Bishav Mohan

Background: Atrial fibrillation (AF) substantially increases the risk of ischemic stroke (IS), underscoring the need for effective anticoagulation strategies. Direct oral anticoagulants (DOACs) have largely supplanted vitamin K antagonists (VKAs) due to their favorable safety profile and ease of use. Factor XI (FXI) inhibitors, which target the intrinsic coagulation pathway, are emerging as potential alternatives that may offer reduced bleeding risk. This systematic review evaluates the efficacy and safety of FXI inhibitors compared with DOACs for stroke prevention in AF. Methods: A total of 20 studies fulfilled the inclusion criteria, comprising 11 randomized controlled trials (RCTs), five systematic reviews or meta-analyses, and four narrative, cohort, or modeling studies. Eligible investigations compared FXI inhibitors with DOACs in patients diagnosed with AF. The primary outcomes assessed were stroke or systemic embolism, major bleeding, and all-cause mortality. Methodological quality was evaluated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, the revised Cochrane Risk of Bias 2 (RoB 2) tool for RCTs, and the Newcastle-Ottawa Scale (NOS). Results: FXI inhibitors were associated with a significant reduction in major bleeding [relative risk (RR) 0.31; 95% confidence interval (CI) 0.21–0.46] and clinically relevant non-major bleeding (RR 0.66; 95% CI 0.47–0.93) compared with DOACs. Conversely, FXI inhibitors demonstrated an increased risk of stroke or systemic embolism (RR 3.17; 95% CI 2.18–4.62), as observed in the OCEANIC-AF trial [hazard ratio (HR) 3.79; 95% CI 2.46–5.83]. No significant difference was noted in all-cause mortality (RR 0.85; 95% CI 0.67–1.08). Limited evidence suggests that FXI inhibitors may also reduce bleeding-related hospitalizations. Discussion: FXI inhibitors provide a favorable bleeding profile but are less effective than DOACs for stroke prevention in patients with AF. Further long-term RCTs are warranted to delineate their role, particularly in populations at high risk of bleeding.

Background: Heart failure (HF) is a complex clinical condition requiring resource-intensive management and substantial health expenditure. The adverse economic impact of medical care on patients or financial burden is increasingly recognised as a significant non-clinical entity affecting HF management in low- and middle-income countries (LMIC). We explored the factors associated with Financial Burden (FB) in HF patients in India. Methods: We recruited HF patients from 21 hospitals across India, selected to reflect regional diversity and varying stages of epidemiological transition. Trained personnel collected clinical and economic data using a validated and structured questionnaire. Expenditures were recorded in Indian rupees (INR) and converted to international dollars (INT$). Results: We recruited 1,859 participants. Nearly one-third of participants (30.2%) were women. The mean age was 55.9 (11.3) years, and the mean duration of formal education was 11.3 (3.8) years. Health insurance coverage was reported in one-third (32.2%) of the study population. The average annual out-of-pocket (OOP) expenditure was INR 1,06,566 (INT$ 4,709.10), constituting 92.6% (95% CI: 92.5–92.7) of the total health expenditure. Compared to the previous year, a decline in monthly income was reported by 32.3% of individuals and 36.2% of households. Catastrophic health spending (CHS) and distress financing (DF) were observed in 37.7% (35.5–39.9) and 17.7% (15.9–19.4) of the households, respectively. However, CHS and DF were lower [30.8% (26.2–35.4) and 13.6% (10.2–17.0), respectively] among those with health insurance compared to the uninsured [40.3% (37.6–43.0) and 18.9% (16.7–21.1), respectively]. Conclusion: Seven out of 10 HF patients in India lack financial health protection. OOP expenditures, accounting for over 90% of total health spending, contribute significantly to economic distress in HF patients. Financial burden, affecting more than one-third of HF patients, carries profound implications for individual well-being. Addressing this financial burden, including CHS and DF, is essential for improving clinical outcomes and ensuring health equity.

