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Agomelatine is an antidepressant with a unique pharmacological action that is both a melatonin agonist and a selective serotonin antagonist. The drug's unique pharmacological profile includes the properties of a dual 5-HT2С receptor antagonist as well as the properties of a melatonin MT1 and MT2 receptor agonist. Through its effect on melatonin receptors, agomelatine resynchronizes disturbed circadian rhythms and has a positive effect on sleep architecture. In addition, agomelatine shows a novel and fundamentally different mechanism of anxiolytic action compared to other classes of drugs used to treat anxiety. The article presents studies of agomelatine that demonstrate good treatment results in terms of response rates and remission in major depressive disorder of varying severity and generalized anxiety disorder. Agomelatine in a daily dose of 25–50 mg not only reduces the degree of anhedonia, apathy, anxiety, reduces somatic symptoms of depressive and anxiety disorders, but is also well tolerated, normalizes sexual dysfunctions in patients in psychiatric and general medical networks, it is used in cardiovascular, neurological diseases, and post-COVID-19.

The study shows how insecure attachment types (anxious and avoidant) are associated with traits of the «dark triad» (narcissism, psychopathy and Machiavellianism) in a sample of patients with borderline personality disorder. It was found that among the respondents, the greatest relationship was found in individuals with a predominance of the anxious type of attachment, who showed a statistically significant sharpening of such traits as: impulsiveness, manipulativeness, lack of sympathy and empathy («psychopathy»). And weakly expressed, relative to the sample, traits of demonstrativeness, egocentrism, inflated self-esteem (“narcissism”) and “Machiavellian” traits: a weak focus on moral standards, fixation on personal gain. There were no reliable data on the relationship between the avoidant type and dark triad traits in the course of the study, however, avoidant and anxious types are significantly correlated with low levels of psychological well-being among patients with borderline personality disorder.

Psychopharmacotherapy and psychotherapy methods are used for psychopathological conditions in neurological patients. The experience of psychopharmacotherapy combined or not combined with psychotherapy in 242 patients with neurological disorders is reported. Beneficial effects of psychopharmacotherapy are observed in 70.1% of cases, while that of psychopharmacotherapy combined with psychotherapy are reported in 78.0% of cases. The data on efficacy and tolerability of a number of psychotropic agents are provided. It has been shown that the use of psychotropic agents and psychotherapy results in the reduced rate of exacerbation of neurological disorders, reduces the rate of visits to neurologist. Optimization of psychopharmacotherapy and psychotherapy in patients with nervous system disorders is discussed.

Somatic and vegetative-somatic depressive symptom clusters (decreased libido, abnormal body sensations, etc.) are one of the reasons for the prolonged patient's follow-up and delayed start of antidepressant therapy. However, many vegetative-somatic side effects of antidepressants (somnolence, hyperphagia, deterioration of sexual function, etc.) can cause poor patient compliance and premature discontinuation of thymoleptic therapy. Modern antidepressants, such as trazodone (Trittico) successfully stop various somatic manifestations of depression and eliminate the adverse somatic effects of the previous psychotropic medication. The paper presents clinical cases of effective trazodone therapy in a woman with somatic depression and a man with depression and SSRI-induced decrease in libido.

Anxiety, depression, somatoform disorders, nosogenic reactions, adjustment disorders, neurasthenia, somatogenic asthenia in patient with chronic cerebral ischemia (dyscirculatory encephalopathy, cerebrovascular disease) (CCI) are very important for the level of social functioning and adaptation. Early initiation of CCI therapy is an important task in preventing the progression not only of cerebrovascular pathology, but also a wide range of comorbid psychopathological disorders. Treatment of patients with CCI requires an individual approach taking into account pathogenetic factors and severity of both cognitive and psychopathological disorders. It should involve a wide range of drugs, including neuroprotectors. For this purpose the neuroprotective agents ethylmethyloxypyridine succinate and citicoline can be used for independent or combined use. Patients with various forms of CCI noticed subjective improvement during treatment which includes decreasing fatigability and general weakness, reduction of symptoms of psychic and somatic anxiety, fatigability, emotional lability, increasing activity and motivation, improvement of memory, attention, ability to concentrate that positively influences their professional activity.

