Risultati per: Analisi sull’uso dei farmaci anti-osteoporotici in sette database europei

Circulation, Volume 150, Issue Suppl_1, Page A4146996-A4146996, November 12, 2024. Background:Due to increased life expectancy, there is increasingly high prevalence of myocardial infarction (MI) in older adults (age ≥75 years). Older adults tend to receive less guideline recommended treatment for MI due to associated frailty. We compare the management and outcomes in older adults with ST elevation myocardial infarction (STEMI) and cardiogenic shock (CS) as compared to adults age

Circulation, Volume 150, Issue Suppl_1, Page A4145617-A4145617, November 12, 2024. Background:Cardiogenic shock (CS) has high morbidity and mortality rates. There is limited understanding of race differences in the management and outcomes of CS.Methods:We queried the US National Inpatient Sample database (years 2016-2021) for CS hospitalizations in adults and categorized them by presence of acute myocardial infarction (AMI) on admission. Using multivariable logistic regression modeling, we adjusted for age, sex, income, insurance, comorbidities, and prior cardiac interventions and compared racial differences in use of and time to interventions, inpatient mortality, and cardiac arrest during hospitalization for AMI-CS and non-MI-CS.Results:Out of a total 1,012,050 weighted hospitalizations for CS, 60% involved non-MI-CS, while 40% were AMI-CS. Among AMI-CS hospitalizations, Black patients were less likely to receive IABP (aOR: 0.87, 95%CI: 0.82-0.93), pLVAD (aOR: 0.79, 95%CI: 0.72-0.86), PCI (aOR: 0.79, 95%CI: 0.75-0.84), and CABG (aOR: 0.77, 95%CI: 0.71-0.83), than White patients (all p

Circulation, Volume 150, Issue Suppl_1, Page A4112775-A4112775, November 12, 2024. Aims and Background:Kaposi sarcoma (KS) is a vascular neoplasm caused by human herpesvirus. Despite its significance, there is limited data regarding the causes and mortality factors associated with KS, particularly concerning cardiovascular mortality rates and specific influencing factors.Methods:The Surveillance, Epidemiology, and End Results (SEER) database was used to gather data from 2000 to 2020. The primary endpoint was overall survival, assessed via log-rank analysis and Kaplan-Meier plots. Hazard ratios (HR) with 95% confidence intervals (CIs) were calculated using SAS v9.4, with significance set at p80 years) vs. 0-19 year age group (HR: 2.263; 95% CI: 1.068-4.795; p=0.033), non-Hispanic Black race vs. non-Hispanic White race (HR 1.492; 95% CI: 1.369-1.627; p=0.001), and visceral involvement vs. cutaneous KS (HR 1.709; 95% CI: 1.487-1.963; p=0.001) were factors associated with increased mortality. Females had a slightly lower long-term survival than males (p

Circulation, Volume 150, Issue Suppl_1, Page A4146081-A4146081, November 12, 2024. Background:Long QT Syndrome (LQTS) is an inherited arrhythmia syndrome that predisposes patients to sudden death. Prior studies on racial disparities in LQTS have shown similar number of cardiac events, but longer QTc in Black patients compared to non-Hispanic Whites (NHW). There is limited data on cardiac events in Hispanic children with LQTS. We hypothesized that Hispanic children with LQTS have worse outcomes compared to NHW children.Methods:This retrospective cohort study of the Pediatric Health Information System (PHIS) database included children ages 0 – 17 years hospitalized from 2013-2024 with an International Classification of Disease 9thor 10thedition code for LQTS listed in the first five admission diagnoses. Patients with congenital heart disease and chromosomal abnormalities were excluded. The primary predictor variable was race/ethnicity, with covariables including age, sex, and insurance type. Our primary outcome variable was a documented lethal arrhythmia, and secondary outcomes included pacemaker and/or implantable cardioverter defibrillator (ICD) placement. Chi-square was used to assess patient characteristics. Univariable mixed-effect log-binomial regression was used to assess risk of outcomes by characteristics using hospital as a random effect with multivariable models generated via backward elimination.Results:We identified 6,476 children (24% Hispanic, 76% NHW). Compared to NHW children, Hispanic children were more often male and presented earlier (median age 11y vs 13y, 25-75 IQR 6-15; p

