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OBJECTIVE: Intensive glycemic control reduced coronary artery disease (CAD) events among the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study participants with the haptoglobin (Hp)2-2 phenotype but not in participants without the Hp2-2 phenotype. It is unknown whether and how these results translate across different demographic/clinical characteristics and treatment strategies. RESEARCH DESIGN AND METHODS: Haptoglobin phenotype was measured in available samples from the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) biomarker case-cohort study. Weighted multivariable-adjusted Cox regression models were used to evaluate the association between intensive glycemic control (HbA1c target of ≤6.5%) versus standard therapy (based on local guidelines) and major CAD events among participants with (n = 1,327) and without (n = 2,077) the Hp2-2 phenotype separately and within prespecified stratifications by sex, race, previous cardiovascular disease (CVD), diabetes duration, and HDL-cholesterol. RESULTS: While the hazard ratios (HRs) were in the hypothesized differing directions, compared with standard therapy, intensive glycemic control was not significantly associated with risk of CAD events among participants without (1.04, 95% CI 0.82–1.32) or with (0.84, 0.63–1.14, P interaction = 0.27) the Hp2-2 phenotype overall. Intensive therapy was associated with lower CAD risk among participants with the Hp2-2 phenotype who had no previous CVD (0.47, 0.29–0.76, P interaction = 0.01). CONCLUSIONS: Our findings suggest that intensive glycemic control contributes to the prevention of major CAD events among ADVANCE participants with the Hp2-2 phenotype and no previous CVD and are in alignment with our hypothesis that intensive glycemic control may be beneficial in a subset of people with the Hp2-2 phenotype. [ABSTRACT FROM AUTHOR]

Rationale: Atrial fibrillation (AF) is associated with an increased risk of thromboembolism. This risk is currently assessed with scoring systems based on clinical characteristics. However, these tools have limited prognostic performance. Circulating biomarkers are proposed for improved prediction of major clinical events and individualization of treatments in patients with AF. Objective: The aim was to assess the cost-effectiveness of precision medicine (PM), i.e., the use of combined biomarkers and clinical variables, in comparison to standard of care (SOC) for risk stratification in a hypothetical cohort of AF patients at risk of stroke. Methods: A Markov cohort model was developed to evaluate the costs and quality-adjusted life-years (QALYs) of PM compared to SOC, over 20 years using a Canadian healthcare system perspective. Results: PM decreased the mean per-patient overall costs by 7% ($94,932 vs $102,057 [Canadian dollars], respectively) and increased the QALYs by 12% (8.77 vs 7.68 QALYs, respectively). The calculated incremental cost-effectiveness ratio was negative, indicating that PM is an economically dominant strategy. These results were robust to one-way and probabilistic sensitivity analyses. Conclusion: PM compared to SOC is economically dominant and is projected to generate cost savings. [ABSTRACT FROM AUTHOR]

The glass cliff phenomenon (GCP) maintains that women are more likely to lead risky organizations than men. Quantitative measures of risk for assessing a possible GCP exist for leaders in the business sector, but no quantitative measures exist for college or university leadership. This article tests one variable of risk for college and university institutions, the financial responsibility composite score (FRCS), to see if it measures the GCP in college or university chief executive officer (CEO) hires. Using an ex post facto causal-comparative design, gender and FRCS in private American colleges and universities were analyzed using the Integrated Postsecondary Education Data System data. Purposive sampling randomly paired institutions with female CEOs with similar institutions with male CEOs. Using the U.S. Department of Education’s FRCS database, the researcher reviewed patterns in FRCS before and after CEO hires over three studies. No statistically significant results were observed, demonstrating that there is no indication that female CEOs are hired into riskier colleges or universities when utilizing FRCS. Future studies should further investigate the GCP using alternative measures of risk. [ABSTRACT FROM AUTHOR]

