Electrocardiograms (ECGs) are commonly performed in hospitals as part of clinical assessment and could be an opportunity to detect other incidental health conditions. This study aims to examine ECG practices among elderly patients at high risk of Atrial Fibrillation (AF) and stroke within a quaternary hospital setting and the prevalence of potentially clinically significant findings. Cross-sectional analysis of all patients ≥75 years admitted to a large quaternary hospital. Data extracted from the electronic medical record included patient demographics, comorbidities, reason for presentation, and ECG records. Each ECG was reviewed by two Cardiologists, with discrepancies resolved by a third Cardiologist. ECGs were assessed according to American Heart Association/American College of Cardiology (AHA/ACC) recommendations. Of 226 patients, [age 82.97±6.16, F = 112 (49.56

Introduction Poor adherence to risk factor control and life-saving medications is a key factor affecting long-term patient prognosis. Evidence indicates that sex plays a significant role in the uptake of both pharmacological and non-pharmacological interventions, ultimately influencing long-term outcomes. This study aimed to quantify sex differences in risk factor management and medication adherence following acute coronary syndrome (ACS).Methods This is a secondary analysis of the TEXTMEDS randomised clinical trial - a single-blind, multicentre randomised controlled trial of patients post-ACS. We compared sex differences in achieving clinical and lifestyle targets for secondary prevention, namely blood pressure control (<140/90 mm Hg), low-density lipoprotein cholesterol (LDL-C) (<1.8 mmol/L), healthy body mass index (BMI) (<25 kg/m²), regular physical activity (Global Physical Activity Questionnaire score ≥600), smoking status and adherence to cardioprotective medications (aspirin, beta blockers, ACE/angiotensin receptor blockers, statins, antiplatelets), using adjusted logistic regression models. Medication adherence was defined as taking ≥80% of prescribed doses in the month prior to follow-up, across all five drug classes, unless contraindicated.Results Of 1379 patients (mean age 58.5±10.7 years; 1095 (79.4%) male), females were less likely than men to achieve LDL-C targets (adjusted OR (aOR): 0.61, 95% CI 0.45 to 0.82) and engage in regular physical activity (aOR: 0.61, CI 0.47 to 0.80), but more likely to achieve a healthy BMI (aOR: 1.47, CI 1.04 to 2.06). Female patients are less likely to adhere to their medication compared with male counterparts (aOR: 0.68, CI 0.50 to 0.92). However, this association weakened and lost statistical significance after further adjustment for socio-economic factors (aOR: 0.71, CI 0.50 to 1.03). There were no significant interactions between sociodemographic or clinical factors and sex in relation to overall medication adherence (P-interactions >0.05).Conclusion This study reveals that female patients are less likely to achieve LDL-C targets and engage in physical activity but more likely to maintain a healthy BMI. Although females showed lower medication adherence, this association weakened after adjusting for socio-economic factors. These findings highlight the importance of sex-sensitive strategies focusing on risk factor control and medication adherence for improving cardiovascular health outcomes.Trial registration number ACTRN12613000793718.

Introduction Atrial fibrillation (AF), a common arrhythmia, is associated with impaired quality of life and increased stroke risk and mortality. Clinical guidelines recommend leveraging digital technologies to support patient education and AF self-management. Conversational artificial intelligence (AI) technologies may support patient engagement with self-management by enabling human-like conversations. This study aims to evaluate the effectiveness of a conversational AI intervention (Conversational artificial intelligence HeAlth supporT in Atrial Fibrillation Self-Management (CHAT-AF-S)) in improving quality of life in patients with AF. Methods and analysis CHAT-AF-S is a 3-month randomised controlled trial with 1:1 allocation and embedded process evaluation. We will randomise 480 adults (aged 18 years and older) with documented AF to the CHAT-AF-S intervention or usual care. Primary outcome is the Atrial Fibrillation Effect on QualiTy-of-life overall score. We will follow the intention-to-treat principles and data analysts will be blinded. Intervention participants will be invited to complete a user experience survey and take part in an interview to explore the feasibility, acceptability, perceived use and barriers and enablers to implementing the intervention. Qualitative data will be analysed thematically. Ethics and dissemination Ethics approval was obtained from the Western Sydney Local Health District Human Ethics Research Committee (2023/ETH00765). Written and informed consent will be obtained from all study participants before commencing any study procedures. Results will be disseminated via peer-reviewed publications and presentations at international conferences. Trial registration number Australian New Zealand Clinical Trials Registry (registration number: ACTRN12623000850673).

