Risultati per: Standard di cura nel diabete – 2022

Circulation, Volume 150, Issue Suppl_1, Page A4120131-A4120131, November 12, 2024. Introduction:A growing number of patients develop atherosclerotic cardiovascular disease (ASCVD) despite the absence of standard modifiable risk factors i.e. hypertension (HTN), type 2 diabetes (T2D), dyslipidemia (DSL), and cigarette smoking (SMuRF-less). There is scarcity of studies on prevalence and clinical profiles of SMuRF-less patients in the Middle Ease (ME).Aim:To study the prevalence and clinical features of ME patients with ASCVD who are SMuRF-less vs. those with ≥ 1 SMuRFs, presence of other risk factors and utilization of secondary preventive medications in the 2 groups, and one year survival.Methods:Clinical details of adult patients with ASCVD who participated in 5 previous registries were analyzed according to the absence or presence of ≥ 1 SMuRFs.Results:Of the 5002 patients included in the analysis, 676 (13.5%) were SMuRF-less and 4326 (86.5%) had ≥ 1 SMuRFs. Prevalence of the 4 SMuRFs in the whole cohort was 53.5% HTN, 47.8% T2D, 40.2% smoking, and 37.5% DSL, and the SMuRF group was 61.9%, 55.2%, 46.5%, and 43.4%, respectively. Compared with the SMuRFs group, patients in the SMuRFless group were younger (mean age 52±11.4 years vs. 56.3±11.5 years, respectively, p

Circulation, Volume 150, Issue Suppl_1, Page A4141352-A4141352, November 12, 2024. Background:Major adverse cardiovascular events (MACE), including myocardial infarction, acute coronary syndrome, ischemic heart disease requiring revascularization, stroke, and heart failure, have been documented as significant contributors to mortality in cancer survivors. Coronary artery calcium (CAC) can predict MACE in non-cancer populations, while calcium in the aorta (CA) has not been evaluated as a prognostic marker. Every patient diagnosed with cancer undergoes a standard-of-care Positron Emission Tomography-Computed Tomography (PET-CT) or a chest CT before the initiation of chemotherapy.Hypothesis:To determine whether the CAC or CA of patients with Hodgkin’s or non-Hodgkin’s lymphoma, derived from standard-of-care PET-CT/chest CT, can predict the incidence of MACE.Methods:Patients treated with anthracycline-based chemotherapy, diagnosed and followed from January 1, 2013, through June 30, 2023, were included. Patients who did not undergo a PET-CT or CT, and/or developed MACE before treatment initiation were excluded. Univariate and multivariate adjusted Cox regression models were employed to assess whether the presence of CAC, CA, or CAC-CA was associated with the development of MACE. Calcium was retrospectively quantified using TeraRecon software (Durham NC) and categorized as: 0, 1-99, and >100. Outcome analyses was estimated using the Kaplan-Meier method.Results:326 patients were included, mean age of 55 years (range: 52-60), predominantly male 201 (61%) and white 314 (96%), CAC was found in 89 patients and CA in 140. In the univariate regression model, a statistically significant association was found with values >100 for CA, CAC and CAC-CA with the risk of MACE. (Fig 1a/b/c). CAC equal to 0 demonstrated a significant protective effect against MACE. (Fig 1a). In the multivariable analysis, these associations persisted even after adjusting for comorbidities. (Table 1).Conclusion:CAC, CA and CAC/CA >100 in the standard-of-care CT/PET CT are predictors of MACE in lymphoma patients undergoing anthracycline treatment, a CAC equal to 0 has protective effect, these relationships remained statistically significant after adjusting for comorbidities.

