Risultati per: GPG: Versione 5.6.2.1 (Aprile 2021)

Circulation, Volume 146, Issue Suppl_1, Page A11426-A11426, November 8, 2022. Introduction:Timely treatment of ST elevation myocardial infarction [STEMI] requires ongoing coordinated care between emergency departments, paramedics, and primary percutaneous coronary (PCI) intervention facilities.Methods:To provide a current view and a national benchmark, we examined 121,576 patient records submitted by 648 hospitals participating the GWTG-CAD registry from Q2 2018 through Q3 2021 [median age 63, women 29%, Black 11%, Hispanic 8%, admission cardiac arrest 5%, shock 7%, heart failure 7%, Covid 0.2%, presentation EMS 47%, walk in 27%, transfer 22%]Results:Reperfusion method for all patients included primary PCI 87%, fibrinolysis 5%, and no reperfusion 8% [increasing from 7 to 9% during the study period]. Median time from symptom onset to reperfusion was shortest for EMS patients 148 minutes, followed by walk-in 195 minutes, ground transferred 238 minutes, and air transferred 247 minutes. Process times did not improve during the study period. First medical contact to device times increased by 5 minutes for EMS and ground transferred patients in Q2 2020 corresponding with the pandemic onset, and adjusted mortality was significantly higher in the final 3 quarters compared to Q2 2018 [OR, 95% CI 1.28(1.07-1.53); 1.35(1.13-1.61); 1.23(1.03-1.48)]. Patients treated within guideline goals had significantly lower mortality [Figure].Conclusions:These data reaffirm the association between process times and lower mortality for STEMI patients. They also identify concerning trends and opportunities for improved care. Increasing delays in treatment, particularly for hospital transfer, greater numbers of untreated patients, and increased risk-adjusted in-hospital mortality all provide strong impetus for renewed focus on STEMI systems. Regional collaborative efforts led by coordinators and informed by a common data system have the potential to reverse these trends and improve survival.

Circulation, Volume 146, Issue Suppl_1, Page A14367-A14367, November 8, 2022. Introduction:Despite aggressive secondary prevention, a persistent risk of cardiovascular (CV) events exists among patients with coronary artery disease (CAD). In addition to traditional risk factors, this residual risk results, at least in part, from persistent pro-inflammatory and metabolic contributors. This study evaluated the incidence of recurrent CV events in contemporary CV outcome trials between 2010-2021.Methods:A total of 45 randomised, controlled trials were included. Studies were categorized based on patient population and enrollment strategy into 3 groups: 1) Early post-ACS (enrolled within 72h of event), 2) late post-ACS (enrolled after 72h of event), and 3) chronic CAD or risk equivalent (type 2 diabetes or 2 or more CV risk factors). Due to a wide range of follow-up durations, data were normalized to events per 100 patient-years.Results:Follow-up duration ranged from 30 to 2957 days. Overall, recurrent CV events varied between 2% and 10%. Trials that enrolled patients within 72h of ACS demonstrated the highest risk for recurrent events with a median of 21.8 events per 100 patient-years (IQR 11.3-66.0). Patients enrolled >72h after ACS had significantly lower risk with a median of 3.4 events per 100 patient-years (IQR 2.9-4.1), likely due to a survival bias in those enrolled later after their index event. The rate of recurrent events was comparable between trials that enrolled patients 72h post-ACS and trials that enrolled patients with chronic CAD. There was no correlation between trial year and event rate.Conclusions:Despite standard of care therapy, there is a persistent residual risk of recurrent events especially early after ACS. Our study demonstrates a residual risk ranging from 3 to as high as 22 events per 100 patient-years. This risk is likely higher in a non-trial setting where medication adherence and follow-up are not strictly controlled. Novel strategies for secondary prevention comprise a major unmet need to further decrease this risk.

Circulation, Volume 146, Issue Suppl_1, Page A10477-A10477, November 8, 2022. Introduction:In 2021-22, Heart Failure (HF) guidelines endorsed quadruple therapy with beta blockers (BB),angiotensin-converting inhibitors/angiotensin receptor blockers (ACEi/ARB) or angiotensin receptor-neprilysin inhibitors (ARNI), mineral receptor antagonists (MRA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) as first-line medications to improve clinical outcomes. AHA 2022 HF guidelines specifically recommended SGLT2i even in patients without diabetes mellitus (DM) irrespective of left ventricular ejection fraction (HF).Hypothesis and Methods:Our analysis evaluated the hypothesis that prescription of guideline directed medical therapy (GDMT) is similar in patients with or without DM. We extracted TriNetX data for patients with HF encounters from May 2021-April 2022 in the University of Colorado health system which includes an ethnically diverse population of rural and urban residents. Patient on dialysis were excluded. GDMT use was compared by chi square.Results:Among 24890 patients with HF encounters, 9240 (37%) had reduced (HFrEF) and 8680 (35%) preserved ejection fraction (HFpEF) and 6970 (28%) unspecified HF. Mean age was 70+14y, 46% were female, 10% Latino in the whole cohort. Diagnosed DM was reported among 3260 (35%) with HFrEF and 3410 (39%) with HFpEF. Older drugs such as BB and ACEi/ARB were widely prescribed in both groups, particularly among patients with DM (Figure, p

