Acute anterior ischaemic optic neuropathy (AION) is a feared ischaemic complication of giant cell arteritis (GCA). However, distinguishing arteritic AION (A-AION) from its non-arteritic counterpart (NA-AION), which accounts for approximately 90% of cases, can be challenging. Rapid initiation of glucocorticoids is essential to prevent irreversible vision loss in GCA but is unnecessary in NA-AION. This study evaluated the use of orbital MRI in differentiating A-AION from NA-AION.

In this prospective single-centre study, patients >50 years who had recent-onset AION were enrolled between June 2021 and October 2024. The final diagnosis of GCA was confirmed after comprehensive assessments and ≥6 months follow-up. Orbital MRIs were independently evaluated by two experienced radiologists blinded to the clinical diagnosis.

Of the 18 patients analysed, nine had A-AION (two with bilateral involvement), while nine had NA-AION. MRI demonstrated differences between the groups, notably in contrast enhancement of the ophthalmic artery (72.7% vs 22.2%; p=0.07), perineural fat (90.9% vs 22.2%; p=0.005) and retrobulbar fat (100% vs 11.1%; p<0.001). The most discriminative MRI feature was retrobulbar fat enhancement, achieving 100% (95% CI 72 to 100) sensitivity and 89% (95% CI 52 to 100) specificity. Bilateral orbital enhancement was identified in more than half of the unaffected contralateral eyes in A-AION patients.

These results suggest that orbital MRI may help clinicians rapidly differentiate between A-AION and NA-AION to provide the most appropriate treatment.

Invasive coronary function testing (CFT) is indicated in patients with refractory angina with non-obstructed coronary arteries (ANOCA). Despite this, questions remain regarding patient selection for testing, safety and integration of CFT within clinical pathways and the impact that endotyping has on long term management of these patients. This study aims to investigate the safety of CFT in patients presenting with anginal chest pain, the prevalence of ANOCA endotypes in the tested population, and the impact of CFT on prescribed medical therapy and secondary care resource utilisation.

A retrospective analysis of electronic case records of 159 consecutive patients who underwent complete invasive CFT at two UK centres between June 2022 and December 2024 was performed. All patients were tested for endothelium-independent coronary microvascular dysfunction (CMD) and coronary vasospasm (vasospastic angina (VSA)). 44 patients (27.6%) also underwent endothelial function assessment. The median length of follow-up was 9 months (IQR 4-16).

An ANOCA endotype was identified in 101 patients (63.5%) (CFT+ve). Of those, 24 (23.8%) were diagnosed with isolated CMD, 53 (52.4%) with isolated VSA and 24 (23.8%) with a mixed endotype. Five (3.1%) experienced intraprocedural adverse events. In 123 patients (77.3%), CFT led to a change in medical therapy. Re-hospitalisation for recurrent chest pain occurred in 21.7% of CFT+ve and 13.7% of CFT-ve patients, with the majority re-presenting within 6 months of CFT. VSA was linked to higher re-hospitalisation odds (OR 2.64 (1.10-6.33), p=0.03), and patients with VSA tended to re-present earlier than others (p=0.017). Higher antianginal therapy prescription and prior emergency presentations were also predictive of risk of re-presentation (OR 1.61, p=0.02 and OR 4.18, p=0.001, respectively).

CFT testing had low intraprocedural risk and influenced onward management. Hospitalisation for chest pain post CFT testing was common. Further refinement of clinical pathways, including early follow-up for medical optimisation, is suggested.

Rapid response systems (RRSs) are designed to detect and treat physiological deterioration before cardiac arrest occurs. Since 2020, Japan has seen a rapid increase in RRS adoption; however, most new team members have not received formal training in critical care. This review synthesises international and Japanese evidence supporting implementation and training for new members.

PubMed, Web of Science and Ichushi Web were searched for English or Japanese studies evaluating adult RRSs (January 2010-April 2025). We included 47 records (43 comparative and 4 systematic reviews); the national guideline was not included.