Circulation, Volume 150, Issue Suppl_1, Page A4141710-A4141710, November 12, 2024. Background:Stress perfusion CMR has excellent diagnostic and prognostic values in assessing chest pain syndromes. AI-guided methods may overcome complex scanning and increase clinical adaptation of stress CMR.Aim:To assess the benefits of AI-guided stress perfusion CMR.Methods:Consecutive patients with stable chest pain underwent stress CMR using either a standard scanning method (SOC) or an AI-assist (AIA) machine learning protocol to automate scan planning, plane prescription, sequence tuning, and image reconstruction. Scan duration, the ratio of scan preparation time over the entire scan duration, and scan quality using a 5-point scale were compared between AIA and SOC. Cox regression models were constructed to associate evidence of ischemia on stress CMR, by either scanning method, with composite endpoints including cardiovascular death, non-fatal MI, unstable angina hospitalization, and late CABG. A second composite endpoint included the performance of additional cardiac imaging tests (stress imaging and CCTA) and invasive coronary procedures after CMR.Results:Among 594 patients (62.8 ± 14 years), 29% underwent stress CMR with AIA. 26% had stress-perfusion ischemia, and 39% had LGE present. AIA stress CMR had lower scan duration (median 44.0 [IQR 40-47] vs. 52.5 min [IQR 46-60]; p

Circulation, Volume 150, Issue Suppl_1, Page A4119868-A4119868, November 12, 2024. Introduction:Low-income working-aged adults in the Medicaid program have a high burden of cardiovascular risk factors and disease, but often face barriers accessing necessary therapies. Little is known about contemporary patterns of utilization and spending on lipid-lowering therapies in Medicaid programs.Goal:To evaluate national trends in utilization and spending on statins and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in Medicaid.Methods:We performed a serial cross-sectional study using the Medicaid Spending by Drug Database, which contains national-level Medicaid spending data for medications partially or fully reimbursed by Medicaid for the approximately 84 million beneficiaries. We evaluated annual trends in utilization (prescription fills) and total spending for statins and PCSK9i from 2018 to 2022, both overall and by individual drug formulation. Spending was adjusted for inflation and reported in 2022 US dollars.Results:Medicaid beneficiaries filled 20.4 million statin prescriptions in 2018 compared to 20.3 million in 2022, representing a 0.4% decrease. However, Medicaid spending on statins decreased by 7.1%, from $246.2 million to $226.8 million over the same period. Prescription fills for generic Rosuvastatin increased the most (0.79 million to 2.6 million, +224.2%), while fills for brand-name Crestor decreased the most (0.065 million to 0.003 million, -95.2%). Medicaid beneficiaries filled 121,737 prescriptions for PCSK9 inhibitors in 2022 compared to 7,617 in 2018 (+1498%), coinciding with a 640% increase in total spending ($8.9 million to $65.7 million). Repatha Sureclick was the most filled PCSK9i in Medicaid with 80,503 fills in 2022, representing $43.9 million in total Medicaid spending.Conclusions:Despite almost no change in statin utilization between 2018 and 2022, Medicaid spending on statins fell by approximately $20 million, driven by a shift from brand-name to generic formulations. In contrast, spending on PCSK9 inhibitors increased by $57 million as these medications became more widely used. Understanding these trends is critical as Medicaid programs work to ensure access to effective cardiovascular therapies while also identifying opportunities for cost efficiencies nationwide.

