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

Circulation, Volume 150, Issue Suppl_1, Page A4147863-A4147863, November 12, 2024. Background:Ischemic heart disease (IHD) affects over 120 million people and is the leading cause of death globally. Our study aims to assess the trends in IHD-related mortality in the regions of the Americas.Research Questions/Hypothesis:Has IHD-related mortality decreased from 2000 to 2019 in all regions of the Americas?Aims:Analyze differences in IHD-related mortality in different regions of the Americas.Methods:We analyzed the Pan American Health Organization (PAHO) database for IHD-related mortality rates in 2000, 2010, and 2019. The age-standardized mortality rates per 100,000 population were extracted, and trends were analyzed by gender and region.Results:The IHD-related mortality was consistently higher in males as compared to females in the last 2 decades. The mortality rate decreased in males in all regions from 2000 to 2019 apart from the Mexico, Central America and Latin Caribbean region where it increased from 115.12 in 2000 to 119.50 in 2019.The greatest decrease in IHD-related mortality in males was seen in the North America region from 164.49 in 2000 to 93.73 in 2019. This opposite trend was seen in females where mortality decreased in all regions from 2000 to 2019.Conclusion:The sociodemographic and temporal trends highlighted by this study need to be further investigated, and targeted policy measures are required to reduce the disparities in IHD-related mortality.

Circulation, Volume 150, Issue Suppl_1, Page A4141344-A4141344, November 12, 2024. Background:Leadless pacemakers offer a safe and effective alternative pacing strategy, crucial for patients with end-stage renal disease (ESRD) overcoming vascular access isues. However, there is limited data available on their use in this population.Methods:We utilized the Nationwide Readmission Database to extract data on all adult patients with ESRD who received either traditional transvenous or leadless pacemaker implantation from 2016 to 2021. We then compared in-hospital mortality, in-hospital complications, healthcare resource utilization, and 30-day readmission rates between these two groups.Results:A total of 6,384 patients (81.2%) were included in the transvenous pacemaker cohort, while 1,481 patients (18.8%) were in the leadless pacemaker cohort. In ESRD patients, leadless pacemaker implantation was associated with higher in-hospital complications compared to transvenous pacemakers, including cardiac complications (aOR 4.12, CI 1.70-9.98, p

Circulation, Volume 150, Issue Suppl_1, Page A4147545-A4147545, November 12, 2024. Introduction:Pulsed field ablation (PFA) is an adaptation of direct current ablation first used for catheter ablation in the 1980s. Expectations of a reduced risk profile led to the current resurgence in investment and interest in the technology as a potential alternative energy source for ablations to treat atrial fibrillation (AF). However, reports of adverse events, including new risks, are increasing.Research Question:How many adverse effects are reported with the use of newly available PFA systems?Aims:Quantify and describe the adverse events from PFA reported to date in the Food and Drug Administration’s (FDA) Manufacturer and User Facility Device Experience (MAUDE) database.Methods:We searched the U.S. FDA’s MAUDE database for all reports filed with the code “QZI”, which is the product code for PFA systems created with the first FDA approvals in February 2024. All reports from inception through April 2024 (a total of 3 months) were included in this review. Per manufacturer presentation in May 2024, approximately 1000 cases utilizing PFA had been captured in a post-market registry of the predominant commercially used technology, but the exact number of cases can not be determined from MAUDE data.Results:A total of 217 adverse events were reported over the first 3 months of US approval, with 91 of these considered patient injuries. These injuries included 10 cases of cardiac tamponade, 7 reports of postoperative arrhythmia, 6 instances of device-related tissue entrapment, 5 cases of hemolysis with impaired renal function, 5 cases of stroke or TIA, including both embolic and hemorrhagic, 3 cases of intraoperative heart block, 2 coronary spasms, and 2 cases of intraoperative ST elevation.(Figure)Of the 91 reported patient safety events, 46 required hospitalization, 13 cases required temporary pacing, 11 required pericardiocentesis, 4 required dialysis, 4 required cardiothoracic surgery, and 2 required cardioversion.Conclusions:A number of adverse events have been reported to the MAUDE database in the first 3 months of FDA approval of PFA. The cardiac electrophysiology community should remain vigilant to ensure that the benefit-risk profile remains acceptable for patient safety.

