Funding Acknowledgements Type of funding sources: None. Background Although current guidelines recommend the use of direct oral anticoagulants in patients with non-valvular atrial fibrillation (NVAF), the use of vitamin K antagonists (VKA) is still very widespread, especially in low to middle-income countries in Asia. If VKA/Warfarin is used, a target international normalized ratio (INR) range of 2.00-3.00 is recommended. Still, various studies conducted in Asia have found bleeding rates to be higher in this range. Thus, the "sweet spot" of INR targets in the Asian population is still under debate. Purpose This study aimed to compare bleeding and ischemic outcomes between the lower target INR and the standard target INR in an Asian population. Methods We conducted a systematic search in Pubmed, ScienceDirect, Cochrane, SinoMed, CNKI, and Wanfang data for studies conducted in East Asian countries comparing the outcome of standard INR targets (2.00-3.00) with lower INR targets in AF patients on VKA/Warfarin medication. The primary endpoints of interest are thromboembolic events and major bleeding. In addition, we performed a sub-analysis based on the lower INR with homogenized range (1.50-2.00) against the standard INR in primary outcomes. Secondary outcomes in this study were ischemic stroke, hemorrhagic stroke, minor bleeding, all-cause mortality, and treatment adherence. We used Review Manager 5.4 to calculate the result of 95% CI for the outcomes and odds ratios (OR). Results A total of 28 studies consisting of 10,533 patients from Japan, Korea, China, Hong Kong, and Thailand were included in our study. The incidence of thromboembolism was significantly higher in patients with a lower INR [OR 1.34 (95% CI 1.10-1.65; p=0.0005; I²=41%)], but if the lower INR was homogenized at range of 1.50–2.00 in the sub-analysis, there was no significant difference in events [OR 1.19 (95% CI 0.85-1.65; p=0.31; I²=0%)]. Major bleeding events [OR 0.36 (95% CI 0.28-0.46; p<0.00001; I²=0%)], hemorrhagic stroke [OR 0.24 (95% CI 0.14-0.42; p<0.00001; I²=0%)], and minor bleeding [OR 0.29 (95% CI 0.09-0.92; p=0.04; I²=0%)] was found to be significantly lower at the lower INR targets. Although there was no significant difference in all-cause mortality and ischemic stroke, a lower INR targets was associated with better treatment adherence in term of fewer patients discontinuing therapy independently [OR 0.48 (95% CI 0.28-0.48; p=0.007; I² =0%)]. Conclusion The incidence of bleeding was significantly higher in the Asian population treated with the standard target INR. Adjusting the lower target INR to 1.50-2.00 might be the sweet spot for the balance of ischemic and bleeding events to provide better outcomes in the Asian population with AF.

Background/Introduction Recent studies have shown that catheter ablation (CA) is more superior compared to the usage of the antiarrhythmic drug (AAD) regarding its efficacy in decreasing the incidence of persistent and chronic atrial fibrillation (AF). However, choosing the right rhythm control strategy to provide holistic care for the patients should be individualized on each patients condition. Purpose In this meta-analysis, the author will compare both CA and AAD regarding their efficacy, safety, and their effect on the quality of life of AF patients. Methods The authors systematically searched the relevant journals throughout PubMed, Medline, and the Cochrane Library, with a range of publications from 2010 to 2021. The primary outcomes were AF recurrence, quality of life score, and adverse events. Secondary outcomes were the rehospitalization rate and all-cause mortality. Analysis was performed using a random-effects model with the Mantel-Haenszel method, and results are presented as 95% CIs. Results A total of 23 RCTs consisted of 10,316 patients were included. Although some adverse events (pericarditis, pleural effusions, and cardiac tamponade) were found in 2.8% population of the CA group (RR: 4.15; 95% CI: 1.65, 10.41; p=0.002), the CA group was found superior in suppressing the rate of AF recurrence (RR: 0.56; 95% CI: 0.48, 0.65; p<0.00001). Regarding the SF-36 Mental (p<0.00001) and Physical Assessment (p<0.0001), both CA and AAD showed increased quality of life post treatment compared with baseline level (pre-treatment) for each therapy. Following the interventions, the CA group significantly showed a lower rehospitalization rate (RR: 0.82; 95% CI: 0.70,0.97; p=0.02) and also showed a lessened mortality trend (6.84%) compared to the AAD group (9.01%) even though not statistically significant. Conclusion(s) Statistically, there is no difference for both groups in their capability of reducing the mortality rate. However, CA was found to be more superior in efficacy and reducing the number of rehospitalizations. Quality of life also significantly improve same as AAD, which further might be provide a holistic outcome of rhytm control. Funding Acknowledgement Type of funding sources: None.