Circulation, Volume 150, Issue Suppl_1, Page A4146291-A4146291, November 12, 2024. Background:Circulatory diseases represent the primary cause of mortality in the US. Comprehending trends and potential disparities in the prevalence of circulatory conditions, such as angina pectoris (AP), myocardial infarction (MI), hypertension (HTN), and coronary heart disease (CHD), is essential for forming public health strategies.Aim:To investigate trends in the prevalence of circulatory conditions, including AP, MI, HTN, and CHD among US adults from 2019 to 2022.Methods:Prevalence percentages for all available circulatory diseases from the Centers for Disease Control and Prevention’s National Health Interview Survey (NHIS) database were retrieved for patients aged >18 years from 2019 to 2022. Annual Percentage Changes (APCs) along with their respective 95% CIs were calculated using regression analysis with Join point. The data was stratified by year, gender, age, race, nativity, veteran status, social vulnerability, employment status, metropolitan statistical area (MSA) status and census region.Results:Between 2019 and 2022, HTN was steadily the most prevalent, staying relatively constant at 27.0% (95% CI: 26.4, 27.7) in 2019 and 27.2% (95% CI: 26.5, 27.8) in 2022. Males consistently had higher prevalence than females with significant increases noted from 2019 to 2022 (APC: 1.0234). Black or African American had the highest prevalence (34.4% in 2022). The South (30.1% in 2022) and the West (22.5% in 2022) had respectively the highest and lowest rates. The second highest prevalence was seen in CHD increasing from 4.6% (95% CI: 4.3, 4.9) in 2019 to 4.9 (95% CI: 4.7, 5.2) in 2020. Males consistently exhibited a higher prevalence than females, with both genders showing significant increases in recent years (Male APC: 3.1448) (Female APC: 2.0165). For MI, a slight decrease was noted from 3.1% (95% CI:2.9, 3.4) in 2019 to 3.0% (95% CI:2.7, 3.2) in 2022. White individuals exhibited the highest prevalence (3.3% in 2022). AP had the lowest overall prevalence staying relatively consistent (1.7% in 2019 and 1.6% in 2022) (Figure 1).Conclusion:Significant trends (Figure 2) in most common circulatory diseases have been identified. Targeted interventions are imperative, particularly for high-risk demographics such as males, older adults, veterans, and unemployed individuals.

Circulation, Volume 150, Issue Suppl_1, Page A4140901-A4140901, November 12, 2024. Background:This meta-analysis aims to compare chest compression-only cardiopulmonary resuscitation (CO-CPR) with standard CPR (sCPR), which includes mouth-to-mouth ventilation, as potential strategies for managing out-of-hospital cardiac arrest (OHCA).Methods:We systematically searched various databases and registries such as MEDLINE, Embase, The Cochrane Library, and Clinicaltrials.gov to retrieve relevant studies. We used the revised Cochrane “Risk of bias” tool for randomized trials (RoB 2.0) to assess the risk of bias in included studies. Revman 5.4 was used to pool dichotomous outcomes under a random effects model.Results:A total of 4 RCTs were included in our meta-analysis. Our results indicate that CO-CPR was associated with a significantly increased survival to hospital discharge compared to sCPR (RR 1.22, 95% CI: 1.01 to 1.46) with minimal heterogeneity (I2= 0%). No significant difference was observed between the two groups regarding 1-day survival (RR 1.07, 95% CI: 0.94 to 1.23), survival to hospital admission with a good neurological outcome (CPC 1 or 2) (RR 1.10, 95% CI: 0.80 to 1.51), return of spontaneous circulation (RR 1.05, 95% CI: 0.95 to 1.17), and survival to hospital admission (RR 1.08, 95% CI: 0.93 to 1.25).Conclusion:This meta-analysis found that chest compression-only CPR (CO-CPR) significantly improves survival to hospital discharge compared to standard CPR for managing OHCA while yielding comparable results for other resuscitation outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4136889-A4136889, November 12, 2024. Background:In patients with acute myocardial infarction (AMI), recent studies have intriguingly reported that up to a quarter of AMI patients have none of the 4 main standard modifiable cardiovascular (CV) risk factors (SMuRFs) (i.e. hypertension (HTN), diabetes mellitus (DM), hypercholesterolemia (HC), and smoking) and have worse mortality.Hypothesis:We tested the hypothesis that the prevalence and prognosis of SMuRF-less patients varies with the definition of risk factors.Aim:Using a French nationwide MI cohort, we aimed to compare SMuRF-less ST-segment elevation MI (STEMI) patients according to 2 HC definitions, given the possibility of using several HC criteria.Methods:The French Cohort of Myocardial Infarction Evaluation (FRENCHIE) is a large ongoing AMI cohort, collecting data from all patients hospitalized for AMI < 48 h of symptom onset in 21 French centers. STEMI patients without prior CAD admitted in 2019 to 2022 were studied. DM was defined as prior DM diagnosis, HbA1c >7% or anti-diabetic medications, ongoing or at discharge, HTN was defined as treated or previous HTN diagnosis and smoking was defined as current smoking within the past month. Restrictive HC (RHC) was defined as either a previous diagnosis of HC or statin therapy. Permissive HC (PHC) was defined as previous diagnosis of HC or lipid-lowering therapy, or LDL-C > 135 mg/dL or total Cholesterol > 213 mg/dL.Results:Among 8008 patients (mean age 61.5± 12.9y, 22.6% women), 41.4% were smokers, 17.4% had diabetes, and 38.5% HTN. According to HC definitions, the prevalence of HC almost doubled, ranging from 30.3% for RHC to 61.0% for PHC. Consequently, the prevalence of SMuRF-less was divided by ≈ two (21.1% vs 11.3%, respectively), depending on the definition of HC used. Age and sex-adjusted logistic regression analysis showed that PHC, but not RHC, was associated with lower odds of in-hospital death (figure). Moreover, having multiple SMuRFs was associated with higher risk of mortality than no SMuRF when using RHC, but not with PHC definition.Conclusion:The prevalence and impact on acute mortality of being SMURFless varies largely with the definition of HC. More research is needed, using HC standardized definitions to explore these patients.Frenchie:was supported in part by the RHU iVASC grant ANR-16-RHUS-00010 from the French National Research Agency (ANR) as part of the Investissements d’Avenir program. The FRENCHIE cohort is registered with ClinicalTrials.gov, NCT04050956.

