Publications by authors named "Benjamin J R Buckley"

16 Publications

  • Page 1 of 1

Exercise rehabilitation associates with lower mortality and hospitalisation in cardiovascular disease patients with COVID-19.

Eur J Prev Cardiol 2021 Jul 5. Epub 2021 Jul 5.

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, William Henry Duncan Building, Liverpool L7 8TX, UK.

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http://dx.doi.org/10.1093/eurjpc/zwaa135DOI Listing
July 2021

Direct-acting oral anticoagulants use prior to COVID-19 diagnosis and associations with 30-day clinical outcomes.

Thromb Res 2021 Jun 27;205:1-7. Epub 2021 Jun 27.

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. Electronic address:

Background: It is unclear if direct-acting oral anticoagulants (DOACs) use before hospitalization due to COVID-19 diagnosis would potentially impact the severity and clinical outcomes thereafter. We compared 30-day hospitalization/re-hospitalization and clinical outcomes between patients on chronic DOAC therapy and patients not on oral anticoagulation (OAC) therapy at time of COVID-19 diagnosis.

Methods: We used data from TriNetX, a global federated health research network. Patients aged ≥18 years who were treated with DOACs at time of COVID-19 diagnosis between 20 January 2020 and 28 February 2021 were included, and matched with patients not on OAC therapy from the same period. All patients were followed-up at 30-days after COVID-19 diagnosis. The primary outcomes were all-cause mortality, hospitalization/re-hospitalization, venous thromboembolism (VTE) and intracranial hemorrhage (ICH).

Results: 738,423 patients were included. After propensity score matching (PSM), 26,006 patients remained in the study (13,003 on DOACs; 13,003 not on OAC). DOAC-treated patients (mean age 67.1 ± 15.4 years, 52.2% male) had higher relative risks (RRs) and lower 30-days event-free survival as compared to patients not on OAC for all-cause mortality (RR 1.27, 95% CI 1.12-1.44; Log-Rank test p = 0.010), hospitalization/re-hospitalization (RR 1.72, 95% CI 1.64-1.82; Log-Rank test p < 0.001) and VTE (RR 4.51, 95% CI 3.91-5.82; Log-Rank test p < 0.001), but not for ICH (RR 0.90, 95% CI 0.54-1.51; Log-Rank test p = 0.513).

Conclusion: In COVID-19 patients, previous DOAC therapy at time of diagnosis was not associated with improved clinical outcomes or lower hospitalization/re-hospitalization rate compared to patients not taking OAC therapy.
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http://dx.doi.org/10.1016/j.thromres.2021.06.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236305PMC
June 2021

Exercise-based cardiac rehabilitation for cardiac implantable electronic device recipients.

Eur J Prev Cardiol 2021 Jun 21. Epub 2021 Jun 21.

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.

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http://dx.doi.org/10.1093/eurjpc/zwab103DOI Listing
June 2021

Cardiovascular risk factors, cardiovascular disease, and COVID-19: an umbrella review of systematic reviews.

Eur Heart J Qual Care Clin Outcomes 2021 07;7(4):330-339

Liverpool Centre for Cardiovascular Science, University of Liverpool & Liverpool Heart and Chest Hospital, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK.

Aims: To consolidate evidence to determine (i) the association between cardiovascular risk factors and health outcomes with coronavirus 2019 (COVID-19); and (ii) the impact of COVID-19 on cardiovascular health.

