Risultati per: GOLD 2019: le indicazioni nella terapia in fase stabile del paziente con BPCO

Circulation, Volume 150, Issue Suppl_1, Page A4139332-A4139332, November 12, 2024. Background:Strong patient-clinician communication may improve health outcomes for marginalized populations, including Hispanic/Latino individuals.Objective:We assessed the association between patient-clinician communication and cardiovascular (CV) events or death in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).Methods:HCHS/SOL is a longitudinal cohort study of individuals aged 18-74 who identified as Hispanic/Latino at 4 U.S. sites. Participants’ ratings of communication with clinicians during the year before enrollment were used to generate a communication score. The primary outcome was the composite of myocardial infarction (MI), heart failure events (HF), stroke, and all-cause mortality. The secondary outcomes included the primary outcome components. The association between the baseline communication score and outcomes of interest was assessed with Cox proportional hazards models adjusting for possible confounders. We also used multivariable linear regression to assess the cross-sectional association between communication and AHA Life’s Essential 8 (LE8), a measure of CV risk factors. All analyses accounted for the complex survey design.Results:Our sample included 10,527 individuals without prior CV events and at least one medical encounter in the year before enrollment. The median age at enrollment was 41 years (IQR 29, 53), 59% were female, and 71% perceived high-quality communication with clinicians. The mean follow-up time was 9.4 years. High-quality communication was associated with the following results in our adjusted analyses: composite outcome (aHR 0.71, 95% CI 0.49, 1.02, p = 0.066), CV events (aHR 0.79, 95% CI 0.41, 1.51, p = 0.47), all-cause mortality (aHR 0.53, 95% CI 0.35, 0.80, p < 0.01).Conclusions:High-quality patient-clinician communication was associated with a non-significant trend toward a lower rate of CV events and death, driven by a significant association with lower all-cause mortality.

Circulation, Volume 150, Issue Suppl_1, Page A4112716-A4112716, November 12, 2024. Background:Deaths from congenital heart disease (CHD) in children have been decreasing in the United States. We examined the differences in mortality trends between Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) infants.Methods:We retrospectively analyzed publicly available data from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). The data was obtained from the linked birth/infant deaths from 2005 to 2019. We evaluated all infant deaths up to 1 year of age with the cause of death listed as CHD (International classification of diseases, 10threvision (ICD-10) codes Q20-Q26 (except atrial septal defect, Q21.1 and patent ductus arteriosus, Q25. CHD infant mortality rate (IMR) was calculated per 100,000 live births. Race was ascertained based on death certificate reporting. Joinpoint regression was used to examine CHD-IMR by year, including stratification by NHB vs NHW, and neonatal vs postneonatal. The difference between NHB and NHW CHD-IMR was ascertained via the Mann-Whitney U test. P

Circulation, Volume 150, Issue Suppl_1, Page A4139875-A4139875, November 12, 2024. Background and Purpose:Older adults in the United States face worsening trends in the incidence and prevalence of comorbid diabetes mellitus (DM) and heart failure (HF). This study aimed to examine the trends in DM and HF-related mortality among adults ≥65 years in the United States.Methods:The Multiple Cause-of-Death data using CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) were analyzed for DM and HF-related deaths from 1999 to 2019 in adults ≥65 years. Age-adjusted mortality rates (AAMRs) per 100,000 population were determined and stratified by year, sex, race/ethnicity, and geographic region. Joinpoint regression was used to analyze trends in AAMRs using annual percent change (APC).Results:A total of 842,785 deaths occurred among older adults in the United States related to comorbid HF and DM. The overall AAMR for deaths due to comorbid DM and HF in older adults was 97.4. The AAMRs remained stable between 1999 and 2005. From 2005 to 2009, AAMRs steadily declined at an APC of -3.41 (95% CI: -4.75 to -0.52). Following a period of stability from 2009 to 2014, AAMRs increased at an APC of 2.80 (95% CI: 1.97 to 4.68) till 2019. Men (116.2) had consistently higher AAMRs than older women (84.8) throughout the study period. Upon stratification by race and ethnicity, AAMRs were observed to be highest in non-Hispanic (NH) American Indian or Alaska Native (144.1), followed by NH Black or African American (124.4), Hispanic or Latino (100.5), NH White (95.3), and NH Asian or Pacific Islander (62.0) populations. Non-metropolitan areas had higher AAMRs for comorbid HF and DM than metropolitan areas, with overall AAMRs of 126.9 and 90.9, respectively. States that fell into the top 90thpercentile included Kentucky, Mississippi, Oklahoma, Oregon, Vermont, and West Virginia, which had twice the AAMRs than states that fell into the bottom 10thpercentile, including Arizona, Florida, Hawaii, Massachusetts, Nevada, and New York.Conclusion:Our analysis revealed a concerning rise in mortality related to comorbid DM and HF in U.S. adults ≥ 65 years old since 2014. Men, NH American Indian and Alaska Native populations, and residents of non-metropolitan areas displayed the highest AAMRs. Future efforts focusing on improved risk assessment and the adoption of therapeutic therapies are needed for the effective management of patients with comorbid DM and HF to help alleviate the mortality burden.