Mature RRSs were associated with a 35% relative reduction in unexpected in-hospital cardiac arrests and a 12% decrease in all-cause hospital mortality. However, the evidence is not uniformly positive-systematic reviews and multicentre analyses reported no significant mortality benefit-and outcome heterogeneity limits comparability. Effective programmes share three key features: (1) single-parameter activation criteria augmented by early-warning scores; (2) tiered response models for advanced practice nurses and (3) audit-feedback cycles with dashboards. Crew resource management, in situ simulation and mindfulness-based self-leadership approaches may be associated with reduced decision latency. Emerging tools like deep-learning prediction algorithms, continuous wearable monitoring and tele-support systems may expand coverage but require governance. Common barriers include limited night-time staffing, cultural reluctance to escalate care and medicolegal ambiguity; targeted education and registry-driven feedback mitigate challenges.

Well-structured RRSs improve outcomes beyond traditional code-blue models. Aligning activation thresholds, multidisciplinary competencies and data-driven quality improvement cycles with local resources may help new Japanese rapid response team members develop resilient, high-performing services.

The current German treatment guideline for chronic ischaemic heart disease (IHD) recommends that general practitioners (GPs) deliver brief advice on physical activity (PA) to patients with IHD. Such advice consists of at least three elements (ie, 3As): (1) assessing the PA level, (2) advising on PA and (3) assisting with recommendations. This study examined the extent to which individuals with self-reported IHD in Germany reported the receipt of such advice.

Cross-sectional population-based face-to-face survey (from June 2023 to August 2024).

Households across Germany.

1004 individuals aged 35+ years with self-reported IHD and GP contact.

Primary outcome: self-reported proportions of receipt of GP-delivered PA advice according to the 3As. Main secondary outcome: associations between person characteristics and the likelihood of receiving PA advice.

Among individuals with self-reported IHD, 36.4% (95% CI 33.4% to 39.4%) received all 3As of PA advice, 42.1% (95% CI 39.1% to 45.2%) received one or two elements, 9.9% (95% CI 8.1% to 11.8%) received no advice at all and 3.8% (95% CI 2.7% to 5.1%) were advised to avoid PA (7.9% did not remember/refused to answer). Women (vs men) were more likely to receive no advice (OR=1.74, 95% CI 1.11% to 2.72%), while middle (vs younger) aged individuals (OR=0.46, 95% CI 0.22% to 0.99%), those with PA levels of 1-149 min/week (vs no PA; OR=0.16, 95% CI 0.08% to 0.31%) and of 150+ min/week (vs no PA; OR=0.13, 95% CI 0.07% to 0.23%) and those with higher (vs lower) education (OR=0.39, 95% CI 0.20% to 0.76%) were less likely to receive no advice. Individuals living in urban (vs rural) areas (OR=0.65, 95% CI 0.46% to 0.88%) and those with PA levels of 1-149 min/week (vs no PA; OR=0.59, 95% CI 0.37% to 0.95%) and of 150+ min/week (vs no PA; OR=0.55, 95% CI 0.36% to 0.84%) were less likely to receive only one or two (vs all) of the 3As. Of those who received at least one element of advice (n=788), 72.5% reported they were more active afterwards, with a higher proportion when all 3As (vs only some elements) were provided (86.8% vs 59.6%).

Only one-third of individuals with self-reported IHD in Germany received comprehensive PA advice. Specific person characteristics, such as female gender and lower education, were associated with lower proportions of received PA advice. Efforts are needed to improve GP-led PA guidance, particularly for underserved groups.

German Clinical Trials Register (DRKS00031304).

The prognostic value of left atrial (LA) strain in patients with heart failure with reduced ejection fraction (HFrEF) has not been fully elucidated. Therefore, this study investigated the prognostic value of LA strain in HFrEF patients in relation to all-cause mortality.

A total of 822 echocardiograms from HFrEF patients admitted to a heart failure clinic were analysed offline. To calculate left atrial reservoir strain (LA RS) and left atrial contractile strain (LA CS), LA two-dimensional speckle tracking was performed in the 4-chamber, 2-chamber and 3-chamber view. The end-point was all-cause mortality. The association between LA strain parameters and outcome was examined using Cox regression.

The median follow-up time was 40 months and follow-up was 100% complete. During follow-up, a total of 137 patients (16.7%) died of all causes. In a final multivariable model adjusted for clinical and echocardiographic parameters including global longitudinal strain, LA RS and LA CS were significantly associated with all-cause death during follow-up (LA RS, HR 0.96, 95% CI 0.92 to 0.99, p=0.014, pr. 1% increase) (LA CS, HR 0.95, 95% CI 0.92 to 0.98, p=0.002, pr. 1% increase).When added to the final multivariable model, both LA RS and LA CS contributed with incremental prognostic value as determined by C-statistic (LA RS: C-stat difference 0.007, 95% CI 0.000 to 0.020, p=0.050) (LA CS: C-stat difference 0.009, 95% CI 0.000 to 0.023, p=0.030).

