Heart failure is a complex cardiovascular syndrome with diverse etiologies. It is prevalent and has a substantial adverse global health impact. This review focuses on the peculiarities of HF in sub-Saharan Africa.

Heart failure poses a significant challenge in sub-Saharan Africa, primarily affecting young adults aged 36.5 to 61.5 years. Patients often present with advanced symptoms, exacerbated by socioeconomic factors and other complications. Key risk factors include hypertension, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease, with new challenges arising from obesity, air pollution, and infectious diseases, further complicating treatment approaches. Diagnostic capabilities in sub-Saharan Africa remain limited. Non-adherence to prescribed medications ranges between 23.7% and 74.7%, worsening disease progression and leading to increased rehospitalizations and mortality rates. Moreover, the high costs of guideline-recommended medications, including sodium-glucose cotransporter-2 inhibitors and angiotensin receptor-neprilysin inhibitors, restrict their availability. Additionally, advanced device therapies like implantable cardioverter-defibrillators and cardiac resynchronization therapy are often inaccessible due to their high costs, the scarcity of invasive cardiac laboratories, and a limited number of trained healthcare professionals. Heart failure poses a significant challenge in sub-Saharan Africa, especially among younger adults. Late clinical presentations, compounded by socioeconomic barriers, underscore the urgent need for improved healthcare access and education. Addressing key risk factors, enhancing diagnostics, and ensuring treatment adherence are vital for better management. Additionally, the high costs of advanced medications highlight the necessity for more affordable healthcare solutions to alleviate the burden of heart failure in the region.

Identifying cost-effective biomarkers for chronic disease screening remains a global challenge. This study examined sex- and age-specific associations between relative handgrip strength (RHGS) and eight chronic diseases to inform targeted screening and resource allocation.

Longitudinal data from 11,415 participants in the China Health and Retirement Longitudinal Study (CHARLS) aged ≥ 45 years were analyzed. Participants were stratified into sex-specific, body mass index-adjusted RHGS quartiles. Multivariable Cox proportional hazards models were used to examine associations between RHGS and risks of diabetes, dyslipidemia, low cognitive performance, depression, heart disease, hypertension, stroke, and arthritis, stratified by sex and age group.

Over a median follow-up of 84 months, higher RHGS quartiles were linked to lower risks of diabetes, dyslipidemia, low cognitive performance, and stroke. In older males, the highest quartile was associated with a 53% lower risk of low cognitive performance and a nonlinear relationship with diabetes risk. In middle-aged males, the highest quartile meant a 64% lower risk of dyslipidemia. Among females, higher RHGS was associated with cardiovascular disease and reduced low cognitive risk in older females. Low baseline RHGS predicted higher risks, even if RHGS improved later.

This study supports incorporating RHGS assessment into routine midlife health screenings and adopting sex- and age-specific strategies to improve cost-effective disease prevention. Clinically, prioritize cognitive screening in older adults with low RHGS, focus on glucose and lipid disorders in middle-aged individuals with low RHGS, and emphasize cardiovascular risk assessment in middle-aged and older females with low RHGS.

While the benefits and need for integrating palliative care (PC) services into heart failure (HF) care have been well recognized, integration has been slow. Currently, only a small proportion of patients with HF utilize PC services, meaning there is a discrepancy between the knowledge about optimal care and the implementation of care. In recent years researchers have attempted to understand the barriers and facilitators of implementing PC models to patients with HF which has been captured in both primary, empirical research and secondary literature review papers. We aimed to synthesize these barriers and facilitators to the implementation of PC approaches for patients with HF within a well-known framework for assessing determinants of implementation, the consolidated framework for implementation research (CFIR).