BACKGROUND:The HeartHealth program is a six-month SMS message-based support program offered to patients with a recent cardiovascular hospitalisation or recent cardiovascular clinic visit in Western Sydney, Australia. Its customised content focuses on cardiovascular risk factors, lifestyle, treatments and general heart health information. OBJECTIVE:To evaluate the implementation of the HeartHealth program. METHODS:A mixed-methods study was conducted assessing program reach, effectiveness, implementation and maintenance using program data, participant feedback surveys and staff focus-group discussions. Consecutive adult patients who had attended cardiology clinics or had been discharged from cardiology hospitalisation at Westmead Hospital, between April 2020 and April 2024, were included in the analysis. Content analysis was utilised to interpret the qualitative data. RESULTS:A total of 23095 patients were invited, 8804 (38.1%; 8804/23095) enrolled into the program, and 7964 (90.5%; 7964/8804) completed the six-month duration. Participants enrolled into the HeartHealth program had a mean age of 58.6 years, 60.3% were male, and 62.4% were recruited from an outpatient clinic setting. A total of 851058 SMS messages were sent, with 99.41% delivered successfully. 3533 (44.4% of program completers) participants completed the post-intervention survey, and four HeartHealth staff members participated in a focus group discussion. Among the participants who completed the survey, 60.5% reported that the program improved the healthiness of their diet, 53.6% reported improved physical activity levels, and 56.1% reported that it helped remind them to take their medications. Content analysis of participant feedback identified that the program was effective in prompting participants to change their diet, providing emotional support, reminding them of the importance of behaviour change, improving their confidence in managing their health, and keeping participants focused. Key barriers included limited personalisation, language options, and SMS scheduling flexibility. Recommended adaptations focused on enhancing personalisation, greater engagement by local clinical teams and expanding program dissemination. CONCLUSIONS:The program had a broad reach, translated to improved patient-reported health behaviours, provided participants with needed support at low cost and low resource requirements. This analysis highlights the successful implementation and scalability of the HeartHealth program and provides key learnings for health systems who are looking to implement similar programs in the future. CLINICALTRIAL:

Introduction Cardiovascular disease is a leading cause of death worldwide, of which coronary artery disease is the most common form. Sudden cardiac death (SCD) is a serious complication following acute myocardial infarction (MI), accounting for the highest percentage of all deaths in this population. Currently implantable cardioverter-defibrillators (ICDs) provide an acceptable method of primary prevention of SCD. However, the current literature is heterogeneous with regard to studies evaluating the benefits of ICDs for the primary prevention of SCD after MI, particularly relating to the timing of ICD implantation, risk stratification of patients for ICD implant selection and reporting non-rhythmic deaths after ICD implantation.Methods and analysis A meta-analysis will be performed to estimate the pooled effect size of randomised controlled trials (RCTs) examining the relationship between prophylactic transvenous ICD (TV-ICD) implantation and other medical therapies for primary prevention of SCD after MI. A comprehensive literature search and review will be performed using electronic medical databases including Scopus, Ovid MEDLINE, EMBASE (Ovid Platform), Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, ProQuest (Health and Medicine) and CINAHL (EBSCO) from January 1980 to June 2025. The literature search will be limited to peer-reviewed original studies carried out in human subjects and published in English. Type of study design will be limited to RCTs. The systematic review and meta-analysis will be developed according to the Joanna Briggs Institute Manual for Evidence Synthesis (2024 edition) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. Data analysis will be performed according to a structured and predetermined analysis plan. The primary outcome of the study will be all-cause-mortality, for which Hazard Ratios (HRs) will be reported as a measure of effect with 95% CI. Based on data availability, subgroup analysis will be carried out. The effect sizes will be reported based on a random effects model.Expected study outcomes and dissemination This systematic review and meta-analysis will evaluate and provide primary evidence for the effectiveness of prophylactic implantation of TV-ICDs on all-cause mortality in patients who experienced MI, aiming for primary prevention of SCD after MI. The primary prevention of SCD after MI is an important goal to reduce community incidence of out-of-hospital cardiac arrests, improving patient survival rates and their quality of life after MI. Out-of-hospital cardiac arrests currently have a survival rate of less than 10% and could result in long-lasting neurological damage in those who survive.PROSPERO registration CRD42023456995.

