Saudi Cultural Missions Theses & Dissertations
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Item Restricted Clinical Outcomes of Dual GLP-1/GIP Receptor Agonist (Tirzepatide) in Patients with Heart Failure: Systematic Review and Meta-analysis(Saudi Digital Library, 2026) Alatawi, Khaled; Giachino, Andrea; Mokbel, KinanThis dissertation presents a systematic review and meta-analysis evaluating the clinical efficacy and safety of the dual GLP-1/GIP receptor agonist tirzepatide in patients with heart failure, with particular focus on HFpEF. The study was conducted in accordance with PRISMA guidelines and includes pooled analyses of mortality and hospitalization outcomes.19 0Item Restricted COPD-Aware Modelling of Heart Failure Hospital Admissions Using Routinely Collected Primary Care Prescription Data(Saudi Digital Library, 2025) Alghamdi, Taghreed Safar; AishwaryaprajnaHeart failure (HF) is a leading cause of unplanned hospital admissions in the United Kingdom (UK), consuming 1–2% of the National Health Service (NHS) annual budget, with most costs from inpatient care. Many predictive models oversimplify medication histories, relying on static indicators instead of time-aware prescribing patterns. This study improves HF admission prediction using UK primary care data, focusing on monthly dosage trends of three therapeutic classes angiotensin converting en- zyme inhibitors (ACEIs), beta-blockers, and angiotensin receptor blockers (ARBs) and the influence of Chronic Obstructive Pulmonary Disease (COPD). Three linked datasets patient demographics and comorbidities (patientinfo), prescription records (prescriptions), and chronic condition diagnoses (indexdates) were merged after cleaning and validation. Static attributes and temporal medication features were used to train Long Short-Term Memory (LSTM) networks, Random Forest, and Logistic Regression. Due to poor performance of the LSTM and Random Forest in a multi-class setting (ad- mission count categories), the task was reframed as binary classification (admission vs. no admission), with class imbalance addressed using the Synthetic Minority Oversampling Technique (SMOTE). The final dataset included 963 patients and over 109521 monthly prescription records. The best perfor- mance was from standard Random Forest (without SMOTE), which retained clinical interpretability, identifying COPD status, total monthly medication dosage, and age at HF diagnosis as top predic- tors. COPD patients had a 12% higher admission rate (59.1% vs. 41.8%). These findings show that granular, dosage-aware prescribing data can enhance HF admission prediction. Future work will ex- plore hybrid classification regression models, incorporate laboratory and lifestyle data, and validate externally to improve generalisability and support NHS decision-making.15 0Item Restricted Generalization of Machine-Learning in Clinical Randomized Controlled Trials: Evaluation and Development(Saudi Digital Library, 2025) ALMADHI, SHAYKHAH; Karwath, AndreasIn healthcare, machine learning (ML) shows significant promise in improving patient diagnostics, prognostics, and personalized care. However, its real-world deployment is often constrained by models' inconsistent performance on diverse and unseen patient data, a critical challenge known as generalization. Despite ongoing advancements, existing methodologies have shown only limited success in assessing and improving ML generalization, raising uncertainty in clinical deployment. This dissertation tackles this gap by presenting a robust evaluation framework and a predictive tool to cultivate more reliable healthcare AI. Applying Logistic Regression and XGBoost models on a dataset from nine double-blind, randomized, placebo-controlled trials investigating beta-blockers in heart failure. This study employs leave-one-trial-out, reverse leave- one-trial-out, and systematic evaluation to comprehensively assess generalization. The findings indicate that while generalization is often suboptimal, strategic selection of training cohorts markedly improves performance. Furthermore, a developed meta-learning framework effectively predicts model degradation. This research provides crucial insights into model generalizability across varied clinical datasets and introduces a practical pre-screening tool, essential for facilitating a safer and more effective integration of ML into clinical practice and promoting fair patient outcomes.22 0Item Restricted A DISEASE BURDEN AND BUDGET IMPACT ANALYSIS OF FINERENONE IN HFPEF IN THE US POPULATION(Saudi Digital Library, 2025) Almasuood, Rawan; Fatimah, SherbenyBackground: Heart failure with preserved or mildly reduced ejection fraction (HFpEF/HFmrEF) presents a growing challenge in cardiovascular care, particularly among older adults. Finerenone, a non-steroidal mineralocorticoid receptor antagonist, has shown clinical benefit in reducing heart failure (HF) hospitalizations and cardiovascular mortality in this population. However, its budgetary impact in the U.S. remains unknown. Objective: To evaluate the 3-year budget impact of incorporating finerenone as an adjunct to standard therapy for HFpEF/HFmrEF from a general U.S. payer perspective, using real-world cost inputs and clinical effectiveness data from the FINEARTS-HF trial. Methods: A static Excel-based cohort model was developed comparing the current standard of care (SOC) with SOC plus finerenone. The analysis included direct medical costs (drug acquisition and hospitalization costs) from the 2023 MEPS database and hospitalization reduction rates from the FINEARTS-HF trial. Uptake assumptions (2%, 6%, and 10% over three years) were modeled, with annual and cumulative cost outcomes evaluated. A one-way sensitivity analysis assessed the impact of key input uncertainties. Results: Cumulative 3-year