Background Data comparing outcomes in heart failure ( HF ) across Asia are limited. We examined regional variation in mortality among patients with HF enrolled in the ASIAN ‐HF (Asian Sudden Cardiac Death in Heart Failure) registry with separate analyses for those with reduced ejection fraction ( EF ; <40%) versus preserved EF (≥50%). Methods and Results The ASIAN ‐ HF registry is a prospective longitudinal study. Participants with symptomatic HF were recruited from 46 secondary care centers in 3 Asian regions: South Asia (India), Southeast Asia (Thailand, Malaysia, Philippines, Indonesia, Singapore), and Northeast Asia (South Korea, Japan, Taiwan, Hong Kong, China). Overall, 6480 patients aged >18 years with symptomatic HF were recruited (mean age: 61.6±13.3 years; 27% women; 81% with HF and reduced r EF ). The primary outcome was 1‐year all‐cause mortality. Striking regional variations in baseline characteristics and outcomes were observed. Regardless of HF type, Southeast Asians had the highest burden of comorbidities, particularly diabetes mellitus and chronic kidney disease, despite being younger than Northeast Asian participants. One‐year, crude, all‐cause mortality for the whole population was 9.6%, higher in patients with HF and reduced EF (10.6%) than in those with HF and preserved EF (5.4%). One‐year, all‐cause mortality was significantly higher in Southeast Asian patients (13.0%), compared with South Asian (7.5%) and Northeast Asian patients (7.4%; P <0.001). Well‐known predictors of death accounted for only 44.2% of the variation in risk of mortality. Conclusions This first multinational prospective study shows that the outcomes in Asian patients with both HF and reduced or preserved EF are poor overall and worst in Southeast Asian patients. Region‐specific risk factors and gaps in guideline‐directed therapy should be addressed to potentially improve outcomes. Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 01633398.

Statin therapy in patients with coronary spasm-induced AMI with nonobstructive coronary arteries was associated with improved clinical outcome, which was predominantly accounted for by reducing the incidence of myocardial infarction.

The graphics processing unit (GPU) has evolved into a flexible and powerful processor of relatively low cost, compared to processors used for other available parallel computing systems. The majority of studies using the GPU within the graphics and simulation communities have focused on the use of the GPU for models that are traditionally simulated using regular time increments, whether these increments are accomplished through the addition of a time delta (i.e., numerical integration) or event scheduling using the delta (i.e., discrete event approximations of continuous-time systems). These types of models have the property of being decomposable over a variable or parameter space. In prior studies, discrete event simulation has been characterized as being an inefficient application for the GPU primarily due to the inherent synchronicity of the GPU organization and an apparent mismatch between the classic event scheduling cycle and the GPU’s basic functionality. However, we have found that irregular time advances of the sort common in discrete event models can be successfully mapped to a GPU, thus making it possible to execute discrete event systems on an inexpensive personal computer platform at speedups close to 10x. This speedup is achieved through the development of a special purpose code library we developed that uses an approximate time-based event scheduling approach. We present the design and implementation of this library, which is based on the compute unified device architecture (CUDA) general purpose parallel applications programming interface for the NVIDIA class of GPUs.

Queuing networks are used widely in computer simulation studies. Examples of queuing networks can be found in areas such as the supply chains, manufacturing work flow, and internet routing. If the networks are fairly small in size and complexity, it is possible to create discrete event simulations of the networks without incurring significant delays in analyzing the system. However, as the networks grow in size, such analysis can be time consuming, and thus require more expensive parallel processing computers or clusters. We have constructed a set of tools that allow the analyst to simulate queuing networks in parallel, using the fairly inexpensive and commonly available graphics processing units (GPUs) found in most recent computing platforms. We present an analysis of a GPU-based algorithm, describing benefits and issues with the GPU approach. The algorithm clusters events, achieving speedup at the expense of an approximation error which grows as the cluster size increases. We were able to achieve 10-x speedup using our approach with a small error in a specific implementation of a synthetic closed queuing network simulation. This error can be mitigated, based on error analysis trends, obtaining reasonably accurate output statistics. The experimental results of the mobile ad hoc network simulation show that errors occur only in the time-dependent output statistics.

Background The 4S‐AF classification scheme comprises of four domains (stroke risk [St], symptoms [Sy], severity of atrial fibrillation (AF) burden [Sb] and substrate [Su]), which has been recommended in the 2020 ESC guidelines to characterize and evaluate patients with AF. Objectives We aimed to determine whether the 4S‐AF scheme would be useful for AF characterization and provides prognostic information in a large contemporary prospective Asian registry conducted by the Asia Pacific Heart Rhythm Society (APHRS). Methods Among 4666 patients enrolled in APHRS registry, 3586 of them whose data about left atrial (LA) dimension and European Heart Rhythm Association (EHRA) symptom score were available have constituted as the study population. The 4S‐AF score was calculated as the sum of each domain with a maximum score of 9. The clinical endpoint was defined as the 1‐year composite risk of any thromboembolic event, ischaemic stroke, heart failure, acute coronary syndrome, significant coronary artery disease requiring coronary intervention and all‐cause mortality. Results Based on the 4S‐AF domains, 86.7% were ‘non‐low risk’ for stroke; 94.3% had EHRA Class I‐II, 48.5% were newly diagnosed or paroxysmal AF; and only 8.4% had no cardiovascular risk factors or LA enlargement. The risk of clinical events was higher in patients who were ‘non‐low risk’ for stroke (aOR 2.175, 95% CI 1.060–4.461), with permanent AF (aOR 1.579, 95% CI 1.106–2.225) and increasing points for substrate (aORs 2.376–4.968 from score 2 to 4). When compared to the first tertile of 4S‐AF score (0–3 points), patients in the second tertile (4–5 points) had approximately 2.5‐fold increase in adverse events (OR 2.478, 95% CI 1.678–3.661, p < .001), while those in the third tertile (6–9 points), had a 3.5‐fold increase (OR 3.484, 95% CI 2.322–5.226, p < .001), both without significant differences between the 5 participating countries (p for interaction > .05). If all 4S‐AF domains were appropriately treated, this was associated with a lower risk of composite clinical outcomes (aOR 0.384, p < .001; p for interaction for different countries = .234). Conclusions Categorization according to the 4S‐AF scheme can be related to the risk of the composite adverse event rate in Asian AF patients, and appropriate treatments based on the 4S‐AF scheme resulted in better clinical outcomes. These observations support the characterization and management according to the 4S‐AF scheme in Asian patients.