Risultati per: GPG: Versione 5.6.2.1 (Aprile 2021)

Stroke, Volume 56, Issue Suppl_1, Page AWMP27-AWMP27, February 1, 2025. Introduction:For the 240,000 patients presenting to the emergency department (ED) annually with transient ischemic attack (TIA), a resource-intensive multimodal evaluation and possible admission to the hospital may help prevent a subsequent stroke. Multiple strategies to approach the location and timing of these evaluations exist. Using a nationally representative data source, we evaluated variation and trends in ED practices for patients with suspected TIA.Methods:Retrospective cross-sectional study of ED visits using the 2013-2021 National Emergency Department Sample, a 20% sample of ED encounters in the United States maintained by the Healthcare Cost and Utilization Project (HCUP). TIA diagnosis was determined by first-listed ICD-9 or -10 code. Imaging utilization was determined in discharged ED patients by CPT code for TIA related modalities. Factors associated with discharge from the ED in a TIA encounter were evaluated with a multivariable logistic regression.Results:Percentage of ED TIA patients discharged from the ED increased from 47% (95%CI 46-49) to 68% (95% CI 66-69) between 2013 and 2021. Average cost per discharged TIA encounter increased from $1559 (95% CI 1482-1635) to $2753 (95% CI 2649-2857). Imaging utilization in discharged TIA patients increased markedly between 2013 and 2021. In 2013, 3.6% (95% CI 2.8-4.4) of discharged TIA patients received a CTA Head during their evaluation, while in 2021 this had increased to 44%(95% CI 42-46). Logistic regression analysis for factors associated with discharge in ED TIA encounters in 2021 showed patients from rural areas were more likely to be discharged (OR 2.95 (95% CI 2.42-3.59) than those in densely populated areas (OR 0.68 (95% CI 0.54-0.86).Conclusion:Discharge rates for patients with TIA increased between 2013 and 2021, with a parallel increase in the ED charges for patients discharged with TIA. Utilization of imaging in the ED increased during the time interval and may explain some of this increased cost. This may suggest a shifting of previously inpatient TIA evaluations to the non-admitted ED setting. Likelihood of discharge with a TIA was inversely related with population density of the patient’s location. More resources should be focused on optimizing ED evaluation and follow up of TIA patients in non-urban areas.

Stroke, Volume 56, Issue Suppl_1, Page A120-A120, February 1, 2025. Background:Decompressive hemicraniectomy (DHC) and mechanical thrombectomy (MT) are critical interventions for acute ischemic stroke. This study examined trends in their use from 2016 to 2021, the relationship between them, and associated patient demographics and outcomes.Methods:National inpatient Sample (NIS) (n=798,712) was analyzed. Trends in DHC and MT per year were analyzed using the Cochran-Armitage test for trend to assess changes in DHC use over time and assessed overall and stratified by MT status. Logistic regression evaluated the association between year, MT, and their interaction with DHC odds. Patient demographics and outcomes were also examined.Results:Overall, DHC use increased significantly from 2016 to 2021 with a non-linear trend (chi2(4)=86.69, p

