{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T14:55:09Z","timestamp":1774968909742,"version":"3.50.1"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T00:00:00Z","timestamp":1712534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1F32HL170592-01"],"award-info":[{"award-number":["1F32HL170592-01"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23HL153775"],"award-info":[{"award-number":["K23HL153775"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000862","name":"Doris Duke Charitable Foundation","doi-asserted-by":"publisher","award":["2022060"],"award-info":[{"award-number":["2022060"]}],"id":[{"id":"10.13039\/100000862","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>An algorithmic strategy for anatomical vs. functional testing in suspected coronary artery disease (CAD) (Anatomical vs. Stress teSting decIsion Support Tool; ASSIST) is associated with better outcomes than random selection. However, in the real world, this decision is rarely random. We explored the agreement between a provider-driven vs. simulated algorithmic approach to cardiac testing and its association with outcomes across multinational cohorts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>In two cohorts of functional vs. anatomical testing in a US hospital health system [Yale; 2013\u20132023; n = 130 196 (97.0%) vs. n = 4020 (3.0%), respectively], and the UK Biobank [n = 3320 (85.1%) vs. n = 581 (14.9%), respectively], we examined outcomes stratified by agreement between the real-world and ASSIST-recommended strategies. Younger age, female sex, Black race, and diabetes history were independently associated with lower odds of ASSIST-aligned testing. Over a median of 4.9 (interquartile range [IQR]: 2.4\u20137.1) and 5.4 (IQR: 2.6\u20138.8) years, referral to the ASSIST-recommended strategy was associated with a lower risk of acute myocardial infarction or death (hazard ratioadjusted: 0.81, 95% confidence interval [CI] 0.77\u20130.85, P &amp;lt; 0.001 and 0.74 [95% CI 0.60\u20130.90], P = 0.003, respectively), an effect that remained significant across years, test types, and risk profiles. In post hoc analyses of anatomical-first testing in the Prospective Multicentre Imaging Study for Evaluation of Chest Pain (PROMISE) trial, alignment with ASSIST was independently associated with a 17% and 30% higher risk of detecting CAD in any vessel or the left main artery\/proximal left anterior descending coronary artery, respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In cohorts where historical practices largely favour functional testing, alignment with an algorithmic approach to cardiac testing defined by ASSIST was associated with a lower risk of adverse outcomes. This highlights the potential utility of a data-driven approach in the diagnostic management of CAD.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjdh\/ztae023","type":"journal-article","created":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T08:35:41Z","timestamp":1712565341000},"page":"303-313","source":"Crossref","is-referenced-by-count":10,"title":["Real-world evaluation of an algorithmic machine-learning-guided testing approach in stable chest pain: a multinational, multicohort study"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4362-0720","authenticated-orcid":false,"given":"Evangelos K","family":"Oikonomou","sequence":"first","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine , 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arya","family":"Aminorroaya","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine , 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lovedeep S","family":"Dhingra","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine , 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caitlin","family":"Partridge","sequence":"additional","affiliation":[{"name":"Yale Center for Clinical Investigation , 2 Church Street South, New Haven, 06519 CT , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2245-7477","authenticated-orcid":false,"given":"Eric J","family":"Velazquez","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine , 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nihar R","family":"Desai","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine , 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harlan M","family":"Krumholz","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine , 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT , USA"},{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital , 195 Church Street 5th Floor, New Haven, 06510 CT , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2156-5962","authenticated-orcid":false,"given":"Edward J","family":"Miller","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine , 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9467-6199","authenticated-orcid":false,"given":"Rohan","family":"Khera","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine , 333 Cedar Street, PO Box 208017, New Haven, 06520-8017 CT , USA"},{"name":"Center for Outcomes Research and Evaluation, Yale-New Haven Hospital , 195 Church Street 5th Floor, New Haven, 06510 CT , USA"},{"name":"Section of Biomedical Informatics and Data Science, Yale School of Medicine , 100 College Street, New Haven, 06511 CT , USA"},{"name":"Section of Health Informatics, Department of Biostatistics, Yale School of Public Health , 60 College Street, New Haven, 06510 CT , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,4,8]]},"reference":[{"key":"2024052015211007800_ztae023-B1","first-page":"e368","article-title":"2021 AHA\/ACC\/ASE\/CHEST\/SAEM\/SCCT\/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology\/American Heart Association Joint Committee on clinical practice guidelines","volume":"144","author":"Gulati","year":"2021","journal-title":"Circulation"},{"key":"2024052015211007800_ztae023-B2","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1056\/NEJMoa1415516","article-title":"Outcomes of anatomical versus functional testing for coronary artery disease","volume":"372","author":"Douglas","year":"2015","journal-title":"N Engl J Med"},{"key":"2024052015211007800_ztae023-B3","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/eurheartj\/ehz425","article-title":"2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes","volume":"41","author":"Knuuti","year":"2020","journal-title":"Eur Heart J"},{"key":"2024052015211007800_ztae023-B4","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1016\/j.jacc.2017.01.046","article-title":"Functional testing or coronary computed tomography angiography in patients with stable coronary artery disease","volume":"69","author":"J\u00f8rgensen","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2024052015211007800_ztae023-B5","doi-asserted-by":"crossref","first-page":"e2028312","DOI":"10.1001\/jamanetworkopen.2020.28312","article-title":"Cost-effectiveness analysis of anatomic vs functional Index testing in patients with low-risk stable chest pain","volume":"3","author":"Kar\u00e1dy","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2024052015211007800_ztae023-B6","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1016\/j.jcmg.2018.07.022","article-title":"Anatomical and functional computed tomography for diagnosing hemodynamically significant coronary artery disease: a meta-analysis","volume":"12","author":"Celeng","year":"2019","journal-title":"JACC Cardiovasc Imaging"},{"key":"2024052015211007800_ztae023-B7","doi-asserted-by":"crossref","first-page":"2607","DOI":"10.1016\/j.jacc.2016.03.523","article-title":"Sex differences in functional and CT angiography testing in patients with suspected coronary artery disease","volume":"67","author":"Pagidipati","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2024052015211007800_ztae023-B8","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.jcmg.2016.02.001","article-title":"Sex differences in demographics, risk factors, presentation, and noninvasive testing in stable outpatients with suspected coronary artery disease: insights from the PROMISE trial","volume":"9","author":"Hemal","year":"2016","journal-title":"JACC Cardiovasc Imaging"},{"key":"2024052015211007800_ztae023-B9","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/j.jacc.2018.11.056","article-title":"Stress testing versus CT angiography in patients with diabetes and suspected coronary artery disease","volume":"73","author":"Sharma","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2024052015211007800_ztae023-B10","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1093\/eurheartj\/ehab724.0203","article-title":"Rising utilization of coronary CT angiography across Europe over the last decade: insights from a large prospective European registry","volume":"42","author":"Foldyna","year":"2021","journal-title":"Eur Heart J"},{"key":"2024052015211007800_ztae023-B11","doi-asserted-by":"crossref","first-page":"2536","DOI":"10.1093\/eurheartj\/ehab223","article-title":"A phenomapping-derived tool to personalize the selection of anatomical vs. Functional testing in evaluating chest pain (ASSIST)","volume":"42","author":"Oikonomou","year":"2021","journal-title":"Eur Heart J"},{"key":"2024052015211007800_ztae023-B12","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1016\/j.jacc.2009.02.013","article-title":"ACCF\/ASNC\/ACR\/AHA\/ASE\/SCCT\/SCMR\/SNM 2009 appropriate use criteria for cardiac radionuclide imaging","volume":"53","author":"Hendel Robert","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"2024052015211007800_ztae023-B13","doi-asserted-by":"crossref","first-page":"407.e1","DOI":"10.1016\/j.jcct.2010.11.001","article-title":"ACCF\/SCCT\/ACR\/AHA\/ASE\/ASNC\/NASCI\/SCAI\/SCMR 2010 appropriate use criteria for cardiac computed tomography","volume":"4","author":"Taylor","year":"2010","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"2024052015211007800_ztae023-B14","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.jacc.2013.11.009","article-title":"ACCF\/AHA\/ASE\/ASNC\/HFSA\/HRS\/SCAI\/SCCT\/SCMR\/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons","volume":"63","author":"Wolk","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2024052015211007800_ztae023-B15","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1007\/s12350-017-0917-9","article-title":"ACC\/AATS\/AHA\/ASE\/ASNC\/SCAI\/SCCT\/STS 