To identify and synthesise evidence pertaining to 'health check' programmes for the assessment of cardiovascular risk factors and disease delivered to adult populations in countries with universal healthcare.

A systematic umbrella review was undertaken. The protocol for this systematic umbrella review was registered on the PROSPERO registry and was undertaken based on Cochrane guidance and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.

Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane Database of Systematic Reviews, Scopus, Google Scholar and Health Management Information Consortium (HMIC) were searched. These searches identified records published between January 2009 and February 2025.

The inclusion criteria for the review were as follows: population-adults aged ≥18 years; intervention-health checks including the assessment of cardiovascular risk factors and disease; comparators-non-recipients, variations of health checks and within-person pre/post assessments; outcomes-uptake and diagnosis rates, cardiovascular disease (CVD) and related clinical and behavioural risk factors, referral changes, and barriers and facilitators to uptake. Studies published prior to 2009 (when NHS Health Checks were introduced) and those from countries without universal healthcare provision were excluded. Screening was performed independently by two reviewers and conflicts were resolved via discussion or adjudication by a third reviewer.

Data extraction and quality appraisal were performed independently by a single reviewer and checked by a second reviewer. The quality of included reviews was assessed using the Risk of Bias in Systematic Reviews (ROBIS) (for quantitative evidence) and the Swedish Agency for Medical and Social Evaluation tool (for qualitative evidence). The results of this systematic umbrella review were synthesised narratively.

Results from meta-analyses reported by the included systematic reviews showed that the effects of health checks on cardiovascular and total mortality, stroke and coronary heart disease were mixed and generally non-significant. Conversely, health checks generally showed significant, positive effects (reductions) in CVD risk factors including blood pressure, body mass index and cholesterol levels. Non-significant reductions in smoking were found in two meta-analyses. Health checks were generally cost-effective; however, it was found that the cost-effectiveness of health checks could be improved through targeting towards 'high risk' populations defined based on socioeconomic factors, obesity and family history of CVD. Health check attendance versus non-attendance was related to demographic, attitudinal, socioeconomic and practical factors. The effectiveness of health checks was influenced by factors including social support to make changes to health behaviours and the availability and accessibility of referral options.

Overall, health checks had a positive impact on the detection of and improvement in the levels of cardiovascular risk factors. There was limited evidence of impact on the occurrence of longer term CVD events, which could reflect the limitations of onward treatment for CVD. Cardiovascular health checks could be more effective and cost-effective if targeted towards high-risk groups. The ability to access appointments at convenient times and venues and increased opportunities for social support may increase health check uptake, and increased availability and accessibility of referral options may improve their effectiveness.

CRD42024487529.

This scoping review aimed to examine the impact of climate change on the health of older adults and to evaluate existing interventions targeting this population.

The review followed Arksey and O'Malley's framework and the PRISMA-ScR guidelines. A comprehensive search was conducted across PubMed, Google Scholar, Scopus, and Web of Science. Eligible studies included those focusing on adults aged 60 years and older that examined the physical and mental health impacts of climate change across any geographic setting or level of care. Descriptive and thematic analyses were performed to identify key findings and knowledge gaps.

Climate change adversely affects the physical and mental health of older adults through increased exposure to infectious diseases, extreme temperatures, and poor air and water quality. Older adults are particularly vulnerable to heat-related illnesses, cardiovascular events, and respiratory conditions, with women and individuals with comorbidities at higher risk. Climate change is also associated with increased anxiety, insomnia, and other mental health concerns in this population. Social support and targeted interventions-such as community awareness programs and subsidized cooling costs-are associated with reduced risk. Community-based initiatives have demonstrated potential in reducing mortality and enhancing resilience among older adults during extreme weather events.

Healthcare professionals should be educated about climate-related health outcomes affecting older adults. Protecting this vulnerable population requires urgent, inclusive, and targeted strategies, including education, improved healthcare access, and tailored interventions.

The aim of this study was to compare the accuracy, scientific quality, and clarity of responses generated by GPT-4o and Gemini to frequently asked patient questions related to carotid artery disease and carotid endarterectomy.

