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Background: The subcutaneous (S) implantable cardioverter-defibrillator (ICD) is safe and effective for sudden cardiac death prevention. However, patients in previous S-ICD studies had fewer comorbidities, had less left ventricular dysfunction, and received more inappropriate shocks (IAS) than in typical transvenous ICD trials. The UNTOUCHED trial (Understanding Outcomes With the S-ICD in Primary Prevention Patients With Low Ejection Fraction) was designed to evaluate the IAS rate in a more typical, contemporary ICD patient population implanted with the S-ICD using standardized programming and enhanced discrimination algorithms. Methods: Primary prevention patients with left ventricular ejection fraction ≤35% and no pacing indications were included. Generation 2 or 3 S-ICD devices were implanted and programmed with rate-based therapy delivery for rates ≥250 beats per minute and morphology discrimination for rates ≥200 and Results: S-ICD implant was attempted in 1116 patients, and 1111 patients were included in postimplant follow-up analysis. The cohort had a mean age of 55.8±12.4 years, 25.6% were women, 23.4% were Black, 53.5% had ischemic heart disease, 87.7% had symptomatic heart failure, and the mean left ventricular ejection fraction was 26.4±5.8%. Eighteen-month freedom from IAS was 95.9% (lower confidence limit, 94.8%). Predictors of reduced incidence of IAS were implanting the most recent generation of device, using the 3-incision technique, no history of atrial fibrillation, and ischemic cause. The 18-month all-cause shock-free rate was 90.6% (lower confidence limit, 89.0%), meeting the prespecified performance goal of 85.8%. Conversion success rate for appropriate, discrete episodes was 98.4%. Complication-free rate at 18 months was 92.7%. Conclusions: This study demonstrates high efficacy and safety with contemporary S-ICD devices and programming despite the relatively high incidence of comorbidities in comparison with earlier S-ICD trials. The inappropriate shock rate (3.1% at 1 year) is the lowest reported for the S-ICD and lower than many transvenous ICD studies using contemporary programming to reduce IAS. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02433379.

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BACKGROUND: Non-attendance for vascular screening potentially restricts the overall benefit of screening at population level, but may be the result of rational judgment on the part of invitees who might not consider their risk to be relevant. The aim of this study was to investigate the role of current use of preventive medication and personal risk attitude as potential factors explaining non-attendance at triple vascular screening.METHODS: This was a case control study across 25,078 men offered screening and intervention for abdominal aortic aneurysm, peripheral artery disease, and hypertension in the Viborg Vascular (VIVA) screening trial. Data on socio-demographic and socio-economic characteristics, diagnoses, and use of preventive medication were extracted from national registries. A proxy for personal risk attitude was constructed. Logistic regression was used to estimate odds ratios with 95% confidence intervals.RESULTS: Use of statins (0.78; 95% CI 0.71-0.85), antihypertensives (1.26, 95% CI 1.13-1.41), or antithrombotics (1.13, 95% CI 1.04-1.23) were all associated with non-attendance. With regards to personal risk attitude, a statistically significant association was found between users of preventive medication with no recent diagnosis of cardiovascular disease and non-attendance (0.82, 95% CI 0.72-0.94). The role of traditional factors explaining non-attendance at vascular screening, such as low socio-economic status and comorbidity, was confirmed.CONCLUSION: Non-attendance at triple vascular screening is influenced by use of preventive medications and traditional explanatory factors of non-attendance at vascular screening, including existing CVD comorbidity. Attendance rates might benefit from rethinking risk communication alongside screening invitations according to varying invitee profiles and clinical risk scenarios, and from providing interventions targeted at individuals with lower levels of health literacy.

