Search Results (798)

Background/Objectives: Primary-prevention implantable cardioverter-defibrillator (ICD) selection remains dominated by left ventricular ejection fraction and clinical heart failure markers, which incompletely distinguish between patients who will experience ventricular arrhythmia and those whose prognosis is limited by competing non-arrhythmic mortality. The Magneto-SCD trial recently reported novel rotation-based magnetocardiography (MCG) indices associated with future appropriate ICD therapies. This substudy explores whether MCG Rotation Score provides incremental information in primary-prevention ICD recipients, particularly beyond NYHA status and MADIT-arrhythmic and non-arrhythmic risk scores. Methods: We included all Magneto-SCD trial participants with a primary-prevention indication with non-missing follow-up/MCG Rotation Score data. The full primary-prevention cohort comprised 54 participants; the post-MI subgroup comprised 28. The primary endpoint was time to first appropriate ICD therapy. Death without prior therapy was used as a pragmatic competing endpoint and not assumed to represent adjudicated non-arrhythmic death. Appropriate shock was a secondary endpoint. Two-year cumulative incidence functions were estimated using Aalen–Johansen methods. Cause-specific Cox models assessed Rotation Score alone and after addition to MADIT-derived scores; nested likelihood-ratio tests evaluated model fit. Results: Of 104 participants, 90 had analysable MCG data and 65 had a primary-prevention ICD indication; after exclusions for missing patients, 54 patients remained (mean age 63.8 ± 13.2 yrs, 45(83.3%) male). Appropriate ICD therapies occurred in 10 (18.5%), including appropriate ICD shock in eight (14.8%); 10 patients (18.5%) died without prior therapy. The median follow-up was 1211.5 days (IQR 793.5–1396.0). Each SD increase in Rotation Score was associated with appropriate ICD therapy with HR 1.64 (95% CI 0.93–2.87; p = 0.086), appropriate ICD shock with HR 2.07 (95% CI 1.15–3.72; p = 0.015), death without prior therapy with HR 1.08 (95% CI 0.54–2.17; p = 0.824), and death without prior ICD shock with HR 0.95 (95% CI 0.48–1.90; p = 0.890). Adding Rotation Score did not significantly improve the primary therapy model beyond MADIT components (LRT p = 0.065) or MADIT benefit score (LRT p = 0.109). Model fit improved for the secondary appropriate ICD shock endpoint when Rotation Score was added to MADIT components (LRT p = 0.016), based on eight shock events. Conclusions: Rotation Score showed an association pattern more closely aligned with arrhythmic endpoints, particularly appropriate ICD shock, than with death without prior therapy. Incremental prognostic value for the primary endpoint was not established. These findings are hypothesis-generating and require confirmation in adequately powered, prospectively designed and externally validated cohorts before any role in clinical risk stratification or ICD decision-making can be determined. Full article

Background: Depression is a major health issue among older adults and is frequently accompanied by chronic physical conditions. Conventional care of depression in older adults is delivered through primary care settings and often fails to address the complex interactions between mental health, physical illness, and social determinants of health in this population. Integrated care models, characterized by coordinated, multidisciplinary, and patient-centered approaches, have emerged as a promising strategy for improving depression outcomes in late life. Objective: This scoping review aimed to characterize integrated care models for managing depression in older adults. The review examined the structure and implementation of these models and evaluated depression-related outcomes. Methods: A systematic literature search was conducted in PubMed and Google Scholar. Studies published in English between 2006 and February 2026 were considered. Eligible studies included randomized controlled trials (RCTs), cluster RCTs, and quasi-RCTs that evaluated integrated care interventions targeting depression in adults aged 65 years or older or mixed adult populations that included older adults. One reviewer conducted the search and initial screening, and four additional reviewers evaluated the eligibility of full-text reports and extracted data using a structured template. Results were synthesized descriptively. Results: Seventeen studies met the inclusion criteria. Integrated care interventions were implemented across primary care clinics, community health centers, and home healthcare programs in several countries. Participants commonly had depression alongside chronic medical conditions, including diabetes, hypertension, heart failure, or chronic obstructive pulmonary disease. Integrated care models varied in staffing, therapeutic components, specialist involvement, delivery intensity, and comparator conditions. Most interventions incorporated multidisciplinary care teams; structured symptom monitoring; care coordination; behavioral or psychological interventions; and, in some studies, chronic disease management, social support, or technology-supported follow-up. Thirteen studies reported a favorable depression-related finding at one or more assessment points; however, benefits were not always sustained, and some studies reported null- or comparator-favoring findings. Conclusions: Integrated care for depression in older adults encompasses heterogeneous models implemented across diverse healthcare contexts. Common themes included multidisciplinary collaboration, coordinated follow-up, structured psychological or behavioral treatment, symptom monitoring, and integration of mental and physical health management. Favorable outcomes were reported in most studies, but findings varied by population, setting, comparator, intervention intensity, and follow-up duration. These findings may inform future program design, although the effectiveness of the integrated care models and the independent contribution of individual components remain uncertain. Full article