Circulation, Volume 150, Issue Suppl_1, Page A4147674-A4147674, November 12, 2024. Background:Leadless pacemaker (LP) is a novel pacemaker offering an innovative approach to bradyarrhythmia treatment. Aveir LP and Micra LP are the two leadless pacing systems available in the United States. Aveir LP was approved by the Food and Drug Administration (FDA) in April 2022. Data regarding the adverse events (AE) following implantation of Aveir LP is scarce, largely limited to single centers, and no real-world comparative analyses were done previously.Methods:We queried the FDA Manufacturer and User Facility Device Experience (MAUDE) database between April 2022 and December 2023 to assess the safety and AE following implantation of Aveir LP. “AVIER” and “MICRA” were the key terms used to search the MAUDE database. The event types “death” and “injury” were included in our search to capture major clinical events related to the patient. Disproportionality analysis was performed using the reporting odds ratio (ROR) to compare the adverse events of Aveir LP with Micra LP. A signal to noise ratio was considered to be significant if the confidence interval (CI) did not cross the number “one”.Results:Our search resulted in 207 event reports for Aveir LP and 1969 event reports for Micra LP. Major device related adverse events with Aveir LP were capturing problem (33.8%) followed by dislodgement (16.9%), and sensing problem (7.2%). Most encountered device related AE with Micra LP were capturing problem (37.8%), pacing problem (11.5%), and sensing problem (9.3%). Frequencies of all the analyzed AE are shown in Figure 1. The reporting of pericardial effusion (ROR 2.84, 95% CI 2.18-3.71), and dislodgment (ROR 1.85, 95% CI 1.26-2.73) were significantly higher with Aveir, whereas cardiac arrest (ROR 0.18, 95% CI 0.04-0.74) was disproportionately lower. Overall, patient related AE were significantly higher (ROR 1.53, 95% CI 1.20-1.95) and device related events were significantly lower (ROR 0.65, 95% CI 0.51-0.83) with Aveir LP compared to Micra LP (Figure 2).Conclusion:This is the first real-world comparative analysis of two leadless pacing systems available in the United States. Our analysis showed that, when compared to Micra LP, the newer Aveir LP had lower device related events but higher patient related events, largely driven by pericardial effusion. These events could be attributed to the operator learning curve and long-term data are needed to further verify these findings.

Circulation, Volume 150, Issue Suppl_1, Page A4148114-A4148114, November 12, 2024. Introduction/Background:Use of the radial artery (RA) is associated with better clinical outcomes compared to the saphenous vein during coronary artery bypass grafting (CABG) and is strongly endorsed by society guidelines. While the safety of using the RA as a sequential T-graft from the internal mammary artery is established, evidence on the safety and efficiency of sequential radial artery grafts directly from the aorta is limited.Research Questions/Hypotheses:The use of a sequential radial artery originating on the aorta is safe and efficient and is associated with an increase in the number of arterial grafts used in patients undergoing CABG.Goals/Aims:To evaluate the safety and efficiency of using the radial artery in a sequential approach directly from the aorta during CABG.Methods:STS database analysis of patients undergoing isolated CABG with ≥1 RA by one surgeon at two centers (2001-2022). Patients with sequential vs. non-sequential RA grafting were compared. Primary outcomes included CPB and cross-clamp time, total number of arterial grafts, and incomplete revascularization. Secondary outcomes were 30-day mortality, reoperation, stroke, renal failure, sepsis, ICU length of stay, and deep sternal wound infection. Statistical methods included Mann-Whitney U test, Chi-Square test, and Optimal Matching Propensity Score analysis (1:3 ratio).Results:Of 503 patients who received an RA graft, 129 (25.6%) were sequential. Before matching, significant differences were noted in median age, BMI, CPB and cross-clamp (XC) time, and elective status between groups. Sequential RA use was associated with a higher median number of arterial grafts and total grafts (3 vs 2, and 4 vs 3, respectively, p

