Measurements, Models, Systems and Design

531 s.

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Development trends of measurement and control systems

W artykule przedstawiono tendencje rozwojowe w obszarze struktury funkcjonalnej i komunikacyjnej systemów pomiarowo - sterujących nowej generacji. Zwrócono uwagę na rosnącą popularność sieci czujników z transmisją bezprzewodową w standardzie ZigBee. Podkreślono korzyści wynikające z wprowadzenia do systemów pomiarowo - sterujących funkcji routowania. Odniesiono się do zagadnień związanych z formatem XML i bezpieczeństwem przesyłanych danych w systemach pomiarowo - sterujących.In the paper, trends in development of functional and communication structures in the area of measurement and control systems (MCS) are presented. The structure of the actual IEC 61158 and IEC 61784 standards is described. The paper gives short an introduction to new version of IEEE 1451.5 standard with three different wireless profiles: WiFi, ZigBee and Bluetooth. ZigBee standard as basic communication network for sensor network is described. Solution of the logical address assignment in ZigBee is presented. With regard to process data communication short introduction to using XML data formats in MCS is outlined. At the end, challenges in the field of security in MCS are discussed

Diffuse measuring systems of a new generation

In the paper, current state and tendency in distributed measurement and control systems based on network architecture are presented. Possibilities of a distributed data processing in such systems are discussed. There are defined basic conditions for an industrial network intelligent node participated in distributed data processing. The two models of object neuron and rule for intelligent nodes are shown

Development trends of measurement and control systems

W artykule przedstawiono tendencje rozwojowe w obszarze struktury funkcjonalnej i komunikacyjnej systemów pomiarowo - sterujących. Zwrócono uwagę na rosnącą popularność sieci czujników z transmisją bezprzewodową w standardzie ZigBee. Odniesiono się do zagadnień związanych z bezpieczeństwem i formatem przesyłanych danych w systemach pomiarowo - sterujących.In the paper, trends in development of functional and communication structures in the area of measurement and control systems (MCS) are presented. The structure of the actual IEC 61158 and IEC 61784 standards is described. The paper gives short an introduction to new version of IEEE 1451.5 standard with three different wireless profiles: WiFi, ZigBee and Bluetooth (Fig. 1). ZigBee standard as basic communication network for sensor network is described. Solution of the logical address assignment in ZigBee is presented (Fig. 2, 3). At the end, challenges in the field of security in MCS are discussed

Task scheduling theory in time deadline analysis of measurement-control systems

W artykule zarysowano elementy teorii szeregowania zadań, które mogą być przydatne do analizy dotrzymania ograniczeń czasowych w systemach pomiarowo-sterujących. Zaprezentowano trzy metody szeregowania zadać ze statycznym i dynamicznym przydziałem priorytetu. Przedstawiono podstawowe zależności do sprawdzenia warunku realizowalności zadań w projektowanym systemie dla szeregowania zadań metodami RM, DM i EDF.In this paper essentials of task scheduling theory, which can be helpful to time deadline analysis in measurement-control systems are outlined. Three task scheduling methods with static and dynamic priority assignment are presented. Basic relations to task utilization condition testing in system being design for task scheduling based on RM, DM and EDF methods are presented

ZigBee networks in Smart Metering systems

W artykule omówiono wybrane architektury komunikacyjne bazujących na profilu komunikacyjnym ZigBee Smart Energy (ZSE). Przedstawiono ich syntetyczną charakterystykę i ocenę rozwiązań według kryterium poziomu bezpieczeństwa w systemach Smart Metering, zbudowanych na bazie dyskutowanych w artykule architektur.The paper deals with communication architectures based on communication profile ZigBee Smart Energy (ZSE). They are characterized and evaluated according to the safety issues in Smart Metering systems built on architectures discussed in the paper. ZSE profile defined in 2008 is described. In Fig. 1 the simplest ZigBee Smart Energy home networking structure belonging to Utility is shown. The more complex ZSE structures are shown in Figs. 2 and 3. In all cases, ZSE net is integrated with the HAN network by means of the Energy Service Provider node. A high level of security required in such applications is provided by ZigBee Trust Center in a local network and by use of VPN tunnels in communications in a public network. The solutions presented are ready for use in the newest generation of smart meters and may provide a good basis for Smart Grid networks. At the end, a new idea of the distributed processing provided for digital power counters (Fig. 4) is described

Independent Measuring Operator in Smart Energy and Media Metering System

W artykule przedstawiono strukturę systemu inteligentnego opomiarowania czynników energetycznych i mediów. Zaprezentowano nowy podmiot funkcjonalny niezależny operator pomiarowy, który byłby odpowiedzialny za jego wdrożenie i utrzymywanie. Określono podstawowe funkcje oraz korzyści wynikające z jego wdrożenia w strukturze systemu energetycznego i mediów.In the paper, a structure of the smart energy and media metering system is presented. The new functional component Independent Measuring Operator, responsible for smart energy and media system implementation and maintenance is described. Basic functions and implementation advantages of the Independent Measuring Operator in smart energy and media system are outlined. The functional model of the Independent Measuring Operator is presented in figure 1, while the diagram of its implementation for energy smart metering system is shown in figure 2. According to the European Smart Metering Industry Group recommendations, the model proposed in this paper ensures two-way communication between the smart metering system and consumers as well as utilities. The logical structure diagram of the Energy Management System and communication relations between the basic system components are shown in the diagram of figure 3. The node logical structure diagram of the smart metering system based on the ZigBee wireless communication integrated with the Home Area Network is depicted in figure 4. The example node logical structure diagram of the smart metering system based on the heterogenic communication (e.g. ZigBee, M-BUS, PLC) and two basic application servers (AMR and AMR) is presented in figure 5