To review existing health behavior assessment tools for coronary heart disease, evaluate their methodological quality and measurement properties, and identify appropriate instruments for health behavior assessment. A systematic search was conducted in PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP Database from inception to August 1, 2026. The Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) risk of bias checklist was used to evaluate methodological quality. COSMIN criteria were applied to rate and summarize the psychometric properties of each PROM. The modified Grading of Recommendation Assessment, Development, and Evaluation approach was used to assess the certainty of evidence. The Coronary Heart Disease Active Health Behavior Assessment Scale, Health Behavior Motivation Scale, and Coronary Artery Disease Empowerment Scale were classified as Grade A based on the available evidence, whereas the remaining six scales received Grade B recommendations and require further validation of certain psychometric properties. The Coronary Heart Disease Active Health Behavior Assessment Scale, Health Behavior Motivation Scale, and Coronary Artery Disease Empowerment Scale can be considered for evaluating health behavior in patients with coronary heart disease. However, most existing tools have not undergone comprehensive evaluation of all PROM psychometric properties, and important dimensions related to barriers to healthy behaviors remain insufficiently represented in item content.
Early disturbances in sodium–chloride homeostasis may reflect systemic illness severity after acute myocardial infarction (AMI), but the prognostic value of the serum sodium-to-chloride (Na/Cl) ratio remains incompletely defined. We performed a retrospective dual-cohort study using a hospital-based clinical cohort of patients with acute myocardial infarction and an independent MIMIC-IV intensive care cohort. The early serum sodium-to-chloride ratio was calculated from admission laboratory measurements in the clinical cohort and from measurements obtained within the first 24 h after ICU admission in MIMIC-IV. The primary outcome was 365-day all-cause mortality. Multivariable Cox proportional hazards models were used to estimate the association between sodium-to-chloride ratio and mortality, with the ratio analyzed as both a continuous variable and according to clinically derived quartiles. Non-linear associations were examined using restricted cubic splines. Model performance and robustness were further evaluated using discrimination analyses, fixed-time logistic regression, inverse-probability weighting, and landmark analyses among 30-day survivors. In the clinical cohort, 3,091 patients were included with 139 deaths at 365 days, of which 130 occurred within 30 days. A higher Na/Cl ratio was associated with increased mortality risk (HR per 0.01 increase: 1.16, 95
Circadian rhythm disruption caused by shift work increases the risk of cardiovascular disease, but its effects on heart rate variability (HRV) and circadian rhythm disruption in shift workers remain poorly understood. This study aims to observe changes in HRV in shift workers during shift work and during rest and to analyze its impact on the autonomic nervous system (ANS) and circadian rhythms. This study recruited 30 shift workers aged 23–50 from a medical center in Chengdu, China, during the period from January to September 2025. Wearable three-electrode Holter electrocardiogram patches were used to collect time-domain, frequency-domain, and nonlinear HRV metrics during shift work and during rest. By dividing the day into daytime and nighttime periods and calculating △HRV values to further investigate the diurnal variations in HRV and ANS following shift work. In the 24-hour analysis, it was observed that individuals experienced a significant decrease in overall HRV indices, including SDNN and S, as well as sympathetic tension indices such as SDANN and SD2, during shift work (P < 0.05). Further analysis by diurnal periods revealed that shift work was associated with significant reductions in overall HRV indices (triangular index, TINN, and S) during nighttime compared to rest in male youth (P < 0.05). In male shift workers, parasympathetic tone indicators (RMSSD, HF, and SD1) and sympathetic tone indicators (SDNNI) were significantly lower during nighttime compared to rest (P < 0.05), while showing paradoxical elevation during daytime (P < 0.05), exhibiting a circadian inversion opposite to normal rhythms. Furthermore, compared with resting conditions, no significant changes were observed in heart rate parameters (mean heart rate, maximum heart rate, and minimum heart rate) or arrhythmia parameters (ventricular premature beats and supraventricular premature beats) among shift workers after shift work (P > 0.05). Shift work significantly reduces the heart rate variability of shift workers, suggesting a relative increase in sympathetic nervous system activity and being related to the normal circadian rhythm of the autonomic nervous system.