Circulation, Volume 150, Issue Suppl_1, Page A4139661-A4139661, November 12, 2024. Introduction:Troponin-defined myocardial injury or N-terminal pro-B-type natriuretic peptide (NT-proBNP) elevation frequently coincides with coronavirus disease 2019 (COVID-19). Our prior study (COVID-MI Registry Cohort-1) confirmed that high-sensitive troponin I (HsTnI) and NT-proBNP effectively stratified mortality risk. However, variants of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) change rapidly, and it remains unclear whether these biomarkers are consistently effective in predicting prognosis of COVID-19 patients irrespective of epidemic periods.Research Questions:Can HsTnI or NT-proBNP stratify mortality risk in recent COVID-19 cohorts?Aims:To assess the potential of HsTnI and NT-proBNP levels for risk stratification in the recent COVID-19 waves.Methods:In the COVID-MI Registry Cohort-2, we enrolled 1115 consecutive COVID-19 patients admitted between October 2021 and October 2022, during the Omicron variant endemic. We collected data of HsTnI or NT-proBNP levels from hospital charts or using the samples in our hospital’s serum/plasma bank if the data were not available. The primary outcome measure was all-cause mortality.Results:On admission, more than one-third of patients were classified as having severe COVID-19. HsTnI and NT-proBNP levels were available for 427 and 414 patients, respectively. The median HsTnI and NT-proBNP levels were 16 (interquartile range [IQR]: 5-57) ng/L and 524 (IQR: 140-2056) pg/mL, respectively. We stratified the patients into three groups by HsTnI level:

Circulation, Volume 150, Issue Suppl_1, Page A4145362-A4145362, November 12, 2024. Background:Women have historically had higher mortality following STEMI than men. The difference in mortality is in part related to higher bleeding rates in women when compated to men. Little is known about the mortality differences in women versus men in the current era of radial first and other bleeding avoidance stategie for PCI.Methods:We queried in the NNE database to identofy all PCI cases between 2019 and 2023. From the dataset, patients who underwent PCI for an indication of STEMI were identified, and demographic as well as procedural variables were collected. Patients with shock prior to PCI were excluded. In-hosptial outcomes were assessed including bleeding and need for transfusion. Mortality was obtained from discharge vital status. Standard statisical methods were used to assess significance of differences, using STATA for calculations.Results:A total of 22,681 pateints were identified who underwent PCI between 2019 and 2023. Of these, 4,356 (19.2%) underwent PCI for STEMI and did not have shock. Of the patients with STEMI, 3,198 (73.4%) were men and 1,158 (26.6%) were women. When compared with men, women tended to be older, have smaller BSA, and similar BMI. Procedurally, the percent radial cases and IIBIIIA receptor inhibitor use were similar between men and women. In-hospital mortalty was 3.3% for women and 1.7% for men (p