In total, 40 unique carotid endarterectomy-related questions were compiled from online sources and clinical experience. Each was entered into separate new sessions with GPT-4o and Gemini 2.5 Flash in Turkish, and responses were collected without modification. Notably, four blinded cardiovascular surgeons independently rated each answer (1-5 Likert scale) in three domains: Accuracy, Scientific Quality, and Clarity. Mean response lengths and domain scores were compared using appropriate paired tests.

GPT-4o produced longer responses than Gemini (258.1±101.6 vs. 193.2±43.7 words; p<0.001). Overall, GPT-4o had higher Accuracy scores (4.33±0.39 vs. 4.16±0.33; p=0.04), with no significant differences in Scientific Quality or Clarity (p=0.377 and p=0.154, respectively). In rater-level analyses, Gemini scored higher in Clarity for one rater, whereas GPT-4o was superior in Accuracy and Scientific Quality for another. Overall mean scores were comparable (4.17±0.36 vs. 4.13±0.31; p=0.636). Physician referral was recommended in 62.5% of GPT-4o and 52.5% of Gemini (p=0.366).

Both GPT-4o and Gemini provided "good"-quality responses to carotid endarterectomy patient questions, with GPT-4o showing a modest accuracy advantage, with no difference in other domains. Explicit disclaimers on both platforms underscore their supportive, not definitive, role in patient education. Physicians should remain the primary source for individualized decisions, and AI-generated information should always be verified.

The aim of the study was to determine the association between low muscle mass and abnormal fluid distribution with in-hospital mortality in patients with acute heart failure.

In a prospective cohort study at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran in Mexico City, patients with acute heart failure who underwent thoracic or abdominal computed tomography within 72 h before or after admission between September 2017 and July 2024 were included. The exclusion criteria were an illegible computed tomography scan, an incorrect bioimpedance analysis lecture, the presence of cancer, COVID-19, chronic kidney disease with renal replacement therapy, or dismissal of a diagnosis of acute heart failure. Bioelectrical impedance analysis was performed within the first 24 h of hospitalization to measure phase angle and impedance ratio for evaluating hydration status. The skeletal muscle area was measured using a single axial slide at L3 for abdominal computed tomography and the T4 level for thoracic computed tomography.

This study included 134 patients, with an overall hospital survival rate of 83.6%. The mortality group had a lower abdominal skeletal muscle area (86.5 vs. 111 cm2, p=0.024), smaller pectoral skeletal muscle area (18.9 vs. 26 cm2, p=0.005), lower phase angle (3 vs. 3.9, p=0.010), increased impedance ratio (0.89 vs. 0.86, p=0.002), greater prevalence of reduced pectoral muscle mass (40.9 vs. 12.5%, p<0.001), and abnormal fluid distribution according to impedance ratio (86.4 vs. 57.1%, p=0.016). In survival analyses, the interaction effect of pectoral skeletal muscle area and increased impedance ratio had the lowest survival probability (log-rank test, p<0.001).

Low skeletal muscle mass and abnormal fluid distribution are associated with in-hospital mortality in patients with acute heart failure.

The prognosis of nonobstructive coronary artery disease (CAD) is not well established. Comparative data between coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) are limited.

To compare CCTA- and ICA-derived information in nonobstructive CAD regarding detection and clinical outcomes.

We followed 4,004 adult patients who underwent either ICA (n = 2,355) or CCTA (n = 1,649) for a median of 9 years. The primary endpoint was a composite of all-cause mortality, acute coronary syndrome/acute myocardial infarction, and stroke. Propensity score matching was performed to compare outcomes between groups. The significance level was set at 5%.

The overall event rate was 6.9%. ICA was associated with worse outcomes than CCTA (hazard ratio [HR] 0.54; 95% CI 0.42-0.68; p < 0.001). Patients with nonobstructive CAD had worse outcomes than those without CAD (HR 1.73; 95% CI 1.32-2.27; p < 0.001). Normal coronary findings on CCTA were associated with better outcomes than normal findings on ICA (HR 0.39; 95% CI 0.24-0.62; p < 0.001). Event rates increased proportionally with plaque burden. In 1,187 matched pairs, CCTA was associated with improved survival (HR 0.57; 95% CI 0.42-0.78; p < 0.001).

