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Article ; Online: Response by Halcox and Wareham to Letter Regarding Article, "Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation: The REHEARSE-AF Study".

Halcox, Julian P J / Wareham, Kathie

2018 Volume 137, Issue 20, Page(s) 2193–2194

MeSH term(s)	Atrial Fibrillation ; Electrocardiography, Ambulatory ; Humans
Language	English
Publishing date	2018-05-09
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/CIRCULATIONAHA.118.033773
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Article ; Online: Identification of vulnerable carotid plaque with histologically validated CT-derived plaque maps.

Obaid, Daniel Rhys / Okonji, Ike / Cheng, Suk F / Giannopoulos, Argyrios A / Kamalathevan, Pragash / Halcox, Julian / Rodriguez-Justo, Manuel / Richards, Toby

The British journal of radiology

2023 Volume 96, Issue 1147, Page(s) 20220982

Abstract: Objectives: Ruptured carotid plaque causes stroke, but differentiating rupture-prone necrotic core from fibrous tissue with CT is limited by overlap of X-ray attenuation. We investigated the ability of CT-derived plaque maps created from ratios of ... ...

Abstract	Objectives: Ruptured carotid plaque causes stroke, but differentiating rupture-prone necrotic core from fibrous tissue with CT is limited by overlap of X-ray attenuation. We investigated the ability of CT-derived plaque maps created from ratios of plaque/contrast attenuation to identify histologically proven vulnerable plaques. Methods: Seventy patients underwent carotid CT angiography and carotid endarterectomy. A derivation cohort of 20 patients had CT images matched with histology and carotid plaque components attenuation defined. In a validation cohort of 50 patients, CT-derived plaque maps were compared in 43 symptomatic Results: In 250 plaque areas co-registered with histology, the median attenuation (HU) of necrotic core 43(26-63), fibrous plaque 127(110-162) and calcified plaque 964 (816-1207) created significantly different ratios of plaque/contrast attenuation. CT-derived plaque maps revealed symptomatic plaques had larger necrotic core than asymptomatic (13.5%(5.9-33.3) Conclusions: Carotid plaque components can be differentiated by CT using a ratio of plaque/contrast attenuation. CT-derived plaque map volumes of necrotic core help distinguished the most vulnerable plaques. Advances in knowledge: CT-derived plaque maps based on plaque/contrast attenuation may provide new markers of carotid plaque vulnerability.
MeSH term(s)	Humans ; Plaque, Atherosclerotic/diagnostic imaging ; Plaque, Atherosclerotic/pathology ; Carotid Arteries/diagnostic imaging ; Endarterectomy, Carotid ; Stroke ; Fibrosis ; Tomography, X-Ray Computed/methods ; Carotid Stenosis/diagnostic imaging ; Carotid Stenosis/pathology
Language	English
Publishing date	2023-05-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2982-8
ISSN	1748-880X ; 0007-1285
ISSN (online)	1748-880X
ISSN	0007-1285
DOI	10.1259/bjr.20220982
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Article ; Online: Adherence to the Atrial fibrillation Better Care pathway and the risk of adverse health outcomes in older care home residents with atrial fibrillation: a retrospective data linkage study 2003-18.

Ritchie, Leona A / Harrison, Stephanie L / Penson, Peter E / Akbari, Ashley / Torabi, Fatemeh / Hollinghurst, Joe / Harris, Daniel / Oke, Oluwakayode B / Akpan, Asangaedem / Halcox, Julian P / Rodgers, Sarah E / Lip, Gregory Y H / Lane, Deirdre A

Age and ageing

2024 Volume 53, Issue 2

Abstract: Background: The Atrial fibrillation Better Care (ABC) pathway is the gold-standard approach to atrial fibrillation (AF) management, but the effect of implementation on health outcomes in care home residents is unknown.: Objective: To examine ... ...

