No validated Serbian-language patient-reported outcome measure exists for wrist and hand conditions. The Patient-Rated Wrist/Hand Evaluation (PRWHE) demonstrates superior responsiveness over broader instruments such as the Disabilities of the Arm, Shoulder, and Hand (DASH) for pathology confined to the wrist and hand.

To translate, culturally adapt, and validate the PRWHE for Serbian-speaking patients with hand and wrist disorders.

Clinical measurement, cross-sectional validation study.

One hundred sixty-three patients (52.1% male; mean age 52.4 ± 15.8 years) with hand and wrist conditions were enrolled. Translation adhered to internationally accepted cross-cultural adaptation guidelines. Participants completed the Serbian PRWHE, DASH, and SF-12. Internal consistency (Cronbach's α), test-retest reliability (ICC; n = 15, 2-week interval), confirmatory factor analysis, and convergent validity (Pearson/Spearman correlations) were assessed.

Internal consistency was excellent for the Pain (α = 0.90) and Function (α = 0.94) subscales. Test-retest reliability was excellent (ICC = 0.96; 95% CI: 0.92-0.98; p < 0.001), with no systematic bias on Bland-Altman analysis (p = 0.550). Confirmatory factor analysis confirmed the two-factor structure with satisfactory loadings (range: 0.73-0.93; RMSEA = 0.09; CFI = 0.95). Convergent validity was supported by significant correlations with the DASH (r = 0.23, p < 0.001) and moderate negative correlations with the SF-12 Physical Component Summary (r = -0.33 to -0.43, p < 0.001).

The Serbian PRWHE demonstrates strong psychometric properties and is a valid, reliable instrument for assessing pain and functional disability in wrist and hand conditions. Its availability enables standardized, patient-centered assessment in Serbian-speaking populations and supports cross-cultural research in hand therapy.

Congenital heart disease (CHD) remains a leading cause of neonatal morbidity and mortality worldwide, with a significant proportion of cases remaining undetected before birth. While pediatric cardiologist-performed echocardiography represents the diagnostic gold standard, access to specialist services is limited across many neonatal care settings globally. Neonatologist-performed point-of-care echocardiography has emerged as a bedside diagnostic tool; however, the evidence supporting its diagnostic performance and clinical impact requires systematic evaluation.

To systematically review the diagnostic performance and clinical impact of point-of-care echocardiography performed by neonatologists or trained non-cardiologist clinicians for the early detection of cardiac lesions in neonates across diverse clinical settings.

A systematic search of PubMed and Google Scholar was conducted in April 2026, supplemented by reference list screening of all included studies (198 additional records screened), forward citation searches (32 additional records), and a supplementary Embase search conducted in August 2026 in response to peer review. Studies evaluating neonatologist-performed echocardiography in neonates aged 0-28 days, reporting diagnostic performance metrics or clinical impact outcomes with a cardiologist comparator or confirmed diagnosis as reference standard, were included. Methodological quality was assessed using the QUADAS-2 tool. Due to substantial clinical and methodological heterogeneity, findings were synthesized narratively in accordance with PRISMA 2020.

Thirteen primary studies (2008-2026, including two ahead-of-print articles) from eleven countries encompassing over 31 800 neonates were included and synthesized across three domains: diagnostic performance and agreement, CHD detection capability, and clinical impact. Concordance between neonatologist and cardiologist echocardiography ranged from 91.15% to 97.9% (kappa 0.68-0.862). One population-based screening study reported sensitivity of 92% and specificity of 99.6%. No cases of missed major or critical CHD were reported in the included studies, although evidence remains limited and predominantly retrospective. Neonatologist-performed echocardiography was associated with management changes in 48%-66% of consultations involving structural or mixed cardiac assessment, and in up to 79% of consultations addressing hemodynamic indications alone (patent ductus arteriosus, pulmonary hypertension, systemic hypotension). Formal diagnostic accuracy data were limited to one study, and heterogeneity precluded meta-analysis.

