Abdul Shakoor

Aims: This study aims to evaluate the impact of a gamified engagement toolkit on registration rates and data completeness in a real-world registry. Methods and results: Engage-HF is a prospective, observational pre-test–post-test exploratory concept study involving 31 hospitals participating in the Netherlands Heart Registration-Heart Failure (NHR-HF) registry: 12 that were technically ready and willing to participate formed the intervention group, while the remaining 19 NHR-HF hospitals served as controls. In the intervention group, 28 HF nurse specialists participated in a 24-week educational programme using the Engage-HF toolkit. The primary endpoint was participation, measured by a performance index (average number of patients registered per hospital per month) at the end of the intervention and at the 3- and 6-month post-test. The secondary endpoint was data completeness, and an exploratory analysis evaluated participants’ experiences with the toolkit and its impact on their HF registries and 2021 ESC HF guideline knowledge. The intervention group showed a numerically higher performance index at the end of the intervention (5.2 vs. 2.1 patients/hospital/month, P = 0.41) and at the 3-month post-test (4.4 vs. 2.9 patients/hospital/month, P = 0.45). However, at the 6-month post-test, the performance index was higher in the control group (3.3 vs. 4.0 patients/hospital/month, P = 0.98). Data completeness was high in both groups, with variable-specific differences without a clear pattern. Participants rated the toolkit positively as an educational toolkit but reported neutral impacts on HF registries or 2021 ESC HF guideline knowledge. Conclusion: The Engage-HF toolkit was well received and may boost short-term participation but did not improve long-term participation or the already high data completeness.

Background and Aims: Heart failure (HF) is a major public health issue, imposing substantial costs on healthcare systems and societies. This study aimed to provide a contemporary overview of its global economic impact. Methods: A systematic search of four databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting direct cost (DC) and/or indirect cost (IC) associated with HF were included. DC and IC were expressed as a percentage of current healthcare expenditure (CHE) and gross domestic product (GDP), which were obtained for 2021 from the World Health Organization Global Health Expenditure Database. Countries were categorized by their Human Development Index (HDI), and weighted group means were calculated to estimate costs based on their 2021 expenditure. Results: Thirty-two studies met the inclusion criteria. In 2021, the estimated economic burden of HF was $284.17 billion across 179 countries. This included $136.86 billion (48.16%) in DC and $147.31 (51.84%) billion in IC. Very high HDI countries account for most absolute HF spending, but HF comprises a smaller share of CHE and GDP (1.07% DC, 0.09% IC) compared with low HDI countries (8.85% DC, 0.29% IC). Conclusions: The global economic burden of HF is substantial, increasing, and varies across countries. Although very high and high HDI countries carry most of the absolute costs, low HDI countries bear a disproportionate burden relative to their total healthcare expenditure or GDP. Data scarcity in these settings further impedes accurate burden estimates. To address this growing challenge, proactive and cost-effective measures tailored to each country’s healthcare system are crucial in optimizing HF care worldwide.

Socio-economic status (SES) has been associated with incident and prevalent heart failure (HF), as well as its morbidity and mortality. However, the precise nature of the relationship between SES and HF remains unclear due to inconsistent data. This study aims to provide a comprehensive assessment and data synthesis of the relationship between SES and HF morbidity and mortality. We performed a systematic search and data synthesis using six databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. The included studies comprised observational studies that reported on HF incidence and prevalence, HF hospitalizations, worsening HF (WHF) and all-cause mortality, as well as treatment options (medical, device and advanced HF therapies). SES was measured on both individual and area levels, encompassing single (e.g., income, education, employment, social risk score, living conditions and housing characteristics) and composite indicators. Among the 4124 studies screened, 79 were included, with an additional 5 identified through cross-referencing. In the majority of studies, a low SES was associated with an increased HF incidence (72%) and prevalence (75%). For mortality, we demonstrated that low SES was associated with increased mortality in 45% of the studies, with 18% of the studies showing mixed results (depending on the indicator, gender or follow-up) and 38% showing non-significant results. Similar patterns were observed for the association between SES, WHF, medical therapy prescriptions and the utilization of devices and advanced HF therapies. There was no clear pattern in the used SES indicators and HF outcomes. This systematic review, using contemporary data, shows that while socio-economic disparity may influence HF incidence, management and subsequent adverse events, these associations are not uniformly predictive. Our review highlights that the impact of SES varies depending on the specific indicators used, reflecting the complexity of its influence on health disparities. Assessment and recognition of SES as an important risk factor can assist clinicians in early detection and customizing HF treatment, while also aiding policymakers in optimizing resource allocation.