AIMS: Therapy with an implantable cardioverter defibrillator (ICD) is established for the prevention of sudden cardiac death (SCD) in high risk patients. We aimed to determine the effectiveness of primary prevention ICD therapy by analysing registry data from 14 centres in 11 European countries compiled between 2002 and 2014, with emphasis on outcomes in women who have been underrepresented in all trials. METHODS AND RESULTS: Retrospective data of 14 local registries of primary prevention ICD implantations between 2002 and 2014 were compiled in a central database. Predefined primary outcome measures were overall mortality and first appropriate and first inappropriate shocks. A multivariable model enforcing a common hazard ratio for sex category across the centres, but allowing for centre-specific baseline hazards and centre specific effects of other covariates, was adjusted for age, the presence of ischaemic cardiomyopathy or a CRT-D, and left ventricular ejection fraction ≤25%. Of the 5033 patients, 957 (19%) were women. During a median follow-up of 33 months (IQR 16-55 months) 129 women (13%) and 807 men (20%) died (HR 0.65; 95% CI: [0.53, 0.79], P-value

This review summarizes the main findings of the French multicentre DAI-PP pilot programme, and discusses the related clinical and research perspectives. This project included retrospectively (2002–2012 period) more than 5000 subjects with structural heart disease who received an implantable cardioverter defibrillator (ICD) for primary prevention of sudden cardiac death, and were followed for a mean period of 3 years. The pilot phase of the DAI-PP programme has provided valuable information on several practical and clinically relevant aspects of primary prevention ICD implantation in the real-world population, which are summarized in this review. This pilot has led to a prospective evaluation that started in May 2018, assessing ICD therapy in primary and secondary prevention in patients with structural and electrical heart diseases, with remote monitoring follow-up using a dedicated platform. This should further enhance our understanding of sudden cardiac death, to eventually optimize the field of preventative actions. © 2019 Elsevier Masson SAS; Cet article résume les principaux résultats de la phase pilote du programme DAI-PP et discute ses perspectives scientifiques. Ce projet a inclus plus de 5000 sujets (pendant la période 2002–2012) ayant une cardiopathie et implantés d’un défibrillateur automatique implantable (DAI) en prévention primaire de la mort subite avec un suivi moyen de 3 ans. Cette évaluation pilote du programme de recherche DAI-PP, mené dans la vraie vie, a permis d'identifier des messages importants concernant la prévention primaire de la mort subite de patients porteurs de cardiomyopathies dilatées ou cardiopathies ischémiques, résumés dans cet article. Cette phase préliminaire a également permis l'initiation d'une évaluation prospective, débutée en mai 2018, avec pour ambition d'évaluer la prévention primaire et secondaire quelque soit le phénotype sous jacent (structurel ou électrique), en utilisant une nouvelle plateforme de télésurveillance. DAI-PP devrait permettre de mieux comprendre différents aspects de la mort subite cardiaque, pour au final en améliorer la prévention.

