Risultati per: Caratterizzazione dell'asma in base all'età di insorgenza: uno studio di coorte multi-database

Circulation, Volume 150, Issue Suppl_1, Page A4141129-A4141129, November 12, 2024. Background:There is a scarcity of data regarding trends in substance use (SU) and mortality related to ischemic heart disease (IHD) in the United States (US).This study aims to evaluate deaths linked to SU+IHD in the US by utilizing the CDC Wide-ranging Online Data for Epidemiologic Research database (CDC WONDER).Methods:The CDC WONDER database was used to access the mortality data of adults aged ≥25 from 1999 to 2020. Both substance use and IHD were mentioned as contributing or underlying causes of death. Results, presented as age-adjusted mortality rates (AAMR) per 100,000 population, underwent Joinpoint regression for trend analysis and annual percentage change (APC).Results:Between 1999 and 2020, a total of 236,832 deaths were attributed to IHD among patients with substance use (AAMR = 4.9, 95% CI: 4.91-4.95). The overall AAMR depicted a consistent rising trend from 3.29 in 1999 to 7.91 in 2020.Throughout the study period, males consistently exhibited higher overall AAMRs compared to females (Male: 8.3 vs Female: 1.9). Among racial/ethnic groups, non-Hispanic American Indian [NH-AI] individuals had the highest AAMRs (10.9, 95% CI: 10.6-11.3), followed by non-Hispanic blacks [NHB] (6.5, 95% CI: 6.5-6.6), non-Hispanic Whites [NHW] (5.0, 95% CI: 5.0-5.1), and Hispanics (3.5, 95% CI: 3.4-3.5). Notably, non-Hispanic Asian/Pacific Islander [NH-API] individuals had the lowest AAMR (1.2, 95% CI: 1.1-1.2). Regionally, the West reported the highest mortality rates (6.3, 95% CI: 6.3-6.4), followed by the Midwest (4.8, 95% CI: 4.8-4.9) and the South (4.6, 95% CI: 4.6-4.7), while the Northeast reported the lowest mortality rate (3.9, 95% CI: 3.9-4.0). Moreover, when comparing urbanization status, metropolitan areas had a higher AAMR value compared to metropolitan areas in 1999, however this trend sharply reversed to non-metropolitan areas having a higher AAMR in 2020 (1999 non-metro: 3.1 vs. metro: 3.3; 2020 non-metro: 9.2 vs. metro: 7.6).Conclusion:Our findings underscore a troubling rise in IHD related mortality among substance users in the US. Addressing gender, racial/ethnic, and regional disparities is crucial for targeted interventions to reduce mortality rates and improve cardiovascular health outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4140505-A4140505, November 12, 2024. Introduction:Syncope is a common condition often leading to testing and hospital admissions. Research assessing sex-based differences in the workup as well as disposition following emergency department (ED) syncope visits is scarce. In this study, we sought to address this gap using a national database.Methods:From 2010 to 2019, we identified syncope patients using ICD-9 and ICD-10 codes. Using data from the IBM MarketScan Research Database, which captures de-identified individual-level health data from approximately 100 commercial payers and self-insured corporations in the United States, we assessed the incidence of testing using CPT codes in the 3 months following syncope diagnosis. Furthermore, we evaluated the percentage of syncope patients discharged from the ED. Sex-based comparisons were performed using the Chi-square test.Results:A total of 557,416 patients (54.0% women) were included in the cohort to assess for testing disparities (these are the patients who had at least 3 months of continuous enrollment following syncope diagnosis). Compared to men, women had significantly lower testing in most domains: long-term monitoring (6.8% vs. 7.4%), echocardiogram (13.3% vs. 17.2%), cardiac stress test (4.0% vs. 7.4%), chest X-ray (17.7% vs. 25.5%), imaging for pulmonary embolism (1.5% vs. 2.0%) and carotid Doppler ultrasound (5.4% vs. 7.3%); p< 0.001 for all above comparisons, figure 1A. Tilt table testing was similar between both sexes (1.4% vs. 1.3%).A total of 1,325,023 patients (58.1% women) were included in the ED disposition cohort. Women presenting to the ED with syncope were more likely to be discharged compared to men (78.7% vs 72.1%; p< 0.001), and this trend remained consistent throughout the study period, figure 1B.Conclusion:Women presenting with syncope are less likely to receive testing compared to men, and more likely to be discharged from the ED. There is a need to evaluate the reasons behind these disparities and assess their impact on patients’ outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4139850-A4139850, November 12, 2024. Introduction:The incidence of Heart Failure (HF) has increased as the US population ages, with Chronic Renal Failure (CRF) being a common comorbidity and risk factor for mortality. This study aims to identify annual, gender, race, and geographical trends in CRF-related mortality in patients with HF for older adults.Methods:We used ICD-10 (International Classification of Diseases 10th Revision) codes to retrospectively analyze death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database between 1999-2020 for patients ≥65 years old with concomitant HF and CRF. Age-adjusted mortality rates (AAMRs) per 100,000 people and Annual Percentage Change (APCs) and their respective 95% Confidence Intervals (CI) were also calculated for patient data grouped according to year, gender, race, and geography.Results:From 1999-2020, 425,854 deaths occurred from CRF and HF in patients ≥ 65 years. The overall AAMR was 46.1 (95% CI: 46 to 46.3), with the APC from 1999-2020 being 2.96 (95% CI: 1.84 to 4.32). Males reported higher AAMRs than females (overall AAMRs: 62.1 vs 36.2). Stratifying data by race revealed NH (Non-Hispanic) Black or African American to have the highest AAMR (62.2) followed by NH American Indian or Alaska Native (52.5), NH White (45.5) and Hispanic or Latino (37.2), with the NH Asian or Pacific Islander race having the lowest AAMR (30). According to the census region, the highest AAMRs were reported in the Midwest (54.3), followed by the West (45.1) and South (43.4), with the lowest AAMRs in the Northeast (42.3). Furthermore, Non-Metropolitan areas revealed higher AAMRs when compared to Metropolitan areas (54.4 vs 43.3). The states in the top 90thpercentile were Indiana, Kentucky, Minnesota, North Dakota, and West Virginia. They had AAMRs nearly double those in the bottom 10th percentile, such as Arizona, Hawaii, Nevada, and New Mexico.Conclusion:Trends in CRF- and HF-related mortality in older adults have varied from 1999-2020, with the highest AAMRs being reported in men, NH Black or African Americans, Non-Metropolitan areas, and in the Midwest. Strategies to target precipitating events are necessary alongside further investigations to explain the trend variations.