For the Riemann problem $$ \left\{\begin{array}{l}u_t+(\Phi(u,x))_x=0,\\ u|_{t=0}=u_-+[u]\theta(x) \end{array}\right. $$ a new definition of the solution is proposed. We associate a Hamiltonian system with initial conservation law, and define the geometric solution as the result of the action of the phase flow on the initial curve. In the second part of this paper, we construct the equalization procedure, which allows us to juxtapose a geometric solution with a unique entropy solution under the condition that $\Phi$ does not depend on $x$. If $\Phi$ depends on $x$, then the equalization procedure allows us to construct a generalized solution of the original Riemann problem.

In the paper we study the reproducing of the initial phase of the inner turbulence (without regard for the boundary effects). The atypical regularization of multiple-component Euler system is made by the viscosity and diffuse layering introduction. The analogue of Hugoniot condition and the analogue of Lax stability condition are constructed for it. The problem of local accessibility of the phase space points is investigated. The bifurcations of one-front solutions of the abridged Euler system to the two-front solutions are obtained. The supersonic behaviour of bifurcations appearance is shown. The reconstruction of the initial phase of the inner turbulence (without regard for the boundary effects) is made including the mathematical description of the birth of two-speed flow (the Riemann-Hugoniot catastrophe) and alternation.

We study the large-time behavior of global smooth solutions to the Cauchy problem for hyperbolic regularization of conservation laws. An attracting manifold of special smooth global solutions is determined by the Chapman projection onto the phase space of consolidated variables. For small initial data we construct the Chapman projection and describe its properties in the case of the Cauchy problem for moment approximations of kinetic equations. The existence conditions for the Chapman projection are expressed in terms of the solvability of the Riccati matrix equations with parameter.Nosotros estudiamos el comportamiento temporal de soluciones globales suaves del problema de Cauchy para regularización hiperbólica de leyes de conservación. Una variedad atractora de soluciones globales suaves es determinada por la proyección de Chapman sobre el espacio de fase de las variables consolidadas. Para datos iniciales peque˜nos nosotros construimos la proyección de Chapman y descubrimos sus propiedades en el caso del problema de Cauchy para aproximación de momentos en ecuaciones kineticas. Las condiciones de existencia para la proyección de Chapman son expresadas en términos de la solubilidad de las ecuaciones matriciales de Riccati con parámetros.

