Article Data

  • Views 233
  • Dowloads 107

Reviews

Open Access

Timely interventions for better outcomes in cardiac emergencies: a narrative review

  • Giustino Varrassi1
  • Antonella Paladini2
  • Marco Mercieri3
  • Ruggero Massimo Corso4
  • Joseph V. Pergolizzi5
  • Alberto Pasqualucci6
  • Salah N. El-Tallawy7,8
  • Giacomo Farì9
  • Barbara Silvestri10
  • Alan David Kaye11
  • Omar Viswanath12
  • Christopher Gharibo13
  • Matteo Luigi Giuseppe Leoni3,*,

1Fondazione Paolo Procacci, 00193 Rome, Italy

2Department of MESVA, University of L’Aquila, 67100 L’Aquila, Italy

3Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy

4Department of Anesthesiology and Intensive Care, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy

5NEMA Research Group, Naples, FL 34108, USA

6Department of Anesthesia and Intensive Care, University of Perugia, 06123 Perugia, Italy

7KKUH & KAUH, College of Medicine, King Saud University, 11454 Riyadh, Saudi Arabia

8Minia University & NCI, Cairo University, 12613 Giza, Egypt

9Department of Experimental Medicine (Di.Me.S.), University of Salento, 73100 Lecce, Italy

10Department of Anesthesia, Palestrina Hospital, 00036 Palestrina, Italy

11Department of Anesthesia, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA

12Department of Anesthesia, Creighton University, Phoenix, NE 68178, USA

13Department of Anesthesia, NYU Grossman School of Medicine, New York, NY 10016, USA

DOI: 10.22514/sv.2025.093 Vol.21,Issue 7,July 2025 pp.16-28

Submitted: 15 May 2025 Accepted: 23 June 2025

Published: 08 July 2025

*Corresponding Author(s): Matteo Luigi Giuseppe Leoni E-mail: matteoluigigiuseppe.leoni@uniroma1.it

Abstract

Cardiac emergencies represent a major challenge in modern healthcare, requiring immediate and effective interventions to improve patient outcomes. Conditions such as ischemic heart disease, myocardial infarction, arrhythmias, and acute heart failure frequently present as life-threatening events that impose substantial demands on healthcare systems worldwide. Early symptom recognition, such as chest pain, dyspnea, palpitations, and syncope, is critical for timely and appropriate management. Rapid diagnosis relies on a combination of clinical assessment and the use of diagnostic tools, including electrocardiography, cardiac biomarkers, advanced imaging techniques, wearable devices, and centralized platforms. For this, an advanced organization of the emergency medical service (EMS) is crucial. Understanding the multifactorial nature of cardiovascular emergencies, encompassing genetic predisposition, lifestyle influences, and environmental factors, enables more personalized and targeted therapeutic approaches. Timely administration of evidence-based therapies such as reperfusion techniques, antiarrhythmic drugs, and hemodynamic support has been shown to significantly improve recovery trajectories and long-term prognosis. Conversely, delays in intervention are associated with increased risk of irreversible myocardial or systemic damage, complicating future treatment efforts. The successful management of cardiovascular emergencies depends on rapid and accurate diagnosis, a thorough understanding of pathophysiology, and the implementation of timely, evidence-based interventions. Coordinated care involving pre-hospital services, streamlined emergency department protocols, and multidisciplinary collaboration is essential. Moreover, continuous research and the integration of emerging technologies are key to advancing outcomes in this dynamic clinical domain.


Keywords

Emergencies; Cardiovascular diseases; Myocardial infarction; Arrhythmias; Cardiac insufficiency


Cite and Share

Giustino Varrassi,Antonella Paladini,Marco Mercieri,Ruggero Massimo Corso,Joseph V. Pergolizzi,Alberto Pasqualucci,Salah N. El-Tallawy,Giacomo Farì,Barbara Silvestri,Alan David Kaye,Omar Viswanath,Christopher Gharibo,Matteo Luigi Giuseppe Leoni. Timely interventions for better outcomes in cardiac emergencies: a narrative review. Signa Vitae. 2025. 21(7);16-28.