Circulation, Volume 150, Issue Suppl_1, Page A4140549-A4140549, November 12, 2024. Introduction:Persistently elevated filling pressure leading to central venous congestion is associated with poor prognosis. This central venous congestion stimulates connective tissue hyperplasia causing tissue fibrosis and stiffness of the liver. However, risk stratification involving hepatic fibrosis in heart failure is limited.Research Question:Is liver stiffness associated with higher mortality in heart failure?Aims:To utilize liver stiffness measured by transient elastography as an imaging phenotype in HF risk stratification and prevention.Methods:De-identified data from 285 HF patients without pre-existing liver disease/cirrhosis, with liver stiffness measured (kPa) by transient elastography from 2015-2023 were extracted from TriNetX, a real-time, electronic, federated data network of 34 healthcare organizations. Liver stiffness was further classified as high and low with 8kPa as a cut-off. Comparisons employed the chi-square or Fisher’s exact test for categorical variables and the student’s t-test or Mann-Whitney-Wilcoxon test, as appropriate. Multivariable Cox proportional hazards models were applied to evaluate the association with mortality and readmissions in 30 days.Results:The mean age of the cohort is 65±11 years. The majority were women (57.9%). Participants were followed for a median of 3.8 (1.52-6.67) years; 83 out of 285 patients died. Multivariable analysis showed that 1 SD increase in liver stiffness was associated with increased mortality (HR 1.13, 95% CI 1.05-1.21; p