Aims: Complexity of the ventricular tachycardia (VT) substrate and the size and thickness of infarction area border zones differ based on location of myocardial infarctions (MIs). These differences may translate into heterogeneity in the effectiveness of treatments. This study aims to examine the influence of infarct location on the effectiveness of VT ablation in comparison with escalated pharmacological therapy in patients with prior MI and antiarrhythmic drug (AAD)-refractory VT.Methods and Results: VANISH trial participants were categorized based on the presence or absence of an inferior MI scar. Inverse probability of treatment weighted Cox models were calculated for each subgroup. Of 259 randomized patients (median age 69.8 years, 7.0% women), 135 had an inferior MI and 124 had a non-inferior MI. Among patients with an inferior MI, no statistically significant difference in the composite primary outcome of all-cause mortality, appropriate implantable cardioverter-defibrillator (ICD) shock, and VT storm was detected between treatment arms [adjusted hazard ratio (aHR) 0.80, 95% confidence interval (CI) 0.51-1.20]. In contrast, patients with non-inferior MIs had a statistically significant reduction in the incidence of the primary outcome with ablation (aHR 0.48, 95% CI 0.27-0.86). In a sensitivity analysis of anterior MI patients (n = 83), a trend towards a reduction in the primary outcome with ablation was detected (aHR 0.50, 95% CI 0.23-1.09).Conclusion: The effectiveness of VT ablation versus escalated AADs varies based on the location of the MI. Patients with MI scars located only in non-inferior regions of the ventricles derive greater benefit from VT ablation in comparison to escalation of AADs in reducing VT-related events. [ABSTRACT FROM AUTHOR]

This clinical case series investigates the recovery of two collegiate football players following exertional rhabdomyolysis, one with concurrent asymptomatic hyponatremia. Differences in clinical and patient-reported measures are discussed in relation to recovery. The patient with a greater serum creatine kinase level returned to play rapidly due to progressive symptom resolution and kidney filtration. [Athletic Training & Sports Health Care. 2021;13(5):e338–e343.] [ABSTRACT FROM AUTHOR]

A common concern of faculty members is student evaluations of teaching scores. Many factors influence student evaluations of teaching including how the course is designed. This study investigated student evaluations of teaching across three pedagogical techniques: the traditional lecture (where lectures were not recorded), recorded lectures, and a flipped classroom model. A between-subject design was used over three semesters. Student evaluations of teaching showed that students rated the instructor significantly higher in a flipped classroom setting. Students also reported liking the course more using the flipped pedagogical technique. Since the flipped format improved both teaching evaluations and student perceptions of the class, this could be useful for instructors when they are deciding how to set up the format of their class. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether a single session of foam rolling increases hamstring flexibility beyond that of a walking warm-up. Methods: Forty-two healthy, physically active participants were dividedbygenderandrandomlyassignedtogroups(30second, 2 minute, or control). Participants completed a 5-minute walking warm-up prior to their assigned intervention. The foam rolling group participants rolled the entire length of their hamstrings. Control group participants remained stationary in a long-seated position for 2 minutes. Goniometric passive range of motion measurements were collected before warm-up, after warm-up, immediately after intervention, and 10 minutes after intervention. Results: A 3 (Group) × 4 (Time) mixed model analysis of variance revealed no statistically significant interaction effect (P =.518). The main effect for Group was not significant (P =.939, η2 = 0.003, post hoc power = 0.059), but the main effect for Time was significant (P <.001). Pairwise comparisons revealed significant increases in range of motion in all three groups combined from before warm-up to after warm-up (P =.001) and from immediately after intervention to 10 minutes after intervention (P =.036). Conclusions: Although statistically significant, increases in range of motion cannot be attributed to a single session of foam rolling for either 30 seconds or 2 minutes following a 5-minute warm-up. [Athletic Training & Sports Health Care. 2021;13(3):123–129.] [ABSTRACT FROM AUTHOR]