Methods And Results: An umbrella review of systematic reviews was conducted. Fourteen medical databases and pre-print servers were searched from 1 January 2020 to 5 November 2020. The review focused on reviews rated as moderate or high-quality using the AMSTAR 2 tool. Eighty-four reviews were identified; 31 reviews were assessed as moderate quality and one was high-quality. The following risk factors were associated with higher mortality and severe COVID-19: renal disease [odds ratio (OR) (95% confidence interval) for mortality 3.07 (2.43-3.88)], diabetes mellitus [OR 2.09 (1.80-2.42)], hypertension [OR 2.50 (2.02-3.11)], smoking history [risk ratio (RR) 1.26 (1.20-1.32)], cerebrovascular disease [RR 2.75 (1.54-4.89)], and cardiovascular disease [OR 2.65 (1.86-3.78)]. Liver disease was associated with higher odds of mortality [OR 2.81 (1.31-6.01)], but not severe COVID-19. Current smoking was associated with a higher risk of severe COVID-19 [RR 1.80 (1.14-2.85)], but not mortality. Obesity associated with higher odds of mortality [OR 2.18 (1.10-4.34)], but there was an absence of evidence for severe COVID-19. In patients hospitalized with COVID-19, the following incident cardiovascular complications were identified: acute heart failure (2%), myocardial infarction (4%), deep vein thrombosis (7%), myocardial injury (10%), angina (10%), arrhythmias (18%), pulmonary embolism (19%), and venous thromboembolism (25%).

Conclusion: Many of the risk factors identified as associated with adverse outcomes with COVID-19 are potentially modifiable. Primary and secondary prevention strategies that target cardiovascular risk factors may improve outcomes for people following COVID-19.
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http://dx.doi.org/10.1093/ehjqcco/qcab029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8294691PMC
July 2021

Exercise-Based Cardiac Rehabilitation and All-Cause Mortality Among Patients With Atrial Fibrillation.

J Am Heart Assoc 2021 Jun 5;10(12):e020804. Epub 2021 Jun 5.

Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool United Kingdom.

Background There is limited evidence of long-term impact of exercise-based cardiac rehabilitation (CR) on clinical end points for patients with atrial fibrillation (AF). We therefore compared 18-month all-cause mortality, hospitalization, stroke, and heart failure in patients with AF and an electronic medical record of exercise-based CR to matched controls. Methods and Results This retrospective cohort study included patient data obtained on February 3, 2021 from a global federated health research network. Patients with AF undergoing exercise-based CR were propensity-score matched to patients with AF without exercise-based CR by age, sex, race, comorbidities, cardiovascular procedures, and cardiovascular medication. We ascertained 18-month incidence of all-cause mortality, hospitalization, stroke, and heart failure. Of 1 366 422 patients with AF, 11 947 patients had an electronic medical record of exercise-based CR within 6-months of incident AF who were propensity-score matched with 11 947 patients with AF without CR. Exercise-based CR was associated with 68% lower odds of all-cause mortality (odds ratio, 0.32; 95% CI, 0.29-0.35), 44% lower odds of rehospitalization (0.56; 95% CI, 0.53-0.59), and 16% lower odds of incident stroke (0.84; 95% CI, 0.72-0.99) compared with propensity-score matched controls. No significant associations were shown for incident heart failure (0.93; 95% CI, 0.84-1.04). The beneficial association of exercise-based CR on all-cause mortality was independent of sex, older age, comorbidities, and AF subtype. Conclusions Exercise-based CR among patients with incident AF was associated with lower odds of all-cause mortality, rehospitalization, and incident stroke at 18-month follow-up, supporting the provision of exercise-based CR for patients with AF.
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http://dx.doi.org/10.1161/JAHA.121.020804DOI Listing
June 2021

Associations between COVID-19 and 30-day thromboembolic events and mortality in people with dementia receiving antipsychotic medications.

Pharmacol Res 2021 05 4;167:105534. Epub 2021 Mar 4.

Liverpool Centre for Cardiovascular Science, University of Liverpool & Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Background: Antipsychotic medications are frequently prescribed to people with dementia to manage behavioural and psychological symptoms. Using a global federated research network, the objectives were to determine: 1) if COVID-19 is associated with 30-day thromboembolic events and mortality for people with dementia receiving antipsychotic medications; and 2) if the proportion of people with dementia receiving antipsychotics is higher during the COVID-19 pandemic compared to 2019.

Methods: A retrospective cohort study was conducted using TriNetX, a global federated health research network. The network was searched for people aged ≥ 65 years with dementia, COVID-19 and use of antipsychotics in the 30-days prior to COVID-19 recorded in electronic medical records between 20/01/2020 and 05/12/2020. These individuals were compared to historical controls from 2019 with dementia and use of antipsychotics in the 30-days before a visit to a participating healthcare organisation. Propensity score matching for age, sex, race, co-morbidities and use of antidepressants and anticonvulsants was used to balance cohorts with and without COVID-19.