Arterial hypertension is the leading driver of hypertensive heart disease (HHD), the cardiac structural or functional injury attributable to sustained pressure overload, which promotes left ventricular hypertrophy and provides the substrate for incident heart failure, especially heart failure with preserved ejection fraction (HFpEF). Antihypertensive pharmacotherapy lowers blood pressure (BP) and regresses hypertrophy, yet residual cardiovascular risk persists, and exercise training may add to what drug therapy achieves. HHD progresses through interwoven autonomic, vascular, structural, and diastolic mechanisms, and the benefits of training are uneven across them: functional capacity, BP, endothelial function, and autonomic indices improve within typical trial durations, whereas resting diastolic indices, left ventricular mass, and myocardial fibrosis markers change inconsistently. Carotid–femoral pulse wave velocity is itself sensitive to distending pressure, so a fall does not by itself establish structural arterial remodeling. Small hypertensive trials support favorable geometry, and animal models support antifibrotic mechanisms, but in predominantly hypertensive HFpEF cohorts, capacity gains often occur without durable resting diastolic reversal or mortality benefit. By pairing each hypertension-specific mechanism with the corresponding human evidence, the present narrative review concludes that exercise training is a beneficial adjunct to antihypertensive therapy and to broader risk-factor management, while reverse remodeling and clinical-event reduction remain incompletely proven. Phenotype-guided trials with sensitive imaging, exercise-load endpoints, and hard outcomes are needed. Full article

Introduction: This study investigates the relationship between long-term aspirin use and mortality in patients experiencing acute radiation-induced pulmonary complications. Methods: We conducted a secondary analysis from the National Inpatient Sample from 2016 to 2020. Our cohort comprised patients diagnosed with acute pneumonitis secondary to chest radiation. We adhered strictly to the STROBE checklist, extracting various patient characteristics for analysis. Categorical variables were compared using Pearson’s chi-square test, while continuous variables were assessed using Student’s two-sample t test. To assess the relationship, we employed multivariable-adjusted logistic regression, presenting results as odds ratios (ORs) with 95% confidence intervals (CIs). Results: The study included a total of 6064 hospitalizations: 5204 hospitalizations were in the not-taking-aspirin group (NAG), while 860 were in the aspirin group (AG). The mean age of the NAG cohort was 68.67 ± 12.31 years (mean ± SD), while for the AG it was 72.64 ± 8.87 (mean ± SD) years. Our multivariable analysis revealed that aspirin use is associated with 29% lower odds mortality (aOR = 0.71, 95% CI = 0.54–0.94, p = 0.02) than the NAG. Patients with heart failure (aOR = 0.34, 95% CI = 0.18–0.64, p < 0.001) showed the most significant mortality benefits. No mortality advantages of aspirin were observed in patients with coronary artery disease, percutaneous coronary intervention, or coronary artery bypass grafting. Conclusions: Aspirin use in patients with acute chest radiation is associated with decreased odds of mortality, particularly in those with a history of congestive heart failure. Full article

Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors, originally developed as glucose-lowering agents for type 2 diabetes mellitus, have been shown in large, randomized trials to improve clinical outcomes in heart failure (HF) across the ejection fraction (EF) spectrum. The imaging-derived and hemodynamic changes that accompany these benefits remain incompletely characterized, and it is not known whether the patterns of cardiac remodeling observed differ between HF with reduced ejection fraction (HFrEF, left ventricular ejection fraction [LVEF] ≤ 40%) and HF with preserved ejection fraction (HFpEF, LVEF ≥ 50%). This systematic review synthesized randomized evidence on the effects of SGLT2 inhibitors on cardiac remodeling parameters and described the patterns observed in each phenotype. Methods: PubMed/MEDLINE, Scopus and Embase were searched for randomized controlled trials (RCTs) published between February 2016 and March 2026. Eligible studies enrolled adults with chronic HF receiving an SGLT2 inhibitor, included a non-SGLT2-inhibitor comparator and assessed cardiac structure, function or loading by echocardiography, cardiac magnetic resonance (CMR) or cardiac catheterization over at least three months. Risk of bias was assessed with Cochrane RoB 2, separately for each outcome domain and targeting the effect of assignment to intervention, and certainty of evidence with GRADE, separately by phenotype and imaging modality. A structured narrative synthesis following Synthesis Without Meta-analysis (SWiM) guidance that prioritized the direction, magnitude and precision of randomized between-group treatment effects was performed. Results: Fourteen publications from thirteen unique RCTs (1232 participants) were included: four trials enrolled HFrEF (LVEF ≤ 40%), five enrolled mixed reduced and mildly reduced EF cohorts (LVEF < 50% or 35–49%), four enrolled HFpEF (LVEF ≥ 50%) and one enrolled a mixed ejection-fraction population. No trial enrolled an exclusively HFmrEF population. In reduced EF, the direction of effect on LV volumes favored SGLT2 inhibition in four of eight trials reporting volumes, but the estimates were not compatible in magnitude, and the one adequately powered trial at low risk of bias (EFFORT) was neutral; the largest volumetric estimates came from EMPA-TROPISM, which published no adjusted between-group estimate. The only prespecified, adjusted and confidence-interval-bearing volumetric estimates were those of SUGAR-DM-HF (left ventricular end-systolic volume index −6.0 mL/m², 95% CI −10.8 to −1.2; end-diastolic volume index −8.2 mL/m², 95% CI −13.7 to −2.6). The global longitudinal strain improved in the trial with blinded core-laboratory reading (EFFORT −1.44%, 95% CI −2.42 to −0.46), but effect sizes in the open-label trials without stated reader blinding were two to three times larger, and the CMR-derived strain was unchanged. In HFpEF, volumes, EF, mass and strain were unchanged throughout. The most secure finding of the review was invasive: in CAMEO-DAPA, dapagliflozin reduced pulmonary capillary wedge pressure at rest by 3.5 mmHg (95% CI −6.6 to −0.4) and at peak exercise by 5.7 mmHg (95% CI −10.8 to −0.7). NT-proBNP results were directionally inconsistent, and the trials in which NT-proBNP was a prespecified primary endpoint (Empire HF, CANDLE) were neutral. Certainty of evidence was very low for 18 of 20 evidence profiles and low for the remaining two. Conclusions: Randomized imaging and hemodynamic studies suggest phenotype-related differences in the cardiac remodeling associated with SGLT2 inhibitor therapy. In studies enrolling patients with reduced EF, treatment was associated predominantly with reverse remodeling of left ventricular volumes and modest improvements in myocardial function, whereas in preserved EF, the observed changes were mainly confined to filling pressures and diastolic function, with no consistent evidence of left ventricular volumetric remodeling. Given the limited number of studies, substantial heterogeneity, and the overall low certainty of evidence, these findings should be considered hypothesis-generating and warrant confirmation in adequately powered phenotype-specific mechanistic trials. Full article