Introduction: Implantable cardioverter-defibrillator (ICD) monitoring zones (MZ) provide passive features that do not interfere with the functioning of active treatment zones. However, it is not known for certain whether programming an MZ affects arrhythmia detection by the ICD. The aim of the present study is to assess the clinical relevance of MZ in a population of patients with ICDs. Methods: In this retrospective analysis of patients with ICDs, with or without cardiac resynchronization therapy, for primary prevention under remote monitoring, the MZ was analyzed and recorded arrhythmias were assessed in detail. Results: A total of 221 patients were studied (77% men; age 64±12 years). Mean ejection fraction was 30±12%. The mean follow-up was 63±35 months. One hundred and seventy-four MZ events were documented in 139 patients (62.9%): 74 of non-sustained ventricular tachycardia (NSVT), 42 of supraventricular tachycardia, 44 of atrial fibrillation/atrial flutter, and five cases of noise. Among the 137 patients who presented with arrhythmias in the MZ (excluding two cases with noise detection only), 22 (16.1%) received appropriate shocks and/or antitachycardia pacing (ATP), while of the other 84 patients, 15.5% received appropriate ICD treatment (p=NS). In patients who presented with NSVT in the MZ, 15 (20.5%) received appropriate shocks and/or ATP. In accordance with the MZ findings, physicians decided to change outpatient medication in 41.7% of all patients in whom arrhythmic events were reported. Conclusion: Ventricular and supraventricular arrhythmias are common findings in the MZ of ICD patients. Programming an MZ is valuable in the diagnosis of arrhythmias and may be a useful tool in clinical practice. Resumo: Introdução: A zona de monitorização (ZM) de cardioversor desfibrilhador implantável (CDI) permite uma funcionalidade passiva que não interfere com o funcionamento das zonas de tratamento ativo. Contudo, não é perfeitamente conhecido se a programação de ZM afeta a deteção de arritmias pelo CDI. O objetivo do presente estudo é avaliar a relevância clínica de ZM numa população submetida a implantação de CDI. Métodos: Análise retrospetiva de doentes submetidos a implantação de CDI, com ou sem terapia de ressincronização cardíaca, em prevenção primária, sob monitorização remota. ZM foi analisada e as arritmias documentadas avaliadas em detalhe. Resultados: Foram estudados 221 doentes (77% homens; 64±12 anos). Fração de ejeção média foi 30±12%. O período de seguimento médio foi 63±35 meses. Foram documentados 174 eventos na ZM, em 139 doentes (62.9%): taquicardia ventricular não sustentada (TVNS) – 74, taquicardia supraventricular – 42, fibrilhação/flutter auricular – 44, ruído – 5. Dos 137 doentes que apresentaram arritmia na ZM (excluindo dois casos de deteção de ruído), 22 (16,1%) receberam choques apropriados ou pacing antitaquicardia (PAT), enquanto que dos restantes 84 doentes, 15,5% receberam terapias apropriadas do CDI (p=NS). Dos doentes que apresentaram TVNS na ZM, 15 (20,5%) receberam choques apropriados e/ou pacing anti-taquicardia (PAT). De acordo com os achados em ZM, o médico decidiu alterar a terapia oral de ambulatório em 41,7% de todos os doentes com eventos arrítmicos reportados. Conclusão: Arritmas ventriculares e supraventriculares são achados comuns na ZM de CDI. A programação de ZM é importante no diagnóstico de arritmias e poderá ser um elemento útil na prática clínica. Keywords: Implantable cardioverter-defibrillator, Monitoring zone, Supraventricular arrhythmias, Ventricular arrhythmias, Clinical practice, Palavras-chave: Cardioversor desfibrilhador implantável, Zona de monitorização, Arritmias supraventriculares, Arritmias ventriculares, Prática clínica

Allergic diseases are common and frequently coexist. Allergen immunotherapy (AIT) is a disease-modifying treatment for IgE-mediated allergic disease with effects beyond cessation of AIT that may include important preventive effects. The European Academy of Allergy and Clinical Immunology (EAACI) has developed a clinical practice guideline to provide evidence-based recommendations for AIT for prevention of i) development of allergic comorbidities in those with established allergic diseases, ii) development of first allergic condition and iii) allergic sensitization. This guideline has been developed using the Appraisal of Guidelines for Research & Evaluation (AGREE II) framework, which involved a multi-disciplinary expert working group, a systematic review of the underpinning evidence and external peer-review of draft recommendations. Our key recommendation is that a three year course of subcutaneous or sublingual AIT can be recommended for children and adolescents with moderate to severe allergic rhinitis (AR) triggered by grass/birch pollen allergy to prevent asthma for up to two years post-AIT in addition to its sustained effect on AR symptoms and medication. Some trial data even suggest a preventive effect on asthma symptoms and medication more than two years post AIT. We need more evidence concerning AIT for prevention in individuals with AR triggered by house dust mites or other allergens and for the prevention of allergic sensitization, the first allergic disease or for prevention of allergic co-morbidities in those with other allergic conditions. Evidence for the preventive potential of AIT as disease modifying treatment exists but there is an urgent need for more high-quality clinical trials. This article is protected by copyright. All rights reserved.