CCTA more closely reflects clinical outcomes than ICA. Nonobstructive CAD carries a substantial risk regardless of imaging modality.

Atrial cardiomyopathy (AC) is a condition detectable by electrocardiogram (ECG) that may play a significant role in the pathophysiology of the etiology of strokes, independently of atrial fibrillation (AF).

To evaluate the association between ECG markers of AC (prolonged P-wave duration >120 ms and P-terminal force in V1 (PTFV1) >4,000 µV·ms) as well as the occurrence of mortality and hospitalization due to stroke.

This retrospective cohort study included patients from Belo Horizonte who underwent ECGs between 2006 and 2018. Patients aged ≥40 years, in sinus rhythm, and without a previous history of stroke at baseline ECG were included. Clinical and ECG data were linked to mortality (SIM) and hospitalization (SIH) public databases. Cox regression was used to calculate hazard ratios (HRs), and incremental adjustment models for age, sex, cardiovascular risk factors, and left ventricular hypertrophy were employed. Statistical significance was set at p<0.05.

245,588 patients were included. 26.3% had prolonged P-wave duration >120 ms, and 10.1% had elevated PTFV1 >4,000 µV·ms. Mean follow-up duration was 3.5 years. AC was associated with mortality and hospitalization due to stroke (HR 1.24; 95% CI, 1.12-1.36 for P-wave duration >120 ms; p<0.001; HR 1.20; 95% CI, 1.05-1.38 for PTFV1 >4,000 µV·ms; p<0.001).

ECG markers of AC are associated with death or hospitalization due to stroke, as well as cardiovascular mortality and incident AF in a large, representative Brazilian cohort, highlighting their prognostic value.

The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score is a risk stratification tool used to predict mortality in heart failure (HF). However, potential sex-related differences in its performance and its applicability to the Brazilian population remain uncertain.

To evaluate sex-based differences in the performance of the MAGGIC score and to validate the score in a Brazilian HF cohort.

This retrospective cohort study included 866 patients followed at a HF outpatient clinic. The primary outcome was 3-year all-cause mortality. The MAGGIC score was calculated for each patient. Discrimination was assessed using the area under the receiver operating characteristic curve, and calibration was evaluated using the Hosmer-Lemeshow test. Analyses were performed for the overall cohort and stratified by sex. A p-value < 0.05 was considered statistically significant.

The overall 3-year mortality rate was 33.4% (36.4% in men and 27.8% in women; p = 0.010). Predicted mortality was 20.9% (mean score 18.3 ± 7), with 22.7% for men and 19.1% for women. The score demonstrated good discrimination (area under the curve = 0.72; 95% CI: 0.686-0.754), with similar performance in men (0.704 [0.661-0.747]) and women (0.733 [0.674-0.792]). Calibration showed good agreement: overall chi-square (χ2) = 1.1 (p = 0.998), men χ2 = 0.9 (p = 0.999), and women χ2 = 1.3 (p = 0.995). Observed mortality was higher in moderate-risk groups, with no significant difference between moderate- and high-risk groups (p = 0.236).

The MAGGIC score showed good performance in a Brazilian HF cohort, with no significant sex-based differences, although higher observed mortality was identified among moderate-risk patients.

A potassium-enriched salt substitute, in which part of sodium chloride is replaced with potassium chloride, has shown considerable potential as a population-level strategy to reduce sodium intake and prevent cardiovascular disease. In recent years, research has focused primarily on individuals with hypertension, demonstrating that salt substitutes can influence blood pressure (BP).

To perform a meta-analysis quantifying the magnitude of BP reduction in patients with hypertension using regular salt compared with those using a salt substitute.

PubMed, Scopus, and Web of Science were searched for randomized controlled trials (RCTs) comparing regular salt with a salt substitute. Mean differences (MD) with 95% CIs were calculated using a random-effects model. Heterogeneity was assessed using the I2 statistic. A p-value < 0.05 was considered statistically significant.