Funding Acknowledgements Type of funding sources: None. Background/Introduction Patients with heart failure (HF) usually have limited functional capacity which ultimately reduces the quality of life and increases mortality rates that burden the health care system, HF currently has the highest readmission rate among all medical conditions. Telecardiology is a modern method based on long-distance telecommunications that are practical to implement and has the potential to improve the outcome of HF patients. Purpose The purpose of this study was to determine the impact of telecardiology on mortality and quality of life of patients with HF Methods A systematic literature search was conducted on PubMed and Cochrane Library with the journal publication period was 2010-2021. The primary outcomes of this study were mortality and quality of life (QoL). Secondary outcomes were major adverse cardiac events (MACE), rehospitalization, and changes in left ventricular ejection fraction (LVEF). Telecardiology in this study covers telephone-based, software-based, and monitoring with devices. Risk Ratio (RR) with 95% CI was calculated using a random-effect model, and the Mantel-Haenszel method was used to combine RR. Results A total of 29 RCTs with 13,837 adult NYHA I-IV HF patients were included. The follow-up range was 1-26 months. Telecardiology resulted in statistically significant risk reduction of all-cause mortality (RR: 0.90 ; 95% CI:0.83,0.99; p=0.02), and significant improvement in quality of life based on the Minnesota Living with Heart Failure Questionnaire (MLHFQ) (p<0.00001 ). We were also found the incidence of rehospitalization (RR: 0.94; 95% CI:0.90,0.98; p=0.004) and MACE (RR: 0.58; 95% CI:0.55,0.62; p<0.00001) were significantly lower in the telecardiology population. when compared with the control population, but not significantly associated with changes in LVEF (p = 0.79). Conclusion(s) Telecardiology is proven to improve patient outcomes in terms of mortality and quality of life. A significant reduction in rehospitalization has the potential to reduce the national health burden.

Funding Acknowledgements Type of funding sources: None. Background/Introduction Recent studies suggest chronotropic incompetence is statistically correlated with poor cardiometabolic health, systemic inflammation, and heart structural abnormalities. All may lead to exercise intolerance, impaired quality of life, and death due to cardiovascular disease (CVD). Unfortunately, there’s still a lack of data regarding which factors are associated with chronotropic incompetence. Purpose The purpose of this study was to identify the cardiometabolic risk factors, electrocardiographic (ECG), and echocardiographic (Echo) parameters that associated with chronotropic incompetence. Methods All patients who underwent cardiac treadmill stress test, ECG, and Echo in our hospital were included in this study, enrolled from 2018 until 2020. Patients were separated into two groups, patients with chronotropic incompetence and those without chronotropic incompetence. Chronotropic incompetence is defined as a maximum heart rate that can’t reach 85% age-predicted maximum heart rate. SPSS version 21 was used for data analysis. Pearson chi-square test was used to compare categorical variables based on clinical baseline characteristic, and cardiometabolic risk factors. We are using the Mann-Whitney U test to evaluate the association between ECG and Echo findings with chronotropic incompetence. Results Among 136 subjects of this study, the mean age was 54.7 years, 71.3% were male and 37.5% had chronotropic incompetence. Baseline characteristics and cardiometabolic factors such as T2DM (PR 2.29; 95%CI 1.16–3.37), HbA1C (PR 3.13; 95%CI 2.31-4.22), dyslipidemia (PR 1.773; 95%CI 1.170–2.687), total cholesterol (PR 2.396; 95%CI 1.650-3;481), and LDL (PR 1.853, 95%CI 1.229-2.794) were significantly associated with chronotropic incompetence (all p-value <0.05), while other factors were not significantly related. In ECG and Echo parameters, patients with chronotropic incompetence were found to had high Cornell product (1823.6±429.6vs1476.9±273.8), lower LVIDd (42.8±0.89 vs 45.2±0.72, p=0.029), lower LVIDi (24.6±0.37 vs 25.5±0.31, p=0.025), higher left ventricular mass (175.6±3.27 vs 125.1±2.63, p<0.001), higher E/E’ ratio (17.3±0.29 vs 13±0.35, p<0.001), and higher LAVI (47±1.98 vs 31.6±1.09, p<0.001) compared with patients without chronotropic incompetence. Conclusion(s) There are association between chronotropic incompetence with cardiometabolic factors and structural abnormalities that indicate increased LV filling pressure. The development of chronotropic incompetence may be predicted by assessing these factors