Background: Antimicrobial resistance (AMR) is a multifaceted global challenge, partly driven by inappropriate antibiotic prescribing. The objectives of this study were to evaluate the impact of the COVID-19 pandemic on treatment of common infections, develop risk prediction models and examine the effects of antibiotics on infection-related hospital admissions., Methods: With the approval of NHS England, we accessed electronic health records from The Phoenix Partnership (TPP) through OpenSAFELY platform. We included adult patients with primary care diagnosis of common infections, including lower respiratory tract infection (LRTI), upper respiratory tract infections (URTI), and lower urinary tract infection (UTI), from 1 January 2019 to 31 August 2022. We excluded patients with a COVID-19 record in the 90 days before to 30 days after the infection diagnosis. Risk prediction models using Cox proportional-hazard regression were developed for infection-related hospital admission in the 30 days after the common infection diagnosis., Results: We found 12,745,165 infection diagnoses from 1 January 2019 to 31 August 2022. Of them, 80,395 (2.05%) cases were admitted to the hospital during follow-up. Counts of hospital admission for infections dropped during COVID-19, for example LRTI from 3,950 in December 2019 to 520 in April 2020. Comparing those prescribed an antibiotic to those without, reduction in risk of hospital admission were largest with LRTI (adjusted hazard ratio (aHR) of 0.35; 95% confidence interval (CI), 0.35-0.36) and UTI (aHR 0.45; 95% CI, 0.44-0.46), compared to URTI (aHR 1.04; 95% CI, 1.03-1.06)., Conclusions: A substantial variation in hospital admission risks between infections and patient groups was found. Antibiotics appeared more effective in preventing infection-related complications with LRTI and UTI, but not URTI. While this study has several limitations, the results indicate that a focus on risk-based antibiotic prescribing could help tackle AMR in primary care., Competing Interests: All authors declare the following: BG and OpenSAFELY has received research funding from the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, NHS England, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organisation, UKRI MRC, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme; he is a Non-Executive Director at NHS Digital; he also receives personal income from speaking and writing for lay audiences on the misuse of science. AM has received consultancy fees (from https://inductionhealthcare.com) and is member of RCGP health informatics group and the NHS Digital GP data Professional Advisory Group that advises on access to GP Data for Pandemic Planning and Research (GDPPR). For the latter, he received payment for the GDPPR role. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are restrictions on access to the data of this study since the data are patient-level and potentially re-identifiable, as described in the Data access and verification section., (Copyright: © 2024 Fahmi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Internal medicine training applications in the UK have become increasingly competitive. This article provides ten tips for optimizing internal medicine training applications covering portfolio development, teaching experience, project selection, and interview preparation. We outline strategies for maximizing application scores through efficient resource allocation, effective project selection, and structured interview preparation. These tips are designed to help candidates navigate the competitive selection process while developing skills valuable for their future medical careers., (© The Author(s) 2024. Published by Oxford University Press on behalf of Fellowship of Postgraduate Medicine.)

Purpose: Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection. The purpose of the study was to measure the associations of specific exposures (deprivation, ethnicity, and clinical characteristics) with incident sepsis and case fatality., Methods: Two research databases in England were used including anonymized patient-level records from primary care linked to hospital admission, death certificate, and small-area deprivation. Sepsis cases aged 65-100 years were matched to up to six controls. Predictors for sepsis (including 60 clinical conditions) were evaluated using logistic and random forest models; case fatality rates were analyzed using logistic models., Results: 108,317 community-acquired sepsis cases were analyzed. Severe frailty was strongly associated with the risk of developing sepsis (crude odds ratio [OR] 14.93; 95% confidence interval [CI] 14.37-15.52). The quintile with most deprived patients showed an increased sepsis risk (crude OR 1.48; 95% CI 1.45-1.51) compared to least deprived quintile. Strong predictors for sepsis included antibiotic exposure in prior 2 months, being house bound, having cancer, learning disability, and diabetes mellitus. Severely frail patients had a case fatality rate of 42.0% compared to 24.0% in non-frail patients (adjusted OR 1.53; 95% CI 1.41-1.65). Sepsis cases with recent prior antibiotic exposure died less frequently compared to non-users (adjusted OR 0.7; 95% CI 0.72-0.76). Case fatality strongly decreased over calendar time., Conclusion: Given the variety of predictors and their level of associations for developing sepsis, there is a need for prediction models for risk of developing sepsis that can help to target preventative antibiotic therapy., (© 2024. The Author(s).)

Background: Pregnancy acts as a cardiovascular stress test. Although many complications resolve following birth, women with hypertensive disorder of pregnancy have an increased risk of developing cardiovascular disease (CVD) long-term. Monitoring postnatal health can reduce this risk but requires better methods to identity high-risk women for timely interventions., Methods: Employing a qualitative descriptive study design, focus groups and/or interviews were conducted, separately engaging public contributors and clinical professionals. Diverse participants were recruited through social media convenience sampling. Semi-structured, facilitator-led discussions explored perspectives of current postnatal assessment and attitudes towards linking patient electronic healthcare data to develop digital tools for identifying postpartum women at risk of CVD. Participant perspectives were gathered using post-it notes or a facilitator scribe and analysed thematically., Results: From 27 public and seven clinical contributors, five themes regarding postnatal check expectations versus reality were developed, including 'limited resources', 'low maternal health priority', 'lack of knowledge', 'ineffective systems' and 'new mum syndrome'. Despite some concerns, all supported data linkage to identify women postnatally, targeting intervention to those at greater risk of CVD. Participants outlined potential benefits of digitalisation and risk prediction, highlighting design and communication needs for diverse communities., Conclusions: Current health system constraints in England contribute to suboptimal postnatal care. Integrating data linkage and improving education on data and digital tools for maternal healthcare shows promise for enhanced monitoring and improved future health. Recognised for streamlining processes and risk prediction, digital tools may enable more person-centred care plans, addressing the gaps in current postnatal care practice., (© 2024. The Author(s).)

