Introduction: Coronary heart disease (CHD) is the leading cause of cardiovascular mortality worldwide, with the greatest burden concentrated in low- and middle-income countries (LMICs). Patient readiness-encompassing knowledge, self-efficacy, and self-care behaviour-is a critical determinant of post-discharge outcomes. Digital education interventions offer an innovative, resource-efficient approach to improving CHD patient readiness in LMICs; however, the available evidence has not been systematically mapped. Methods: This scoping review followed the Arksey and O'Malley framework and was reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). A systematic search was conducted across four databases-PubMed, ScienceDirect, Wiley Online Library, and the Cochrane Library-for publications from 2019 to 2026. The most recent searches were run on 1 March 2026 and supplemented by manual screening of reference lists. Results: Eleven studies were included, comprising 7 full RCTs (63.6%), 1 pilot RCT (9.1%), 2 RCT protocols (18.2%), and 1 feasibility study (9.1%). Geographic distribution included China (n = 4; 36.4%), Iran (n = 4; 36.4%), Colombia (n = 1; 9.1%), Tunisia (n = 1; 9.1%), and Brazil (n = 1; 9.1%). The most frequently used primary delivery platforms were mobile applications/smartphones (n = 3; 27.3%), WeChat (n = 2; 18.2%), WhatsApp (n = 2; 18.2%), Web-based/online platforms (n = 2; 18.2%), augmented reality (n = 1; 9.1%), and digital multimedia (n = 1; 9.1%). The most commonly measured outcomes were self-efficacy (n = 4; 36.4%), quality of life (n = 3; 27.3%), disease knowledge/illness perception (n = 3; 27.3%), medication adherence/self-management (n = 3; 27.3%), and clinical events (n = 1; 9.1%). Discharge readiness was not measured as a primary outcome in any included study. Conclusion: Digital education interventions show promising potential for improving the components of CHD patient readiness in LMICs; however, the evidence remains concentrated in China and Iran. Research specifically targeting discharge readiness with validated instruments is urgently needed across diverse LMIC settings, particularly in Southeast Asia, sub-Saharan Africa, and Latin America.
Background: Atrial fibrillation is the most common cardiac arrhythmia, which has effects that goes beyond the heart, often affecting mental health. Over the years, increasing evidence has highlighted a bidirectional connection between anxiety and atrial fibrillation. However, the connection between the two in clinical practice is vague. Objective: This systematic review aims to investigate the relationship between anxiety and atrial fibrillation, including how anxiety might contribute to the onset and relapse of atrial fibrillation, how it may impact the treatment outcomes and its effects on the patient’s overall quality of life. Methods: We conducted an extensive search of PubMed, Scopus, Embase, and Cochrane to systematically identify studies between 2020 and 2025. Adult patients with atrial fibrillation diagnosis who were assessed for anxiety were included using validated scales. A total of 84 articles met the inclusion criteria, with data extracted on anxiety measures, features of atrial fibrillation, clinical impact, and treatment effects. Results: Among the reviewed studies, anxiety was both prevalent in AF patients and significantly associated with poorer clinical outcomes across the majority of included studies, though the strength and nature of associations varied across study designs and populations. Patients with higher levels of anxiety had a higher probability of recurrent atrial fibrillation, increased symptom burden, and lower health-related quality of life. Anxiety also influenced treatment outcomes and adherence, particularly regarding anticoagulation and ablation therapy. Notably, several interventions including catheter ablation and structured patient education were associated with reductions in anxiety and improvements in outcomes. Importantly, one Mendelian randomisation study found no causal relationship between anxiety and AF, while depression and panic disorder showed causal associations, underscoring the need for cautious interpretation of observational findings. Conclusion: Anxiety and atrial fibrillation appear to share a complex, predominantly bidirectional association. While most observational studies support a link between anxiety and worse AF-related outcomes, evidence from Mendelian randomisation does not confirm a causal role for anxiety in AF onset, suggesting that residual confounding may partly account for observational associations. Addressing mental health in AF care is nonetheless clinically important. Incorporating psychological assessment and support into AF management may reduce symptom burden and improve treatment adherence and quality of life. Further research, particularly longitudinal interventional studies using standardised instruments, is required to guide more comprehensive, patient-centred care.