Abstract	Background: The Atrial fibrillation Better Care (ABC) pathway is the gold-standard approach to atrial fibrillation (AF) management, but the effect of implementation on health outcomes in care home residents is unknown. Objective: To examine associations between ABC pathway adherence and stroke, transient ischaemic attack, cardiovascular hospitalisation, major bleeding, mortality and a composite of all these outcomes in care home residents. Methods: A retrospective cohort study of older care home residents (≥65 years) in Wales with AF was conducted between 1 January 2003 and 31 December 2018 using the Secure Anonymised Information Linkage Databank. Adherence to the ABC pathway was assessed at care home entry using pre-specified definitions. Cox proportional hazard and competing risk models were used to estimate the risk of health outcomes according to ABC adherence. Results: From 14,493 residents (median [interquartile range] age 87.0 [82.6-91.2] years, 35.2% male) with AF, 5,531 (38.2%) were ABC pathway adherent. Pathway adherence was not significantly associated with risk of the composite outcome (adjusted hazard ratio, 95% confidence interval [CI]: 1.01 [0.97-1.05]). There was a significant independent association observed between ABC pathway adherence and a reduced risk of myocardial infarction (0.70 [0.50-0.98]), but a higher risk of haemorrhagic stroke (1.59 [1.06-2.39]). ABC pathway adherence was not significantly associated with any other individual health outcomes examined. Conclusion: An ABC adherent approach in care home residents was not consistently associated with improved health outcomes. Findings should be interpreted with caution owing to difficulties in defining pathway adherence using routinely collected data and an individualised approach is recommended.
MeSH term(s)	Humans ; Male ; Aged ; Aged, 80 and over ; Female ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/epidemiology ; Atrial Fibrillation/therapy ; Retrospective Studies ; Critical Pathways ; Anticoagulants/adverse effects ; Information Storage and Retrieval ; Outcome Assessment, Health Care
Chemical Substances	Anticoagulants
Language	English
Publishing date	2024-02-23
Publishing country	England
Document type	Journal Article
ZDB-ID	186788-x
ISSN	1468-2834 ; 0002-0729
ISSN (online)	1468-2834
ISSN	0002-0729
DOI	10.1093/ageing/afae021
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Zs.A 877: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Incident atrial fibrillation and adverse clinical outcomes during extended follow-up of participants recruited to the remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: the REHEARSE-AF study.

Ellins, Elizabeth A / Wareham, Kathie / Harris, Daniel E / Hanney, Matthew / Akbari, Ashley / Gilmore, Mark / Barry, James P / Phillips, Ceri J / Gravenor, Michael B / Halcox, Julian P

European heart journal open

2023 Volume 3, Issue 3, Page(s) oead047

Abstract: Aims: Atrial fibrillation (AF) is an important risk factor for stroke, which is commonly asymptomatic, particularly in older patients, and often undetected until cardiovascular events occur. Development of novel technology has helped to improve ... ...

Abstract	Aims: Atrial fibrillation (AF) is an important risk factor for stroke, which is commonly asymptomatic, particularly in older patients, and often undetected until cardiovascular events occur. Development of novel technology has helped to improve detection of AF. However, the longer-term benefit of systematic electrocardiogram (ECG) screening on cardiovascular outcomes is unclear. Methods and results: In the original REHEARSE-AF study, patients were randomized to twice-weekly portable electrocardiogram (iECG) assessment or routine care. After discontinuing the trial portable iECG assessment, electronic health record data sources provided longer-term follow-up analysis. Cox regression was used to provide unadjusted and adjusted hazard ratios (HR) [95% confidence intervals (CI)] for clinical diagnosis, events, and anticoagulant prescriptions during the follow-up period. Over the median 4.2-year follow-up, although a greater number of patients were diagnosed with AF in the original iECG group (43 vs. 31), this was not significant (HR 1.37, 95% CI 0.86-2.19). No differences were seen in the number of strokes/systemic embolisms or deaths between the two groups (HR 0.92, 95% CI 0.54-1.54; HR 1.07, 95% CI 0.66-1.73). Findings were similar when restricted to those with CHADS-VASc ≥ 4. Conclusion: A 1-year period of home-based, twice-weekly screening for AF increased diagnoses of AF for the screening period but did not lead to increased diagnoses of AF or a reduction in cardiovascular-related events or all-cause death over a median of 4.2 years, even in those at highest risk of AF. These results suggest that benefits of regular ECG screening over a 1-year period are not maintained after cessation of the screening protocol.
Language	English
Publishing date	2023-05-03
Publishing country	England
Document type	Journal Article
ISSN	2752-4191
ISSN (online)	2752-4191
DOI	10.1093/ehjopen/oead047
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Article ; Online: Lipid-lowering therapy and mortality post-MI: is it just about the LDL?