Circulation, Volume 150, Issue Suppl_1, Page A4138225-A4138225, November 12, 2024. Background:Timely transfer for PCI is paramount in the management of STEMI. This has been shown to reduce myocardial damage, optimize reperfusion therapy and mitigate the post procedural complications associated with PCI. This study’s aim was to describe the in-hospital outcomes associated with acute inter-hospital transfer of patients with STEMI for PCI in comparison with patients directly admitted to a primary PCI center.Methods:The National Inpatient Sample (NIS) was used to identify patients who underwent PCI for STEMI between the years 2016-2021. Based on several transfer indicators, primarily admitted patients and patients with acute inter-hospital transfer were identified. Logistic and linear regression models were used to analyze the primary outcome of in-hospital mortality and secondary outcomes of length of hospital stay, hospital charge, and occurrences of post-procedure complications.Results:Observations were weighted to obtain a national estimate of 748,430 patients with known transfer status who underwent PCI for STEMI. Of these, 625,520 patients were primarily admitted at PCI centers and 122, 910 patients were transferred from non-PCI centers. The mean age of patients with STEMI undergoing PCI was 62 years, and 72 % of the patients were male. There was no significant difference in mortality between patients transferred and patients primarily admitted for PCI due to STEMI. However, patients transferred had longer hospital stay and significantly higher healthcare cost, with a mean difference of 0.72 days (95% CI: 0.65 – 0.81 days, p-value

Circulation, Volume 150, Issue Suppl_1, Page A4147484-A4147484, November 12, 2024. Introduction:Heart transplant (HT) is the gold standard for advanced heart failure, and the individuals burdened by advanced heart failure often have multiple comorbidities. Protein-energy malnutrition (PEM) is a common comorbidity and is frequently underdiagnosed. Previous studies examined the relationship between PEM and mortality in HT and found a positive association. However, the relationship between PEM and HT rejection, HT failure, and cardiac allograft vasculopathy (CAV) is scarce. Given that these complications also impact survival, we sought to explore the relationship.Methods:We identified all HT patients using ICD-10 codes from the 2016 to 2021 National Inpatient Sample database. Then, the PEM group was compared to the no-PEM group. We used Student’s Test and Pearson’s Chi-squared to analyze continuous and categorical variables. Then, multivariable logistic regression models were used to account for confounders and to predict the outcomes. The primary outcomes were HT rejection, HT failure, and CAV. The secondary outcomes were mortality, arrhythmias (composite of atrial and ventricular fibrillation and flutter, and supraventricular tachycardia), length of hospital stay, and cost of hospitalization. A 2-sided p-value was the statistical threshold for significance.Results:During the study period, 31,215 HT hospitalizations occurred, and 11.9% (3,700) had PEM. The median age for the PEM group was 65 years.Compared to the no-PEM group, HT rejection 0.8 (0.4-1.5), HT failure 0.8 (0.3-2.1), and CAV 1.08 (0.6-1.9) did not differ between both groups, p >0.05, each.The PEM group had a higher association with mortality 2.8 (2.1-3.6), arrhythmias 1.4 (1.07-1.8), longer LOS 8 vs. 4 days, and higher cost of hospitalization, $84,687 vs. $43,285, p