Background: Oral creatine is biologically plausible as an adjunct in heart failure (HF), but its clinical efficacy and safety remain uncertain. Methods: We performed a PRISMA 2020 systematic review (PROSPERO CRD420261391605) of oral creatine supplementation in adults with HF. Randomized parallel-group and crossover trials formed the primary causal evidence base; non-randomized HF evidence was analyzed separately. Risk of bias was assessed with RoB 2 and certainty with GRADE. Results: Four randomized HF-only trials were identified as primary evidence, with one additional open-label HF study retained as exploratory evidence. Because studies differed in dose, duration, outcome definitions, measurement scales, crossover structure, and availability of variance data, meta-analysis was not considered defensible. Randomized evidence showed no consistent benefit for peak VO2, 6-min walk distance, quality of life, or cardiac systolic function. A preliminary signal was observed for selected peripheral muscle and muscle-energetic outcomes. Safety reporting was sparse and insufficient to establish long-term renal or clinical safety. Certainty was very low across critical outcomes. Conclusions: Current evidence does not support routine oral creatine supplementation in HF. Larger contemporary placebo-controlled trials with systematic safety surveillance are required. Full article

Background/Objectives: Respiratory syncytial virus (RSV) causes morbidity in older adults with cardiovascular disease, in whom infection may precipitate severe lower respiratory tract disease, hospitalization, functional decline, and cardiovascular destabilization. We evaluate the evidence for RSV vaccination in cardiovascular disease and propose a jurisdiction-adaptable framework for integrating vaccination into cardiovascular care. Methods: Observational studies, randomized trials, pragmatic and test-negative studies, prespecified cardiovascular analyses of DAN-RSV, and eligibility recommendations were narratively synthesized and translated into a pathway encompassing patient identification, eligibility and risk assessment, vaccine delivery and co-administration, documentation, and follow-up. Results: Acute cardiac events are frequent during RSV hospitalization, and cardiovascular risk may persist after infection. Randomized trials establish protection against RSV-associated lower respiratory tract disease and respiratory illness, while real-world studies support effectiveness against RSV-related hospitalization. DAN-RSV reduced all-cause cardiorespiratory hospitalization but did not demonstrate significant reductions in cardiovascular hospitalization, myocardial infarction, heart failure (HF) hospitalization, atrial fibrillation, stroke, cardiovascular death, or major adverse cardiovascular events; observational associations with lower post-vaccination cardiovascular-event rates remain hypothesis-generating. The framework prioritizes adults aged ≥75 years and those aged 50–74 years with high-risk cardiovascular conditions where consistent with national recommendations, embeds vaccination assessment across cardiology, HF, primary care, pharmacy, and long-term care, and incorporates co-administration, documentation, and outcome surveillance. Conclusions: The principal contribution is a pathway for moving RSV vaccination from recommendation to routine preventive care for adults with cardiovascular disease. It anchors implementation in established RSV and cardiorespiratory benefits while treating cardiovascular-event reduction as a research priority rather than a demonstrated indication. Full article

Atrial fibrillation (AF) and heart failure (HF) frequently coexist, but the clinical relevance of AF may differ according to whether it appears to be a potentially reversible contributor, an aggravating factor in established HF, or a marker of advanced substrate. The driver–modifier–marker lens used in this review is a provisional, nonvalidated aid to clinical reasoning and should not be interpreted as a treatment score. This narrative review was informed by dated searches of PubMed/MEDLINE, the Cochrane Library, and OpenAlex through 29 July 2026, followed by a targeted update on 30 July 2026. It considers HF with reduced, mildly reduced, and preserved ejection fraction together with AF timing, burden, ventricular-rate exposure, myocardial substrate, and reversibility. Early rhythm control may be particularly relevant when AF is recent or temporally associated with ventricular dysfunction, symptoms, decompensation, or inadequate cardiac resynchronization therapy delivery. Evidence supporting catheter ablation is most direct in suspected AF-mediated cardiomyopathy and selected HFrEF populations, whereas evidence in HFpEF more consistently supports symptom relief, improved exercise hemodynamics, and AF-burden reduction than mortality reduction. Pulmonary vein isolation remains the procedural foundation. Radiofrequency, cryoballoon, and pulsed-field ablation are effective in broad AF populations, but HF phenotype-specific prognostic superiority has not been established for any energy source. Clinical decisions should reflect the design and directness of the evidence together with expected benefit, rhythm durability, procedural risk, patient-reported outcomes, stroke prevention, guideline-directed HF therapy, risk-factor management, and patient preference. Full article