Circulation, Volume 150, Issue Suppl_1, Page A4125334-A4125334, November 12, 2024. Background:Limited knowledge exists regarding non-acute myocardial infarction-associated cardiogenic shock (nACS-CS) and its associated outcomes within the African American population.Aim:This investigation aimed to examine the clinical outcomes of nACS-CS in the African American population compared to the non-African-American population in the United States.Methods:The National Inpatient Sample (NIS) database was employed to identify hospitalizations with nACS-CS from 2018 to 2020. Patients were categorized as either African Americans or non-African Americans. Statistical analyses, including Chi-square and t-tests, were conducted using STATA version 18.Results:Out of 8,607 nACS-CS hospitalizations, 1,325 (15.4%) involved African Americans between 2018 and 2020 (Figure 1a). African American patients with nACS-CS tended to be younger (60.9±16.6 vs. 65.8±16.7 years; p < 0.05). Moreover, the length of stay for this cohort was notably longer (16.2±0.75 vs. 14.8±0.32 days; p < 0.05). The demographic age group affected by cardiogenic shock exhibited a decreasing trend as time progressed up to 2020 (p-trend

Circulation, Volume 150, Issue Suppl_1, Page A4127990-A4127990, November 12, 2024. Background:Matrix Gla protein (MGP) inhibits arterial calcification. Higher inactive MGP, dephosphorylated-uncarboxylated (dp-ucMGP), is positively associated with vascular calcification, possibly portending cardiovascular events. The objective was to determine the association of dp-ucMGP with incident cardiovascular disease (CVD) events and mortality in the Multi-Ethnic Study of Atherosclerosis (MESA).Methods:MESA is a cohort study of 45-84 year-old individuals enrolled between 2000-02 with adjudicated outcomes through 2019. Dp-ucMGP was measured at baseline in n=2663 participants with cardiac computed tomography at Exams 1 (2000-02) and 5 (2010-12). Using age-stratified Cox proportional hazard models, adjusted for sex, race-ethnicity, body mass index, systolic blood pressure, statin use, anti-hypertensive medication use, smoking status, physical activity, alcohol use, diabetes, high density lipoprotein, low density lipoprotein, triglycerides, phosphate, and estimated glomerular filtration rate, we determined the association of dp-ucMGP with risk of all CVD (mean follow-up 16+4 years), hard CVD (17+3 years), hard CHD (17+3 years), and all-cause mortality (18+2 years).Results:The youngest age quartile (45-53-years-old) with higher dp-ucMGP levels (520-2934 pmol/L) had an increased risk of all CVD (HR 3.01 [95% CI 1.56, 5.80], p=0.001), hard CVD (HR 2.78 [95% CI 1.29, 6.02], p=0.009), hard CHD (HR 3.37 [95% CI 1.29, 8.81], p=0.013) and all-cause mortality (HR 2.69 [95% CI 1.06, 6.79], p=0.037) compared to dp-ucMGP levels between 150-519 pmol/L in maximally adjusted models. There was no relationship with any outcomes for the other age quartiles (Table).Conclusions:Middle aged individuals with elevated dp-ucMGP levels ( >520 pmol/L) had an increased risk of incident CVD, CHD, and all-cause mortality.

Circulation, Volume 150, Issue Suppl_1, Page A4141762-A4141762, November 12, 2024. Introduction:Chronic heart failure (HF) is linked to elevated serum TNF-α levels and affects multiple signaling pathways in non-cardiomyocytes, such as immune cells, intestinal epithelial cells, lymphatic endothelial cells, vascular cells, and their interactions. The combined dysbiosis of host transcriptomics and gut microbiota concerning altered TNF-α signaling in older adults with HF remains unknown.Methods:We recruited 10 older adults with heart failure (HF) (6 females) and 16 healthy controls (HCs) (10 females) from the Northeastern U.S. Non-fasting peripheral blood and stool samples were collected. Serum TNF-α was assayed using Enzyme-linked Immunosorbent Assay (ELISA) kits. Differentially expressed genes (DEGs) between HF and HCs were investigated using the R package “DESeq2” after aligning the raw blood RNA sequence data to the reference database and undergoing quality control. The QIAGEN Ingenuity Pathway Analysis (IPA) was used to analyze the canonical pathways associated with the DEGs. The 16S rRNA V4 gene regions of stool samples were sequenced and processed using the Mothur 1.42.3 pipeline. The Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) was used to predict the metagenomic functions of different gut microbiota compositions.Results:The mean ages of the HF and HC subjects were 73.50 (SD = 8.33) and 63.19 (SD = 7.75), respectively. HF subjects had significantly higher serum TNF-α levels than HCs (p < 0.05). Among the DEGs, HF subjects had 18 downregulated genes (e.g.,AK5,FAM167A,RGCC, andSARDH) and 3 upregulated genes (SMPD3,TMIGD3, andFRRS1) compared with HCs. TNF signaling (p < 0.01) was one of the significantly different canonical pathways in the DEGs between HF and HCs. HF subjects had significantly enrichedMogibacteriumand diminishedSutterellathan HCs (p < 0.05) and lower P53 signaling pathway activity than HCs (p < 0.05) among the predicted functions in stool samples.Conclusions:By analyzing serum TNF-α, whole transcriptomics, and gut microbiota, we identified higher serum TNF-α, differentially expressed genes (DEGs) and their canonical pathways, and distinct compositions and predicted functions of gut microbiota in older adults with HF compared to healthy controls. These findings suggest that TNF-α signaling may be a potential target for developing precise HF interventions and highlight the need for further large-scale multi-omics analysis in understanding and treating HF.

