The impact of platelet-to-lymphocyte ratio on clinical outcomes in heart failure: a systematic review and meta-analysis.

BACKGROUND: Inflammation has been suggested to play a role in heart failure (HF) pathogenesis. However, the role of platelet-to-lymphocyte ratio (PLR), as a novel biomarker, to assess HF prognosis needs to be investigated. We sought to evaluate the impact of PLR on HF clinical outcomes. METHODS: English-published records in PubMed/Medline, Scopus, and Web-of-science databases were screened until December 2023. Relevant articles evaluated PLR with clinical outcomes (including mortality, rehospitalization, HF worsening, and HF detection) were recruited, with PLR difference analysis based on death/survival status in total and HF with reduced ejection fraction (HFrEF) patients. RESULTS: In total, 21 articles (n = 13,924) were selected. The total mean age was 70.36 ± 12.88 years (males: 61.72%). Mean PLR was 165.54 [95% confidence interval (CI): 154.69-176.38]. In total, 18 articles (n = 10,084) reported mortality [either follow-up (PLR: 162.55, 95% CI: 149.35-175.75) or in-hospital (PLR: 192.83, 95% CI: 150.06-235.61) death rate] and the mean PLR was 166.68 (95% CI: 154.87-178.50). Further analysis revealed PLR was significantly lower in survived HF patients rather than deceased group (152.34, 95% CI: 134.01-170.68 versus 194.73, 95% CI: 175.60-213.85, standard mean difference: -0.592, 95% CI: -0.857 to -0.326, p < 0.001). A similar trend was observed for HFrEF patients. PLR failed to show any association with mortality risk (hazard ratio: 1.02, 95% CI: 0.99-1.05, p = 0.289). Analysis of other aforementioned outcomes was not possible due to the presence of few studies of interest. CONCLUSION: PLR should be used with caution for prognosis assessment in HF sufferers and other studies are necessary to explore the exact association.

Platelet to lymphocyte ratio and heart failureInflammation plays a role in heart failure (HF), and a blood test called the platelet-to-lymphocyte ratio (PLR) might be helpful in predicting patients' outcomes. We found that deceased HF patients had higher PLR values in comparison to those who survived, irrespective of cardiac pump function, with similar pattern for patients with decreased cardiac function (HF with reduced ejection fraction). However, this biomarker failed to show any significant association with death risk. In conclusion, PLR may have some potential to help predict HF prognosis, but it needs more research and physicians should probably be cautious about using PLR alone in clinical settings.

Automated Detection of Patients at High Risk of Polypharmacy including Anticholinergic and Sedative Medications.

Ensuring that medicines are prescribed safely is fundamental to the role of healthcare professionals who need to be vigilant about the risks associated with drugs and their interactions with other medicines (polypharmacy). One aspect of preventative healthcare is to use artificial intelligence to identify patients at risk using big data analytics. This will improve patient outcomes by enabling pre-emptive changes to medication on the identified cohort before symptoms present. This paper presents a mean-shift clustering technique used to identify groups of patients at the highest risk of polypharmacy. A weighted anticholinergic risk score and a weighted drug interaction risk score were calculated for each of 300,000 patient records registered with a major regional UK-based healthcare provider. The two measures were input into the mean-shift clustering algorithm and this grouped patients into clusters reflecting different levels of polypharmaceutical risk. Firstly, the results showed that, for most of the data, the average scores are not correlated and, secondly, the high risk outliers have high scores for one measure but not for both. These suggest that any systematic recognition of high-risk groups should consider both anticholinergic and drug-drug interaction risks to avoid missing high-risk patients. The technique was implemented in a healthcare management system and easily and automatically identifies groups at risk far faster than the manual inspection of patient records. This is much less labour-intensive for healthcare professionals who can focus their assessment only on patients within the high-risk group(s), enabling more timely clinical interventions where necessary.

Translation, cultural adaptation, validation and reliability of Persian version of Edmonton frailty score questionnaire among Iranian heart failure individuals.

Background: Frailty is a common problem in elderly individuals. However, this issue is not well investigated among heart failure (HF) patients with appropriate scales. We aimed to translate and evaluate Edmonton frailty scale (EFS) validity and reliability in Iranian HF adults. Methods: We implemented this methodological study on stable HF patients referred to an outpatient heart clinic in Isfahan, Iran. The translation was done using the forward-backward method. Ten individuals were asked to comment about all items in terms of understandability and simplicity. Fifteen experts were invited, and their ratings on each item were collected to measure the content validity index (CVI) and content validity ratio (CVR). Cronbach's alpha was used for the assessment of internal consistency. After completing the scale for the second time with a two-week interval, test-retest reliability with intraclass correlation coefficient (ICC) measurement was done. Results: The translation process was performed uneventfully. All items were reported to be simple and meaningful. CVI of items ranged from the minimum of 0.80 to a maximum of 1.00 plus an acceptable CVR of at least 0.60. Fifty HF patients (age: 67.2±14.1 years, males: 56%) completed the questionnaire twice without missing data. Cronbach's alpha was first to be 0.550. After omitting three items about social support, drug usage, and nutrition, the value was raised to 0.711. Test-retest reliability showed a good index of consistency (ICC: 0.693, 95% confidence interval: 0.527-0.810). Conclusion: Modified Persian EFS is a simple and meaningful tool with high validity and acceptable reliability for assessing frailty in HF individuals irrespective of age.

