaging findings related to this uncommon entity and comprehensively discuss its clinical presentation and management strategies. The goal is to alert pediatric neuroradiologists to consider this rare condition in the differential diagnosis of hydrocephalus, particularly during prenatal screening or in pediatric cases. The electronic patient record systems of 2 tertiary care children's hospitals were reviewed to identify pediatric patients with confirmed DVAs leading to obstructive hydrocephalus. Age at diagnosis, gender, MRI findings (including location of the obstruction), clinical presentation, and symptoms were recorded. Data on treatment and follow-up imaging were also collected. The search yielded 5 cases of pediatric patients with DVA-induced obstructive hydrocephalus. The mean age at diagnosis of the DVA was 2.9 years (range: 0-7 years), and in two cases, ventriculomegaly was diagnosed in utero during prenatal cranial ultrasound screenings. In all patients, the DVA caused stenosis of the aqueduct of Sylvius, and one case presented with multiple DVAs. Although aqueductal stenosis caused by a DVA is rare, it is crucial to consider it in the differential diagnosis of hydrocephalus during prenatal screening or in the pediatric population. Brain MRI, especially post-contrast T1WI, and SWI sequences are particularly valuable for visualizing the typical "caput medusae" appearance of DVAs and detecting associated complications such as hemorrhages.

Experiences of Patients With Cancer Using Electronic Symptom Management Systems: Qualitative Systematic Review and Meta-Synthesis.

There are numerous symptoms related to cancer and its treatments that can affect the psychosomatic health and quality of life of patients with cancer. The use of electronic symptom management systems (ESMSs) can help patients with cancer monitor and manage their symptoms effectively, improving their health-related outcomes. However, patients' adhesion to ESMSs decreases over time, and little is known about their real experiences with them. Therefore, it is necessary to gain a deep understanding of patients' experiences with ESMSs. The purpose of this systematic review was to synthesize qualitative studies on the experiences of patients with cancer using ESMSs. A total of 12 electronic databases, including PubMed, Web of Science, Cochrane Library, EBSCOhost, Embase, PsycINFO, ProQuest, Scopus, Wanfang database, CNKI, CBM, and VIP, were searched to collect relevant studies from the earliest available record until January 2, 2024. Qualitative and mixed methods studies published in English or Chinese were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement checklist) and the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) statement were used to improve transparency in reporting the synthesis of the qualitative research. The Critical Appraisal Skills Program (CASP) checklist was used to appraise the methodological quality of the included studies, and a meta-synthesis was conducted to interpret and synthesize the findings. A total of 21 studies were included in the meta-synthesis. The experiences of patients with cancer using ESMSs were summarized into three major categories: (1) perceptions and attitudes toward ESMSs; (2) the value of ESMSs; and (3) barriers, requirements, and suggestions for ESMSs. Subsequently, 10 subcategories emerged from the 3 major categories. The meta-synthesis revealed that patients with cancer had both positive and negative experiences with ESMSs. In general, patients recognized the value of ESMSs in symptom assessment and management and were willing to use them, but they still encountered barriers and wanted them to be improved. This systematic review provides implications for developing future ESMSs that improve health-related outcomes for patients with cancer. Future research should focus on strengthening electronic equipment and technical support for ESMSs, improving their functional contents and participation forms, and developing personalized applications tailored to the specific needs and characteristics of patients with cancer. PROSPERO CRD42023421730; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=421730.

E-Waste and Hazardous Elements: A Comprehensive Study of Chemical Components and Environmental Threats

Electronic waste, or "e-waste," has grown significantly as a result of the exponential rise of electronic gadgets and is currently one of the waste streams with the fastest rate of growth in the world. Many dangerous substances, such as organic pollutants like brominated flame retardants and heavy metals like lead, mercury, and cadmium, can be found in e-waste. The chemical components of e-waste are thoroughly analyzed in this work, with an emphasis on the identification, measurement, and health and environmental effects of these hazardous materials. According to study, e-waste improper disposal and unofficial recycling can release dangerous substances into the environment, posing a major risk to human health including endocrine disruption and neurological damage. This can result in soil, water, and air contamination. The results highlight the necessity of more advanced recycling technology, stringent laws, and environmentally friendly design principles in order to reduce these hazards. This study adds to the expanding body of information on e-waste and urges immediate action to mitigate the risks that electronic trash poses to the environment and public health.