We conducted a rapid synthesis of reviews using systematic review methods which sought to collate existing review articles pertaining to the research question. We used four search term categories: (1) Heart failure, (2) Palliative care, (3) Implementation, and (4) Review. We conducted searches in four databases (Scopus, EMBASE, CINAHL, COCHRANE) on the 1st of September 2025. We used the CFIR framework to synthesize the data. Firstly, we extracted key barriers and facilitators from the articles. We then categorized this information into sub-constructions of two of the CFIR's constructs (II. the Outer setting and III. The Inner setting). The search generated 2,080 results, of which 512 were duplicates. After screening, twenty-nine reviews were included in the data extraction and synthesis process. A range of barriers and facilitators were highlighted across the reviews. For the inner setting, this included a need for improving communication with patients and between healthcare professionals (HCPs) by engaging more openly and honestly about dying, an increase in joint working as part of multidisciplinary teams, funding and resource issues, and workforce recruitment and training issues. For the outer setting barriers and facilitators were associated with prognostic challenges and the complexity of caring for patients with HF, the needs of HF and geriatric patients, and the evidence and policy landscape associated with the principles of care and implementation of care for HF patients. Despite knowledge about the importance of PC, HCPs will struggle to integrate it into heart failure care unless they address practical, social, cultural, clinical, and economic determinants associated with care. By doing so, health care providers can develop implementation strategies for improving care.

The present prospective study aimed to elucidate improvements in affected upper extremity motor function after carotid endarterectomy (CEA) for symptomatic patients without obvious cognitive decline and to clarify associations between this post-CEA improvement and postoperative recovery of cerebral perfusion and/or cerebral neurotransmitter receptor function. Fifty-three symptomatic patients undergoing CEA were subjected to the Action Research Arm Test (ARAT) and early (within 30 min after ¹²³I-iomazenil administration) and late (at 180 min after ¹²³I-iomazenil administration) single-photon emission computed tomography (SPECT) before and after surgery. Based on the difference in time taken to complete the ARAT before and after surgery for the affected upper extremity, improvement in motor function was classified into three categories. Relative mean radioactive counts for each Brodmann's area on SPECT images were calculated before and after surgery, and the difference between pre- and postoperative relative counts Δ was calculated on early (ΔRC_early) and late (ΔRC_late) images. Motor function in the affected upper extremity was definitely improved in 9 patients (17%), probably improved in 9 patients (17%), and not improved in 35 patients (66%). Both ΔRC_early and ΔRC_late for Brodmann's areas 4, 6, and 7 were significantly higher in the definitely improved motor function group than in the probably or not improved motor function group. Area under the receiver operating characteristic curve for detecting patients with definitely improved motor function was greater for ΔRC_late than for ΔRC_early on Brodmann's areas 4 (0.995 versus 0.947), 6 (0.992 versus 0.965), and 7 (0.992 versus 0.917). Motor function in the affected upper extremity infrequently (17%) improves after CEA for symptomatic patients without obvious cognitive decline, and this post-CEA improvement is associated with recovery of neurotransmitter receptor function resulting from post-CEA restoration of cerebral perfusion in the motor and somatosensory association cortices.

Cerebral vasospasm (CV) is a major complication following aneurysmal subarachnoid hemorrhage (aSAH), significantly contributing to morbidity and mortality. Nicardipine Prolonged-Release Implants (NPRI) offer targeted, localized drug delivery to prevent CV. This meta-analysis evaluated NPRI's efficacy and safety in reducing CV, mortality, and adverse events in patients with aSAH undergoing aneurysm repair. A systematic review and meta-analysis followed PRISMA guidelines. We searched PubMed, Embase, and Cochrane (inception-November 2024). Included RCTs compared NPRI plus standard care vs. standard care alone. Outcomes: CV, mortality, and adverse events. A random-effects model calculated risk ratios (RR) with 95% confidence intervals (CI). Heterogeneity was assessed via I². Registered in PROSPERO (CRD42024629347). From 214 identified records, three RCTs comprising 84 patients (NPRI group: 45; control group: 39) met inclusion criteria. NPRI significantly reduced CV incidence (RR, 0.24 [95% CI, 0.09-0.60]; P = .002) with low heterogeneity (I² = 37%). Mortality was also significantly reduced in the NPRI group (RR, 0.18 [95% CI, 0.03-0.95]; P = .044; I² = 0%). Adverse events were less frequent in the NPRI group (RR, 0.42 [95% CI, 0.18-0.97]; P = .043; I² = 0%). This meta-analysis provides preliminary evidence supporting NPRI to reduce CV, mortality, and adverse events in aSAH. Despite the small number of included studies, low heterogeneity and significant effect sizes suggest NPRI as a promising intervention. Larger-scale RCTs with extended follow-up are required to validate these findings and define NPRI's role in clinical practice.