Background: The HeartHealth program is a 6-month SMS text messaging-based support program offered to patients with a recent cardiovascular hospitalization or recent cardiovascular clinic visit in Western Sydney, Australia. Its customized content focuses on cardiovascular risk factors, lifestyle, treatments, and general heart health information. Objective: This study aimed to evaluate the implementation of the HeartHealth program. Methods: A mixed methods study was conducted assessing program reach, effectiveness, implementation, and maintenance using program data, participant feedback surveys, and staff focus group discussions. Consecutive adult patients who had attended cardiology clinics or had been discharged from cardiology hospitalization at Westmead Hospital, between April 2020 and April 2024, were included in the analysis. Content analysis was used to interpret the qualitative data. Results: A total of 23,095 patients were invited, 8804 (38.1%) enrolled into the program, and 7964 out of 8804 (90.5%) completed the 6-month duration. Participants enrolled in the HeartHealth program had a mean age of 58.6 years, 60.3% (5302/8788) were male, and 62.4% (5382/8624) were recruited from an outpatient clinic setting. A total of 851,058 SMS text messages were sent, with 99.41% (846,009/851,058) delivered successfully. A total of 3533 out of 7964 (44.4% of program completers) participants completed the postintervention survey, and 4 HeartHealth staff members participated in a focus group discussion. Among the participants who completed the survey, 60.5% (2137/3533) reported that the program improved the healthiness of their diet, 53.6% (1894/3533) reported improved physical activity levels, and 56.1% (1982/3533) reported that it helped remind them to take their medications. Content analysis of participant feedback identified that the program was effective in prompting participants to change their diet, providing emotional support, reminding them of the importance of behavior change, improving their confidence in managing their health, and keeping participants focused. Key barriers included limited personalization, language options, and SMS text messaging scheduling flexibility. Recommended adaptations focused on enhancing personalization, greater engagement by local clinical teams, and expanding program dissemination. Conclusions: The program had a broad reach, translated to improved patient-reported health behaviors, and provided participants with needed support at low cost and low resource requirements. This analysis highlights the successful implementation and scalability of the HeartHealth program and provides key learnings for health systems that are looking to implement similar programs in the future.

BackgroundClinical guidelines recommend the early initiation of secondary prevention strategies prior to hospital discharge for patients with myocardial infarction (MI) to reduce morbidity and mortality, but implementation is resource-intensive. Multilingual videos can deliver information in diverse preferred languages and literacy levels, but their impact on MI knowledge among hospitalized patients remains unclear. ObjectiveThis study aims to assess whether the delivery of a multilingual educational video to hospitalized patients with MI can improve patient MI knowledge before hospital discharge. MethodsWe conducted a single-arm pre-post study with embedded formative implementation evaluation from December 2023 to October 2024 in a tertiary hospital. The intervention was a video on post-MI management, available in English, Arabic, Hindi, and Mandarin (with Simplified Chinese subtitles). The intervention was delivered via a tablet provided by the research assistant. The primary outcome was the change in patient knowledge of MI, measured by comparing the mean number of correct responses before and after the intervention using a 2-tailed paired t test. We assessed early-stage implementation using 2 prespecified elements from the Proctor implementation outcomes framework: acceptability and fidelity of the video delivery. We performed content analysis on the notes taken from participants’ feedback to improve the video. ResultsWe recruited 129 participants (mean age of 59.4, SD 12.6 years) for this study. English was the preferred language (n=96, 74.4%) and Hindi was the predominant non-English language (n=17, 13.2%). Of the 129 participants enrolled, 128 completed follow-up immediately postintervention (1 lost interest). The average number of correct responses out of 10 was 5.4 (SD 2.7) at baseline and 7.2 (SD 2.5) postintervention (mean difference=1.9, 95% CI 1.6-2.2; P<.001; Cohen drm for paired change=0.72). The educational video was well-accepted, with 83.6% (107/128) of participants finding it easy to understand, 74.2% (95/128) engaging, and 87.5% (112/128) useful. Participants’ feedback for improvement highlighted content complexity and a preference for conversational language and dialects. Fidelity of the intervention was subjectively assessed as reasonably achieved, given that the core components of the intervention (ie, animations and educational content conveyed through the audio and subtitles) were delivered as intended. Fidelity of the implementation strategy was similarly assessed as reasonably achieved because there were no technology issues preventing delivery of the intervention as intended, through video display from a weblink embedded in REDCap, using a tablet with internet connection. ConclusionsA short educational video may improve patient knowledge of MI before discharge. Further scaled research is needed to evaluate the effectiveness and implementation of this intervention in additional languages and diverse populations. This study highlights the need for culturally and linguistically tailored resources in clinical settings, informing future research and policy on inclusive patient education.