Halcox, Julian P / Currie, Craig J

Heart (British Cardiac Society)

2014 Volume 100, Issue 11, Page(s) 825–826

MeSH term(s)	Azetidines/therapeutic use ; Drug Combinations ; Ezetimibe, Simvastatin Drug Combination ; Female ; Humans ; Lipids/blood ; Male ; Myocardial Infarction/drug therapy ; Population Surveillance ; Simvastatin/therapeutic use ; Survivors/statistics & numerical data
Chemical Substances	Azetidines ; Drug Combinations ; Ezetimibe, Simvastatin Drug Combination ; Lipids ; Simvastatin (AGG2FN16EV)
Language	English
Publishing date	2014-06
Publishing country	England
Document type	Comment ; Editorial
ZDB-ID	1303417-0
ISSN	1468-201X ; 1355-6037
ISSN (online)	1468-201X
ISSN	1355-6037
DOI	10.1136/heartjnl-2014-305556
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Zs.MO 112: Show issues

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Article ; Online: Glucagon-like peptide-1 receptor agonists improve biomarkers of inflammation and oxidative stress: A systematic review and meta-analysis of randomised controlled trials.

Bray, Jonathan J H / Foster-Davies, Harri / Salem, Ahmed / Hoole, Amy L / Obaid, Daniel R / Halcox, Julian P J / Stephens, Jeffrey W

Diabetes, obesity & metabolism

2021 Volume 23, Issue 8, Page(s) 1806–1822

Abstract: Aim: To conduct a meta-analysis and systematic review to examine the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on clinical biomarkers of inflammation and oxidative stress in patients with type 2 diabetes.: Methods: Medline, ... ...

Abstract	Aim: To conduct a meta-analysis and systematic review to examine the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on clinical biomarkers of inflammation and oxidative stress in patients with type 2 diabetes. Methods: Medline, Embase and the Cochrane Library were searched for randomised controlled trials (RCTs) that examined changes with GLP-1RAs in a priori selected biomarkers of inflammation: C-reactive protein (CRP), adiponectin, tumour necrosis factor-alpha (TNFα), plasminogen activator inhibitor-1, interleukin-6, leptin; and of oxidative stress: malondialdehyde (MDA); 8-iso-prostaglandin F2α; and 8-hydroxy-2'-deoxyguanosine (8-OHdG). Results: We included 40 eligible RCTs (n = 6749) with a median follow-up of 6 months, a mean participant age of 53.1 years, 56.3% females, glycated haemoglobin (HbA1c) 55.6 mmol/mol, body mass index 28.8 kg/m Conclusions: There is strong evidence supporting clinically relevant anti-inflammatory and antioxidant effects of GLP-1RAs. This may be used to guide future targeted clinical use of GLP-1RAs and the development of medications seeking to target the cardioprotective properties of GLP-1RAs.
MeSH term(s)	Biomarkers ; Diabetes Mellitus, Type 2/drug therapy ; Female ; Glucagon-Like Peptide-1 Receptor ; Humans ; Hypoglycemic Agents/therapeutic use ; Inflammation/drug therapy ; Male ; Middle Aged ; Oxidative Stress ; Randomized Controlled Trials as Topic
Chemical Substances	Biomarkers ; Glucagon-Like Peptide-1 Receptor ; Hypoglycemic Agents
Language	English
Publishing date	2021-05-06
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	1454944-x
ISSN	1463-1326 ; 1462-8902
ISSN (online)	1463-1326
ISSN	1462-8902
DOI	10.1111/dom.14399
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Article ; Online: Asthma and high-intensity interval training have no effect on clustered cardiometabolic risk or arterial stiffness in adolescents.

McNarry, M A / Lester, L / Ellins, E A / Halcox, J P / Davies, G / Winn, C O N / Mackintosh, K A

European journal of applied physiology

2021 Volume 121, Issue 7, Page(s) 1967–1978

Abstract: ... Those with asthma demonstrated lower arterial stiffness factor scores mid-intervention (P = 0.047) and lower ... cholesterol factor scores post-intervention (P = 0.022) but there was no effect of the intervention, or ...

