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Regional Variation of Mortality in Heart Failure With Reduced and Preserved Ejection Fraction Across Asia: Outcomes in the ASIAN‐HF Registry

MacDonald, Michael R. ; Tay, Wan Ting ; Teng, Tiew‐Hwa Katherine ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2020

In: Journal of the American Heart Association Vol. 9, No. 1 ( 2020-01-07)

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In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 9, No. 1 ( 2020-01-07)

Abstract: Data comparing outcomes in heart failure ( HF ) across Asia are limited. We examined regional variation in mortality among patients with HF enrolled in the ASIAN ‐HF (Asian Sudden Cardiac Death in Heart Failure) registry with separate analyses for those with reduced ejection fraction ( EF ; 〈 40%) versus preserved EF (≥50%). Methods and Results The ASIAN ‐ HF registry is a prospective longitudinal study. Participants with symptomatic HF were recruited from 46 secondary care centers in 3 Asian regions: South Asia (India), Southeast Asia (Thailand, Malaysia, Philippines, Indonesia, Singapore), and Northeast Asia (South Korea, Japan, Taiwan, Hong Kong, China). Overall, 6480 patients aged 〉 18 years with symptomatic HF were recruited (mean age: 61.6±13.3 years; 27% women; 81% with HF and reduced r EF ). The primary outcome was 1‐year all‐cause mortality. Striking regional variations in baseline characteristics and outcomes were observed. Regardless of HF type, Southeast Asians had the highest burden of comorbidities, particularly diabetes mellitus and chronic kidney disease, despite being younger than Northeast Asian participants. One‐year, crude, all‐cause mortality for the whole population was 9.6%, higher in patients with HF and reduced EF (10.6%) than in those with HF and preserved EF (5.4%). One‐year, all‐cause mortality was significantly higher in Southeast Asian patients (13.0%), compared with South Asian (7.5%) and Northeast Asian patients (7.4%; P 〈 0.001). Well‐known predictors of death accounted for only 44.2% of the variation in risk of mortality. Conclusions This first multinational prospective study shows that the outcomes in Asian patients with both HF and reduced or preserved EF are poor overall and worst in Southeast Asian patients. Region‐specific risk factors and gaps in guideline‐directed therapy should be addressed to potentially improve outcomes. Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 01633398.

Type of Medium: Online Resource

ISSN: 2047-9980

URL: Article

DOI: 10.1161/JAHA.119.012199

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2020

detail.hit.zdb_id: 2653953-6

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Socioeconomic Status and Outcomes in Heart Failure With Reduced Ejection Fraction From Asia

Teng, Tiew-Hwa K. ; Tay, Wan Ting ; Richards, Arthur Mark ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2021

In: Circulation: Cardiovascular Quality and Outcomes Vol. 14, No. 4 ( 2021-04)

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In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 14, No. 4 ( 2021-04)

Abstract: Little is known regarding the impact of socioeconomic factors on the use of evidence-based therapies and outcomes in patients with heart failure with reduced ejection fraction across Asia. Methods: We investigated the association of both patient-level (household income, education levels) and country-level (regional income level by World Bank classification, income disparity by Gini index) socioeconomic indicators on use of guideline-directed therapy and clinical outcomes (composite of 1-year mortality or HF hospitalization, quality of life) in the prospective multinational ASIAN-HF study (Asian Sudden Cardiac Death in Heart Failure). Results: Among 4540 patients (mean age: 60±13 years, 23% women) with heart failure with reduced ejection fraction, 39% lived in low-income regions; 34% in regions with high-income disparity (Gini ≥42.8%); 64.4% had low monthly household income ( 〈 US$1000); and 29.5% had no/only primary education. The largest disparity in treatment across regional income levels pertained to β-blocker and device therapies, with patients from low-income regions being less likely to receive these treatments compared with those from high-income regions and even greater disparity among patients with lower education status and lower household income within each regional income strata. Higher country- and patient-level socioeconomic indicators related to higher quality of life scores and lower risk of the primary composite outcome. Notably, we found a significant interaction between regional income level and both household income and education status ( P interaction 〈 0.001 for both), where the association of low household income and low education status with poor outcomes was more pronounced in high-income compared with lower income regions. Conclusions: These findings highlight the importance of socioeconomic determinants among patients with heart failure in Asia and suggest that attention should be paid to address disparities in access to care among the poor and less educated, including those from wealthy regions. Registration: URL: https://clinicaltrials.gov ; Unique Identifier: NCT01633398.

