A new application developed at the University of Turku, Finland, can detect atrial fibrillation that causes strokes. Atrial fibrillation can be detected with the mobile phone application without any extra equipment. The mobile application can save lives all over the world as timely diagnosis of atrial fibrillation is crucial for effective stroke prevention.
The joint research project of the University of Turku and the Heart Centre of the Turku University Hospital studied three hundred patients with heart problems, half of whom had atrial fibrillation. The researchers managed to identify the patients with atrial fibrillation from the other group with a smart phone.
The mobile application that was developed at the Department of Future Technologies of the University of Turku detected which patients had atrial fibrillation even with a 96-percent accuracy. In other words, the application recognised automatically nearly all cases with atrial fibrillation and the number of false alarms was very low.
– The results are also significant in that the group included different kinds of patients, some of whom had heart failure, coronary disease, and ventricular extrasystole at the same time. The research was conducted as a blind study, which means that the hospital sent us measurement data for analysis without any additional information, says Project Manager Tero Koivisto from the Department of Future Technologies.
The completed analyses were sent back to the hospital where their reliability was checked. This way, additional optimisation during the study on the basis of the data was not possible.
– At first, I was rather anxious about how well the algorithm will do in the blind study, especially because I felt that the patient group was particularly challenging. You could say that I was surprised myself how well it worked in the end, says Mr Koivisto.
University of Torkuwww.utu.fi/en/news/news/Pages/Mobile-Application-Detecting-Atrial-Fibrillation-Reduces-the-Risk-of-Stroke.aspx

The first keynote speakers for the 42nd World Hospital Congress have been announced! The World Hospital Congress will be held on 10-12 October in Brisbane, Australia and health sector leaders and patients will be examining the question “How can healthcare evolve to meet 21st century demands?”

Each day will look at this question from a different angle. On day one, under the sub-theme “From Volume to Value” the topics covered will address the global movement that is changing the focus of hospitals from volume of services and activities to the value of outcomes achieved.

Along with respected leaders from the value-based healthcare movement you will hear from Chris Pointon, co-founder of #hellomynameis as he shares the inspiring story of the campaign that he and his late wife Dr Kate Granger MBE founded to improve patient care through the basic message of introductions.

Day two’s sub-theme “From Four Walls to the Neighbourhood” will examine the role of hospitals in the broader medical community, how primary, acute and community care can be better integrated and how integrated approaches can provide better health outcomes.

Integrated care innovation, education and research expert Prof Claire Jackson from the University of Queensland will provide insights into health system reform and integration during her keynote speech.

Nigel Edwards, Chief Executive of Nuffield Trust will share his views, along with many he has collected from the clinicians and managers he meets and works with, on the transformation required to build high-performing health systems.

The sub-theme for the final day of the congress “From Information to Intelligence” will look at the impact the information and technology revolution has had, but more importantly the impact it will have in the future.

Prof Jeffrey Braithwaite, Foundation Director of the Australian Institute of Health Innovation in Macquarie University will bring together research on health reform in 152 countries and territories to examine how health systems are heading towards and dealing with issues such as universal healthcare, affordability and resource allocation and coping with shifting population dynamics.

Other keynote speakers confirmed to date are Dr Daphne Khoo, Deputy Director Medical Services (Healthcare Performance Group) of the Ministry of Health Singapore, Harold F. Wolf III, President & CEO of HIMSS, Melissa Thomason, Patient and Family Advisor from the USA, and Dr Karen Knight, General Manager Advocacy and Engagement / QLD, NSW & NT Client Services at Vision Australia.

More will be announced soon. To find out more about these speakers, click here.

The early bird registration ends on 30 June. IHF members get bigger discounts. To find out if your hospital or association is a member, click here or email 2018congress@ihf-fih.org to get your discount code.