References

[1] Zhu XY, Shi MQ, Jiang ZM, Xiao L, Tian JW, Su FF. Global, regional, and national burden of cardiovascular diseases attributable to metabolic risks across all age groups from 1990 to 2021: an analysis of the 2021 global burden of disease study data. BMC Public Health. 2025; 25: 1704.

[2] Johannessen TR, Ruud SE, Larstorp ACK, Atar D, Halvorsen S, Nilsen B, et al. Rapid rule-out of acute myocardial infarction using the 0/1-hour algorithm for cardiac troponins in emergency primary care: the OUT-ACS implementation study. BMC Primary Care. 2025; 26: 34.

[3] Sinha SS, Geller BJ, Katz JN, Arslanian-Engoren C, Barnett CF, Bohula EA, et al.; American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular and Stroke Nursing; and Council on Kidney in Cardiovascular Disease. Evolution of critical care cardiology: an update on structure, care delivery, training, and research paradigms: a scientific statement from the American heart association. Circulation. 2025; 151: e687–e707.

[4] Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-hospital cardiac arrest: a review. JAMA. 2019; 321: 1200–1210.

[5] World Health Organization. Noncommunicable diseases. 2023. Available at: https://www.who.int/health-topics/noncommunicable-diseases (Accessed: 14 May 2025).

[6] Olasveengen TM, Mancini ME, Perkins GD, Avis S, Brooks S, Castrén M, et al. Adult basic life support: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2020; 142: S41–S91.

[7] Dali M, Bogle CME, Bogle RG. The evolving paradigm of myocardial infarction in the era of artificial intelligence. British Journal of Hospital Medicine. 2025; 86: 1–7.

[8] Rodríguez-Reyes H, Muñoz-Gutiérrez M, Salas-Pacheco JL. Current behavior of sudden cardiac arrest and sudden death. Archivos de Cardiología de México. 2020; 90: 183–189.

[9] Garg M, Gupta M, Patel NN, Bansal K, Lam PH, Sheikh FH. Predictors and outcomes of sudden cardiac arrest in heart failure with preserved ejection fraction: a nationwide inpatient sample analysis. The American Journal of Cardiology. 2023; 206: 277–284.

[10] Alrawashdeh A, Nehme Z, Williams B, Smith K, Brennan A, Dinh DT, et al. Impact of emergency medical service delays on time to reperfusion and mortality in STEMI. Open Heart. 2021; 8: e001654.

[11] Newman-Toker DE, Nassery N, Schaffer AC, Yu-Moe CW, Clemens GD, Wang Z, et al. Burden of serious harms from diagnostic error in the USA. BMJ Quality & Safety. 2024; 33: 109–120.

[12] Ferreira D. If ‘time is muscle,’ then the patient’s knowledge must save time. Arquivos Brasileiros de Cardiologia. 2022; 119: 35–36.

[13] Kalman JM, Kistler PM, Hindricks G, Sanders P. Atrial fibrillation ablation timing: where is the sweet spot? European Heart Journal. 2025; 46: 805–813.

[14] Chioncel O, Parissis J, Mebazaa A, Thiele H, Desch S, Bauersachs J, et al. Epidemiology, pathophysiology and contemporary management of cardiogenic shock—a position statement from the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure. 2020; 22: 1315–1341.

[15] Kochan A, Lee T, Moghaddam N, Milley G, Singer J, Cairns JA, et al. Reperfusion delays and outcomes among patients with st-segment-elevation myocardial infarction with and without cardiogenic shock. Circulation: Cardiovascular Interventions. 2023; 16: e012810.

[16] Baethge C, Goldbeck-Wood S, Mertens S. SANRA—a scale for the quality assessment of narrative review articles. Research Integrity and Peer Review. 2019; 4: 5.

[17] Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. The BMJ. 2008; 336: 924–926.

[18] Peterson ED, Roe MT, Chen AY, Fonarow GC, Lytle BL, Cannon CP, et al. The NCDR ACTION registry-GWTG: transforming contemporary acute myocardial infarction clinical care. Heart. 2010; 96: 1798–1802.