Circulatory failure in sepsis is reflected jointly by blood lactate, a marker of tissue perfusion, and the vasoactive-inotropic score (VIS), an index of pharmacologic support, yet the two are usually modeled separately. Whether their joint 48-h courses define internally stable, clinically interpretable phenotypes with distinct post-landmark prognoses is uncertain. In this single-center retrospective cohort study of MIMIC-IV version 3.1, we included adults meeting Sepsis-3 criteria who were alive and still in the intensive care unit (ICU) at a fixed 48-h landmark. Four 12-h summaries of lactate and VIS were modeled as separate longitudinal processes connected through shared latent classes in a finite-mixture trajectory model. Class associations with post-landmark 28-day (primary) and 90-day mortality were estimated with proportional-hazards models, with posterior pseudo-class sampling as a misclassification sensitivity analysis. Incremental predictive value over a baseline clinical model (A) was quantified for lactate-only (B1), VIS-only (B2), joint-class (C), and dynamic-summary (D) models, with temporal validation in 2017–2019 admissions and a 2020–2022 drift stress test. Among 6,820 patients, three classes emerged: low lactate with no or minimal vasoactive support (C1, 51.5
To analyze the implementation status of guideline-directed medical therapy (GDMT) in women with chronic heart failure (HF). This cross-sectional study included women with chronic HF admitted to Lanzhou University Second Hospital from January 2022 to December 2025. Patients were categorized into three groups according to left ventricular ejection fraction (LVEF): heart failure with reduced ejection fraction (HFrEF, LVEF ≤ 40
Hospitalization increases the chance of developing venous thromboembolism. Moreover, the risk of thromboembolism of the veins will be increased by co-morbidities, surgery, and current infections, which emphasizes the necessity of meticulous evaluation of high-risk patients and proper pharmacological prophylaxis in order to prevent venous thromboembolism and enhance the outcome of therapy. This study aimed to assess the appropriateness of venous thromboembolism prophylaxis and its associated factors among hospitalized medical patients. A retrospective observational study was conducted from January 2023 to December 2023 on medical patients at Tikur Anbessa Specialized Hospital (TASH). The Padua Prediction Score (PPS) was used to assess the risk and eligibility of thromboprophylaxis among the participants. Descriptive statistics were performed to describe the explanatory and outcome variables. Bivariable and multivariable analysis and Fisher exact tests were performed to assess the factor association with venous thromboembolism prophylaxis. A p-value < 5
This study aimed to investigate the value of myocardial work (MW) parameters for the early identification of cancer therapy-related cardiac dysfunction (CTRCD) in an echocardiographic (ECHO) cohort. This retrospective study included 312 patients with malignant tumors [mean age 54.63 ± 10.28 years; 160 (51.28
Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve heart failure outcomes, but whether relative effects are consistent across normoglycemia, prediabetes, and diabetes/type 2 diabetes remains uncertain. Linked publications from the same randomized populations may also be double counted in publication-based syntheses. We conducted a PROSPERO-registered systematic review and stratified meta-analysis. PubMed, Embase, Web of Science Core Collection, Cochrane CENTRAL, ClinicalTrials.gov, and supplementary sources were searched from inception to June 1, 2026. Independent parent trial populations were the quantitative analysis units. Trial-reported hazard ratios were pooled with random-effects REML models, and source-defined glycemic strata were analyzed separately. Source-reported interaction tests were interpreted without estimating a new cross-trial interaction. Modified Knapp–Hartung sensitivity analysis assessed the five Wald-type models with only three or four contributing trials. Seventeen eligible reports were mapped to four independent chronic heart failure trials—DAPA-HF, EMPEROR-Reduced, EMPEROR-Preserved, and DELIVER—with 20,725 randomized participants. Dapagliflozin or empagliflozin reduced the trial-defined primary composite outcome (HR, 0.78; 95
The contribution of socioeconomic position (SEP) to arrhythmias remains unclear. We aimed to examine the extent to which accelerated ageing mediates the associations of SEP and atrial fibrillation/flutter (AF), ventricular arrhythmias (VA), and bradyarrhythmias. Data were collected from the UK Biobank. SEP was determined by household income, education level and employment status using latent class analysis. Accelerated ageing was assessed by PhenoAge and BioAge acceleration calculated using nine and seven blood biomarkers respectively. Outcomes were AF, VA and bradyarrhythmia. Counterfactual mediation analysis was used to evaluate the mediation proportion of accelerated ageing in the association of SEP with arrhythmias. A total of 224,389 participants were included in the study. With a median follow-up of 13.33 years, 1,843 (0.82