Aims The COLchicine Cardiovascular Outcomes Trial (COLCOT) demonstrated the benefits of targeting inflammation after myocardial infarction (MI). We aimed to determine whether time-to-treatment initiation (TTI) influences the beneficial impact of colchicine. Methods and results In COLCOT, patients were randomly assigned to receive colchicine or placebo within 30 days post-MI. Time-to-treatment initiation was defined as the length of time between the index MI and the initiation of study medication. The primary efficacy endpoint was a composite of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina requiring coronary revascularization. The relationship between endpoints and various TTI (< 3, 4–7 and > 8 days) was examined using multivariable Cox regression models. Amongst the 4661 patients included in this analysis, there were 1193, 720, and 2748 patients, respectively, in the three TTI strata. After a median follow-up of 22.7 months, there was a significant reduction in the incidence of the primary endpoint for patients in whom colchicine was initiated < Day 3 compared with placebo [hazard ratios (HR) = 0.52, 95% confidence intervals (CI) 0.32–0.84], in contrast to patients in whom colchicine was initiated between Days 4 and 7 (HR = 0.96, 95% CI 0.53–1.75) or > Day 8 (HR = 0.82, 95% CI 0.61–1.11). The beneficial effects of early initiation of colchicine were also demonstrated for urgent hospitalization for angina requiring revascularization (HR = 0.35), all coronary revascularization (HR = 0.63), and the composite of cardiovascular death, resuscitated cardiac arrest, MI, or stroke (HR = 0.55, all P  < 0.05). Conclusion Patients benefit from early, in-hospital initiation of colchicine after MI. Trial Registration COLCOT ClinicalTrials.gov number, NCT02551094. [ABSTRACT FROM AUTHOR]

Background Propensity score (PS) methods are frequently used in cardiovascular clinical research. Previous evaluations revealed poor reporting of PS methods, however a comprehensive and current evaluation of PS use and reporting is lacking. The objectives of the present survey were to (1) evaluate the quality of PS methods in cardiovascular publications, (2) summarise PS methods and (3) propose key reporting elements for PS publications. Methods A PubMed search for cardiovascular PS articles published between 2010 and 2017 in high-impact general medical (top five by impact factor) and cardiovascular (top three by impact factor) journals was performed. Articles were evaluated for the reporting of PS techniques and methods. Data extraction elements were identified from the PS literature and extraction forms were pilot tested. Results Of the 306 PS articles identified, most were published in Journal of the American College of Cardiology (29%; n=88), and Circulation (27%, n=81), followed by European Heart Journal (15%; n=47). PS matching was performed most often, followed by direct adjustment, inverse probability of treatment weighting and stratification. Most studies (77%; n=193) selected variables to include in the PS model a priori. A total of 38% (n=116) of studies did not report standardised mean differences, but instead relied on hypothesis testing. For matching, 92% (n=193) of articles presented the balance of covariates. Overall, interpretations of the effect estimates corresponded to the PS method conducted or described in 49% (n=150) of the reviewed articles. Discussion Although PS methods are frequently used in high-impact medical journals, reporting of methodological details has been inconsistent. Improved reporting of PS results is warranted and these proposals should aid both researchers and consumers in the presentation and interpretation of PS methods. [ABSTRACT FROM AUTHOR]

Aims: Randomized trials suggest reductions in all-cause mortality and heart failure (HF) rehospitalizations with catheter ablation (CA) in patients with atrial fibrillation (AF) and HF. Whether these results can be replicated in a real-world population with long-term follow-up or varies over time is unknown. We sought to evaluate the long-term effectiveness of CA in reducing the incidence of all-cause mortality, HF hospitalizations, stroke, and major bleeding in AF-HF patients.Methods and Results: In a cohort of patients newly diagnosed with AF-HF in Quebec, Canada (2000-2017), CA patients were matched 1:2 to controls on time and frequency of hospitalizations. Confounders were controlled for using inverse probability of treatment weighting. Multivariable Cox models adjusted for the presence of cardiac electronic implantable devices and medication use during follow-up, and the effect of time since CA was modelled with B-splines. For non-fatal outcomes, the Lunn-McNeil approach was used to account for the competing risk of death. Among 101 933 AF-HF patients, 451 underwent CA and were matched to 899 controls. Over a median follow-up of 3.8 years, CA was associated with a statistically significant reduction in all-cause mortality [hazard ratio 0.4 (95% confidence interval 0.2-0.7)], but no difference in stroke or major bleeding. The hazard of HF rehospitalization for CA patients, relative to non-CA patients, varied with time since CA (P = 0.01), with a reduction in HF rehospitalizations until approximately 3 years post-CA.Conclusion: Compared with matched non-CA patients, CA was associated with a long-term reduction in all-cause mortality and a reduction in HF rehospitalizations until 3 years post-CA. [ABSTRACT FROM AUTHOR]