Assessing adherence to remote monitoring recommendations for cardiovascular implantable electronic devices: a retrospective analysis

Abstract Background The recently published Expert Consensus Statement on the Practical Management of Remote Device Clinic offers evidence-based recommendations for managing patients with cardiovascular implantable electronic devices (CIEDs). Purpose This study evaluates adherence to remote monitoring (RM) recommendations in current clinical practice using data from a RM database. Methods According to RM guidelines, patient connectivity should be maintained. If continuous connection is ensured, it is reasonable to schedule in-person visits every 24 months, with alert-based RM potentially replacing structured intermittent device follow-up. Data from 6553 CIED patients followed on the LATITUDE (Boston Scientific) remote network at 26 Italian centers between 2010 and 2023 were analyzed. Median RM duration was 40 months (25th-75th percentile: 23-67). Results Enrollment of patients at centers significantly increased over the observation period (Figure). As of the January 2024 data extraction, 4723 patients had transmitted data in the last 12 months. Among these, 639 (14%) were NOT MONITORED (i.e. interrupted connectivity), with no significant differences among CIED types (Pacemaker: 13%; ICD: 12%; CRT-P: 7%; CRT-D: 13%; S-ICD: 18%). Scheduled device transmissions occurred at least once every 3 months in 96% of patients. The volume of in-office device interrogations and remote transmissions is detailed in Figure. In 2023, among the 4084 MONITORED patients, 6600 in-office device interrogations were conducted, and 64296 remote transmissions were reviewed. Of these, 34267 (53%) were scheduled, 15091 (24%) were patient-initiated, and only 14938 (23%) were triggered by alerts. Conclusions In current clinical practice, RM adoption is increasing, alongside the volume of in-office and remote visits. Solutions must be implemented to ensure transmission continuity in a substantial percentage of patients. Additionally, there persists a significant reliance on frequent scheduled transmissions and in-office visits. Centers stand to gain from implementing the guideline-recommended alert-based RM strategy, reducing the considerable burden of nonactionable remote and in-office visits among patients with continuous connectivity.

Identifying at-risk patients for atrial high-rate episodes by machine learning

Abstract Background Current evidence suggests that atrial high rate episodes (AHRE)/subclinical atrial fibrillation (AF) are associated with increasing risk of clinical AF, and subsequently, ischaemic stroke and other adverse cardiovascular events. Purpose To construct a high-performance model by machine learning (ML) for the prediction of AHRE detected by a cardiac implantable electronic device (CIED) capable of atrial sensing in a European cohort. Methods We utilized data from a prospective cohort of patients with CIED. AHRE was defined as an episode lasting at least 5 minutes with atrial rate ≥ 175 beats per minute. We divided the cohort into training and internal validation cohorts in 7:3 and used 5-fold cross-validation in the training cohort to assess model performance and prevent model overfitting. Pre-selected features were imported into eight common ML algorithms to predict AHRE, including light gradient boosting machine (LightGBM), random forest (RF), logistic regression, support vector machine, multiple perceptron, eXtreme gradient boosting machine (XGBoost), Gaussian naïve Bayes, and K nearest neighbours. The importance ranking of the features was interpreted by calculating the SHapley Additive exPlanationation (SHAP) value for each feature within the optimal model. Results A total of 500 consecutive patients with CIEDs (mean age 70.2±13.3; 39.2% female) were included. Of these, 164 patients (32.8%) were found to have AHRE. Among all ML models, RF was the best performing model, which obtained the highest AUC (0.738), recall (0.673) and F1-score (0.584) in the internal validation cohort. The results of SHAP showed that antiplatelet, statin, age, white blood cell count, and cardiomyopathy were the first five important features, indicating that the RF model had good interpretability and reliability. Conclusion Our study is the first to demonstrate in a European cohort the effectiveness and feasibility of ML algorithms in predicting AHRE in patients detected by CIEDs. The best RF models require further external validation to assess generalizability to other cohorts.Figure 1Figure 2