Catheter ablation is the cornerstone of rhythm control in atrial fibrillation (AF), yet recurrence remains common, and obesity is among the most consistently implicated modifiable risk factors. Weight reduction and metabolic pharmacotherapy are increasingly used in the periprocedural period, but whether they act through a shared pathway has not been systematically examined. This narrative review compares the two approaches and asks whether metabolic agents confer protection beyond weight loss itself. Three observations argue that they do not act identically. First, the benefit of weight reduction is dose-dependent yet contingent on delivery: a structured, physician-led risk-factor program reduced 12-month arrhythmia recurrence (risk ratio 0.53), whereas nurse-led care that improved guideline adherence without structured delivery did not alter the primary endpoint. Second, sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been associated with reduced recurrence across BMI strata despite producing only modest weight loss; notably, a randomized trial in patients without cardiovascular or metabolic comorbidity showed no additional benefit, whereas benefit was observed in patients with type 2 diabetes and heart failure. Third, glucagon-like peptide-1 receptor agonists (GLP-1RA) achieve greater weight loss but yield inconsistent recurrence data, and Mendelian randomization suggests their cardiometabolic benefit is largely BMI-mediated, whereas that of SGLT2i is weight-independent. Together, these observations are consistent with a working hypothesis of two partly distinct atrial substrates—an obesity-related substrate responsive to weight reduction, and a metabolic-inflammatory substrate that may respond to SGLT2i predominantly when metabolic comorbidity is present. This framework is hypothesis-generating: it rests on indirect, cross-study comparisons and has not been tested by formal mediation analysis. If confirmed, it would imply that the two interventions are complementary rather than interchangeable. Full article

Cardiac rehabilitation (CR) is a central component of optimized secondary prevention. Since their inception, CR programmes have progressively evolved. These incorporate several components in a multidisciplinary setting, aimed at addressing the diverse needs of the complex cardiovascular patient. From ischaemic heart disease to heart failure and cardio-oncology, CR has shown its relevance across various moments of the cardiovascular continuum. Notably, data has underscored the importance of an individualized assessment coupled to programme tailoring according to patient characteristics, to harness the full benefits of CR while ensuring safety. Against this background, current guidelines have endorsed CR in different clinical settings. Despite this, several challenges concerning CR implementation remain, including suboptimal referral and compliance rates, as well as underrepresentation of specific patient subgroups. In this article, we provide an overview concerning current paradigms for CR in contemporary clinical practice, while also exploring novel developments and future perspectives on this pivotal field. Full article