Stroke, Volume 56, Issue Suppl_1, Page AWP257-AWP257, February 1, 2025. Background:Non-Hispanic Black (NHB) and other minority patients in the United States (US) receive intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) less frequently compared with non-Hispanic White (NHW) patients during acute ischemic stroke (AIS) admission. It remains uncertain how the interaction between race and the income category of patients influences treatment and outcome.Methods:We identified all primary AIS hospitalizations in the 2006-2021 National Inpatient Sample (NIS) receiving IVT and MT using International Classification of Diseases (ICD) codes. Admissions were categorized into income quartiles (Q1-Q4) using the median household income of the patient’s zip code. Multivariable logistic regression models adjusted for age, sex, clinical and hospitalization factors were used to compare odds of IVT, MT, in-hospital mortality and good outcome (defined as routine home discharge) between race and income groups.Results:Of 7,476,163 weighted AIS hospitalizations from 2006-2021, 31.1% were in the lowest (Q1) and 19.4% in the highest (Q4) income quartile. 9.3 % of admissions received IVT and 2.7% received MT across the study period. Utilization of both procedures increased in all income groups over time but usage was persistently lower in Q1 admissions compared to Q4 (figure 1). In multivariable-adjusted models restricted to 2015-2021, all minority racial groups including NHB admissions had lower odds of IVT (OR 0.74, 95%CI 0.72-0.76) and MT (OR 0.74, 95%CI 0.71-0.77) vs NHW. Q1, Q2 and Q3 admissions had lower odds of IVT compared to Q4 and Q1 admissions had lower MT odds (OR 0.92, 95%CI 0.90-0.95) vs Q4. Further stratification by income and race, showed that IVT and MT odds increased with income for NHW admissions but notably all quartiles of NHB admissions including Q4 had up to 20% lower odds of IVT and MT compared to Q1 of NHW admissions (Figures 2a and 2c). Among NHB and NHW admissions, odd of in-hospital mortality was significantly lower in Q4 vs Q1, while odds of good outcome was greater in Q4 vs Q1 income categories, but these differences were not consistently seen in Hispanic and Asian hospitalizations (Figure 3).Conclusion:Racial disparities in IVT and MT use in the US is not explained by income alone. NHB individuals in all income categories receive IVT and MT at rates less than the lowest income category of NHW individuals. Q1 admissions have higher mortality and lower odds of good outcome compared to Q4 admissions.

Life expectancy in the US may now vary by more than 2 decades based on demographic differences, according to a new systematic analysis. The largest gap between highest and lowest life expectancies was 12.6 years in 2000. It reached 13.9 years in 2010 and 15.8 years by 2019 before climbing to 20.4 years after the first 2 years of the COVID-19 pandemic—with the largest life expectancy difference being between Asian individuals and American Indian or Alaska Native people in the West.

Objectives
To determine the prevalence of hospital discharge communication problems with older adults, compare them across countries and determine factors associated with those problems.

Design
Secondary analysis of cross-sectional survey data.

Setting
2021 Commonwealth Fund International Health Policy (IHP) Survey of Older Adults conducted across 11 high-income countries, including Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the USA.

Participants
4501 respondents aged 60 and older in the USA and 65 and older in all other included countries who were hospitalised at least once in the past 2 years before the survey and answered discharge communication-related questions.

Primary outcome measure
Our primary outcome measure is poor discharge communication (PDC), a composite variable of three IHP questions related to written information, doctor follow-up and medicines discussed.

Results
Overall PDC rate was 19.2% (864/4501), although rates varied by nation. PDC was highest in Norway (31.5%) and lowest in the USA (7.5%). Gender, education, income and the presence of at least one chronic disease were not statistically associated with PDC.

Conclusions
Given the high rate of PDC observed, hospital discharge teams and leadership should carefully examine communication during the hospital discharge process to ensure minimisation of care gaps, particularly regarding medication, since this was the most reported problem.

Objective
This study examined economic inequality in coverage of selected maternal and child healthcare (MCH) indicators in India and its states over the last 15 years.

Design
The study analysed last three rounds of the National Family Health Survey data, conducted during 2005–2006, 2015–2016 and 2019–2021. Bivariate analyses, ratio of richest to poorest, slope index of inequality (SII) and multivariate binary logistic regression analyses were used to examine the coverage as well as inequalities in the outcome indicators for India and its states and at district level.

Primary outcomes
The outcome variables analysed in the study were full antenatal care, institutional delivery, postnatal care of mothers within 48 hours of delivery, and full immunisation among children.

Participants
Women aged 15–49 who had given a birth in the last 5 years before the surveys were unit of analysis for the maternal healthcare indicators, and children aged 12–23 months were unit of the analysis for childhood immunisation.