For more information about the Congress and to register visit: www.hospitalcongress2018.com

A new combination therapy for the first-line treatment of advanced non-squamous non-small-cell lung cancer (NSCLC) improves progression-free survival (PFS), according to results of the phase III IMpower150 trial presented at the ESMO Immuno Oncology Congress 2017.
“This is the first phase III trial to report on the combination of chemotherapy, antiangiogenic treatment and immunotherapy as first-line treatment for advanced non-squamous NSCLC,” said lead author Professor Martin Reck, chief oncology physician, Department of Thoracic Oncology, Lung Clinic Grosshansdorf, Germany. “The trial met its co-primary endpoint of PFS and the preliminary results of the co-primary endpoint of overall survival (OS), although immature, look encouraging.”
There is a scientific rationale to support the combinations that have been explored in the trial. Bevacizumab may enhance the ability of atezolizumab to restore anti-cancer immunity by inhibiting vascular endothelial growth factor (VEGF)-related immunosuppression and other mechanisms while chemotherapy may induce immune responses. The chemotherapy used in the trial was carboplatin plus paclitaxel. Atezolizumab is a monoclonal antibody that inhibits programmed death-ligand 1 (PD-L1), while bevacizumab is a biologic antiangiogenic drug.
IMpower150 enrolled 1,202 patients who were randomized to one of three arms: A) chemotherapy plus atezolizumab; B) chemotherapy plus atezolizumab plus bevacizumab; or C) chemotherapy plus bevacizumab.
The PFS survival comparison was made between arms B and C and showed that the combination of atezolizumab, bevacizumab and chemotherapy was superior to bevacizumab and chemotherapy alone with a median PFS of 8.3 versus 6.8 months (hazard ratio [HR] 0.62; 95% confidence interval [CI] 0.52, 0.74; P < 0.0001) in the intention-to-treat (ITT) wild type (WT) population, which excluded patients with epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangements.
The corresponding median PFS in the Teff-WT population, which included patients with defined expression of a T-effector gene signature in the tumour tissue, was 11.3 versus 6.8 months (HR 0.51; 95% CI 0.38, 0.68; P < 0.0001). PFS benefit was seen regardless of PD-L1 immunohistochemistry status, including PD-L1–negative pts (TC0/IC0: HR 0.77; 95% CI 0.61, 0.99).
There were no new safety signals with the combination therapy. Due to prespecified testing hierachy, Arm A versus C has not been formally tested yet.
Reck said: “There was a significant and clinically relevant improvement in progression-free survival favouring the addition of atezolizumab to bevacizumab and chemotherapy. The results show that there is a way to improve the efficacy of platinum-based chemotherapy in patients with advanced non-squamous NSCLC. There were no new safety signals or toxicity issues with this combination so it appears to be a feasible  approach for this group of patients.”
ESMOhttps://tinyurl.com/y9tqg5tl

Patients who survive a brief cardiac arrest and who appear neurologically intact should nonetheless receive a detailed neuropsychological assessment before being discharged, suggests a joint study by researchers at Baycrest’s Rotman Research Institute (RRI) and Israel’s Rambam Medical Center.
The study found that patients discharged in “good neurological condition” after a brief cardiac arrest (when the heart suddenly stops beating normally and cannot pump blood effectively) had significant memory problems and a 10 to 20 per cent reduction in size of their brain’s memory region, the hippocampus. Individuals who performed worse on memory tests showed greater changes to their hippocampus.
In Canada and the U.S., 464,000 people suffer a cardiac arrest outside of a hospital with an average of 46,400 people (10 per cent) surviving these incidents annually. It’s estimated that 20 to 50 per cent of these survivors continue to experience memory and cognitive problems that impact their quality of life.
Comprehensive neuropsychological testing could provide cardiac arrest survivors better support for the challenges they may face upon discharge, says Dr. Vess Stamenova, first author on the study and a postdoctoral fellow at the Women’s College Hospital, who completed the research during her time as a fellow at the RRI.
“Identifying patients at risk will allow cardiac arrest survivors to have appropriate recommendations for rehabilitation before they are discharged,” says Dr. Stamenova. “These people may go home and think they are neurologically fine, but then they realize things have changed and they may not be able to do their job, and it can be difficult for them to figure out where to seek help.”
Dr. Stamenova adds that a comprehensive neurological consult would be helpful to patients, since individual cognitive screening measures such as the Cerebral Performance Category Scale, Mini Mental Status Examination and the Montreal Cognitive Assessment, cannot detect the memory problems faced by cardiac arrest survivors.
This joint study conducted neuropsychological assessments and brain imaging on 18 patients who either had a heart attack or brief cardiac arrest at the Rambam Medical Center in Haifa, Israel. Patients who had cardiac arrests lasting for a brief period before receiving CPR (less than three minutes on average) were tested between two to four years after the incident.
The hippocampus is known to be sensitive to a lack of oxygen, but the effect is larger than expected, says Dr. Stamenova. This is the first study to capture brain imaging of patients who had short cardiac arrests. Previous research has looked at animals or patients with more prolonged cardiac arrest.
“Unfortunately cardiac arrest survivors may return home after the incident without a clear understanding of their memory deficits or access to rehabilitation programs,” says Dr. Asaf Gilboa, the paper’s senior author, scientist at the RRI and assistant professor of psychology at the University of Toronto. “Arming these patients with appropriate resources will improve their recovery and allow them to resume their day-to-day activities.”
Baycrest’s Rotman Research Institutewww.baycrest.org/Baycrest-Pages/News-Media/News/Research/brief-cardiac-arrest-tend-to-the-heart

