Risultati per: Passo 12. Ripulire in modo mirato le cartelle cliniche degli assisiti

Circulation, Volume 150, Issue Suppl_1, Page A4144918-A4144918, November 12, 2024. Background:The adverse effects of iron deficiency (ID) on left ventricular function and outcomes in patients with acute coronary syndrome have been established. However, the effects of ID and its treatment in patients with myocardial infarction (MI) have not been adequately studied.Aim:To study left ventricular systolic function, assessed by evaluation of the wall motion score index (WMSI) and left ventricular ejection fraction (LVEF), in patients with corrected ID and persistent ID within 12 months after MI.Methods:This is open prospective study. 100 patients, 53 males (53%), and 47 females (47%) hospitalized with MI in “Kazan city clinical hospital 7” were enrolled in 2022 year. The mean age was 62±13 years. All patients had ID. ID is assumed to be present when serum ferritin

Circulation, Volume 150, Issue Suppl_1, Page A4136776-A4136776, November 12, 2024. Introduction:Resting Heart Rate (HR) and Heart Rate Variability (HRV) reflect autonomic control, and are implicated as prognostic factors. We aimed to evaluate the prognostic value of HR and HRV in a cohort from a nationwide telemedicine network.Methods:We assessed unique ECGs recorded from patients ≥16 years-old, from the tele-ECG database of the Telehealth Network of Minas Gerais, Brazil, between 2010 and 2017. Variables of interest were HR and standard deviation of normal RR intervals (SDNN). Self-informed data were collected: sex, age, risk factors (hypertension, dyslipidemia, diabetes, smoking) and comorbidities (myocardial infarction, Chronic Obstructive Pulmonary Disease, and Chagas disease). Outcomes of interest were all-cause and cardiovascular mortality, assessed by ICD codes reported in death certificates, through linkage with the Mortality Information System. Cox regression was applied to evaluate the association between HR and HRV and the outcomes, in 4 models: 1. Unadjusted; 2. Adjusted for sex and age; 3. Model 2 + risk factors + clinical comorbidities; 4. Model 3 + HRV or HR, respectively.Results:At total 992.611 individuals were included, median age of 55 years, 60% women. In 6 years, there were 33.292 deaths (3,37%), 21% due to cardiovascular causes. Patients who died had higher prevalence of all risk factors and comorbidities, as well as higher HR: 76 (IQR 66-87) vs. 74 (IQR 65-83) bpm, p

Circulation, Volume 150, Issue Suppl_1, Page A4139672-A4139672, November 12, 2024. Introduction:Obesity is a risk factor for atrial fibrillation (AF) and its incidence that has tripled over the past 30 years. Obesity is associated with dramatic changes in atrial structure and electrophysiology through unclear mechanisms. The linoleic acid metabolite 12,13-dihydroxy-9Z-octadecenoic acid (12,13-diHOME) is a signaling lipid released by brown adipose tissue that acts in an endocrine manner on myriad tissues including the heart. 12,13-diHOME enhances cardiac myocyte Ca2+cycling and overall function, though the precise mechanisms are undetermined. This study tested the hypothesis that 12,13-diHOME inhibits the pro-arrhythmic molecule Ca2+/calmodulin-dependent kinase II (CaMKII). We propose that obesity-induced loss of 12,13-diHOME promotes CaMKII dysfunction,in vitroectopy and atrial arrhythmia (AA).Methods:Adult male and female mice were fed either high fat diet (HFD, 60% kcal from fat) or normal chow (NFD) (21% kcal from fat) for 8-16 weeks. Atrial myocytes were isolated for action potential (AP) measurements using whole-cell patch clamp ±12,13-diHOME (5 μM). To test the effect of 12,13-diHOME on AA inducibility, a second cohort of mice was fed HFD and subjected to weekly tissue nanotransfection for non-viral delivery of either Ephx1/2 (HFD-TNT), enzymes responsible for production of 12,13-diHOME, or empty plasmid (HFD-con). Following treatment, mice underwent intracardiac pacing studies to determine AA inducibility. The ability of 12,13-diHOME to directly interact with and inhibit CaMKII was tested using purified components within vitroradioassay and microscale thermophoresis.Results:HFD induced atrial myocyte AP duration prolongation and a higher incidence of spontaneous depolarization compared to NFD, both of which were reversed by 12,13-diHOME (figure). HFD-TNT exhibited decreased phospho-CaMKII compared to HFD-con mice. In parallel, HFD-TNT trended toward reduced inducibility of AA (0/7 mice inducible, 0%) compared to TNT-CON mice (5/7, 58%) (p=0.07). Radioassay revealed that 12,13-diHOME inhibits CaMKII; thermophoresis demonstrated direct binding withK1/2= 19 mM.Conclusion:HFD induces dysregulation in 12,13-diHOME and CaMKII signaling together with defects in atrial myocyte excitability and AA in mice. Non-viral overexpression of 12,13-diHOME shows promise in normalizing CaMKII activity and reducing AA burden. 12,13-diHOME represents a novel avenue for direct regulation of CaMKII signaling and downstream pathology in the heart.

