{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:08:19Z","timestamp":1790824099147,"version":"4.1.0"},"reference-count":44,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,10,21]],"date-time":"2023-10-21T00:00:00Z","timestamp":1697846400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background and objectives: Secondary prevention after acute coronary syndrome (ACS) is essential to reduce cardiovascular mortality and hospital readmission, ensuring patients return to normal with an improved quality of life. Thus, we investigate the benefits of a comprehensive cardiac rehabilitation (CR) program on lifestyle, risk factors and adherence to guideline-directed medical therapy (GDMT) in patients after ACS and myocardial revascularization through coronary artery by-pass grafting (CABG) or percutaneous coronary intervention (PCI). Methods: This is a prospective, longitudinal study in consecutive post-CABG or PCI patients after ACS that participated or not in a comprehensive CR. Cardiovascular risk factors, quality of life and adherence to GDMT were analyzed in terms of assessing the benefit of 12 months of comprehensive CR on reaching guidelines secondary prevention targets. Results: At the inclusion in comprehensive CR of all patients (n = 480), 85% had hypertension; 86% had elevated total cholesterol values; 69% were characterized by metabolic syndrome; 43% were obese; 31% were active smokers and 29% had type 2 diabetes mellitus. Only 26.66% (n = 128) followed the entire program for 12 months. No statistically significant differences in the prescription of GDMT at hospital discharge after myocardial revascularization between the CR (+) group (n = 128) versus CR (\u2212) group (n = 352) (p &gt; 0.05) were observed. After 12 moths, a significant adherence to GDMT in the CR (+) group vs. CR (\u2212) group was recorded, as follows: antiplatelet agents (100% versus 96%, p = 0.001), beta-blockers (99% versus 92%, p = 0.02), ACE inhibitors\/ARAB (89% versus 79%, p = 0.04), lipid-lowering drugs (100% versus 89%, p = 0.001). In total, 82% of the CR (+) patients had a significantly higher adherence at GDMT (82% versus 64%, p = 0.001). At 12 moths, the CR (+) group was characterized by significantly lower values than at the inclusion but some values still increased: systolic blood pressure (139.25 + 19.20 mmHg (p &lt; 0.03)), total cholesterol (171.07 + 48.59 mg\/dL (p = 0.0001)) and LDL-cholesterol (102.83 + 41.30 mg\/dL (p = 0.009)). At the same time, the analysis of psychosocial factors using the HAD questionnaire revealed a statistically significant improvement in anxiety and depression scores: HAD-A score (9.1 \u00b1 3.7 at T0 vs. 7.1 \u00b1 4.2 at T1, p = 0.001) and HAD-D score (7.7 \u00b1 3.19 at T0 vs. 6.4 \u00b1 4.3 at T1, p = 0.003). A multivariable analysis, following GDMT, showed the actual value or information and training of patients regarding optimal cardiovascular risk factor control was independently associated with lower values of systolic blood pressure (R2 = 0.48), diastolic (R2 = 0.38), serum glucose (R2 = 0.48), glycated hemoglobin (R2 = 0.50), total cholesterol (R2 = 0.31), LDL-cholesterol (R2 = 0.30), HDL-cholesterol (R2 = 0.19) and serum triglycerides (R2 = 0.20). Conclusion: The twelve-month participation of post-ACS patients in comprehensive CR resulted in excellent post-revascularization management, as well as good adherence to guideline-directed medical therapy, provided further confirmation of the benefit of secondary prevention. Despite high adherence to drug treatments, targets for blood pressure, total cholesterol and LDL-cholesterol are inadequately achieved. Therefore, in the era of personalized medicine, patients with ACS should benefit from specific, comprehensive cardiovascular recovery programs that contain physiotherapists, psychologists, nutritionists and an experienced cardiologist in cardiovascular rehabilitation.