Circulation, Volume 150, Issue Suppl_1, Page A4141704-A4141704, November 12, 2024. Background:The multiple electrodes needed to generate a 12-lead electrocardiogram (12L ECG) limits its use to traditional health care settings. An innovative credit-card sized unit (HeartBeam, Santa Clara, CA, USA) when placed on the chest without cables captures a vectorcardiogram (VCG). A personalized transformation matrix (PTM) then converts the signals into a 12L ECG.Objective:This is the first quantitative (standard intervals and amplitudes) and qualitative (rhythm diagnosis) accuracy assessment of a synthesized 12L ECG (Syn 12L) compared to a simultaneously recorded standard 12L ECG (Std 12L) on patients in sinus rhythm (SR) or in a non-life-threatening arrhythmia.Methods:The 80 patients, who were enrolled at a single center (Dedinje Cardiovascular Research Institute, Belgrade, Serbia), first underwent recording of a Std 12L and VCG to create a unique PTM, which was used to create the Syn 12L from the VCG. Then a simultaneous Std 12L and VCG were recorded. The quantitative endpoint was the calculated difference (mean and standard deviation [SD]) between the Syn 12L and Std 12L in a series of intervals (RR, PQ, QJ, and QT) and amplitudes (P wave, R wave, and T wave). For the qualitative endpoint, 2 blinded electrophysiology physicians (EP) classified the Syn 12L and Std 12L arrhythmia status.Results:Of the 80 patients, 41 were in SR and 39 in another rhythm (3:SR with PACs, 5:SR with PVCs, 1:SR with pre-excitation, 16:atrial fibrillation, 3:atrial flutter, 2:atrial pacing, and 9:ventricular pacing). The interval and amplitude differences are listed in the table. Rhythm classification by the blinded EPs demonstrated a sensitivity of 94.9% (95% CI: 82.7-99.4%) and specificity of 100% (95% CI: 91.4-100%) compared to Std 12L.Conclusion:In this first study comparing the performance of a 12L ECG created from a credit card sized VCG recorder, the 12L Syn demonstrated clinically equivalent interval and amplitude accuracy and excellent agreement in arrhythmia classification when compared to a simultaneously recorded 12L Std. This approach holds significant promise, potentially permitting patients to obtain a 12L ECG outside of a health care setting with a compact, easy to use device.