Circulation, Volume 150, Issue Suppl_1, Page A4140245-A4140245, November 12, 2024. INTRODUCTION:Atrial fibrillation (AF), often diagnosed in the Emergency Department (ED), increases the risk of stroke by 64% but can be mitigated by guideline-directed oral anticoagulant (OAC) treatment.RESEARCH QUESTION:Does clinician education of an AF clinical decision support (CDS) tool increase OAC prescription rates for patients with new-onset AF or paroxysmal AF (pAF)?GOALS:To increase guideline recommended care practice of OAC prescribing for appropriate candidates in the ED.Methods:This multi-center, multi-phase, stepped-wedge cluster-randomized clinical trial includes a retrospective phase (Phase 0) and implementation of an external browser link to the CDS in the EHR (Phase 1) which included patient-specific stroke and bleeding risk stratification scores with recommendation for OAC based on professional society guidelines, along with targeted provider education on how to use the resource. Data was collected from ED visits of patients aged > 18 with a primary AF/pAF diagnosis from Jan 1, 2020–May 25, 2024. The three sites, one academic and two community hospitals, implemented Phase 1 in January ‘22, April ‘22, and April ‘23. Eligibility for OAC treatment was based on clinical judgment weighing the benefit of stroke prevention against the risk of bleeding. A logistic GEE model assessed the intervention’s impact on OAC prescribing and treated ED providers as a random effect to account for clustering. The model included the CDS intervention and covariates for site, cardiology consultation, guideline citation, and patient factors such as sex, race, ethnicity, and age.Results:Of 4397 patients analyzed, 655 met inclusion criteria, among which 296 (45.19%, median age 68) were prescribed OAC, 175 in Phase 0, and 121 in Phase 1. The odds ratio estimates and their corresponding 95% confidence intervals are as follows: CDS intervention 1.75 [1.20, 2.54], sex female vs male 2.31 [1.57, 3.38], age 0.27 [0.12, 0.61], site 0.55 [0.29, 1.04] and 0.45 [0.25, 0.83] for each community site vs academic, cardiology consultation 4.56 [2.80, 7.42], and guideline citation 2.23 [1.44, 3.43]. Race and ethnicity did not show significant associations.CONCLUSION(S):We demonstrated that clinician education and limited CDS tool integration into the EHR are linked to an almost two-fold increase in OAC prescribing for suitable AF/pAF patients. Future studies should evaluate the influence of further CDS integration on OAC prescribing, long-term adherence, patient outcomes.