Current evidence supports moderate-to-high diagnostic agreement and potential clinical utility of neonatologist-performed point-of-care echocardiography for identifying major and critical neonatal cardiac lesions. Evidence suggests this modality may be most appropriately utilized as an initial bedside triage and rule-in tool in settings where immediate pediatric cardiology access is limited. However, robust diagnostic accuracy data remain limited, and high-quality prospective multicenter validation studies are urgently required before definitive conclusions can be drawn.

The European Society of Cardiology (ESC) released new guidelines in 2025 for the management of myocarditis and pericarditis, which include systemic autoimmune rheumatic diseases as one of the potential aetiologies. Myopericardial involvement in systemic autoimmune rheumatic diseases is common and associated with poor outcomes; however, the unique pathophysiology of myopericardial involvement in systemic autoimmune rheumatic diseases poses specific challenges and limits the applicability of the generic diagnostic pathways proposed in the 2025 ESC guidelines to the systemic autoimmune rheumatic disease population. Myopericardial disease in patients with systemic autoimmune rheumatic disease is usually subclinical, often with atypical clinical presentation, and the accuracy of conventional biomarkers including advanced imaging, to detect myopericaridal disease is reduced in this population compared with the general population due to chronic inflamation. Management of myopericardial involvement in patients with systemic autoimmune rheumatic diseases primarily targets the underlying rheumatic disease; however, disease-specific guidance and multidisciplinary care pathways for the management of myopericardial involvement in patients with systemic autoimmune rheumatic diseases are urgently required and should be developed jointly by experts in both rheumatology and cardiology.

Worsening heart failure (HF) is common and associated with rehospitalisation, premature death, poor quality of life and high healthcare costs. Patients frequently delay seeking medical care for hours or days after symptom escalation, and longer delays are linked to more severe clinical status at presentation and worse outcomes. Existing quantitative and qualitative studies have explored multiple potential determinants of patient delay, but findings remain fragmented and inconsistent, partly due to differing sets of candidate predictors and variation in populations and healthcare settings. To date, no HF-specific, theory-driven systematic review has synthesised determinants of patient delay for worsening HF within Andersen's Behavioural Model of Health Services Use or quantified their associations with delay.

This protocol describes a systematic review and meta-analysis that will synthesise determinants of patient delay in seeking care for worsening HF symptoms arising in out-of-hospital settings among adults (≥18 years). We will include observational analytical studies (cohort, case-control and analytical cross-sectional designs) that report quantitative measures of patient delay, defined as the time from first awareness or onset of worsening HF symptoms to the decision to seek care or first contact with a healthcare facility. Based on Andersen's model, candidate determinants will be grouped as predisposing, enabling and need factors. We will search PubMed, EMBASE, Web of Science Core Collection, CINAHL, Cochrane Library, CNKI, WanFang Data and SinoMed from inception to 25 November 2025, include full-text articles in English or Chinese and perform duplicate screening and data extraction. Risk of bias will be assessed using the Newcastle-Ottawa Scale for cohort and case-control studies and the JBI critical appraisal tool for analytical cross-sectional studies and where appropriate we will conduct random-effects meta-analyses to pool effect estimates for the same determinant and delay definition with prespecified subgroup and sensitivity analyses to explore heterogeneity. The certainty of evidence for key determinant-delay relationships will be graded using the Grading of Recommendations Assessment, Development and Evaluation approach, and where meta-analysis is not feasible, we will provide structured narrative synthesis.

As this study involves secondary analysis of published, anonymised data, formal ethical approval and informed consent are not required. Findings will be disseminated through peer-reviewed journals, academic conferences and knowledge translation to inform clinical practice and patient education.

CRD420251242808.

Up to 15% of patients with acute ischaemic stroke, eligible for endovascular treatment (EVT), have a carotid tandem lesion (TL) of atherosclerotic origin; defined as an extracranial carotid artery stenosis of ≥50% or occlusion with an intracranial large vessel occlusion. The optimal periprocedural antithrombotic (AT) management is unclear for this subgroup.