[19] Lu L, Liu M, Sun R, Zheng Y, Zhang P. Myocardial infarction: symptoms and treatments. Cell Biochemistry and Biophysics. 2015; 72: 865–867.

[20] Wu Y, Pan N, An Y, Xu M, Tan L, Zhang L. Diagnostic and prognostic biomarkers for myocardial infarction. Frontiers in Cardiovascular Medicine. 2020; 7: 617277.

[21] Sciahbasi A, Rosa SD, Gargiulo G, Giacoppo D, Calabrò P, Talarico GP, et al. Management of patients treated with oral anticoagulant therapy undergoing percutaneous coronary intervention with stent implantation: the PERSEO Registry. Journal of Cardiovascular Pharmacology. 2024; 84: 457–467.

[22] Bardai A, Blom MT, van Hoeijen DA, van Deutekom HWM, Brouwer HJ, Tan HL. Atrial fibrillation is an independent risk factor for ventricular fibrillation. Circulation: Arrhythmia and Electrophysiology. 2014; 7: 1033–1039.

[23] Germanova O, Galati G, Germanov A, Stefanidis A. Atrial fibrillation as a new independent risk factor for thromboembolic events: hemodynamics and vascular consequence of long ventricular pauses. Minerva Cardiology and Angiology. 2023; 71: 175–181.

[24] Liu Y, Xiao D, Wu Y, Li M, Liu J, Zhuang R, et al. Bioresorbable scaffolds vs. drug-eluting stents for patients with myocardial infarction: a systematic review and meta-analysis of randomized clinical trials. Frontiers in Cardiovascular Medicine. 2022; 9: 974957.

[25] Chou L, Liu J, Gong S, Chou Y. Corrigendum on: a life-threatening arrhythmia detection method based on pulse rate variability analysis and decision tree. Frontiers in Physiology. 2022; 13: 1102527.

[26] Miszczyk M, Hoeksema WF, Kuna K, Blamek S, Cuculich PS, Grehn M, et al. Stereotactic arrhythmia radioablation (STAR)—a systematic review and meta-analysis of prospective trials on behalf of the STOPSTORM.eu consortium. Heart Rhythm. 2025; 22: 80–89.

[27] Tsiachris D, Argyriou N, Tsioufis P, Antoniou CK, Laina A, Oikonomou G, et al. Aggressive rhythm control strategy in atrial fibrillation patients presenting at the emergency department: the HEROMEDICUS study design and initial results. Journal of Cardiovascular Development and Disease. 2024; 11: 109.

[28] Emmons-Bell S, Johnson C, Roth G. Prevalence, incidence and survival of heart failure: a systematic review. Heart. 2022; 108: 1351–1360.

[29] Deniau B, Costanzo MR, Sliwa K, Asakage A, Mullens W, Mebazaa A. Acute heart failure: current pharmacological treatment and perspectives. European Heart Journal. 2023; 44: 4634–4649.

[30] Isath A, Pfeffer M, Mehra MR. Advancing antithrombotic therapies for left ventricular assist devices: challenges, innovations, and future perspectives. Future Cardiology. 2025; 21: 411–413.

[31] Galinier M, Roubille F, Berdague P, Brierre G, Cantie P, Dary P, et al. Telemonitoring versus standard care in heart failure: a randomised multicentre trial. European Journal of Heart Failure. 2020; 22: 985–994.

[32] Cenko E, van der Schaar M, Yoon J, Manfrini O, Vasiljevic Z, Vavlukis M, et al. Sex-related differences in heart failure after ST-segment elevation myocardial infarction. Journal of the American College of Cardiology. 2019; 74: 2379–2389.

[33] Roe MT, Goodman SG, Ohman EM, Stevens SR, Hochman JS, Gottlieb S, et al. Elderly patients with acute coronary syndromes managed without revascularization. Circulation. 2013; 128: 823–833.

[34] Angiolillo DJ, Rollini F, Storey RF, Bhatt DL, James S, Schneider DJ, et al. International expert consensus on switching platelet P2Y12 receptor-inhibiting therapies. Circulation. 2017; 136: 1955–1975.