Spontaneous supratentorial intracerebral hemorrhage (SSICH) is a critical condition with a high risk of morbidity and mortality, often requiring prompt intervention. Various surgical approaches have been employed to enhance outcomes; however, their comparative effectiveness remains uncertain. Databases including PubMed, Cochrane Central, and ScienceDirect were searched from inception till February 2025 for Randomized controlled trials (RCTs) investigating neuroendoscopy (NE), stereotactic aspiration (SA), craniopuncture surgery (CP), craniotomy (CR), decompressive craniectomy (DC), and conservative medical treatment (CMT). A frequentist network meta-analysis was conducted using R version 4.2.1 and the "netmeta" package, employing the random effects model. Treatment ranking was performed using p-scores, and the risk of bias was assessed using the ROB 2.0 tool. Publication bias was evaluated visually through funnel plots and statistically through Egger's Regression test. The analysis included 25 RCTs involving 4,324 patients. Compared to CMT, NE (RR = 1.77, 95% CI: [1.43,2.20]; p < 0.0001), SA (RR = 1.65, 95%CI: [1.38,1.98]; p < 0.0001), and CR (RR = 1.26, 95%CI: [1.04,1.54]; p = 0.019) showed significant improvement in good functional outcome (GFO) and NE was ranked the best for functional improvement (p-score = 0.93). Mortality was significantly reduced in NE (RR = 0.67, 95%CI: [0.52,0.85]; p = 0.001), and CR (RR = 0.82, 95%CI: [0.69,0.98]; p = 0.028) compared to CMT. NE was considered the most optimal treatment for reducing mortality (p-score = 0.81). Compared to CMT, the risk of rebleeding and overall complications was not significantly different with the surgical interventions. NE, SA and CR significantly improved functional outcomes whereas NE and CR reduced mortality in patients with SSICH compared to CMT. NE may be the most optimal treatment for improving functional scores and mortality according to p-score ranking. Further, high-quality multicenter randomized clinical trials are required.

The aim was to evaluate the effects of anti-VEGF and dexamethasone (DEX) implants on choroidal vascular structures in eyes with branch retinal vein occlusion (BRVO).

Eyes with temporal BRVO, unaffected fellow eyes, and age- and gender-matched healthy control eyes were retrospectively analyzed. Swept-source optical coherence tomography (SS-OCT) images were collected initially and at the 12-month follow-up visit. Choroidal vascularity index (CVI), choroidal thickness (CT), and central macular thickness (CMT) were measured. Demographic characteristics, treatment modalities, and best-corrected visual acuity (BCVA) were recorded.

The study involved 305 eyes: 104 with BRVO, 104 healthy fellow eyes, and 97 eyes from healthy controls. Initially, BRVO eyes had lower CVI than fellow eyes and controls (p = 0.032, p = 0.001, respectively). CT was lower in BRVO eyes compared to fellow eyes and controls. Among BRVO eyes, 50 received DEX implants, 54 received anti-VEGF treatment. Significant CVI decrease at 12 months was seen in the anti-VEGF group (p = 0.014), while it remained similar in the DEX implant group (p = 0.619). No difference was observed among anti-VEGF agents.

The study primarily showed how different treatment approaches affected choroidal parameteres in a condition largely triggered by hypoxia. It suggested the use of CVI as a prognostic indicator to monitor anti-VEGF drug treatment in BRVO patients.