Background: With the global challenge of antimicrobial resistance intensified during the COVID-19 pandemic, evaluating adverse events (AEs) post-antibiotic treatment for common infections is crucial. This study aims to examines the changes in incidence rates of AEs during the COVID-19 pandemic and predict AE risk following antibiotic prescriptions for common infections, considering their previous antibiotic exposure and other long-term clinical conditions., Methods: With the approval of NHS England, we used OpenSAFELY platform and analysed electronic health records from patients aged 18-110, prescribed antibiotics for urinary tract infection (UTI), lower respiratory tract infections (LRTI), upper respiratory tract infections (URTI), sinusitis, otitis externa, and otitis media between January 2019 and June 2023. We evaluated the temporal trends in the incidence rate of AEs for each infection, analysing monthly changes over time. The survival probability of emergency AE hospitalisation was estimated in each COVID-19 period (period 1: 1 January 2019 to 25 March 2020, period 2: 26 March 2020 to 8 March 2021, period 3: 9 March 2021 to 30 June 2023) using the Kaplan-Meier approach. Prognostic models, using Cox proportional hazards regression, were developed and validated to predict AE risk within 30 days post-prescription using the records in Period 1., Results: Out of 9.4 million patients who received antibiotics, 0.6% of UTI, 0.3% of URTI, and 0.5% of LRTI patients experienced AEs. UTI and LRTI patients demonstrated a higher risk of AEs, with a noted increase in AE incidence during the COVID-19 pandemic. Higher comorbidity and recent antibiotic use emerged as significant AE predictors. The developed models exhibited good calibration and discrimination, especially for UTIs and LRTIs, with a C-statistic above 0.70., Conclusions: The study reveals a variable incidence of AEs post-antibiotic treatment for common infections, with UTI and LRTI patients facing higher risks. AE risks varied between infections and COVID-19 periods. These findings underscore the necessity for cautious antibiotic prescribing and call for further exploration into the intricate dynamics between antibiotic use, AEs, and the pandemic., (© 2024. The Author(s).)

Previous studies have demonstrated the association between antibiotic use and severe COVID-19 outcomes. This study aimed to explore detailed antibiotic exposure characteristics among COVID-19 patients. Using the OpenSAFELY platform, which integrates extensive health data and covers 40% of the population in England, the study analysed 3.16 million COVID-19 patients with at least two prior antibiotic prescriptions. These patients were compared to up to six matched controls without hospitalisation records. A machine learning model categorised patients into ten groups based on their antibiotic exposure history over the three years before their COVID-19 diagnosis. The study found that for COVID-19 patients, the total number of prior antibiotic prescriptions, diversity of antibiotic types, broad-spectrum antibiotic prescriptions, time between first and last antibiotics, and recent antibiotic use were associated with an increased risk of severe COVID-19 outcomes. Patients in the highest decile of antibiotic exposure had an adjusted odds ratio of 4.8 for severe outcomes compared to those in the lowest decile. These findings suggest a potential link between extensive antibiotic use and the risk of severe COVID-19. This highlights the need for more judicious antibiotic prescribing in primary care, primarily for patients with higher risks of infection-related complications, which may better offset the potential adverse effects of repeated antibiotic use.