The prevalence of chronic kidney disease and diabetes is rising in Europe. These patients are at high cardiovascular and renal risk and need a challenging multifactorial therapeutic approach. The goal of this cross-sectional study was to examine the treatment and attainments of goals related to cardiovascular risk factors within chronic kidney disease stages in type 2 diabetic patients followed up by primary care physicians in Switzerland. Each participating physician entered into a web database the anonymised data of up to 15 consecutive diabetic patients attending her/his office between December 2013 and June 2014. Diabetes, hypertension and lipid lowering therapies were analysed, as well as glycated haemoglobin (HbA1c), blood pressure and low-density lipoprotein-cholesterol (LDL-c) levels and goal attainments by KDIGO chronic kidney disease stage 1 to 4. A total of 1359 patients (mean age 66.5±12.4 years) were included by 109 primary care physicians. Chronic kidney disease stages 0-2, 3a, 3 b and 4 were present in 77.6%, 13.9%, 6.1%, and 2.4%, respectively. Average HbA1c was independent of chronic kidney disease stage and close to 7%; more than half of the patients reached the HbA1c goal. Eighty-four percent of patients were hypertensive and only 18.2% reached the then current Swiss or American Diabetes Association 2013 blood pressure goals. Despite loosening of blood pressure goals in 2015, only half of the patients reached them and most needed multiple therapies. Increased body mass index and advanced chronic kidney disease stage decreased the chance of reaching blood pressure goals. Lipid lowering therapy was prescribed in 62.1% of cases, with average LDL-c levels similar across chronic kidney disease stages. Only 42% of patients reached the LDL-c goal of

Background Exercise is an important component of a healthy lifestyle, the development of which is a relapse prevention strategy for those with alcohol use disorder. However, it is a challenge to create exercise interventions with a persistent behavioural change. The aim of this qualitative study was to investigate perceived barriers to participation in an exercise intervention among alcohol use disorder patients, who dropped out of the intervention program. Furthermore, this study aims to propose possibilities for a better practice of future intervention studies based on the participants’ experiences and suggestions. Methods Qualitative interviews with 17 patients who dropped out from an exercise intervention in an outpatient treatment centre about their experiences and reasons for dropping out. Social cognitive theory informed the development of the interview guides and systematic text condensation was used for analysis. Results Analysis revealed three central themes: 1) Structural barriers described as the type of exercise and the timing of the intervention, 2) Social barriers described as need for accountability and unsupportive relations, and 3) Emotional barriers described as fear, guilt and shame, and negative affect of the intervention on long term. Conclusions Future exercise interventions should include socio-psychological support during the first weeks, begin shortly after treatment initiation instead of concurrently, and focus on garnering social support for participants in both the intervention context and among their existing network in order to best reduce barriers to participation. Trial registration This study was retrospectively registered at Current Controlled Trials ISRCTN74889852 on 11 July 2013.

Background— Indications for prophylactic implantable cardioverter-defibrillator (ICD) therapy in patients with inherited cardiac diseases stem from observational studies and are uncertain. This study evaluates the efficacy and harm rate of ICD implantations for primary prevention compared with secondary prevention in inherited cardiac diseases. Methods and Results— Between January 1, 1993, and April 1, 2011, 354 patients with inherited cardiac diseases were treated with ICDs. Incidence rates of appropriate shocks in primary prevention patients with arrhythmogenic right ventricular cardiomyopathy and hypertrophic cardiomyopathy were 4.2 to 6.7/100 patient-years, whereas the risk for appropriate shocks in primary prevention patients with Brugada syndrome, long QT syndrome, or carrying the DPP6 haplotype approached zero. Conversely, in secondary prevention patients there was a considerably higher incidence rate of appropriate shocks. None of the indications for primary prevention were associated with appropriate shock therapy. One hundred twenty-three patients (35%) experienced ICD-related adverse events. Conclusions— For Brugada syndrome, long QT syndrome, and DPP6 the efficacy of an ICD for primary prevention contrasts with the amount of harm, and factors that formed the indication for ICD implantation do not relate to the occurrence of appropriate shocks. The higher appropriate discharge rates in arrhythmogenic right ventricular cardiomyopathy and hypertrophic cardiomyopathy compared with primary electric diseases might result from a more advanced risk stratification scheme in these inherited cardiomyopathies.