Results: Within the TriNetX network, 8414 individuals with COVID-19, dementia and use of antipsychotics and 31,963 historical controls were identified. After propensity score matching there were 8396 individuals with COVID-19 and 8396 historical controls. The cohorts were well balanced for age, sex, race, co-morbidities and use of antidepressants and anticonvulsants. The odds of 30-day thromboembolic events and all-cause mortality were significantly higher in adults with COVID-19 (Odds Ratios: 1.36 (95% confidence interval (CI): 1.21-1.52) and 1.93 (1.71-2.17), respectively). The number of people with dementia with a visit to a participating healthcare organisation was lower between 20/01/2020 and 05/12/2020 (n = 165,447) compared to the same period in 2019 (n = 217,391), but the proportion receiving antipsychotics increased from 14.7% (95%CI: 14.6-14.9%) to 16.4% (95%CI: 16.2-16.5%), P < .0001.

Conclusions: These findings add to the evidence base that during the COVID-19 pandemic there was an increase in the proportion of people with dementia receiving antipsychotics. The negative effects of antipsychotics in patients with dementia may be compounded by concomitant COVID-19.
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http://dx.doi.org/10.1016/j.phrs.2021.105534DOI Listing
May 2021

Association of Exercise-Based Cardiac Rehabilitation with Progression of Paroxysmal to Sustained Atrial Fibrillation.

J Clin Med 2021 Jan 23;10(3). Epub 2021 Jan 23.

Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health & Life Sciences, William Henry Duncan Building, Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool L7 8TX, UK.

Progression of atrial fibrillation (AF) is associated with worsened prognosis for cardiovascular events and mortality. Exercise-based-cardiac rehabilitation programmes have shown preliminary promise for primary and secondary prevention of AF. Yet, such interventions are typically reserved for patients with acute coronary syndrome or undergoing revascularization. Using a retrospective cohort design, the present study investigated the association of exercise-based cardiac rehabilitation on the progression of paroxysmal to sustained AF, compared to propensity-matched controls. Patients with a diagnosis of paroxysmal AF were compared between those with and without an electronic medical record of exercise-based cardiac rehabilitation within 6-months of diagnosis. Using cox regression models, we ascertained odds of 2-year incidence for AF progression. This cohort of 9808 patients with paroxysmal AF demonstrated that exercise-based cardiac rehabilitation was associated with 26% lower odds of AF progression (odds ratio 0.74, 95% CI 0.66-0.83) compared to propensity-matched controls. This beneficial effect seemed to vary across patient subgroups. In conclusion, findings revealed that exercise-based cardiac rehabilitation was associated with significantly lower odds of progression from paroxysmal to sustained AF at 2-years follow-up compared to propensity-matched controls.
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http://dx.doi.org/10.3390/jcm10030435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865453PMC
January 2021

Physical activity or fitness as medicine for your arteries?

Int J Clin Pract 2020 12;74(12):e13688

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool John Moores University, Liverpool, UK.

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http://dx.doi.org/10.1111/ijcp.13688DOI Listing
December 2020

Endothelial dysfunction and vascular maladaptation in atrial fibrillation.

Eur J Clin Invest 2021 May 1;51(5):e13477. Epub 2021 Feb 1.

Liverpool Centre for Cardiovascular Science, Liverpool John Moores University and University of Liverpool, Liverpool, UK.