Results
Over the last 15 years, coverage of the MCH indicators has increased in India and across socioeconomic segment of the population, and the absolute increase was higher among the worse-off segments than the better-off. This led to decline in the inequality in coverage of all the MCH indicators. For instance, the value of SII for institutional births decreased from 0.76 in 2005–2006 to 0.45 in 2015–2016 and further to 0.37 in 2019–2021. Although inequality has decreased, geographic disparities persist across states and districts.

Conclusion
Though substantial improvement was observed, coverage of MCH indicators increased and the economic inequality declined; certain geographies are still characterised with the low coverage and persistent high inequality. This suggests that adding a spatial perspective to the inequality research and targeted strategies is essential for achieving universal access to reproductive healthcare services by 2030 in India.

Objectives
We aim to delineate the digestive congenital abnormalities burden in children under 14 years old between 1990 and 2021.

Design
We implemented data from the Global Burden of Disease (GBD) 2021 database to evaluate digestive congenital abnormalities burden with different measures in 204 countries and territories from 1990 to 2021. We present precise estimations with 95% uncertainty intervals. In addition, we computed the estimated annual percentage change (EAPC) to examine the temporal patterns of these indicators.

Setting
It uses prevalence, deaths and disability-adjusted life years (DALYs) data from the GBD study to analyse this issue.

Participants
Patients with digestive congenital abnormalities diagnosis.

Outcomes
Total numbers, age-standardised rates (ASRs) of prevalence, mortality and DALYs and their EAPCs were the main outcomes among children aged 0–14 years.

Results
In 2021, 2206.79 thousand prevalent cases were reported worldwide, with digestive congenital anomalies accounting for 47.16 thousand deaths and 4324.56 thousand DALYs among children aged 0–14 years. Digestive congenital anomalies prevalence was mitigated by 8.15% between 1990 and 2021, with the global ASR of prevalence declining to 40.09 per 100 000. Digestive congenital anomalies mortality was mitigated by 35.35% between 1990 and 2021, with an ASR of deaths declining to 0.77 per 100 000. The worldwide burden of digestive congenital anomalies decreased by 34.96% in terms of DALYs from 1990 to 2021, with an ASR of 70.44 DALYs per 100 000 population. There was a significant hindrance in the prevalence, particularly among older children. The likelihood of digestive congenital abnormalities peaked during infancy (2–4 years) in all regions.

Conclusion
We highlight promising global declines in the digestive congenital anomalies burden among children over the past 32 years. Prevalence, deaths and DALYs associated with these anomalies have shown consistent decreases, although regional variations persist. These findings offer crucial insights for shaping effective prevention and management strategies for paediatric digestive congenital anomalies.

Background
Bismuth quadruple therapies (BQTs) including bismuth, a proton pump inhibitor (PPI) and two antibiotics have been shown to be highly effective for treating Helicobacter pylori infection even in areas of high bacterial antibiotic resistance.

Objective
To describe the time trends of use, effectiveness and safety of BQT in Europe using the European Registry on Helicobacter pylori Management (Hp-EuReg).

Design
Patients registered in the Hp-EuReg from 2013 to 2021 who had received BQT were included. The regimens prescribed, the number of eradication attempts, effectiveness, adherence and safety were analysed. The effectiveness was assessed by modified intention to treat (mITT). Time-trend and multivariate analyses were performed to determine variables that predicted treatment success.

Results
Of the 49 690 patients included in the Hp-EuReg, 15 582 (31%) had received BQT. BQT use increased from 8.6% of all treatments in 2013 to 39% in 2021. Single-capsule BQT—containing bismuth, metronidazole and tetracycline—plus a PPI (single-capsule BQT, ScBQT) was the most frequent treatment mode (43%). Schemes that obtained an effectiveness above 90% were the 10-day ScBQT and 14-day BQT using tetracycline plus metronidazole, or amoxicillin plus either clarithromycin or metronidazole. Only ScBQT achieved above 90% cure rates in all the geographical areas studied. Using the ScBQT scheme, adherence, the use of standard or high-dose PPIs, 14-day prescriptions and the use of BQT as first-line treatment were significantly associated with higher mITT effectiveness.

