Objectives To compare the outcomes of transfemoral ACURATE neo (NEO) and Sapien 3 (S3) patients in terms of device success and clinical safety outcomes using a propensity score analysis. Background Differences in clinical outcomes between the latest‐generation balloon‐expandable S3 and self‐expanding NEO in a “real‐world transfemoral TAVI population” are still unclear. Methods We compared up to 6 months clinical outcomes using a propensity score analysis (inverse probability of treatment weighting [IPTW]) to account for differences in baseline characteristics. Results A total of 345 patients underwent transfemoral transcatheter aortic valve implantation (TAVI) with either NEO or S3 at two centers in the Netherlands. Composite device success and early safety endpoints were comparable between NEO and S3 (Device success: IPTW‐adjusted OR: 0.35 [95% CI: 0.12–1.18], and early safety: IPTW‐adjusted OR: 0.51 [95% CI: 0.19–1.38]). Six‐months mortality was 5.3 versus 3.6%, stroke was 2.8 versus 3.3%, and pacemaker rate was 6.1 versus 8.6%, respectively with p = NS. Mean aortic gradient was lower in the NEO group (5.72 ± 2.47 vs. 9.05 ± 3.48; p = <.001), with a comparable rate of moderate or severe paravalvular leak (0 versus 2.1%; p = NS). Conclusions Device success and clinical safety outcomes were comparable for both valves. Up to 6‐months follow‐up clinical outcomes and mortality rate remained excellent. Mean aortic gradient was lower after ACURATE neo implantation.

Funding Acknowledgements Type of funding sources: None. Introduction Cardiac rehabilitation (CR) is considered a Class IA recommendation in secondary prevention of ischemic heart disease and heart failure. Participation rates are low however. Telerehabilitation (TR) is widely studied to overcome known barriers. However, the willingness of patients that refuse centre-based CR to participate in TR is scarcely studied. This study aims to assess the willingness to participate in TR in patients that refuse conventional centre-based CR, as well as the main barriers to participation in CR and TR. Methods Patients were screened during hospitalisation on the cardiology, cardiac surgery and cardiac intensive care departments. Patients that were eligible for CR but refused to participate were asked to participate in the study. A semi-structured interview consisting of 18 questions was performed during hospitalisation. After signing an informed consent, interviews were conducted, recorded and analysed. Additional data was extracted and analysed from the hospital electronic health records. Results A total of 20 patients were included. Mean age was 69.6 years (± 10), 17 patients were male (85%), cardiac pathologies were ischemic heart disease (10), heart failure (5) and arrhythmia (5). Six patients (30%) owned a smartphone. Primary reasons not to participate in conventional CR were transport issues (7), lack of motivation (5), cost (3), already being physically active at home (2), or other reasons (3). Eight patients (40%) indicated that, if a programme existed, they would participate in a TR programme. In the group of patients that would not want to participate in TR (n = 12), 10 said lack of digital literacy was a reason, 9 said not having the needed technology (either a computer, a smartphone or both) was a reason. Five said that lack of motivation was a reason and 3 didn’t see the utility of doing rehabilitation at home or rehabilitation at all. The most important reason not to participate was a lack of digital literacy in 6 patients, and a lack of motivation or not seeing the utility of rehabilitation in 6 patients. In the group of patients that would participate in TR, all 8 said that not needing transport was an advantage, 2 indicated that being able to perform rehabilitation on flexible hours was an advantage. All 8 indicated that not needing transport was the main advantage of TR for them. The most important barrier for this group was not being fluent with computers and/or smartphone (3). Conclusions Of a group of patients not willing to participate in conventional CR, 40% would be prepared to participate in TR. Lack of digital literacy and lack of motivation were the main reasons not to participate in TR. Not needing transport was seen as the main advantage of TR. Further research in larger populations will be needed to confirm these results.

Aims Coronary artery disease (CAD) is related to high rates of morbidity and mortality among cardiovascular diseases (CVDs). Activity trackers have been used in cardiac rehabilitation (CR) in the last years. However, their effectiveness to influence outcomes after CAD is debated. This review summarizes the latest data of impact of activity trackers on CVD risk and outcomes: peak oxygen consumption (VO2), major adverse cardiovascular events (MACE), quality of life (QoL), and low-density lipoprotein-cholesterol (LDL-C). Methods and results Articles from 1986 to 2020 in English were searched by electronic databases (PubMed, Cochrane Library, and Embase). Inclusion criteria were: randomized controlled trials of CAD secondary prevention using an activity tracker which include at least peak VO2, MACE, QoL, or LDL-C as outcomes. Meta-analysis was performed. After removing duplicates, 604 articles were included and the screening identified a total of 11 articles. Compared to control groups, intervention groups with activity trackers significantly increased peak VO2 [mean difference 1.54; 95% confidence interval (CI) (0.50–2.57); P = 0.004] and decreased MACE [risk ratio 0.51; 95% CI (0.31–0.86); P = 0.01]. Heterogeneity was low (I2 = 0%) for MACE and high (I2 = 51%) for peak VO2. Intervention with an activity tracker also has positive impact on QoL. There was no between-group difference in LDL-C. Conclusion CR using activity trackers has a positive and multi-faceted effect on peak VO2, MACE, and QoL in patients with CAD.