Circulation, Volume 150, Issue Suppl_1, Page A4141272-A4141272, November 12, 2024. Aims:This study aimed to analyze two decades of consecutive mortality data to investigate the association between cancer and cancer with heart failure across the United States (US), discerning patterns and disparities in mortality rates.Methods:Data were obtained from the multiple cause of death files using CDC WONDER spanning 1999 to 2020; ICD-10 codes were used to identify cancer and cancer with heart failure related deaths in adults aged ≥25. Demographic and regional distributions of mortality were analyzed. Joinpoint regression analysis was used to determine trends in age-adjusted mortality rates (AAMR) to estimate annual percentage changes (APC).Results:Between 1999 and 2020, 14,309,991 cancer-related deaths occurred in the US out of which 612,346 were associated with cancer and heart failure. The overall AAMR per 100,000 for cancer-related deaths decreased from 353.9 in 1999 to 260.9 in 2020 characterized by an annual percentage change (APC) of -1.60 spanning from 1999 to 2018, and an APC of 0.58 thereafter till 2020. AAMR per 100,000 for heart failure and cancer-related deaths decreased from 16.1 to 14.0, with varied APCs, declining from 1999 to 2013, reaching a minimum AAMR of 11 followed by a rise from 2013 to 2020. For cancer related only, men accounted for 52.7% of deaths, compared to 47.3% for women. Similarly, cancer with heart failure had mortality higher in males. Non-Hispanic (NH) White and Hispanic populations had the highest AAMRs for cancer related mortality while NH White and NH American Indian or Alaskan Native had the highest mortality in cancer with heart failure. Regional differences were observed, with the most cancer-related deaths observed in the South while the most cancer with heart failure related deaths occurred in the Midwest. State-wise stratification further supported the difference.Conclusions:Cancer-related mortality is decreasing while cancer with heart failure related mortality is increasing following initial decline. The highest AAMRs were observed for cancer related mortality among NH White population, men, people living in the South; and non-metropolitan US while cancer with heart failure had highest mortality in NH White population, men, people living in Midwest; and non-metropolitan areas. The findings underscore the need for focused interventions aimed at reducing mortality related to cancer and cancer with heart failure, particularly among vulnerable populations.

Circulation, Volume 150, Issue Suppl_1, Page A4129533-A4129533, November 12, 2024. Background:Heart failure with preserved ejection fraction (HFpEF) is a heterogenous syndrome with 5 phenotypes. We aimed to evaluate the clinical outcome of HFpEF patients with various phenotypes in China.Methods and Results:Data from the Chinese Cardiovascular Association (CCA) Database-HF Center Registry between January 2017 and December 2021 were analyzed, 51,466 hospitalized HFpEF patients with 1-year follow-up results were included in this analysis. The patients were categorized into five phenotypes based on published phenotyping method. Clinical characteristics and 1-year outcome and related risk factors of HFpEF patients with various phenotypes were explored. Results demonstrated significant differences in baseline characteristics and clinical outcomes among the phenotypes, patients with phenotype-3 (right heart and pulmonary-related HFpEF), phenotype-4 (valvular- and rhythm-related HFpEF) and phenotype-5 (extracardiac disease-related HFpEF) exhibited high incidence of adverse outcomes. Phenotype-3 and -4 exhibited high risk of heart failure rehospitalization, whereas phenotype-5 showed high cardiovascular mortality. The independent prognostic risk factors varied across different phenotypes as well.Conclusion:One-year outcome differs among HFpEF patients with various phenotyping. Future studies are warranted to validate if personalized treatment strategies based on HFpEF phenotypes could improve the individual outcome of HFpEF patients, especially for phenotype-3, -4 and -5 HFpEF patients.Keywords:Heart failure with preserved ejection fraction, phenotype, prognosis, population study, risk factors.

Circulation, Volume 150, Issue Suppl_1, Page A4146872-A4146872, November 12, 2024. Introduction:Increased prevalence and incidence of heart failure has resulted in a significant rise in the number of patients progressing to advanced heart failure (AHF). Heart transplant improves morbidity and mortality in patients with heart failure refractory to medical therapy. We examined resource utilization as measured in 30-day readmission in a contemporary population utilizing the NRD database.Aim:We conducted a thorough analysis to identify trends in 30-day readmissions of HTs and analyze the associated costs.Methods:Using the National Readmission Database from 2010 to 2021, the study focused on new HT recipients. We evaluated various parameters, including readmission rates and the costs associated with 30-day readmissions. Patients aged