Type of Medium: Online Resource

ISSN: 1941-7713 , 1941-7705

URL: Article

DOI: 10.1161/CIRCOUTCOMES.120.006962

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2021

detail.hit.zdb_id: 2453882-6

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Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI): a phase 3, placebo-controlled, randomised trial

Bhatt, Deepak L ; Steg, Philippe Gabriel ; Mehta, Shamir R ; [et al.]

Elsevier BV ; 2019

In: The Lancet Vol. 394, No. 10204 ( 2019-09), p. 1169-1180

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In: The Lancet, Elsevier BV, Vol. 394, No. 10204 ( 2019-09), p. 1169-1180

Type of Medium: Online Resource

ISSN: 0140-6736

URL: Article

DOI: 10.1016/S0140-6736(19)31887-2

RVK:

XA 10000

Language: English

Publisher: Elsevier BV

Publication Date: 2019

detail.hit.zdb_id: 2067452-1

detail.hit.zdb_id: 3306-6

detail.hit.zdb_id: 1476593-7

SSG: 5,21

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Malnutrition in acute heart failure with preserved ejection fraction: clinical correlates and prognostic implications

Chien, Shih‐Chieh ; Lo, Chi‐In ; Lin, Chao‐Feng ; [et al.]

Wiley ; 2019

In: ESC Heart Failure Vol. 6, No. 5 ( 2019-10), p. 953-964

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In: ESC Heart Failure, Wiley, Vol. 6, No. 5 ( 2019-10), p. 953-964

Abstract: This study aimed to evaluate the prognostic significance of nutritional status in post‐discharge Asians with heart failure with preserved ejection fraction (HFpEF). Methods and results We examined the prognostic implications of body mass index (BMI) and nutritional markers among consecutive patients hospitalized for HFpEF. Nutritional metrics were estimated by serum albumin (SA), prognostic nutritional index (PNI), Controlling Nutritional Status (CONUT) score, and geriatric nutritional risk index. Among 1120 patients (mean age: 77.2 ± 12.6 years, 39.4% men), mean SA levels, PNI, CONUT scores, and geriatric nutritional risk index were 3.3 ± 0.6 g/dL, 40.2 ± 8.7, 5.5 ± 2.1, and 95.9 ± 14.5, respectively. Lean body size, higher white blood cell counts and C‐reactive protein levels, anaemia, and lack of angiotensin blocker use were independently associated with malnutrition (defined by SA 〈 3.5 g/dL). Higher SA levels [hazard ratio (HR): 0.67 (95% confidence interval, CI: 0.53–0.85)], higher PNI [HR: 0.97 (95% CI: 0.95–0.99)] , and higher geriatric nutritional risk index [HR: 0.98 (95% CI: 0.97–0.99)] (all P 〈 0.05) were all associated with longer survival, with higher CONUT score [HR: 1.08 (95% CI: 1.02–1.13)] exhibited higher mortality in Cox regression models and with higher SA levels/PNI but not BMI further contributing to the reduced rate of re‐hospitalization (both P 〈 0.05). Categorizing BMI (25 kg/m 2 as cut‐off) and nutritional status showed significantly higher mortality rates among patients with lower BMI/malnutrition than among those with BMI/better nutrition (SA level, PNI, and CONUT score, all P 〈 0.01). Restricted cubic spline regression revealed a marked survival benefit of better nutrition with increasing BMI (adjusted P interaction for both SA level and PNI: 〈 0.001; adjusted P interaction for CONUT score: 0.046). Conclusions Malnutrition was frequently and strongly associated with systemic inflammation in Asian patients hospitalized for acute HFpEF. Our findings also indicate that nutrition may play a pivotal role in metabolic protection in this population.