Conclusion
The use of BQT increased notably in Europe over the study period. A 10-day ScBQT was the scheme that most consistently achieved optimal effectiveness.

Trial registration number
NCT02328131.

Background
Gastrointestinal cancers comprise nearly one-third of global mortality from cancer, yet the comprehensive global burden of these cancers remains uninvestigated.

Objective
We aimed to assess the global, regional and national burden of gastrointestinal cancers.

Designs
Data on oesophagus, gastric, colorectal, liver, pancreas and biliary tract cancers were extracted from the Global Burden of Disease 2021 database. Age-standardised incidence rate (ASIR) and age-standardised death rate (ASDR) were calculated by sex, region and Sociodemographic Index (SDI).

Results
In 2021, there were 5.26 million incidences and 3.70 million deaths from gastrointestinal cancer. The greatest burden is from colorectal, followed by gastric, oesophageal, pancreatic, liver and biliary tract cancer. We noted geographical and socioeconomic differences in ASIR and ASDR across all types of cancers. From 2000 to 2021, ASIR increased for colorectal cancer (annual percent change (APC): 0.10%, 95% CI 0.05% to 0.14%), pancreatic cancer (APC: 0.27%, 95% CI 0.14% to 0.41%), and liver cancer from metabolic dysfunction-associated steatotic liver disease (APC: 0.62%, 95% CI 0.58% to 0.67%) and alcohol-related liver disease (APC: 0.26%, 95% CI 0.22% to 0.30%). ASDR increased for pancreatic cancer (APC: 0.18%, 95% CI 0.02% to 0.34%). Higher SDI countries had higher incidence rates for most types of gastrointestinal cancer.

Conclusions
Although the ASIR of oesophageal, gastric and biliary tract cancer has decreased, the ASIR still increased in colorectal, pancreatic and liver cancer from steatotic liver disease. Public policies are important for controlling gastrointestinal cancers—most importantly, reducing alcohol consumption, hepatitis B immunisation and tackling the burden of metabolic diseases.

Objectives
Although primary care is central to healthcare provision, inconsistent methods and data sources mean that relatively little is known about long-term trends in general practice consultation rates. We aimed to explore long-term trends in English general practice consultation rates using two electronic health records databases, Clinical Practice Research Datalink Gold and Aurum, from 1995 to 2021.

Methods
Consultations were identified and classified using a set of rules and code lists. Consultation rates were calculated as the ratio of the count of consultations and the registration duration. We used negative binomial regression to model the relationship between the number of consultations and the patient’s age, sex and year from each database. These models are then used to estimate annual crude consultation rates for England.

Results
The number of general practices in the Gold database decreased from 346 (1995) to 41 (2021), while in Aurum, it increased from 555 (1995) to 1347 (2021). In Gold, the average number of consultations per person-year increased from 2.91 in 1995 to 5.12 in 2012, then fell to 4.59 in 2019 and to 4.12 in 2021. In Aurum, average consultations per person-year rose from 2.17 (1995) to 4.89 (2012), then fell to 4.76 (2019) and rose again to 5.40 (2021). Half of the total increase in consultations from Aurum was due to a new consultation code, for ‘AccurX consultations’, an electronic messaging system for communication with patients.

Conclusion
Trends in general practice consultation showed three distinct epochs: rising from 1995 to 2012, falling from 2012 to 2019 and rising in Aurum but falling in Gold from 2019 to 2021. Consultation rates in Gold were higher than Aurum until the inclusion of a new consultation code in Aurum in 2019, which underscores the need for operational definitions of a consultation.

Objective
To examine the contribution of the active job openings-to-applicants ratio, a macroeconomic indicator, to the number of ambulance dispatches.

Design
Longitudinal ecological study.

Setting
Japan, between January 2003 and December 2021.

Participants
All ambulance dispatches.

Primary and secondary outcome measures
The contribution of the active job openings-to-applicants ratio in a month, adjusted by the number of older people, mean temperature and total population, to the number of ambulance dispatches in that specific month was examined and the primary model was compared to the conventional model considering only the older population, mean temperature, and total population.

