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Background: Heart failure (HF) societies classify LVEFs of 41–49% as mildly reduced ejection fraction (HFmrEF)1,2. HFmrEF is an intermediate HF type between HF with preserved EF (HFpEF) and HF with reduced EF (HFrEF), as it shares characteristics from both ends of the spectrum. HFmrEF is controversial due to LVEF changes and inter-rater variability3,4. Studies on HFmrEF are inconsistent and it is not clear whether HFmrEF is a transition or an independent clinical entity. No prospective studies have assessed the effect of therapy in patients with HFmrEF. Current evidence in patients with HFmrEF is based on post-hoc analyses of studies³. Patients and Methods: This was a prospective observational study conducted at University Hospital Dubrava, Zagreb. We recruited patients presenting with HF symptoms from May 2021 to August 2023. We collected data on gender, age, drugs and adherence, comorbidities, NT-proBNP and HbA1c levels and EF. Categorical variables are presented as frequencies and percentages and continuous variables are presented as medians and interquartile ranges. P value < 0.05 was considered as significant. Statistical analysis was performed using JASP software. Results: We collected data from 850 participants. HFmrEF was diagnosed in 129 patients (15.1%). 76 (58.9%) participants had coronary artery disease and 59 participants (46%) had atrial fibrillation. Dapagliflozin was initiated in 60 (47%) and empagliflozin in 68 (53%) participants. Only 8 participants had optimal medical therapy prior to SGLT-2 initiation. Adherence was evaluated in 87 participants, and it was high in 48, moderate in 21 and low in 18 participants. EF at 12 months was assessed in 51 participants. Median EF was 44.6% (95% CI 44.2%-45%) at initiation and 49% at 12 months (95% CI 47%- 51%) (p=0.0001). EF has improved to >50% in 21 and decreased to <40% in 4 participants. EF has not changed in 26 participants. Level of NT-proBNP was 1.834pg/mL (95% CI 66-32,127) during initial visit and 651pg/mL (95% CI 44-12,555) at 12 months (p<0.001). HbA1c levels decreased from 6.3% (95% CI 5.3- 10.9) at the initial visit to 5,85% (95% CI 4.9-8.3) at 12 months (p<0.001). Conclusion: HFmrEF remains a mystery. Optimal medical treatment might improve EF or prevent it from deteriorating further in some patients, but long-term real-world data is needed. [ABSTRACT FROM AUTHOR]

Introduction: The coexistence of heart failure (HF) with type 2 diabetes (T2D) is common and T2D is considered one of the risk factors for adverse outcomes in HF patients1-3. Studies found conflicting results in terms of HF outcomes with some studies showing lower rates of HF hospitalization among glucagon-like peptide-1 (GLP1) receptor agonists users and others showing neutral effects on HF hospitalizations. We aimed to evaluate whether adding semaglutide to sodium-glucose cotransporter-2 (SGLT2) inhibitors benefits HF patients with T2D. Patients and Methods: This was a prospective observational study conducted at University Hospital Dubrava, Zagreb. We recruited patients presented with HF symptoms from May 2021 to August 2023. We collected data on gender, age, prescribed medications, body mass index, comorbidities, NT-proBNP, lipid and HbA1c levels, ejection fraction and number of hospitalizations. Categorical variables are presented as frequencies and percentages and continuous variables are presented as median and interquartile range (IQR). P values <0.05 were considered as statistically significant. Statistical analysis was performed using JASP software. Results: We collected data of 850 participants in total. 121 (14.2%) participants already had DM2 at the time of the study initiation, 42 (5%) were diagnosed with DM2 during the checkup and 145 participants had prediabetes (17%). Semaglutide was started in 72 participants. There was a reduction in BMI in both groups with more significant decrease in semaglutide group (0.3 in the non-semaglutide group and 2.2 in the semaglutide group, P < 0.0001). NT-proBNP levels were lower in the semaglutide group (881 vs 1945.4pg/mL, P<0.001) and HbA1c was reduced by 1.11 points (95% CI 0.55-1.69) in the semaglutide group and 0.35 (95% CI 0.26-0.44) in the non-semaglutide group. There was no change in the cholesterol, LDL levels or HF hospitalizations. Conclusion: Semaglutide offers significant metabolic advantages in patients with HF and TD2 by reducing glucose levels and body weight. Use of semaglutide should be facilitated in patients with TD2 as it decreases NT-proBNP and HbA1c levels. While yielding no difference in hospitalizations, adding semaglutide provides better control of cardiovascular risk factors. Future studies are needed to assess long term impact of semaglutide in HF and T2D patients. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus disease (COVID-19) pandemic is a public health emergency caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Vaccines are the most effective measure for both preventing COVID-19 infections and its complications. Even before the COVID-19, vaccine hesitancy was becoming prevalent in European Union (EU) and Croatia. Vaccine hesitancy is correlated to lack of trust in science, lower levels of education and lower health literacy¹. Lower medication adherence is a problem in treating chronic disease, especially cardiovascular disease. Identifying patients prone to lower drug adherence could help target interventions for better adherence². Seeing as data on SARS-CoV-2 vaccination is readily available, vaccination status could help identify these patients. In this study, we wanted to see if vaccination status correlated with drug adherence in patients with cardiovascular disease. Patients and Methods: This was a retrospective observational study conducted at Dubrava University Hospital, Zagreb. We recruited patients hospitalized for acute coronary syndrome (ACS) from January 2017 to January 2020. We collected data on sociodemographic data, type of ACS, prescribed drugs, body mass index (BMI) and vaccination status. Adherence score was calculated using Morisky Medication Adherence score. Data was collected either during regular visits or by telephone contact. Results: We collected data for 1,441 participants in total. Median age of the participants was 64y (interquartile range, IQR 56-72), with 409 females (29.6%) and 974 (70.4%) males. Majority of participants had at least high school level of education and were retired. Median BMI of the participants was 28.87 (IQR 25.73-31.20). We grouped the participants according to their SARS-CoV-2 vaccination status. The groups did not differ by age, sex, marital status, BMI, or smoking status. The vaccinated group had a higher number of participants with higher level of education and active employment. Medication adherence score was higher in the vaccinated group (odds ratio, OR=1.64 (1.55-1.74), p<0.001). Conclusion: Vaccinated participants had a higher medication adherence score. Vaccination status could be used to identify ACS patients that might benefit from an early intervention to improve drug adherence. [ABSTRACT FROM AUTHOR]