Circulation, Volume 150, Issue Suppl_1, Page A4144399-A4144399, November 12, 2024. Introduction:Transcatheter aortic valve replacement (TAVR) has emerged as an effective and less invasive percutaneous treatment option for select patients with severe aortic stenosis. Nutritional status plays a role in risk stratification for TAVR given its impact on peri-procedural outcomes. We aim to evaluate the impact of protein-calorie malnutrition (PCM) on the outcomes of TAVR.Methods:We queried the national inpatient sample database from year 2016 – 2020 to identify all patients who underwent TAVR. They were classified based on the presence of protein-calorie malnutrition. Statistical significance was assigned at p

Circulation, Volume 150, Issue Suppl_1, Page A4144389-A4144389, November 12, 2024. Background:Obstructive sleep apnea (OSA) may influence the outcomes of catheter ablation in atrial fibrillation (AF) patients, but its impact at different stages of AF is not well understood.Objective:This study aims to evaluate whether OSA influences catheter ablation outcomes differently in patients with paroxysmal AF compared to those with persistent AF.Methods:We included AF patients with and without obstructive sleep apnea (OSA) in a late gadolinium enhancement (LGE) MRI database of patients who underwent catheter ablation. Our study population was stratified based on the type of AF: paroxysmal or persistent. Patients were followed for 24 months post-ablation, with a 3-month blanking period. To analyze time-to-AF recurrence, we used Kaplan-Meier curve along with the log-rank test to compare recurrence rates between patients with and without OSA in both AF types. Additionally, we used Cox regression analysis to adjust for potential confounders.Results:324 patients with paroxysmal AF (mean age: 64.5) and 512 patients with persistent AF (mean age: 65.2) were included. The left atrial (LA) volume was similar between OSA and non-OSA patients in both the paroxysmal AF cohort (83.1 mm3 vs. 83.6 mm3; p=0.73) and the persistent AF cohort (115 mm3 vs. 119 mm3; p=0.37). Patients with OSA exhibited a higher prevalence of comorbidities, including congestive heart failure (CHF), coronary artery disease, obesity, and diabetes, compared to non-OSA patients (p

Circulation, Volume 150, Issue Suppl_1, Page A4147256-A4147256, November 12, 2024. Introduction:Studies suggest a complex relationship between body mass index (BMI) and percutaneous coronary intervention (PCI) outcomes. However, the effect of obesity on in-hospital outcomes of PCI with mechanical circulatory support (MCS) for acute myocardial infarction complicated by cardiogenic shock (AMICS) has not been established.Objective:To characterize outcomes of PCI with MCS for AMICS in patients with and without obesity.Methods:In the National Inpatient Sample (NIS) 2016-2020, we identified patients with AMICS treated with MCS with obesity (BMI 30.0-39.9) or normal BMI (20.0-24.9). The primary outcome was in-hospital mortality. Secondary outcomes included cardiac arrest, stroke, acute kidney injury, bleeding, acute respiratory failure, palliative consults, hospital length of stay (LOS), and total charges. Multivariate logistic regression models adjusted for baseline characteristics and estimated odds ratios (ORs) with 95% confidence intervals (CIs).Results:5270 patients met study criteria (4870 obese). Obese and normal weight patients had a mean age of 69.8 vs. 63.5 years and male sex 78.1% vs. 71.3%. Obese patients had more hypertension, diabetes, dyslipidemia, and previous myocardial infarction (Table 1A). There was no difference in mortality [OR 0.84, CI (0.41-1.71), P=0.623] or the secondary outcomes (Table 1B). Normal weight was associated with longer LOS (13.0 vs. 8.5 days) and higher charges ($325,926.3 vs. $294,629.1).Conclusion:There were no significant differences in in-hospital mortality or secondary outcomes between obese and normal-weight AMICS patients treated with PCI and MCS. PCI with MCS may be performed safely in AMICS patients with and without obesity.