Evolution over time of cardiac biomarkers, electrocardiographic and echocardiographic features in a large cohort of patients with wild-type transthyretin cardiac amyloidosis treated with tafamidis

Abstract Introduction Data on evolution of transthyretin wild-type cardiac amyloidosis (ATTRwt) during treatment with tafamidis is scarce. This hinders the quest for parameters of response and a priori treatment eligibility. Purpose To study the evolution of biomarkers, ECG, and echocardiographic features during early tafamidis treatment. Methods We prospectively collected data after 12-18 months of treatment in a single-centre database. Changes of NT-proBNP and high-sensitivity Troponin I (hs-cTnI) between baseline and follow-up evaluations (at 12 and 18 months) were tested for significance. For ECG and echocardiographic features, we considered baseline and the last available follow-up (median interval 11.1 months). Results We included 253 patients (median age 77[71-82]years; 90% males). Median (IQR) baseline NT-proBNP was 2472(1355-4749)ng/L, hs-cTnI 47(30-82)ng/L. Furosemide was administered in 58% of cases (median dose 25[25-50]mg/day). Compared to baseline, NT-proBNP was 2342(1316-4148)ng/L at 12 (p=0.886), and 2633(1393-6063)ng/L at 18 months (p=0.285), with 4% and 30% of patients showing ≥30% and ≥300ng/L increase at 12 and 18 months, respectively; hs-cTnI was 46(29-70)ng/L at 12 (p=0.947), and 44(25-68)ng/L at 18 months (p=0.866), with 35% and 7% showing a ≥20% increase at 12 and 18 months, respectively, and 21 (11.5% over 183 analyzable) with increase at 12 and reduction at 18 months. Patients on furosemide were 69% and 70% at 12 and 18 months, respectively; the dose increased to 37.5(25-75)mg/day at 18 months (p=0.009). At baseline, 117(47%) patients had history/permanent atrial fibrillation (AF). Forty-one(16%) had an implantable electronic device, 16(6%) underwent subsequent implantation. Median PR interval was 210(185-240)msec, trending toward prolongation (p=0.054). QRS duration increased (100[86-130]vs120[90-140]msec, p=0.004), together with conduction disturbances (left anterior fascicular block 30[21%]vs43[29%], p=0.036; right bundle branch block 14[10%]vs27[18%], p=0.002). AF prevalence raised from 19% to 25%. There were no significant changes in left ventricular (LV) geometry (septum thickness 18[16-20]vs18[16-20]mm, p=0.666; end-diastolic diameter 45±7vs45±8mm, p=0.434), systolic function (ejection fraction 51±10%vs49±11%, p=0.070), filling pressures (E/e’ 17[11-20]vs14.9[13-19], p=0.086) and left atrial size (mean volume 46±15vs48±13ml/m2, p=0.649). Tricuspid annular plane systolic excursion (18±4vs17±4mm) and pulmonary artery systolic pressure (40[33-45]vs36[30-45]mmHg) remained stable. Conclusions We did not observe neither improvement nor worsening of laboratory/instrumental variables within the first 12-18 months of tafamidis. There was a progression of electrical disorders. After initial progression hs-cTnI tended to improve. Extended follow-up and a matched case-control series will help identify possible later changes useful to monitor treatment response and effects of supporting heart failure treatments.

