Risultati per: GPG: Versione 5.0 (25 Novembre 2019)

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 A4121890-A4121890, November 12, 2024. Background:Abnormal resting heart rate (RHR) is associated with cardiovascular events and mortality. Longitudinal RHR trajectories may offer unique prognostic, but research exploring these trajectories over extended periods and their prognostic implications is limited.Methods:Using data from 5,794 participants in the Atherosclerosis Risk in Communities (ARIC) study, we first characterized RHR trajectories over 25 years (from visit 1 [1987-89] to visit 5 [2011-13]) with latent class growth mixture models. Then, we determined the predictors of those trajectories using multinomial logistic regression (n=5,432 with data on predictors of interest). We ran Cox models to quantify the associations between RHR trajectories with cardiovascular outcomes (coronary heart disease, heart failure, stroke) and all-cause mortality (n=4,329 free of cardiovascular disease at baseline).Results:We identified one typical pattern (stable/slight decline, 88.4%) and three atypical patterns (stable-slight increase, 9.2%; increase-decrease, 2.0%; stable-sharp increase, 0.4%) (Figure-Left panel). Obesity, ever smoking, a history of heart failure, and lower education levels predicted the atypical patterns. The stable-increase (combined for slight and sharp) trajectory was significantly and robustly associated with heart failure and all-cause mortality (Figure-Right panel). The increase-decrease trajectory showed a hazard ratio of ~2 for coronary heart disease, although statistical significance was restricted in the demographically adjusted model.Conclusions:We identified one typical (stable/slight decline) and three atypical (increase-decrease, stable-slight increase, and stable-sharp increase) RHR trajectories over 25 years. The atypical trajectories, particularly the stable-increase pattern, were associated with poorer prognosis. These findings highlight the value of monitoring long-term RHR trajectories for cardiovascular risk assessment.

Circulation, Volume 150, Issue Suppl_1, Page A4123849-A4123849, November 12, 2024. Background:Older adults and adults with comorbidities are at increased risk for severe respiratory syncytial virus (RSV) disease and related complications.Aims:To estimate the risk of myocardial infarction (MI) and all−cause mortality among adults aged ≥50 years hospitalized with RSV compared to those with no recent acute respiratory illness (ARI) and those hospitalized with influenza.Methods:Data from Optum’s de−identified Clinformatics® Data Mart Database were analyzed (October 2015–June 2023) in this retrospective cohort study. Adults aged ≥50 years with ≥12 months of continuous enrollment were assigned to cohorts based on RSV or influenza hospitalization (from ICD−10 codes; RSV and flu cohorts) or no recent ARI (control cohort). Index dates for RSV and flu cohorts were the start of an ARI that included hospitalization. Baseline characteristics were measured in the 12 months pre−index. MI (from ICD−10 codes) and all−cause mortality were measured during follow−up and compared between cohorts using time−varying coefficient multivariable adjusted Cox models (MI results accounted for the competing risk of death).Results:In the RSV cohort (n=14,759), mean age (76.5 years) and mean Charlson comorbidity index (CCI; 3.3) were higher than the flu (n=77,468; 75.4 years, CCI=2.9) and control (n=73,795; 69.5 years, CCI=1.0) cohorts. Adjusted HRs (95% CI) for MI and all−cause mortality risk were significantly higher in the RSV vs control cohort across follow−up, ranging from 30.96 (26.22–36.54) within 30 days post−index to 2.26 (2.04–2.51) >365 days post−index for MI and 10.77 (9.19–12.63) within 30 days post−index to 2.29 (2.18–2.42) >365 days post−index for mortality. Compared to the flu cohort, adjusted MI and mortality risk in the RSV cohort were lower during the 30 days post−index (MI: 0.87 [0.82–0.92]; mortality: 0.84 [0.78–0.90]) but higher >365 days post−index (MI: 1.11 [1.01–1.22]; mortality: 1.05 [1.01–1.10]).Conclusion:MI and all−cause mortality risk were higher for hospitalized RSV cases compared to controls. Smaller differences in outcomes were observed when comparing hospitalized RSV cases with hospitalized influenza cases, with varying direction over time. With existing evidence of increased MI and mortality risk after influenza and these findings on MI and mortality risk after RSV, future research should aim to further understand the impact of RSV on cardiovascular outcomes and assess the role of RSV prevention in lowering the risk of MI and mortality.