Circulation, Volume 150, Issue Suppl_1, Page A4145329-A4145329, November 12, 2024. Background:The diagnosis of suspected ST-elevation myocardial infarction (STEMI) requires electrocardiograms (ECGs) done in emergent settings across the world. Despite access to ECG machines, the expertise of clinicians reading them is scarce. Automated reads are often inaccurate. We sought to address this challenge by developing an AI-enabled approach for automated cardiologist-level diagnosis from photos of 12-lead ECGs.Methods:We identified patients undergoing ECGs in a large, diverse US health system (2015-2023). We used self-supervised pretraining to develop a convolutional neural network to first detect ECG features without any diagnostic flags, designed to enhance the efficiency of training a STEMI-specific model. To ensure the model learned the signature for STEMI independent of other ECG features, each STEMI ECG (cases defined by reads by cardiologists) was matched to 10 ECGs of those without STEMI (controls) but of the same age, sex, and with the same set of conduction and rhythm abnormalities on their ECGs. To mimic variations in ECG formats in real-world clinical settings, the training ECGs were randomly plotted using any of 2880 unique formats, with variations in lead layouts, background colors, label fonts, grid, and signal line widths. The model was evaluated on a held-out set of ECG images from patients presenting to the emergency (ED) with chest pain.Results:The model development set included 49,995 ECGs from 39,697 individuals (age 65 years [IQR, 52-76], 18,926 [48%] women, 5941 [15%] Black). The test set included 7551 patients who had presented to the ED with chest pain (1 ECG/individual, median age 50 years [IQR, 34-62], 4063 [54%] women, 1661 [22%] Black). Of these, 104 (1.4%) had STEMI. The model achieved an AUROC of 0.95 (95% CI, 0.93-0.96) and AUPRC of 0.21 (0.15-0.28), with a sensitivity of 90.3% (84.0-95.8) and specificity of 87.7% (87.0-88.4). The model performance was consistent among demographic subgroups of age (AUROC 0.95-0.97), sex (AUROC 0.93-0.97), and race/ethnicity (AUROC 0.95-0.96).Conclusion:We have developed an AI algorithm that can diagnose STEMI on photos of ECGs with high accuracy, potentially enabling the triaging of patients in low-resource settings by offering accurate diagnosis at the point of care. The reliance on ECG images across formats and layouts ensures its use without changing ECG acquisition or related infrastructure.

Circulation, Volume 150, Issue Suppl_1, Page A4147096-A4147096, November 12, 2024. Introduction:Increased prevalence and incidence of heart failure have resulted in a significant rise in the number of patients progressing to advanced heart failure (AHF). Heart transplantation (HT) has been the gold standard treatment for AHF. However, there is limited long-term data on trends in HT procedures and associated costs.Aim:This study aims to perform a comprehensive analysis to ascertain the trends in the number of HTs and the corresponding costs incurred.Methods:Utilizing the National Readmission Database 2010 to 2021, the study population was identified as new recipients of HT, and their median index admission charges were evaluated. We excluded patients aged < 18 with HT and LVAD during the index hospitalization.Results:We identified 36,379 weighted index hospital admissions from January to December 2010 - 2021. The annual HTs increased from 2,905 to 4,046, and the HT numbers increased by 39.28% (Figure 1). From 2010 to 2017, the HT numbers increased by approximately 11.46%; from 2018 to 2021, the increase was about 19.81%. Concurrently, median index admission costs increased from $146,817 in 2010 to $243,079 in 2021 (Figure 2), with a 65.57% cost increase. Considering patient demographics, 47% had private insurance, and Medicare covered 34%. Most patients were discharged home (48%) or to home with health care services (42%).Conclusion:Over the past 12 years, the total number of HT procedures rose by 39.28%. However, associated costs have surged disproportionately by 65.57% since 2010. A significant increase in OHT procedures from 2018 may be linked to policy changes by the United Network for Organ Sharing(Maitra, Dugger et al., 2023). Escalating costs warrant in-depth evaluation and potential policy revisions to curb healthcare expenses for managing advanced end-stage heart failure.