In HFrEF patients, LA RS and LA CS were associated with all-cause mortality and contributed incremental prognostic value in addition to established prognostic measures.

Heart failure (HF) is associated with complex symptoms and frequent hospitalisation that reduce patients' quality of life (QoL). This study aims to assess the association between angiotensin receptor-neprilysin inhibitor (ARNI) use and changes in QoL and disease-related outcomes among patients with HF in Jordan.

Prospective observational cohort study.

The study was conducted among patients with HF attending the outpatient cardiology clinics at Jordan University Hospital, a tertiary care centre in Amman, Jordan. Patients either initiated on ARNI or receiving angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) were included in the study at a 1:2 ratio. All participants were followed up for up to 1 year after recruitment. The study period was from 4 February 2024 to 29 May 2025.

Data on QoL, New York Heart Association (NYHA) functional class and left ventricular ejection fraction (LVEF) were collected at baseline and after 3 months of treatment. Hospitalisation data were collected for the preceding year and the year following participants' recruitment. Medication adherence and ARNI side effects were assessed after 3-month of follow-up period.

A total of 227 patients with HF were included; 74 were initiated on ARNI, and 153 were receiving ACEIs/ARBs. At baseline, significantly lower QoL scores and LVEF were observed in the ARNI group compared with the ACEIs/ARBs group. After 3-month, the ARNI group showed improvements in all QoL scores, NYHA functional class and LVEF (p<0.05). Worsened QoL scores (symptom stability, symptom burden, self-efficacy domains and clinical summary score) were detected within the ACEIs/ARBs group (p<0.05). One-year post-recruitment a significant reduction in cardiovascular and all-cause hospitalisations (p<0.05) was observed in the ARNI group compared with the ACEIs/ARBs group. Adherence levels assessed after 3 months of treatment were shown to be high in both study groups (p=0.558). The main ARNI side effect was hypotension.

ARNI use was associated with favourable QoL, NYHA class, and LVEF as well as lower hospitalisation rates among patients with HF in Jordan. The safety profile was consistent with previous studies.

Hand dysfunction following stroke, especially during the flaccid paralysis phase, significantly impairs patients' motor abilities and daily functioning. Electroacupuncture (EA) is widely used in post-stroke rehabilitation; however, inconsistent clinical outcomes and lack of standardised treatment parameters have limited its broader adoption.This protocol describes a randomised controlled trial designed to determine optimal EA parameters for post-stroke hand dysfunction using an orthogonal experimental design.

This protocol presents a single-centre, randomised controlled trial design with 10 arms. A total of 110 patients with post-stroke hand dysfunction will be randomly assigned to nine electroacupuncture groups or one sham acupuncture group in equal proportions. Participants will receive 12 treatment sessions over 2 weeks. The EA groups are designed based on a four-factor, three-level orthogonal design to systematically evaluate the main effects of acupoint selection, stimulation frequency, needle thickness and treatment duration. The primary outcome is the effective response rate, defined as reduction in the Chinese Stroke Scale (CSS) score at 2 weeks. Secondary outcomes include assessments with the Modified Lindmark Rating Scale, range of motion measures, Modified Barthel Index and hand motor subscores of the CSS. As this is a trial protocol, results are not yet available. Statistical analyses will be conducted after completion of recruitment and follow-up according to the prespecified analysis plan. Safety and adverse events will be monitored throughout the study.

This trial is designed to address the current lack of evidence-based standardisation of EA parameters for post-stroke hand dysfunction. By systematically evaluating key treatment components using an orthogonal experimental design, the study aims to identify optimal EA strategies and provide a methodological framework to improve consistency, reproducibility and clinical effectiveness in post-stroke hand rehabilitation.

This manuscript describes a study protocol and does not report any data from participants at this stage. Ethical approval for the planned trial was obtained from the Medical Ethics Committee of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine (Approval No. TYLL2024(K)072). Written informed consent will be obtained from all participants prior to enrolment. The results of the study will be disseminated through peer-reviewed journals and academic conferences.

ITMCTR2024000819.