[35] Claassens DMF, Vos GJA, Bergmeijer TO, Hermanides RS, van’t Hof AWJ, van der Harst P, et al. A genotype-guided strategy for oral P2Y12 inhibitors in primary PCI. The New England Journal of Medicine. 2019; 381: 1621–1631.

[36] Pereira NL, Farkouh ME, So D, Lennon R, Geller N, Mathew V, et al. Effect of genotype-guided oral P2Y12 inhibitor selection vs conventional clopidogrel therapy on ischemic outcomes after percutaneous coronary intervention: the TAILOR-PCI randomized clinical trial. JAMA. 2020; 324: 761–771.

[37] Soleimanian M, Bijani M, Nikrouz L, Naghizadeh MM, Ranjbar K, Heidari G. A timeliness analysis of emergency services and cardiovascular outcomes in cardiac patients referred through prehospital emergency services between 2020 and 2023: a cross-sectional study in Iran. BMC Research Notes. 2024; 17: 250.

[38] Reinier K, Dizon B, Chugh H, Bhanji Z, Seifer M, Sargsyan A, et al. Warning symptoms associated with imminent sudden cardiac arrest: a population-based case-control study with external validation. The Lancet Digital Health. 2023; 5: e763–e773.

[39] Perona M, Cooklin A, Thorpe C, O’Meara P, Rahman MA. Symptomology, outcomes and risk factors of acute coronary syndrome presentations without cardiac chest pain: a scoping review. European Cardiology. 2024; 19: e12.

[40] Greulich S, Mayr A, Gloekler S, Seitz A, Birkmeier S, Schäufele T, et al. Time-dependent myocardial necrosis in patients with ST-segment-elevation myocardial infarction without angiographic collateral flow visualized by cardiac magnetic resonance imaging: results from the multicenter STEMI-SCAR project. Journal of the American Heart Association. 2019; 8: e012429.

[41] Nathan AS, Raman S, Yang N, Painter I, Khatana SAM, Dayoub EJ, et al. Association between 90-minute door-to-balloon time, selective exclusion of myocardial infarction cases, and access site choice: insights from the cardiac care outcomes assessment program (COAP) in Washington state. Circulation Cardiovascular Interventions. 2020; 13: e009179.

[42] Faxon D, Lenfant C. Timing is everything: motivating patients to call 9-1-1 at onset of acute myocardial infarction. Circulation. 2001; 104: 1210–1211.

[43] Xue YL, Ma YT, Gao YP, Zhang SX, Su QY, Li YF, et al. Long-term outcomes of delayed percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction. Medicine. 2021; 100: e27474.

[44] Aversano T, Aversano LT, Passamani E, Knatterud GL, Terrin ML, Williams DO, et al. Thrombolytic therapy vs primary percutaneous coronary intervention for myocardial infarction in patients presenting to hospitals without on-site cardiac surgery: a randomized controlled trial. JAMA. 2002; 287: 1943–1951.

[45] Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, et al. 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. European Heart Journal. 2022; 43: 3997–4126.

[46] Sampaio Rodrigues T, Garcia Quarto LJ, Nogueira SC, Theuerle JD, Farouque O, Burrell LM, et al. Door-to-diuretic time and mortality in patients with acute heart failure: a systematic review and meta-analysis. American Heart Journal. 2024; 269: 205–209.

[47] Fålun N, Langørgen J, Fridlund B, Pettersen T, Rotevatn S, Norekvål TM. Patients’ reflections on prehospital symptom recognition and timely treatment of myocardial infarction. European Journal of Cardiovascular Nursing. 2021; 20: 526–533.

[48] Del Pozo Vegas C, Zalama-Sánchez D, Sanz-Garcia A, López-Izquierdo R, Sáez-Belloso S, Mazas Perez Oleaga C, et al. Prehospital acute life-threatening cardiovascular disease in elderly: an observational, prospective, multicentre, ambulance-based cohort study. BMJ Open. 2023; 13: e078815.