drug cost for finerenone was $3.21 billion, with avoided hospitalization savings of $176 million, yielding a net budget impact of $3.03 billion. Only ~5.5% of drug costs were offset by hospitalization savings. The model was most sensitive to hospitalization costs and finerenone acquisition costs. Conclusion: Finerenone substantially increases short-term costs when added to SOC for HFpEF/HFmrEF, with limited cost offset from reduced hospitalizations. These findings provide timely insights for U.S. payers in anticipation of FDA approval and market entry.21 0Item Restricted The Relationship Between Caregivers' Contribution to Heart Failure Self-Care and Patient Self-Care: Exploring the Moderating Effect of Patient Cognitive Status(Case Western Reserve University, 2025-05) Aldossary, Heba Mohammed; Dolansky, Mary; Irani, Elliane; Schiltz, Nicholas; Sundaram, VarunHeart failure (HF) impacts millions worldwide and necessitates ongoing self-care, including maintenance, monitoring, and management, to prevent symptom worsening and hospitalization. Cognitive impairment, impacting memory, attention, and decision-making, is prevalent among patients with HF and may impede their self-care capabilities. In these instances, family caregivers frequently offer essential assistance. The effectiveness of this support in cases of cognitive impairment is not well established. Furthermore, other factors, including patient and caregiver self-efficacy, mental quality of life, and satisfaction with dyadic care may impact self-care, yet they remain insufficiently examined. This research employed a secondary analysis of data from 277 HF patient-caregiver dyads (N = 554) participating in a descriptive cross-sectional study conducted in Italy. Regression analyses, both multiple and moderated, were performed to investigate the relationships between caregiver contributions and patient HF self-care behaviors while evaluating the moderating effect of patient cognitive status and the impact of the covariates. The findings indicated that caregiver contributions were significant predictors of patient self-care in the domains of maintenance, monitoring, and management. Patient self-efficacy was identified as a significant and reliable predictor in all domains of self-care. The relationship between caregiver contribution and patient self-care maintenance and monitoring was significantly moderated by cognitive status, with caregiver support proving more effective for patients without cognitive impairment. Furthermore, caregiver satisfaction with dyadic care exhibited a negative correlation with self-care maintenance, while showing a positive correlation with self-care monitoring. The findings underscore the critical importance of caregiver support and patient self-efficacy in HF self-care, while also indicating that caregivers provide more support when there is no cognitive impairment. The results highlight the necessity of regular cognitive assessments and caregiver training when cognitive impairment exists to assist with HF self-management. The role of caregiver satisfaction indicates that relational dynamics may affect different aspects of self-care, necessitating further investigation. This research informs the creation of tailored interventions that include caregivers, with the goal of enhancing HF management.23 0Item Restricted Influence of Participation in the BPCI-A Initiative on 30-Day Heart Failure Unplanned Readmission Rates Among U.S. Hospitals(University of Texas Health Science Center at Houston, 2025) Balhareth, Ibrahim Ali; Linder, StephenBackground: The Bundled Payments for Care Improvement Advanced (BPCI-A) initiative incentivize participating hospitals if they achieved less than the target spending amount for the selected condition and penalizes them if they exceeded the target. The BPCI-A program aims to enhance care quality and reduce spending. One of the quality measures targeted by BPCI-A is hospital readmissions. Heart failure is one of the leading causes of hospital readmission effectiveness of BPCI-A in reducing cardiac-related readmissions, particularly for heart failure, and the influence of hospital characteristics on program outcomes remain uncertain. This series of studies comprehensively evaluated the impact of BPCI-A on heart failure readmission rates. Methods: First, a scoping review was conducted to synthesize the existing literature on hospital characteristics, BPCI-A participation, and associated readmission outcomes, specifically focusing on cardiac care. Subsequently, a second study utilizing a propensity score matching (PSM) with national hospital-level datasets compared the baseline characteristics and readmission outcomes between hospitals participating in the program and a matched group of their counterparts that never participated in the program. Lastly, a retrospective matched-cohort study was conducted to validate the findings from the second study by evaluating whether participation in the BPCI-A program influenced 30-day heart failure readmissions, including subgroup analyses by hospital size, ownership, and teaching status, using weighted regression modeling and interaction analyses. Results: The scoping review revealed limited effectiveness of BPCI-A in reducing cardiac-related readmissions broadly, emphasizing existing disparities among hospitals. Empirical findings from Journal Article 2 demonstrated significant baseline differences: BPCI-A hospitals were larger, urban, teaching-oriented, and for-profit institutions. Post-matching analyses indicated a modest but significant association between BPCI-A participation and reduced heart failure readmissions (4.1 percentage points lower, p<0.001). Confirmatory analyses from Journal Article 3 validated these results, showing a 4.2 percentage-point reduction in readmissions