Heart failure (HF) is a prevalent condition among older adults in Canada, often leading to reduced quality of life and frequent hospitalizations. HF disease management interventions, particularly those delivered through telehealth, aim to improve care by fostering self-care and reducing readmissions. However, disparities in access to and use of HF telehealth services persist among vulnerable populations.

This study aimed to present the findings of a scoping review and a rapid realist synthesis of HF telehealth interventions for vulnerable groups of patients with HF. This review is underpinned by the metatheory of critical realism and intersectionality theory.

A rapid realist synthesis of the retrieved literature was undertaken to explore the underlying mechanisms and contexts that make HF telehealth interventions work or not work for marginalized groups of patients with HF.

The realist review findings indicated that vulnerable patients require simple interventions. The findings also suggested that for effective use of telehealth and remote monitoring services, these patients require simplified training that could increase their confidence. The review findings further demonstrated that involving patients' family members in the delivery of telehealth interventions ensures success.

Future research with vulnerable populations should be underpinned by the critical realism and intersectionality theory and should apply the principles of intersectionality at all stages of the research process, including evaluation and analysis. This review also urges HF practitioners to apply the principles of intersectionality and health equity in clinical practice, such that interventions are simple and personalized, involve family members, include an in-person component, provide training for patients and health professionals, and integrate telemonitoring data.

Heart failure (HF) is a prevalent chronic condition for which optimal management depends not only on guideline-directed medical therapy but also on patients' understanding of their disease, recognition of warning signs, and sustained medication adherence, which remains challenging in routine care. Mobile health interventions may support therapeutic education and self-management; however, many available apps lack validated content and local relevance. Cardio-Meds is a mobile app developed at Geneva University Hospitals to support HF self-management through structured educational content, interactive quizzes, medication lists with reminders, and tools for monitoring weight and vital signs.

This study aims to evaluate the impact of a 30-day Cardio-Meds intervention on HF knowledge and medication adherence in patients with HF with reduced or mildly reduced ejection fraction.

We conducted a single-center, pilot randomized controlled trial in patients followed at the outpatient HF clinic or enrolled in cardiac rehabilitation at Geneva University Hospitals in 2024. Eligible participants had HF with a left ventricular ejection fraction less than 50%, were receiving HF-specific pharmacotherapy, speak French, and owned a smartphone. Participants were recruited by phone and randomized to Cardio-Meds use for 30 days, a self-guided intervention with a single standardized technical support call. Outcomes were self-assessed using standardized questionnaires: HF knowledge and self-management using the Dutch Heart Failure Knowledge Scale (DHFKS; score range 0-15); medication adherence using the Basel Assessment of Adherence to Immunosuppressive Medication Scale, covering initiation, implementation, and persistence; and usability in the intervention group using the System Usability Scale (score range 0-100). Between-group differences in DHFKS scores were analyzed using analysis of covariance adjusted for baseline values.

A total of 49 participants were included (25 intervention, 24 control); 78% (n=38) were male, and the mean age was 62 (SD 11.4) years. In the intervention group, median app usage was 123 (IQR 74-273) minutes, with a median of 43 (IQR 19-85) logins. Mean baseline DHFKS scores were similar between groups (intervention 11.1, SD 2.4 vs control 10.5, SD 2.9). At 30 days, mean scores increased significantly in the intervention group (12.4, SD 2.4; mean change +1.3; P<.001) and remained stable in the control group (10.4, SD 3; mean change -0.1; P=.82), with a significant adjusted between-group difference of +1.3 points (P<.001). No significant between-group differences were observed for medication adherence. Usability was high, with a mean score of 84.3 (SD 15), and 64% (16/25) of intervention participants reported that they would continue using the app.

In a stable ambulatory HF population, the Cardio-Meds intervention demonstrated short-term improvement in HF knowledge, while no effect was observed on medication adherence within the 30-day follow-up period. The app showed high usability and acceptability. Larger multicenter studies with longer follow-up are needed to assess clinical impact.

Variations in thrombus composition significantly influence the efficacy of conventional thrombolytic therapies in acute ischemic stroke. Emerging treatments, designed to target distinct components of the thrombus, are currently under evaluation and offer renewed hope for enhancing clot dissolution and improving clinical outcomes. This review will examine the current evidence surrounding glycoprotein IIb/IIIa inhibitors in the treatment of acute ischemic stroke, drawing on the latest randomised-controlled trials, identifying promising therapeutic candidates and evaluating the clinical contexts in which these agents are most likely to be beneficial.