This post-hoc analysis of the MR CLEAN-MED randomised multicentre clinical trial (ISRCTN76741621) evaluated the effect of various periprocedural AT regimens on outcomes in TL patients.

TL patients randomised in the MR CLEAN-MED trial were included. Good functional outcome (GFO) was defined as modified Rankin Scale score of 0-2 at 90 days. Symptomatic intracranial haemorrhage (sICH) was classified according to the Heidelberg criteria. Outcomes were compared by AT regimen (aspirin, heparin or both aspirin and heparin) using logistic regression, adjusted for baseline variables.

Between 22 January 2018 and 27 January 2021, 628 patients were included, of which 100 had a TL. Among 76 patients receiving AT, 26 (34.2%) achieved GFO, versus 14/24 (60.9%) without AT (adjusted OR (aOR) 0.79, 95% CI 0.63 to 0.99). Rates of GFO were comparable across regimens; 30.4% with aspirin (aOR 0.82, 95% CI 0.61 to 1.11), 29.2% with heparin (aOR 0.75, 95% CI 0.57 to 0.99) and 41.4% with both (aOR 0.81, 95% CI 0.62 to 1.06).sICH occurred in 15.8% of AT treated patients versus 4.4% without AT (OR 4.31, 95% CI 0.53 to 35.02). By regimen, sICH rates were 17.4% with aspirin, 16.7% with heparin and 13.8% with both.

In TL patients undergoing EVT, periprocedural AT was associated with worse functional outcome and there was a numerically higher rate of sICH; however, this association was not statistically significant and the estimate was imprecise.

To examine the association between pre-transient ischaemic attack (TIA) physical activity (PA) and subsequent cerebrovascular events.

Register-based cohort study SETTING: Stroke units in Gothenburg, Sweden, using a local stroke register linked to national healthcare and demographic registers.

1610 adults (51.7% female, mean age 72.5 years) with a registered TIA between November 2014 and December 2019.

The primary outcome was ischaemic stroke (International Classification of Diseases, 10th Revision I63 and I64). Secondary outcomes were total stroke (I61, I63 and I64) and a composite of stroke or TIA (I61, I63, I64 and G45.9). Time-to-event analyses were performed using Cox proportional hazards models with progressive adjustment for demographic, clinical and treatment-related factors.

Most participants reported light PA (50.4%). In crude analyses, moderate/vigorous PA was associated with lower hazards of ischaemic stroke (HR 0.36, 95% CI 0.16 to 0.78) and total stroke (HR 0.39, 95% CI 0.20 to 0.79) compared with sedentary individuals. These associations were attenuated after adjustment for age and sex and were no longer statistically significant (HR 0.48, 95% CI 0.22 to 1.08 for ischaemic stroke; HR 0.53, 95% CI 0.26 to 1.09 for total stroke). Further adjustment for clinical, socioeconomic and treatment-related factors did not materially alter the estimates.

Higher pre-TIA PA was associated with substantially lower crude hazards of subsequent ischaemic and total stroke, but these associations were attenuated after accounting for age and remained similar with further adjustment. Pre-TIA PA may therefore reflect broader health and vascular risk rather than show a strong independent association with recurrence. However, imprecise estimates for moderate/vigorous PA remain compatible with a potentially lower stroke hazard and warrant further investigation.

Evidence regarding optimal haemodynamic parameters and prognostic predictors in right ventricular dysfunction (RVD) remains limited. The aim of this study was to examine the relationship between haemodynamic parameters and cardiac output (CO) in RVD and to identify clinically relevant prognostic predictors.

This retrospective, single-centre cohort study analysed data from patients with heart failure complicated by RVD between 2014 and 2024. RVD was defined as Pulmonary Artery Pulsatility Index <1.85 and right atrial pressure (RAP)/pulmonary artery wedge pressure ratio >0.63. Two substudies were conducted: Study A assessed the relationship between CO and haemodynamic parameters derived from right heart catheterisation (RHC) and Study B evaluated the prognostic value of haemodynamic indices in RVD. The primary outcome of Study B was a composite of all-cause death and heart failure hospitalisation.