Circulation, Volume 146, Issue Suppl_1, Page A14349-A14349, November 8, 2022. Introduction:Diseases of despair (DoD) are a major cause of premature mortality in the United States (U.S.) and include substance use and sequela, and suicidality. How despair-related illnesses are associated with atherosclerotic cardiovascular disease (ASCVD) and impact healthcare utilization in those with ASCVD is not established.Methods:International Classification of Diseases-10 codes were used to identify adults in the Highmark Health insurance claims database with ASCVD (composite of myocardial infarction, ischemic stroke, ischemic cardiomyopathy and peripheral vascular disease) from 2017-2021. In patients with ASCVD, baseline characteristics were compared between those with and without DoD. Hazard ratios (HR) and 95% confidence intervals (CIs) were calculated to assess the risk of ASCVD between those with and without DoD over 5-years of follow-up.Results:Among patients analyzed (n=983,513), 67,340 were diagnosed with ASCVD. Among those with ASCVD, 3.1% (2,059) had DoD. Those with DoD that developed ASCVD were younger (

Circulation, Volume 146, Issue Suppl_1, Page A14287-A14287, November 8, 2022. Introduction:Heart Failure (HF) is an important health care issue given its high prevalence, mortality, and cost of care. Despite numerous evidence-based strategies in the literature aiming at reducing HF readmissions, patients with HF remain at high risk for subsequent hospitalization with 20 to 25% readmitted within 30 days.Hypothesis:The UPMC Hospitalist and Cardiology leadership recognized the need to foster consistent inpatient hospitalist providers, which was lacking in the current model. The concept of a dedicated Heart Failure Hospitalist service line emerged.Methods:Patients with both primary HF: UPMC Hospitalist, Cardiologist, teaching service N= 4192 (70%); CHF hospitalist Team N=1785 (30%). Heart failure order set usage, length of stay, all-cause 30-day readmission rates, readmission with HF, cost per case were assessed between these two groups from 2018-2021.Results:All-cause 30-day HF readmission rates at UPMC (Harrisburg, West Shore, Community General Hospitals) for all providers is 21% from 2018-2021, matching the national average. HF Hospitalist team (only at Harrisburg Hospital) has consistently lower readmission rates: 9% (2018), 8.34% (2019), 8.6% (2020), 6.95% (2021). HF hospitalist length of stay was also consistently lower, by 0.5 to 0.9 days. Potential cost savings to UPMC hospitals is $1.5 million dollars since start of HF Hospitalist service line.Conclusions:Heart failure is a major health care issue. The HF Hospitalist service line was created to support an environment of patient-centered care by providing continuity of care for HF admissions and HF patients admitted for non-HF medical issues. The HF Hospitalists provide quality care with frequent daily rounding, optimization of HF medications, providing education to the patient and family to improve treatment plan adherence, as well as engaging in early discussion of palliative and hospice transition. At this community-based healthcare system, HF Hospitalist outcomes include decreasing length of stay; decreased 30 day all-cause readmission to an impressive 8.2%, and reduced 30 day HF readmissions 4.12%. This was done while reducing healthcare costs during the 4yrs of the HF Hospitalist service line at UPMC.

This study uses employment census data to show trends in behavioral health employment during and after the COVID-19 pandemic.

vedi ANSA “

Il convegno dell’Osservatorio nazionale nel Modenese

This narrative review discusses the implications of the 2021 updates to the World Health Organization (WHO) central nervous system (CNS) tumor classification relative to adult-type glioma diagnosis, prognosis, and treatment.

Objectives
To describe and map scientific literature related to alcohol consumption, its determinants, governance, harm and control policies by publication output, author affiliations, funding, countries of study and research themes.

Design
Bibliometric analysis using performance analysis and science mapping techniques.

Data sources
Scientific articles.

Eligibility criteria
Indexed scientific articles published between 1 January 2010 and 31 December 2021 with an English abstract focused on alcohol consumption, its determinants, harms, governance and control policies.