Abstract	Purpose: Cardiometabolic risk, including arterial stiffness, is increasing in youth. Those with asthma are suggested to be particularly at risk of cardiovascular disease. Efficient and effective strategies are required to prevent the atherosclerotic process in youth. The purpose of this study was to investigate the effect of 6 months high-intensity interval training (HIIT) on cardiometabolic risk in youth with and without asthma. Methods: 65 adolescents (31 mild asthma; 34 non-asthma) were recruited, 32 (16 asthma) of whom were randomly allocated to receive HIIT three times per week for 6 months. At baseline, mid-intervention, post-intervention and at a 3-month follow-up, anthropometric, metabolic and vascular determinants of cardiometabolic risk were assessed. Following principal component analysis (PCA), linear mixed models were used to assess the influence of asthma, HIIT and their interaction. Results: Seven factors were identified which explained 88% of the common variance shared among the parameters. Those with asthma demonstrated lower arterial stiffness factor scores mid-intervention (P = 0.047) and lower cholesterol factor scores post-intervention (P = 0.022) but there was no effect of the intervention, or interaction effects, on any PCA-identified factor, at any time-point. HIIT was associated with a lower low-density lipoprotein and diastolic blood pressure at mid-intervention. Discussion: Neither arterial stiffness nor clustered cardiometabolic risk are influenced by HIIT in adolescents with or without asthma, despite important changes in blood lipid and pressure profiles. Blood pressure, augmentation and pulse wave velocity should be considered physiologically distinct constructs and as potential markers of cardiovascular health.
MeSH term(s)	Adolescent ; Anthropometry ; Asthma/physiopathology ; Cardiorespiratory Fitness/physiology ; Female ; High-Intensity Interval Training ; Humans ; Lipids/blood ; Male ; Pulse Wave Analysis ; Risk Factors ; Vascular Stiffness
Chemical Substances	Lipids
Language	English
Publishing date	2021-03-29
Publishing country	Germany
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	124793-1
ISSN	1439-6327 ; 1432-1025 ; 0301-5548 ; 1439-6319
ISSN (online)	1439-6327 ; 1432-1025
ISSN	0301-5548 ; 1439-6319
DOI	10.1007/s00421-020-04590-4
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Article ; Online: Single-lead ECGs (AliveCor) are a feasible, cost-effective and safer alternative to 12-lead ECGs in community diagnosis and monitoring of atrial fibrillation.

Bray, Jonathan James Hyett / Lloyd, Elin Fflur / Adenwalla, Firdaus / Kelly, Sarah / Wareham, Kathie / Halcox, Julian P J

BMJ open quality

2021 Volume 10, Issue 1

Abstract: Background: Community management of atrial fibrillation (AF) often requires the use of electrocardiographic (ECG) investigation. Patients discharged following treatment of AF with fast ventricular response (fast AF) can require numerous ECGs to monitor ... ...

Abstract	Background: Community management of atrial fibrillation (AF) often requires the use of electrocardiographic (ECG) investigation. Patients discharged following treatment of AF with fast ventricular response (fast AF) can require numerous ECGs to monitor rate and/or rhythm control. Single-lead ECGs have been proposed as a more convenient and relatively accurate alternative to 12-lead ECGs for rate/rhythm management and also diagnosis of AF. We aimed to examine the feasibility of using the AliveCor single-lead ECG monitor for diagnosis and monitoring of AF in the community setting. Methods: During the course of 6 months, this evaluation of a clinical service improvement pathway used the AliveCor in management of patients requiring (1) follow-up ECGs for AF with previously documented rapid ventricular rate or (2) ECG confirmation of rhythm where AF was suspected. Twelve AliveCor devices provided to the acute community medical team were used to produce 30 s ECG rhythm strips (iECG) that were electronically sent to an overreading physician. Results: Seventy-four patients (mean age 82 years) were managed on this pathway. (1) The AliveCor was successfully used to monitor the follow-up of 37 patients with fast AF, acquiring a combined total of 113 iECGs (median 1.5 ±3.75 per patient). None of these patients required a subsequent 12-lead ECG and this approach saved an estimate of up to £134.49 per patient. (2) Of 53 patients with abnormal pulses, the system helped identify 8 cases of new onset AF and 19 cases of previously known AF that had reverted from sinus back into AF. Conclusions: We have demonstrated that the AliveCor system is a feasible, cost-effective, time-efficient and potentially safer alternative to serial 12-lead ECGs for community monitoring and diagnosis of AF.
MeSH term(s)	Aged, 80 and over ; Atrial Fibrillation/diagnosis ; Cost-Benefit Analysis ; Electrocardiography ; Humans ; Monitoring, Physiologic
Language	English
Publishing date	2021-03-19
Publishing country	England
Document type	Journal Article
ISSN	2399-6641
ISSN (online)	2399-6641
DOI	10.1136/bmjoq-2020-001270
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Article ; Online: Guidelines for type 2 diabetes: keeping a finger on the pulse.