Circulation, Volume 150, Issue Suppl_1, Page A4137975-A4137975, November 12, 2024. Introduction:In the US, the most common cause of death among active-duty firefighters is sudden cardiac death (SCD). Underlying heart diseases are important propagator of ventricular tachyarrhythmias that cause SCD. The objective of this abstract is to assess the incidence of underlying heart disease, identified on 12-lead electrocardiograph (ECG), that may place firefighters at greater risk of SCD.Methods:We digitalized 12-lead ECGs recorded among firefighters who visited a firefighter health screening program at least 4 times from 2011-2019. We extracted the interval measurements (Heart Rate, T-axis, QRS-axis, QRS duration, QTc duration) and interpretation statements from each of the 12-lead ECGs and grouped potential propagators of ventricular tachyarrhythmias including left ventricular hypertrophy (LVH), coronary artery disease (CAD), and cardiac conduction disease. We used simple mean imputation to handle missing data. Descriptive statistics including means and frequencies were used to analyze the sample.Results:Among 465 firefighters (90.1% male) with a mean age of 47.1 (±13.6) whom 1,296 12-lead ECGs were analyzed, 21.5% (n=278) of Heart Rate, 0.39% (n=5) T-axis, 26.4% (n=342) QRS-axis, 40.0% (n=518) QRS duration, 5.40% (n=70) QTc duration were abnormal. In addition to intervals, the 12-lead ECGs generated 1,970 interpretation statements of which 28.2% (n=555) were deemed possible pathoanatomical substrates including 3.1% (n=34) LVH, 24.7% (n=137) CAD, and 69.2% (n=384) cardiac conduction diseases. Among cardiac conduction diseases, intraventricular conduction disease was the most prevalent (n=204, 36.8%), followed by vertical axis (n=70, 12.6%), right bundle branch block (n=59, 10.6%), left anterior fascicular block (n=34, 6.1%), and left bundle branch block (n=17, 3.1%). Interestingly, we did not observe a temporal relationship regarding the number of pathoanatomical substrates over the screening period.Conclusions:Nearly 30% of the interpretation statements generated from 12-lead ECGs were indicative of possible pathoanatomical substrates that cause SCD, which reflects the apparently negative effect of fire suppression activity on one’s cardiopulmonary health. Our result justifies the imperative need of effective prevention method for cardiac conduction diseases among firefighters. Further research is needed to collect 12-lead ECG systematically amongst other measures such as diet and BMI which reflect work culture and lifestyle of firefighters.

Circulation, Volume 150, Issue Suppl_1, Page A4146935-A4146935, November 12, 2024. Background:Current guidelines recommend DAPT for 12 months in patients with ACS undergoing PCI. However, data on ticagrelor monotherapy after early aspirin discontinuation (