Data extraction and synthesis
Searches were run in Web of Science and PubMed. Performance metrics were analysed using descriptive statistics. Keywords were used for science mapping in a deductive approach to cluster articles by five main research themes. The ‘policy response’ theme was further analysed by six subthemes.

Results
4553 articles were included in the analysis. Three out of four articles (3479/4553, 76.4%) were authored solely by authors affiliated with HIC institutions. One in five articles (906/4553, 19.9%) had at least one author affiliated to an institution from an upper-middle-income, middle-income or low-income country context. Governments, followed by research institutions, were the predominant funding source. Half (53.1%) studied a single country and, of these, 77.0% were high-income countries (HICs). Australia, USA and UK were the most studied countries, together accounting for 44.9% (975/2172) of country-specific articles. Thematically, ‘consumption’ was most studied, and ‘alcohol determinants’, least. ‘Policy response’ articles were predominately conducted in HIC contexts.

Conclusions
Although the attributable harm of alcohol is known to affect more significantly lower-income and middle-income countries, scientific publications primarily report on HIC contexts by authors from HICs. Research themes reflect known cost-effective policy actions, though skewed towards HICs and a focus on consumption. The implementation of context-specific alcohol control policies requires addressing the determinants of the uneven geographical and thematic distribution of research.

Objectives
Nigeria reported an upsurge in cholera cases in October 2020, which then transitioned into a large, disseminated epidemic for most of 2021. This study aimed to describe the epidemiology, diagnostic performance of rapid diagnostic test (RDT) kits and the factors associated with mortality during the epidemic.

Design
A retrospective analysis of national surveillance data.

Setting
33 of 37 states (including the Federal Capital Territory) in Nigeria.

Participants
Persons who met cholera case definition (a person of any age with acute watery diarrhoea, with or without vomiting) between October 2020 and October 2021 within the Nigeria Centre for Disease Control surveillance data.

Outcome measures
Attack rate (AR; per 100 000 persons), case fatality rate (CFR; %) and accuracy of RDT performance compared with culture using area under the receiver operating characteristic curve (AUROC). Additionally, individual factors associated with cholera deaths and hospitalisation were presented as adjusted OR with 95% CIs.

Results
Overall, 93 598 cholera cases and 3298 deaths (CFR: 3.5%) were reported across 33 of 37 states in Nigeria within the study period. The proportions of cholera cases were higher in men aged 5–14 years and women aged 25–44 years. The overall AR was 46.5 per 100 000 persons. The North-West region recorded the highest AR with 102 per 100 000. Older age, male gender, residency in the North-Central region and severe dehydration significantly increased the odds of cholera deaths. The cholera RDT had excellent diagnostic accuracy (AUROC=0.91; 95% CI 0.87 to 0.96).

Conclusions
Cholera remains a serious public health threat in Nigeria with a high mortality rate. Thus, we recommend making RDT kits more widely accessible for improved surveillance and prompt case management across the country.

Objective
The institutional-based cross-sectional study was designed to assess the magnitude of birth trauma and its associated factors in South Wollo, northeast Ethiopia.

Setting
This study was conducted in the public hospitals of South Wollo, northeast Ethiopia. South Wollo is one of the 12 zones in the Amhara regional state with a total population of >3 million. There are 13 hospitals in South Wollo, of these 4 hospitals were selected randomly.

Participants
A total of 612 mother-newborn pairs were selected to conduct the study. However, data were collected from 594 mother-neonate pairs giving a response rate of 97%. The study participants were selected by applying a simple random sampling technique after proportional allocation of the total sample to each study hospital. Live neonates delivered during the study period were included, whereas stillborn, neonates born with major congenital malformation and neonates whose mothers died during the birth process were excluded.

Result
A total of 594 mother-newborn pairs were involved with a response rate of 97%. Seventy-eight newborns 13.13% (95% CI: 10.30 to 16.00) had experienced birth trauma. Prolonged labour (AOR: 5.78, 95% CI: 3.00 to 11.15), birth weight >4 kg (AOR: 9.18, 95% CI: 3.92 to 21.50), vacuum delivery (AOR: 6.74, 95% CI: 2.01 to 22.56), forceps delivery (AOR: 7.36, 95% CI: 1.96 to 27.58) and shoulder dystocia (AOR: 9.83, 95% CI: 4.13 to 23.50) were risk factors of birth trauma.

Conclusion
The prevalence of birth trauma was higher than the report from most of the African countries. Prolonged labour, instrumental deliveries, large birth weight and shoulder dystocia were the identified risk factors of birth trauma. The ministry of health and the local healthcare system should give attention to the maternal health services.

