Background: Cardiovascular disease is the major cause of death worldwide, leading to a significant socioeconomic burden. Although secondary prevention is a cornerstone in chronic disease management, adherence to guideline recommendations in this regard often falters, leading to suboptimal outcomes. While eHealth technologies are promising for improving treatment adherence, they also represent a new approach to secondary prevention. However, a common critique is that extensive digitalization may not adequately address the needs of older adults with chronic medical conditions. Objective: This study aims to analyze eHealth literacy, digital use patterns, and general attitudes toward digital technologies in a collective of patients with cardiovascular disease to identify potential obstacles in implementing mobile health technologies in secondary preventive therapy. Methods: This survey-based study was a part of the baseline examination of the PreventiPlaque trial. It involved 240 participants with known coronary artery disease. The assessment evaluated their current understanding of the general use of digital devices. The questionnaire covered aspects such as the duration of daily use, personal attitudes, and the perceived burden associated with digital media. eHealth literacy was assessed within the target population and general demographic data were gathered, focusing on cardiovascular comorbidities and risk factors. Results: The analysis revealed an average age of 61.9 (SD 8.9) years, with 59.9% (n=144) of the participants being male. Overall, 37.3% (n=90) of the participants had previous knowledge of digital health interventions, while only 17.8% (n=41) had used them. Despite the generally low practical application within this study population, there was a high level of confidence in handling digital devices, with 61.9% (n=149) expressing themselves as either rather confident or very confident. Regarding the levels of eHealth literacy among the participants, 71.2% (n=170) claimed to be familiar with locating health information on the internet, and 64% (n=153) of participants felt capable of critically evaluating its quality. These levels of digital confidence were consistent across all age groups. Moreover, internet use rates remained high even among the older participants, with 80% (n=192) of those participants older than 75 years using the internet for 1-3 hours a day. Conclusions: The study unveiled a notable confidence level among participants regarding the use of digital devices, coupled with a favorable attitude toward digital media evident across all age brackets. Remarkably, internet use rates remained high, even among older participants. The actual utilization of digital health interventions was relatively low, potentially stemming from challenges in locating reliable sources. These findings emphasize the prospect of future eHealth interventions customized to the distinct needs and preferences of patients in cardiovascular disease management. Recognizing the incongruity between confidence in device use and the restricted adoption of digital health tools can guide the development of focused interventions to narrow this divide.

Summary: Background: Endothelial dysfunction defines outcomes and serves as a surrogate parameter for the progression of cardiovascular disease. For symptomatic peripheral artery disease (PAD) endovascular treatment is the primary revascularization strategy, which affects endothelial function. Interventional mechanical atherothrombectomy (MATH) provides advantages when treating complex atherosclerotic and thrombotic lesions. We now aimed to determine the impact and mechanisms of MATH on endothelial function. Patients and methods: Endothelial function was determined using flow-mediated dilation (FMD) before and after lower limb intervention with a six-month follow-up in the target and control vessel in 15 PAD MATH+DCB treated patients and compared to 15 non-Math controls. In a further cohort of 20 patients the impact of MATH and DCB on vascular structure and virtual histology was assessed through intravascular ultrasound (IVUS) and compared to DCB treatment alone. Results: Improved endothelial function after 6 months was observed in both groups for the target and nontarget vessel. When comparing the changes from baseline endothelial function, treatment with MATH+DCB was superior to DCB treatment in the target vessel. IVUS revealed a greater improvement in luminal area and plaque burden reduction after MATH treatment. Virtual histology disclosed MATH-associated changes in plaque composition evidenced by alterations in fibrous volume and reductions in superficial calcium. Conclusions: We demonstrate an improved endothelial function after MATH treatment as compared to DCB treatment. The improved vessel function is evidenced by MATH-related plaque burden reduction, improved luminal gain and a decrease in superficial calcification. Clinicaltrials.gov: NCT04092972.

