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  1. Article ; Online: Rise of the machines: will heart failure become the first cyber-specialty?

    Sze, Shirley

    The British journal of cardiology

    2020  Volume 27, Issue 1, Page(s) 6

    Abstract: Digital healthcare is being introduced to the management of heart failure as a consequence of innovations in information technology. Advancement in technology enables remote symptom and device monitoring, and facilitates early detection and treatment of ... ...

    Abstract Digital healthcare is being introduced to the management of heart failure as a consequence of innovations in information technology. Advancement in technology enables remote symptom and device monitoring, and facilitates early detection and treatment of heart failure exacerbation, potentially improving patient outcomes and quality of life. It also provides the potential to redesign our heart failure healthcare system to one with greater efficacy through resource-sparing, computer-aided decision-making systems. Although promising, there is, as yet, insufficient evidence to support the widespread implementation of digital healthcare. Patient-related barriers include user characteristics and health status; privacy and security concerns; financial costs and lack of accessibility of digital resources. Physician-related barriers include the lack of infrastructure, incentive, knowledge and training. There are also a multitude of technical challenges in maintaining system efficiency and data quality. Furthermore, the lack of regulation and legislation regarding digital healthcare also prevents its large-scale deployment. Further education and support and a comprehensive workable evaluation framework are needed to facilitate confident and widespread use of digital healthcare in managing patients with heart failure.
    Language English
    Publishing date 2020-03-04
    Publishing country England
    Document type Journal Article
    ZDB-ID 1354589-9
    ISSN 1753-4313 ; 0969-6113
    ISSN (online) 1753-4313
    ISSN 0969-6113
    DOI 10.5837/bjc.2020.006
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  2. Article ; Online: Ultrasound-guided explantation technique for implantable loop recorder in patients with high body mass index: a practical approach.

    Thaitirarot, Chokanan / Sze, Shirley / Armstrong, Suzanne / Somani, Riyaz

    Heart rhythm O2

    2024  Volume 5, Issue 3, Page(s) 198–199

    Language English
    Publishing date 2024-02-06
    Publishing country United States
    Document type Journal Article
    ISSN 2666-5018
    ISSN (online) 2666-5018
    DOI 10.1016/j.hroo.2024.01.009
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  3. Article ; Online: Biomarkers in heart failure: a focus on natriuretic peptides.

    Eltayeb, Mohamed / Squire, Iain / Sze, Shirley

    Heart (British Cardiac Society)

    2023  

    Abstract: While progress has been made in the management of most aspects of cardiovascular disease, the incidence and prevalence of heart failure (HF) remains high. HF affects around a million people in the UK and has a worse prognosis than most cancers. Patients ... ...

    Abstract While progress has been made in the management of most aspects of cardiovascular disease, the incidence and prevalence of heart failure (HF) remains high. HF affects around a million people in the UK and has a worse prognosis than most cancers. Patients with HF are often elderly with complex comorbidities, making accurate assessment of HF challenging. A timely diagnosis and initiation of evidence-based treatments are key to prevent hospitalisation and improve outcomes in this population. Biomarkers have dramatically impacted the way patients with HF are evaluated and managed. The most studied biomarkers in HF are natriuretic peptides (NPs). Since their discovery in the 1980s, there has been an explosion of work in the field of NPs and they have become an important clinical tool used in everyday practice to guide diagnosis and prognostic assessment of patients with HF. In this article, we will review the physiology of NPs and study their biological effects. Then, we will discuss the role of NPs in the diagnosis, management and prognostication of patients with HF. We will also explore the role of NPs as a potential therapeutic agent.
    Language English
    Publishing date 2023-09-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 1303417-0
    ISSN 1468-201X ; 1355-6037
    ISSN (online) 1468-201X
    ISSN 1355-6037
    DOI 10.1136/heartjnl-2020-318553
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  4. Article ; Online: Should we always call 911/999 to get it right first time in suspected myocardial infarction?

    Sze, Shirley / Ayton, Sarah L / Moss, Alastair James

    Heart (British Cardiac Society)

    2022  Volume 108, Issue 14, Page(s) 1082–1083

    MeSH term(s) Humans ; Myocardial Infarction/diagnosis ; Registries
    Language English
    Publishing date 2022-06-24
    Publishing country England
    Document type Editorial ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 1303417-0
    ISSN 1468-201X ; 1355-6037
    ISSN (online) 1468-201X
    ISSN 1355-6037
    DOI 10.1136/heartjnl-2022-320918
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  5. Article ; Online: Frailty in acute coronary syndromes. A systematic review and narrative synthesis of frailty assessment tools and interventions from randomised controlled trials.