Background: The EUROASPIRE (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) cross-sectional surveys describe time trends in lifestyle and risk factor control among coronary patients between 1999 and 2013 in Belgium, Czech Republic, Finland, France, Ireland, the Netherlands, Poland, Slovenia, and the United Kingdom as part of the EuroObservational Research Programme under the auspices of European Society of Cardiology.Objectives: This study sought to describe time trends in lifestyle, risk factor control, and the use of evidencebased medication in coronary patients across Europe.Methods: The EUROASPIRE II (1999 to 2000), III (2006 to 2007), and IV (2012 to 13) surveys were conducted in the same geographical areas and selected hospitals in each country. Consecutive patients (≤70 years) after coronary artery bypass graft, percutaneous coronary intervention, or an acute coronary syndrome identified from hospital records were interviewed and examined ≥6 months later with standardized methods.Results: Of 12,775 identified coronary patients, 8,456 (66.2%) were interviewed. Proportion of current smokers was similar across the 3 surveys. Prevalence of obesity increased by 7%. The prevalence of raised blood pressure (≥140/90 mm Hg or ≥140/80 mm Hg with diabetes) dropped by 8% from EUROASPIRE III to IV, and therapeutic control of blood pressure improved with 55% of patients below target in IV. The prevalence of low-density lipoprotein cholesterol ≥2.5 mmol/l decreased by 44%. In EUROASPIRE IV, 75% were above the target low-density lipoprotein cholesterol

BACKGROUND: European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) IV in primary care was a cross-sectional survey carried out by the European Society of Cardiology, EURObservational Research Programme in 2014-2015 in 71 centres from 14 European countries. The main objective was to determine whether the 2012 Joint European Societies' guidelines on cardiovascular disease (CVD) prevention in people at high CVD risk have been followed in clinical practice. METHODS: Patients without a history of atherosclerotic disease started on either blood pressure and/or lipid and/or glucose-lowering treatments were identified and interviewed at least six months after the start of medication. RESULTS: Medical notes of 6700 patients were reviewed, and 4579 patients (58.7% women; mean age 58.8 (standard deviation (SD) 11.3) years) interviewed (interview rate 68.3%). Overall, 16.6% were smokers, 39.9% were overweight (body mass index (BMI)≥25 and

INTRODUCTION: Alcohol use is one of the leading modifiable morbidity and mortality risk factors among young adults. STUDY DESIGN: 2 parallel-group randomized controlled trial with follow-up at 1 and 6 months. SETTING/PARTICIPANTS: Internet based study in a general population sample of young men with low-risk drinking, recruited between June 2012 and February 2013. INTERVENTION: Internet-based brief alcohol primary prevention intervention (IBI). The IBI aims at preventing an increase in alcohol use: it consists of normative feedback, feedback on consequences, calorific value alcohol, computed blood alcohol concentration, indication that the reported alcohol use is associated with no or limited risks for health. INTERVENTION group participants received the IBI. Control group (CG) participants completed only an assessment. MAIN OUTCOME MEASURES: Alcohol use (number of drinks per week), binge drinking prevalence. Analyses were conducted in 2014-2015. RESULTS: Of 4365 men invited to participate, 1633 did so; 896 reported low-risk drinking and were randomized (IBI: n = 451; CG: n = 445). At baseline, 1 and 6 months, the mean (SD) number of drinks/week was 2.4(2.2), 2.3(2.6), 2.5(3.0) for IBI, and 2.4(2.3), 2.8(3.7), 2.7(3.9) for CG. Binge drinking, absent at baseline, was reported by 14.4% (IBI) and 19.0% (CG) at 1 month and by 13.3% (IBI) and 13.0% (CG) at 6 months. At 1 month, beneficial intervention effects were observed on the number of drinks/week (p = 0.05). No significant differences were observed at 6 months. CONCLUSION: We found protective short term effects of a primary prevention IBI. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN55991918. Language: en