[49] Quinn T, Johnsen S, Gale CP, Snooks H, McLean S, Woollard M, et al. Effects of prehospital 12-lead ECG on processes of care and mortality in acute coronary syndrome: a linked cohort study from the Myocardial Ischaemia National Audit Project. Heart. 2014; 100: 944–950.

[50] Park K, Park JS, Cho YR, Park TH, Kim MH, Yang TH, et al. Community-based pre-hospital electrocardiogram transmission program for reducing systemic time delay in acute ST-segment elevation myocardial infarction. Korean Circulation Journal. 2020; 50: 709–719.

[51] Moxham RN, d’Entremont MA, Mir H, Schwalm JD, Natarajan MK, Jolly SS. Effect of prehospital digital electrocardiogram transmission on revascularization delays and mortality in ST-elevation myocardial infarction patients: systematic review and meta-analysis. CJC Open. 2024; 6: 1199–1206.

[52] Curtis JP, Portnay EL, Wang Y, McNamara RL, Herrin J, Bradley EH, et al. The pre-hospital electrocardiogram and time to reperfusion in patients with acute myocardial infarction, 2000–2002. Journal of the American College of Cardiology. 2006; 47: 1544–1552.

[53] Björklund E, Stenestrand U, Lindbäck J, Svensson L, Wallentin L, Lindahl B. Pre-hospital thrombolysis delivered by paramedics is associated with reduced time delay and mortality in ambulance-transported real-life patients with ST-elevation myocardial infarction. European Heart Journal. 2006; 27: 1146–1152.

[54] Guy A, Gabers N, Crisfield C, Helmer J, Peterson SC, Ganstal A, et al. Collaborative heart attack management program (CHAMP): use of prehospital thrombolytics to improve timeliness of STEMI management in British Columbia. BMJ Open Quality. 2021; 10: e001519.

[55] Muhlestein JB, Le V, Albert D, Moreno FL, Anderson JL, Yanowitz F, et al. Smartphone ECG for evaluation of STEMI: results of the ST LEUIS Pilot Study. Journal of Electrocardiology. 2015; 48: 249–259.

[56] Brunetti ND, Gennaro LD, Amodio G, Dellegrottaglie G, Pellegrino PL, Biase MD, et al. Telecardiology improves quality of diagnosis and reduces delay to treatment in elderly patients with acute myocardial infarction and atypical presentation. European Journal of Preventive Cardiology. 2010; 17: 615–620.

[57] Krantz MJ, Coronel SM, Whitley EM, Dale R, Yost J, Estacio RO. Effectiveness of a community health worker cardiovascular risk reduction program in public health and health care settings. American Journal of Public Health. 2013; 103: e19–e27.

[58] Bergrath S, Brokmann JC, Beckers S, Felzen M, Czaplik M, Rossaint R. Implementation of a full-scale prehospital telemedicine system: evaluation of the process and systemic effects in a pre–post intervention study. BMJ Open. 2021; 11: e041942.

[59] Wilcock AD, Schwamm LH, Zubizarreta JR, Zachrison KS, Uscher-Pines L, Richard JV, et al. Reperfusion treatment and stroke outcomes in hospitals with telestroke capacity. JAMA Neurology. 2021; 78: 527.

[60] Odeh VA, Chen Y, Wang W, Ding X. Recent advances in the wearable devices for monitoring and management of heart failure. Reviews in Cardiovascular Medicine. 2024; 25: 386.

[61] Pergolizzi JV III, LeQuang JAK, El-Tallawy SN, Varrassi G. What clinicians should tell patients about wearable devices and data privacy: a narrative review. Cureus. 2025; 17: e81167.

[62] Bayoumy K, Gaber M, Elshafeey A, Mhaimeed O, Dineen EH, Marvel FA, et al. Smart wearable devices in cardiovascular care: where we are and how to move forward. Nature Reviews Cardiology. 2021; 18: 581–599.

[63] Del-Valle-Soto C, Briseño RA, Valdivia LJ, Nolazco-Flores JA. Unveiling wearables: exploring the global landscape of biometric applications and vital signs and behavioral impact. BioData Mining. 2024; 17: 15.