Economic status has a measurable and significant effect on cardiovascular health. Socioeconomic- and income-related disparities worsen cardiovascular risk factors. Peripheral artery disease (PAD) remains a major risk factor for morbidity and mortality. Not all patients benefit equally from recent advances in outpatient healthcare. The implementation of guideline recommendations regarding treatment is inadequate. Income-related disparities for PAD treatment are unknown. We aimed to analyse income-stratified PAD prevalence, outpatient treatment and pharmacotherapy. Associations of statutory health insurance physicians at the regional level, income-stratified PAD prevalence and differences in outpatient care and pharmacotherapy were analysed in 70.1 million statutorily insured patients/year between 2009 and 2018. Analysis was based on claims data (§295 of the social code (SGB V)) and drug-prescription data (§300 SGB V). The diagnosis of PAD was defined by ICD I70.2-9. Regional income data were derived from the German Census Bureau. PAD prevalence was higher in low-income than in high-income areas. Low-income patients more often presented to angiology outpatient care and more frequently received guideline recommended pharmacotherapy. High-income patients more often presented to outpatient vascular surgery. This was true for statins, antiplatelets, intermittent claudication and critical limb ischemia alike. These data indicate that PAD and income are associated. Regional income is related to insufficiencies in guideline-recommended treatment and contact to vascular specialists. Our results aim to encourage medical professionals to implement PAD guideline recommendations, especially in high-income areas. Further studies on associations between spatial-level income and healthcare in PAD are needed.

Summary: Background: Ageing is a major cardiovascular risk factor with detrimental changes that culminate in a high atherosclerotic burden. Peripheral artery disease (PAD) is a major manifestation of atherosclerosis with high mortality. Guideline-recommended treatment is essential, however implementation is inadequate. With an ageing society, age-related inequalities are important and have not been elucidated in a high-risk PAD population on a nation-wide scale. We sought to analyse outpatient treatment structures and guideline adherence in treatment of PAD patients older than 80 years. Patients and methods: The study is based on ambulatory claims data comprising 70.1 million statutorily insured patients per year in Germany from 2009 to 2018. We analysed age-related differences in prevalence, pharmacotherapy and specialized outpatient care in PAD patients. Results: Of 17,633,970 PAD patients included, 28% were older than 80 years. PAD prevalence increased between 2008 and 2018 (1.85% vs. 3.14%), with the proportion of older patients increasing by a third (24.4% vs. 31.2%). Octogenarians were undertreated regarding guideline-recommended statin pharmacotherapy compared to younger patients while antiplatelets were prescribed more often (statins 2016: 46.5% vs. 52.4%; antiplatelets 2016 30.6% vs. 29.3%; p<.05). Furthermore, octogenarians received less specialized outpatient care (angiology: 6.4% vs. 9.5%, vascular surgery: 8.1% vs. 11.8%, cardiology: 25.2% vs. 29.2%, p<.05). Conclusions: Our results demonstrate that age-related differences in pharmacotherapy and specialized outpatient care of PAD patients are evident. While overall guideline-recommended outpatient treatment is low, patients 80 years and older are less likely to receive both, leaving age-related health inequalities a challenge of our future.

Summary: Background: Pulmonary embolism (PE) can result in high mortality. Early risk stratification and treatment are critical for individualized management. In patients with intermediate-high-risk (IHR) PE, guidelines recommend to consider a percutaneous catheter-directed treatment (CDT). While different techniques are available, comparisons between treatments regarding right ventricular (RV) function and outcome are still scarce. This study aimed to compare changes in RV function as well as outcomes in patients with IHR PE after CDT with ultrasound-assisted thrombolysis (USAT) as compared to large-bore mechanical thrombectomy (MT). Patients and methods: This is a retrospective, single-center study in IHR PE, diagnosed in accordance with the ESC Guidelines. All patients underwent a CDT either with USAT (EKOS, Boston Scientific) or MT (FlowTriever System, Inari). Right heart function (RV/LV ratio, TAPSE) was assessed via transthoracic echocardiography before and after CDT as well as interventional characteristics and postinterventional hospital stay were compared. Results: From June 2022 to April 2024, 26 patients (35% female; aged 61.2±15.2 years) were diagnosed with IHR PE and underwent CDT. 14 patients (53.8%) were treated with USAT and 12 patients (46.2%) with MT. The mean procedural time was 40.4±19.8 minutes for USAT and 104±32.2 minutes for MT. RV/LV ratio was improved in both groups (change from baseline USAT –0.48±0.25; MT –0.36±0.13). TAPSE increased by 6.95±3.7 mm in USAT and by 9.8±4.6 mm in MT. Major bleeding (defined as BARC ≥ 3a) occurred only in three patients of the USAT group. The 90-day mortality rate was 0% in both groups. Conclusions: In patients with IHR PE both USAT and MT lead to an improved RV function without mortality within 90 days. Further randomized data have to discriminate the differential impact of novel tools for the treatment of IHR PE.