Circulation, Volume 150, Issue Suppl_1, Page A4141933-A4141933, November 12, 2024. Introduction:Supraventricular tachycardia (SVT) is known to affect children and teenagers predominantly but can also occur in adults. However, due to a presumed good disease outcome, fatality rates of SVT in adults (above 25 years) are yet to be explored.Aim:This study aims to shed light on the mortality trends of SVT in the adult population across the United States from 1999 to 2020.Methodology:The CDC WONDER database was used to identify SVT-related deaths using ICD-10 code I47.2 in adults (above 25 years) from 1999 to 2020. The reported data was in the form of crude rate and age-adjusted mortality rate (AAMR) per 100,000 individuals and was stratified by year, ten-year age groups, gender, races, census region, census division, states, and rural-urban division. The Joinpoint regression was then used to determine the changes in trends and annual percentage change (APC).Results:From1999 to 2020, 31,036 (AAMR=0.6) SVT-related deaths were reported. AAMR showed an initial steep decline from 0.9 in 1999 to 0.5 in 2011 (APC -5.11 [95% CI -6.08 to -4.14]), followed by a gradual increase till 2020 (0.8) (APC 5.14 [95% CI 3.41 to 6.90]). The crude death rates increased with age and were reported to be highest in ages greater than or equal to 85 (9.1); the trend showed a steep decrease from 1999 (12.4) to 2008 (7.9) (APC -4.35 [95% CI -5.36 to -3.33]), followed by a gradual decline till 2017 (7.8) (APC -0.66 [95% CI -2.04 to 0.73]), and ultimately rising sharply till 2020 (10.6) (APC 9.23 {95% CI 3.32 to 15.47]). Among races, Blacks and Whites displayed the highest mortality (0.7). Blacks showed an initial decrement from 1999 (1.0) to 2017 (0.6) (APC -2.71), followed by a rise back to 1.0(2020) (APC 19.58), while whites showed an initial fall (0.9 (1999) to 0.6 (2008), APC -4.91), followed by no change till 2017 (APC 0.18), and ultimately rise to 0.9 in 2020 (APC 13.66). Although no significant gender or geographical variations were observed, more deaths were seen in rural areas (1.0) than in Urban (0.6).Conclusion:Following an initial decline, the incidence of SVT-related mortality has been increasing over the years, pre-dominantly among the 85+ age group, Blacks, and rural populations. However, due to a limited understanding of the epidemiology of SVT in adult populations, more extensive research is needed to formulate better preventive and management strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4146016-A4146016, November 12, 2024. Introduction:Atrial Fibrillation is the most common arrhythmia, causing an irregular and rapid heart rate. This occurs due to electric and structural remodeling of the atria, which creates the rapidly discharging foci.Aims:This study aims to explore the national mortality trends resulting from Atrial Fibrillation and Flutter in the United States from 1999-2022 while also studying the discrepancies among the various socio- demographic groups.Methods:The death certificate data from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiological Research (CDC Wonder) database were explored to investigate the Atrial fibrillation and flutter mortality from 1999 to 2022, focusing on the Age-Adjusted Mortality Rate (AAMR) per 1,000,000 individuals. We employed Joinpoint Regression Analysis to compute Annual Percent Changes (APC) with a 95% Confidence Interval. The data was further stratified into epidemiological groups of age, gender, ethnicity, and census region.Results:There was a steady rise in mortality from 1999 to 2017 (APC: 2.96), followed by a rapid surge in mortality trends from 2017 to 2022 (APC: 7.35). The mortality rate rose fairly equally among both genders over the years, with males having a slightly steeper incline (Male AAPC: 4.27, Female AAPC: 3.43). African Americans had the greatest number of deaths due to atrial fibrillation and flutter and the greatest rise was during recent years from 2017 to 2022 (APC: 9.64). The atrial fibrillation and flutter related mortality was the greatest among 25-34-year-olds, with the mortality decreasing among the older populations. All US Census regions had similar mortality rates and trends.Conclusion:This study reveals an overall rise in mortality associated with atrial fibrillation and flutter. It also highlighted disparities across gender, age, and geographic regions. These findings emphasize the need for further research and the development of targeted interventions to reduce mortality and alleviate the burden of this debilitating condition.

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 A4137925-A4137925, November 12, 2024. Introduction:Thoracic endovascular aortic repair (TEVAR) has emerged as a promising treatment option for patients with type B aortic dissection (TBAD). However, there is a lack of evidence regarding the long-term morbidity of initial TEVAR compared to optimal medical therapy (OMT) in acute uncomplicated TBAD (uTBAD).Objective:To evaluate real-world data(RWD) on the long-term outcome of Japanese patients with acute uTBAD using a nationwide claims database.Methods:This retrospective cohort study utilizes JMDC, a nationwide claims database under Japan’s universal healthcare system. We included patients who were initially hospitalized with a diagnosis of acute TBAD. We defined acute uTBAD by excluding those who died within one month, suffered aortic rupture, traumatic thoracic aortic injury, underwent open-chest surgery, experienced stroke or paralysis, or had less than six months of history in the JMDC. Patients who underwent TEVAR within three months of the index hospitalization (TEVAR group) were compared with those who received optimal medical therapy (OMT group). Propensity score (PS) matching was performed based on age, sex, and year of hospitalization. Using the Kaplan-Meier method, we calculated the cumulative rate of all-cause mortality and aorta-related events.Results:Of 18,445 patients diagnosed with aortic disease between January 2005 and December 2020, 641 were included in the study (OMT group: n=580, TEVAR group: n=61). After PS-matching, demographics of the groups (OMT_PSM: n=183 vs. TEVAR_PSM: n=61) were female (12.6% vs. 13.1%), median age (54 years [IQR, 48-60] vs. 54 years [IQR, 50-61]) and follow-up time (18 months [8-32] vs. 19 months [9-32]), respectively. Kaplan-Meier curves for the aortic-related events (Figure1, 2) are shown as long-term outcomes.Conclusions:This study successfully demonstrated that the estimated 5-year aortic-related event rate in acute uTBAD patients undergoing OMT is approximately 20%, demonstrating the relevance of the RWD source. However, the number of death events in the TEVAR and OMT groups was not sufficient to provide statistical power. Therefore, further studies are warranted to evaluate the long-term prognosis of initial TEVAR for uTBAD.