Lo indica l’analisi della Federazione europea medici salariati

Circulation, Volume 150, Issue Suppl_1, Page A4136636-A4136636, November 12, 2024. Introduction:Substantial evidence indicates that racial and ethnic diversity among the physician workforce bridges cultural gaps and improves patient care. Trends in racial diversity across the full training pipeline from undergraduate to practicing cardiologist are not yet well-characterized.Aims:We analyze racial disparities at each stage of training towards becoming a practicing cardiologist, and identify changes in these disparities between 2012 and 2022.Methods:We conducted a retrospective analysis of data specifying the racial composition of medical trainees acquired from the Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, and Electronic Residency Application Service. Population data was acquired from the US Census Bureau. We computed the representation quotient (RQ) for each racial group at each stage to compare representation among the trainees or physicians to age-matched segments of the US population.Results:RQ decreases from undergraduate to active cardiologist for African Americans (0.719 to 0.314), Hispanics (0.660 to 0.359), American Indians (0.551 to 0.221), and Native Hawaiians (1.121 to 0.512). The lowest RQs of 0.133 and 0.137 were observed for American Indian active internal medicine residents and cardiology fellows, respectively. Racial disparities in medical education declined between 2012 and 2022, with RQs increasing from 0.541 to 0.735 for African American medical school matriculants and from 0.444 to 0.578 for Hispanic medical school matriculants. Similar increases were seen in the active cardiologist population for African Americans (2013 RQ: 0.227, 2022 RQ: 0.342) and Hispanics (2013 RQ: 0.283, 2022 RQ: 0.375).Conclusion:While racial diversity in the cardiology training pipeline has increased over the last decade, significant disparities persist for under-represented minorities. Addressing these barriers will help achieve a cardiology workforce reflective of the diverse population it serves.

Circulation, Volume 150, Issue Suppl_1, Page A4137708-A4137708, November 12, 2024. Introduction:Intravenous hydration and contrast media volume reduction are the most important preventive factors against CI-AKI after PCI. Multiple studies have demonstrated the effectiveness of intravenous hydration before PCI, however, varied hydration protocols have rather complicated standardization. Doctors’ preferences and local institutional factors further hinder protocol implementation, resulting in reduced compliance.Hypothesis:Standardizing hydration protocol increases the compliance rate of preprocedural hydration orders and administration, reducing the incidence of CI-AKI.Methods:A team at Memorial Hermann The Woodlands Medical Center, comprising a cardiovascular nurse coordinator, catheterization laboratory director, pharmacist, information technologist, and hospital administrators, was formed to improve PCI outcomes through a multi-faceted approach. This involved a standardized hydration protocol with direct education, continuous monitoring, and repeated internal feedback, reviewed monthly. The new protocol included normal saline pre- and post-procedure maintenance fluids, with a 250 ml normal saline bolus pre-operatively. Maintenance fluids were set at 75 ml/hr, and 20 ml/hr for patients with congestive heart failure and an ejection fraction ≤ 40%. The team reviewed 233 patients under the old protocol and 281 under the new protocol. Compliance rates of pre-procedural intravenous hydration were compared and CI-AKI incidence, defined as a >50% increase or a 0.3 mg/dL increase in creatinine levels within 5 days post-procedure, was assessed. Chi square tests and t-tests were used to compare cohorts on 12 parameters and CI-AKI incidence assessment, with a p-value of 0.05.Results:Compliance with pre-procedural hydration significantly increased under the new protocol (86.1% vs 55.4%, p

