BACKGROUND:Female sex is associated with an increased risk of ischemic stroke in patients with atrial fibrillation (AF). Studies from Europe suggest that sex disparities in stroke risk have declined over time, but the generalizability of these findings to other populations remains uncertain. OBJECTIVE:The purpose of this study was to examine the 20-year temporal trends in sex differences in stroke risk among patients with newly diagnosed AF in Israel. METHODS:We conducted a population-based retrospective cohort study using the database of the largest health care provider in Israel. Nonanticoagulated patients with newly diagnosed nonvalvular AF between 2004 and 2023 were included and followed up for the occurrence of ischemic stroke or systemic embolism. The CHA2DS2-VA score-adjusted relative risk comparing the 1-year cumulative incidence function of female patients with that of male patients was estimated using the pseudo-value approach. RESULTS:The study included 112,478 patients [57,951 (51.5%) females] with AF. Females were older than males, with a median age of 76.7 years (interquartile range 68.1-83.8 years) and 69.8 years (interquartile range 60.1-78.6 years), respectively. Females consistently had a higher 1-year crude cumulative incidence of stroke, with both sexes showing an increase over time followed by a recent decline, peaking earlier in females. The CHA2DS2-VA score-adjusted relative risks for stroke in females compared with males were 1.16 (95% confidence interval 0.85-1.57), 1.20 (0.92-1.57), 1.29 (1.01-1.64), 1.06 (0.85-1.32), and 0.99 (0.79-1.23) in 2004-2007, 2008-2011, 2012-2015, 2016-2019, and 2020-2023, respectively. CONCLUSION:While the point estimates suggest a gradual attenuation in the excess stroke risk among females over time, no statistically significant temporal trend was observed.

martwatches have evolved from timekeeping and fitness tracking to enabling on-demand established validation for atrial fibrillation (AF) detection.1 Guidelines endorse their use for AF screening in selected populations,1 specifying that a definitive diagnosis requires review by "a physician with expertise in ECG rhythm interpretation"; however, what constitutes sufficient expertise remains undefined. As smartwatch adoption grows, primary care physicians (PCPs) are increasingly expected to interpret data from consumer-grade devices-a task for which many have limited training. Despite their central role in outpatient care, the ability of PCPs to interpret AF from smartwatch recordings remains uncharacterized. The aim of the study was to determine PCPs' accuracy in identifying AF using smartwatch ECGs and the electrocardiographic factors influencing diagnostic performance.

BACKGROUND Masquerading bundle branch block (MBBB) is a rare electrocardiographic (ECG) pattern combining features of left bundle branch block and right bundle branch block (RBBB), reflecting advanced conduction disease. Given the high pacemaker implantation rate post-transcatheter aortic valve replacement (TAVR), preprocedural recognition of MBBB may hold clinical relevance. OBJECTIVE This study aimed to assess the prevalence and clinical impact of MBBB in TAVR patients. METHODS Consecutive TAVR cases (2010-2023) from a single-center database were reviewed. Pre-TAVR ECGs were classified by bundle branch block subtype by 2 blinded cardiologists, with discrepancies resolved by arbitration. Pacemaker implantation within 30 days was assessed. RESULTS Of 1085 patients, 980 were included after excluding 72 with preexisting devices, 15 owing to missing data, 2 with pre-excitation, and 16 in-hospital deaths. Conduction abnormalities included MBBB in 13 (1.3%), RBBB in 151 (15.4%), and left bundle branch block in 158 (16.1%). All MBBB cases were initially mislabeled as RBBB, representing 7.9% of that group. Early pacemaker implantation was required in 166 patients (16.9%), including 92.5% of MBBB cases and 44.3% of RBBB cases. At 1 year after TAVR, 38% of patients with MBBB had died or were hospitalized for heart failure. CONCLUSION MBBB is not rare in TAVR candidates, occurring in approximately 8% of pre-TAVR ECGs labeled as RBBB. Its potential association with early pacemaker implantation highlights the need for careful preprocedural identification.