Type of Medium: Online Resource

ISSN: 2055-5822 , 2055-5822

URL: Issue

URL: Article

DOI: 10.1002/ehf2.v6.5

DOI: 10.1002/ehf2.12501

Language: English

Publisher: Wiley

Publication Date: 2019

detail.hit.zdb_id: 2814355-3

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Atrioventricular Longitudinal Mechanics Using Novel Speckle-Tracking Improved Risk Stratification Beyond Baseline Thyroid Hormone in Asymptomatic Subclinical Hypothyroidism

Huang, Wen-Hung ; Sung, Kuo-Tzu ; Kuo, Jen-Yuan ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2021

In: Circulation: Cardiovascular Imaging Vol. 14, No. 11 ( 2021-11)

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In: Circulation: Cardiovascular Imaging, Ovid Technologies (Wolters Kluwer Health), Vol. 14, No. 11 ( 2021-11)

Abstract: Hypothyroidism is reportedly associated with increased cardiovascular risk and heart failure. We aimed to elucidate the mechanistic influence of atrio-ventricular deformations and their prognostic utilizations in asymptomatic subclinical hypothyroidism (SCH). Methods: We assessed speckle-tracking of deformations among 4173 population-based asymptomatic individuals classified as euthyroid (0.25 〈 thyroid-stimulating hormone [TSH] ≤4.0 μIU/mL, n=3799) or having mild (4 〈 TSH ≤10.0 μIU/mL, n=349) or marked (TSH 〉 10 μIU/mL, n=25) SCH. We further related deformational indices to outcomes of atrial fibrillation and heart failure. Results: Despite borderline differences in indexed left ventricular mass and left atrial volume ( P =0.054 and 0.051), those classified as mild and marked SCH presented with modest but significant reductions of global longitudinal strain, and showed elevated E/tissue Doppler imaging (TDI)-e′, markedly diminished peak atrial longitudinal strain and higher left atrial stiffness (all P 〈 0.05) when compared with euthyroid subjects. A higher TSH level was independently associated with reduced TDI-s′/TDI-e′, worse global atrio-ventricular strains (global longitudinal strain/peak atrial longitudinal strain), elevated E/TDI-e′, and worsened left atrial strain rate components (all P 〈 0.05). Over a median 5.6 years (interquartile range, 4.7–6.5 years) follow-up, myocardial deformations yielded independent risk prediction using Cox regression in models adjusted for baseline covariates, N-terminal pro-brain natriuretic peptide, E/e′, and treatment effect. Incorporation of global atrio-ventricular strain (global longitudinal strain/peak atrial longitudinal strain) and strain rates further showed improved risk reclassification when added to the baseline TSH strata (classified as euthyroid and mild and marked SCH; all P 〈 0.05). Cox regression models remained significant with improved risk reclassification beyond TSH-based strata by using slightly different deformational cutoffs after excluding marked SCH group. Conclusions: Hypothyroidism, even when asymptomatic, may widely influence subclinical atrio-ventricular mechanical functions that may lead to higher heart failure and atrial fibrillation risk. We proposed the potential usefulness and prognostic utilization of myocardial strains in such population.

Type of Medium: Online Resource

ISSN: 1941-9651 , 1942-0080

URL: Article

DOI: 10.1161/CIRCIMAGING.121.012433

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2021

detail.hit.zdb_id: 2440475-5

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The relationship of renal function to segmental vascular stiffness, ankle‐brachial index, and peripheral artery disease

Lin, Yueh‐Hung ; Sung, Kuo‐Tzu ; Tsai, Cheng‐Ting ; [et al.]

Wiley ; 2018

In: The Journal of Clinical Hypertension Vol. 20, No. 6 ( 2018-06), p. 1027-1035

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In: The Journal of Clinical Hypertension, Wiley, Vol. 20, No. 6 ( 2018-06), p. 1027-1035