Circulation, Volume 150, Issue Suppl_1, Page A4138507-A4138507, November 12, 2024. Background:SARS-CoV2 infection has been associated with cardiovascular consequences, including myocarditis and cardiac arrhythmias. Myocarditis secondary to SARS-CoV2 infection and cardiac arrhythmias may often go unrecognized and can present with late and nonspecific symptoms. Predicting those at risk allows for prompt treatment and prevention of their potentially life-threatening consequences.Methods:The National COVID Cohort Collaborative (N3C) database was used to identify patients aged 0-30 years with COVID-19 index date between 1/1/2020 and 3/31/2022, whose sites provided data for at least six months beyond the index date. Outcomes included myocarditis and new arrythmias within 6 months of the index visit. Patients with known cardiac comorbidities were excluded. Predictors included gender, race, COVID severity as an ordinal scale, vaccination status, clinical comorbidities, and Area Deprivation Index (ADI). The data were stratified by age groups (0-4, 5-17, 18-30). Random forest models were used for data analysis and SHapley Additive exPlanations (SHAP) method was applied to optimize results. These analyses were conducted using the NCATS N3C Data Enclave.Results:Of the 1,487,741 patients in our study population, 4,105 (0.28%) had the measured outcomes; 404 had myocarditis only, 3,634 had arrhythmia only and 67 had both. Severity of COVID (SHAP 0.2344 for 0-4 years, 0.2114 for 5-17, 0.1370 for 18-30) was identified as the most important risk factor for de-novo myocarditis and arrhythmias overall. Increase in ADI (indicating lower socioeconomic status) was the second most important risk factor for the 0-4 and 5-17 age groups (SHAP: 0.0370, 0.0223). Among the 18-30 age group, race (SHAP 0.0321) and gender (SHAP 0.0289) were the second and third most important risk factors, with White and Black patients more likely to develop an event and Hispanic patients less likely. Women were less likely to develop a cardiac outcome than men.Conclusion:The severity of COVID was identified as the most important risk factor for the occurrence of myocarditis or cardiac arrhythmia within 6 months of infection. ADI, race, and gender were also identified as important, though less influential, risk factors.

Circulation, Volume 150, Issue Suppl_1, Page A4140731-A4140731, November 12, 2024. Introduction:Myeloproliferative neoplasms (MPN) are stem cell disorders that include include polycythemia vera (PV), essential thrombocythemia (ET), chronic myeloid leukemia (CML), primary myelofibrosis (PMF), chronic neutrophilic leukemia, and less well defined entities such as chronic eosinophilic leukemia. MPN are associated with an increased cardiovascular risk including acute coronary syndrome. However, there is a lack of comprehensive data regarding the rate of coronary revascularization, as well as the in-hospital characteristics and outcomes for MPN patients.Objective:We aimed to evaluate the temporal trends and outcomes of percutaneous coronary intervention (PCI) among patients with MPN.Methods:The National Inpatient Sample database from 2016 to 2020 was queried to identify all PCI hospitalizations. Temporal trends and outcomes of patients with and without MPN following PCI were described. Propensity score matching (PSM) was implemented to compare outcomes between MPN and non-MPN groups.Results:Our study included 2,237,210 PCI hospitalizations with 7,560 (0.27%) patients having MPN. Throughout the study period, the prevalence of MPN among PCI admissions remained stable (p-value for trend = 0.12). Within the MPN subgroup, ET was the predominant condition (53.2%), followed by PV (24.2%), CML (19.6%) and PMF (3.0%), with no significant temporal variation in the distribution of these subtypes. Patients with MPN had higher prevalence of cardiovascular comorbidities than non-MPN patients. Following propensity score matching, MPNs were significantly associated with an higher risk of blood transfusions (OR: 1.66, 95% CI: 1.22-2.24, p=0.001) and AKI (OR: 1.39, 95% CI: 1.17-1.65, p