Circulation, Volume 150, Issue Suppl_1, Page A4146007-A4146007, November 12, 2024. Introduction:Non-Rheumatic Valvular Heart Disease (NRVHD) stands as the 5th leading cause of mortality and the 6th leading cause of disability in High-Income Asia Pacific (HIAP) nations. Despite its profound impact, there exists a dearth of comparable and consistent country-level measures for NRVHD.Method:Using global burden of disease methodology, incidence, mortality, and disability-adjusted life years (DALYs) due to NRVHD were estimated stratified by age, sex, year across HIAP countries from 1990-2019.Results:The total prevalence of NRVHD surged from 3 million (95%UI: 2.9-3.1) in 1990 to 5.8 million (5.5-6.2) in 2019, with deaths escalating from 6,023 (5307-6368) to 16,604 (11,447-19,355) over the same period. The age-standardized incidence rate (ASIR) witnessed a 6% annual percentage change (APC) from 1990 to 2019. Notably, Singapore exhibited the highest APC in ASIR at 53%, while Brunei Darussalam reported the highest mortality rate with a 45% increase, and DALYs rate with a 30% rise from 1990 to 2019. The highest incidence occurred in the 55-59 age group, accounting for 32,069 cases, while the highest number of deaths was observed in the 90-94 age group, totaling 4,450 cases, and DALYs peaked in the 85-89 age group, reaching 43,221 cases in 2019. Regarding gender disparities, females bore a higher burden compared to males, with APC in incidence rates of 52% versus 44%, deaths at 113% versus 214%, and DALYs at 47% versus 97% from 1990 to 2019.Conclusion:The study reveals a concerning rise in NRVHD burden across HIAP countries from 1990-2019, necessitating immediate attention and targeted interventions to curb its impact on public health. These findings provide vital insights for policymakers and healthcare stakeholders to formulate effective strategies in combating NRVHD.

Circulation, Volume 150, Issue Suppl_1, Page A4142467-A4142467, November 12, 2024. Background:Despite profound disparities in stroke mortality, there is limited research on geographic variation across and within US racial and ethnic populations.Research Question/Hypothesis:Do geographic trends in stroke mortality vary across and within racial and ethnic populations living in the US? We hypothesized that changes in county-level stroke mortality would vary across and within racial and ethnic groups.Methods:We applied validated small-area estimation methods to US National Vital Statistics System death certificates to estimate stroke mortality rates by county (N=3110) and race and ethnicity (American Indian or Alaska Native [AIAN], Asian, Black, Hispanic or Latino [Latino], and White) from 2000-19. Mortality estimates were corrected for race and ethnicity misclassification on death certificates and age-standardized to the 2010 Census.Results:In 2019, age-standardized county-level stroke mortality rates per 100,000 ranged from 10.9 to 170.6 among AIAN, 11.8 to 96.9 among Asian, 17.4 to 179.7 among Black, 6.5 to 114.3 among Latino, and 14.5 to 139.7 among White populations. Despite stroke mortality declining nationally among all racial and ethnic populations, there were counties where mortality increased (AIAN: 15/474; Asian: 46/667; Black: 11/1488; Latino: 154/1478; White: 46/3051),Fig. Among these counties, median absolute increases were 3.5 (IQR 1.9-5.3; max: 26.8) among AIAN, 4.1 (1.1-5.4; max: 12.2) among Asian, 7.1 (1.0-10.2; max: 52.5) among Black, 2.4 (1.3-4.6; max: 18.3) among Latino, and 5.6 (1.9-12.3; max: 47.5) among White populations. Increased stroke mortality largely occurred in the Carolinas, Florida, and Georgia (72.4% of counties with increases) for all racial and ethnic groups except AIAN, which were mostly in Oklahoma (n=9). Geographic and temporal trends also varied across stroke type.Conclusions:Stroke mortality increased in over 200 counties nationally, with differential effects by race and ethnicity. Most increases occurred in the lower South Atlantic states. These findings underscore the importance of understanding drivers of stroke mortality disparities, as well as creating prevention and treatment strategies that target populations and places at high risk.