Circulation, Volume 150, Issue Suppl_1, Page ASu703-ASu703, November 12, 2024. Introduction:Out of hospital cardiac arrest (OHCA) is a leading cause of death in the United States, with upwards of 360,000 OHCAs annually. Receiving bystander cardiopulmonary resuscitation (CPR) almost doubles an individual’s odds of survival compared to those who don’t receive bystander CPR. Unfortunately, in the US, bystander application of CPR only occurs in 40% of OHCA. Improving the rate of bystander CPR and AED use will improve survival rates for OHCA.Minoritized populations experience worse outcomes from OHCA. Compared to non-Hispanic whites, they are less likely to survive to hospital discharge. A cross-sectional study of witnessed OHCA patients found that Black and Hispanic patients had lower rates of bystander CPR. Less is known about disparities in care for Asian American persons who experience OHCA. Studies using the Resuscitation Outcomes Consortium Epidemiologic Registry (ROC) and the Cardiac Arrest Registry to Enhance Survival (CARES) have concluded discrepant results, with ROC finding that Asian Americans were less likely to receive bystander CPR and CARES finding that they were just as likely to receive bystander CPR compared to non-Hispanic Whites. To that end, we sought to evaluate the association between bystander CPR and Asian race after witnessed OHCA.Objective:To evaluate the association between race/ethnicity and the odds of receiving bystander cardiopulmonary resuscitation (bCPR) after witnessed out-of-hospital cardiac arrest (OHCA).Methods:Data were obtained from the National Emergency Medical Services Information System (NEMSIS) database for adults (≥18 years) with a witnessed non-traumatic OHCA in the year 2022. Patients were separated into two groups: Non-Hispanic White and Asians. The primary outcome was the odds of receiving bCPR. Exclusions included traumatic etiology, do-not-resuscitate orders, and arrests witnessed by healthcare providers. Pearson’s chi-square test was used to test significance.Results:A total of 73,215 witnessed OHCA activations were included in this study. Overall, bystander CPR rates were lower for the Asian group (59.8%) compared to the Non-Hispanic White group (65.0%). Pearson’s chi-square test showed a statistically significant difference between the bCPR rates of the Asian group and Non-Hispanic White group, with a p-value of less than 0.001.Conclusion:Racial/ethnic disparities exist for Asian individuals in the odds of receiving bCPR after a witnessed non-traumatic OHCA.

Circulation, Volume 150, Issue Suppl_1, Page A4143372-A4143372, November 12, 2024. Background:Cardiogenic shock is associated with significant morbidity and mortality, necessitating a multidisciplinary approach to achieve optimal outcomes.Aims:This study evaluated the impact of a multi-component, multidisciplinary cardiogenic shock program on clinical outcomes.Methods:In 2021, we initiated a cardiogenic shock program incorporating several key components: monthly meetings within the entirety of the heart and vascular service line for patient review and dissemination of protocols and initiatives; formation of a core leadership group comprising representatives from cardiac surgery, heart failure, interventional cardiology, cardiac intensivists, and shock nursing coordinators; implementation of a shock paging system for real-time multidisciplinary discussions; appointment of two nursing coordinators for protocol development, education, and data tracking; development of a temporary MCS quality scorecard; and establishment of a program to transition Impella patients to a stepdown unit for bed optimization. Patient outcomes were compared between the inaugural year and the subsequent year of the shock program.Results:143 patients in cardiogenic shock were activated through our shock paging system during the study period. Patient age averaged 54.5 years. 51.1% of patients were located at our institution and 48.9% were located at an outside hospital upon shock call initiation. The most common etiology for shock was decompensated HF (33.6%), followed by acute MI (25.2%), arrhythmia (14%), and other (27.3%). The majority of patients presented with a SCAI shock stage of C (41.3%), followed by D (25.9%) and E (20.3%). 78.3% of patients received an MCS device as a result of the shock call, with 33.6% receiving an Impella CP, 16.8% receiving an Impella 5.5, 29.4% receiving an IABP, and 27.3% requiring VA ECMO. Prior to the shock team initiation, historical hospital survival rates in cardiogenic shock patients approached 30% at our institution. After initiation of the shock program, survival to hospital discharge improved to 67.8% and 1-year survival was 53.2%. 30-day survival improved in the second year of the program compared to the inaugural year (70.1% vs. 53.6%, p=0.0447).Conclusion:Implementation of a multi-component multidisciplinary shock program facilitates a systematic approach to cardiogenic shock and is associated with improved hospital culture and collaboration and excellent outcomes in a challenging patient subset.