Background and Aims: Sepsis is a serious and life-threatening condition caused by a dysregulated immune response to an infection. Recent guidance issued in the UK gave recommendations around recognition and antibiotic treatment of sepsis, but did not consider factors relating to health inequalities. The aim of this study was to summarise the literature investigating associations between health inequalities and sepsis., Methods: Searches were conducted in Embase for peer-reviewed articles published since 2010 that included sepsis in combination with one of the following five areas: socioeconomic status, race/ethnicity, community factors, medical needs and pregnancy/maternity., Results: Five searches identified 1,402 studies, with 50 unique studies included in the review after screening (13 sociodemographic, 14 race/ethnicity, 3 community, 3 care/medical needs and 20 pregnancy/maternity; 3 papers examined multiple health inequalities). Most of the studies were conducted in the USA (31/50), with only four studies using UK data (all pregnancy related). Socioeconomic factors associated with increased sepsis incidence included lower socioeconomic status, unemployment and lower education level, although findings were not consistent across studies. For ethnicity, mixed results were reported. Living in a medically underserved area or being resident in a nursing home increased risk of sepsis. Mortality rates after sepsis were found to be higher in people living in rural areas or in those discharged to skilled nursing facilities while associations with ethnicity were mixed. Complications during delivery, caesarean-section delivery, increased deprivation and black and other ethnic minority race were associated with post-partum sepsis., Conclusion: There are clear correlations between sepsis morbidity and mortality and the presence of factors associated with health inequalities. To inform local guidance and drive public health measures, there is a need for studies conducted across more diverse setting and countries., (© 2024. The Author(s).)

Background: The global outbreak of the COVID-19 pandemic resulted in significant changes in the delivery of health care services such as attendance of scheduled outpatient hospital appointments. This study aimed to evaluate the impact of COVID-19 on the rate and predictors of missed hospital appointment in the Sultanate of Oman., Methods: A retrospective single-centre analysis was conducted to determine the effect of COVID-19 on missed hospital appointments at various clinics at The Royal Hospital (tertiary referral hospital) in Muscat, Sultanate of Oman. The study population included scheduled face-to-face and virtual appointments between January 2019 and March 2021. Logistic regression models were used with interaction terms (post COVID-19) to assess changes in the predictors of missed appointments., Results: A total of 34, 3149 scheduled appointments was analysed (320,049 face-to-face and 23,100 virtual). The rate of missed face-to-face hospital appointments increased from 16.9% pre to 23.8% post start of COVID-19, particularly in early pandemic (40.5%). Missed hospital appointments were more frequent (32.2%) in virtual clinics (post COVID-19). Increases in missed face-to-face appointments varied by clinic (Paediatrics from 19.3% pre to 28.2% post; Surgery from 12.5% to 25.5%; Obstetrics & Gynaecology from 8.4% to 8.5%). A surge in the frequency of missed appointments was seen during national lockdowns for face-to-face and virtual appointments. Most predictors of missed appointments did not demonstrate any appreciable changes in effect (i.e., interaction term not statistically significant). Distance of patient residence to the hospital revealed no discernible changes in the relative effect pre and post COVID-19 for both face-to-face and virtual clinic appointments., Conclusion: The rate of missed visits in most clinics was directly impacted by COVID-19. The case mix of patients who missed their appointments did not change. Virtual appointments, introduced after start of the pandemic, also had substantial rates of missed appointments and cannot be viewed as the single approach that can overcome the problem of missing hospital appointments., (© 2023. The Author(s).)