Introduction: Catheter ablation (CA) has been increasingly used to treat atrial fibrillation (AF) in patients with heart failure (HF), however, its safety at the population‐level has not yet been evaluated. To assess the safety of CA in AF‐HF patients, the frequency and potential risk factors for adverse events (AEs) within 30 days post‐CA were determined. Methods: A population‐based cohort of AF‐HF patients who underwent CA in Quebec, Canada (2000‐2017) was constructed using administrative databases. Major AEs included all‐cause mortality, cerebrovascular accident (CVA), pericardial effusion requiring drainage (PERD), vascular AEs, hemorrhage/hematoma, and pulmonary embolism. Univariate logistic regression models were employed to assess potential risk factors for major AEs. Results: Of 700 AF‐HF patients who underwent CA (median age 64.5 years [interquartile range, IQR, 56.2‐71.0], 22.0% female, and median CHA2DS2‐Vasc 3 [IQR, 2‐4]), 14 (2.0%) patients developed 16 major AEs within 30 days of CA. Hemorrhage/hematoma was the most frequent major AE (four patients; 0.6%) followed by all‐cause mortality, CVA/TIA, PERD, and vascular AEs (three patients each; 0.4%). Coronary artery disease (odds ratio [OR], 3.9 [95% confidence interval, CI, 1.2‐12.3]) and age ≥65 years (OR, 3.1 [95% CI, 1.1‐9.8]) were identified predictors for the composite outcome of major AEs. More than half of the patients (57.2%) underwent a second CA within a median of 0.8 (IQR, 0.2‐2.2) years from the date of first CA. Conclusion: CA performed in the AF‐HF population portends a relatively low incidence of major AEs. A larger study is required to determine whether certain patient factors are independently associated with a higher risk of post‐CA AEs. [ABSTRACT FROM AUTHOR]

Men in university administration repeatedly outnumber women in leadership positions. The problem under investigation is that this gender gap exists due to barriers to advancement and discrimination in both the hiring process and in the workplace. With less representation of women in higher education leadership, there is a higher risk of bias for women in this field. This study used an ex-post facto methodology and gathered public data from the University of California (UC) Annual Payroll Compensation database. Three separate studies were run to determine the level of gender differences in the representation of educational leaders, compensation, and career progression. Significant differences in gender equity existed, with more men represented at several levels of educational leadership. Significant differences were also found in compensation levels, where men earned more money than women in the same position. Lastly, a small effect, although not significant, was observed when comparing early career gender representation to non-early career gender representation. There are more women recent graduates than men in leadership positions. Together these results suggest that while there are gender gaps in representation and compensation, there may be slow progress towards better representation in early career leadership positions in the UC system. The implication of this research supports further research into factors which impact the compensation of women leaders in academia. Higher education hiring professionals and candidates for leadership positions could benefit from further development of theories around gender equity and representation. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of 5% sodium chloride ophthalmic ointment (5% NaCl) on thickness and morphology of the normal canine cornea using ultrasonic pachymetry (USP), in vivo confocal microscopy (IVCM), and Fourier‐domain optical coherence tomography (FD‐OCT). Methods: Five healthy laboratory Beagles received ophthalmic examinations including USP, IVCM, and FD‐OCT prior to and at fixed intervals following treatment. The right and left eyes were treated with 5% NaCl and artificial tears ophthalmic ointment (AT), respectively, every 2 hours for 4 treatments/d (days 2‐9), and then hourly for 7 treatments/d (day 10). Treatment groups were statistically compared using mixed‐effects linear regression. Results: Treatment with 5% NaCl resulted in a 12 μm decrease in corneal thickness from baseline (P < .001), while there was no significant difference in corneal thickness between values obtained at baseline and following treatment with AT (P = .82). Epithelial cell density significantly increased from baseline (530 ± 52 cells/mm2) to 577 ± 43 and 567 ± 15 cells/mm2 with 5% NaCl and AT, respectively (P = .003 and.005, respectively). However, keratocyte cell density in the anterior and posterior stroma and endothelial cell density did not significantly differ following treatment with 5% NaCl or AT ointment (P > .05). Conclusions: Short‐term topical treatment with 5% NaCl decreased corneal thickness in normal dogs with no observable changes in corneal morphology or signs of ocular toxicity. [ABSTRACT FROM AUTHOR]