Carotid–femoral pulse wave velocity (cfPWV), an index of arterial stiffness, is one of the earliest indicators of cardiovascular risk. Studies of adolescents with anorexia nervosa have demonstrated increased arterial stiffness compared to healthy controls. Little information is available on the effect of weight restoration on arterial stiffness in adolescents with anorexia nervosa. This pilot longitudinal study examined changes in arterial stiffness during weight restoration in adolescent females admitted to an inpatient eating disorder unit. Female adolescents aged 15–19 years with a diagnosis of anorexia nervosa and a body mass index (BMI) < 85

Background:Patient education and self-management support are critical for atrial fibrillation (AF) management. Conversational artificial intelligence (AI) has the potential to provide interactive and personalized support, but has not been evaluated in patients with AF. Objective:This study aimed to evaluate the feasibility of a conversational AI intervention to support patients with AF postdischarge. Methods:This was a single-blinded, 4:1-parallel-randomized controlled trial with process evaluation of feasibility and engagement. The primary outcome was the change in Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire total score between groups. Patients with AF (18 y and older) were recruited postdischarge from Westmead Hospital cardiology services and randomized to receive either the intervention or usual care. The 6-month intervention consisted of fully automated conversational AI phone calls (with speech recognition and natural language processing) that regularly assessed patient health and symptoms and provided self-management support and education. These phone calls were supplemented with an online survey (sent via text message or email) containing replicated call content when participants could not be reached after 3 call attempts. If participant responses were concerning (eg, poor overall health, low medication confidence, and high symptom burden), they would be followed up with an ad hoc phone call and directed to clinical care if required. A semipersonalized education website was also available as part of the intervention, and participants were encouraged weekly (nudges delivered via text messages or emails) to visit it. Results:A total of 103 patients (mean age, 63.7 y, SD 11.2 y; n=72, 70% male) were randomized (82 to the intervention); the target sample size was 385. The difference in the AFEQT total score was nonsignificant (adjusted mean difference 2.08, 95% CI -7.79 to 11.96; P=.46). An exploratory prepost comparison revealed an improvement in total AFEQT score in the intervention group only (baseline: 69.9, 95% CI 64.4 to 75.5; 6 months: 79.9, 95% CI 74.9 to 84.8; P=.01). Participants completed 4 of 7 outreaches on average, and 88.4% (304/344) of completed outreaches were reported as useful. Conclusions:This proof-of-concept study demonstrates the feasibility of conversational AI in supporting patients with chronic conditions postdischarge. Intervention participants had improvement in their atrial fibrillation quality of life, though the forced shortening of the evaluation was unable to demonstrate a significant difference between groups.

RM use is rapidly evolving, requiring improved guidance for clinic personnel to manage this workload is required. This document builds up upon existing position statements to provide pragmatic recommendations on managing RM clinical alerts which will enhance the standardization of RM data management and improve engagement between clinicians and patients. This document underscores the workload demands and the necessity for specialist expertise in managing CIED RM. In recognition of the increasing complexity of clinical management that comes with the continual RM of CIEDs adequate funding, resource allocation, and optimization of models of care with appropriately trained workforce are also needed to ensure effective care.

Background Accurate mortality prediction following transcatheter aortic valve implantation (TAVI) is essential for mitigating risk, shared decision-making and periprocedural planning. Surgical risk models have demonstrated modest discriminative value for patients undergoing TAVI and are typically poorly calibrated, with incremental improvements seen in TAVI-specific models. Machine learning (ML) models offer an alternative risk stratification that may offer improved predictive accuracy.Methods PubMed, EMBASE, Web of Science and Cochrane databases were searched until 16 December 2023 for studies comparing ML models with traditional statistical methods for event prediction after TAVI. The primary outcome was comparative discrimination measured by C-statistics with 95% CIs between ML models and traditional methods in estimating the risk of all-cause mortality at 30 days and 1 year.Results Nine studies were included (29 608 patients). The summary C-statistic of the top performing ML models was 0.79 (95% CI 0.71 to 0.86), compared with traditional methods 0.68 (95% CI 0.61 to 0.76). The difference in C-statistic between all ML models and traditional methods was 0.11 (p<0.00001). Of the nine studies, two studies provided externally validated models and three studies reported calibration. Prediction Model Risk of Bias Assessment Tool tool demonstrated high risk of bias for all studies.Conclusion ML models outperformed traditional risk scores in the discrimination of all-cause mortality following TAVI. While integration of ML algorithms into electronic healthcare systems may improve periprocedural risk stratification, immediate implementation in the clinical setting remains uncertain. Further research is required to overcome methodological and validation limitations.

