Publications by authors named "Mark De Belder"

Background: Whether a conservative strategy of medical therapy alone or a strategy of medical therapy plus invasive treatment is more beneficial in older adults with non-ST-segment elevation myocardial infarction (NSTEMI) remains unclear.

Methods: We conducted a prospective, multicenter, randomized trial involving patients 75 years of age or older with NSTEMI at 48 sites in the United Kingdom. The patients were assigned in a 1:1 ratio to a conservative strategy of the best available medical therapy or an invasive strategy of coronary angiography and revascularization plus the best available medical therapy.

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Article Synopsis
  • * Results showed that 80% of patients received HF specialist support, which led to higher rates of medical therapy prescriptions at discharge and a lower likelihood of discharge on diuretics.
  • * Patients receiving HF specialist care had better long-term survival rates and lower in-hospital mortality, indicating the importance of specialized care for improving outcomes in acute heart failure cases.
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Aims: The COVID-19 pandemic disrupted the delivery of care for patients with heart failure (HF), leading to fewer HF hospitalizations and increased mortality. However, nationwide data on quality of care and long-term outcomes across the pandemic are scarce.

Methods And Results: We used data from the National Heart Failure Audit (NHFA) linked to national records for hospitalization and deaths.

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Introduction: The role of balloon aortic valvuloplasty (BAV) in the era of transcatheter aortic valve replacement remains a topic of debate. We sought to study the safety and feasibility of combined BAV and percutaneous coronary intervention (BAV-PCI).

Methods: Between November 2009 and July 2020, all patients undergoing BAV were identified and divided into three groups: combined BAV-PCI (group A), BAV with significant unrevascularised CAD (group B), and BAV without significant CAD (group C).

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BACKGROUND: In patients with acute myocardial infarction (MI), therapies that could further reduce the risk of adverse cardiovascular and metabolic outcomes are needed. METHODS: In this international registry-based, randomized, double-blind trial, patients without prior diabetes or chronic heart failure, presenting with acute MI and impaired left ventricular systolic function, were randomly assigned 10 mg of dapagliflozin or placebo, given once daily. The primary outcome was the hierarchical composite of death, hospitalization for heart failure, nonfatal MI, atrial fibrillation/flutter, type 2 diabetes mellitus, New York Heart Association Functional Classification at the last visit, and body weight decrease of 5% or greater at the last visit using the win ratio analysis method.

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Background: Acute myocardial infarction (AMI) causes significant mortality and morbidity in people with impaired kidney function. Previous observational research has demonstrated reduced use of invasive management strategies and inferior outcomes in this population. Studies from the USA have suggested that disparities in care have reduced over time.

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Article Synopsis
  • Therapies are needed to prevent heart failure and other cardiovascular problems after a recent heart attack.
  • DAPA-MI is a major clinical trial testing the drug dapagliflozin versus a placebo in patients with heart attack and poor heart function, focusing on outcomes like death and hospitalization for heart failure.
  • The trial aims to improve patient outcomes using an innovative design that leverages existing national clinical registries for efficient data collection and patient recruitment.
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Background: An increasing proportion of patients with cancer experience acute myocardial infarction (AMI). We investigated differences in quality of AMI care and survival between patients with and without previous cancer diagnoses.

Methods: A retrospective cohort study using Virtual Cardio-Oncology Research Initiative data.

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Aims: Currently, little evidence exists on survival and quality of care in cancer patients presenting with acute heart failure (HF). The aim of the study is to investigate the presentation and outcomes of hospital admission with acute HF in a national cohort of patients with prior cancer.

Methods And Results: This retrospective, population-based cohort study identified 221 953 patients admitted to a hospital in England for HF during 2012-2018 (12 867 with a breast, prostate, colorectal, or lung cancer diagnosis in the previous 10 years).

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Background: Institutions or clinicians (units) are often compared according to a performance indicator such as in-hospital mortality. Several approaches have been proposed for the detection of outlying units, whose performance deviates from the overall performance.

Methods: We provide an overview of three approaches commonly used to monitor institutional performances for outlier detection.

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Background: The Global Registry of Acute Coronary Events (GRACE) 2.0 score was developed and validated in predominantly male patient populations. We aimed to assess its sex-specific performance in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and to develop an improved score (GRACE 3.