<\/jats:p>","DOI":"10.3390\/jpm13101516","type":"journal-article","created":{"date-parts":[[2023,10,21]],"date-time":"2023-10-21T12:59:01Z","timestamp":1697893141000},"page":"1516","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The Benefits of a Comprehensive Cardiac Rehabilitation Program for Patients with Acute Coronary Syndrome: A Follow-Up Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Laura Maria","family":"Craciun","sequence":"first","affiliation":[{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9814-9561","authenticated-orcid":false,"given":"Florina","family":"Buleu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"Pah","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Badalica-Petrescu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Bodea","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana Emilia","family":"Man","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania"},{"name":"Research Center of the Timisoara Institute of Cardiovascular Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana Catalina","family":"Cosor","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stela","family":"Iurciuc","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3892-0211","authenticated-orcid":false,"given":"Simona","family":"Dragan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania"},{"name":"Research Center of the Timisoara Institute of Cardiovascular Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Rada","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1038\/s41569-021-00611-7","article-title":"The role of cardiac rehabilitation in improving cardiovascular outcomes","volume":"19","author":"Taylor","year":"2022","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2458","DOI":"10.1161\/CIR.0b013e318235eb4d","article-title":"AHA\/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation","volume":"124","author":"Smith","year":"2011","journal-title":"Circulation"},{"key":"ref_3","unstructured":"NICE (2023, August 23). Acute Coronary Syndromes: NICE Guideline [NG185]. Available online: https:\/\/www.nice.org.uk\/guidance\/NG185."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"128","DOI":"10.5694\/mja16.00368","article-title":"National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016","volume":"205","author":"Chew","year":"2016","journal-title":"Med. J. Aust."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC)","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.ihj.2022.11.011","article-title":"Revisiting secondary prevention in coronary heart disease","volume":"74","author":"Sigamani","year":"2022","journal-title":"Indian Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/1745-6215-12-92","article-title":"A meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction: Start early and go longer for greatest exercise benefits on remodeling","volume":"12","author":"Haykowsky","year":"2011","journal-title":"Trials"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/eurheartj\/ehaa605","article-title":"2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease","volume":"42","author":"Pelliccia","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1177\/2047487312449597","article-title":"Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: A Policy Statement from the Cardiac Rehabilitation Section of the European Association for Cardiovascular Prevention & Rehabilitation. Endorsed by the Committee for Practice Guidelines of the European Society of Cardiology","volume":"21","author":"Piepoli","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1161\/CIRCULATIONAHA.119.044282","article-title":"Secondary Prevention for Atherosclerotic Cardiovascular Disease","volume":"141","author":"Virani","year":"2020","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1016\/j.jacc.2018.08.2141","article-title":"Promoting Physical Activity and Exercise: JACC Health Promotion Series","volume":"72","author":"Fletcher","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Jolliffe, J.A., Rees, K., Taylor, R.S., Thompson, D., Oldridge, N., and Ebrahim, S. (2001). Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst. Rev., CD001800.","DOI":"10.1002\/14651858.CD001800"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"901","DOI":"10.33963\/KP.a2021.0066","article-title":"Comprehensive cardiac rehabilitation as the keystone in the secondary prevention of cardiovascular disease","volume":"79","author":"Jegier","year":"2021","journal-title":"Kardiol. Pol."},{"key":"ref_14","unstructured":"Zierle-Ghosh, A., and Jan, A. (2021, November 21). Body Mass Index (BMI) [Updated 16 December 2018], StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK535456\/figure\/article-18425.image.f1\/."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1097\/01.psy.0000149256.81953.49","article-title":"DS14: Standard assessment of negative affectivity, social inhibition, and Type D personality","volume":"67","author":"Denollet","year":"2005","journal-title":"Psychosom. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e022198","DOI":"10.1161\/JAHA.121.022198","article-title":"Event Rates and Risk Factors for Recurrent Cardiovascular Events and Mortality in a Contemporary Post Acute Coronary Syndrome Population Representing 239,234 Patients During 2005 to 2018 in the United States","volume":"11","author":"Steen","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"633","DOI":"10.21037\/cdt.2017.04.06","article-title":"The EUROASPIRE surveys: Lessons learned in cardiovascular disease prevention","volume":"7","author":"Kotseva","year":"2017","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1097\/01.hjr.0000183910.59741.96","article-title":"Treatment and secondary prevention of ischemic coronary events in Croatia (TASPIC-CRO study)","volume":"13","author":"Reiner","year":"2006","journal-title":"Eur. J. Cardiovasc. Prev. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"342","DOI":"10.4330\/wjc.v15.i7.342","article-title":"Risk factors in cardiovascular patients: Challenges and opportunities to improve secondary prevention","volume":"15","author":"Gabulova","year":"2023","journal-title":"World J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"A20","DOI":"10.1093\/eurheartj\/sut006","article-title":"Hypertension and acute coronary syndromes in Romania: Data from the ISACS-TC registry","volume":"16","author":"Dorobantu","year":"2014","journal-title":"Eur. Heart J. Suppl."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/01.hjh.0000434937.62412.24","article-title":"Hypertension prevalence and control in Romania at a seven-year interval. Comparison of SEPHAR I and II surveys","volume":"32","author":"Dorobantu","year":"2014","journal-title":"J. Hypertens."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Luca, C.T., Crisan, S., Cozma, D., Negru, A., Lazar, M.A., Vacarescu, C., Trofenciuc, M., Rachieru, C., Craciun, L.M., and Gaita, D. (2021). Arterial Hypertension: Individual Therapeutic Approaches-From DNA Sequencing to Gender Differentiation and New Therapeutic Targets. Pharmaceutics, 13.","DOI":"10.3390\/pharmaceutics13060856"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1007\/BF03086261","article-title":"A genome wide association analysis in the GENDER study","volume":"17","author":"Sampietro","year":"2009","journal-title":"Neth. Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1177\/2047487314561876","article-title":"Secondary prevention after acute myocardial infarction: Drug adherence, treatment goals, and predictors of health lifestyle habits. The BLITZ-4 Registry","volume":"22","author":"Urbinati","year":"2015","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Nguyen, T.V., Tran, D.T.T., Ngo, T.T.K., and Nguyen, T.N. (2022). Sex Difference in Control of Low-Density Lipoprotein Cholesterol in Older Patients after Acute Coronary Syndrome. Geriatrics, 7.","DOI":"10.3390\/geriatrics7040071"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Cojocariu, S.A., Ma\u0219taleru, A., Sasc\u0103u, R.A., St\u0103tescu, C., Mitu, F., Cojocaru, E., Trandafir, L.M., and Leon-Constantin, M.-M. (2021). Relationships between Psychoeducational Rehabilitation and Health Outcomes\u2014A Systematic Review Focused on Acute Coronary Syndrome. J. Pers. Med., 11.","DOI":"10.3390\/jpm11060440"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e14894","DOI":"10.1111\/ijcp.14894","article-title":"Smoking cessation after acute coronary syndrome: A systematic review and meta-analysis","volume":"75","author":"Lovatt","year":"2021","journal-title":"Int. J. Clin. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1177\/2048872614548602","article-title":"Mortality and missed opportunities along the pathway of care for ST-elevation myocardial infarction: A national cohort study","volume":"4","author":"Simms","year":"2015","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s43044-021-00237-7","article-title":"Implementation of clinical audit to improve adherence to guideline-recommended therapy in acute coronary syndrome","volume":"74","author":"George","year":"2022","journal-title":"Egypt. Heart J."