Circulation, Volume 150, Issue Suppl_1, Page A4134668-A4134668, November 12, 2024. Background:Obstructive sleep apnoea (OSA) is a significant cause of hypertension. ACC/AHA Guidelines recommended screening and treatment of OSA in patients with hypertension; however, evidence comparing mandibular advancement devices (MAD) to continuous positive airway pressure (CPAP) on cardiovascular health is lacking. We present the complete 12 months follow-up data on the comparative effectiveness of MAD versus CPAP in ambulatory BP reduction, QoL, cardiac arrhythmia, and myocardial remodelling.Method:In a randomized, non-inferiority trial (margin 1.5 mmHg), 321 participants, aged over 40, with hypertension and high cardiovascular risk were recruited. Of these, 220 participants with OSA (apnoea–hypopnea index ≥15 events/h) were randomized to either MAD or CPAP (1:1). Pre-specified secondary outcomes include: ambulatory BP, quality of life (QoL) (sleep-specific: ESS, SAQLI, FOSQ; non-sleep-specific: SF-36, EQ-5D), ambulatory ECG monitoring, and cardiac MRI.Results:A total of 89 (80.9% of 110) participants from MAD, and 91 (82.7% of 110) participants from CPAP completed 12 months follow-up. The median daily usage was 5.5 hours for MAD and 4.9 hours for CPAP. The between-group difference in 24h mean BP from baseline to 12 months was – 0.57 mmHg (95% confidence interval: (-2.53 to 1.39, non-inferiority P < 0.001). Compared with the CPAP group, MAD group demonstrated a larger reduction in all the 24h with the most pronounced differences observed in the asleep BP parameters (Table 1). Both the MAD and CPAP improved QoL (Table 2). CPAP had greater improvement in FOSQ from sleep-specific questionnaires (P=0.038), and social QoL in SF-36 from non-sleep-specificl questionnaires (P=0.013). The ambulatory ECG monitoring (MAD: 2.8 ± 1.0 days, CPAP: 2.3 ± 1.1 days) showed no between-group differences in % atrial fibrillation(P=0.209), % ventricular ectopic isolated count (P=0.790) and % supraventricular ectopic isolated count (P= 0.333). The cardiac MRI sub-study (101 participants : MAD= 45, CPAP= 56) showed CPAP had greater improvement in right ventricular stroke volume (P=0.023) and MAD had greater improvement in circumferential strain favours the MAD group (P=0.015) (Table 3).Conclusion:At 12 months , MAD was non-inferior to CPAP for reducing 24h mean arterial BP. MAD showed greater reduction in 24h BPs, especially during asleep. While both the MAD and CPAP are effective in improving QoL, CPAP is more effective in improving FOSQ and social QoL (SF-36).

Circulation, Volume 150, Issue Suppl_1, Page A4142589-A4142589, November 12, 2024. Background:GLP-1 receptor agonists (GLP1RA) agonists have been shown to reduce cardiovascular events in patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). However, it is unclear whether early subclinical therapeutic changes can be detected from routine 12-lead electrocardiograms (ECGs).Methods:We finetuned a neural network (NN) from Pheiron’s phenotyping platform to predict subclinical risk markers from 12-lead ECGs using data from Dandelion Health, comprised of longitudinal, multimodal real-world clinical data for 106,289 patients receiving care from Sharp Healthcare in the US. Based on the finetuned NN, we predicted risk markers within an independent cohort of 48,376 patients with a history of T2D, ASCVD, or obesity and emulated a target trial to evaluate the subclinical effect of GLP1RA. The primary analysis compared percentile rank transformed ECG markers for GLP1RA and non-GLP1RA patients using inverse probability weighted (IPW) linear regression models, adjusted for key variables including demographics, comorbidities, medications, HbA1c, and BMI at baseline. Sensitivity analyses included unadjusted models, models with only covariate adjustments, and propensity score-matched models.Results:The emulated trial study cohort was, on average, 59.6 [SD 15.9] years old, predominantly female (56%), and racially diverse: 46.6% White, 25.3% Hispanic, 9.6% Asian, and 4.6% Black. Compared to the control group, the GLP1RA cohort had a higher baseline risk profile (BMI: 35.1 [SD 7.6] vs. 31.0 [SD 6.0], HbA1c: 7.1 % [SD 1.8] vs. 5.8 % [SD 0.9]) but cardiovascular risk progressed slower during the observation time: Each year of GLP1RA treatment was linked to percentile risk reductions of -1.65 (p

Circulation, Volume 150, Issue Suppl_1, Page A4146872-A4146872, November 12, 2024. Introduction:Increased prevalence and incidence of heart failure has resulted in a significant rise in the number of patients progressing to advanced heart failure (AHF). Heart transplant improves morbidity and mortality in patients with heart failure refractory to medical therapy. We examined resource utilization as measured in 30-day readmission in a contemporary population utilizing the NRD database.Aim:We conducted a thorough analysis to identify trends in 30-day readmissions of HTs and analyze the associated costs.Methods:Using the National Readmission Database from 2010 to 2021, the study focused on new HT recipients. We evaluated various parameters, including readmission rates and the costs associated with 30-day readmissions. Patients aged