Circulation, Volume 150, Issue Suppl_1, Page A4139978-A4139978, November 12, 2024. Background:Discrepant transthoracic echocardiography (TTE) parameters are not infrequently observed in patients with significant aortic stenosis (AS), however, there is limited literature regarding their computed tomography (CT) characteristics and prognostic implications.Aims:We compared the multi-modality imaging characteristics and outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) by AS subtype.Methods:Patients with severe AS (defined as aortic valve area

Circulation, Volume 150, Issue Suppl_1, Page A4136289-A4136289, November 12, 2024. Background:Aortic valve calcium (AVC) is associated with an increased risk of cardiovascular disease, non-cardiovascular disease such as dementia, and all-cause mortality. Traditional atherosclerotic cardiovascular disease risk factors are associated with both AVC and chronic kidney disease (CKD), but whether there is an association between AVC and CKD is unknown.Objectives:To ascertain whether AVC quantified by cardiac CT scanning is independently associated with the long-term risk of incident CKD among individuals without a previous history of cardiovascular disease.Methods:We examined 6,346 Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent cardiac CT scanning at Visit 1 (2000-02) and had an eGFR of ≥ 60 mL/min/1.73 m2. AVC was quantified using the Agatston method and categorized as 0, 1-99, and ≥100. Incident CKD was defined as an eGFR < 60 mL/min/1.73 m2accompanied with an at least 40% decline in eGFR from baseline, and/or a diagnosis of CKD and indicators of end stage renal disease extracted from hospital records using the International Classification of Disease (ICD) codes. We performed Kaplan-Meier survival curve analyses along with multivariable Cox proportional hazard regression models, adjusted for age, gender, race/ethnicity, highest level of education and traditional cardiovascular risk factors along with coronary artery calcium (CAC), lipoprotein (a) (Lp[a]), and the APOE-ε4 genotype to examine the association between AVC (categorical and log-transformed) and incident CKD.Results:Participants had a mean age 62.2±10.1 years, 53% were women, and AVC >0 was present in 795 (12%) participants. During a median follow-up time of 16.9 years, 982 (15%) participants developed incident CKD. AVC examined as a continuous variable was associated with a significantly increased risk of developing CKD (per log-unit [AVC+1] HR 1.06 [95% CI: 1.02-1.10];p= 0.005). There was a stepwise increased risk for CKD with higher AVC levels (Figure). Similarly, in the multivariable adjusted Cox models, participants with AVC ≥100 had a higher risk of incident CKD, compared with the AVC=0 group (HR 1.48 [95% CI: 1.15-1.89];p= 0.002). The observed associations remained after further adjusting for CAC score (p= 0.024), Lp (a) (p= 0.004), and the APOE-ε4 genotype (p= 0.004).Conclusions:In a multi-ethnic cohort of participants free of CKD at baseline, AVC was independently associated with a higher risk of incident CKD.

Circulation, Volume 150, Issue Suppl_1, Page A4139904-A4139904, November 12, 2024. Background:Atrial Fibrillation (AF) in patients with metabolic syndrome is a substantial health concern among older adults in the United States. This study investigated trends and disparities in AF mortality among older adults aged 65 and older with metabolic syndrome from 1999-2020.Methods:We used the Centers for Disease Control database for mortality statistics with an underlying cause of death of AF in metabolic syndrome (ICD code I48 for AF and scattered codes indicating metabolic syndrome i.e. E10-14, E66, E78, E88, I10) between the years 1999 – 2020. Age-adjusted mortality rates (AAMR) were calculated per 100,000 deaths. The AAMR were assessed by demographic variables, including race, geographic density, sex, age, and US Census Region. Temporal trends were evaluated using Joinpoint regression software. Average annual percent change (AAPC) was considered statistically significant if p < 0.05.Results:Between 1999 and 2020, AF in metabolic syndrome caused 944,960 deaths among U.S. adults aged 65+. Most deaths occurred in medical facilities (35.8%). The overall AAMR for AF in metabolic syndrome-related deaths rose from 36.6 in 1999 to 173.4 in 2020, with an AAPC of 6.48 (95% CI: 5.07 to 7.77, p < 0.000001). A significant increase was noted from 1999 to 2001 (APC: 26.58; 95% CI: 6.04 to 43.91, p < 0.000001), followed by a continued rise from 2001 to 2020 (APC: 4.56; 95% CI: 3.60 to 5.15, p = 0.012797). Older men had higher AAMRs than older women (116.0 vs 92.3). Among racial/ethnic groups, White population had the highest AAMRs (108.8) and AAPC (6.70; 95% CI: 5.23 to 7.95), followed by American Indians/Alaska Natives (81.7), Blacks (74.1), Hispanics (68.2), and Asians (61.6). AAMRs varied by state, from 61.1 in Nevada to 170.0 in Vermont. The Western region had the highest average AAMR (116.7). Nonmetropolitan areas had slightly higher AAMRs than metropolitan areas (113.0 vs. 99.9).Conclusion:The analysis reveals a dramatic fourfold increase in AF-related mortality within metabolic syndrome among older U.S. adults over two decades. This substantial rise in mortality rates underscores the urgent need for targeted interventions and strategies to address these trends. By addressing structural barriers to quality healthcare and health disparities, we can effectively counter this concerning trend and achieve positive outcomes for this vulnerable group.