Complete blood count (CBC)-derived inflammatory indices, including the aggregate index of systemic inflammation (AISI), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), are low-cost indicators of systemic inflammatory status. However, their associations with screening-defined hypertension in occupational populations remain unclear. This cross-sectional study analyzed occupational health examination data from construction workers in Shanghai, China, during 2024–2025. After retaining the first examination per worker, 123,265 workers were included in the primary analysis. Screening-defined hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg, based on the mean of the second and third blood pressure readings. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95
Cardiac foreign bodies (CFBs) resulting from potential self-insertion behaviors are clinically rare and diagnostically challenging. In patients with cognitive impairment, obtaining a precise etiology can be complex due to an unclear medical history. While surgical removal is the definitive treatment, the dynamic evolution of secondary structural sequelae warrants detailed investigation. This study highlights the diagnostic value of multimodal imaging in monitoring localized myocardial wall abnormalities and the progression of remodeling throughout the clinical course. A 35-year-old male with a childhood history of intellectual disability presented with persistent haematuria and dysuria for 2 weeks. He remained haemodynamically stable without cardiopulmonary symptoms. Contrast-enhanced computed tomography (CT) identified multiple needle-like metallic foreign bodies (FBs) distributed in the pericardium adjacent to the left ventricle (LV), abdominal wall, pelvis, bladder, and penis. Transthoracic echocardiography (TTE) demonstrated a 36-mm linear hyperechoic structure within the LV cavity, moving synchronously with the LV wall. The patient was diagnosed with multiple systemic metallic FBs, including a penetrating intracardiac foreign body, likely originating from self-insertion. The patient underwent an elective median sternotomy for the removal of the cardiac foreign body under intraoperative transesophageal echocardiography (TEE) guidance. A black, corroded metallic needle was successfully extracted from the mid-portion of the anterior LV wall. Other systemic FBs were managed conservatively following multidisciplinary consultation. On postoperative Day 7, follow-up TTE revealed the clinical manifestation of a LV apical outpouching (33 × 21 mm) and a suspected mural thrombus (13 × 7mm). These findings, reflecting the combined impact of chronic myocardial irritation and acute perioperative surgical stress, resulting in a significant reduction in systolic function (LVEF 45
Cardiovascular disease (CVD) remains a leading cause of mortality worldwide, with glucose and lipid metabolic disturbances closely involved. We therefore assessed how the glycated hemoglobin (HbA1c)/ high-density lipoprotein cholesterol (HDL-C) ratio (HHC) relates to composite CVD and individual subtypes across two population-based cohorts, while also testing whether the associations varied by population and cardiovascular outcome. Two nationally representative data sources were analyzed: the U.S. National Health and Nutrition Examination Survey (NHANES, 2001–2018) and the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). Within NHANES, receiver operating characteristic (ROC) curves compared how well HHC, HbA1c, and HDL-C discriminated prevalent composite CVD. Survey-weighted logistic regression was used for the cross-sectional NHANES analysis, whereas Cox proportional hazards regression was used for the longitudinal CHARLS analysis. We further assessed how HHC relates to CVD and its subtypes through restricted cubic splines (RCS), separate subgroup analyses, and an exploratory mediation analysis. In NHANES, higher HHC was associated with prevalent composite CVD and several cardiovascular subtypes after multivariable adjustment. After full adjustment, the odds of composite CVD were greater in the highest than in the lowest HHC quartile (OR = 1.77, 95
To provide reference for clinical treatment of trauma-induced coagulopathy. Persistent bleeding caused by endogenous heparin-like substances is difficult to identify and diagnose. This report describes the clinical manifestations and management of patients with continuous non-surgical bleeding after trauma. It not only provides the importance of thromboelastography in assisting diagnosis, but also summarizes the effective therapeutic drugs, and provides reference for clinical treatment of trauma-induced coagulopathy. A 31-year-old previously healthy Chinese male was referred to our department with continuous non-surgical bleeding after trauma. The patient received significant amounts of red cells, platelets, plasma and cryoprecipitate. Tranexamic acid and fibrinogen were used to prevent fibrinolysis. Then the patient underwent an interventional left iliac artery embolization in the early morning of the next day due to the inability to stop the bleeding. But the abnormal bleeding symptoms in the left thigh could not be corrected. Coagulation disturbances in this patient were confirmed by monitoring TEG to be caused by increased endogenous heparin-like substances. This bleeding disorder was quickly corrected by protamine, neutralizing the heparin-like substances. TEG monitoring should be repeated in cases of unexplained coagulopathy when other coagulopathies and exogenous medication are excluded. Protamine is an effective treatment for endogenous heparinization.