Aims  The prevalence of type 2 diabetes mellitus (T2DM) is very high and still rising. Optimal medical therapy and lifestyle management are essential in reducing the long-term complications of T2DM. Gamification, which is the use of design elements, and characteristics of games in a non-gaming context, is an innovative approach to improve healthy behaviour. It thereby could be able to improve glycaemic control in T2DM. The aim of this systematic review and meta-analysis is to evaluate the effect of gamification on glycaemic control expressed by haemoglobin A1c (HbA1c) levels in T2DM patients. Methods and results  All articles from 2000 to 2021 were searched in electronic databases (PubMed, Cochrane Library, Embase). The total number of patients was 704. The rate of male participants and their mean ages ranged, respectively, from 46% to 94% and 60 to 63 years. Inclusion criteria were randomized controlled trials of T2DM management using gamification which included HbA1c as an outcome measure. A meta-analysis was performed. After removing duplicates, 129 articles were screened and a total of 3 articles corresponding to the inclusion criteria were identified. Haemoglobin A1c was significantly reduced [mean difference −0.21; 95% confidence interval (−0.37 to −0.05); P = 0.01; I2 = 0%] in the intervention group using gamification as compared to the control group. Conclusion  Gamification has a positive effect on glycaemic control expressed by HbA1c changes in patients with T2DM. However, only three studies were included in this review. More research is needed to confirm the effectiveness of gamification in T2DM.

Funding Acknowledgements Type of funding sources: None. Background Hypertension is one of the most important cardiovascular risk factors. Twenty-four-hour ambulatory blood pressure (BP) monitoring remains the gold standard to diagnose hypertension. However, it is still unclear whether different time periods of measurement differ in their predictive value for cardiovascular events. Purpose To investigate whether different time periods of home BP monitoring can be used as a predictor of cardiovascular events and mortality. Methods In this retrospective study, we included patients who had a 24-hour BP measurement between May 2015 and March 2016. Follow-up data were collected up to a maximum of 67 months. BP measurements were taken every 15 minutes from 9 AM until 9 PM and subdivided into 4 time periods, each consisting of 3 hours of measurements. Correlation of BP with major adverse cardiovascular event (MACE) defined as cardiovascular hospitalization and all-cause mortality was examined using a Cox-regression model, which was adjusted for possible confounding factors. Results A total of 301 patients were included for analysis with mean follow-up of 1830,4 days ± 229. The mean age was 64.3 ± 15.2 and 52.8% of patients were female. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) for the 4 time periods were respectively 135,3 ± 16/ 82,6 ± 13,2mmHg, 132,3 ± 15,5/ 79,7 ± 12,7mmHg, 135,3 ± 15,5/ 81,7 ± 12,3mmHg and 136,4 ± 16,4 mmHg/ 81,6 ± 12,1mmHg. MACE occurred in 66 (21.9%) patients. The multivariable Cox proportional hazard risk model revealed that SBP between 12 and 3PM (HR 0.966 95% CI (0.945-0.989)) and the DBP between 6 and 9PM (HR 0.935 95% CI (0.898-0.973)) were associated with a reduced risk for MACE. Furthermore, the SBP between 6 and 9PM (HR 1.044 95% CI (1.021-1.068)) and the DBP between 3 and 6PM (HR 1.05 95% CI (1.013-1.089)) were associated with an increased risk for MACE. Conclusions The risk of cardiovascular events is higher in patients with a high SBP between 6 and 9PM and high DBP between 3 and 6PM. Lower risk is seen when the SBP is high between 12 and 3PM and the DBP is high between 6 and 9PM. These results might be explained by the circadian rhythm of BP. Further study is needed to confirm this time dependent predictive value of BP measurements.