ObjectivesWe previously identified that general practitioners (GPs) in French-speaking regions of Europe had a variable uptake of common preventive recommendations. In this study, we describe GPs’ reports of how they put different preventive recommendations into practice.Design, setting and participantsCross-sectional study conducted in 2015 in Switzerland and France. 3400 randomly selected GPs were asked to complete a postal (n=1100) or online (n=2300) questionnaire. GPs who exclusively practiced complementary and alternative medicine were not eligible for the study. 764 GPs (response rate: postal 47%, online 11%) returned the questionnaire (428 in Switzerland and 336 in France).Main outcome measuresWe investigated how the GPs performed five preventive practices (screening for dyslipidaemia, colorectal and prostate cancer, identification of hazardous alcohol consumption and brief intervention), examining which age group they selected, the screening frequency, the test they used, whether they favoured shared decision for prostate cancer screening and their definition of hazardous alcohol use.ResultsA large variability was observed in the way in which GPs provide these practices. 41% reported screening yearly for cholesterol, starting and stopping at variable ages. 82% did not use any test to identify hazardous drinking. The most common responses for defining hazardous drinking were, for men, ≥21 drinks/week (24%) and ≥4 drinks/occasion for binge drinking (20%), and for women, ≥14 drinks/week (28%) and ≥3 drinks/occasion (21%). Screening for colorectal cancer, mainly with colonoscopy in Switzerland (86%) and stool-based tests in France (93%), was provided every 10 years in Switzerland (65%) and 2 years in France (91%) to patients between 50 years (87%) and 75 years (67%). Prostate cancer screening, usually with shared decision (82%), was provided yearly (62%) to patients between 50 years (74%) and 75–80 years (32%–34%).ConclusionsThe large diversity in the way these practices are provided needs to be addressed, as it could be related to some misunderstandingof the current guidelines, to barriers for guideline uptake or, more likely, to the absence of agreement between the various recommendations.

Despite infection control efforts, bacteraemia remains one of the most frequent and challenging hospital-acquired infections and is associated with high attributable morbidity and mortality and additional use of healthcare resources. Prevention and control of hospital-acquired blood-stream infection requires improved detection methods, better definition of patient populations at risk, more refined guidelines for the interpretation of positive blood cultures and a better discrimination between sporadic contaminants and true bacteraemia. These issues are addressed in the current review together with those related to the diagnosis, management and recent advances in the prevention of cathether-related bacteraemia, the leading cause of hospital-acquired blood-stream infection. Finally, the reasons and perspectives for blood-stream infection surveillance are briefly discussed.

Despite high immunisation coverage, several measles outbreaks occurred in the canton of Geneva between 2003 and 2010, with 161 reported cases (52 in 2003, 16 in 2005 and 93 in 2007-2010). It affected mainly 10-14 year-old children in 2003 (31%), and adults 20 years and older in 2005 (75%) and 2007-2010 (39%). Several cases were imported from neighbouring cantons and countries, as confirmed by the diversity of the genotypes identified (D8, D6, D5, D4 and G3). Infections were mainly transmitted via family (54%) and school (22%) in 2003, hospital (71%) and family (29%) in 2005, and family (55%) and school (26%) in 2007-2010. In 2003, 6% of infected patients were vaccinated, 27% in 2005 and 2% in 2007-2010, none of them with two doses of measles-containing vaccine. Between 2003 and 2008, measles vaccine coverage, particularly for the second dose, increased by 23 percentage points to 91.7% in the 28 month-olds, by 27 points to 92.3% in the 5-6 year-olds, and by 19 points to 86% in the 13-14 year-olds. In a cosmopolitan setting where immunisation coverage is high but not sufficient to eradicate measles, outbreaks can be limited by efficient surveillance and early control measures. Catch-up vaccination needs to be reinforced among teenagers and young adults. .

Joint Bone Spine - In Press.Proof corrected by the author Available online since samedi 6 juillet 2013