Abstract: The authors consecutively assessed various arterial pulse‐wave velocity ( PWV ) indices and ankle‐brachial index ( ABI ) by an automatic device (VP2000, OMRON Health Care Co. Ltd., Kyota, Japan) in outpatients with ≥ 1 cardiovascular risk. PAD was defined as ABI ≤ 0.9. Among 2309 outpatients (mean age 62.4 years), worse renal function was associated with higher brachial‐ankle PWV , heart‐carotid PWV , heart‐femoral PWV (hf‐ PWV ), and lower ABI (all P 〈 .001). Multivariate regression models showed independent associations between lower eGFR , lower ABI (Coef: 0.42 & 0.41 for right and left), higher hf‐ PWV (Coef: −11.4 [95% CI : −15.4, −7.3]) and greater PAD risk (adjusted OR : 0.83 [95% CI : 0.76, 0.91], all P 〈 .05). eGFR set at 77 mL /min/1.73m 2 was observed to be useful clinical cutoff (c‐statistics: 0.67) for identifying PAD ( P for Δ AUROC : .009; likelihood X 2 : 93.82 to 137.43, P 〈 .001) when superimposed on clinical risks. This study suggested early renal insufficiency is tightly linked to region‐specific vascular stiffness and PAD.

Type of Medium: Online Resource

ISSN: 1524-6175 , 1751-7176

URL: Issue

URL: Article

DOI: 10.1111/jch.2018.20.issue-6

DOI: 10.1111/jch.13297

Language: English

Publisher: Wiley

Publication Date: 2018

detail.hit.zdb_id: 2058690-5

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Association of Region‐Specific Cardiac Adiposity With Dysglycemia and New‐Onset Diabetes

Sung, Kuo‐Tzu ; Kuo, Jen‐Yuan ; Yun, Chun‐Ho ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2021

In: Journal of the American Heart Association Vol. 10, No. 24 ( 2021-12-21)

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In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 24 ( 2021-12-21)

Abstract: Visceral adipose tissue is assumed to be an important indicator for insulin resistance and diabetes beyond overweight/obesity. We hypothesized that region‐specific visceral adipose tissue may regulate differential biological effects for new‐onset diabetes regardless of overall obesity. Methods and Results We quantified various visceral adipose tissue measures, including epicardial adipose tissue, paracardial adipose tissue, interatrial fat, periaortic fat, and thoracic aortic adipose tissue in 1039 consecutive asymptomatic participants who underwent multidetector computed tomography. We explored the associations of visceral adipose tissue with baseline dysglycemic indices and new‐onset diabetes. Epicardial adipose tissue, paracardial adipose tissue, interatrial fat, periaortic fat, and thoracic aortic adipose tissue were differentially and independently associated with dysglycemic indices (fasting glucose, postprandial glucose, HbA1c, and homeostasis model assessment of insulin resistance) beyond anthropometric measures. The superimposition of interatrial fat and thoracic aortic adipose tissue on age, sex, body mass index, and baseline homeostasis model assessment of insulin resistance expanded the likelihood of baseline diabetes (from 67.2 to 86.0 and 64.4 to 70.8, P for ∆ ꭕ 2 : 〈 0.001 and 0.011, respectively). Compared with the first tertile, the highest interatrial fat tertile showed a nearly doubled risk for new‐onset diabetes (hazard ratio, 2.09 [95% CI, 1.38–3.15], P 〈 0.001) after adjusting for Chinese Visceral Adiposity Index. Conclusions Region‐specific visceral adiposity may not perform equally in discriminating baseline dysglycemia or diabetes, and showed differential predictive performance in new‐onset diabetes. Our data suggested that interatrial fat may serve as a potential marker for new‐onset diabetes.

Type of Medium: Online Resource

ISSN: 2047-9980

URL: Article

DOI: 10.1161/JAHA.121.021921

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2021

detail.hit.zdb_id: 2653953-6

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Prognostic superiority of global longitudinal strain beyond four-tiered ventricular hypertrophy in asymptomatic individuals

Sung, Kuo-Tzu ; Chen, Yi-Hsuan ; Kuo, Jen-Yuan ; [et al.]

Elsevier BV ; 2022

In: Journal of the Formosan Medical Association Vol. 121, No. 8 ( 2022-08), p. 1414-1424

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In: Journal of the Formosan Medical Association, Elsevier BV, Vol. 121, No. 8 ( 2022-08), p. 1414-1424

Type of Medium: Online Resource

ISSN: 0929-6646

URL: Article

DOI: 10.1016/j.jfma.2021.09.017

Language: English

Publisher: Elsevier BV

Publication Date: 2022

detail.hit.zdb_id: 2250901-X

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Associations of region‐specific visceral adiposity with subclinical atrial dysfunction and outcomes of heart failure

Huang, Bo‐Han ; Chang, Shun‐Chuan ; Yun, Chun‐Ho ; [et al.]