Cost impact of the use of a universal cardiac implantable electronic devices remote monitoring solution: results of the Evidence RM study

Abstract Background Remote monitoring (RM) is considered the standard of care for patients with cardiac implantable electronic devices (CIED). In 2023 the HRS/EHRA/APHPRS/LAHRS expert consensus highlighted the potential interest of alert-based monitoring and the use of a third-party platform for RM management. By lightening the RM workload for clinical staff, valuable time and resources can be redirected towards patient care. Purpose This study aims to assess the impact on healthcare expenditures of the adoption of a Universal, vendor-neutral, and alert-focused remote monitoring (RM) platform for CIED in France, as opposed to the Conventional RM conducted via device specific manufacturers' platforms. Methods This study utilizes the French National Health Database (SNDS) to evaluate the effectiveness of RM solutions among patients with implantable cardioverter defibrillators (ICD), including cardiac resynchronization therapy defibrillators (CRT-D). All patients under RM were categorized based on the type of monitoring, either the Universal RM or the Conventional RM. The analysis was conducted on year 2019 and included only patients maintaining consistent RM solutions and device types throughout the entirety of the study period. To mitigate potential biases, costs were adjusted according to age, gender, device type, year of first implantation, year of RM initiation, medical center experience with RM, and Elixhauser score for comorbidities. Results Study cohort consisted of 36,401 patients (age 67.3 ± 13.0 years / male 78.4% / CRT-D 40.1%), 1,482 patients followed using the Universal RM platform and 34,419 patients monitored with the Conventional RM solutions. The study findings revealed a 4% decrease in corrected total costs and a notable 17.8% reduction in hospital costs among patients utilizing the Universal RM. Analysis further identified that this decrease in hospital expenses was primarily influenced by a reduction of the costs associated with cardiovascular diseases. Conversely, the group utilizing the Universal RM experienced a 7.9% increase in total outpatient costs compared to Conventional RM, while ambulatory visit costs remained unchanged. As costs incurred by patients were not included, total costs may however be underestimated. Patients under the Universal RM solution may benefit of more proactive preventive measures delivered through outpatient care. By addressing issues preemptively, critical conditions may be averted, enhancing overall patient management, and diminishing hospital costs. The adoption of a third-party Universal platform may thus yield to cost savings, exemplified by a negative Incremental Cost-Effectiveness Ratio (ICER) of -103€ per Day Alive and Out of Hospital (DAOH) as observed in this study. Conclusions The use of a third-party Universal RM platform showed a positive impact in terms of costs reduction for the French healthcare system on this ICD population.

Ventricular and supraventricular ectopic beats burden is correlated with bone mineral density and osteoporotic fracture risk in postmenopausal females