Circulation, Volume 150, Issue Suppl_1, Page A4145229-A4145229, November 12, 2024. Background:Stress-induced cardiomyopathy (CM) is a form of acute transient left ventricular dysfunction triggered by underlying physiological stress which often leads to increased morbidity and mortality. Coronavirus disease 2019 (COVID-19) is thought to cause stress-induced CM due to overwhelming systemic inflammation. There is paucity of data regarding the impact of COVID-19 on in-hospital outcomes of patients with stress-induced CM. The purpose of this study is to investigate in-hospital outcomes, including mortality and cardiogenic shock, of patients with concomitant COVID-19 and stress-induced CM.Methods:We queried the 2020 USA National Inpatient Sample (NIS) Database in conducting this retrospective cohort study. We identified hospitalized adult patients ≥ 18 years old with stress-induced CM and concomitant COVID-19 using ICD-10 CM codes. We used a survey multivariable logistic and linear regression analysis to calculate adjusted odds ratios (aORs) for outcomes of interest. A p value of

Circulation, Volume 150, Issue Suppl_1, Page A4136600-A4136600, November 12, 2024. Background:Hypertensive disorders of pregnancy (HDP) are associated with maternal adverse cardiovascular outcomes. However, their association with maternal Dementia and Alzheimer’s disease is not well established with limited and conflicting results to date.Objective:We sought to evaluate the association between HDP and risk of incidence of Dementia, and Alzheimer’s disease.Methods:We performed a systematic review and meta-analysis of available literature that enrolled women with HDP and women without HDP groups. PubMed, Embase and ClinicalTrials.gov were systematically searched from inspection till May 2024 without any language restrictions. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were pooled using a random-effect model.Results:A total of 8 studies with 2503538 patients (1,51,905 in women with HDP and 23,51,633 in the women without HDP group) were included. Pooled analysis shows that HDP women were having 37% higher risk of dementia (aHR, 1.37(95%CI: 1.27-1.46), 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 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.

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 A4147150-A4147150, November 12, 2024. Background:Coronary artery disease (CAD) in patients with hypertension is a significant health concern among adults in the United States. This study investigates trends and demographic disparities in mortality rates due to CAD in hypertensive patients aged 25 and older from 1999 to 2020.Methods:The CDC WONDER database’s mortality data from 1999 to 2020 was used for a retrospective analysis. Average Annual Percentage Change (AAPC) and Annual Percent Change (APC) were used to evaluate trends and calculate age-adjusted mortality rates (AAMRs) per 100,000 people. The year, sex, race/ethnicity, and geographic regions were used to stratify the data.Results:Between 1999 and 2020, CAD in hypertension caused 1,512,89 medical facilities, accounting for 37.9% of all deaths. With an AAPC of 1.88 (95% CI: -0.81 to 4.36, p = 0.118), the overall AAMR grew from 7.7 in 1999 to 36.0 in 2020. There was a notable increase between 1999 and 2001 (APC: 30.07, p = 0.040) and a minor growth between 2001 and 2020 (APC: 0.85, p = 0.030). Adult men had higher AAMRs than women (men: 40.2; women: 25.2), with increases for both sexes [Men: AAPC: 4.75, p = 0.002; Women: AAPC: 2.70, p = 0.058]. AAMRs varied significantly by race, highest among Black individuals (39.9), followed by Whites (31.4), American Indians (30.4), Hispanics (27.7), and Asians (21.3). The AAMR increased for all races from 1999 to 2020, most notably in American Indians (AAPC: 4.91, p = 0.004). AAMRs varied by state, from 16.4 in Utah to 51.4 in West Virginia. The Midwest had the greatest regional death rate (33.6), followed by the West (31.1), Northeast (31.0), and South (30.9). Nonmetropolitan areas had higher AAMRs than metropolitan areas (34.7 vs. 31.0), with a greater increase in nonmetropolitan areas (AAPC: 6.22, p < 0.000001).Conclusion:This analysis reveals significant demographic and geographic disparities in mortality rates due to CAD in hypertensive adults in the U.S. The AAMR has increased fivefold over the past two decades, particularly among certain racial groups and geographical regions. These findings underscore the urgent need for targeted interventions and equitable healthcare access to mitigate these disparities and improve outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4142564-A4142564, November 12, 2024. Introduction:Obesity is a known risk factor for cardiovascular disease (CVD) morbidity and mortality. A body shape index (ABSI) is a waist circumference (WC) measure of abdominal obesity independent of body mass index (BMI) that has been shown to predict mortality and numerous clinical outcomes.Aims:To study the predictive value of ABSI in conjunction with BMI for all-cause mortality and coronary heart disease (CHD) hospitalization among adult participants.Methods:Participants (n=2,225) were drawn from the First Israeli National Health and Nutrition Survey (1999-2001), constituting adults aged 25-64. Baseline anthropometrics, including weight, height, and WC, were measured and expressed as their allometric indices: BMI (weight/height2) and ABSI [WC/(BMI2/3*height1/2)]. Follow-up lasted through 2021 for mortality and 2022 for hospitalizations. Cox regressions assessed the adjusted risk of all-cause mortality and CHD hospitalization.Results:The baseline mean [SD] age was 43 [11] years, and 50% were women. The correlation between BMI and WC was 0.78, and 0.02 for BMI and ABSI. Over a median follow-up of 21 years, 247 (11.1%) deaths occurred. The multivariable-adjusted hazard ratios (HRs) for mortality per 1 SD increase in BMI and ABSI were 1.11 (95% CI: 0.97; 1.27) and 1.55 (95% CI: 1.33; 1.79), respectively (Table). ABSI exhibited a significant association with mortality risk across all standard BMI categories; adjusted for demographics and classic CVD risk factors, the HRs (95% CIs) per 1 SD increase in ABSI were 1.38 (1.01; 1.88) for individuals with a BMI of 18.5-24.9, 1.70 (1.34; 2.16) for BMI 25.0-29.9, and 1.46 (1.13; 1.87) for BMI ≥30.0. Among CVD-free participants at baseline (n=2,146), 267 (12.4%) were hospitalized for CHD during follow-up. The latter had higher ABSI (0.082 vs. 0.078, P

