Optimization of stratégies of sudden cardiac death prévention in heart failure patients

Heart failure (HF) causes high mortality and morbidity of whom at least 50% die suddenly, termed sudden cardiac death (SCD). HF is an independent risk factor of SCD and its incidence are comparable to the total incidence of common cancers (i.e., lung, prostate, breast, colon). Current preventive strategies are suboptimal and there is a growing need to optimize treatment to further improve the actual poor survival. In fact, HF patients are usually put under a polydrug regimen (e.g., beta-blockers (BB), angiotensin-converting enzyme inhibitors (ACE-i), angiotensin receptor blockers (ARBs), aldosterone antagonists, diuretics, hydralazine/isorbide di-nitrate, ivabradine, digoxin, amiodarone and anti-arrhythmic agents (AADs), omega-3 polyunsaturated fatty acids (PUFA)…etc.) in addition to non-drug devices (e.g., cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD)). Importantly, it is known that not all HF evidence-based drugs reduce SCDs or all-cause mortality. Therefore, we reviewed the current evidence on SCD prevention for commonly prescribed drug interventions; and our findings showed three evidence categories: - effective interventions as BB, anti-aldosterone agents or mineralocorticoid-receptor antagonists, and combined ARB/neprilysin inhibitors. - ineffective interventions as ACE-i, ARBs, and statins. - uncertain evidence (conflicting or inconclusive evidence) as amiodarone & AADs, PUFA or fish oil supplementation. We used a variety of evidence-based medicine methodology: systematic reviews and meta-analysis, overviews, survival analysis, statistical models such as Cox proportional hazards model, Kaplan-Meier survival curves, propensity score analysis and instrumental variables approaches. Through adopting effective drugs, our work allowed paving the way toward an optimization of SCD prevention strategies in HF that would finally lead to a better survival and quality of life and a potential reduction of public health expenditure. -- L'insuffisance cardiaque (IC) entraîne une morbidité et une mortalité élevées dont au moins 50% de décès surviennent subitement, appelée mort subite cardiaque (MSC). L’IC est un facteur de risque indépendant de MSC ; son incidence est comparable à l'incidence totale de cancers courants (c'est-à-dire poumon, prostate, sein, côlon). Les stratégies préventives actuelles sont sous optimales ; il est ainsi de plus en plus nécessaire d'optimiser le traitement pour améliorer la mauvaise survie actuelle. En effet, les patients souffrants d’IC sont généralement soumis à un traitement polyconsommateur (par exemple, bêtabloquants (BB), inhibiteurs de l'enzyme de conversion de l'angiotensine (IEC), antagonistes des récepteurs de l'angiotensine (ARA), antialdostérone (AA), diurétiques, hydralazine/ dinitrate d’isorbide, ivabradine, digoxine, amiodarone et autres antiarythmique, acides gras poly-insaturés oméga-3 (AGPI), etc.) en plus des dispositifs non médicamenteux (par exemple la thérapie de resynchronisation cardiaque et les défibrillateurs implantables). Il est important de savoir que les médicaments prescrits chez l’IC ne sont pas tous efficaces contre la mort subite ou la mortalité totale. Par conséquent, nous avons examiné les preuves actuelles sur la prévention de MSC par les interventions médicamenteuses couramment prescrites; nos résultats ont montré trois catégories de preuves : - interventions efficaces comme BB, AA, et inhibiteurs combinés ARB/ néprilysine. - interventions inefficaces comme l’IEC, les ARA et les statines. - preuves incertaines (preuves contradictoires ou non concluantes) comme l'amiodarone et autres antiarythmique, les AGPI ou les suppléments en huile de poisson. Nous avons utilisé diverses méthodologies de médecine factuelle : revues systématiques et méta-analyses, analyse de survie, modèles statistiques tels que le modèle de Cox, les courbes de survie de Kaplan-Meier, l'analyse par score de propension et la méthode de variables instrumentales. Grâce à l'adoption de médicaments efficaces, nos travaux pourraient permettre d'optimiser les stratégies de prévention des MSC chez les patients atteints d’IC, ce qui mènerait finalement à une meilleure survie et qualité de vie, et à une réduction potentielle des dépenses de santé

Prevalence of occupational burnout in Swiss workers: a systematic review and meta-analysis

Introduction: Occupational burnout (OB) has been associated with job dissatisfaction, lower productivity, intentions to leave the job, increased turnover and health-care costs, as well as other socioeconomic issues. Despite such negative consequences, the prevalence of burnout among Swiss workers remains unknown. Material and Methods: We interrogated international databases such as Medline (Pubmed), EMBASE, and PsycINFO, and 15 Swiss universities’ databases from 2010 up to July 6, 2021 to identify studies reporting the prevalence of OB and/or emotional exhaustion (EE) - the core OB dimension- in Swiss workers. Data were summarized descriptively and quantitatively using random effects meta-analysis. Results: We identified 23 studies that used different outcome assessment methods: hetero-assessment by physicians and self-reported, using a specific question or one burnout inventory scale (frequently used: Maslach Burnout Inventory (MBI) and Copenhagen Burnout Inventory (CBI)). We estimated the prevalence of clinical/severe burnout, overall burnout and emotional exhaustion (EE)] at 4%, 18% and 18%, respectively, with considerable heterogeneity (I-square >90%, p< 0.00). Conclusions: Despite between-study heterogeneity, our overall estimate of OB in Swiss workers is high enough to reinforce the current efforts to detect it better and earlier and reduce its negative consequences at individual and societal levels