Wiley ; 2020

In: ESC Heart Failure Vol. 7, No. 6 ( 2020-12), p. 3545-3560

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In: ESC Heart Failure, Wiley, Vol. 7, No. 6 ( 2020-12), p. 3545-3560

Abstract: Excessive visceral adiposity (VAT) plays an essential role in metabolic derangements with those close to heart further mediates myocardial homeostasis. The disparate biological links between region‐specific VAT and cardiometabolic profiles as mediators influencing atrial kinetics remain unexplored. Methods and results Among 1326 asymptomatic individuals, region‐specific VAT including peri‐aortic root fat (PARF) and total pericardial fat (PCF) of cardiac region, together with thoracic peri‐aortic adipose tissue (TAT), was assessed using multiple‐detector computed tomography. VAT measures were related to functional left atrial (LA) metrics assessed by speckle‐tracking algorithm and clinical outcomes of atrial fibrillation (AF) and heart failure (HF). Multivariate linear regression models incorporating body fat, metabolic syndrome, and E/TDI‐e' consistently demonstrated independent associations of larger PARF/PCF with peak atrial longitudinal systolic strain (PALS) reduction, higher LA stiffness, and worsened strain rate components; instead, TAT was independently associated with cardiometabolic profiles. PARF rather than PCF or TAT conferred independent prognostic values for incident AF/HF by multivariate Cox regression (adjusted hazard ratio: 1.56, 95% confidence interval: 1.17–2.08, P = 0.002) during a median of 1790 days (interquartile range: 25th to 75th: 1440–1927 days) of follow‐up, with subjects categorized into worst PALS and largest VAT tertiles demonstrating highest events (all log‐rank P 〈 0.001). Mediation analysis showed that higher triglyceride and lower high‐density lipoproteins may serve as intermediary factors for effects between VAT and LA functional metrics, with lesser role by glucose level. Conclusions Visceral adiposity surrounding atrial region was tightly associated with subclinical atrial dysfunction and incident AF or HF beyond metabolic factors. Instead, peri‐aortic adiposity may mediate their toxic effects mainly through circulating cardiometabolic profiles.

Type of Medium: Online Resource

ISSN: 2055-5822 , 2055-5822

URL: Issue

URL: Article

DOI: 10.1002/ehf2.v7.6

DOI: 10.1002/ehf2.12761

Language: English

Publisher: Wiley

Publication Date: 2020

detail.hit.zdb_id: 2814355-3

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Associations of obesity and malnutrition with cardiac remodeling and cardiovascular outcomes in Asian adults: A cohort study

Chien, Shih-Chieh ; Chandramouli, Chanchal ; Lo, Chi-In ; [et al.]

Public Library of Science (PLoS) ; 2021

In: PLOS Medicine Vol. 18, No. 6 ( 2021-6-1), p. e1003661-

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In: PLOS Medicine, Public Library of Science (PLoS), Vol. 18, No. 6 ( 2021-6-1), p. e1003661-