Circulation, Volume 150, Issue Suppl_1, Page A4123308-A4123308, November 12, 2024. Introduction/ Background:Gestational diabetes mellitus (GDM) is one of the most frequent adverse pregnancy outcomes and increases the risk of lifetime cardiometabolic disease. Given known geographic disparities in maternal morbidity and mortality in the US, we examined state-level prevalence and trends in GDM from 2019-2023.Methods:We conducted a serial, cross-sectional analysis of maternal health data recorded on birth certificates from all livebirths in the US using the National Center for Health Statistics Natality Files. We included pregnant individuals aged 15-44 years who gave birth from 2019-2023, had a singleton, live birth, and did not have pre-pregnancy diabetes. We calculated the age-standardized prevalence and average-annual percent change (AAPC) in GDM from 2019-2023, overall, by U.S. census region (Northeast, Midwest, South, and West), and in each US state and the District of Columbia (DC).Results:Of the 17,432,486 individuals with live births between 2019 and 2023, overall prevalence of GDM per 100 live births (95% confidence interval) was 6.9 (6.9, 6.9) in 2019 and 8.0 (8.0, 8.1) in 2023 (AAPC 3.2 [-1.7, 8.5]). There was significant geographic variation in overall prevalence of GDM by US region and state (Figure 1). In 2023, prevalence was higher in the Midwest (8.8 [8.7, 8.9]) and Western states (8.6, [8.5,8.6]) compared with the Southern (7.3, [7.3, 7.4]) and Northeastern states (8.1, [8.0,8.2]), ranging from 5.5 (4.9,6.0) in DC to 13.0 (12.2,13.8) in Alaska. Prevalence was higher in 2023 compared with 2019 in all US regions and states and DC, except Alaska, Connecticut, Idaho, Maine, New Jersey, and Wyoming. Prevalence increased most rapidly in the Western US states (AAPC 4.2%/year [0.1, 8.4]) with the greatest change observed in Montana from 5.1 (4.7, 5.6) in 2019 to 8.0 (7.5, 8.5) in 2023 (AAPC 10.3%/year [5.6, 15.3]).Conclusions:GDM prevalence increased significantly from 2019-2023 with substantial heterogeneity by US region and state. More localized state-level analysis with context-specific polices that address factors associated with geographic differences in GDM are needed to promote maternal cardiometabolic health equity in the US.

Circulation, Volume 150, Issue Suppl_1, Page A4122048-A4122048, November 12, 2024. Introduction:Heart failure (HF) majorly affects the elderly, but can also affect the younger population. This study aims to examine the trends of HF-related deaths among reproductive-aged women in the United States (US).Method:We conducted a retrospective analysis using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, extracting data through ICD-10 codes I11, I13.0, I13.2, and I50 to find HF-related deaths among women aged 15-44 from 1999 to 2019. We examined demographic disparities in HF mortality rates over time, considering age, ethnicity, and geographic areas. Results were reported as age-adjusted mortality rate (AAMR) and 95% confidence interval (CI). Joinpoint regression assessed trend changes and annual percentage change (APC).Results:Between 1999 and 2019, a total of 43,683 women aged 15-44 died from HF in the US, with an AAMR of 3.5 per 100,000 (95% CI: 3.5-3.5). The AAMR increased from 2.6 in 1999 to 4.8 in 2019. Non-Hispanic Black women had the highest AAMR at 10.2, while Hispanics had the lowest at 1.8. Geographically, the South was the most affected region with an AAMR of 4.6, contributing to nearly half (48.9%) of all deaths. States including Massachusetts, Oregon, New Hampshire, and Minnesota had the lowest AAMRs. Rural areas showed a higher AAMR compared to urban areas (4.4 Vs. 3.3). The age group (35-44) accounted for the majority of deaths (73.7%).Conclusion:HF-related mortality among reproductive-aged women increased from 1999 to 2019, with the highest burden among non-Hispanic Black women and those in the Southern region. Enhancing access to care, particularly in rural areas, and implementing targeted prevention programs are vital to reducing mortality rates.

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