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Increasing emphasis and expectation is being placed on the role of healthcare data in addressing the problems faced by the NHS. The ideal is to replace the current fragmented system of individual systems and registries with a universal, integrated data system that provides frontline staff with what they need while also allowing monitoring of services, intelligent population-based commissioning and the facilitation of quality improvement (QI) and research. With the recently published tender for the creation of a federated data platform (FDP) there is optimism that these aspirations are being addressed; however, concerns remain that the future use of healthcare data in the UK will not fulfil its potential if the current well-recognised shortcomings of existing systems and processes are not dealt with.

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Aims: PFO closure is a percutaneous intervention, which aims to reduce risk of recurrent stroke by preventing paradoxical embolism. The objective of this study was to measure procedural safety and longer-term effectiveness of PFO closure in a UK setting.

Methods And Results: Prospective registry data from patients with cryptogenic stroke eligible for PFO closure were collected for up to 2 years and linked to routine data sources for additional follow-up.

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Article Synopsis
  • - This study looks at the rates of cardiovascular disease (CVD) in patients diagnosed with potentially curable cancers in England, revealing that 16.2% of the 634,240 patients studied had prior CVD.
  • - The research found that men, older individuals, and those from deprived areas showed higher rates of CVD, with non-small-cell lung cancer patients having the highest prevalence at 36.1% compared to just 7.7% in breast cancer patients.
  • - The authors emphasize the importance of accounting for CVD when assessing cancer treatment strategies and outcomes, highlighting the significant overlap between cancer and cardiovascular health issues.
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Importance: Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement and is the treatment of choice for patients at high operative risk. The role of TAVI in patients at lower risk is unclear.

Objective: To determine whether TAVI is noninferior to surgery in patients at moderately increased operative risk.

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Background: Patients with significant (≥50%) left main disease (LMD) have a high risk of cardiovascular events, and guidelines recommend revascularization to improve survival. However, the impact of intermediate LMD (stenosis, 25%-49%) on outcomes is unclear.

Methods: Randomized ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) participants who underwent coronary computed tomography angiography at baseline were categorized into those with (25%-49%) and without (<25%) intermediate LMD.

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Objectives: Acute myocardial infarction (AMI) case ascertainment improves for the UK general population using linked health data sets. Because care pathways for people with chronic kidney disease (CKD) change based on disease severity, AMI case ascertainment for these people may differ compared with the general population. We aimed to determine the association between CKD severity and AMI case ascertainment in two secondary care data sets, and the agreement in estimated glomerular filtration rate (eGFR) between the same data sets.

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  • * Although cardiovascular death rates were similar between the two approaches (2.6% for invasive vs 3.0% for conservative), non-cardiovascular deaths were higher in the invasive group (3.3% vs 2.1%).
  • * The study also reported fewer undetermined causes of death with invasive treatment, but a higher prevalence of cancer-related deaths; these findings need further investigation and must be viewed cautiously with respect to existing research.
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The UK is one of the few countries in the world with national registries that record key statistics across a broad range of cardiovascular disorders. The British Cardiovascular Society and its affiliated groups have played a central role in the development of these registries and continue to provide clinical oversight to the present day. Seven of the UK's national registries are now integrated under the management of the National Institute for Cardiovascular Outcomes Research (NICOR) that currently holds records on nearly 6.

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Objectives: This study sought to determine if percutaneous coronary intervention (PCI) prior to transcatheter aortic valve replacement (TAVR) in patients with significant coronary artery disease would produce noninferior clinical results when compared with no PCI (control arm).

Background: PCI in patients undergoing TAVR is not without risk, and there are no randomized data to inform clinical practice.

Methods: Patients with severe symptomatic aortic stenosis and significant coronary artery disease with Canadian Cardiovascular Society class ≤2 angina were randomly assigned to receive PCI or no PCI prior to TAVR.

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Background And Objective: The impact of the COVID-19 pandemic on the quality of care for patients with acute myocardial infarction (AMI) is uncertain. We aimed to compare quality of AMI care in England and Wales during and before the COVID-19 pandemic using the 2020 European Society of Cardiology Association for Acute Cardiovascular Care quality indicators (QIs) for AMI.

Methods: Cohort study of linked data from the AMI and the percutaneous coronary intervention registries in England and Wales between 1 January 2017 and 27 May 2020 (representing 236 743 patients from 186 hospitals).

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