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide. Conventional risk prediction models often demonstrate suboptimal calibration and limited generalizability across populations. Artificial intelligence (AI) approaches, including machine learning (ML) and deep learning (DL), enable integration of multimodal clinical and imaging data for individualized cardiovascular risk estimation. To evaluate the applications, predictive performance, and translational limitations of AI models for cardiovascular risk prediction within an umbrella review framework. PubMed, Scopus, and Web of Science were systematically searched for studies published between January 2015 and October 2025 investigating AI-based prediction of cardiovascular outcomes. Eligible designs included randomized controlled trials (RCTs), cohort studies, systematic reviews, and meta-analyses. Predictive performance was the primary outcome, mainly assessed using the area under the receiver operating characteristic curve (AUC). Methodological quality was evaluated using established risk-of-bias tools. From 3500 identified records, 48 studies (8 RCTs, 28 cohort studies, and 12 systematic reviews or meta-analyses) were included in the final analysis. AI models achieved AUC values greater than 0.90 in more than 70% of imaging-based studies. Evidence synthesis showed predominant reliance on internal validation, inconsistent calibration reporting, and limited evaluation of algorithmic fairness. Multimodal data integration improved detection of coronary artery disease (CAD) and heart failure (HF). Wearable monitoring was associated with 18–25% lower hospitalization rates compared with usual care. AI improves predictive accuracy in cardiovascular risk assessment. Despite strong discrimination performance (AUC), methodological heterogeneity, insufficient calibration assessment, algorithmic bias, limited external validation, and regulatory uncertainty remain major barriers to implementation. Clinical translation requires multicenter RCTs, explainable AI frameworks, and standardized reporting guidelines such as Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis Artificial Intelligence (TRIPOD-AI).

Heart failure with preserved ejection fraction (HFpEF) has emerged as the predominant of heart failure (HF), particularly among aging populations and individuals with a high burden of comorbidities. Its underlying pathophysiological mechanisms are complex, multifactorial and, heterogeneous. This systematic review aims to synthesize contemporary evidence on the epidemiology, pathophysiology, diagnostic challenges, and therapeutic strategies for HFpEF, with especially emphasis on emerging clinical approaches and future research directions. A comprehensive systematic literature search was conducted using PubMed, Scopus, Web of Science, and the Cochrane Library, covering publications from January 2015 through June 2025. Eligible studies included randomized controlled trials (RCTs), observational cohort studies, systematic reviews, meta-analyses, and current clinical guidelines talking key aspects of HFpEF. HFpEF now accounts for more than 50% of all HF diagnoses worldwide. Although it shares overlapping clinical features with other cardiovascular (CV) and systemic disorders, recent advances in echocardiographic techniques and the use of circulating biomarkers have substantially improved diagnostic accuracy. Current management strategies primarily focus on comorbidity control, optimization of volume status, structured exercise and rehabilitation programs, and the adoption of novel pharmacological therapies, most notably sodium glucose cotransporter 2 (SGLT2) inhibitors. Notable recent advances include the nonsteroidal mineralocorticoid receptor antagonist finerenone, which demonstrated reductions in worsening HF events and CV mortality in patients with heart failure with mildly reduced ejection fraction (HFmrEF) and HFpEF in the FINEARTS-HF trial. In addition, incretin-based therapies such as semaglutide (STEP-HFpEF program) and tirzepatide (SUMMIT trial) have shown clinically meaningful improvements in symptoms, exercise capacity, weight reduction, and composite CV or HF outcomes, notably in obesity-associated HFpEF phenotypes. HFpEF continues to pose substantial diagnostic and therapeutic challenges owing to its marked heterogeneity and historically limited treatment options. Advances in phenotypic classification, personalized therapeutic strategies, and integrated multidisciplinary care models are critical for improving long-term outcomes in this expanding patient population. The emergence of finerenone and glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide (GLP-1/GIP) receptor agonists, including semaglutide and tirzepatide, represents a promising extension beyond SGLT2 inhibitors, particularly in cardiometabolic and obesity-driven HFpEF. However, further incorporation into clinical guidelines and validation through real-world evidence remain necessary.