In clinical practice, it has been observed that patients undergoing joint replacement surgery during the perioperative period have a higher probability of developing cardiovascular diseases (CVD). Additionally, the overall health status of patients varies depending on whether they require joint replacement. This study uses Mendelian randomization to analyze whether there is an increased risk of cardiovascular disease in osteoarthritis (OA) patients eligible for joint replacement surgery and those not eligible, compared to non-OA patients. Mendelian randomization was conducted using downloaded genome-wide association study (GWAS) data on OA and CVD. The OA data was categorized into four groups: knee OA with joint replacement, knee OA without joint replacement, hip OA with joint replacement, and hip OA without joint replacement. CVD considered included coronary artery disease, heart failure, atrial fibrillation, ischemic stroke, and venous thromboembolism. Causal inference analyses were performed using inverse variance weighted (IVW), weighted median, and MR-Egger methods. Finally, MR-Egger, MR-Presso, and Cochran’s Q statistical methods were used to evaluate heterogeneity and pleiotropy. The IVW analysis revealed that individuals who underwent knee joint replacement had an increased risk of coronary artery disease (OR: 1.06, 95
Insomnia symptoms may contribute to atrial remodeling, but their association with left atrial structure in established nonvalvular atrial fibrillation remains unclear. We examined whether Athens Insomnia Scale-defined sleep status was associated with body surface area-indexed left atrial diameter (LADi). This multicenter cross-sectional study included 748 patients with nonvalvular atrial fibrillation from three centers. Patients were classified as having no sleep disturbance, suspected insomnia, or insomnia. Continuous LADi was the primary outcome, and elevated LADi (≥ 2.4 cm/m²) was the secondary outcome. Multivariable linear and logistic regression analyses were supplemented by sensitivity analyses, subgroup analyses, and propensity score overlap weighting. The groups included 284, 306, and 158 patients, respectively. Mean LADi increased across the three groups (2.22 ± 0.46, 2.36 ± 0.55, and 2.49 ± 0.58 cm/m²; P < 0.001), as did the proportion with elevated LADi (26.8
Interventricular septal hypertrophy (IVSH) is considered to be an early-stage alteration of left ventricular hypertrophy and is a major risk factor for a wide range of fatal arrhythmias and heart failure. We aimed to develop and validate a diagnostic model to detect patients with IVSH. This study included 1097 participants grouped according to the presence or absence of IVSH. An echocardiography (UCG) was used as a diagnostic criterion for IVSH, and we fit three logistics regression models, each composed of (a) electrocardiographic parameters (ECG-IVSH), (b) clinical factors (Clinic-IVSH), and (c) terms for both ECG-IVSH and Clinic-IVSH (Joint-IVSH). We assessed the performance of the models by calculating discrimination (area under the receiver operating characteristic curve, AUROC), calibration (calibration curves), and clinical value (clinical decision curves). The SHapley Additive exPlanations (SHAP) method explained global feature importance. The Joint-IVSH, which consisted of V1 lead R-wave duration (V1Rd), V1 lead R-wave area (V1Rs), age, body surface area, hypertension history, smoking status, and drinking status, had the highest accuracy compared to the other two models, with sensitivity and specificity of 76.7
Simple and scalable tools for mortality risk stratification in individuals with overweight or obesity remain limited. The triglyceride–glucose–waist circumference (TyG-WC) index integrates insulin resistance and central adiposity, but its prognostic value for mortality in this high-risk population is not well established. We analyzed 11,560 adults with overweight or obesity from the National Health and Nutrition Examination Survey (1999–2018) with mortality follow-up through 2019. Associations between TyG-WC and all-cause and cardiovascular mortality were assessed using multivariable Cox proportional hazards models and restricted cubic spline analyses. Subgroup, exploratory mediation, and sensitivity analyses, including propensity score matching and competing risk models, were performed. Over a median follow-up of 7.6 years, 1,098 deaths occurred, including 294 from cardiovascular disease. Compared with participants in the lowest TyG-WC quartile (Q1), those in the highest quartile (Q4) had significantly higher risks of all-cause mortality (HR 1.589, 95