Women with peripartum cardiomyopathy are at increased risk of cancer
Girls who survive cancer have a higher risk of developing a deadly heart disease when pregnant later in life, according to a study presented on August 27 at Heart Failure 2018 and the World Congress on Acute Heart Failure, a European Society of Cardiology congress.
 
Researchers say young cancer survivors should be warned of this pregnancy-associated heart failure called peripartum cardiomyopathy so that they can be closely monitored. Separately, the researchers found that women with existing peripartum cardiomyopathy are at increased risk of developing cancer.
 
“Our finding that cancer and peripartum cardiomyopathy share some biological markers in the blood suggests that there is a physiological connection between these diseases,” said Professor Denise Hilfiker-Kleiner, author of the study and Dean of Research in Molecular Cardiology, Hannover Medical School, Germany.
 
Peripartum cardiomyopathy is a life-threatening type of heart failure where the heart becomes enlarged and weak in late pregnancy or after childbirth. It occurs in about one in 1,000 pregnant women worldwide.2 “Without treatment, up to 30% of women die and less than half of patients fully recover,” said Professor Johann Bauersachs, Director of the Department of Cardiology and Angiology, Hannover Medical School.
 
“It has been suspected, without having real data, that cardiotoxic anticancer treatment injures the heart and years later a second stress on the heart like pregnancy induces cardiomyopathy,” said Professor Hilfiker-Kleiner. “Our study provides evidence for links between the two diseases.”
 
The two-part study was conducted using German registry data. In part one, Stella Schlothauer, a young medical student in Professor Hilfiker-Kleiner’s lab, compared the ten-year prevalence of cancer, which occurred before or after peripartum cardiomyopathy in 207 women to the ten-year cancer prevalence in the general population of women aged 0–49 years in Germany.
 
Thirteen of the 207 women with peripartum cardiomyopathy had cancer during the ten-year period – a prevalence of 6.3%. One woman had two cancers. Of the 14 cancer diagnoses, nine occurred before peripartum cardiomyopathy and five occurred after peripartum cardiomyopathy. The ten-year cancer prevalence in the general population of women in Germany aged 0–49 years was 0.59%.
 
Professor Hilfiker-Kleiner said: “Women with peripartum cardiomyopathy had ten times more cancer, either before or after their heart failure, than the general population of women. About two-thirds of cancers occurred in children or young adults who then developed peripartum cardiomyopathy, while one-third were diagnosed two to three years after peripartum cardiomyopathy. We think there may be genetic or epigenetic factors which make women more prone to both diseases. This is on top of the long-term cardiotoxic effects of anticancer therapies.”
 
In part two, the researchers analysed the blood of 47 women with peripartum cardiomyopathy and 29 healthy women of the same age and time since pregnancy to look for peptides and proteins associated with cancer. Levels of several of these cancer markers were higher in the peripartum cardiomyopathy group – for example human epidermal growth factor receptor 2 (HER2), a protein which is elevated in around one in five breast cancers. Compared to healthy women, cancer markers were elevated in women with peripartum cardiomyopathy regardless of whether or not they had previous or subsequent cancer during the study.
 
“Cancer survivors should be warned that they are at increased risk of pregnancy-associated heart failure,” said Professor Hilfiker-Kleiner. “These are high-risk pregnancies and women need close monitoring of their hearts for any sign of heart failure. We need more data so that we can tell pregnant women with a history of cancer how high their risk of developing a second deadly disease is.”
 
“Women who develop peripartum cardiomyopathy are at higher risk of subsequent cancer and should make sure they attend routine cancer screening,” she said.