An editorial is presented on the long‐term out comes of catheter ablation for atrial fibrillation (AF). Topics include the efficacy and effectiveness of AF ablation to decrease the incidence of hard outcomes, stroke, and heart failure hospitalizations, the meta‐analysis demonstrated that AF ablation has associated with statistically significant reductions with medical therapy, and the importance of assessing the hazards of AF ablation has highlighted in a observational study.

Purpose: Femoral venous access is required for most electrophysiology procedures. Limited data are available regarding post-procedure venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE). Potential preventative strategies are unclear. We aimed to survey Canadian centers regarding incidence of VTE and strategies for prevention of VTE after procedures that do not require post-procedure anticoagulation.Methods: An online survey was distributed to electrophysiologists representing major Canadian EP centers. Participants responded regarding procedural volume, incidence of VTE post-procedure, and their practice regarding pharmacological and non-pharmacological peri-procedural VTE prophylaxis.Results: The survey included 17 centers that performed a total of 6062 procedures in 2016. Ten patients (0.16%) had VTE (including 9 DVTs and 6 PEs) after diagnostic electrophysiology studies and right-sided ablation procedures excluding atrial flutter. Five centers (41.6%) administered systemic intravenous heparin during both diagnostic electrophysiology studies and right-sided ablation procedures. For patients taking oral anticoagulants, 10 centers (58.8%) suspend therapy prior to the procedure. Two centers (11.8%) routinely prescribed post-procedure pharmacologic prophylaxis for VTE. Four centers (23.5%) used compression dressings post-procedure and all prescribed bed rest for a maximum of 6 h. Of the variables collected in the survey, none were found to be predictive of VTE.Conclusions: VTE is not a common complication of EP procedures. There is significant variability in the strategies used to prevent VTE events. Future research is required to evaluate strategies to reduce the risk of VTE that may be incorporated into EP practice guidelines. [ABSTRACT FROM AUTHOR]

Background: Catheter ablation (CA) is an established therapy for atrial fibrillation (AF). Studies regarding long‐term real‐world outcomes post‐CA have inconsistently accounted for oral anticoagulation (OAC). Objectives: To describe patterns of OAC use post‐CA and to compare the OAC‐adjusted long‐term risk of stroke and major bleeding in AF patients with and without CA. Methods: A population‐based cohort of AF patients was constructed in Quebec and Ontario, Canada (1999‐2014). Propensity score matching was performed to determine the incidence rates of stroke and major bleeding among those undergoing CA, adjusted for time‐dependent OAC use. Results: From the entire cohort, 6391 patients were identified as having undergone CA as compared to 482 977 patients who did not. Of these, 1240 patients with government medical insurance undergoing CA were matched with 2427 patients without CA. Post‐CA, 78%, 65%, and 61% remained on an OAC at 1, 2, and 5 years, while 75%, 71%, and 68% of patients not undergoing CA were on OACs at 1, 2, and 5 years. At follow‐up, there was no statistically significant difference for stroke (adjusted hazard ratio [HR], 0.88; 95% CI, 0.63 to 1.21) or major bleeding (adjusted HR, 0.88; 95% CI, 0.73 to 1.06). Conclusion: No evidence was found that CA significantly decreases the risk of stroke or major bleeding when adjusting for OAC use over time. It may be prudent to continue anticoagulation post‐CA based on patient‐risk profile until randomized trials demonstrate both reduced stroke rates with CA, and improved safety (balancing stroke and bleeding risk) with OAC discontinuation post‐CA. [ABSTRACT FROM AUTHOR]