BackgroundCoronary heart disease (CHD) remains a leading cause of mortality and disability worldwide. Approximately half of the patients who have had a prior hospital admission for CHD will have a recurrent coronary event, with the majority of these occurring within 12 months. Despite well-established evidence-based therapies, medication non-adherence is highly prevalent and reasons for medication non-adherence are poorly understood. This study evaluates factors influencing adherence to secondary prevention medications in people with acute coronary syndrome (ACS).MethodsWe performed a secondary analysis of TEXT messages to improve MEDication adherence and Secondary prevention after ACS (TEXTMEDS), a single-blind randomised clinical trial of 1424 patients with ACS from 18 hospitals across Australia. The primary outcome was self-reported medication adherence to each of up to five classes of guideline-recommended cardioprotective medications indicated for secondary prevention after ACS. Patients were followed up at 6-month and 12-month time points and were defined as adherent if at both time points, the proportion of indicated medications taken was >80% (>24/30 days in the preceding 1 month) for all five classes if not otherwise contraindicated. Logistic regression analysis and the Least Absolute Shrinkage and Selection Operator regularisation technique were used to assess the effect of sociodemographic and clinical factors on medication adherence.ResultsThe analyses included 1379 participants with complete adherence data (mean age 58.5±10.7 years; 1095 (79.4%) men). The following variables were associated with adherence to cardiovascular medications at both 6 and 12 months: greater number of total medications taken (OR: 1.33; 95% CI: 1.25 to 1.42) and attending a cardiac rehabilitation programme (1.47; 95% CI: 1.17 to 1.86). In contrast, female sex (0.67; 95% CI: 0.50 to 0.90) and physical disability (0.43; 95% CI: 0.23 to 0.77) were associated with lower likelihood of medication adherence.ConclusionsSociodemographic and clinical factors may influence medication adherence. Greater awareness, discussion and monitoring of these factors during patient follow-up may help improve medication adherence.Trial registration numberAustralian New Zealand Clinical Trials Registry; URL:https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364448;registration number: ACTRN12613000793718.

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and is strongly linked with systemic vascular comorbidities. This study investigated if DR predicts risk of cardiovascular disease (CVD) mortality in a high CVD risk cohort. This was a prospective cohort study of 1582 adult participants who presented to a tertiary Australian hospital for evaluation of acute coronary syndrome by coronary angiography. Participants were concurrently examined for DR from mydriatic fundus photographs which were mask-graded according to International Clinical Classification categories of no DR, mild non-proliferative DR, moderate-to-severe NPDR, and proliferative DR. Coronary artery disease was graded from coronary angiograms using the Gensini score. CVD mortality follow-up was assessed 9 years after baseline examination using linkage with the Australian National Death Index. At baseline, 355 (22.4%) participants had any DR. There were 181 (11.4%) fatal CVD events after 9-years follow-up. After controlling for age, sex, BMI, diabetes, total cholesterol, smoking status, hypertension, previous myocardial infarction and stroke, any DR was associated with 1.8-fold higher risk of CVD mortality (Hazard Ratio [HR] 1.84, 95% Confidence Interval [95% CI: 1.30-2.61]). Mild non-proliferative DR (1.85 [1.26-2.72]) and proliferative DR (5.27 [2.32-12.00]) were associated with greater CVD mortality risk. Further adjustment for coronary artery disease using Gensini scores and excluding patients without diabetes had minimal impact on the association. The increased risk of CVD mortality was significant in both men (2.25 [1.60-3.19]) and women (2.38 [1.24-4.58]) with any DR. In individuals with high CVD risk, presence of DR independently predicts increased CVD mortality. This likely reflects additional contribution of microvascular disease to CVD mortality. Individuals with DR may benefit from a comprehensive cardiovascular risk assessment, lifestyle changes, more intensive cardiovascular management and follow-up to minimise risk of death from CVD events.