Background: Sepsis, characterised by significant morbidity and mortality, is intricately linked to socioeconomic disparities and pre-admission clinical histories. This study aspires to elucidate the association between non-COVID-19 related sepsis and health inequality risk factors amidst the pandemic in England, with a secondary focus on their association with 30-day sepsis mortality., Methods: With the approval of NHS England, we harnessed the OpenSAFELY platform to execute a cohort study and a 1:6 matched case-control study. A sepsis diagnosis was identified from the incident hospital admissions record using ICD-10 codes. This encompassed 248,767 cases with non-COVID-19 sepsis from a cohort of 22.0 million individuals spanning January 1, 2019, to June 31, 2022. Socioeconomic deprivation was gauged using the Index of Multiple Deprivation score, reflecting indicators like income, employment, and education. Hospitalisation-related sepsis diagnoses were categorised as community-acquired or hospital-acquired. Cases were matched to controls who had no recorded diagnosis of sepsis, based on age (stepwise), sex, and calendar month. The eligibility criteria for controls were established primarily on the absence of a recorded sepsis diagnosis. Associations between potential predictors and odds of developing non-COVID-19 sepsis underwent assessment through conditional logistic regression models, with multivariable regression determining odds ratios (ORs) for 30-day mortality., Findings: The study included 224,361 (10.2%) cases with non-COVID-19 sepsis and 1,346,166 matched controls. The most socioeconomic deprived quintile was associated with higher odds of developing non-COVID-19 sepsis than the least deprived quintile (crude OR 1.80 [95% CI 1.77-1.83]). Other risk factors (after adjusting comorbidities) such as learning disability (adjusted OR 3.53 [3.35-3.73]), chronic liver disease (adjusted OR 3.08 [2.97-3.19]), chronic kidney disease (stage 4: adjusted OR 2.62 [2.55-2.70], stage 5: adjusted OR 6.23 [5.81-6.69]), cancer, neurological disease, immunosuppressive conditions were also associated with developing non-COVID-19 sepsis. The incidence rate of non-COVID-19 sepsis decreased during the COVID-19 pandemic and rebounded to pre-pandemic levels (April 2021) after national lockdowns had been lifted. The 30-day mortality risk in cases with non-COVID-19 sepsis was higher for the most deprived quintile across all periods., Interpretation: Socioeconomic deprivation, comorbidity and learning disabilities were associated with an increased odds of developing non-COVID-19 related sepsis and 30-day mortality in England. This study highlights the need to improve the prevention of sepsis, including more precise targeting of antimicrobials to higher-risk patients., Funding: The UK Health Security Agency, Health Data Research UK, and National Institute for Health Research., Competing Interests: BG has received research funding from the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, NHS England, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organisation, UKRI MRC, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme; he is a Non-Executive Director at NHS Digital; he also receives personal income from speaking and writing for lay audiences on the misuse of science. AM has received consultancy fees (from https://inductionhealthcare.com) and is member of RCGP health informatics group and the NHS Digital GP data Professional Advisory Group that advises on access to GP Data for Pandemic Planning and Research (GDPPR). For the latter, he received payment for the GDPPR role. All other authors declare no competing interests. BMK is a trustee for IMMIGRANT COUNSELLING AND PSYCHOTHERAPY (ICAP), all other declarations can be viewed openly online at https://www.whopaysthisdoctor.org/doctor/491/active., (© 2023 The Authors.)

Introduction: Older patients may be less likely to receive cardiac resynchronisation therapy (CRT) for the management of heart failure. We aimed to describe the differences in clinical response, complications, and subsequent outcomes following CRT implantation compared to younger patients., Methods: We conducted a retrospective cohort study of unselected, consecutive patients implanted with CRT devices between March 2008 and July 2017. We recorded complications, symptomatic and echocardiographic response, hospitalisation for heart failure, and all-cause mortality comparing patients aged <70, 70-79 and ≥ 80 years., Results: Five hundred and seventy-four patients (median age 76 years [interquartile range 68-81], 73.3% male) received CRT. At baseline, patients aged ≥80 years had worse symptoms, were more likely to have co-morbidities, and less likely to be receiving comprehensive medical therapy, although left ventricular function was similar. Older patients were less likely to receive CRT-defibrillators compared to CRT-pacemakers. Complications were infrequent and not more common in older patients. Age was not a predictor of symptomatic or echocardiographic response to CRT (67.2%, 71.2% and 62.6% responders in patients aged <70, 70-79 and ≥ 80 years, respectively; P = 0.43), and time to first heart failure hospitalisation was similar across age groups (P = 0.28). Ten-year survival was lower for older patients (49.9%, 23.9% and 6.8% in patients aged <70, 70-79 and ≥ 80 years, respectively; P < 0.001)., Conclusions: The benefits of CRT on symptoms and left ventricular function were not different in older patients despite a greater burden of co-morbidities and less optimal medical therapy. These findings support the use of CRT in an ageing population., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society.)