A total of 202 RHC examinations from 155 patients (median age 69 years, 66% male) were analysed. In Study A, cardiac output was highest at an RAP of approximately 10-15 mm Hg and declined beyond this level. CO showed a non-linear association with heart rate in sinus rhythm, reaching its peak at around 80 beats per minute. In Study B, 34 patients experienced the primary outcome during a median follow-up of 1.4 years. Those who experienced the primary outcome had higher RAP and lower pulmonary artery (PA) compliance. In Kaplan-Meier analysis, RAP >10 mm Hg (median) and PA compliance <4.9 mL/mm Hg (median) were associated with the primary outcome (p=0.004 and p=0.005, respectively). On multivariable Cox regression analysis, PA compliance <4.9 mL/mm Hg was a predictor of the primary outcome, while RAP >10 mm Hg was not.

In patients with RVD, CO was highest at an RAP of 10-15 mm Hg. Among those with sinus rhythm, heart rate showed a non-linear association with CO. Low PA compliance was a predictor of adverse events.

The additional impact of coexisting Sjögren's syndrome (SS) on cardiac involvement in patients with systemic lupus erythematosus (SLE) remains insufficiently understood. This study aimed to investigate the association of coexisting SS with cardiac function and left ventricular (LV) remodelling in patients with SLE using cardiac magnetic resonance (CMR) imaging.

The study included 36 consecutive patients with SLE and coexisting SS, 36 patients with SLE without SS and 20 age- and sex-matched healthy controls who underwent CMR. LV global strain parameters, native T1 and T2 values, extracellular volume fraction(ECV) and late gadolinium enhancement (LGE) were compared among the three groups. Univariable and multivariable linear regression analyses were performed to investigate the associations of coexisting SS with LV global strain and myocardial mapping parameters.

Patients with SLE and coexisting SS had the lowest global longitudinal strain (GLS) between the three groups (-14.21% (-16.74, -12.81) vs -16.38% (-17.73, -14.25) vs -17.09% (-17.63, -12.97), p=0.030). However, there were similar global circumferential strain and global radial strain between those three groups (p>0.05). Native T1 values were highest in patients with SLE and coexisting SS (1302 ms (1266, 1338) vs 1265 ms (1216, 1289) in patients with SLE without SS and 1262 ms (1241, 1314) in healthy controls, p=0.016). Similarly, ECV was highest in the SLE-with-SS group (29.00% (27.00, 31.00) vs 27.50% (25.25, 29.00) and 27.00% (25.00, 29.00), respectively, p=0.019). Native T2 values did not differ significantly among the three groups (p>0.05). LGE was detected in 30.56% of patients with SLE and coexisting SS and 25.00% of patients with SLE without SS, with no significant between-group difference (p=0.792). Among all patients with SLE, coexisting SS was independently associated with impaired GLS (β = -0.211, p=0.041), higher native T1 (β=0.227, p=0.048) and higher ECV (β=0.268, p=0.009).

Coexisting SS was independently associated with greater subclinical LV dysfunction and more pronounced myocardial tissue abnormalities in patients with SLE. These findings suggest that SS may contribute additional cardiac involvement in SLE, although prospective longitudinal studies are required to determine its clinical and prognostic significance.

OBJECTIVES: The objective of this study is to evaluate the effect of a continuous remote patient monitoring (CRPM) program on reducing 30-day readmissions in a case-versus-retrospective-propensity-matched-control study of heart failure (HF) patients.

METHODS: The study was conducted at Endeavor Health (formerly known as NorthShore University HealthSystem), Evanston, IL, in three post-soft launch phases: Phase IIa, IIb, and Phase III. HF patients were monitored for 30 days postdischarge with wearable biosensors to collect continuous ambulatory physiological data and a study phone for capturing patient-reported outcomes via daily surveys. Sensor data were analyzed by rules-based and machine learning algorithms to alert on physiologic perturbation. Platform alerts and survey data were monitored by home health nurses (HHNs) who assessed patients and, following a structured escalation pathway, referred them to HF advanced practice providers (APPs) or physicians for further management.