Atrial fibrillation (AF) is the most common arrhythmia and is associated with worsened morbidity and mortality. The prevalence of AF is estimated to increase with an ageing population resulting in an ever-increasing burden on the healthcare system. Despite improvements in AF treatment, several questions remain unanswered in relation to the development and progression of AF. In this review, we discuss the evidence supporting the presence of vascular dysfunction in the development of AF, but also as a final common pathway explaining why AF constitutes a markedly increased risk of cardiovascular morbidity and mortality. Specifically, we summarise the work performed in humans related to the impact of AF on vascular structure and function, and whether measures of vascular function predict AF progression and the development of cardiovascular events. Subsequently, we discuss the potential mechanisms linking AF to the development of vascular dysfunction. Finally, we propose future perspectives of vascular health and AF, advocating a strong focus on regular exercise training as a safe and effective strategy to improve vascular function and, hence, reduce the risk for development and progression of AF and its associated risk for cardiovascular events.
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http://dx.doi.org/10.1111/eci.13477DOI Listing
May 2021

Facilitators and challenges in delivering a peer-support physical activity intervention for older adults: a qualitative study with multiple stakeholders.

BMC Public Health 2020 Dec 12;20(1):1904. Epub 2020 Dec 12.

Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.

Background: Involving peer volunteers in intervention delivery can provide social support and improve adherence. Whilst such interventions have the potential to reduce physical activity (PA) intervention costs, little is known about the process of delivering them in practice. This qualitative study explored the facilitators and challenges of delivering a peer-support PA intervention for older adults, with a view to making recommendations for the delivery of future interventions.

Methods: Data were collected via (7) semi-structured interviews and a focus group with stakeholders involved in a peer-support PA intervention for older adults in a large city in the North-West of England. Participants included local authority staff (n = 3), peer volunteers (n = 2) and service users (n = 7). Audio data were transcribed verbatim and thematically coded to identify perceived facilitators and challenges.

Results: Facilitators to delivery included social interaction, community referral pathways, suitable facilities, peer volunteers and high-quality instructors. Challenges surrounded inconsistent practice, staff capacity, safety and accountability, and awareness raising.

Conclusions: Peer volunteers can provide an additional support mechanism alongside qualified instructors for increasing social interaction within PA interventions. For optimal intervention delivery, consideration needs to be given to equipment and space, safety and accountability and consistency of practice.
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http://dx.doi.org/10.1186/s12889-020-09990-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733256PMC
December 2020

End-Stage renal disease and 30-day mortality for adults with and without COVID-19.

Eur J Intern Med 2021 01 9;83:93-95. Epub 2020 Nov 9.

Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

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http://dx.doi.org/10.1016/j.ejim.2020.11.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649657PMC
January 2021

"You've Got to Pick Your Battles": A Mixed-Methods Investigation of Physical Activity Counselling and Referral within General Practice.

Int J Environ Res Public Health 2020 10 12;17(20). Epub 2020 Oct 12.

Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK.

One in four people say they would be more active if advised by a general practitioner (GP), yet 72% of GPs do not discuss physical activity (PA) with patients and 80% of GPs are unaware of the PA guidelines. The aim of this study was therefore to investigate GP perspectives on PA counselling and referral and interpret these within the context of the socio-ecological model (SEM). Fifty-six GPs completed an online survey to investigate factors influencing PA counselling and referral. Semi-structured interviews were then conducted with seven GPs to explore topics in more depth. Interview data were analysed thematically and mapped to the SEM. GPs were more likely to discuss PA with patients if they were physically active themselves ( = 0.004). Influences on PA counselling and referral were identified at the policy (provision of education, priority), organisational (feedback, e-referral), interpersonal (PA as everybody's business, patient factors) and intrapersonal (knowledge, GP PA levels) levels of the SEM. Multi-level strategies are required to help GPs promote PA and make use of exercise referral schemes, including making PA a strategic priority, introducing systems for feedback from referrals, and involving other members of the care team in PA counselling and referral.
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http://dx.doi.org/10.3390/ijerph17207428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7650624PMC
October 2020

Relative skeletal muscle mass and incident hypertension: associations, caveats, and future perspectives.

J Hypertens 2020 11;38(11):2150-2151

Liverpool Centre for Cardiovascular Science, Liverpool John Moores University and University of Liverpool, Liverpool, UK.

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http://dx.doi.org/10.1097/HJH.0000000000002548DOI Listing
November 2020

The counterintuitive role of exercise in the prevention and cause of atrial fibrillation.

Am J Physiol Heart Circ Physiol 2020 11 18;319(5):H1051-H1058. Epub 2020 Sep 18.

Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, United Kingdom.

Atrial fibrillation (AF) is the most common cardiac arrhythmia, characterized by irregular atrial activity. AF is related to increased risk of thromboembolic events, heart failure, and premature mortality. Recent advances in our understanding of its pathophysiology include a potentially central role for inflammation and presence of cardiovascular risk factors. The role of physical activity and exercise in the development and progression of AF, however, are not yet fully understood. Physical activity is protective for modifiable cardiovascular risk factors, including those associated with AF. Indeed, emerging research has demonstrated beneficial effects of exercise on AF-specific outcomes, including AF recurrence postablation. Counterintuitively, the prevalence of AF in veteran endurance athletes seems higher compared with the general population. In this review, we discuss the novel evidence and underlying mechanisms underpinning the role of exercise as medicine in the development and management of AF but also the counterintuitive detrimental role of excessive endurance exercise. Finally, we advocate regular (but not long-term high-intensity endurance) exercise training as a safe and effective strategy to reduce the risk of incident AF and to minimize the associated risk of secondary cardiovascular events.
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http://dx.doi.org/10.1152/ajpheart.00509.2020DOI Listing
November 2020

Cardiac rehabilitation meta-analysis of trials in patients with coronary heart disease using individual participant data (CaReMATCH): Project protocol.

Int J Cardiol Heart Vasc 2020 Dec 2;31:100616. Epub 2020 Sep 2.

Liverpool Centre for Cardiovascular Science, Liverpool John Moores University and University of Liverpool, Liverpool, UK.

Background: Exercise-based cardiac rehabilitation (CR) has long been a cornerstone in the secondary prevention of coronary heart disease (CHD). Despite meta-analyses of randomised trials demonstrating a positive impact of CR on cardiovascular mortality, hospitalisation, exercise capacity and health related quality of life, the impact of CR on all-cause mortality remains uncertain, especially in the context of contemporary clinical practice. This CR meta-analysis of trials in patients with coronary heart disease using individual participant data (IPD) (CaReMATCH) seeks to (1) provide definitive estimates of the effectiveness of CR in terms of all-cause mortality, cardiovascular mortality, hospitalisation and health-related quality of life, and (2) determine the influence of individual patient characteristics (e.g. age, sex, risk factors) on the effectiveness of CR to inform a personalised CR-approach.

Methods: Randomised controlled trials will be identified that were performed in the last decade, to ensure that CR was performed in combination with contemporary medical care (2010-2020). For our first aim, outcomes of interest include all cause- and CVD-related mortality and hospitalisations. To answer our second research question, we will collect data on exercise capacity, health-related quality of life, and patient baseline demographic and clinical data. Original IPD will be requested from the authors of all eligible trials; we will check original data and compile a master dataset. IPD meta-analyses will be conducted using a one-step meta-analysis approach where the IPD from all studies are modelled simultaneously whilst accounting for the clustering of participants within studies.

Discussion: Findings from CaReMATCH will inform future (inter)national clinical and policy decision-making on the (personalised) application of exercise-based CR for patients with CHD.
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http://dx.doi.org/10.1016/j.ijcha.2020.100616DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7479493PMC
December 2020

Carotid Artery Function Is Restored in Subjects With Elevated Cardiovascular Disease Risk After a 12-Week Physical Activity Intervention.

Can J Cardiol 2019 01 14;35(1):23-26. Epub 2018 Nov 14.

Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address:

Sympathetic nervous system activation elicits carotid artery vasodilation in healthy subjects, yet vasoconstriction in those with cardiovascular disease (CVD). Whether carotid artery vasoconstriction can be reversed is currently unknown. Nineteen subjects with increased risk for CVD were referred to a 12-week physical activity intervention, and 12 participants with increased risk for CVD were recruited as a no treatment control group. Cardiorespiratory and vascular health measures were collected at baseline and 12 weeks. Results indicate that carotid artery vasoconstriction in response to sympathetic stimulation may be reversed in subjects at increased risk of CVD. These findings warrant further investigation.
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http://dx.doi.org/10.1016/j.cjca.2018.10.015DOI Listing
January 2019
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