Circulation, Volume 150, Issue Suppl_1, Page A4145554-A4145554, November 12, 2024. Background:Cancer and obstructive sleep apnea (OSA) individually elevate cardiovascular diseases (CVD) and stroke risk. However, it is unclear whether OSA contributes additional CVD risk in persons with pre-existing cancer.Methods:Using the TriNetX, an electronic healthcare records-based database from large healthcare organizations, we compared adverse CVD outcomes and ischemic stroke incidence between patients with and without OSA diagnosed with cancer between 01/2012 and 06/2023. Adverse CVD outcomes was defined as a composite of incident heart failure, incident atrial fibrillation / flutter, incident myocardial infarction or all-cause mortality. Patients were eligible to enter the cohort on the day of cancer diagnosis. The follow-up period for outcome events began one year after patients entered the cohort and patients contributed follow-up time till the outcome event occurred or till the end of the study period.After propensity risk score matching on demographics and comorbidities we conducted a time-to-event analyses.Results:A total of 509,477 patients with both cancer and OSA were propensity score matched to 509,477 patients with cancer but without OSA. The table shows the demographic and comorbidities of the matched groups. Among persons with cancer, OSA diagnosis was associated with increased risk of adverse CVD outcomes (HR: 1.37, 95% CI: 1.36 – 1.38). OSA in persons with cancer increased the risk of heart failure, atrial fibrillation / flutter and myocardial infarction. OSA also increased the risk of ischemic stroke. However, total mortality risk was reduced among those with OSA. See the table for details.Conclusion:OSA increases the risk of adverse CVD outcomes and ischemic stroke in persons with cancer. These analyses suggest that persons with cancer should be screened and treated for OSA. Future studies will need to determine the impact of OSA treatment e.g., positive airway pressure (PAP) therapy on CVD related outcomes in persons with cancer. Further investigation into the paradoxical reduction in all-cause mortality with OSA is warranted.

Circulation, Volume 150, Issue Suppl_1, Page A4116285-A4116285, November 12, 2024. Background:Low molecular weight heparin (LMWH) is the preferred anticoagulant for venous thromboembolism (VTE) prophylaxis in patients with ischemic stroke and reduced mobility. However, some patients may have indications for early direct oral anticoagulants (DOACs) and are continued on this therapy rather than transitioning to LMWH. Whether outcomes differ between these groups is unknown. We compared the safety and efficacy of early DOACs versus LMWH from a large retrospective database.Methods:Patients within the TriNetX Research Network receiving either DOACs or LMWH within 72 hours of ischemic stroke and a Modified Rankin Scale of 4-5 were included. A 1:1 propensity score matching analysis was performed using 27 covariables including demographic information, comorbidities, and medications. Chi-square and independentt-tests were used in bivariable analyses. Outcomes were all-cause mortality, VTE, intracranial and extracranial hemorrhage at 30 and 90 days.Results:Of 5,492 propensity-matched patients, mean age was 73±13, and 43% were male. Mortality in the DOAC group was significantly lower than in the LMWH group at 30 days (RR=0.59, 95% CI: 0.51-0.69) and 90 days (RR=0.63, 95% CI: 0.56-0.71). Risk of VTE was not significantly different at 30 days (RR=0.80, 95% CI: 0.43-1.50) or 90 days (RR=0.74, 95% CI: 0.45-1.22). Risk of intracranial hemorrhage was not significantly different at 30 days (RR=0.81, 95% CI: 0.36-1.80) or 90 days (RR=0.62, 95% CI: 0.34-1.15).Conclusions:In patients with acute ischemic stroke and reduced mobility, early use of DOACs was associated with lower mortality compared to early use of LMWH.