Circulation, Volume 150, Issue Suppl_1, Page A4146155-A4146155, November 12, 2024. Importance:Despite the increasing use of intra-aortic balloon pumps (IABP) and Impella bridge to heart transplant (HTx), there is a paucity of comparative data on their use as bridges to heart transplantation.Objective:To compare the efficacy of IABP vs Impella (5.5 and 5.0) devices as a bridge to HTx in a cohort transplanted under the current UNOS heart allocation system.Design, Setting, and Participants:A retrospective longitudinal study of the United Network for Organ Sharing (UNOS) registry included adult patients listed for HTx between Oct 2018 and April 2022 as status 2, who were supported by IABP or Impella (5.5 and 5.0) and had a complete set of demographics, hemodynamics, medical comorbidities, inotrope requirements, and biochemical variables. The primary endpoint was a successful bridging to HTx as status 2. IABP and Impella groups were propensity-matched at a 3:1 ratio for demographics, UNOS region, baseline hemodynamics, and liver and kidney function.Results:Of 32,806 HTx during the study period, 991 patients met the inclusion criteria (Impella n=88, IABP n=903). Post-matching, there were no differences between the IABP and Impella groups in any baseline characteristic. The primary outcome occurred in 89.5% of the pre-matched population (IABP 90.1% vs Impella 83%, P = 0.055). In the matched cohort, the primary outcome occurred in 85.2% (IABP 86%, Impella 83%, P = 0.603); there was no difference in the listing by exception, multiorgan transplantation, waitlist time, waitlist mortality, or delisting. Post-transplant graft survival, infection, and renal failure were not different. Impella was associated with a lower rehospitalization rate (OR 0.54, 95% CI 0.33–0.9, P = 0.02), coronary allograft vasculopathy (OR 0.23, 95% CI 0.05–1, P = 0.05), and rejection requiring hospitalization (OR 0.13, 95% CI 0.02–1, P = 0.05).Conclusions:IABP and Impella (5.5 and 5.0) devices are equally effective as bridge-to-transplant platforms with a high transplantation rate as status 2. Additionally, Impella was associated with lower post-HTx events.

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 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 A4137854-A4137854, November 12, 2024. Background:The effects of sacubitril/valsartan (ARNI) on myocardial tissue characterization in heart failure (HF) with left ventricular ejection fraction (LVEF)

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 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.