Background and Aims We investigated whether patients with coronary heart disease (CHD) in Europe are achieving the standards set by prevention and rehabilitation guidelines. Variability in achieved standards was also studied: (i) between countries, (ii) between geographical risk regions, and (iii) according to attendance at cardiac rehabilitation (CR). Methods EUROASPIRE VI is an observational study conducted between September 2024 and February 2026 in 160 hospitals across 27 countries. Geographical risk regions were defined as high, moderate, or low based on World Health Organization cardiovascular mortality data. Results were standardized by age and sex. Results Among 8590 patients with CHD (23.7% female), 17.1% were current smokers, 32.0% were obese, and 33.5% reported low physical activity. 59.8% were above blood pressure target (systolic >= 130 and/or diastolic >= 80 mmHg), 82.7% were above LDL-cholesterol target (>= 1.4 mmol/L), 32.8% had known diabetes of whom 42.2% had HbA1c >= 7%, and 30.6% had chronic kidney disease. Prevalences of these risk factors were all highest in countries from high-risk regions. 29.1% of patients attended at least one CR session, with country variability ranging from 0% to 79% and differing by risk region (55.9% low risk, 29.7% moderate risk and 10.2% high risk; P < .001). Attendance at CR programmes was associated with significantly better lifestyles, risk factor control, and use of cardioprotective drugs. Conclusions Most European patients are not achieving targets set by prevention guidelines. Despite better outcomes for those attending CR, there is marked variability in CR attendance and evidence of inverse care, with lowest attendance in highest risk regions. These results provide a baseline to inform the challenges for future implementation of the first European Society of Cardiology guideline on CR.
BACKGROUND: Among the > 80 million people living > 2,500 m are patients with pulmonary arterial hypertension (PAH). RESEARCH QUESTION: How does descent to sea level (SL) affect pulmonary hemodynamics and 6-minute walk distance (6MWD) in patients with PAH living at high altitude (HA)? STUDY DESIGN AND METHODS: HA residents with PAH were transported to SL. Vital signs including heart rate (HR), arterial oxygen saturation (SaO2), 6MWD, systolic pulmonary artery pressure (sPAP), cardiac output (CO), and other measures were assessed at 2,850 m and after the first night (day 2) and second night (day 3) at SL. RESULTS: Twenty-eight patients (24 female; age, 46 +/- 12 y), treated with phosphodiesterase type 5 inhibitors (n = 28) and endothelin receptor antagonists (n = 9), were included. SaO2, sPAP, HR, CO, and 6MWD at HA were 90% +/- 5%, 68 +/- 24 mm Hg, 74 +/- 14 bpm, 3.9 +/- 1.1 L/min, and 462 +/- 100 m. On SL day 2, SaO2 was higher (+5.5% [3.9%-7.1%], sPAP and HR were lower (-11 [-16 to-5] mm Hg and-7 [-12 to-3] bpm) (all P < .001), resulting in unchanged sPAP/CO and oxygen delivery. HR and CO further decreased on day 3, resulting in unchanged sPAP/CO vs HA. 6MWD was higher at SL vs HA on day 2 (+41 [16-67] m; P < .001) but not day 3. No adverse events occurred, including after re-ascent. INTERPRETATION: Our results show that typical patients with PAH living at 2,850 m reveal improved blood oxygenation after descent to SL along with decreased sPAP, but also HR, resulting in unchanged pulmonary resistance and oxygen delivery. Although 6MWD initially increased at SL, it returned to high-altitude baseline after the second night, along with further HR and CO decrease. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; Nos.: NCT06092424, NCT05996302; URL: www.clinicaltrials.gov CHEST 2026; 170(2):512-523
ABSTRACT Background and Objective Non‐invasive ventilation (NIV) and inhaled bronchodilator therapy are foundational in the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, optimal drug‐delivery strategies during NIV remain uncertain. This study compared bronchodilator delivery via a pressurized metered‐dose inhaler (pMDI) interface versus standard jet nebulization during NIV. Methods This randomized, open‐label trial enrolled adults with hypercapnic AECOPD requiring NIV. Participants were randomized 1:1 to receive ipratropium bromide via pMDI using a modified NIV mask, or via jet nebulizer integrated into the inspiratory limb. Serum ipratropium concentrations at 30 min constituted the primary bioequivalence endpoint, analysed using geometric mean ratios (GMR) and Bayesian posterior probabilities. Secondary outcomes included changes in physiologic parameters, blood gases, ventilatory asynchrony, duration of stay and cost effectiveness. Results Forty‐four patients were randomized; 41 were included in the intention‐to‐treat analysis (pMDI n = 20, nebulizer n = 21). At 30 min, geometric mean serum ipratropium levels were higher with pMDI (110.9 pg/mL) versus nebulization (51.6 pg/mL), yielding a GMR of 2.15. Bayesian analysis showed a 95.9% probability that GMR exceeded the non‐inferiority threshold (0.80). At 6 h, differences again favoured pMDI (GMR 3.18; p = 0.022; posterior probability 99.8%). Physiologic outcomes, gas exchange, and NIV duration were similar between groups, though ICU stay was shorter in the pMDI arm. No safety concerns or device‐related complications were observed. Post hoc cost analysis showed markedly lower therapy cost with pMDI. Conclusions pMDI‐based bronchodilator delivery during NIV using a customized interface is feasible, safe, cost‐efficient, and achieves higher systemic drug levels than jet nebulization. Larger multicentre trials are warranted to determine clinical impact. Trial Registration Clinical Trials Registry of India CTRI/2023/07/054734
