No abstract

Myocardial infarction (MI) is among the commonest attributable risk factors for heart failure (HF). We compared clinical characteristics associated with the progression to HF in patients with or without a history of MI in the HOMAGE cohort and validated our results in UK Biobank.

Background Physical activity (PA) is a complex multidimensional human behaviour. Currently, there is no standardised approach for measuring PA using wearable accelerometers in health research. The total volume of PA is an important variable because it includes the frequency, intensity and duration of activity bouts, but it reduces them down to a single summary variable. Therefore, analytical approaches using accelerometer raw time series data taking into account the way PA are accumulated over time may provide more clinically relevant features of physical behaviour. Advances on these fields are highly needed in the context of the rapid development of digital health studies using connected trackers and smartwatches. The objective of this review will be to map advanced analytical approaches and their multidimensional summary variables used to provide a comprehensive picture of PA behaviour. Methods This scoping review will be guided by the Arksey and O’Malley methodological framework. A search for relevant publications will be undertaken in MEDLINE (PubMed), Embase and Web of Science databases. The selection of articles will be limited to studies published in English from January 2010 onwards. Studies including analytical methods that go beyond total PA volume, average daily acceleration and the conventional cut-point approaches, involving tri-axial accelerometer data will be included. Two reviewers will independently screen all citations, full-text articles and extract data. The data will be collated, stored and charted to provide a descriptive summary of the analytical methods and outputs, their strengths and limitations and their association with different health outcomes. Discussion This protocol describes a systematic method to identify, map and synthesise advanced analytical approaches and their multidimensional summary variables used to investigate PA behaviour and identify potentially clinically relevant features. The results of this review will be useful to guide future research related to analysing PA patterns, investigate their association with health conditions and suggest appropriate recommendations for changes in PA behaviour. The results may be of interest to sports scientists, clinical researchers, epidemiologists and smartphone application developers in the field of PA assessment. Scoping review registration This protocol has been registered with the Open Science Framework (OSF): https://osf.io/yxgmb.

Pulmonary congestion is a critical finding in patients with heart failure (HF) that can be quantified by lung ultrasound (LUS) through Bline quantification, the latter of which can be easily measured by all commercially-available probes/ultrasound equipment. As such, LUS represents a useful tool for the assessment of patients with both acute and chronic HF. Several imaging protocols have been described in the literature according to different clinical settings. While most studies have been performed with either the 8 or 28 chest zone protocol, the 28-zone protocol is more time-consuming while the 8-zone protocol offers the best trade-off with no sizeable loss of information. In the acute setting, LUS has excellent value in diagnosing acute HF, which is superior to physical examination and chest X-ray, particularly in instances of diagnostic uncertainty. In addition to its diagnostic value, accumulating evidence over the last decade (mainly derived from ambulatory settings or at discharge from an acute HF hospitalisation) suggests that LUS can also represent a useful prognostic tool for predicting adverse outcome in both HF with reduced (HFrEF) and preserved ejection fraction (HFpEF). It also allows realtime monitoring of pulmonary decongestion during treatment of acute HF. Additionally, LUS-guided therapy, when compared with usual care, has been shown to reduce the risk of HF hospitalisations at short-and mid-term follow-up. In addition, studies have shown good correlation between B-lines during exercise stress echocardiography and invasive, bio-humoral and echocardiographic indices of haemodynamic congestion; B-lines during exercise are also associated with worse prognosis in both HFrEF and HFpEF. Altogether, LUS represents a reliable and useful tool in the assessment of pulmonary congestion and risk stratification of HF patients throughout their entire journey (i.e., emergency department/acute settings, in-hospital management, discharge from acute HF hospitalisation, monitoring in the outpatient setting), with considerable diagnostic and prognostic implications.