Background: Severe aortic stenosis (AS) remains the most prevalent primary valvular disease in Europe and North America, causing heart failure (HF), with pulmonary hypertension (PH) occurring in up to 75% of symptomatic patients. The coexistence of AS and atrial septal defect (ASD) is rare and may generate dual mechanisms of PH, complicating both diagnosis and management. Case summary and review: We report a 78-year-old patient with symptomatic severe AS and right heart failure, in whom an unrecognized secundum ASD with significant left-to-right shunt was identified as a major contributor to persistent HF and right ventricular (RV) dysfunction. Due to prohibitive surgical risk, a staged interventional strategy was decided: transcatheter aortic valve implantation (TAVI), followed by cardiac catheterization and ultimately by percutaneous ASD closure. Marked clinical benefit with the reduction of the RV dimensions and improved systolic function were observed at one year follow-up. A focused review of the literature was conducted to contextualize the pathophysiological mechanisms, diagnostic challenges, and therapeutic strategies in patients with coexisting AS and ASD. Conclusions: This case emphasizes the importance of comprehensive hemodynamic assessment in AS complicated by PH and HF, particularly in the presence of congenital anomalies such as ASD. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) is a global epidemic strongly associated with an increased risk of heart failure, independent of coronary artery disease or hypertension. This condition, historically termed diabetic cardiomyopathy (DCM) and recently redefined as “diabetic myocardial disorder,” remains frequently underdiagnosed in its subclinical stages. The objective of this non-systematic review is to synthesize current evidence on the pathophysiological mechanisms, diagnostic advancements, and evolving therapeutic strategies for diabetic myocardial involvement. Methods: A comprehensive review of contemporary literature was conducted, focusing on recent consensus statements from the ESC and AHA, large-scale epidemiological data (IDF/WHO), and pivotal clinical trials (EMPA-REG, DAPA-HF, and LEADER). We analyzed the role of multimodal imaging—specifically speckle-tracking echocardiography (STE) and multiparametric cardiac magnetic resonance (CMR)—and circulating biomarkers in early phenotyping. Results: Pathophysiological drivers include lipotoxicity, oxidative stress, and AGE-mediated fibrosis. Advanced imaging techniques, such as global longitudinal strain (GLS) and CMR T1-mapping/ECV quantification, demonstrate superior sensitivity over LVEF in detecting early subendocardial dysfunction and diffuse fibrosis. Furthermore, NT-proBNP serves as a robust prognostic marker for the HFpEF-like trajectory typical of diabetes. Clinically, the therapeutic landscape has shifted with SGLT2 inhibitors and GLP-1 receptor agonists, which provide significant cardioprotection and reduction in heart failure hospitalizations through mechanisms beyond glycemic control. Conclusions: Diabetic myocardial disorder represents a complex continuum within the cardiometabolic spectrum. Early detection through multimodal imaging and biomarkers is essential for risk stratification. Integrating novel glucose-lowering therapies with proven cardiovascular benefits is now mandatory to alter the natural history of the disease and prevent progression to overt heart failure. Full article

Objectives: The aim of this study was to determine whether direct evidence shows that contemporary guideline-directed heart failure (HF) pharmacotherapies influence cardiac remodeling through hydrogen sulfide (H₂S) signaling, and to define the resulting evidence gap. Design: A systematic review was conducted according to PRISMA 2020. Registration: PROSPERO CRD420251238589. Data Sources: MEDLINE (PubMed), Web of Science, Scopus, and the Cochrane Library; searches were initiated in March 2025, covered publications from January 2007 onward, and were last updated in November 2025. Eligibility Criteria: Primary studies had to include (A) an HF or cardiac-remodeling model, (B) an HF-relevant pharmacological intervention, (C) direct assessment or manipulation of H₂S biology, and (D) at least one cardiac-remodeling endpoint. Results: Of the 40,796 unique records screened, 50 reports underwent full-text assessment and 14 unique studies were included. No study demonstrated that the remodeling benefits of ACE inhibitors, ARBs, ARNIs, beta-blockers, MRAs, hydralazine/isosorbide dinitrate, or SGLT2 inhibitors are mediated by endogenous H₂S signaling. Doiron et al. evaluated empagliflozin with or without the H₂S donor SG1002 in experimental HFpEF; the combination improved several outcomes beyond empagliflozin alone, but this adjunctive design does not establish H₂S mediation of empagliflozin action. Most eligible evidence concerned exogenous H₂S donors in animal models and reported improvements in fibrosis, hypertrophy, oxidative stress, mitochondrial injury, and cardiac function. The overall certainty was low because of preclinical predominance, heterogeneous models and H₂S assays, donor-specific pharmacology, and incompletely reported randomization and blinding. Conclusions: The principal finding is negative but clinically important: direct evidence that H₂S mediates established HF pharmacotherapy is currently absent. H₂S remains a promising experimental therapeutic candidate rather than an established shared mechanism or clinically validated treatment target. Full article