Background Catheter ablation (CA) is superior to antiarrhythmic therapy at reducing recurrence of atrial fibrillation (AF); however, there are limited data regarding whether this decrease translates into a reduction in health care resource utilization. Objective To evaluate the impact of AF ablation on long-term health care resource utilization. Methods A population-based cohort was constructed to include patients who underwent CA for AF in Quebec, Canada, between April 2005 and March 2011. Resource utilization was evaluated 24 months pre- and postindex CA procedure. Results In a cohort of 1,556 patients, resource utilization increased progressively over the 24-month period leading to index CA (P for trend <0.05 for hospitalizations, ER visits, outpatient visits, cardioversions, and echocardiograms). After index CA, all-cause hospitalizations, hospitalizations for AF, ER visits, cardioversions, and echocardiograms were reduced 12 months post-CA compared to 12 months prior (all-cause hospitalizations 0.8-0.6 per patient per year; hospitalizations for AF 0.4-0.3; ER visits 2.9-1.8; cardioversions 0.5-0.2; echocardiograms 0.8-0.5; P < 0.05 for all trends). Resource utilization continued to decline at 24 months post-CA (vs. 12 months prior) for all-cause hospitalizations (0.4), cardioversions (0.1), and echocardiograms (0.3) (per patient year; P < 0.05 for all trends). Conclusion In conclusion, the pattern of increasing health care resource utilization preceding CA for AF reverses after CA to lower than preablation levels up to 24 months post-CA. [ABSTRACT FROM AUTHOR]

Background Outpatient ambulatory cardiac rhythm monitoring is a routine part of the management of patients with paroxysmal atrial fibrillation (AF). Current systems are limited by patient convenience and practicality. Methods We compared the Zio® Patch, a single-use, noninvasive waterproof long-term continuous monitoring patch, with a 24-hour Holter monitor in 74 consecutive patients with paroxysmal AF referred for Holter monitoring for detection of arrhythmias. Results The Zio® Patch was well tolerated, with a mean monitoring period of 10.8 ± 2.8 days (range 4-14 days). Over a 24-hour period, there was excellent agreement between the Zio® Patch and Holter for identifying AF events and estimating AF burden. Although there was no difference in AF burden estimated by the Zio® Patch and the Holter monitor, AF events were identified in 18 additional individuals, and the documented pattern of AF (persistent or paroxysmal) changed in 21 patients after Zio® Patch monitoring. Other clinically relevant cardiac events recorded on the Zio® Patch after the first 24 hours of monitoring, including symptomatic ventricular pauses, prompted referrals for pacemaker placement or changes in medications. As a result of the findings from the Zio® Patch, 28.4% of patients had a change in their clinical management. Conclusions The Zio® Patch was well tolerated, and allowed significantly longer continuous monitoring than a Holter, resulting in an improvement in clinical accuracy, the detection of potentially malignant arrhythmias, and a meaningful change in clinical management. Further studies are necessary to examine the long-term impact of the use of the Zio® Patch in AF management. [ABSTRACT FROM AUTHOR]

The article reports on the study that determines the impact of a practical duration of acute static and ballistic stretching on vertical jump (VJ), lower-extrenity power, and hamstring torque. The study reveals that static and ballistic stretching did not affect VJ, while stretching has caused a decrease in lower-extremity power. It suggests strength coaches to use dynamic stretching before activity.