BACKGROUND Ischemic heart disease (IHD) is related to high rates of morbidity and mortality among cardiovascular diseases (CVD). Activity trackers have been used in cardiac rehabilitation (CR) in the last years. However, their effectiveness to influence outcomes after IHD is debated. OBJECTIVE This review summarizes the latest data of impact of activity trackers on CVD risk and outcomes. METHODS Articles from 1986 to 2020 in English were searched by electronic databases (PubMed, Cochrane Library, Embase). Inclusion criteria were: randomized controlled trials of IHD secondary prevention using an activity tracker which include at least peak oxygen consumption (VO2), major adverse cardiovascular events (MACE), quality of life (QoL), LDL-cholesterol (LDL-C) as outcomes. Meta-analysis and qualitative analysis were performed. RESULTS After removing duplicates, 604 articles were included and the screening identified a total of 11 articles. Compared to control groups, intervention groups with activity trackers significantly increased peak VO2 (mean difference 1.54; 95% CI [0.50–2.57]; P=.004) and decreased MACE (risk ratio 0.51; 95% CI [0.31–0.86]; P=.01). Heterogeneity was low (I2=0%) for MACE and high (I2=51%) for peak VO2. Intervention with an activity tracker also has positive impact on QoL in qualitative analyses. There was no between-group difference in LDL-C. CONCLUSIONS CR using activity trackers has a positive and multi-faceted effect on peak VO2, MACE, and QoL in patients with IHD.

Aims Depression and anxiety have a detrimental effect on the health outcomes of patients with heart disease. Digital health interventions (DHIs) could offer a solution to treat depression and anxiety in patients with heart disease, but evidence of its efficacy remains scarce. This review summarises the latest data about the impact of DHIs on depression/anxiety in patients with cardiac disease. Methods Articles from 2000 to 2021 in English were searched through electronic databases (PubMed, Cochrane Library, Embase). Articles were included if they incorporated a randomised controlled trial design for patients with cardiac disease and used DHIs in which depression or anxiety was set as outcomes. A systematic review and meta-analysis were performed. Results 1675 articles were included and the screening identified a total of 17 articles. Results indicated that telemonitoring systems have a beneficial effect on depression (standardized mean difference for depression questionnaire score -0.78 [P = 0.07], -0.55 [P &lt; 0.001], for with and without involving a psychological intervention, respectively). Results on PC or cell phone-based psychosocial education and training have also a beneficial influence on depression (standardized mean difference for depression questionnaire score -0.49 [P = 0.009]). Conclusion Telemonitoring systems for heart failure and PC/cell phone-based psychosocial education and training for patients with heart failure or coronary heart disease had a beneficial effect especially on depression. Regarding telemonitoring for heart failure, this effect was reached even without incorporating a specific psychological intervention. These results illustrate the future potential of digital health interventions for mental health in cardiology.

Summary Pituitary carcinoma is a rare type of malignancy and only accounts for 0.1–0.2% of all pituitary tumours. Most pituitary carcinomas are hormonally active and they are mostly represented by corticotroph and lactotroph carcinomas. Corticotroph carcinoma can present as symptomatic Cushing’s disease or can evolve from silent corticotroph adenoma which is not associated with clinical or biochemical evidence of hypercortisolism. We hereby present a case of a bone-metastasized corticotroph pituitary carcinoma masquerading as an ectopic adrenocorticotropic hormone (ACTH) syndrome in a patient with a history of a non-functioning pituitary macro-adenoma. Our patient underwent two transsphenoidal resections of the primary pituitary tumour followed by external beam radiation therapy. Under hydrocortisone substitution therapy she developed ACTH-dependent hypercortisolism without arguments for recurrence on pituitary MRI and without central-to-peripheral ACTH-gradient on inferior petrosal sinus sampling, both suggesting ectopic production. Ultimately, she was diagnosed with an ACTH-secreting vertebral metastasis originating from the primary pituitary tumour. This case report demonstrates the complex pathophysiology of pituitary carcinoma and the long diagnostic work-up. Certain features in pituitary adenoma should raise the suspicion of malignancy. Learning points The diagnosis of pituitary carcinoma can only be made based on documented metastasis, therefore, due to the often long latency period between the detection of the primary tumour and the occurrence of metastasis, the diagnostic work-up most often spans over multiple years. Pituitary carcinoma including corticotroph carcinoma is very rare in contrast to pituitary adenoma and only accounts for 0.1–0.2% of all pituitary tumours. Histopathology in pituitary adenoma should certainly accomplish the following goals: accurate tumour subtyping and assessment of tumoural proliferative potential. Repeated recurrence of pituitary adenoma after surgical resection, a discrepancy between biochemical and radiological findings, resistance to medical and radiation therapy, and silent tumours becoming functional are all hallmarks of pituitary carcinoma. Silent corticotroph adenomas are non-functioning pituitary adenomas that arise from T-PIT lineage adenohypophyseal cells and that can express adrenocorticotropic hormone on immunohistochemistry, but are not associated with biochemical or clinical evidence of hypercortisolism. Silent corticotroph adenomas exhibit a more aggressive clinical behaviour than other non-functioning adenomas. Treatment options for corticotroph carcinoma include primary tumour resection, radiation therapy, medical therapy, and chemotherapy. Sometimes bilateral adrenalectomy is necessary to achieve sufficient control of the cortisol excess.