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 A4144822-A4144822, November 12, 2024. Background:The relationship between anion gap (AG) and short-term mortality in intensive care unit (ICU) sepsis patients complicated by pulmonary hypertension (PH) remains unclear.Methods:Retrospective analysis of incident sepsis patients complicated by PH first admitted to ICU in MIMIC database (2008 to 2019) were enrolled. Short-term outcomes include in-hospital mortality and 28-day mortality. According to the AG value (17.0 mmol/L), patients were divided into high and low AG groups. The Kaplan-Meier survival curve was used to compare the cumulative survival rates of the high and low groups using the log-rank test. Multivariable Cox regression analyses were constructed to assess the relationship between AG and short-term outcomes in sepsis patients complicated by PH.Results:2012 sepsis patients with pulmonary hypertension were included. The in-hospital mortality rates (11.4%) and 28-day mortality rates (12.8%) in the high AG group were higher than those in the low AG group (5.0% or 7.2%, respectively;P< 0.001). The Kaplan-Meier curve showed that the in-hospital and 28-day cumulative survival rates were lower in the high AG group than that in the low AG group (P< 0.001). Multivariable Cox regression analysis confirmed that elevated AG was an independent risk factor of in-hospital mortality, 28-day mortality, length of stay in ICU and hospital. The relationship between elevated AG and in-hospital mortality remain stable after subgroups analyses.Conclusions:Elevated serum AG is associated with increased risk-adjusted short-term mortality in sepsis patients complicated by PH, and it may remind clinicians to identify patients with poor prognosis as early as possible.

Riccardi: ‘Maggiore efficienza, sicurezza e tempi più rapidi’

Riccardi: ‘Maggiore efficienza, sicurezza e tempi più rapidi’

Purpose
To study epidemiology, complications, risk factors, clinical course and treatment patterns of diabetes, the Nanjing Diabetes Cohort (NDC) was established using anonymised electronic health records from 650 hospitals and primary care since 2020. This cohort provides valuable data for researchers and policy-makers focused on diabetes management and public health strategies.

Participants
Diabetes was defined as having inpatient or outpatient encounters with a diagnosis of diabetes International Classification of Diseases-9/10 codes, any use of insulin or oral hypoglycaemic drugs, or one encounter with haemoglobin A1C >4.8 mmol/mol or 6.5%. Patients with diabetes have been continuously enrolled on hospitals and primary care in Nanjing since 2020. Demographic, medications and comorbidities data were extracted from clinical notes, diagnostic codes, labs, prescriptions and vital signs among different types of diabetes.

Findings to date
The NDC consisted of 1 033 904 patients from 1 January 2020 to 31 December 2022, the majority were male (50.62%) and from the Gulou district (30.79%). The clinical characteristics and medication usage of patients with type 1 diabetes, type 2 diabetes, gestational diabetes and other diabetes were assessed. The prevalences of hypertension, ischemic heart disease, and cerebrovascular disease were 49.72%, 17.85% and 24.90%, respectively.

Future plans
NDC will annually enrol eligible patients and include socioeconomic data in future updates. The data of NDC are maintained by the Department of Medical Informatics at Nanjing Medical University.

Background
Patient medication knowledge and health literacy affect patient safety. Taking angiotensin-converting enzyme inhibitors (ACE-i) or angiotensin II receptor blockers (ARBs), with diuretics and non-steroidal anti-inflammatory medications (NSAIDs) is nephrotoxic. Patients may not know of this risk. An eHealth information package was developed to inform patients at risk of taking this combination of medication.

Objective
To assess the impact of the eHealth information package on patient knowledge and behaviour.

Design
This was a two-arm, parallel, randomised control trial. A knowledge quiz and NSAID use survey were undertaken at baseline, and repeated after two weeks. The intervention group accessed the information package after completing the baseline assessment. The control group received normal care.

Setting and participants
Primary healthcare patients prescribed an ACE-i or ARB plus a diuretic in Aotearoa New Zealand.

Intervention
A novel eHealth information package was made available to participants in the intervention group consisting of a downloadable PDF and online education activity. This took approximately 15 min for participants to complete.

Primary outcome measures
Change in knowledge scores and in NSAID use between pre-intervention and post-intervention assessment.

Secondary outcome measures
Self-reported patient intentions regarding future NSAID use

Results
The 201 participants who completed the study had high baseline NSAID medication knowledge, which did not substantially change at follow-up. The intervention group had a 0.35 (95% CI: -0.18, 0.88) higher knowledge score than the control group. NSAID use decreased over the study; the intervention group had 62% lower odds of NSAID use at follow-up assessment compared with the control group (OR=0.37, 95% CI: 0.14, 1.03). There was no substantial difference between study groups at follow-up for self-reported action. The information package was considered acceptable and useful.

Conclusion
This tailored eHealth information package may reduce NSAID use in patients at increased risk from NSAID-related harm.

Trial registration number
Australian New Zealand Clinical Trial Registry (ACTRN:12622001132730).