Background:Smartwatches, such as the Apple Watch (AW), are well-established tools for detecting atrial fibrillation (AF). We hypothesize that atrial flutter (AFL) is frequently misdiagnosed using traditional single-lead electrocardiogram configurations and that modified device positioning could substantially improve diagnostic accuracy. Methods:Standard smartwatch lead-I (AW-I) recordings were obtained from 75 patients, including 25 with AFL, 25 with AF, and 25 with sinus rhythm. Additionally, modified lead-II (AW-II) recordings were collected for all AFL cases, resulting in a total of 100 tracings. Twenty blinded physicians from 4 different specialties independently analyzed all recordings. Results:Physicians' ability to detect AFL using the AW-I lead was poor, with only 11.6% of cases correctly identified (P = 0.362). AFL was most often misdiagnosed as AF (55.6%), undetermined (21%), or sinus rhythm (11.8%). Diagnostic accuracy improved significantly with the AW-II lead, exceeding 80% among electrophysiologists, cardiologists, and primary care physicians (P = 0.001). Variable atrioventricular conduction was associated strongly with correct diagnosis exclusively through the AW-II lead (odds ratio 1.85, 95% confidence interval 1.14-3.0, P = 0.012). Conclusions:The standard lead-I configuration used by smartwatches is prone to misclassifying AF as AFL, particularly in the setting of variable conduction. A simple modification to lead-II positioning significantly enhances diagnostic accuracy. This adjustment may be especially valuable during post-pulmonary vein isolation surveillance and in broader clinical scenarios in which precise rhythm identification can influence therapeutic decision-making.

BACKGROUND:Evidence remains scarce on the risk of transition from hypothyroidism to thyrotoxicosis in patients treated with amiodarone. OBJECTIVE:This study aimed to assess the association between amiodarone and thyrotoxicosis in patients with atrial fibrillation (AF) and concomitant diagnosis of hypothyroidism. METHODS:We conducted a population-based retrospective cohort study using the Clalit Health Services database, the largest health care provider in Israel. Patients with a new diagnosis of AF between 2010 and 2023 were used to identify 2 separate cohorts defined based on their thyroid function status (hypothyroidism cohort vs normal thyroid cohort). Using Cox proportional hazard regression, exposure to amiodarone was examined as a time-dependent variable, allowing subjects to transfer from one exposure group to another during follow-up. RESULTS:A total of 23,854 patients with AF were included in the hypothyroidism cohort, with thyrotoxicosis diagnosed during follow-up in 107 patients (66 of 8212 amiodarone users and 41 of 15,622 non-users), reflecting a crude incidence rate of 3.43 and 0.63 per 1000 person-years in amiodarone users and non-users, respectively. In this cohort, amiodarone was independently associated with increased risk of thyrotoxicosis with an adjusted hazard ratio of 5.18 (95% confidence interval [CI], 3.48-7.69). The magnitude of amiodarone effect was higher in patients with normal thyroid function, with an incidence rate of 19.78 and 1.14 per 1000 person-years in amiodarone users and non-users, respectively, and an adjusted-hazard ratio of 15.02 (95% confidence interval, 13.56-16.64). CONCLUSION:Although the magnitude of the effect of amiodarone on the risk of thyrotoxicosis is lower in patients with hypothyroidism, the risk remains elevated and mandates caution.

BACKGROUND:Current guidelines require physician confirmation for smartwatch-diagnosed atrial fibrillation (AF), increasing telemedicine workloads. The newest ChatGPT-4o (GPT-4o) incorporates advanced image input capabilities. OBJECTIVE:To assess GPT-4o's performance in identifying AF from smartwatch recordings. METHODS:Consecutive 120 patients with AF and 60 controls with sinus rhythm (SR), confirmed by conventional 12-lead ECG, recorded single-lead ECGs using an Apple Watch (AW) Series 6®. Two blinded cardiologists independently classified the smartwatch recordings as AF, SR, or undetermined. GPT-4o was subsequently prompted to analyze all smartwatch ECGs. RESULTS:Six AF cases were excluded due to undetermined AW-ECG recordings, leaving 114 AF patients (mean age: 73.4 ± 10.4 years) and 60 controls. The AW algorithm achieved 97.3 % and 100 % accuracy for AF and SR, respectively, while GPT-4o correctly analyzed 47.3 % of AF and 71.6 % of SR tracings. None of the AF characteristics-chronicity, heart rate, QRS width, fibrillatory wave amplitude, or R-wave amplitude and polarity-were predictive of GPT-4o's diagnostic accuracy. CONCLUSION:The current capabilities of GPT-4o are insufficient to make a reliable diagnosis of AF from smartwatch ECGs. Despite the theoretical appeal of leveraging this innovative technology for such purpose, the findings highlight that human expertise remains indispensable. Consumers must remain aware of the current limitations of this technology.