Translation, Cultural Adaptation, Validation and Reliability of Persian Left Ventricular Dysfunction-36 Questionnaire.

BACKGROUND: The left ventricular dysfunction 36 (LVD-36) questionnaire is considered to be a tool to assess the impact of left ventricle impairment on patients' daily life. This methodological study was aimed to translate and assess the validity and reliability of the Persian draft of the LVD-36 questionnaire among Iranian heart failure (HF) patients. METHODS: We recruited stable HF patients who referred to an outpatient heart clinic in Isfahan, Iran. The LVD-36 questionnaire was translated using the forward-backward method. Twenty HF patients were recruited for content validity assessment and were asked to express their opinions about the comprehensibility and meaningfulness of each item. We invited 14 experts to assess validity through content validity index (CVI) and content validity ratio (CVR). Reliability was assessed by Cronbach's alpha and intraclass correlation coefficient (ICC), with the latter evaluated after invitation of the participants to complete the questionnaire for the second time. RESULTS: The translation process was performed uneventfully without any significant alterations. A total of 150 HF patients were recruited to assess the reliability of the questionnaire in this study (age: 64.6±16 years, males: 58.6%). All items had acceptable CVI and CVR, ranging 0.85-1.00 and 0.57-1.00, respectively. Cronbach's alpha was 0.971. All participants completed the questionnaire for the second time with no missing data. Test-retest reliability revealed an excellent ICC value of 0.981 (95% CI: 0.977-0.985). CONCLUSION: The Persian version of the LVD-36 questionnaire is a simple, valid and reliable tool for evaluating the impact of left ventricle impairment on the well-being of Iranian HF patients.

Translation, Cultural Adaptation, Validation, and Reliability of Persian-Revised Heart Failure Compliance Questionnaire.

Background: Compliance with health-related behaviors is a dilemma among heart failure (HF) patients. The present study aimed to assess the validity and reliability of a Persian translation of the revised heart failure compliance questionnaire (RHFCQ) in Iranian HF sufferers. Methods: This methodological study was performed on outpatient HF individuals referred to a heart clinic in Isfahan, Iran. The forward-backward translation method was used for translation. Twenty subjects were invited to express their opinions on the provided items concerning simplicity and understandability. Twelve experts were invited to rate the items regarding the content validity index (CVI). Cronbach's α was used to evaluate internal consistency. The patients were asked to complete the questionnaire for the second time after 2 weeks to investigate test-retest reliability using the intraclass correlation coefficient (ICC). Results: There were no obvious difficulties during the translation and assessment of the simplicity and comprehensiveness of the questionnaire items. The CVI of the items ranged from 0.833 to 1.000. Totally, 150 patients (age: 64.60±15.00 y, males: 58.0%) filled in the questionnaire twice with no missing data. The highest and lowest compliance rates were attributed to alcohol and exercise domains, respectively (83.00±7.70% and 45.55±12.00%, respectively). Cronbach's α was 0.629. After the omission of 3 items related to smoking and alcohol cessation, Cronbach's α rose to 0.655. The ICC showed an acceptable value of 0.576 (95% CI, 0.462 to 0.673). Conclusion: The modified Persian RHFCQ is a simple and meaningful tool with acceptable moderate reliability and good validity for assessing compliance in Iranian HF patients.

The association between platelet-to-lymphocyte ratio with mortality among patients suffering from acute decompensated heart failure.

BACKGROUND: Platelet-to-lymphocyte ratio (PLR) is an inflammation index suggested to have the prognostic capability in heart failure (HF). We sought to investigate the association of PLR with cardiovascular disease (CVD) mortality and creatinine (Cr) rise among Iranian individuals suffering from acute decompensated HF (ADHF). METHODS: This retrospective cohort study was in the context of the Persian Registry Of cardioVascular diseasE/Heart Failure (PROVE/HF) study. 405 individuals with ADHF admitted to the emergency department were recruited from April 2019 to March 2020. PLR was calculated by division of platelet to absolute lymphocyte counts and categorized based on quartiles. We utilized the Kaplan-Meier curve to show the difference in mortality based on PLR quartiles. Cr rise was defined as the increment of at least 0.3 mg/dl from baseline. Cox proportional hazard ratio (HR) was used to investigate the association of PLR with CVDs mortality. RESULTS: Mean age of participants was 65.9 ± 13.49 years (males: 67.7%). The mean follow-up duration was 4.26 ± 2.2 months. CVDs mortality or re-hospitalization was not significantly associated with PLR status. Multivariate analysis of PLR quartiles showed a minimally reduced likelihood of CVDs death in 2nd quartile versus the first one (HR 0.40, 95% confidence interval (CI) 0.16-1.01, P = 0.054). Cr rise had no remarkable relation with PLR status in neither model. CONCLUSION: PLR could not be used as an independent prognostic factor among ADHF patients. Several studies are required clarifying the exact utility of this index.