OBJECTIVE:To investigate whether age-related macular degeneration (AMD) predicts the risk of all-cause and cardiovascular disease (CVD) mortality in a high CVD risk cohort. DESIGN:Prospective cohort study. PARTICIPANTS:A total of 1545 adult participants who presented to a tertiary Australian hospital for evaluation of acute coronary syndrome were included in this study. METHODS:Participants were evaluated for acute coronary syndrome using coronary angiography. Participants were concurrently examined for AMD from mydriatic fundus photographs, which were graded using the Wisconsin grading system into categories of any AMD, early AMD, and late AMD. Coronary artery disease was graded from coronary angiograms using the Gensini score. Mortality data were obtained 9 years after baseline examination through data linkage with the Australian National Death Index. Hazard ratios (HRs) were obtained using Cox regression analysis. MAIN OUTCOME MEASURES:All-cause and CVD mortality data were obtained through data linkage with the Australian National Death Index. Death rates through June 2018 were compared by demographics and potential confounders. RESULTS:Any AMD was identified in 107 (6.9%) participants, including those with early (n = 86) and late AMD (n = 21). Over 9 years of follow-up, 234 (15.1%) participants had died, including 174 (11.3%) participants from fatal CVD events. After controlling for age, sex, body mass index, total cholesterol, smoking status, history of diabetes, hypertension, myocardial infarction, stroke, and macrovascular coronary artery disease severity using the Gensini score, there was an increased rate of all-cause mortality for those with any AMD (HR, 2.37; 95% confidence interval [CI], 1.54-3.64), early AMD (HR, 2.42; 95% CI, 1.48-3.94), and late AMD (HR, 2.25; 95% CI, 1.08-4.71). Any AMD (HR, 2.62; 95% CI, 1.61-4.26) and early AMD (HR, 2.61; 95% CI, 1.50-4.64) were also associated with a greater likelihood of CVD mortality. Late AMD was not associated with CVD mortality. CONCLUSIONS:In individuals with high CVD risk, the presence of AMD at any stage independently predicted increased all-cause mortality. Meanwhile, any AMD and early AMD increased the risk of CVD mortality. Although mechanisms are unclear, this potentially reflects shared pathways between AMD and CVD. FINANCIAL DISCLOSURE(S):The authors have no proprietary or commercial interest in any materials discussed in this article.

BACKGROUND Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) reduces health care visits and improves clinical outcomes, but its use and service models are poorly characterized. OBJECTIVE This study aimed to examine the current landscape of CIED RM in Australia and New Zealand, including the prevalence of CIED and RM use, care models for RM data management, and infrastructure and resource requirements. METHODS A cross-sectional study was conducted using surveys of CIED clinics in Australia and New Zealand and analysis of deidentified CIED industry data. Data were obtained from public and private clinics and all 5 major CIED manufacturers. RESULTS Operational data were obtained from 50 clinics and implant/RM distribution data from all 5 manufacturers. From 2019 to 2023, total CIED implantations increased by 10.2% (125.9-138.8 per 100,000 people), whereas RM transmitter distribution rose 55.8% (75.5-117.6 per 100,000 people). In 2023, RM use was highest in remote (88.4%) and rural regions (85.3%) compared with regional (73.1%) and metropolitan (80.3%) areas. From survey data, the median clinic patient load was 1303 patients (interquartile range 1820) per year. On average, 30.2% of clinic workload (standard deviation 21.8%) was dedicated to managing RM alerts, primarily by cardiac physiologists (90.5%). The mean interval between scheduled in-person CIED follow-ups was longer for RM patients than non-RM patients (10.0 vs 7.2 months; P < .001). CONCLUSION This study provides the first comprehensive analysis of CIED RM service use, offering insights to inform future RM care models and the development of other virtual care systems using remote patient data.