Unruptured intracranial aneurysms are common neurovascular diseases, and flow diverters (FDs) have emerged as a key treatment modality. However, in-stent stenosis (ISS) remains a frequent complication after FD treatment, increasing the risk of thromboembolic events. Thrombin time (TT), a critical coagulation indicator, has potential associations with ISS risk. The objective of this study was to investigate the relationship between TT and ISS risk, with a focus on potential threshold effects. This multicenter retrospective cohort study included 389 patients with unruptured intracranial aneurysms treated with FD between March 2016 and October 2024. The primary exposure was preoperative TT, and the primary outcome was ISS occurrence during follow-up. Generalized additive models were used to explore non-linear relationships, while segmented linear regression identified threshold points. ISS occurred in 22.62% (88/389) of patients. TT exhibited a non-linear relationship with ISS risk, with a threshold of 19.2 s. For TT values below this threshold, each unit increase was associated with a 59% higher likelihood of developing ISS (OR = 1.59, 95% CI: 1.19-2.13, p = 0.002). These findings may help identify patients at higher risk for ISS who could benefit from more intensive angiographic follow-up with shortened intervals, enabling earlier detection and timely intervention.

Many patients who suffer an aneurysmal subarachnoid hemorrhage (aSAH) are active smokers that may experience nicotine withdrawal following hospital admission. Nicotine replacement therapy (NRT) could alleviate abstinence and delirium but may have unwanted side-effects. Cerebral vasospasm (VS) is a feared complication of aSAH that can worsen outcome. The impact of NRT on VS, complications and outcome is still not fully delineated.

Retrospective study using anonymized data from a prospective quality registry. Patients smoking status, age, sex, comorbidities, along with aSAH severity were registered. Smokers were dichotomized into non-NRT and NRT groups depending on whether they had received a nicotine patch or not and subdivided into light smokers (≤ 10 cigarettes/day) and moderate to heavy smokers (> 10 cigarettes/day). We also registered radiological/sonological and clinical VS, delayed cerebral ischemia (DCI) related infarction and other common aSAH complications. Outcome was scored in terms of mortality and modified Rankin Score (mRS) at 90 days.

495 patients were included; 220 received NRT. NRT was not a predictor of radiological/ultrasonological VS or DCI-related infarction. Poor outcome was more frequent in light smokers when they had received NRT (12.49% vs 29.31%) and their length of hospitalization was longer. Moderate to heavy smokers that had received NRT developed less frequently atrial fibrillation (3.4% vs 11.7%) and their length of stay at the ICU was shorter. There was no difference in thromboembolic or epileptic events, or respiratory failure between groups. There was no difference in smoking cessation at 90 days with or without NRT.

NRT had no impact on vasospasm or DCI-related infarction and it did not increase the frequency of complications. It seems advisable to abstain from NRT in light smokers.

Atrial fibrillation (AF) is the most prevalent sustained arrhythmia, and given its associations with stroke, heart failure and dementia, AF confers a major impact on public health. Optimal AF management should be based on three pillars: assessment and treatment of stroke risk factors, treatment of comorbidities, and symptom management through rhythm/rate control. In untreated AF, depending on other risk factors, the risk of stroke increases almost fivefold, and one in five strokes is related to AF. Therefore, effective assessment and prevention of stroke are the first pillar of AF management. The basis of stroke prevention is oral anticoagulation, which includes vitamin K antagonists and direct oral anticoagulants. Comorbidities and lifestyle factors exert a substantial influence on the progression risk, course, symptom severity, and prognosis in patients with AF. Hence, the appropriate management of these factors represents a crucial aspect, being the second pillar of AF treatment. The last pillar of AF management is symptom management through rhythm or rate control. Rhythm control in AF encompasses sinus rhythm restoration (antiarrhythmic drugs, cardioversion, and ablation techniques). Conversely, rate control aims to maintain AF while ensuring a well-regulated ventricular rate. Each of these pillars needs regular reassessment and dynamic shared decision-making with patients. The aim of AF treatment is to reduce mortality and improve prognosis and quality of life, which is influenced by each of the three pillars. In addition, it is important to emphasise that each pillar is linked to the others. For example, comorbidities increase the risk of stroke, and inadequate rhythm/rate control can accelerate the development of heart failure. Therefore, treatment of AF must not be punctual, but holistic and personalised, as outlined in this review.