2017 appropriate use criteria for coronary revascularization in patients with stable ischemic heart disease: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons","volume":"24","author":"Patel","year":"2017","journal-title":"J Nucl Cardiol"},{"key":"2024052015211007800_ztae023-B16","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1007\/s11606-013-2441-1","article-title":"Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities","volume":"28","author":"Chapman","year":"2013","journal-title":"J Gen Intern Med"},{"key":"2024052015211007800_ztae023-B17","article-title":"Sex\/gender bias in the management of chest pain in ambulatory care","volume":"14","author":"Clerc Liaudat","year":"2018","journal-title":"Womens Health (Lond)"},{"key":"2024052015211007800_ztae023-B18","doi-asserted-by":"crossref","first-page":"e1001779","DOI":"10.1371\/journal.pmed.1001779","article-title":"UK Biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age","volume":"12","author":"Sudlow","year":"2015","journal-title":"PLoS Med"},{"key":"2024052015211007800_ztae023-B19","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1161\/CIRCULATIONAHA.120.049755","article-title":"Outcomes in the ISCHEMIA trial based on coronary artery disease and ischemia severity","volume":"144","author":"Reynolds","year":"2021","journal-title":"Circulation"},{"key":"2024052015211007800_ztae023-B20","doi-asserted-by":"crossref","first-page":"20","DOI":"10.7326\/M17-3011","article-title":"Clinical implications of revised pooled cohort equations for estimating atherosclerotic cardiovascular disease risk","volume":"169","author":"Yadlowsky","year":"2018","journal-title":"Ann Intern Med"},{"key":"2024052015211007800_ztae023-B21","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1093\/bioinformatics\/btr597","article-title":"MissForest\u2014non-parametric missing value imputation for mixed-type data","volume":"28","author":"Stekhoven","year":"2012","journal-title":"Bioinformatics"},{"key":"2024052015211007800_ztae023-B22","doi-asserted-by":"crossref","first-page":"djw323","DOI":"10.1093\/jnci\/djw323","article-title":"Reporting and guidelines in propensity score analysis: a systematic review of cancer and cancer surgical studies","volume":"109","author":"Yao","year":"2017","journal-title":"J Natl Cancer Inst"},{"key":"2024052015211007800_ztae023-B23","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.jacc.2016.10.060","article-title":"Comparison of propensity score methods and covariate adjustment: evaluation in 4 cardiovascular studies","volume":"69","author":"Elze","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2024052015211007800_ztae023-B24","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"335","author":"von Elm","year":"2007","journal-title":"BMJ"},{"key":"2024052015211007800_ztae023-B25","doi-asserted-by":"crossref","first-page":"e757","DOI":"10.1016\/S2589-7500(22)00151-0","article-title":"CODE-EHR best-practice framework for the use of structured electronic health-care records in clinical research","volume":"4","author":"Kotecha","year":"2022","journal-title":"Lancet Digit Health"},{"key":"2024052015211007800_ztae023-B26","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1001\/jamacardio.2017.4973","article-title":"Use of high-risk coronary atherosclerotic plaque detection for risk stratification of patients with stable chest pain: a secondary analysis of the PROMISE randomized clinical trial","volume":"3","author":"Ferencik","year":"2018","journal-title":"JAMA Cardiol"},{"key":"2024052015211007800_ztae023-B27","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1056\/NEJMsb1901642","article-title":"The magic of randomization versus the myth of real-world evidence","volume":"382","author":"Collins","year":"2020","journal-title":"N Engl J Med"},{"key":"2024052015211007800_ztae023-B28","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/1745-6215-13-137","article-title":"Diagnostic randomized controlled trials: the final frontier","volume":"13","author":"Rodger","year":"2012","journal-title":"Trials"},{"key":"2024052015211007800_ztae023-B29","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1186\/s13012-017-0670-0","article-title":"The effects of care bundles on patient outcomes: a systematic review and meta-analysis","volume":"12","author":"Lavall\u00e9e","year":"2017","journal-title":"Implement Sci"},{"key":"2024052015211007800_ztae023-B30","doi-asserted-by":"crossref","first-page":"e005462","DOI":"10.1161\/JAHA.116.005462","article-title":"Comparison of anatomic and clinical outcomes in patients undergoing alternative initial noninvasive testing strategies for the diagnosis of stable coronary artery disease","volume":"6","author":"Roifman","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"2024052015211007800_ztae023-B31","doi-asserted-by":"crossref","first-page":"e003807","DOI":"10.1161\/JAHA.116.003807","article-title":"Changes in medical therapy and lifestyle after anatomical or functional testing for coronary artery disease","volume":"5","author":"Ladapo","year":"2016","journal-title":"J Am Heart