Aims: Heart failure (HF) registries provide valuable insights into patient management and quality of care. However, healthcare professionals face challenges due to the administrative burden of participation in registries. This study aims to evaluate the impact of education through an engagement toolkit on HF nurse practitioners’ participation rate and data completeness in a national registry: the Netherlands Heart Registration-Heart Failure (NHR-HF) registry. Methods and results: Engage-HF is an observational study (intervention at the HF nurse level) with a pretest–posttest design within the participating hospitals. Between December 2022 and April 2024, 28 HF nurse practitioners from 12 hospitals will participate in a 24-week educational programme using the Engage-HF engagement toolkit. The main interaction platform in this toolkit is a gamified smartphone-based educational application called BrightBirds. The complete toolkit includes this educational application with weekly challenges, interactive posters, pop-ups, and alert messages, and a follow-up call at Week 4. The primary endpoints are the NHR-HF participation rates and data completeness at 1 and 6 months after using the toolkit. Additionally, we will analyse the experience of participants with the toolkit concerning their HF registry and knowledge of ESC 2021 HF guidelines. Conclusion: The Engage-HF study is the first to explore the impact of education through a gamified engagement toolkit to boost participation rates in a HF registry (NHR-HF) and test participant knowledge of the ESC 2021 HF guidelines. This innovative approach addresses challenges in the rollout of healthcare registries and the implementation of guidelines by providing a contemporary support base and a time-efficient method for education.

Aims: Heart failure (HF) is a chronic and progressive syndrome associated with a poor prognosis. While it may seem intuitive that the risk of adverse outcomes varies across the different stages of HF, an overview of these risks is lacking. This study aims to determine the risk of all-cause mortality and HF hospitalizations associated with new-onset HF, chronic HF (CHF), worsening HF (WHF), and advanced HF. Methods and results: We performed a systematic review of observational studies from 2012 to 2022 using five different databases. The primary outcomes were 30-day and 1-year all-cause mortality, as well as 1-year HF hospitalization. Studies were pooled using random effects meta-analysis, and mixed-effects meta-regression was used to compare the different HF groups. Among the 15 759 studies screened, 66 were included representing 862 046 HF patients. Pooled 30-day mortality rates did not reveal a significant distinction between hospital-admitted patients, with rates of 10.13% for new-onset HF and 8.11% for WHF (p = 0.10). However, the 1-year mortality risk differed and increased stepwise from CHF to advanced HF, with a rate of 8.47% (95% confidence interval [CI] 7.24–9.89) for CHF, 21.15% (95% CI 17.78–24.95) for new-onset HF, 26.84% (95% CI 23.74–30.19) for WHF, and 29.74% (95% CI 24.15–36.10) for advanced HF. Readmission rates for HF at 1 year followed a similar trend. Conclusions: Our meta-analysis of observational studies confirms the different risk for adverse outcomes across the distinct HF stages. Moreover, it emphasizes the negative prognostic value of WHF as the first progressive stage from CHF towards advanced HF.

Aims: Heart failure (HF) is a progressive disease in which periods of clinical stability are interrupted by episodes of clinical deterioration known as worsening heart failure (WHF). Patients who develop WHF are at high risk of subsequent death, rehospitalization, and excessive healthcare costs. As such, WHF could be seen as a separate disease stage and precursor of advanced HF. Whether WHF has a substantial health, societal, and economic impact evidence regarding its multifactorial nature and the specific barriers in treatment, including advanced HF therapies, remains scarce. The CHAIN-HF registry aims to describe the incidence, characteristics, current treatment, and outcomes of WHF. Additionally, it will promote structured regional collaboration and educate on increasing awareness for WHF and describe the implementation of guideline directed medical therapy and utilization of advanced HF therapies in a collaborative network. Methods and results: The CHAIN-HF registry is a prospective, observational, and multicentre study from the collaborating hospitals (Rijnmond HF Network) in the Rotterdam area. Unselected and consecutive patients (irrespective of ejection fraction) with a WHF event will be included. Comprehensive data including demographics, co-morbidities, treatment, and in-hospital and post-discharge outcomes will be collected. Notably, data on socio-economic status, treatment decisions, and referral for advanced HF therapies will be included. Conclusions: CHAIN-HF will be the first prospective, dedicated WHF registry in a collaborative network of hospitals that will provide robust real-world evidence on the incidence, characteristics, and outcomes of WHF. Moreover, it will provide information on of the value of regional collaboration to improve awareness and outcomes of WHF.

18F-FDG PET/CT is a valuable diagnostic tool in infective endocarditis (IE). However, the prognostic value is unclear. This study aims to evaluate the prognostic performance of 18F-FDG PET/CT in na...