The diagnosis of vasospastic angina remains challenging. It may present with syncope and life-threatening arrhythmia. Patients with syncope usually require automatic modes of recording. We describe a patient with recurrent syncope and polymorphic ventricular tachycardia documented by a smartwatch. Eventually, the arrhythmia was attributed to vasospasm and effectively managed with pharmacotherapy.

Journal Article Accepted manuscript Multimodality imaging in a young patient with antiphospholipid syndrome-related acute myocardial infarction Get access Ibrahim Naoum, Ibrahim Naoum Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel Search for other works by this author on: Oxford Academic PubMed Google Scholar Jorge E Schliamser, Jorge E Schliamser Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel Search for other works by this author on: Oxford Academic PubMed Google Scholar Keren Zissman, Keren Zissman Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel Search for other works by this author on: Oxford Academic PubMed Google Scholar Alexander Fuks, Alexander Fuks Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel Search for other works by this author on: Oxford Academic PubMed Google Scholar Barak Zafrir Barak Zafrir Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, IsraelRappaport Faculty of Medicine, Technion – Israel Institute of technology, Haifa Israel Corresponding author: Barak Zafrir, MD, Director, Cardiac Prevention and Rehabilitation Service, Cardiovascular Department, Lady Davis Carmel Medical Center, 7 Michal St., Haifa 3436212, Israel, Tel. +972-48250801, Fax. +972-48250916. Email: barakzmd@gmail.com https://orcid.org/0000-0002-2391-8397 Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal - Cardiovascular Imaging, jeae088, https://doi.org/10.1093/ehjci/jeae088 Published: 28 March 2024 Article history Received: 28 September 2023 Accepted: 25 March 2024 Published: 28 March 2024

Abstract Background Atrial fibrillation (AF) is associated with the risk of stroke and death. Advancements in patient care, such as direct oral anticoagulant (DOAC) use, are expected to improve AF patients' outcomes. However, real-world data examining this expectation are sparse. Methods We performed a historical population-based study among patients of Israel's largest health-maintenance-organization among patients aged>21 years diagnosed with AF between 01/01/2010 and 01/01/2020. The study population was divided into early-era (2010-2014) and late-era (2015-2020). We compared the time-dependent 5-year risk of stroke, intracranial hemorrhage (ICH), gastrointestinal bleeding (GIB), or death. Results Of 98,241 patients (median-age:76, 51.3% women), 48,852 were in the early-era, and 49,389 were in the late-era. The late-era group had higher rates of OAC than the early-era group (51.3% vs. 33.5%, p<0.001). The predominant OACs were warfarin (28.4%) in the early-era and DOACs (45.1%) in the late-era. Five-year death rates were 17,226 (35.3%) and 14,702 (29.8%) in the early-era and late-era groups, respectively (p<0.001), and 5-year stroke rates were 1,997 (4.1%) and 1,474 (3.0%) in the early-era and late-era groups, respectively (p<0.001). In multivariate models, era-related death risk was mediated by between-group OAC changes (p-for-interaction<0.001). OAC was associated with lower death risk (aHR 0.93, 95%CI(0.89,0.96),p<0.001). The late-era group had a lower stroke risk (aHR 0.90 95%CI(0.82,0.99),p=0.037), which was associated with between-group OAC changes (p-for-interaction=0.002). OAC was associated with reduced stroke risk in the late-era only (aHR 0.87, 95%CI(0.78,0.97),p=0.012). The risk of ICH was similar across study groups (p=0.40). GIB risk was lower in the late-era (aHR 0.85 95%CI(0.78,0.93),p<0.001). OAC was associated with increased GIB risk in the early-era (aHR 1.32, 95%CI(1.21,1.43),p<0.001) but not in the late-era (aHR 1.06 95%CI(0.96,1.17),p=0.24). Conclusions Contemporary AF management is associated with lower stroke, death, and significant bleeding risks. The pendulum shift from warfarin to DOACs was associated with improved clinical benefits.Survival curves of the outcome