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors improve outcomes in heart failure, but the mechanisms remain incompletely understood. Metabolic remodeling has been proposed as a key mediator. Methods and Results: Myocardial infarction (MI) was induced in cardiomyocyte-specific BDH1 knockout (BDH1-KO) wild-type (WT) mice and in liver-specific Fibroblast Growth Factor-21 knockout (FGF21-KO) mice. Following confirmation of reduced ejection fraction (EF), mice were randomized to empagliflozin (Empa, 10 mg/kg/day) or saline. After 4 weeks, untreated WT mice demonstrated progressive systolic dysfunction (ΔEF: −11.6 ± 6.3%), whereas Empa-treated WT mice showed significant improvement (ΔEF: 9.9 ± 4.3%). This benefit was completely abolished in BDH1-KO mice (ΔEF: −10.5 ± 2.8%) or FGF21-KO mice, suggesting that FGF21 regulation and cardiomyocyte ketone oxidation are required for Empa cardioprotection. In WT and hepatocyte-specific FGF21-KO mice, 1 week of Empa treatment increased cardiac BDH1 expression in WT but not FGF21-deficient mice. In human iPSC-cardiomyocytes, FGF21 induced BDH1 expression, whereas Empa had no direct effect on BDH1. In HepG2 liver cells, Empa increased both FGF21 and BDH1 expression. Conclusions: Empa activates the liver–heart metabolic axis. Loss of cardiomyocyte BDH1 or FGF21 production by the liver abolishes Empa-mediated improvement in post-MI cardiac function, identifying FGF21/ketone metabolism as a key mechanism of SGLT2 inhibitor cardioprotection. Full article

Background/Objectives: In France, remote monitoring for chronic heart failure transitioned from the experimental ETAPES programme (Expérimentations de télémédecine pour l’amélioration des parcours de santé) to routine reimbursement in July 2023. Whether patient-reported experience remained similar during routine implementation in a real-world respondent population was unknown. This study compared satisfaction, usability, and perceived benefits among Satelia^® Cardio users surveyed in 2020–2021 and 2024. Methods: This repeated cross-sectional study compared 978 adult users surveyed between August and December 2024 with 400 digitally literate users from the 2020–2021 reference cohort. Ten comparable items were analysed as the proportion selecting scores of 7–10. Differences were assessed using Pearson’s chi-square test with Yates’ continuity correction. Exploratory age-stratified analyses examined three usability items. Results: In 2024, 30.1% of respondents were aged ≥80 years. Overall satisfaction was similar (80.3% vs. 77.0%; p = 0.20). Two perception items showed higher unadjusted ratings: perceived improvement in treatment adherence (60.1% vs. 52.3%; +7.9 percentage points; p = 0.009) and perceived help to the treating physician (76.5% vs. 70.3%; +6.2 percentage points; p = 0.019); however, these findings remained exploratory after correction for multiplicity. Usability ratings were slightly lower in 2024, with the largest differences versus the aggregate 2021 reference among respondents aged ≥80 years; ratings among those aged <70 years were similar to 2021 values. The recommendation rate to other patients was high at 70.3%. The three most frequently reported perceptions of Satelia^® Cardio were that telemonitoring was reassuring, useful and simple. Conclusions: During the routine-reimbursement period, satisfaction remained high in a respondent population in which 30.1% were aged ≥80 years. Two perception items showed higher unadjusted ratings, but these findings remained exploratory after correction for multiplicity. Descriptively lower usability ratings in the ≥80-year stratum warrant further evaluation and tailored support. Because the surveys involved independent, differently composed samples, causal and longitudinal conclusions cannot be drawn. These findings describe patient experience across two successive implementation contexts and should not be interpreted as evidence of a causal effect of reimbursement policy. Full article