Introduction: Statin use in secondary prevention after acute coronary syndrome (ACS) is one of the most researched areas in cardiology¹. The aim of this study was to determine the association between adherence to statin therapy and major adverse cardiovascular events in patients after a myocardial infarction. Patients and Methods: The examined group consisted of 421 patients who were treated for ACS- percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) from 2019 to 2020 at the Dubrava University Hospital, Zagreb. We have collected basic demographic, clinical and laboratory data available in digital medical documentation. Adherence to the drug therapy was measured by Morisky Medical Adherence scale during telephone monitoring. It was primarily analyzed association between adherence to recommended statin therapy and occurrence of major adverse cardiovascular events (MACE), and secondarily the association of other demographic and clinical features with MACE. Results: Adherence to therapy after discharge was measured successfully in 371 (88%) patients. Most of them had moderately high adherence. Of the recommended drugs at discharge, the drug that respondents indicated as the one they most often forget to take, do not take regularly as prescribed was statin. Even 11% of patients did not take any dose of statin and 189 patients (51%) took the statin as recommended. A total of 93 (22%) patients experienced a composite MACE. Patients with low adherence to statin therapy had the highest proportion of MACE (26%) compared to the other two groups. Relative risk for experiencing MACE in patients who did not reach value of low-density lipoprotein cholesterol (LDL) <1,8 mmol/L at 12 months follow-up was 1.25 (25% higher relative risk, p=0.248) and was not statistically significant. On the other hand, the relative risk for experiencing MACE in patients who did not reach the target LDL-cholesterol value of less than 2.6 mmol/L after 12 months was 1.68 (68% higher relative risk, p=0.008) and was statistically significant. Conclusion: Our study aimed to show that regular statin therapy intake is as much important as achieving target LDL values in reducing MACE. [ABSTRACT FROM AUTHOR]

Aim: In the last few years University Hospital Center Sestre milosrdnice, Zagreb has become dedicated to the radial approach with nearby 90% of percutaneous coronary interventions (PCI) performed with either left or right radial access route. In time, left radial approach has become the first choice option for most of the patients (pts) with acute ST-segment elevation myocardial infarction (STEMI). The aim of this study was to compare the efficacy and safety of left transradial access (L-TRA) with the right transradial (R-TRA) and transfemoral (TFA) access in the setting of primary (PCI) for acute (STEMI). Patients and Methods: This single-center, retrospective study included 767 consecutive acute STEMI patients, treated with primary PCI from January 2011 to May 2013, who were divided in three groups according to the arterial access site: L-TRA group (413 patients, 53.85%), R-TRA group (110 patients, 14.34%) and TFA group (244 patients, 31.81%). We collected data on the procedure success, procedure, door-to-balloon and fluoroscopy time and bleeding complications. Of all the patients, 43.5% of them were admitted directly through the emergency department and 56.5% of them were transported from other hospitals being the part of the Croatian pCi network. Results: Procedural success was similar among the three groups (L-TRA vs TFA 93.2% : 88.5%, p=0.495; and L-TRA vs R-TRA 93.2% : 90.1%, p=0.855). Additionally, all investigated procedural characteristics were similar among compared groups, including total procedure time (L-TRA vs TFA 71.9±18.4 : 73.3±21min, p=0.366; and L-TRA vs R-TRA 71.9±18.4 : 72.7±21.3min, p=0.966) and fluoroscopy time (L-TRA vs TFA 11.1±6.9 : 11.6±9.3min, p=0.461; and L- TRA vs R-TRA 11.1±6.9 : 12.8±8.2min, p=0.128). When considering the bleeding complications (change in the concentration of haemoglobin), there were no differences between the three groups (L-TRA vs TFA 10±10.1 : 11±10.8 g/L, p=0.308; and L-TRA vs R-TRA 10±10.1 : 10±11.8 g/L, p=0.254). Conclusion: In a PCI center committed to PCI, left transradial approach for acute STEMI patients undergoing primary PCI, is as equally effective and safe as transfemoral or right transradial approach. [ABSTRACT FROM AUTHOR]