AIM:Rapid access chest pain clinics (RACCs) are an innovative outpatient pathway that allows low-intermediate risk patients to avoid hospitalisation. However, the extent of RACCs in Australia is unknown. We aimed to identify Australian RACCs and describe the characteristics and landscape of this model of care in Australia. METHOD:Australian RACCs were identified through four pathways: 1) Systematic literature search; 2) Google Search; 3) Word of mouth via RACC leaders including through the National Health and Medical Research Council Translation Centres that form the membership of the Australian Health Research Alliance; and 4) through the Cardiac Society of Australia and New Zealand emailing list. All RACCs identified were invited to complete a survey exploring the clinic's characteristics. RESULTS:Twenty-five (25) RACCs were identified, and present in all Australian states and territories. All public (n=16 of 16, response rate=100%) and three private (n=3 of nine, response rate=33%) RACCs completed the survey, with most RACCs located in major cities (n=14, 74%). In the 2022 calendar year, responding RACCs reported assessing 7,718 patients. RACCs had a median waiting time of 8.5 days (interquartile range [IQR] 4-18 days), 10 RACCs assessed >50% of patients within 7 days of referral, and 11 RACCs assessed ≥80% of patients within 14 days. Service variations included: clinic days/week (median=3; IQR 1.25-4 days), patient volume (median=335; IQR 130-600; range, 96-1,674 patients/yr), staffing (all RACCs had at least one consultant), other RACCs involved cardiology advanced trainees (n=13), nursing staff (n=11), basic physician trainees or senior resident medical officers, that is, post-graduate year (PGY) 3+ (n=2), and PGY1/PGY2s (n=3). All clinics accepted emergency department referrals (n=19), with additional referrals from general practitioners in 12 RACCs, and in-hospital/other clinic referrals in nine. Telehealth was used in 13 clinics. The most common initial investigation was stress echocardiography (eight clinics), computed tomography coronary angiogram (six clinics), and exercise stress test (five clinics). CONCLUSION:Our survey is the first known to describe the national implementation of RACC and map the delivery of care in Australia. An additional outcome is the development of a national network of centres to collaboratively develop a "best practice" model of care for RACCs to improve patient outcomes.

BACKGROUND:The HeartHealth program is a text message support program for cardiovascular patients in Western Sydney, Australia. It comprised regular semipersonalized text messages providing cardiovascular disease information, advice, and support over a 6-month period. OBJECTIVES:This study aimed to examine the impact of the HeartHealth program on health care service utilization. METHODS:This is an observational study that compared hospitalization rates in patients who enrolled in the HeartHealth program to patients who did not. Patients ≥18 years old who attended cardiology clinics or were discharged from the cardiology unit at Westmead Hospital between April 2020 and April 2022 were invited to participate in HeartHealth. The primary outcome was the incidence rate of all-cause health care utilization events in the 6 months postdischarge. All analyses were adjusted for demographic and comorbidity variables. RESULTS:11,542 patients were included in the analysis (intervention: 4,324, control: 7,218), with a mean age of 58.8 ± 17.0 years, and 60.7% (7,003/11,535) were male. HeartHealth participants had lower rates of health care service events compared to control participants (number of events per patient: 0.43 intervention vs 0.52 control; adjusted rate ratio [RR]: 0.91 [95% CI: 0.83-0.99]; P = 0.033). There was a greater reduction in health care utilization events in older (>65 years old) compared to younger patients (RR: 0.82; 95% CI: 0.72-0.93 vs RR: 0.98; 95% CI: 0.87-1.10, respectively; interaction P = 0.043). HeartHealth participants reported that the program improved diet, physical activity levels, and medication compliance. CONCLUSIONS:This analysis demonstrates the potential of text message-based postdischarge support for cardiovascular disease patients to decrease their need for health care service utilization for all medical causes.

OBJECTIVES:To assess the effects of digital patient decision-support tools for atrial fibrillation (AF) treatment decisions in adults with AF. STUDY DESIGN:Systematic review and meta-analysis. ELIGIBILITY CRITERIA:Eligible randomised controlled trials (RCTs) evaluated digital patient decision-support tools for AF treatment decisions in adults with AF. INFORMATION SOURCES:We searched MEDLINE, EMBASE and Scopus from 2005 to 2023.Risk-of-bias (RoB) assessment: We assessed RoB using the Cochrane Risk of Bias Tool 2 for RCTs and cluster RCT and the ROBINS-I tool for quasi-experimental studies. SYNTHESIS OF RESULTS:We used random effects meta-analysis to synthesise decisional conflict and patient knowledge outcomes reported in RCTs. We performed narrative synthesis for all outcomes. The main outcomes of interest were decisional conflict and patient knowledge. RESULTS:13 articles, reporting on 11 studies (4 RCTs, 1 cluster RCT and 6 quasi-experimental) met the inclusion criteria. There were 2714 participants across all studies (2372 in RCTs), of which 26% were women and the mean age was 71 years. Socioeconomically disadvantaged groups were poorly represented in the included studies. Seven studies (n=2508) focused on non-valvular AF and the mean CHAD2DS2-VASc across studies was 3.2 and for HAS-BLED 1.9. All tools focused on decisions regarding thromboembolic stroke prevention and most enabled calculation of individualised stroke risk. Tools were heterogeneous in features and functions; four tools were patient decision aids. The readability of content was reported in one study. Meta-analyses showed a reduction in decisional conflict (4 RCTs (n=2167); standardised mean difference -0.19; 95% CI -0.30 to -0.08; p=0.001; I2=26.5%; moderate certainty evidence) corresponding to a decrease in 12.4 units on a scale of 0 to 100 (95% CI -19.5 to -5.2) and improvement in patient knowledge (2 RCTs (n=1057); risk difference 0.72, 95% CI 0.68, 0.76, p<0.001; I2=0%; low certainty evidence) favouring digital patient decision-support tools compared with usual care. Four of the 11 tools were publicly available and 3 had been implemented in healthcare delivery. CONCLUSIONS:In the context of stroke prevention in AF, digital patient decision-support tools likely reduce decisional conflict and may result in little to no change in patient knowledge, compared with usual care. Future studies should leverage digital capabilities for increased personalisation and interactivity of the tools, with better consideration of health literacy and equity aspects. Additional robust trials and implementation studies are warranted. PROSPERO REGISTRATION NUMBER:CRD42020218025.