RESULTS: A total of 39 patients completed the study. Baseline characteristics were appropriately matched in all categories with the exception of the New York Heart Association (NYHA) classification (intervention vs. control, class II: 10.3 vs. 41.0%, class III: 76.9 vs. 53.8%, class IV: 12.8 vs. 5.1%; p = 0.006). The intervention group had more patients who received HF APP calls (66.7 vs. 7.7%; p ≤ 0.001), HF APP visits (43.6 vs. 5.1%; p < 0.001), HF physician visits (64.1 vs. 41.0%; p = 0.041), diuretic escalation (43.6 vs. 12.8%; p = 0.006), and laboratories within 30 days of discharge (76.9 vs. 43.6%; p = 0.005). There was no significant difference between the adjusted 30-day readmission rates for the intervention and control groups (0.31, 95% confidence interval [CI]: 0.06-1.38; p = 0.138). All-cause readmissions occurred, but none were due to HF in phases IIa, IIb, and III.

CONCLUSION: Integrating CRPM directly into clinical workflows is feasible but challenging. Further research with larger patient cohorts and an adequately powered randomized trial is required to robustly evaluate the role of CRPM, machine learning algorithms, and cascading workflows in reducing 30-day readmissions.

Medication nonadherence in patients with myocardial infarction (MI) is a key obstacle to managing cardiovascular disease. However, there is a lack of studies, particularly randomized controlled trials (RCTs), focusing on objective measures of medication adherence behavior.

This study aimed to (1) characterize daily medication adherence behavior and dose consistency using objective digital bottle cap data in patients post-MI enrolled in the Dapagliflozin in Patients with Myocardial Infarction (DAPA-MI) RCT, (2) identify patient and contextual factors associated with nonadherence, and (3) assess whether dose consistency is associated with adherence over time.

DAPA-MI was a phase 3, double-blind, placebo-controlled RCT evaluating the effect of 10 mg of dapagliflozin versus a placebo given once daily, in addition to standard-of-care therapy, on adults hospitalized for MI. This post hoc analysis used 733,490 timepoints from a digital bottle cap that recorded when study drug bottles were opened. Adherence and dose consistency were evaluated using mixed-effects regression. Adherence was defined at the patient-day level as at least one bottle opening on a given day. Dose consistency was derived from the day-to-day variation in timing of the first recorded opening event. Digital cap data were linked with demographic, clinical, behavioral, and contextual variables to assess factors associated with nonadherence and lower dose consistency over time.

In total, 2429 participants were included in the analysis. Features associated with lower adherence included age <40 years (odds ratio [OR] 0.47, 99.9% CI 0.23-0.98), current smokers (OR 0.67, 99.9% CI 0.51-0.87), nonworking days, and serious adverse events. Higher adherence was associated with the New York Heart Association (NYHA) functional class III/IV (OR 1.48, 99.9% CI 1.18-1.86), low (<15 min) 7-day average time variance (OR 1.99, 99.9% CI 1.78-2.23), and morning medication use. Lower dose consistency was observed in patients aged 40-50 years (dose consistency ratio [DCR] 1.23, 99.9% CI 1.03-1.47), in current smokers (DCR 1.16, 99.9% CI 1.03-1.31), and on weekends, while patients with severe angina grading (DCR 0.83, 99.9% CI 0.74-0.94) or morning medication use (DCR 0.88, 99.9% CI 0.86-0.90) had higher dose consistency. Patients with early high dose consistency tended to maintain better adherence over time, whereas missed-dose streaks and routine disruptions were associated with worsening consistency.

This study demonstrated the value of objective, continuous digital medication adherence behavior monitoring within a large RCT. Unlike studies relying on self-reported or prescription data, it quantified both adherence and dose consistency at scale, revealing a strong association between them. The findings indicate that temporal irregularity of medication taking may serve as a practical behavioral marker for identifying patients at increased risk of future nonadherence. These findings may advance medication adherence behavior research and inform behavior change interventions, remote monitoring strategies, and predictive adherence models.