Circulation, Volume 150, Issue Suppl_1, Page A4144666-A4144666, November 12, 2024. Background:There is limited data on the safety and efficacy of ventricular tachycardia (VT) ablation in patients with chronic kidney disease (CKD). We examined the outcomes of patients with CKD undergoing VT ablation in a nationally representative cohort of patients.Methods:The National Inpatient Sample Database (NIS) was analyzed from 2018 to 2021 to identify patients ≥18 years old with VT undergoing ablation. Patients with atrial fibrillation, atrial flutter, supraventricular tachycardia, or pre-excitation syndrome were excluded. Patients were divided into those with CKD and without CKD. A multivariable logistic regression model was utilized to assess the association of CKD with in-hospital mortality and outcomes after adjusting for confounders.Results:Our cohort included 1608 VT ablation procedures, of which 428 (27%) were performed on CKD patients. Mean age was 63 (±13) years, 318 (19%) were female, and 1194 (74%) were White. 1475 (92%) of the procedures were done at an urban teaching hospital, and 1240 (77%) at a private non-profit hospital. On multivariable analysis, CKD was associated with significantly higher odds of death (adjusted odds ration [aOR]: 3.43; 95% confidence interval [CI]: 1.79-6.5; p=0.0002), acute decompensated heart failure (aOR: 3.1; 95% CI 2.24-4.56; p

Circulation, Volume 150, Issue Suppl_1, Page A4143199-A4143199, November 12, 2024. Introduction:Exercise is critical to cardiovascular health. However, the underlying molecular mechanisms are not well described. The Molecular Transducers of Physical Activity Consortium (MoTrPAC) seeks to create a detailed molecular map of the response to exercise. Described here is the first human cohort of MoTrPAC, enrolled prior to the COVID-19 shutdown (N=175).Methods:Healthy, sedentary adults were randomized to an 8-exercise circuit of resistance exercise (RE, N=73), a 40 minute submaximal endurance exercise bout (EE, N=65), or to non-exercising control (N=37). Blood, muscle, and adipose tissue were sampled at 4-7 time points relative to exercise, depending on tissue/modality. Samples were deep phenotyped across multiple omic domains including chromatin accessibility, transcriptomics, proteomics, phosphoproteomics, and metabolomics.Results:The cohort was 72% female, with a mean±sd age of 41±15 years and BMI of 27.1±4.0 kg/m2. Exercise affected over 34,000 molecular features in ≥1 tissue/time point including a high proportion of transcriptomic and phosphoproteomic features (Figure A). Molecular signatures were compared between EE and RE: enrichment analysis of muscle phosphoproteomics showed a greater activation of MAP kinases in RE compared to EE at all time points. To identify plausible exerkines (secreted molecules signaling an acute exercise bout), differentially abundant features in any sampled tissue cells were compared to temporally-matched cognate protein levels in plasma, yielding 110 features. A known exerkine, CX3CL1 (fractalkine) was identified, in addition to novel candidates, such as cellular communication network factor 1 (CCN1), a secreted extracellular matrix protein linked to plasma triglyceride levels, which showed increased abundance early post exercise (Figure B). Network analysis across tissues and omes identified novel transcription factor “hubs” as candidate master regulators of exercise response.Conclusions:These first MoTrPAC data represent an unparalleled multi-tissue, multi-omic, multi-time point, multi-modality map of acute exercise, enhancing our understanding of the molecular transducers that may link exercise and cardiovascular health.