BACKGROUND:Ischaemic stroke remains one of the leading causes of death and disability worldwide. The population of Western Sydney has a unique demographic with lower socioeconomic status and a culturally and linguistically diverse population. This study aims to investigate the demographics and cardiovascular risk factors of patients in Western Sydney, focusing on the prevalence and profile of cardioembolic (CE) strokes and embolic strokes of undetermined source (ESUS). METHOD:Prospective data were collected in 463 patients with ischaemic stroke presenting to a tertiary centre in Western Sydney, who underwent predischarge transthoracic echocardiography. Patients with haemorrhagic strokes or unclear stroke diagnosis were excluded. Analysis of stroke subtype (CE, ESUS, or non-embolic) and clinical characteristics was performed based on age, gender, and prior atrial fibrillation (AF) prevalence. RESULTS:Of the 463 patients, 147 (32%) had CE strokes, and 147 (32%) had ESUS. Cardioembolic (CE) strokes were associated with older age (≥65 years) and a history of congestive cardiac failure. Older patients had higher rates of hypertension, ischaemic heart disease, AF, and congestive heart failure. History of AF was present in 67 patients (14.5%); however, only 51% received anticoagulation before admission despite a low bleeding risk. The transthoracic echocardiography characteristics of ESUS/non-embolic strokes differed from those of CE strokes; 20% of patients with ESUS had an enlarged left atrium, suggesting a subset of patients with ESUS with a left atrial myopathy. CONCLUSIONS:Patients with ischaemic stroke in Western Sydney have a high prevalence of cardiovascular risk factors which were often undertreated. Half of the patients with prior AF did not receive anticoagulation despite low bleeding risk, indicating a gap in optimal stroke prevention. There were distinct echocardiographic characteristics among stroke subtypes. Further analysis of left atrium parameters may provide greater insights into the pathogenesis and prevention of embolic strokes.

Aims Embolic stroke of undetermined source (ESUS) results in significant morbidity. A left atrial (LA) myopathy is implicated in a proportion of these patients. We hypothesized that LA shape varies by cause of stroke [CE (cardioembolic) vs. ESUS]. Methods and results A total of 236 ischaemic stroke and atrial fibrillation (AF) patients and controls were recruited prospectively. AF was classified as paroxysmal AF (PAF) or persistent AF (PersAF). Stroke patients comprised CE stroke secondary to AF and ESUS. There were 81 AF (47 PAF, 34 PersAF), 50 ESUS, 57 CE patients [subdivided into CE with PAF (CEpaf) and CE with PersAF (CEpers)], and 48 controls. Echocardiographic parameters including LA volume, function, and shape/sphericity (3D LA sphericity and 2D-derived LA circularity, ellipticity, sphericity, and eccentricity indices) were evaluated. Increased LA volume and sphericity with LA dysfunction were present in CE, AF, and ESUS groups compared with controls. K-means cluster analysis demonstrated a spectrum of LA myopathy with controls at the lowest and CEpers and PersAF at the upper extremes, with ESUS, PAF, and CEpaf being similar and falling between these extremes. After adjusting for age, sex, and left ventricular (LV) and LA parameters, LA sphericity markers differentiated ESUS from controls (P < 0.01). Conclusion Alterations in LA shape are present in ESUS, AF, and CE patients, particularly increased spherical remodelling. The novel markers of LA sphericity proposed may identify LA myopathy in ESUS patients and potentially guide management for secondary prevention.