Abstract: Treatment fragmentation between hospitals and the community can result in catastrophic outcomes; uninterrupted treatment with anticoagulant and platelet aggregation inhibitors is particularly important. We assessed the proportion and characteristics of patients who did not visit their primary community-based physician within 1 week of discharge from our department of cardiovascular medicine and the proportion that failed to procure essential drugs at the community pharmacy. We prospectively studied 423 patients who were discharged from our department. They were provided detailed explanations, tablets for 7 days, prescriptions, and a printed drug plan. We traced the time from discharge until a visit with a primary community-based physician, and the time until the procurement of medications, using our computerized community–hospital–integrated system. Complete data were available for 313 patients, of whom 220 were treated with anticoagulants or platelet aggregation inhibitors. For 175 patients, these drugs were initiated during index hospitalizations. Only 1 patient did not receive platelet aggregation inhibitors despite recommendations. Seventy-nine patients (25%) first visited their primary care physicians more than 1 week after discharge. Predictors for delayed visits were living alone (hazard ratio 1.91) and having an in-house caregiver (hazard ratio 2.01). In conclusion, all but 1 patient continued drug therapy after discharge from the hospital. The simple predischarge steps included patient education and provision of a 1-week supply of tablets and prescriptions. Treatment continuation was independent of visits to the community-based primary physician. Patients living alone or with an in-house caregiver more often delayed visits to primary physicians yet continued relevant drug therapy.

Aims: Over the last four decades, in-hospital mortality from acute coronary syndromes (ACS) has declined. We characterized the patients who died in our cardiovascular intensive care unit (CICU) over a 15-year period. Based on these data, we described the changing patient population in the CICU. Methods: This retrospective study compared characteristics of patients who died in our CICU in 2005-6, 2013-4 and 2019. During these 5 years, 13,931 patients were hospitalized; 251 (1.8%) died. The mean age of the patients who died was 76 years, 144 (57%) were men. ACS was the leading cause of admission (93 patients, 37%), and 145 (58%) patients had a history of heart failure prior to hospitalization. The leading cause of death was cardiogenic shock in 104 (41%) patients, septic shock in 48 (19%) patients, and combined cardiogenic and septic shock in 31 (12%). Patients hospitalized in the later years of the study were significantly older (67.7, 69.0 and 70.5 years, 2005-6, 2013-4 and 2019, respectively, p < 0.02) but their medical characteristics did not differ significantly between the years examined. Conclusions: The profile of the patients who died did not change significantly over the 15-year study period. Age of admitted patients was higher in later years of the study. The leading cause of admission was ACS and the leading causes of death were cardiogenic and septic shock. Based on our observations, additional skills should be added to the curriculum of cardiology, including the management of patients with multiorgan failure. (C) 2020 The Authors. Published by Elsevier B.V.