Objective: To investigate the association between health-related quality of life (HRQoL) and major adverse cardiovascular and cerebrovascular events (MACCE) in individuals with ischaemic heart disease (IHD)., Methods: Medline(R), Embase, APA PsycINFO and CINAHL (EBSCO) from inception to 3 April 2023 were searched. Studies reporting association of HRQoL, using a generic or cardiac-specific tool, with MACCE or components of MACCE for individuals with IHD were eligible for inclusion. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale to assess the quality of the studies. Descriptive synthesis, evidence mapping and random-effects meta-analysis were performed stratified by HRQoL measures and effect estimates. Between-study heterogeneity was assessed using the Higgins I 2 statistic., Results: Fifty-one articles were included with a total of 134 740 participants from 53 countries. Meta-analysis of 23 studies found that the risk of MACCE increased with lower baseline HeartQoL score (HR 1.49, 95% CI 1.16 to 1.93) and Short Form Survey (SF-12) physical component score (PCS) (HR 1.39, 95% CI 1.28 to 1.51). Risk of all-cause mortality increased with a lower HeartQoL (HR 1.64, 95% CI 1.34 to 2.01), EuroQol 5-dimension (HR 1.17, 95% CI 1.12 to 1.22), SF-36 PCS (HR 1.29, 95% CI 1.19 to 1.41), SF-36 mental component score (HR 1.18, 95% CI 1.08 to 1.30)., Conclusions: This study found an inverse association between baseline values or change in HRQoL and MACCE or components of MACCE in individuals with IHD, albeit with between-study heterogeneity. Standardisation and routine assessment of HRQoL in clinical practice may help risk stratify individuals with IHD for tailored interventions., Prospero Registration Number: CRD42021234638., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare the following: AS has received grant from the European Society of Cardiology, support from AstraZeneca, Bayer, Novartis, Gedeon Richter, Amgen and Servier—outside the submitted work; CPG has received grants or contracts from Alan Turing Institute, British Heart Foundation, National Institute for Health Research, Horizon 2020, Abbott Diabetes, Bristol Myers Squibb, European Society of Cardiology; consulting fees from AI Nexus, AstraZeneca, Amgen, Bayer, Bristol Myers Squibb, Boehrinher-Ingleheim, CardioMatics, Chiesi, Daiichi Sankyo, GPRI Research, Menarini, Novartis, iRhyth, Organon, The Phoenix Group, Payment or honoraria from AstraZeneca, Boston Scientific, Menarini, Novartis, Raisio Group, Wondr Medical, Zydus, support form AstraZeneca, participation on a Data Safety Monitoring Board or Advisory Board in DANBLCOK trial and TARGET CTCA trial, leadership or fiduciary role in EHJ Quality of Care and Clinical Outcomes as Deputy Editor, NICE Indicator Advisory Committee, Chair ESC Quality Indicator Committee, Stock or stock options CardioMatics Receipt of Kosmos device. SA has received support for attending meetings and/or travel from the European Society of Cardiology and participates on a Data Safety Monitoring Board or Advisory Board of EuroHeart; HVS has received grants from CIHR and Heart and Stroke Foundation; GB has received fees to the institution from Bayer and Pfizer, honoraria for lectures from AstraZeneca, Bristol Myers Squibb, Boehringer Ingelheim, Novo Nordisk, Pfizer and Sanofi—outside of present work. Other authors have nothing to declare., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)