Abstract Introduction Patients (pts) with osteoporosis (OP) have an increased 10-year cardiovascular death risk. Low bone mineral density (BMD) observed in OP may be associated with arrhythmic presentation of cardiovascular diseases (CVD). Few studies assessed the relationship between OP and arrhythmia. Aim Arrhythmias assessment in pts with OP. Methods A total of 103 postmenopausal female pts (mean age 69 +/- 7), consulted by endocrinologist, were divided into 2 groups according to BMD (assessed by dual energy X-ray absorptiometry). BMD measurements, expressed as T-score (T-sc), were taken from the femoral neck (T-sc Neck), entire total hip (T-sc TH) and/or spine (T-sc L2-L4, L1-L4). Arrhythmia was evaluated using 24-hour Holter-ECG monitoring (HM). Major osteoporotic and total hip fracture risks (MOFR and THFR, respectively) were assessed by the FRAX scale. We compared 51 pts with OP (T-sc ≤ -2.5), with 52 matched controls without OP, including 44 pts with osteopenia (T-sc > -2.5). There were no significant differences between the groups regarding the history of stroke, myocardial infarction, coronary artery disease or arterial hypertension. Exclusion criteria included heart failure NYHA >II and/or LVEF <36%, acute coronary syndrome within the last 6 months, severe valvular disease, cardiac implantable electronic device. Results There was a trend towards a greater number of supraventricular and ventricular arrhythmias in the OP group compared to the controls. Arrhythmic burden was significantly correlated with BMD measures: correlations were observed between 24-hour ventricular ectopic beats (VEB) count with T-sc Neck (r=-0.20, p=0.04), with T-sc TH (r=-0.22, p=0.03). The number of supraventricular ectopic beats (SVEB) in HM was also correlated with BMD parameters: T-sc Neck (r=-0.21, p=0.03), T-sc TH (r=-0.23, p=0.02). Multivariate analysis (linear regression model) revealed that age and T-sc TH were independently related with ectopy: age (0.07; CI: 0.01 - 0.13, p=0.03) and T-sc TH (-0.58; CI: -1.07 - -0.08, p=0.02) were predictors for VEB, and SVEB were related to age (0.07; CI: 0.03 - 0.12, p<0.01) and, with borderline significance with T-sc TH (-0.34; CI: -0.699 - 0.012, p=0.058). Ectopic beats count was also positively correlated with osteoporotic fracture risk: VEB with THFR (r=0.206, p=0.04) and SVEB with MOFR (r=0.21, p=0.04). Conclusions The study showed an increased arrhythmia burden as detected in HM in pts with OP. Beside the T-sc TH, age was identified as an independent factor of increased SVEB / VEB. The main significant negative correlations were observed between the number of VEB / SVEB and BMD in femur (T-sc Neck, T-sc TH). Ectopic beats count was also positively correlated with osteoporotic fracture risk: VEB with THFR and SVEB with MOFR.

Influence of persistent atrial fibrillation on the prognosis of heart failure with preserved, mildly reduced, and reduced ejection fraction in women and men

Abstract Introduction Heart failure (HF) is one of the leading causes of death from cardiovascular disease. Persistent atrial fibrillation (PAF) is associated with a worse prognosis in HF. However, little is known about the influence of AF on mortality in women and men with heart failure with preserved (HFpEF ≥50%), mildly reduced (HFmrEF 41% to 49%), and reduced ejection fraction (HFrEF ≤40%). Purpose to analyze the characteristics and influence of PAF on the prognosis of different HF phenotypes. Methods From February 2017 to September 2020, we analyzed hospitalizations, emergency admissions, and mortality of different HF phenotypes with and without PAF. Baseline data included clinical features and echocardiographic findings. Statistical analyses were performed using the Kaplan-Meier (K-M) and Cox proportional hazards methods to analyze mortality rates. Results We studied 11,543 patients, with a mean of 64.1±14.0 years: 55.1% male, 42% with HFrEF, 12.8% with HFmrEF, and 45.1% with HFpEF. PAF was associated with higher mean age (67.6±14.3 vs. 62.8±13.4 years, p<0.001) and more prevalent in men (21% vs. 19%; p=0.019) and in patients with valvular and Chagas etiologies, chronic kidney disease (CKD), stroke, and anemia. The prevalence of PAF in women and men was, respectively, 12.4% vs. 18.3% (p<0.001) in HFrEF, 18.1% vs. 22.2% (p=0.029) in HFmrEF, and 23.3% vs. 23.9 (p=NS) in HFpEF. The overall mortality was 21.6%, with mortality being 2.4 times higher in patients with PAF (40.9% vs. 16.7%, p<0.001) compared to sinus rhythm but similar in women and men with PAF (39.5% vs. 41.9%; p=NS), respectively. The hospitalization (30.3% vs 19.4%, p<0.001) and emergency admissions (38.4% vs 25.7%, p<0.001) were higher in patients with AF. Cumulative mortality was higher in patients with PAF in all HF phenotypes: HFrEF (36.6%), HFmrEF (16.8%), HFpEF (46.6%; p<0.001). Men had higher cumulative mortality in HFrEF (18.3% vs. 12.4%; p<0.001) and in HFmrEF (22.2% vs. 18.09%; p=0.029), but not for HFpEF (23.9% vs. 23.3%; p=NS). In the multivariate analysis, adjusted for age, sex, previous myocardial infarction and stroke, diabetes, CKD, PAF, Cardiac surgery, and electronic device implantation, PAF was an independent predictor of death in all HF phenotypes: HFrEF [HR=1.78(95%CI:1.57-2.02); p<0.001], HFmrEF [HR=2.14(95%CI:1.74-2.65); p<0.001], HFpEF [HR=2.08(95%CI:1.82-2.37); p<0.001]. Conclusion PAF is a frequent comorbidity in HF and is associated with a worse prognosis in all HF phenotypes. Women with PAF had a better prognosis than men with AF in HFrEF and HFmrEF. Sex-specific strategies to maintain sinus rhythm in HF patients on the overall risk of death are needed.