Asso"},{"key":"2024052015211007800_ztae023-B32","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1136\/emermed-2019-208446","article-title":"Recognising bias in studies of diagnostic tests part 1: patient selection","volume":"36","author":"Hall","year":"2019","journal-title":"Emerg Med J"},{"key":"2024052015211007800_ztae023-B33","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1136\/emermed-2019-208447","article-title":"Recognising bias in studies of diagnostic tests part 2: interpreting and verifying the index test","volume":"36","author":"Kea","year":"2019","journal-title":"Emerg Med J"},{"key":"2024052015211007800_ztae023-B34","doi-asserted-by":"crossref","first-page":"e000505","DOI":"10.1161\/JAHA.113.000505","article-title":"Clinical implications of referral bias in the diagnostic performance of exercise testing for coronary artery disease","volume":"2","author":"Ladapo","year":"2013","journal-title":"J Am Heart Assoc"},{"key":"2024052015211007800_ztae023-B35","doi-asserted-by":"crossref","first-page":"e796","DOI":"10.1016\/S2589-7500(22)00170-4","article-title":"Individualising intensive systolic blood pressure reduction in hypertension using computational trial phenomaps and machine learning: a post-hoc analysis of randomised clinical trials","volume":"4","author":"Oikonomou","year":"2022","journal-title":"Lancet Digit Health"},{"key":"2024052015211007800_ztae023-B36","doi-asserted-by":"crossref","first-page":"965","DOI":"10.2337\/dc21-1765","article-title":"Phenomapping-derived tool to individualize the effect of canagliflozin on cardiovascular risk in type 2 diabetes","volume":"45","author":"Oikonomou","year":"2022","journal-title":"Diabetes Care"},{"key":"2024052015211007800_ztae023-B37","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1038\/s41746-023-00963-z","article-title":"An explainable machine learning-based phenomapping strategy for adaptive predictive enrichment in randomized clinical trials","volume":"6","author":"Oikonomou","year":"2023","journal-title":"NPJ Digit Med"},{"key":"2024052015211007800_ztae023-B38","doi-asserted-by":"crossref","first-page":"e024199","DOI":"10.1161\/JAHA.121.024199","article-title":"Sex and race differences in the evaluation and treatment of young adults presenting to the emergency department with chest pain","volume":"11","author":"Banco","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"2024052015211007800_ztae023-B39","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1136\/heartjnl-2019-315667","article-title":"Sex disparities in the assessment and outcomes of chest pain presentations in emergency departments","volume":"106","author":"Mnatzaganian","year":"2020","journal-title":"Heart"},{"key":"2024052015211007800_ztae023-B40","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.annemergmed.2020.10.022","article-title":"Evaluating sex disparities in the emergency department management of patients with suspected acute coronary syndrome","volume":"77","author":"Preciado","year":"2021","journal-title":"Ann Emerg Med"},{"key":"2024052015211007800_ztae023-B41","doi-asserted-by":"crossref","first-page":"2483","DOI":"10.1016\/j.jacc.2021.05.051","article-title":"Race and ethnicity considerations in patients with coronary artery disease and stroke","volume":"78","author":"Rohit","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2024052015211007800_ztae023-B42","doi-asserted-by":"crossref","first-page":"l1945","DOI":"10.1136\/bmj.l1945","article-title":"Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data","volume":"365","author":"Haase","year":"2019","journal-title":"BMJ"},{"key":"2024052015211007800_ztae023-B43","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1056\/NEJMoa1915922","article-title":"Initial invasive or conservative strategy for stable coronary disease","volume":"382","author":"Maron","year":"2020","journal-title":"N Engl J Med"},{"key":"2024052015211007800_ztae023-B44","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1056\/NEJMoa070829","article-title":"Optimal medical therapy with or without PCI for stable coronary disease","volume":"356","author":"Boden","year":"2007","journal-title":"N Engl J Med"}],"container-title":["European Heart Journal - Digital Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjdh\/advance-article-pdf\/doi\/10.1093\/ehjdh\/ztae023\/57302685\/ztae023.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjdh\/article-pdf\/5\/3\/303\/57764978\/ztae023.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjdh\/article-pdf\/5\/3\/303\/57764978\/ztae023.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T15:21:54Z","timestamp":1716218514000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjdh\/article\/5\/3\/303\/7641487"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,8]]},"references-count":44,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,4,8]]},"published-print":{"date-parts":[[2024,5,20]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjdh\/ztae023","relation":{},"ISSN":["2634-3916"],"issn-type":[{"value":"2634-3916","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,5]]},"published":{"date-parts":[[2024,4,8]]}}}