    Chad, Thomas / Koulouroudias, Marinos / Layton, Georgia R / Fashina, Oluwatomini / Sze, Shirley / Roman, Marius / Murphy, Gavin J

    International journal of cardiology

    2024  Volume 399, Page(s) 131764

    Abstract: Aim: We aimed to review all randomised controlled trial (RCT) data to explore optimal identification and treatment strategies of frail patients with Acute Coronary Syndromes (ACS).: Methods: The protocol was preregistered (PROSPERO - CRD42021250235). ...

    Abstract Aim: We aimed to review all randomised controlled trial (RCT) data to explore optimal identification and treatment strategies of frail patients with Acute Coronary Syndromes (ACS).
    Methods: The protocol was preregistered (PROSPERO - CRD42021250235). We performed a systematic review including RCT's that 1; used at least one frailty assessment tool to assess frailty and its impact on outcomes in patients diagnosed with ACS and 2; used at least one intervention where change in frailty was measured in patients diagnosed with ACS. The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were searched on the 1st April 2021 and updated on 4th July 2023. Owing to low search output results are presented as a narrative synthesis of available evidence.
    Results: A single RCT used a frailty assessment tool. A single RCT specifically targeted frailty with their intervention. This precluded further quantitative analysis. There was indication of selection bias against frail participants, and a signal of value for physical activity measurement in frail ACS patients. There was a high level of uncertainty and low level of robustness of this evidence.
    Conclusions: Data from RCT's alone is inadequate in answering the reviews question. Future RCT's need to address ways to incorporate frail participants, whilst mitigating selection biases. Physical performance aspects of the frailty syndrome appear to be high yield modifiable targets that improve outcomes. Intervention trials should consider using change in frailty status as an outcome measure. Any trials that include frail participants should present data specifically attributable to this group.
    MeSH term(s) Humans ; Frailty/diagnosis ; Frailty/therapy ; Acute Coronary Syndrome/diagnosis ; Acute Coronary Syndrome/therapy ; Outcome Assessment, Health Care ; Research Design ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2024-01-09
    Publishing country Netherlands
    Document type Systematic Review ; Journal Article
    ZDB-ID 779519-1
    ISSN 1874-1754 ; 0167-5273
    ISSN (online) 1874-1754
    ISSN 0167-5273
    DOI 10.1016/j.ijcard.2024.131764
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  6. Article ; Online: Impact of Malnutrition Using Geriatric Nutritional Risk Index in Heart Failure With Preserved Ejection Fraction.

    Clark, Andrew L / Sze, Shirley

    JACC. Heart failure

    2019  Volume 7, Issue 8, Page(s) 676–677

    MeSH term(s) Aged ; Heart Failure ; Humans ; Malnutrition ; Nutrition Assessment ; Stroke Volume ; Ventricular Function, Left
    Language English
    Publishing date 2019-07-10
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 2705621-1
    ISSN 2213-1787 ; 2213-1779
    ISSN (online) 2213-1787
    ISSN 2213-1779
    DOI 10.1016/j.jchf.2019.06.002
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  7. Article ; Online: Which frailty tool best predicts morbidity and mortality in ambulatory patients with heart failure? A prospective study.

    Sze, Shirley / Pellicori, Pierpaolo / Zhang, Jufen / Weston, Joan / Clark, Andrew L

    European heart journal. Quality of care & clinical outcomes

    2022  Volume 9, Issue 7, Page(s) 731–739

    Abstract: Background: Frailty is common in patients with heart failure (HF) and is associated with adverse outcome, but it is uncertain how frailty should best be measured.: Objectives: To compare the prognostic value of commonly-used frailty tools in ... ...