A sane approach to the high volume of alert transmissions in remote monitoring- turning of clinically non-relevant alerts decreases substantially workload

Abstract Background Remote monitoring (RM) offers a safe and effective method of monitoring patients with cardiac implantable electronic devices (CIEDs). The downside of RM is the data deluge of various transmissions, the majority of which are non-actionable. It has been suggested that optimizing alert transmissions could partly overcome this problem. Purpose The purpose of this study is to evaluate how the workload in RM can be safely decreased by thoroughly assessing the clinical relevance of each alert and deactivating non-relevant alerts. Methods Data on the number of alerts, scheduled and patient-initiated transmissions, as well as the causes and actions initiated by the transmissions, were systematically collected from the year 2023, during which the approach of actively deactivating clinically non-relevant alerts was conducted (A sane approach, Figure 1). The trend of alert transmissions and the proportion of actionable scheduled transmissions are presented. Results Overall, during the study period, 8182 transmissions were generated from 3732 followed CIEDs. Of these, 2306 were alert transmissions, and the rate of alerts decreased by 56% during the follow-up, from 0.07 to 0.04 per device per month. Additionally, our data shows that new alerts that have not occurred in the previous six months occurred on average at a rate of 0.03 per CIED per month, and this trend remained unchanged during the follow-up. Of the 3335 scheduled transmissions, 11% (364) were actionable, and both the number and proportion of actionable scheduled transmissions remained unchanged during the follow-up period. Interestingly, no alerts were triggered from 1124 (70%) of all patients but 88 (2%) of all CIEDs generated 30% of all alerts. Conclusions In this study, we demonstrate that RM workload can be decreased by actively evaluating the clinical relevance of each alert transmission. Our approach, where non-relevant alerts are turned off, likely does not impair patient safety and thus this practise enhance the RM.

Survey of Reliability Challenges and Assessment in Power Grids with High Penetration of Inverter-Based Resources

Decarbonization is driving power systems toward more decentralized, self-governing models. While these technologies improve efficiency, planning, operations, and reduce the carbon footprint, they also introduce new challenges. In modern grids, particularly with the integration of power electronic devices and high penetration of Renewable Energy Sources (RES) and Inverter-Based Resources (IBRs), traditional reliability concepts may no longer ensure adequate performance due to systemic restructuring. This shift necessitates new or significantly modified reliability indices to capture the characteristics of the evolving power system. Ensuring converter reliability is essential for effective planning, which requires precise, component-to-system-level modeling, as different converters impact system performance indicators. However, the existing literature in this field faces a significant limitation, as most studies focus on a singular perspective. Some examine reliability at the device-level, others at the component-level, while broader reviews in power systems often emphasize system-level analysis. In this paper, we aim to bridge these gaps by comprehensively reviewing the interconnections between these levels and analyzing the mutual influence of power converter and system reliability. A key point to highlight is that, with the rapid evolution of modern power grids, decision-makers must adopt a multi-level approach that incorporates insights from all levels to enable more accurate and realistic planning and operational strategies. Our ultimate goal is to provide an in-depth investigation of studies addressing the unique challenges posed by modern power grids. Finally, we will highlight the gaps in the literature and suggest directions for future research.