Circulation, Volume 150, Issue Suppl_1, Page A4138167-A4138167, November 12, 2024. Background:Intracerebral hemorrhage (ICH) has high morbidity and mortality. Traditional craniotomy causes significant trauma and lacks proven benefits. Minimally invasive techniques (MIT) like CT-guided thrombolysis, endoscopic, and neuronavigation surgeries show promise in reducing secondary neurotoxicity. Our meta-analysis compares MIT with standard treatments for supratentorial spontaneous intracerebral hematomas (SSICHs) to evaluate their effectiveness in improving clinical outcomes.Methods:We comprehensively searched PubMed, EMBASE, and Cochrane Library for studies published before June 1, 2024, comparing MIT versus standard treatment for ICH. Data were analyzed using R (v.4.3). Pooled proportions with 95% confidence intervals (CIs) were calculated using a random effects model. Odds ratios (ORs) and mean differences (MDs) with 95% CIs were used for dichotomous and continuous variables. Outcomes included overall survival, functional neurological outcome, hospitalization length, recurrent bleeding, volume reduction, and Glasgow Coma Scale (GCS) score at discharge.Results:We identified six studies, including 1,117 patients. There were 463 patients who underwent MIT and 654 patients who received standard treatment. The MIT group exhibited statistically significant increased odds of survival (OR: 1.98 [1.25, 3.15]; I2=26%; p=0.004) and functional neurological outcome (OR: 1.94 [1.27, 2.96]; I2=25%; p=0.002) compared to the standard treatment group. The MIT group demonstrated statistically significant lower length of hospitalization (MD: -2.89 [-4.49, -1.30]; I2=47%; p=0.0004) and better GCS score at discharge (MD: 1.50 [1.00, 2.00]; I2=0%; p

Circulation, Volume 150, Issue Suppl_1, Page A4141113-A4141113, November 12, 2024. Background:Pericardial Diseases (PD) have become a significant cause of morbidity and mortality over the last two decades. They contribute secondarily to deaths associated with other primary illnesses and can present clinically as pericarditis, pericardial effusion, and hemopericardium. Despite treatment advances, U.S. mortality trends for PD are unexplored.Aim:This study aims to assess the trends in PD-related deaths in the United States from 1999 to 2022.Methods:PD-related deaths in adults aged 25 years and above were identified through CDC WONDER database from 1999 to 2022 from multiple causes of death. Crude mortality rates and age-adjusted mortality rates (AAMR) per 100,000 population were determined. Joinpoint regression was used to examine changes in trends and annual percentage change (APC) overall, and then stratified by sex, ethnicity, and age groups.Results:A total of 105,536 deaths occurred from PD between 1999 to 2022. Overall, AAMR related to PD decreased from 1999 (2.4) to 2012 (1.7) (APC -2.73 [95% CI, -3.09 to -2.36]), then gradually increased until 2019 (2.0) (APC 2.92 [95% CI, 1.57 to 4.29]), followed by a sharp increase until 2022 (APC 7.65 [95% CI, 4.42 to 10.99]). After an initial decline, APC in AAMR increased in women (4.36) starting in 2012, while in men, it decreased significantly until 2011 (-2.26), followed by a slight increase until 2016 (1.05), and then a marked increase from 2016 to 2022 (4.19). After an initial decline, AAMR increased among non-Hispanic (NH) Blacks (APC 5.42) and NH Whites (APC 4.95) starting in 2014, among Hispanics (APC 4.10) from 2012 to 2022, and among NH Asian or Pacific Islanders (APC 2.4) from 2007 to 2022. Mortality rates have been steadily increasing across all age groups over the last decade, with the highest increase seen recently in the 85+ age group (2017-2022 APC 9.09 [95% CI, 6.50 to 11.76]).Conclusion:PD-related mortality has increased over the last decade. Mortality among males, NH Blacks, and the 85+ age group has been growing at a faster rate than any of the other groups. These results highlight the need for further investigation into the factors contributing to the observed disparities and trends in PD mortality rates.