Results
There were 108 724 969 ambulance dispatches during this period. The active job openings-to-applicants ratio was significantly associated with the number of ambulance dispatches (the increase rate of monthly ambulance dispatches for 1% rise in the active job openings-to-applicants ratio, 1.00082; 95% CI 1.00052 to 1.00112). Additionally, the primary model effectively demonstrated better fitness to the actual trend than the conventional model (the quasi-likelihood under the independence model criteria were –2 626 817 720 and –2 626 775 185, respectively).

Conclusions
The number of ambulance dispatches was correlated with the active job openings-to-applicants ratio. Macroeconomic perspectives may be needed to address the issue of increasing ambulance dispatches.

Objectives
With a projected rise in care home residency and the disproportionate impact of epilepsy and seizures on older adults, understanding seizure-related needs in this population is crucial. Data silos and inconsistent recording of residence status make this challenging. We thus leveraged ambulance data to investigate seizure call-out incidence, characteristics, management and costs in care homes compared with the wider community.

Design
Retrospective analysis of dispatch data from a regional English ambulance service over four 9-month periods between 2014/2015 and 2021/2022. Suspected seizures in adults (≥16 years) were identified, with data on location, patient age, severity and management extracted. Incidence rates, trends over time and case characteristics were compared. Costs of ambulance response were estimated, and factors influencing emergency department (ED) conveyance were analysed using logistic regression.

Setting
North West Ambulance Service National Health Service Trust, serving an adult population of ~5.5 million.

Participants
Dispatch data for 98 752 suspected seizure cases.

Results
Care homes, accommodating ~0.8% of the regional population, accounted for 7.2% of seizure call-outs. Incidence was higher in care homes than the wider community (55.71 vs 5.97 per 1000 person/year in 2021/2022) and increased over time. Care home cases peaked around 8:00–9:00. Despite similar or lower severity, they had a higher ED conveyance rate (78.3% vs 70.6%). Conveyance likelihood was influenced by factors beyond severity: reduced in homes specialising in learning disabilities (adjusted OR=0.649) and increased in homes with nursing provision (adjusted OR=1.226). Care homes accounted for 7.26% of the £24 million cost.

Conclusions
This study highlights the growing seizure-related needs in care homes. Despite similar severity, most cases result in ED conveyance. Future research should examine the appropriateness and implications of these transfers, ensuring specialist services support the care home population effectively.

Global stroke burden increased substantially between 1990 and 2021, according to a study in The Lancet Neurology. In 2021, almost 12 million people had a new stroke event, an increase of 70% since 1990. Stroke-related deaths rose to more than 7 million, up by 44% since 1990, making it the third leading cause of death worldwide.

Circulation, Volume 150, Issue Suppl_1, Page A4145873-A4145873, November 12, 2024. Background:Recent studies have suggested performing coronary artery bypass grafting (CABG) within 24 hours of acute myocardial infarction increases mortality risk. However, the ideal timing after the first day remains unclear. This study aims to suggest an optimal timing of CABG in NSTEMI patients using the large National Inpatient Sample (NIS) database over a 5-year period.Methods:This retrospective cohort study analyzed survey-weighted NIS data over 2017-2021, including adult-age admissions with NSTEMI as the principal diagnosis who underwent CABG without prior transfer from another hospital. Patients were categorized into eight groups based on days from admission to CABG (0, 1, 2, 3, 4, 5, 6, and ≥7 days). Baseline characteristics were compared across groups. Multivariate regression analysis adjusted for multiple confounders to assess the association between Time-to-CABG and in-hospital mortality and stroke prevalence.Results:Table 1 presents the baseline characteristics across the eight groups, encompassing 142,200 included admissions (mean age 65.24 years; 26.78% female).In-Hospital Mortality:The adjusted odds ratios (OR) were less than one for groups 1 through 7 compared to group 0, indicating that immediate CABG (day 0) is associated with higher mortality risk. While the reduced odds in the day 1 group were not statistically significant, substantial and statistically significant reductions in mortality were observed between days 2 and 5 (OR: 0.624 – 0.609; p