We report the case of a 33-year-old male mountaineer, presenting with chest pain, severe headache, dyspnea, and lower extremity edema, on his first expedition to Paraw mountain located in Kermanshah Province. His condition involved a complex thrombotic presentation, including both venous and arterial events, such as a myocardial infarction due to stenosis of the left main coronary artery, which we believe to be a coincidental pathology. His neurological symptom includes headache, vomiting, and slight drowsiness associated with chest pain, which were evaluated alongside confirmatory testing for protein C-S deficiency. Physical examination revealed right lower extremity edema, respiratory distress (RR=34), and mid-drowsiness. Chest X ray showed lung congestion. A history of recurrent thrombophlebitis, along with the current myocardial infarction, raised suspicion of a thrombophilic state. The final diagnosis of these complications was confirmed to have protein C-S deficiency based on laboratory tests performed during the acute phase. However, the hereditary nature of this deficiency remains unconfirmed as no genetic testing or family screening was undertaken. The patient underwent coronary artery bypass grafting of left anterior descending artery (LAD) and LCX associated with anticoagulant therapy, and his neurologic sign and symptom and lower extremity deep vein thrombosis recovered uneventfully.
Background: Transthyretin amyloidosis (ATTR) is a progressive disease that causes a restrictive cardiomyopathy. Vutrisiran, a subcutaneous RNA interference (RNAi) therapy, is an approved treatment. This systematic review and meta-analysis evaluates its efficacy and safety with respect to transthyretin (TTR) reduction, functional capacity, quality of life, mortality, and adverse events. Methods: We identified 1,032 records, of which three randomized controlled trials-HELIOS-A, HELIOS-B, and a Phase 1 study-comprising 976 participants (508 vutrisiran; 468 comparator) met the inclusion criteria. Comparator participants received placebo, patisiran (an active reference comparator in HELIOS-A), or external placebo from the APOLLO trial. Outcomes assessed were TTR reduction, functional capacity, quality of life, mortality, and adverse events, pooled using random-effects models reporting mean differences and risk ratios. Results: Vutrisiran achieved a rapid, durable TTR reduction of up to 97% in healthy volunteers at the highest dose, and a sustained steady-state reduction in the HELIOS-A and HELIOS-B trials. QoL outcomes showed a protective effect of vutrisiran, with slowed deterioration in the intervention group. Functional outcomes (10-MWT, 6-MWT) suggested slower decline in mobility and functional capacity. Mortality showed a non-significant reduction (RR 0.51; p = 0.29; I2 = 62%), with most deaths considered unrelated to treatment. The safety analysis showed fewer falls (RR 0.62; p = 0.001; I2 = 0%) but no significant difference in overall adverse events (AEs) (RR 1.01; p = 0.76) or serious AEs (RR 0.82; p = 0.23). A sensitivity analysis supported the adverse-event findings. Conclusions: Vutrisiran consistently suppressed TTR and showed signals of benefit in quality of life, function, and mortality, though most of these outcomes did not reach statistical significance. It reduced fall risk without increasing adverse events, indicating a favourable safety profile. Larger, long-term RCTs are needed to confirm survival and functional benefits.
Oxidative stress and adipokine imbalance are important contributors to the pathogenesis of diabetic cardiovascular disease. The nuclear factor erythroid 2-related factor 2 (Nrf2) regulates antioxidant defense, while adipokines link metabolism and inflammation. Incretin-based therapies and PPARγ agonists may join on these pathways to provide cardiovascular protection beyond glycemic control. This review aims to investigate the current evidence on how incretin-based agents and PPARγ agonists regulate the adipokine-Nrf2 axis and their impact on cardiovascular outcomes in diabetes. A literature search was performed using PubMed, Google Scholar and Scopus to include reviews, experimental, clinical, and translational studies published in English until November 2025. Evidence indicates that incretin-based agents and PPARγ agonists synergistically activate Nrf2 and inhibit NF-kB signaling, leading to improved oxidative status and favorable adipokine levels. Increased adiponectin and omentin, and suppressed resistin, leptin and TNF-α contribute to reduced inflammation and enhanced vascular and myocardial protection. Collectively, combined activation of incretin and PPARγ pathways modulates the adipokine-Nrf2 axis, offering joined antioxidant and anti-inflammatory benefits that may reduce diabetic cardiovascular risk.
