Aims: Angiotensin receptor–neprilysin inhibitor (ARNI) has played an increasingly important role in the management of heart failure (HF). However, the evidence on the benefits of ARNI in HF patients with end-stage kidney disease (ESKD) undergoing dialysis is limited. This study aimed to investigate the efficacy and safety of ARNI in patients with concomitant HF and ESKD on maintenance dialysis. Methods and results: We systematically searched the MEDLINE, Embase, Web of Science, Cochrane, and ClinicalTrials.gov databases for studies reporting outcomes after ARNI treatment in HF patients with ESKD on dialysis. All meta-analyses were performed using the random effects model. Twenty-six studies comprising 2494 patients with concomitant HF and ESKD undergoing dialysis were included. Our synthesis showed a significant improvement in left ventricular ejection fraction (LVEF) between before and after ARNI treatment (mean change: 8.05%; 95% confidence interval [CI] 5.57–10.54). Compared to the conventional group, the ARNI group showed a greater improvement in LVEF (mean difference: 4.03%; 95% CI 2.90–5.16). This effect was more pronounced in patients with HF with reduced ejection fraction (pinteraction < 0.0001). Patients treated with ARNI had a lower risk of all-cause mortality (risk ratio [RR] 0.64; 95% CI 0.45–0.92; p = 0.01) but had a similar rate of HF hospitalization (RR 0.71; 95% CI 0.43–1.18; p = 0.19). ARNI treatment showed benefits in the improvement of left ventricular end-systolic diameter, left ventricular mass index, left atrial diameter, and E/e′ ratio (p < 0.05), while it did not significantly increase the risk of severe hyperkalaemia (p = 0.33) or symptomatic hypotension (p = 0.53). Conclusion: This meta-analysis provided insights into the benefits of ARNI in HF patients with ESKD undergoing dialysis by improving left ventricular function, reversing left ventricular remodelling, and reducing the risk of all-cause mortality, without increasing the risk of HF hospitalizations, severe hyperkalaemia, and symptomatic hypotension.

Background: Prehypertension (PHT) and hypertension (HTN) in young adults are essential risk factors for other cardiovascular diseases (CVD) in later years of life. However, there is a lack of knowledge about the burden and risk factors of PHT/HTN for Vietnamese youth. The aim of this study was to investigate the prevalence of PHT/HTN and risk factors among university students in Hanoi, Vietnam. Methods: This study was designed as a cross-sectional investigation with 840 students (394 males and 446 females) randomly sampled from freshmen of Vietnam National University, Hanoi (VNU). Socio-demographic, anthropometric, and lifestyle data were collected using questionnaire forms and physical measurements. HTN was defined as blood pressure (BP) ≥ 140/90 mmHg and/or current treatment with antihypertensive medications. PHT was defined as a systolic BP from 120 to 139 mmHg and/or a diastolic BP from 80 to 89 mmHg. Body mass index (BMI) was classified according to the WHO diagnostic criteria for Asian adults: normal weight (BMI 18.5–22.9 kg/m²), underweight (BMI < 18.5 kg/m²), overweight (BMI 23–24.9 kg/m²), and obese (BMI ≥ 25 kg/m²). Bivariable and multivariable log-binomial regression analyses were conducted to explore the association of PHT/HTN with different risk factors. Results: The overall prevalence of prehypertension and hypertension was 33.5% [95% CI: 30.3–36.8%] (54.1% in men and 15.3% in women) and 1.4% [95% CI: 0.7–2.5%] (2.5% in men and 0.5% in women), respectively. Regarding CVD major risk factors, 119 (14.2%) were identified as overweight/obese, 461 (54.9%) were physical inactivity, 29.4% of men and 8.1% of women reported consuming alcohol. The multivariable analysis indicated the male sex (adjusted prevalence ratio [aPR] = 3.07; 95% CI: 2.32–4.06), alcohol consumption (aPR = 1.28; 95% CI: 1.03–1.59) and obesity (aPR = 1.35; 95% CI: 1.08–1.68) as the independent risk factors for PHT/HTN. Conclusions: The results revealed the high burden of prehypertension and hypertension among university freshmen in VNU. Male sex, alcohol consumption, and obesity were identified as important risk factors for PHT/HTN. Our study suggests an early screening program for PHT/HTN and campaigns to promote a healthy lifestyle for young adults in Vietnam.

Among older adults with acute illnesses, frailty is common and strongly associated with poorer prognosis. This study aimed to investigate the prevalence of pre-stroke frailty and its association with short-term functional outcomes in older patients with acute ischemic stroke (AIS). We included consecutive AIS patients aged ≥ 60 years admitted to a hospital in Vietnam. Pre-stroke frailty was assessed using the modified Short Emergency Geriatric Assessment (mSEGA) frailty scale (score 0–8: not frail; score 9–11: frail; score 12–26: very frail). Short-term functional outcomes were evaluated using the modified Rankin Scale (mRS) at 30 days based on follow-up clinical assessments and interviews, with poor outcomes defined as mRS ≥ 3. The association between pre-stroke frailty and stroke outcomes was assessed using multivariable logistic regression analysis. A total of 304 participants (61.5% with mild and 38.5% with moderate stroke) were included, with a mean age of 78.0 ± 8.5 years, and 57.6% were female. The prevalence of pre-stroke frailty and very frailty was 30.6% and 32.2%, respectively. Multivariable logistic regression analysis demonstrated that pre-stroke very frail status remained an independent predictor of poor functional outcomes at 30 days, with an adjusted odds ratio (OR) of 3.29 (95% CI: 1.45–7.46, p = 0.004), after adjustment for age, sex, baseline NIHSS, and treatment strategy. This study revealed a high prevalence of pre-stroke frailty among older patients with AIS in Vietnam. Pre-stroke very frail status was significantly associated with an increased risk of poor functional outcomes in this population.