Circulation, Volume 150, Issue Suppl_1, Page A4146312-A4146312, November 12, 2024. Introduction:Atrial Fibrillation (Afib) and Flutter ranks as the fifth leading cause of death among all cardiovascular diseases (CVD). Given the scarcity of consistent previous estimates, this study is the first to assess the burden of Afib and Flutter in the European Union (EU) over the past three decades, including the initial two years of the COVID-19 pandemic.Methods:Using global burden of disease study 2021 meta tool, we estimated prevalence, incidence, deaths, disability adjusted life years (DALYs), years lived with disability (YLDs) due to Afib and Flutter by age, sex, year and location across the 27 EU countries from 1990-2021.Results:The total number of prevalence rose from 5 million (95% uncertainty interval: 3.9-6.4 million) in 1990 to 8.6 million (7.2-10.3 million) in 2021. The total percentage of change (TPC) in deaths increased by 130% (110%-143%), and YLDs by 69% (56%-84%) from 1990-2021. Austria saw the highest increase in age-standardized incidence rates (ASIR) at 83%, followed by Czechia at 50%. Sweden experienced the largest rise in mortality rates (ASMR) at 93%, with Estonia at 35%, and in YLD rates (ASYLDR), Austria led with a 90% increase followed by Sweden at 49%. In terms of age, individuals aged 55 and older recorded the highest death toll at 70,269 (57,793-77,019) and the highest incidence at 607,960 (397,686-868,122) in 2021. Regarding gender, males showed an increased TPC in overall burden compared to females, with males observing an increase and females a decreasing trend in ASIR (5% vs -7%), ASMR (7% vs -4%), and ASYLDR (7% vs -5%) from 1990-2021.Conclusion:Deaths due to Afib and Flutter accounted for 4.26% of all CVD in EU. The escalating prevalence and mortality rates of Afib and Flutter across the EU highlight an urgent need for comprehensive healthcare strategies. Effective management should focus on bolstering preventive measures, advancing diagnostic techniques, and enhancing patient care frameworks, particularly for the aging demographic most at risk. Strategic collaboration across sectors, including innovative public health initiatives and policy reinforcement, is essential to curb this growing trend and safeguard public health.

Circulation, Volume 150, Issue Suppl_1, Page A4144597-A4144597, November 12, 2024. Introduction:The National Survey of Children’s Health (NSCH) provides data for key measures of child health and well-being. The aim of this study is to characterize the cardiovascular health (CVH) status of youth with neurodevelopmental disabilities (NDD) compared to those without neurodevelopmental disabilities (non-NDD).Hypothesis:Youth with NDD are more likely to have poor CVH status compared to non-NDD youth.Methods:We compared the odds of poor CVH status in youth with NDD vs non-NDD, using 2021 NSCH data, according to a modified AHA Life’s Essential 8 (LE8) scoring system. Participants were identified as having NDD based on the Diagnostic and Statistical Manual of Mental Disorders and diagnosis of an intellectual, communication, autism spectrum, attention-deficit/hyperactivity, specific learning, or neurodevelopmental motor disorder, including Tic disorder. The CVH status of each youth was scored according to a modified LE8 score- range 0 to 100 points, with higher scores indicating good health. Individual scores were generated for sleep (sleep duration), smoking (smoking/exposure), diabetes mellitus (yes/no), obesity (BMI percentile), heart condition (yes/no), and dyslipidemia (yes/no). A composite CVH score was generated using scores for sleep, smoking, diabetes mellitus, and obesity. Logistic regression was used to analyze the relationship between NDD and CVH status. Propensity score techniques were applied to address the potential selection bias between NDD and non-NDD.Results:12,134 youth, 3 to 17 years of age, were identified as having NDD and 44,960 without. Compared to those with NDD, non-NDD participants were less likely to have age-inappropriate sleep duration (63.4 vs. 55.3,p