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

Stationary Radiation Monitors in Radiology Supervision System

W artykule zaprezentowany zostanie rozproszony system informatyczny przeznaczony do nadzoru pracy stacjonarnych monitorów promieniowania (SMP). W artykule zostaną zaprezentowane urządzenia SMP wraz ich możliwościami i wybranymi parametrami oraz przedstawione zostaną możliwości systemu informatycznego zbudowanego do ich nadzoru. System wykorzystuje nowoczesne technologie, takie jak technologie sieciowe, kamery video IP do dokumentowania zdarzeń oraz bazy danych do przechowywania informacji.In the paper Stationary Radiation Monitors (SRMs) and a radiology control system based on them are presented. SRMs manufactured by the division Polon of the Relpol company are described. Selected parameters of the elaborated SRM and information system to supervise their work are outlined. Components of the SRM are shown in figure 1. The basic SRM components are gamma and neutron detection modules and a control module with a touch screen and thermal printer. SRMs are used for detection of nuclear and radioactive materials. SRMs presented in the paper are a new generation of gamma and neutron radiation detector devices and can be used on border crossings, airports, nuclear factories, etc. SRMs installed in the field can be configured and monitored by a local control module or remotely by a monitoring system. The monitoring system can manage up to 16 SRMs. The monitoring system collects information about the SRM current status and events generated by the SRM and stores them in a data base. The functional and program modules and the main window view of the monitoring program are shown in figures 3 and 4. The new generation of SRMs is equipped with intelligent IP cameras with pre-triggering function. This function allows tracing a picture up to one minute before the alarm occurs. Video pictures and alarms are stored in the monitoring system data base and can be displayed by the authorized personnel

Sealing Compound with highly modified bitumen.

W artykule przedstawiono analizę możliwości wykorzystania asfaltu wysokomodyfikowanego do produkcji masy zalewowej o różnym zastosowaniu. Drugim składnikiem masy zalewowej był wypełniacz kamienny lub mieszany. Oba składniki mieszano ze sobą w różnych proporcjach (dodatkowo przy zmiennej ilości wapna hydratyzowanego), a otrzymane zaczyny badano pod względem ich przydatności do zastosowania jako masa zalewowa. W wyniku wykonanych prac badawczych otrzymano optymalny skład masy zalewowej spełniającej normatywne wymagania.The article presents an analysis of the possibilities of using highly modified bitumen in production of sealing compound for different applications. The second component of the sealing compound stone or was mixed filler. Both components were mixed together in various proportions (in addition to a variable quantity of hydrated lime), and the resulting mixtures were tested for their suitability as sealing compounds. As a result of studies the optimal composition of the mixture was obtained