Abstract: Obesity, a known risk factor for cardiovascular disease and heart failure (HF), is associated with adverse cardiac remodeling in the general population. Little is known about how nutritional status modifies the relationship between obesity and outcomes. We aimed to investigate the association of obesity and nutritional status with clinical characteristics, echocardiographic changes, and clinical outcomes in the general community. Methods and findings We examined 5,300 consecutive asymptomatic Asian participants who were prospectively recruited in a cardiovascular health screening program (mean age 49.6 ± 11.4 years, 64.8% male) between June 2009 to December 2012. Clinical and echocardiographic characteristics were described in participants, stratified by combined subgroups of obesity and nutritional status. Obesity was indexed by body mass index (BMI) (low, ≤25 kg/m 2 [lean]; high, 〉 25 kg/m 2 [obese]) (WHO-recommended Asian cutoffs). Nutritional status was defined primarily by serum albumin (SA) concentration (low, 〈 45 g/L [malnourished]; high, ≥45 g/L [well-nourished] ), and secondarily by the prognostic nutritional index (PNI) and Global Leadership Initiative on Malnutrition (GLIM) criteria. Cox proportional hazard models were used to examine a 1-year composite outcome of hospitalization for HF or all-cause mortality while adjusting for age, sex, and other clinical confounders. Our community-based cohort consisted of 2,096 (39.0%) lean–well-nourished (low BMI, high SA), 1,369 (25.8%) obese–well-nourished (high BMI, high SA), 1,154 (21.8%) lean–malnourished (low BMI, low SA), and 681 (12.8%) obese–malnourished (high BMI, low SA) individuals. Obese–malnourished participants were on average older (54.5 ± 11.4 years) and more often women (41%), with a higher mean waist circumference (91.7 ± 8.8 cm), the highest percentage of body fat (32%), and the highest prevalence of hypertension (32%), diabetes (12%), and history of cardiovascular disease (11%), compared to all other subgroups (all p 〈 0.001). N-terminal pro B-type natriuretic peptide (NT-proBNP) levels were substantially increased in the malnourished (versus well-nourished) groups, to a similar extent in lean (70.7 ± 177.3 versus 36.8 ± 40.4 pg/mL) and obese (73.1 ± 216.8 versus 33.2 ± 40.8 pg/mL) ( p 〈 0.001 in both) participants. The obese–malnourished (high BMI, low SA) group also had greater left ventricular remodeling (left ventricular mass index, 44.2 ± 1.52 versus 33.8 ± 8.28 gm/m 2 ; relative wall thickness 0.39 ± 0.05 versus 0.38 ± 0.06) and worse diastolic function (TDI-e′ 7.97 ± 2.16 versus 9.87 ± 2.47 cm/s; E/e′ 9.19 ± 3.01 versus 7.36 ± 2.31; left atrial volume index 19.5 ± 7.66 versus 14.9 ± 5.49 mL/m 2 ) compared to the lean–well-nourished (low BMI, high SA) group, as well as all other subgroups ( p 〈 0.001 for all). Over a median 3.6 years (interquartile range 2.5 to 4.8 years) of follow-up, the obese–malnourished group had the highest multivariable-adjusted risk of the composite outcome (hazard ratio [HR] 2.49, 95% CI 1.43 to 4.34, p = 0.001), followed by the lean–malnourished (HR 1.78, 95% CI 1.04 to 3.04, p = 0.034) and obese–well-nourished (HR 1.41, 95% CI 0.77 to 2.58, p = 0.27) groups (with lean–well-nourished group as reference). Results were similar when indexed by other anthropometric indices (waist circumference and body fat) and other measures of nutritional status (PNI and GLIM criteria). Potential selection bias and residual confounding were the main limitations of the study. Conclusions In our cohort study among asymptomatic community-based adults in Taiwan, we found that obese individuals with poor nutritional status have the highest comorbidity burden, the most adverse cardiac remodeling, and the least favorable composite outcome.

Type of Medium: Online Resource

ISSN: 1549-1676

URL: Article

DOI: 10.1371/journal.pmed.1003661

DOI: 10.1371/journal.pmed.1003661.g001

DOI: 10.1371/journal.pmed.1003661.g002

DOI: 10.1371/journal.pmed.1003661.t001

DOI: 10.1371/journal.pmed.1003661.t002

DOI: 10.1371/journal.pmed.1003661.t003

DOI: 10.1371/journal.pmed.1003661.t004

DOI: 10.1371/journal.pmed.1003661.s001

DOI: 10.1371/journal.pmed.1003661.s002

DOI: 10.1371/journal.pmed.1003661.s003

DOI: 10.1371/journal.pmed.1003661.s004

DOI: 10.1371/journal.pmed.1003661.s005

DOI: 10.1371/journal.pmed.1003661.s006

DOI: 10.1371/journal.pmed.1003661.s007

DOI: 10.1371/journal.pmed.1003661.s008

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2021

detail.hit.zdb_id: 2164823-2

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