    Abstract Background: Frailty is common in patients with heart failure (HF) and is associated with adverse outcome, but it is uncertain how frailty should best be measured.
    Objectives: To compare the prognostic value of commonly-used frailty tools in ambulatory patients with HF.
    Methods and results: We assessed, simultaneously, three screening tools [clinical frailty scale (CFS); Derby frailty index (DFI); acute frailty network (AFN) frailty criteria), three assessment tools (Fried criteria; Edmonton frailty score (EFS); deficit index (DI)) and three physical tests (handgrip strength, timed get-up-and-go test (TUGT), 5-metre walk test (5MWT)] in consecutive patients with HF attending a routine follow-up visit. 467 patients (67% male, median age = 76 years, median NT-proBNP = 1156 ng/L) were enrolled. During a median follow-up of 554 days, 82 (18%) patients died and 201 (43%) patients were either hospitalised or died. In models corrected for age, Charlson score, haemoglobin, renal function, sodium, NYHA, atrial fibrillation (AF), and body mass index, only log[NT-proBNP] and frailty were independently associated with all-cause death. A base model for predicting mortality at 1 year including NYHA, log[NT-proBNP], sodium and AF, had a C-statistic = 0.75. Amongst screening tools: CFS (C-statistic = 0.84); amongst assessment tools: DI (C-statistic = 0.83) and amongst physical test: 5MWT (C-statistic = 0.80), increased model performance most compared with base model (P <0.05 for all).
    Conclusion: Frailty is strongly associated with adverse outcomes in ambulatory patients with HF. When added to a base model for predicting mortality at 1 year including NYHA, NT-proBNP, sodium, and AF, CFS provides comparable prognostic information with assessment tools taking longer to perform.
    MeSH term(s) Humans ; Male ; Aged ; Female ; Prospective Studies ; Frailty/complications ; Hand Strength ; Heart Failure/complications ; Morbidity ; Atrial Fibrillation/complications ; Sodium
    Chemical Substances Sodium (9NEZ333N27)
    Language English
    Publishing date 2022-11-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 2823451-0
    ISSN 2058-1742 ; 2058-5225
    ISSN (online) 2058-1742
    ISSN 2058-5225
    DOI 10.1093/ehjqcco/qcac073
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  8. Article: Overstimulation of the ergoreflex-A possible mechanism to explain symptoms in long COVID.

    Sze, Shirley / Pan, Daniel / Moss, Alastair J / Ong, Cheng Ken / Pareek, Manish / Squire, Iain B / Clark, Andrew L

    Frontiers in cardiovascular medicine

    2022  Volume 9, Page(s) 940832

    Abstract: Long COVID refers to a multitude of symptoms that persist long after SARS-CoV-2 infection. Fatigue and breathlessness are the most common symptoms of long COVID across a range of studies. They are also cardinal symptoms of chronic heart failure (CHF). In ...

    Abstract Long COVID refers to a multitude of symptoms that persist long after SARS-CoV-2 infection. Fatigue and breathlessness are the most common symptoms of long COVID across a range of studies. They are also cardinal symptoms of chronic heart failure (CHF). In this review, we propose that fatigue and breathlessness in patients with long COVID may be explained by skeletal muscle abnormalities, in a manner similar to patients with CHF. The ergoreflex is a cardiorespiratory reflex activated by exercise, which couples ventilation and cardiovascular function to exercise intensity. At least part of the symptomatology of CHF is related to abnormal skeletal muscle and an enhanced ergoreflex, resulting in heightened sympathetic, vasoconstrictor and ventilator drives. Similarly, SARS-CoV-2 infection results in a hyperinflammatory and hypercatabolic state. This leads to reduction in skeletal muscle mass and altered function. We postulate that the ergoreflex is chronically overstimulated, resulting in fatigue and breathlessness. Exercise training preserves muscle mass and function as well as reduces ergoreflex activation; therefore may have a role in improving symptoms associated with long COVID. Should the ergoreflex be proven to be an important pathophysiological mechanism of long COVID, tailored exercise interventions should be trialed with the aim of improving both symptoms and perhaps outcomes in patients with long COVID.
    Language English
    Publishing date 2022-07-15
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2781496-8
    ISSN 2297-055X
    ISSN 2297-055X
    DOI 10.3389/fcvm.2022.940832
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  9. Article ; Online: Authors' reply: Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis.

    Pan, Daniel / Sze, Shirley / Nevill, Clareece R / Nellums, Laura B / Pareek, Manish

    EClinicalMedicine

    2020  Volume 31, Page(s) 100686

    Language English
    Publishing date 2020-12-25
    Publishing country England
    Document type Journal Article
    ISSN 2589-5370
    ISSN (online) 2589-5370
    DOI 10.1016/j.eclinm.2020.100686
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  10. Article ; Online: To PPE or not to PPE? Making sense of conflicting international recommendations for PPE during chest compressions in patients with COVID-19.

    Mudalige, N Lakmal / Sze, Shirley / Oyefeso, Oluwatobiloba / Koeckerling, David / Barker, Joseph / Pan, Daniel

    Resuscitation

    2020  Volume 156, Page(s) 146–148

    Keywords covid19
    Language English
    Publishing date 2020-09-22
    Publishing country Ireland
    Document type Letter ; Comment
    ZDB-ID 189901-6
    ISSN 1873-1570 ; 0300-9572
    ISSN (online) 1873-1570
    ISSN 0300-9572
    DOI 10.1016/j.resuscitation.2020.09.019
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