Background Mild cognitive impairment (MCI) is a cognitive state falling between normal aging and dementia. The relation between alcohol intake and risk of MCI as well as progression to dementia in people with MCI (PDM) remained unclear. Objective To synthesize available evidence and clarify the relation between alcohol intake and risk of MCI as well as PDM. Method We searched electronic databases consisting of PubMed, EMBASE, Cochrane Library, and China Biology Medicine disc (CBM) from inception to October 1, 2019. Prospective studies reporting at least three levels of alcohol exposure were included. Categorical meta-analysis was used for quantitative synthesis of the relation between light, moderate and heavy alcohol intake with risk of MCI and PDM. Restricted cubic spline and fixed-effects dose-response models were used for dose-response analysis. Result Six cohort studies including 4244 individuals were finally included. We observed an unstable linear relation between alcohol intake (drinks/week) and risk of MCI (P linear = 0.0396). It suggested that a one-drink increment per week of alcohol intake was associated with an increased risk of 3.8% for MCI (RR, 1.038; 95% CI 1.002-1.075). Heavy alcohol intake (> 14 drinks/week) was associated with higher risk of PDM (RR = 1.76; 95% CI 1.10-2.82). And we found a nonlinear relation between alcohol intake and risk of PDM. Drinking more than 16 drinks/week (P nonlinear = 0.0038, HR = 1.42; 95% CI 1.00-2.02), or 27.5 g/day (P nonlinear = 0.0047, HR = 1.46; 95% CI 1.00-2.11) would elevate the risk of PDM. Conclusion There was a nonlinear dose-response relation between alcohol intake and risk of PDM. Excessive alcohol intake would elevate the risk of PDM.

Objectives Population ageing and the increasing burden of chronic conditions challenge traditional metrics of assessing the efficacy of health care interventions and as a consequence policy and planning. Using chronic heart failure (CHF) as an exemplar this manuscript seeks to describe the importance of patient-reported outcomes to inform policy decisions. Methods The method of an integrative review has been used to identify patient-reported outcomes (PROs) in assessing CHF outcomes. Using the Innovative Care for Chronic Conditions the case for developing a metric to incorporate PROs in policy planning, implementation and evaluation is made. Results In spite of the increasing use of PROs in assessing CHF outcomes, their incorporation in the policy domain is limited. Conclusions Effective policy and planning is of health care services is dependent on the impact on the individual and their families. Epidemiological transitions and evolving treatment paradigms challenge traditional metrics of morbidity and mortality underscoring the importance of assessing PROs.

Authors' objectives: HTW aimed to identify and summarise evidence that addressed the following question: what is the clinical and cost effectiveness of percutaneously implanted pulmonary artery pressure sensors plus guideline-directed monitoring of chronic heart failure, compared to guideline-directed monitoring alone?

Authors' objectives: This health technology assessment evaluates the effectiveness and safety of transcatheter valve-in-valve implantation for adults with degenerated mitral or tricuspid bioprosthetic valves. It also evaluates the budget impact of publicly funding transcatheter valve-in-valve implantation and the experiences, preferences, and values of people with degenerated mitral or tricuspid bioprosthetic valves.

Authors' objectives: This health technology assessment evaluates the diagnostic accuracy, clinical impact, and cost-effectiveness of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) for adults with suspected heart failure. It also evaluates the budget impact of publicly funding BNP and NT-proBNP tests and the experiences, preferences, and values of people with suspected heart failure.

Authors' objectives: This health technology assessment evaluates the effectiveness, safety, and cost-effectiveness of a portable normothermic cardiac perfusion system for the preservation and transport of hearts donated after cardiocirculatory death for adult heart transplantation. It also evaluates the budget impact of publicly funding a perfusion system and the experiences, preferences, and values of people with heart failure and family members of organ donors.

Authors' objectives: The appraisal aimed to identify and summarise evidence that addresses the following question: what is the clinical and cost effectiveness of N-terminal pro B-type natriuretic peptide (NT-proBNP) or B-type natriuretic peptide (BNP) as a diagnostic test to rule-in and rule-out acute heart failure in adults in the emergency department setting, compared with NT-proBNP, BNP, or standard care to rule-out acute heart failure?

Authors' objectives: HTW has assessed hand-held ultrasound devices, to help NHS Wales decide whether to use these products in day-to-day community care settings. Heart failure is a common condition in Wales, with over 33,000 people who have been diagnosed with heart failure by their GP. Hand-held ultrasound devices are small, “pocket-sized” machines that can be used to visualise heart structure and function. They can help decide whether people who have symptoms of heart failure, such as breathlessness, need to be referred to cardiology for further tests.