associated with participation, with substantial heterogeneity by hospital characteristics. Small, public, and non-teaching hospitals benefited disproportionately from participation. Conclusion: Participation in BPCI-A is modestly associated with lower heart failure readmission rates, especially among hospitals historically disadvantaged by resource constraints. However, BPCI-A alone appears insufficient to eliminate persistent disparities or achieve substantial reductions universally. Future bundled payment policies must be tailored to hospital contexts, address under-resourced institutions by providing targeted support to enhance equity and effectiveness in reducing heart failure readmissions.34 0Item Restricted Improving Heart Failure Management in Saudi Arabia: A Quality and Safety Improvement Project Using Telemedicine(University of Nottingham, 2024) Alansari, Dareen; Stacy, JohnsonHeart failure is a common and complex healthcare problem in Saudi Arabia. Due to the lack of emphasis on primary and secondary prevention, the ageing population, and the increased prevalence of heart failure risk factors, especially among the younger population, the number of people with HF is expected to increase, leading to an increased burden on the national healthcare system in Saudi Arabia. This proposed quality improvement project will utilise telemedicine to monitor the progression of heart failure and heart failure risk factors, facilitate early identification of disease worsening and prompt referral to specialists, as well as educate people about the importance of managing their disease, in an effort to delay the development of heart failure and to improve the quality and safety of existing heart failure care in Saudi Arabia. Well-recognised quality improvement methodology and tools, including the Model for Improvement and Davidge’s Seven Steps to Measurement, supported by statistical process control charts as well as qualitative methods, will be used to guide the improvement process. A high emphasis will be placed on stakeholders involvement through an appropriate leadership style and engagement of stakeholders in the development of the design of this project at the early stages. This proposed quality improvement project provides a sustainable solution that is well-aligned with the vision of Saudi Arabia as well as the Institute of Medicine’s six domains of healthcare quality, taking advantage of a well-established technology infrastructure to tackle a persistent healthcare threat.44 0Item Restricted The Effeciveness of Combining both Exercise Training and Inspiratory Muscle Training in the Treatment of Patients with Heart Failure to Improve their Quality of Life: A Systematic Review(2023-03-20) Jaber, Amal; Tame, Jo-DeeBackground: Heart failure is a multi-organ dysfunction that affects multiple systems, including the cardiovascular, and respiratory systems, potentially becoming a major contributor to oedema, dyspnoea and exercise intolerance. Dyspnoea and exercise intolerance are associated with a poor prognosis, worsened by raising physical activity levels during regular everyday activities. Consequently, poor quality of life is reported in heart failure patients as they are less healthy or able to engage in daily activities. Exercise training alone has enhanced the quality of life for heart failure patients as has inspiratory muscle training alone. Combining exercise with inspiratory muscle training may offer additional benefits in terms of patients’ quality of life. This review aims to determine the benefits in quality of life when combining exercise and inspiratory muscle training for therapy with heart failure patients. Objectives: To determine if there is evidence that exercise and inspiratory muscle training combined enhance people with heart failure's quality of life. To identify any evidence that indicates that using exercise and inspiratory muscle training combined is more beneficial for treating people with heart failure than using either one alone, in terms of enhancing quality of life. To determine the course of future research in this field. Methods: To meet the aim and objectives, a systematic review was conducted. Randomised control trials were selected for this review. Several sources were used between September first and November 18, 2022, including EMBASE, CINAHL, Web of Science, Scopus, Trip PRO, ASSIA and Dimensions.ai. Each randomised control trial’s methodological quality was evaluated by two independent reviewers. Data was synthesised using a narrative synthesis because of heterogeneity of the data. Results: There were found to be five randomised control trials of moderate to high quality with a total of 402 participants. The combination of exercise and inspiratory muscle training was shown to be statistically significant regarding quality of life outcomes pre-post intervention in all five trials (P < 0.05). There were statistically significant findings regarding quality of life outcomes pre-post inspiratory muscle training alone but not for exercise alone. Conclusion: The use of exercise training and inspiratory muscle training together to improve quality of life in people with heart failure is consistently supported by the present data, according to this systematic review. This combination may improve the quality of life in heart failure patients more than exercise alone, but to an extent that is similar to inspiratory muscle training alone. Further research is required to investigate the effects of specific types of exercise and inspiratory muscle training on quality of life outcomes in patients with heart failure, in addition to comparing the results of the combination intervention with exercise or inspiratory muscle training alone. Keywords: Inspiratory muscle training, exercise, quality of life, heart failure.28 0