Circulation, Volume 150, Issue Suppl_1, Page A4147972-A4147972, November 12, 2024. Introduction:Recent studies have highlighted the cardiotoxic effects of novel androgen deprivation therapy for prostate cancer. The association of demographic and geographic background on cardiovascular disease (CVD)-related mortality in patients with prostate cancer is unclear.Goals:We aimed to analyze the trends in CVD mortality among patients with prostate cancer in the United States (US) from 1999-2022, with stratification by age, race, census region, rural-urban status, place of death, and specific CVD types.Methods:The age-adjusted mortality rates (AAMR) per 100,000 people were extracted using the Centers for Disease Control and Prevention WONDER database from 1999-2022. Joinpoint regression was utilized to calculate annual percentage change (APC) with 95% confidence intervals to assess for significant differences in change in AAMR over time.Results:A total of 440,318 deaths occurred due to CVD in patients with prostate cancer in the US in the last 20 years. The AAMR declined from 1999 to 2016 (APC -3.0 [-3.3, -2.8]) and rose till 2022 (APC 4.6 [3.4, 6.2]). AAMRs were stable in recent years for Non-Hispanic (NH) Asian or Pacific Islanders (2018-2020; APC (11.7 [-0.9, 17.9]) and NH American Indian or Alaska Native men (1999-2022, APC (-0.6 [-1.6, 0.3]). NH Black, NH White, and Hispanic men had a significant increase in AAMR from 2017 (APC 4.9), 2016 (APC 5.1), and 2018 (APC 7.0) to 2022, respectively, after an initial decline. NH Black men had the highest AAMR across all census regions. Mississippi, the District of Columbia, Nebraska, and California had the greatest overall AAMRs. The AAMRs were higher in rural than urban areas (5.9 vs 5.3/100000 people). Most deaths occurred in the decedent’s home (35.3%) and in men aged >85 years. Ischemic heart disease (AAMR 2.0), hypertensive disease (AAMR 1.7), and cardiac arrest (AAMR 1.4) were the top 3 causes of CVD-related mortality among patients with prostate cancer.Conclusion:CVD mortality in prostate cancer patients has increased in recent years with the greatest AAMR in NH Black and elderly men, and those living in rural areas. Identifying the causes and creating policies to reduce disparities requires further research.

Circulation, Volume 150, Issue Suppl_1, Page A4137991-A4137991, November 12, 2024. Introduction:The 2022 AHA/ACC/HFSA heart failure (HF) classification newly incorporates cardiac biomarkers to identify patients at risk of HF.Research Question:Given shared risk factors between HF and other cardiorenal events, the HF stages may also guide prognosis and management of cardiovascular (CV) and kidney-related events beyond HF.Aims:Examine the association of HF stage with CV and kidney events.Methods:SCORED was a randomized trial in diabetes with kidney disease comparing sotagliflozin (sota) v. placebo on CV death, hospitalizations for HF, and urgent HF visits. SCORED participants were grouped by HF stagepost hoc. Stage A: No HF, normal cardiac biomarkers (NT-proBNP;

Circulation, Volume 150, Issue Suppl_1, Page A4147960-A4147960, November 12, 2024. Introduction:Blood pressure targets for the elderly are still controversial, there is a lack of certainty about the benefit and safety of targeting ≤ 130mmHg systolic blood pressure. Evaluate the benefit in important cardiovascular outcomes and safety in elderly patients of a blood pressure control ≤ 130mmHg compared to standard of care.Methods:The research was performed in PubMed, EMBASE, Scielo, LILACS, and Cochrane Central Register of Controlled Trials (CENTRAL) from January 1st, 2013 to May 1st, 2023. Randomized controlled trials that were published between January 1st, 2013 and May 1st, 2023 that included hypertensive patients over 60 years old which reported major adverse cardiovascular outcomes (MACE) or all-cause mortality, cardiovascular mortality and safety outcomes were selected. The data extraction was performed independently by two investigators following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A meta-analysis was performed using a fixed-effect model. The results were reported as the pooled results using risk ratio (RR) and a confidence interval (CI) of 95%.Results:The 4 trials included a number of 16,834 patients, the mean age was over 65 years, there was a good balance between genders, 13.3% of patients had cardiovascular disease, 10.9% diabetes, and 15.5% chronic kidney disease. The mean achieved blood pressure was roughly under 130mmHg, only one study was over (135mmHg) and the mean follow-up time was over 32 months. The intensive therapy decreased the outcomes for mortality (RR = 0.75, 95% CI 0.64 – 0.87, p