Circulation, Volume 150, Issue Suppl_1, Page A4143848-A4143848, November 12, 2024. Introduction:Ischemic cardiomyopathy (IC) is a significant contributor to cardiovascular mortality, especially among older adults in the United States. Understanding mortality trends related to IC can help identify at-risk populations and make informed targeted healthcare strategies. This study investigates IC-related mortality trends and disparities among older adults aged ≥75 years in the US population.Methods:The CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was used to analyze the National Vital Statistics System data from 1999 to 2020. Deaths with IC as the primary cause of mortality were identified, and results were presented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to assess changes in trends and annual percentage change (APC).Results:A total of 186,136 deaths occurred in patients with IC from 1999 to 2020 (AAMR = 42.9, 95% CI: 42.7 – 43.2). Males had higher mortality rates (AAMR = 67.8) compared to females (AAMR = 27.7). Non-Hispanic Whites (NHW) had the highest AAMR (45.2, 95% CI: 45-45.4), followed by Hispanics (29.8, 95% CI: 29.1-30.5), non-Hispanic Blacks (NHB) (29.6, 95% CI: 29-30.1), non-Hispanic American Indian/Alaska Native (NH-AIAN) (29.1, 95% CI: 26.8-31.3). Non-Hispanic Asian/Pacific Islanders (NH-API) had the lowest AAMR (16.9, 95% CI: 16.2-17.6). Regionally, the South had the highest mortality rates (47.8, 95% CI: 47.5-48.2), followed by the Midwest (47.4, 95% CI: 46.9-47.8), the West (36.7, 95% CI: 36.3-37.1), and the Northeast (36.3, 95% CI: 35.9-36.7). Mortality rates were higher in rural areas (44.1, 95% CI: 43.5-44.7) compared to urban areas (36.5, 95% CI: 36.1-36.8). Overall, the AAMR increased from 51.3 in 1999 to 51.9 in 2005, followed by a decline to 31.5 in 2020 (APC: -2.0, 95% CI: -2.2, -1.7). Noteworthy declines in AAMR were observed in both men (APC: -2.0) and women (APC: -2.9) throughout the study (Figure, Panel A). Moreover, significant downward trends were evident in NH-AIAN (APC: -3.5), NHB (APC: -1.2), NHW (APC: -2.7 since 2004), Hispanics (APC: -5.5 since 2016), and NH-API (APC: -2.4) racial groups (Figure, Panel B).Conclusion:Our study reveals disparities in IC-related mortality, highlighting males, NHW, and the residents in the South and Midwest as well as those living in rural areas are at increased risk. Targeted interventions and resource allocation are essential to improve outcomes for vulnerable populations.

Circulation, Volume 150, Issue Suppl_1, Page A4139724-A4139724, November 12, 2024. Background:Advancements in heart transplant has expanded boundaries to greater range of patients to receive transplant. Despite concerns of increased morbidity and mortality, data from previous studies showed selected patients 70 years or older who underwent heart transplant had similar morbidity and mortality compared to younger patients. With growing population age and increase in technology, transplant candidacy is expanded to selected robust geriatric patients.Objective(s):Determine change in the number of transplant cases and the percent from total yearly cardiac transplant in geriatric populationMethod:Heart transplant recipients of all ages from 2000 to 2023 were identified in the United Network for Organ Sharing (UNOS) database and stratified into different age groups. Primary outcomes of interest included number of heart transplant cases and percentage from total yearly transplant.Results:In total, we identified 66,079 heart transplant recipients from 2000 to 2023. Among these patients, 9,964 (12.40%) were patients aged 65 above and 28,554 (45.50%) were 50-64 years old (figure 1A). There was an overall increase in the number of heart transplants from 2000 to 2023, 2,199 to 4,545 cases per year, respectively. There was an increase in the number of heart transplants in the geriatric population from 216 to 841 (figure 1B). From 2000 to 2013, there was an increase in the percent of transplant recipients in patients 65 years and older from 9.80% to 17.60%, after which remained stable (figure 1C). There was a relative decrease in proportion of patients 50-64 years from 2000 to 2014, from 51.10% to 42.80%, respectively. The number of cardiac transplants among 50-64 year old group from 2000 to 2008 decreased from 1,123 to 920 then increased again by 2014.Conclusion:There has been a significant increase in the total number of heart transplants from 2000 to 2023. Currently, heart transplants in geriatric population consist of a significant portion of total heart transplants close to 1 of 5 transplants that occur per year (18% to 19%). This number has grown from 9.80% (2000) to 18.50% (2023) among all heart transplants per year.