[64] Kang HS, Exworthy M. Wearing the future-wearables to empower users to take greater responsibility for their health and care: scoping review. JMIR mHealth and uHealth. 2022; 10: e35684.

[65] Hughes A, Shandhi MMH, Master H, Dunn J, Brittain E. Wearable devices in cardiovascular medicine. Circulation Research. 2023; 132: 652–670.

[66] Haleem A, Javaid M, Singh RP, Suman R. Telemedicine for healthcare: capabilities, features, barriers, and applications. Sensors International. 2021; 2: 100117.

[67] Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, Brooks M. Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ Open. 2017; 7: e016242.

[68] Castaneda D, Esparza A, Ghamari M, Soltanpur C, Nazeran H. A review on wearable photoplethysmography sensors and their potential future applications in health care. International Journal of Biosensors & Bioelectronics. 2018; 4: 195–202.

[69] Sjoding MW, Dickson RP, Iwashyna TJ, Gay SE, Valley TS. Racial bias in pulse oximetry measurement. New England Journal of Medicine. 2020; 383: 2477–2478.

[70] Attia ZI, Kapa S, Lopez-Jimenez F, McKie PM, Ladewig DJ, Satam G, et al. Screening for cardiac contractile dysfunction using an artificial intelligence-enabled electrocardiogram. Nature Medicine. 2019; 25: 70–74.

[71] Hannun AY, Rajpurkar P, Haghpanahi M, Tison GH, Bourn C, Turakhia MP, et al. Cardiologist-level arrhythmia detection and classification in ambulatory electrocardiograms using a deep neural network. Nature Medicine. 2019; 25: 65–69.

[72] Belbase P, Bhusal R, Ghimire SS, Sharma S, Banskota B. Assuring assistance to healthcare and medicine: internet of things, artificial intelligence, and artificial intelligence of things. Frontiers in Artificial Intelligence. 2024; 7: 1442254.

[73] Alowais SA, Alghamdi SS, Alsuhebany N, Alqahtani T, Alshaya AI, Almohareb SN, et al. Revolutionizing healthcare: the role of artificial intelligence in clinical practice. BMC Medical Education. 2023; 23: 689.

[74] Haribhai-Thompson J, McBride-Henry K, Hales C, Rook H. Understanding of empathetic communication in acute hospital settings: a scoping review. BMJ Open. 2022; 12: e063375.

[75] Mukherjee D, Fang J, Chetcuti S, Moscucci M, Kline-Rogers E, Eagle KA. Impact of combination evidence-based medical therapy on mortality in patients with acute coronary syndromes. Circulation. 2004; 109: 745–749.

[76] Rao P, Kern KB. Improving community survival rates from out-of-hospital cardiac arrest. Current Cardiology Reviews. 2018; 14: 79–84.

[77] Cenko E, Bergami M, Yoon J, Vadalà G, Kedev S, Kostov J, et al. Age and sex differences in the efficacy of early invasive strategy for non-ST-elevation acute coronary syndrome: a comparative analysis in stable patients. American Journal of Preventive Cardiology. 2025; 22: 100984.

[78] O’Sullivan SF, Schneider H. Developing telemedicine in emergency medical services: a low-cost solution and practical approach connecting interfaces in emergency medicine. The Journal of Medicine Access. 2022; 6: 27550834221084656.

[79] Li X, Huang L, Zhang H, Liang Z. Enabling telemedicine from the system-level perspective: scoping review. Journal of Medical Internet Research. 2025; 27: e65932.

[80] Evans NR, Sibson L, Day DJ, Agarwal S, Shekhar R, Warburton EA. Hyperacute stroke thrombolysis via telemedicine: a multicentre study of performance, safety and clinical efficacy. BMJ Open. 2022; 12: e057372.

[81] Janßen A, Pardey N, Zeidler J, Krauth C, Blaser J, Oedingen C, et al. Support by telestroke networks is associated with increased intravenous thrombolysis and reduced hospital transfers: a German claims data analysis. Health Economics Review. 2024; 14: 100.