Four RCTs involving 1,430 participants were included, of whom 725 (49.57%) received the salt substitute. The use of a salt substitute was associated with a significant reduction in systolic BP (SBP) (MD, -5.75 mmHg; 95% CI, -6.98 to -2.39 mmHg; I2 = 37%; p < 0.01) and a significant reduction in diastolic BP (DBP) (MD, -1.62 mmHg; 95% CI, -2.34 to -0.91 mmHg; I2 = 0%; p < 0.001).

In patients with hypertension, the use of a salt substitute is associated with a significant reduction in both SBP and DBP compared with regular salt.

YouTube, a video-sharing platform, aids health information sharing, and while social media's role in heart failure care remains unclear, it can enhance interaction, education, and engagement, fostering patient-centered care and encouraging treatment adherence and active health management.

The aim of the study was to evaluate the quality and usability of heart failure-related YouTube videos as a source of information for patients.

A total of 100 English-language YouTube videos on heart failure were analyzed. Videos were categorized based on uploader identity (healthcare vs. non-healthcare professionals) and assessed using quality criteria for consumer health information, Global Quality Scale, Journal of the American Medical Association criteria, and Video Power Index. Quantile regression analysis was performed to identify independent predictors of video quality.

Of the videos analyzed, 69% were uploaded by healthcare professionals. The mean quality criteria for consumer health information score was 21, Global Quality Scale was 3, and Journal of the American Medical Association was 3. Videos from professionals and longer videos had significantly higher quality scores. Quantile regression showed that video duration predicted high Global Quality Scale values at the 75th and 90th percentiles, while professional source was a consistent predictor across most quantiles.

The overall quality of YouTube videos on heart failure was found to be low to moderate, with substantial room for improvement. Videos uploaded by healthcare professionals, however, consistently demonstrated higher quality across evaluation metrics. Longer videos tend to have higher quality, but popularity does not correlate with content reliability. Efforts should be made to improve video content for better patient education.

Stroke is a global health problem that often causes physical disability and mental health issues for the survivor. While physical activity (PA) improves outcomes post stroke, it can be challenging to maintain. Barriers to maintaining PA post stroke include the setting of PA, motivation, and impairments from the stroke. There is often a desire to maintain PA after stroke, but effective interventions are currently limited.

This study aims to coproduce an intervention to support long-term PA maintenance for adults living with the effects of stroke in Northern Ireland. The objectives of this study are to understand the perspectives of key stakeholders on the components, structure, and content of an intervention to support PA maintenance and to coproduce and refine a prototype intervention to meet their specific needs and preferences.

A mixed methods study will be conducted, consisting of three stages informed by the Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer) co-production framework. Stage 1 will include a scoping review on PA maintenance in survivors of stroke and stakeholder consultation via focus groups to gain understanding from their perspective of PA. Survivors of stroke and their carers, physiotherapists, and care coordinators from community and voluntary organizations will be recruited from ongoing Post Rehabilitation Exercise Program (PREP) classes. Additional health care professionals with experience in PA and stroke will also be recruited via relevant organizations. Individuals who complete stage 1 focus groups will be invited to take part in stage 2 co-design workshops to develop a PA maintenance program for participants post PREP. Stage 3 will involve expert review of the co-production program by members of the project advisory board via a questionnaire survey. Qualitative data will be analyzed using reflexive thematic analysis from data collected in stages 1 and 2. Data from the scoping review will help shape the questions for the focus groups, and data from the focus groups will help inform questions for the three workshops. All stages will involve the stakeholders to gain feedback and suggestions for the next wave.

Five focus groups were conducted with 38 participants: three in-person (stroke survivors and their caregivers) and two online (one for PREP staff and one for other health and exercise professionals) between September and November 2025. Results from the focus groups identified two themes: shifting realities of physical activity post stroke and motivation through community. Eighteen participants subsequently consented to participate in three co-design workshops, which resulted in an intervention prototype being developed.

This study aims to co-develop an intervention to support PA maintenance in adults living with stroke after completion of community rehabilitation. To our knowledge, there is no further support for the survivors to help maintain their PA levels once they finish the 6- to 12-week community program. Engaging with survivors of stroke and their carers, PREP staff, and other exercise professionals will help shape the beginning stages of this study. Upcoming results from the pilot study will provide vital information on how to support PA maintenance in this population.