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Zwart, B., Parker, W.A.E., and Storey, R.F. (2020). New Antithrombotic Drugs in Acute Coronary Syndrome. J. Clin. Med., 9.","DOI":"10.3390\/jcm9072059"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Salaminia, S., Sayehmiri, F., Angha, P., Sayehmiri, K., and Motedayen, M. (2018). Evaluating the effect of magnesium supplementation and cardiac arrhythmias after acute coronary syndrome: A systematic review and meta-analysis. BMC Cardiovasc. Disord., 18.","DOI":"10.1186\/s12872-018-0857-6"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Negru, A.G., Pastorcici, A., Crisan, S., Cismaru, G., Popescu, F.G., and Luca, C.T. (2022). The Role of Hypomagnesemia in Cardiac Arrhythmias: A Clinical Perspective. Biomedicines, 10.","DOI":"10.3390\/biomedicines10102356"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1161\/CIRCULATIONAHA.120.050771","article-title":"Colchicine in Patients With Acute Coronary Syndrome","volume":"142","author":"Tong","year":"2020","journal-title":"Circulation"},{"key":"ref_34","first-page":"1671","article-title":"Secondary prevention of cardiovascular diseases: Current state of the art","volume":"76","year":"2018","journal-title":"Kardiol. Pol. (Pol. Heart J.)"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Silverio, A., Cancro, F.P., Esposito, L., Bellino, M., D\u2019Elia, D., Verdoia, M., Vassallo, M.G., Ciccarelli, M., Vecchione, C., and Galasso, G. (2023). Secondary Cardiovascular Prevention after Acute Coronary Syndrome: Emerging Risk Factors and Novel Therapeutic Targets. J. Clin. Med., 12.","DOI":"10.3390\/jcm12062161"},{"key":"ref_36","first-page":"73","article-title":"ICAROS (Italian survey on CardiAc RehabilitatiOn and Secondary prevention after cardiac revascularization): Temporary report of the first prospective, longitudinal registry of the cardiac rehabilitation network GICR\/IACPR","volume":"78","author":"Griffo","year":"2012","journal-title":"Monaldi Arch. Chest Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/imj.12982","article-title":"Inaccurate risk perceptions contribute to treatment gaps in secondary prevention of cardiovascular disease","volume":"46","author":"Thakkar","year":"2016","journal-title":"Intern. Med. J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jacc.2015.10.044","article-title":"Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis","volume":"67","author":"Anderson","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Soldati, S., Di Martino, M., Rosa, A.C., Fusco, D., Davoli, M., and Mureddu, G.F. (2021). The impact of in-hospital cardiac rehabilitation program on medication adherence and clinical outcomes in patients with acute myocardial infarction in the Lazio region of Italy. BMC Cardiovasc. Disord., 21.","DOI":"10.1186\/s12872-021-02261-6"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e208","DOI":"10.1097\/MJT.0000000000000914","article-title":"Current Perspectives in Facilitated Angioplasty","volume":"26","author":"Crisan","year":"2019","journal-title":"Am. J. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.ahj.2004.06.003","article-title":"Impact of age on management and outcome of acute coronary syndrome: Observations from the global registry of acute coronary events (GRACE)","volume":"149","author":"Avezum","year":"2005","journal-title":"Am. Heart J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1016\/j.jacc.2023.02.007","article-title":"Combination Moderate-Intensity Statin and Ezetimibe Therapy for Elderly Patients with Atherosclerosis","volume":"81","author":"Lee","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Buda, V., Prelipcean, A., Cozma, D., Man, D.E., Negres, S., Scurtu, A., Suciu, M., Andor, M., Danciu, C., and Crisan, S. (2022). An Up-to-Date Article Regarding Particularities of Drug Treatment in Patients with Chronic Heart Failure. J. Clin. Med., 11.","DOI":"10.3390\/jcm11072020"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Bonanad, C., Esteve-Claramunt, F., Garc\u00eda-Blas, S., Ayesta, A., D\u00edez-Villanueva, P., P\u00e9rez-Rivera, J., Ferreiro, J.L., C\u00e1noves, J., L\u00f3pez-Forn\u00e1s, F., and Sol\u00e9, A.A. (2022). Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes. J. Clin. Med., 11.","DOI":"10.3390\/jcm11113008"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/10\/1516\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:09:38Z","timestamp":1760130578000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/10\/1516"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,21]]},"references-count":44,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["jpm13101516"],"URL":"https:\/\/doi.org\/10.3390\/jpm13101516","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,21]]}}}