Circulation, Volume 146, Issue 11, Page e166-e166, September 13, 2022.

Objective
Contaminated reprocessed duodenoscopes pose a serious threat to patients in the endoscopy unit. Despite manufacturer changes to reprocessing guidelines, 20% of reprocessed duodenoscopes meet criteria for quarantine-level contamination based on microbiological or ATP testing. We aimed to examine risk factors for postendoscopic retrograde cholangiopancreatography (ERCP) infection.

Design
Retrospective cohort analysis.

Setting
US Medicare Fee-For-Service claims (2015–2021) and all-payer data (2017).

Participants
In the Medicare data, 823 575 ERCP procedures were included. The all-payer five-state data, 16 609 procedures were included.

Interventions
ERCP was identified by Current Procedural Terminology and International Classification of Disease (ICD) procedure codes. We identified inpatient infections using ICD diagnosis codes.

Outcome measures
A logistic regression model predicted risk factors for infections occurring within 7-day and 30-day periods following ERCP. 7-day and 30-day all-cause hospitalisations and post-ERCP pancreatitis were also examined.

Results
Post-ERCP infection occurred within 3.5% of 7-day and 7.7% of 30-day periods in Medicare. Disposable duodenoscopes were billed in 711 procedures, with 1.4% (n=10, 7-day) and 3.5% (n=25, 30-day) post-ERCP infections. Urgent ERCPs were the strongest risk factor for infections in the 7-day period (OR 3.3, 95% CI 3.2 to 3.4). Chronic conditions, sex (male), age (older) and race (non-white) were also risk factors. In the all-payer five-state data, fewer infections (2.4%, 7 days) were observed. No difference arose between Medicare and other payers for 7-day period infections (OR 1.0, 95% CI 0.7 to 1.3).

Conclusions
Urgent ERCPs, patient chronic conditions and patient demographics are post-ERCP infection risk factors. Patients with infection risk factors should be targeted for specialised infection control prevention measures, including disposable duodenoscopes.

Objectives
Examine if pre-COVID-19 pandemic (prior March 2020) health-related behaviours during primary school are associated with (1) being tested for SARS-CoV-2 and (2) testing positive between 1 March 2020 and 31 August 2021.

Design
Retrospective cohort study using an online cohort survey (January 2018 to February 2020) linked with routine PCR SARS-CoV-2 test results.

Setting
Children attending primary schools in Wales (2018–2020), UK, who were part of the Health and Attainment of Pupils in a Primary Education Network (HAPPEN)_school network.

Participants
Complete linked records of eligible participants were obtained for n=7062 individuals. 39.1% (n=2764) were tested (age 10.6±0.9; 48.9% girls) and 8.1% (n=569) tested positive for SARS-CoV-2 (age 10.6±1.0; 54.5% girls).

Main outcome measures
Logistic regression of health-related behaviours and demographics were used to determine the ORs of factors associated with (1) being tested for SARS-CoV-2 and (2) testing positive for SARS-CoV-2.

Results
Consuming sugary snacks (1–2 days/week OR=1.24, 95% CI 1.04 to 1.49; 5–6 days/week OR=1.31, 95% CI 1.07 to 1.61; reference 0 days), can swim 25 m (OR=1.21, 95% CI 1.06 to 1.39) and age (OR=1.25, 95% CI 1.16 to 1.35) were associated with an increased likelihood of being tested for SARS-CoV-2. Eating breakfast (OR=1.52, 95% CI 1.01 to 2.27), weekly physical activity ≥60 min (1–2 days OR=1.69, 95% CI 1.04 to 2.74; 3–4 days OR=1.76, 95% CI 1.10 to 2.82; reference 0 days), out-of-school club participation (OR=1.06, 95% CI 1.02 to 1.10), can ride a bike (OR=1.39, 95% CI 1.00 to 1.93), age (OR=1.16, 95% CI 1.05 to 1.28) and girls (OR=1.21, 95% CI 1.00 to 1.46) were associated with an increased likelihood of testing positive for SARS-CoV-2. Living in least deprived areas (quintile 4 OR=0.64, 95% CI 0.46 to 0.90; quintile 5 OR=0.64, 95% CI 0.46 to 0.89) compared with the most deprived (quintile 1) was associated with a decreased likelihood.

Conclusions
Associations may be related to parental health literacy and monitoring behaviours. Physically active behaviours may include coparticipation with others and exposure to SARS-CoV-2. A risk-versus-benefit approach must be considered in relation to promoting these health behaviours, given the importance of health-related behaviours such as childhood physical activity for development.