In the current issue of International Journal of Cardiology, Voskoboinik et al. examined the effects of alcohol binge drinking on the autonomic system and on the occurrence of atrial fibrillation [ [1] Voskoboinik A. McDonald C. Chieng D. O'Brien J. Gutman S. Ngu P. Sugumar H. Wong G. Kalman J.M. Taylor A.J. Kistler P.M. Acute electrical, autonomic and structural effects of binge drinking: Insights into the 'holiday heart syndrome'. Int. J. Cardiol. 2021; (Feb 3:S0167-5273(21)00153–4. (Epub ahead of print. PMID: 33548379))https://doi.org/10.1016/j.ijcard.2021.01.071 Abstract Full Text Full Text PDF Scopus (6) Google Scholar ]. The impact of alcohol on the normal and abnormal heart is of major importance, in light of the high global consumption of alcohol [ [2] Peacock A. Leung J. Larney S. Colledge S. Hickman M. Rehm J. Giovino G.A. West R. Hall W. Griffiths P. Ali R. Gowing L. Marsden J. Ferrari A.J. Grebely J. Farrell M. Degenhardt L. Global statistics on alcohol, tobacco and illicit drug use: 2017 status report. Addiction. 2018 Oct; 113 (Epub 2018 Jun 4. PMID: 29749059): 1905-1926https://doi.org/10.1111/add.14234 Crossref PubMed Scopus (405) Google Scholar ]. The effect of low to moderate daily alcohol consumption on reducing coronary artery disease occurrence remains controversial [ [3] Nestel P.J. Beilin L.J. Clifton P.M. Watts G.F. Mori T.A. Practical guidance for food consumption to prevent cardiovascular disease. Heart Lung Circ. 2021 Feb; 30 (Epub 2020 Nov 3. PMID: 33158734): 163-179https://doi.org/10.1016/j.hlc.2020.08.022 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar ]. However, chronic excessive alcohol consumption is associated with cardiomyopathy [ [4] Artico J. Merlo M. Asher C. Cannatà A. Masci P.G. De Lazzari M. Pica S. De Angelis G. Porcari A. Vitrella G. De Luca A. Belgrano M. Pagnan L. Chiribiri A. Marra M.P. Sinagra G. Nucifora G. Lombardi M. Carr-White G. The alcohol-induced cardiomyopathy: A cardiovascular magnetic resonance characterization. Int. J. Cardiol. 2021; (Feb 2:S0167-5273(21)00149–2. (Epub ahead of print. PMID: 33545263))https://doi.org/10.1016/j.ijcard.2021.01.067 Abstract Full Text Full Text PDF Scopus (3) Google Scholar ], and alcohol binge drinking is associated with multiple effects on the heart such as acute myocardial infarction and lethal ventricular arrythmias [ 5 Piano M.R. Mazzuco A. Kang M. Phillips S.A. Cardiovascular consequences of binge drinking: an integrative review with implications for advocacy, policy, and research. Alcohol. Clin. Exp. Res. 2017 Mar; 41 (Epub 2017 Feb 13. PMID: 28067964; PMCID: PMC7318786): 487-496https://doi.org/10.1111/acer.13329 Crossref PubMed Scopus (34) Google Scholar , 6 Tran P. Tran L. Tran L. A cross-sectional analysis of binge drinking levels in US myocardial infarction survivors. Heart Lung. 2020; (Oct 20:S0147-9563(20)30394–0. (Epub ahead of print. PMID: 33097296))https://doi.org/10.1016/j.hrtlng.2020.10.003 Abstract Full Text Full Text PDF Scopus (1) Google Scholar , 7 Sliman H. Zissman K. Goldstein J. Flugelman M.Y. Hellman Y. Magnesium-responsive polymorphic ventricular tachycardia associated with alcoholic binge drinking. Isr. Med. Assoc. J. 2016 Jul; 18 (PMID: 28471572): 439-440 PubMed Google Scholar ]. Acute electrical, autonomic and structural effects of binge drinking: Insights into the 'holiday heart syndrome'International Journal of CardiologyVol. 331PreviewBinge drinking is a common atrial fibrillation (AF) trigger, however the mechanisms are poorly understood. Full-Text PDF

Background: The Trial to Assess Chelation Therapy (TACT) found that chelation therapy significantly reduced clinical events in patients with a history of myocardial infarction (MI). The initial report of TACT included the observation of an interaction between edetate disodium infusions and MI location, as well as diabetes. Thus, we examined in greater detail the effect of edetate disodium chelation therapy as a function of MI location and diabetes. Methods: Patients (n= 1708) at least 6 weeks post-MI and age >= 50 were randomized to receive 40 infusions of a 500 mL chelation solution or placebo (median follow-up 55 months). The effect of edetate disodium on the primary outcome (all-cause mortality, MI, stroke, hospitalization for angina, or coronary revascularization) was assessed as a function of MI location using log-rank test and Cox regression model, adjusting for other prognostic variables. Results: Among patients with post anterior MI (n = 674), chelation was associated with a lower risk of the primary endpoint (HR 0.63, 95% CI 0.47-0.86, p = 0.003) among anterior MI patients, but not in post non-anterior MI (n= 1034) patients (HR 0.96, 95% CI 0.77-1.20, p = 0.702) (p-for-interaction = 0.032). The point estimates for each component of the primary endpoint favored chelation therapy. The differing treatment effect in patients with post anterior vs. non-anterior MI was consistent among patients with or without diabetes and remained significant after adjusting for other prognostic variables (p < 0.01). Conclusions: Edetate disodium infusions reduced the risk of cardiovascular events among patients with a prior anterior MI. Future studies should focus on replicating these results and understanding the mechanisms of benefit. (C) 2020 Published by Elsevier Inc.