Background: Heart failure (HF) is a complex, life-threatening condition marked by high morbidity, mortality, reduced functional capacity, poor quality of life, and substantial health care costs. HF with reduced ejection fraction (HFrEF) represents the subgroup of HF with the highest risks of mortality and hospitalization, necessitating the prioritization of care and management models to optimize treatment outcomes in these patients. Currently, data on the effectiveness of telemedicine models in resource-limited settings, such as low- and middle-income countries, are scarce. Objective: This study aimed to evaluate the impact of telemedicine on improving prognosis in patients with HFrEF in Vietnam. Methods: In this prospective cohort study, we recruited patients who received either remote monitoring and management (telemedicine) or standard monitoring and management (usual care) in the outpatient department of the Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam. Eligible patients were ≥18 years old, had a diagnosis of HFrEF defined as left ventricular ejection fraction (LVEF) ≤40%, had a history of HF hospitalization within the past 12 months, and presented with clinical symptoms classified as New York Heart Association (NYHA) II or III. The primary composite outcome was defined as the time to the first unplanned HF hospitalization or all-cause mortality. The follow-up period for all outcomes extended to 12 months. Results: In total, 426 patients (298/426, 70% male; 128/426, 30% female) with a mean age of 61.3 (SD 14.6) years and a mean LVEF of 32.1% (SD 6.0%) were included in our study. Of these patients, 121 received telemedicine care, while 305 received usual care. The primary outcome occurred in 23 (23/121, 19%) patients in the telemedicine group and 82 (82/305, 26.9%) patients in the usual care group during the follow-up period, indicating a significant reduction in risk (adjusted hazard ratio [aHR] 0.57, 95% CI 0.35-0.94; P=.03). However, this effect was primarily driven by a significant reduction in unplanned HF hospital admissions (aHR 0.57, 95% CI 0.33-0.98; P=.04) rather than in all-cause mortality (aHR 0.77, 95% CI 0.36-1.63; P=.49). Conclusions: This study demonstrates that a simplified telemedicine model, even in resource-limited settings such as Vietnam, can effectively facilitate the remote monitoring and management of patients with HFrEF, resulting in significant reductions in HF-related hospitalizations and all-cause mortality. Trial Registration: National Agency for Science and Technology Information (NASATI), Vietnam CT07/01-2022-3; https://nsti.vista.gov.vn/projects/dth/xay-dung-mo-hinh-theo-doi-va-tu-van-suc-khoe-tim-mach-tu-xa-tai-thanh-pho-ha-noi-109276.html

Background: The prevalence and risk factors of atrial fibrillation (AF) in patients with transient ischemic attack (TIA) or ischemic stroke in Northern Vietnam are not well understood. This study aimed to estimate the prevalence and identify factors associated with AF in this population. Methods: A cross-sectional study was conducted on 2038 consecutive patients with TIA or ischemic stroke admitted to Bach Mai Hospital. AF was diagnosed using an electrocardiogram or Holter monitor. Logistic regression analyses were performed to determine the association between AF and risk factors. Results: Among the patients, 18.1% (95% CI: 16.46 to 19.85) had AF. Older age, renal dysfunction, valvular heart disease (VHD), and low ejection fraction were significantly associated with AF. Advanced age (per 10 years) (adjusted OR, aOR 1.39; 95% CI, 1.23 to 1.57), estimated glomerular filtration ratio decrease (per 10 mL/min/1.73 m²) (aOR 1.12; 95% CI, 1.06 to 1.17), VHD (aOR 9.59; 95% CI, 7.10 to 12.95), and low ejection fraction (<50%) (aOR 2.61; 95% CI, 1.62 to 4.21) had notable odds ratios for AF. Conclusions: Atrial fibrillation is prevalent among patients with TIA or ischemic stroke in Northern Vietnam, surpassing rates in other Southeast Asian countries. Age, renal dysfunction, VHD, and low ejection fraction were significant risk factors for AF in this population.

Background: In recent heart failure (HF) trials, the win ratio statistical approach, developed to address the limitations of conventional methods, has been increasingly applied to better capture clinical benefits. The TOPCAT study was a randomised controlled trial designed to evaluate the efficacy of spironolactone in patients with HF and a left ventricular ejection fraction (LVEF) ≥45%. This study evaluated the cardiovascular benefits of spironolactone according to their clinical importance using the win ratio method. Methods: A post hoc analysis was conducted using data from the TOPCAT Americas cohort. The primary outcome was a hierarchical composite comprising the time to cardiovascular death, time to first aborted cardiac arrest, time to first hospitalisation for HF, time to first hospitalisation for arrhythmia and change in the Kansas City Cardiomyopathy Questionnaire Overall summary score at 36 months. Outcomes were analysed using the win ratio statistical model. Results: In all, 1,767 patients were included; 886 were assigned to receive spironolactone and 881 to receive placebo. Hierarchical analysis of the primary composite outcome revealed a significant higher probability of win (28.3%) compared to loss (23.1%) in the spironolactone group, yielding a win ratio of 1.22 (95% CI [1.05–1.42]; p=0.008) and a net clinical benefit (win difference) of 5.2% (95% CI [1.36–9.04]). Detailed assessment of the win differences revealed a concordant positive benefit (win difference >0) across all components of the outcome hierarchy. Subgroup analyses indicated no significant effect of age (<75 years versus ≥75 years), sex (male versus female) or LVEF (0.05). Conclusion: This post hoc analysis, using a novel statistical approach, demonstrates the consistent benefits of spironolactone across adverse cardiovascular events, patient symptoms, functional status and quality of life in individuals with HF and mildly reduced or preserved LVEF.