Introduction
Differential target multiplexed spinal cord stimulation (DTM SCS) is a new stimulation paradigm for chronic pain management with the aim of modulating glial cells and neurons in order to rebalance their interactions. Animal studies revealed positive effects of this type of stimulation; however, studies in humans are still scarce, pointing towards the need for an evaluation of the effectiveness and safety of DTM SCS in clinical settings. Furthermore, the differential target multiplexed (DTM) algorithm consists of a combination of several programmes, which will presumably consume more energy from the spinal cord stimulation (SCS) battery. Therefore, the objective of DETECT is to investigate the feasibility, effectiveness and safety of DTM SCS in patients with Persistent Spinal Pain Syndrome Type II through a longitudinal cohort study.

Methods and analysis
DETECT is a prospective multicentre cohort study (n≥250) with a follow-up until 12 months after receiving DTM SCS. The study initiated in October 2021 and is currently still recruiting patients. Self-reporting outcome variables were evaluated at baseline (before SCS) and at 1, 6 and 12 months of DTM SCS. The primary effectiveness endpoint is overall pain intensity, measured with the visual analogue scale. Secondary effectiveness outcome measures are back pain intensity, leg pain intensity, disability, health-related quality of life, pain medication use, functional disability, clinical holistic responder status, self-management, impression of change, work status, pain catastrophising, symptoms of central sensitisation, anxiety, depression and healthcare utilisation. Time spent in different body postures and SCS stimulation parameters will be read out from the pulse generator. The prevalence of technical issues, recharge frequency, (serious) adverse events and the proportion of successful DTM trials will be collected as well. Longitudinal mixed models will be calculated to evaluate the effectiveness of DTM SCS over time.

Ethics and dissemination
The study protocol was approved by the central Ethics Committee of the Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (B.U.N.1432021000563) and the Ethics Committees of each participating centre. Research findings will be disseminated to key stakeholders through peer-reviewed publications in scientific journals and presentations to clinical audiences.

Trial registration number
NCT05068011.

Giornata mondiale,con prevenzione evitabili fino al 90% dei casi

Logopedisti: “Impatto sulla scuola e sul futuro lavorativo dei bambini”

Objective
The primary objective of this study was to assess caregivers’ perceptions of feeding practices (breastfeeding and complementary feeding) and diet diversity among children aged 12–59 months in a rural district of South India. The secondary objective was to identify potential predictors of these perceptions and diet diversity.

Design
An analytical cross-sectional study was performed from March 2023 to May 2023.

Setting
In a rural district of Tamil Nadu, South India.

Participants
This study included 301 mothers/caregivers of children between 12 and 59 months of age in a rural district of Tamil Nadu. The research gathered demographic information from caregivers, including details such as age, educational background, occupation, relationship with the child and place of residence. Additionally, the caregivers’ perspectives were evaluated through a questionnaire focused on breastfeeding/complementary feeding, and the diet diversity of the children was also assessed.

Outcome measures
The primary outcome was the perceptions of mothers/caregivers of children between 12 and 59 months of age about breastfeeding/complementary feeding practices, and the diet diversity of the children was measured. Additionally, predictors associated with these perceptions were evaluated through regression analysis.

Results
In the present study, 188 (62.5%) and 179 (59.5%) of the participants had good perceptions of breastfeeding practices and complementary feeding practices, respectively. This binomial regression revealed that subjects with unstable occupations (adjusted OR=2.24, 95% CI 1.25 to 4.01), schooling (7.71, 95% CI 2.73 to 8.9) and higher education (38.32, 95% CI 4.63 to 316.85) had increased chances of having good perceptions of breastfeeding practices. Subjects with unstable occupations (0.23, 95% CI 0.06 to 0.85), stable occupations (0.13, 95% CI 0.04 to 0.51), schooling (0.43, 95% CI 0.25 to 0.74), higher education (0.15, 95% CI 0.04 to 0.50) and increased birth weights (2.54, 95% CI 1.35 to 4.78) had increased chances of having good perceptions of complementary feeding practices (p

La quota maggiore quando aggressore non è un parente, studio Usa

La quota maggiore quando aggressore non è un parente, studio Usa