Background: Patients with pre-existing heart failure (HF) are particularly vulnerable to adverse outcomes following coronavirus disease 2019 (COVID-19). Understanding of the long-term cardiovascular sequelae of COVID-19 in this high-risk group is essential to improve post-infection management and outcomes. Methods: A systematic review of PubMed, Scopus, Web of Science, and Embase was conducted to identify peer-reviewed studies published between 2020 and 2025. Eligible studies included adults with a confirmed diagnosis of HF prior to COVID-19 infection and reported cardiovascular outcomes assessed at least 12 weeks after the acute phase. Data were extracted on patient demographics, HF subtype, cardiovascular outcomes, quality of life (QoL), and management approaches. Results: Forty-five studies met the inclusion criteria, encompassing heterogeneous but predominantly high-income country populations across multiple regions and HF phenotypes. COVID-19 was associated with increased HF symptoms, hospital readmissions 28% [95% confidence interval (CI) 24–32%] at 12 months, and mortality 18% (95% CI 15–22%) at ≥ 12 months. Patients with HF with reduced ejection fraction (HFrEF) had a 1.4-fold greater readmission risk than HF with preserved ejection fraction (HFpEF). Mechanistic data implicated persistent myocardial inflammation, endothelial dysfunction, and autonomic dysregulation. Functional capacity declined, with a mean 68-meter reduction in six-minute walk distance (6MWD). Vaccination was associated with a ~40% reduction in mortality and major adverse cardiovascular events (MACE). Discussion: COVID-19 is associated with a sustained cardiovascular burden in individuals with HF, underscoring the importance of long-term surveillance, optimization of guideline-directed medical therapy, and structured rehabilitation. Standardized, prospective studies are needed to elucidate causal mechanisms and refine post-COVID management strategies.

Thirst is a common yet underrecognized symptom in patients with heart failure (HF), exerting a significant impact on disease management, treatment adherence, and quality of life (QoL). Approximately 65-75% of patients with HF report moderate to severe thirst, particularly in advanced stages of the disease or under strict fluid restrictions contributing to psychological distress, social isolation, and diminished well-being. This systematic review explores the pathophysiology, clinical consequences, and management of thirst in HF. A literature search of PubMed, Embase, Scopus, and Web of Science (2015-2025) identified studies addressing thirst prevalence, neurohormonal and electrolyte mechanisms, and therapeutic interventions. Severe thirst has been associated with poor adherence to fluid restriction, increased psychological distress, and a 40% higher risk of hospital readmission within six months of discharge. Patient-centered strategies, such as structured education and follow-up programs, have been shown to improve adherence and reduce thirst burden. Despite its clinical importance, thirst remains underaddressed in HF care, with fewer than 20% of studies evaluating it as an outcome. The development of standardized assessment tools, implementation of long-term intervention studies, and incorporation of thirst management into routine HF care are essential steps toward improving patient outcomes and QoL. For many people living with heart failure, thirst is an everyday struggle that is often overlooked by doctors and researchers. Nearly 7 out of 10 patients report feeling moderate to severe thirst, especially when their condition is advanced or when they are asked to limit how much fluid they drink. This constant thirst can be exhausting, leading to stress, loneliness, and a poorer quality of life.This review looked at recent studies on why thirst happens in heart failure, what it means for patients, and how it can be managed. Severe thirst has been linked to difficulties in following fluid restrictions, greater emotional distress, and even a higher chance of returning to the hospital within six months. Supportive strategies like patient education, regular follow-ups, and certain medications such as tolvaptan may help ease this burden.Despite its impact, thirst is rarely studied in heart failure, and more attention is urgently needed.