Pre-excited, fast conducting atrial fibrillation (AF) is a serious life-threatening arrhythmia that requires urgent pharmacological or electrical cardioversion. When anti-arrhythmic medications fail to restore sinus rhythm, biphasic, direct current (DC) cardioversion is required. Appropriate synchronization of the DC shock with the QRS is crucial, however not easily achieved. Since the QRS-T complexes in pre-excited AF are severely distorted, the diagnosis of inaccurate synchronization may be overlooked. Here, we report a unique case where during electrical cardioversion of pre-excited AF with inappropriate synchronization on the T wave inadvertently resulted in ventricular fibrillation (VF), and review the literature.

BACKGROUND Catheter ablation reduces recurrence of atrial fibrillation and improves quality of life. Only few studies have assessed the effect of catheter ablation on long-term outcomes.OBJECTIVE The purpose of this study was to assess the association between catheter ablation and risk of stroke and mortality in patients with atrial fibrillation.METHODS Using the computerized database of the largest health maintenance organization in Israel, we identified all adults hospitalized with a primary diagnosis of atrial fibrillation between January 1, 2005, and December 31, 2015. Of them, a total of 969 individuals who underwent catheter ablation during the same admission were matched, on the basis of the propensity of having ablation, with 3772 individuals who did not undergo catheter ablation during the same period. The cohort was followed for the occurrence of stroke or transient ischemic attack (TIA) and mortality until June 30, 2016.RESULTS Overall, 3953 (83.4%) of patient in both groups had a CHA(2)DS(2)VASc score of 2 or greater. The incidence rate of stroke/TIA was 2.10 and 3.26 per 100 person-years in the ablation group and the nonablation group, respectively. The crude hazard ratio [HR] for stroke/TIA was 0.61 (95% confidence interval [CI] 0.48-0.79) in the ablation group compared with the nonablation group. The results were similar after controlling for CHA(2)DS(2)-VASc score (HR 0.58; 95% CI 0.43-0.72). The adjusted HRs for stroke alone, TIA alone, and mortality were 0.62 (95% CI 0.47-0.82), 0.47 (95% CI 0.20-0.78), and 0.57 (95% CI 0.47-0.66), respectively.CONCLUSION Catheter ablation of atrial fibrillation is associated with a decreased risk of stroke/TIA and mortality in predominantly patients with a high CHA(2)DS(2)-VASc score. (C) 2017 Heart Rhythm Society. All rights reserved.

ObjectiveWe tested whether remote dielectric sensing (ReDS)-directed fluid management reduces readmissions in patients recently hospitalized for heart failure (HF).BackgroundPulmonary congestion is the most common cause of worsening HF leading to hospitalization. Accurate remote monitoring of lung fluid volume may guide optimal treatment and prevent re-hospitalization. ReDS technology is a quantitative non-invasive method for measuring absolute lung fluid volume.MethodsPatients hospitalized for acute decompensated HF were enrolled during their index admission and followed at home for 90days post-discharge. Daily ReDS readings were obtained using a wearable vest, and were used as a guide to optimizing HF therapy, with a goal of maintaining normal lung fluid content. Comparisons of the number of HF hospitalizations during ReDS-guided HF therapy were made, both to the 90days prior to enrollment and to the 90days following discontinuation of ReDS monitoring.ResultsFifty patients were enrolled, discharged, and followed at home for 76.9±26.2days. Patients were 73.8±10.3years old, 40% had LVEF above 40%, and 38% were women. Compared to the pre- and post-ReDS periods, there were 87% and 79% reductions in the rate of HF hospitalizations, respectively, during ReDS-guided HF therapy. The hazard ratio between the ReDS and the pre-ReDS period was 0.07 (95% CI [0.01–0.54] p=0.01), and between the ReDS and the post-ReDS period was 0.11 (95% CI [0.014–0.88] p=0.037).ConclusionsThese findings suggest that ReDS-guided management has the potential to reduce HF readmissions in acute decompensated HF patients recently discharged from the hospital.