Barnett, Anthony H / O'Hare, Paul / Halcox, Julian

The lancet. Diabetes & endocrinology

2017 Volume 5, Issue 6, Page(s) 420

MeSH term(s)	Cardiovascular Diseases/drug therapy ; Cardiovascular Diseases/etiology ; Clinical Trials as Topic ; Diabetes Mellitus, Type 2/complications ; Health Policy ; Humans ; Hypoglycemic Agents/therapeutic use
Chemical Substances	Hypoglycemic Agents
Language	English
Publishing date	2017-04-19
Publishing country	England
Document type	Letter
ISSN	2213-8595
ISSN (online)	2213-8595
DOI	10.1016/S2213-8587(17)30136-5
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Article ; Online: Associations between inflammation, coagulation, cardiac strain and injury, and subclinical vascular disease with frailty in older men: a cross-sectional study.

McKechnie, Douglas G J / Patel, Meera / Papacosta, A Olia / Lennon, Lucy T / Ellins, Elizabeth A / Halcox, Julian P J / Ramsay, Sheena E / Whincup, Peter H / Wannamethee, S Goya

BMC geriatrics

2022 Volume 22, Issue 1, Page(s) 405

Abstract: ... systolic blood pressure. Explanatory variables with p < 0.05 were carried forward into mutually-adjusted ...

Abstract	Background: Inflammation, coagulation activation, endothelial dysfunction and subclinical vascular disease are cross-sectionally associated with frailty. Cardiac-specific biomarkers are less-well characterised. We assessed associations between these and frailty, in men with, and without, cardiovascular disease (CVD). Methods: Cross-sectional analysis of 1096 men without, and 303 with, CVD, aged 71-92, from the British Regional Heart Study. Multinominal logistic regression was performed to examine the associations between frailty status (robust/pre-frail/frail) and, separately, C-reactive protein (CRP), interleukin-6 (IL-6), tissue plasminogen activator (tPA), D-dimer, von Willebrand factor (vWF), high-sensitivity cardiac troponin-T (hs-cTnT), N-terminal pro B-type natriuretic peptide (NT-proBNP) (all natural log-transformed), and, in men without CVD, carotid intima-media thickness (CIMT), carotid-femoral pulse wave velocity (cfPWV), carotid distensibility coefficient (DC), and ankle-brachial pressure index (ABPI), adjusted for age, renal function, BMI, social class, smoking, polypharmacy, cognition, multimorbidity and systolic blood pressure. Explanatory variables with p < 0.05 were carried forward into mutually-adjusted analysis. Results: In men without CVD, higher CRP, IL-6, vWF, tPA, hs-cTnT, NT-proBNP, cfPWV, and lower DC were significantly associated with frailty; mutually-adjusted, log IL-6 (OR for frailty = 2.02, 95%CI 1.38-2.95), log hs-cTnT (OR = 1.95, 95%CI 1.24-3.05) and DC (OR = 0.92, 95%CI 0.86-0.99) retained associations. In men with CVD, higher CRP, IL-6, and hs-cTnT, but not vWF, tPA, NT-proBNP or D-dimer, were significantly associated with frailty; mutually-adjusted, log hs-cTnT (OR 3.82, 95%CI 1.84-7.95) retained a significant association. Conclusions: In older men, biomarkers of myocardial injury are associated with frailty. Inflammation is associated with frailty in men without CVD. Carotid artery stiffness is associated with frailty in men without CVD, independently of these biomarkers.
MeSH term(s)	Aged ; Aged, 80 and over ; Biomarkers ; Cardiovascular Diseases/diagnosis ; Cardiovascular Diseases/epidemiology ; Carotid Intima-Media Thickness ; Cross-Sectional Studies ; Frailty/complications ; Frailty/diagnosis ; Frailty/epidemiology ; Humans ; Inflammation/diagnosis ; Inflammation/epidemiology ; Interleukin-6 ; Male ; Natriuretic Peptide, Brain ; Peptide Fragments ; Pulse Wave Analysis ; Risk Factors ; Tissue Plasminogen Activator ; Troponin T ; Vascular Diseases/complications ; von Willebrand Factor
Chemical Substances	Biomarkers ; Interleukin-6 ; Peptide Fragments ; Troponin T ; von Willebrand Factor ; Natriuretic Peptide, Brain (114471-18-0) ; Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2022-05-09
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2059865-8
ISSN	1471-2318 ; 1471-2318
ISSN (online)	1471-2318
ISSN	1471-2318
DOI	10.1186/s12877-022-03106-3
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