[82] Ansari Y, Mourad O, Qaraqe K, Serpedin E. Deep learning for ECG arrhythmia detection and classification: an overview of progress for period 2017–2023. Frontiers in Physiology. 2023; 14: 1246746.

[83] Banerjee A. Artificial intelligence enabled mobile health technologies in arrhythmias—an opinion article on recent findings. Frontiers in Cardiovascular Medicine. 2025; 12: 1548554.

[84] Panwar A, Narendra M, Arya A, Raj R, Kumar A. Integrated portable ECG monitoring system with CNN classification for early arrhythmia detection. Frontiers in Digital Health. 2025; 7: 1535335.

[85] Sana F, Isselbacher EM, Singh JP, Heist EK, Pathik B, Armoundas AA. Wearable devices for ambulatory cardiac monitoring: JACC state-of-the-art review. Journal of the American College of Cardiology. 2020; 75: 1582–1592.

[86] Koshiyama A, Firoozye N, Treleaven P. Algorithms in future capital markets: a survey on AI, ML and associated algorithms in capital markets. Proceedings of the first ACM International Conference on AI in Finance. New York. 15–16 October 2020. Association for Computing: New York, NY, USA. 2020.

[87] Fiorina L, Chemaly P, Cellier J, Said MA, Coquard C, Younsi S, et al. Artificial intelligence-based electrocardiogram analysis improves atrial arrhythmia detection from a smartwatch electrocardiogram. European Heart Journal Digital Health. 2024; 5: 535–541.

[88] Topol EJ. High-performance medicine: the convergence of human and artificial intelligence. Nature Medicine. 2019; 25: 44–56.

[89] Rajkomar A, Dean J, Kohane I. Machine learning in medicine. The New England Journal of Medicine. 2019; 380: 1347–1358.

[90] Johnson KW, Torres Soto J, Glicksberg BS, Shameer K, Miotto R, Ali M, et al. Artificial intelligence in cardiology. Journal of the American College of Cardiology. 2018; 71: 2668–2679.

[91] Vasey B, Nagendran M, Campbell B, Clifton DA, Collins GS, Denaxas S, et al. Reporting guideline for the early-stage clinical evaluation of decision support systems driven by artificial intelligence: DECIDE-AI. Nature Medicine. 2022; 28: 924–933.

[92] Wang Z, Hassan N, LeBaron V, Flickinger T, Ling D, Edwards J, et al. CommSense: a wearable sensing computational framework for evaluating patient-clinician interactions. Proceedings of the ACM on Human-Computer Interaction. 2024; 8: 1–31.

[93] Radhakrishna K, Bowles K, Zettek-Sumner A. Contributors to frequent telehealth alerts including false alerts for patients with heart failure: a mixed methods exploration. Applied Clinical Informatics. 2013; 4: 465–475.

[94] Cohen DJ, Van Hout B, Serruys PW, Mohr FW, Macaya C, den Heijer P, et al. Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery. The New England Journal of Medicine. 2011; 364: 1016–1026.

[95] Ting HH, Krumholz HM, Bradley EH, Cone DC, Curtis JP, Drew BJ, et al. Implementation and integration of prehospital ECGs into systems of care for acute coronary syndrome: a scientific statement from the American Heart Association Interdisciplinary Council on quality of care and outcomes research, Emergency Cardiovascular Care Committee, Council on cardiovascular nursing, and Council on clinical cardiology. Circulation. 2008; 118: 1066–1079.

[96] Cohen DJ, Lincoff AM, Lavelle TA, Chen HL, Bakhai A, Berezin RH, et al. Economic evaluation of bivalirudin with provisional glycoprotein IIB/IIIA inhibition versus heparin with routine glycoprotein IIB/IIIA inhibition for percutaneous coronary intervention: results from the REPLACE-2 trial. Journal of the American College of Cardiology. 2004; 44: 1792–1800.

[97] McConnell MV, Shcherbina A, Pavlovic A, Homburger JR, Goldfeder RL, Waggot D, et al. Feasibility of obtaining measures of lifestyle from a smartphone app: the myheart counts cardiovascular health study. JAMA Cardiology. 2017; 2: 67–76.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.3 (2024) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Top