Effects of statins to reduce all-cause mortality in heart failure patients: findings from the epical2 cohort study

Introduction: The addition of statins to standard care in heart failure (HF) patients remains controversial in clinical practice. Large-scale clinical trials failed to show mortality benefits, but uncertainty persists in real-world settings.Objective: We evaluated whether the prescription of statins at hospital discharge is associated with a reduction in all-cause mortality at up to 1 year of follow-up in HF patients.Methods: We analyzed data from Epidémiologie et Pronostic de l’Insuffisance Cardiaque Aiguë en Lorraine (EPICAL2) cohort study of 2254 hospitalized acute HF patients who were admitted to 21 hospitals located in northeast France for acute HF between October 2011 and October 2012 and who received statins at discharge compared with patients who did not. We used propensity score matching and instrumental variable analyses to estimate the treatment effects of statins, and a multivariable Cox proportional- hazards model to examine survival with statin use, adjusting for patient demographics, HF characteristics, medical history, comorbidities, drug treatment and other known potential confounders. We plotted Kaplan–Meier survivor curves, and used log-rank test to determine the equality of survivor functions.Results: We included 2032 patients in this investigation: 919 (45%) in the statin-treated group and 1113 (55%) in the control group. The estimated average statin-treatment effects for all-cause mortality in HF failed to demonstrate a significant effect on mortality [Z = − 1.73, 95% confidence interval (CI) − 0.11 to 0.007, p value = 0.083, and Z = − 0.95, 95% CI − 1.34 to 0.46, p value = 0.34] for propensity score matching and instrumental variable analyses, respectively. Moreover, the Cox proportional-hazards model showed that statin prescription was not significantly associated with the rate of death (hazard ratio = 0.85, 95% CI 0.66–1.11, p value = 0.26), adjusted for all confounders.Conclusion: In patients with HF (and reduced or preserved ejection fraction), the prescription of statins did not appear to be associated with better survival after 1 year of follow-up in the EPICAL2 cohort. We cannot exclude that a subpopulation of HF patients may have some benefits compared with the whole HF population or that there might be a lack of power to show such effect

Association between continuity of care (COC), healthcare use and costs: what can we learn from claims data? A rapid review.

To describe how longitudinal continuity of care (COC) is measured using claims-based data and to review its association with healthcare use and costs. Rapid review of the literature. We searched Medline (PubMed), EMBASE and Cochrane Central, manually checked the references of included studies, and hand-searched websites for potentially additional eligible studies. We included 46 studies conducted in North America, East Asia and Europe, which used 14 COC indicators. Most reported studies (39/46) showed that higher COC was associated with lower healthcare use and costs. Most studies (37/46) adjusted for possible time bias and discussed causality between the outcomes and COC, or at least acknowledged the lack of it as a limitation. Whereas a wide range of indicators is used to measure COC in claims-based data, associations between COC and healthcare use and costs were consistent, showing lower healthcare use and costs with higher COC. Results were observed in various population groups from multiple countries and settings. Further research is needed to make stronger causal claims

MT180 (Ma thèse en 180 seconds) https://www.youtube.com/watch?v=OZQlBBsoNWE

https://www.youtube.com/watch?v=OZQlBBsoNW

COVID-19 vaccines and post-vaccination data: Literature update (9) - 30.09.2021

This report addresses the most relevant data on COVID-19 vaccines literature as of 27 September 2021. The current report addresses vaccine effectiveness against the Delta (B.1.617.2) variant, methodological issues in assessing vaccine effectiveness, an in-depth overview of both mRNA vaccines (Pfizer-BioNTech and Moderna), protection of booster doses against COVID-19 infections, the effects of vaccination on transmissibility of SARS-CoV-2, the characteristics of breakthrough infections, and maternal vaccinations. To conclude, the report highlights the latest SARS-CoV-2 vaccine development information on COVID-19 vaccine candidates

COVID-19 vaccines and post-vaccination data: literature update (8) - 30.08.2021

This report addresses the most relevant data on COVID-19 vaccines literature as of 27 August, 2021. The current report addresses vaccine effectiveness against SARS-CoV-2 infection, focusing in particular, on vaccine effectiveness against variants, vaccine duration of protection, virus transmissibility and shedding post vaccination, the administration of booster doses, and the importance of children and adolescent’s timely vaccination. Lastly, the report highlights the latest updates regarding ‘new’ SARS-CoV-2 vaccines