Endomyocardial fibrosis (EMF) is a neglected restrictive cardiomyopathy reported predominantly in tropical regions. In Mozambique, the published evidence is fragmented, geographically concentrated, and based on heterogeneous study designs. This systematic review summarizes the available evidence on the geographic distribution, clinical and echocardiographic profile, complications, and factors reported in association with EMF in Mozambique. This systematic review followed PRISMA 2020 and was prospectively registered in PROSPERO (CRD420251108231). PubMed, Embase, Scopus, ScienceDirect, the Virtual Health Library, USC Library, and Google Scholar were searched through June 2025. Eligible records included observational studies, case series, and case reports involving Mozambican populations with EMF. Case reports and case series were retained primarily for descriptive clinical information and were not treated as population-level prevalence evidence. Two reviewers independently screened records and extracted data, with cross-checking by a third reviewer. Risk of bias was assessed according to study design. Because the included studies differed substantially in population, diagnostic approach, sampling strategy, and denominator, quantitative pooling was considered exploratory and was not interpreted as a national summary prevalence. Of 552 records identified, 33 underwent full-text assessment and nine studies published between 1979 and 2016 met the inclusion criteria. The evidence was concentrated in southern Mozambique, particularly Inhambane, Maputo, and Gaza. Reported prevalence estimates varied from 0.23
Atrial fibrillation is associated with both clinical stroke and covert brain infarction (CBI). Atrial cardiomyopathy has been proposed in absence of atrial fibrillation as an independent stroke risk factor, but supporting evidence is limited. This study aimed to investigate the association between echocardiographic and biochemical markers of atrial cardiomyopathy and the presence of CBI on magnetic resonance imaging (MRI) in an elderly population-based cohort. In the Akershus Cardiac Examination 1950 Study, transthoracic echocardiography and biobanking were performed at first visit (2012–2015). Markers of atrial cardiomyopathy included echocardiographic body surface area-indexed left atrial maximum and minimum volume, left atrial reservoir and contractile strain, and N-terminal pro B-type natriuretic peptide (NT-proBNP). Brain MRI was performed in a subset of participants (2016–2024), that were drawn according to participation in another study and stratified by blood pressure at age 40. Of 3706 participants, 414 (11
The prevalence of cardiometabolic multimorbidity (CMM) continues to rise among middle-aged and older populations, with central adiposity increasingly recognized as a major contributing factor. A Body Shape Index (ABSI), a relatively new metric describing physical form, shows an uncertain relationship with CMM. This investigation sought to evaluate how ABSI relates to CMM in middle-aged and older cohorts drawn from both China and the United States. Data analyzed in this study were obtained via two major national databases: the China Health and Retirement Longitudinal Study (CHARLS, n = 13,128) and the U.S. National Health and Nutrition Examination Survey (NHANES, n = 13,506), covering the years 2011 and 2011–2022, respectively. Weighted logistic regression was used to assess the associations between ABSI and CMM, as well as between ABSI and individual cardiometabolic conditions. Restricted cubic spline (RCS) analyses and subgroup analyses were conducted to further explore the dose–response relationships and population-specific differences. In both the CHARLS and NHANES datasets, among adults aged ≥ 65 years, the prevalence of CMM was significantly higher than in younger age groups in both the CHARLS and NHANES datasets. Overall, ABSI showed a positive association with CMM. In the Model 3, participants in the highest ABSI quartile had a 27
