Search Results for: Atlante della salute mentale 2011

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 A4142264-A4142264, November 12, 2024. Background:Two de-escalation options of dual antiplatelet therapy (DAPT) have been proposed to mitigate bleeding risk in patients (pts) with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI), including maintaining DAPT but reducing its intensity by changing potent P2Y12 inhibitor (P2Y12i) to clopidogrel or discontinuation of DAPT by using P2Y12i monotherapy. Our study aims to evaluate the use of de-escalation therapies after discharge in AMI pts undergoing PCI and compare the clinical outcomes of the two de-escalation options.Methods and Results:In the Taiwan National Health Insurance Research Database, we included adult pts (≥ 18 yrs) who received PCI for AMI and survived to discharge with DAPT. Pts who need oral anticoagulant were excluded. From 2011 to 2021, 58989 pts (mean age 61.9±13.2 yrs, male 81.4%) were included. After 2016, >70% pts were treated with aspirin plus ticagrelor (A+T) at discharge. In A+T users (n=28698), de-escalation for any reason occurred in 52.2% during follow-up. Among de-escalation therapy, aspirin plus clopidogrel (A+C, 55.8%) and ticagrelor monotherapy (T mono, 15.5%) were most commonly used in the first 6 mo. The mean duration from discharge to de-escalation to T mono vs. A+C was 52.5±69.3 vs. 68.4±70.7 days (p

Circulation, Volume 150, Issue Suppl_1, Page A4139542-A4139542, November 12, 2024. Background:Cardiac sympathetic denervation (CSD) is a well-established procedure to prevent ventricular arrhythmias in genetic and acquired arrhythmia syndromes. It is unknown whether initial bilateral (B) CSD or left (L) CSD, followed by right (R) CSD for breakthrough events is the better strategy.Aims: We compared the antiarrhythmic efficacy and complications of primary B vs L CSD at a single center where both are performed routinely.Methods:Patients who underwent CSD were retrospectively identified. At our center L CSD is performed in children while B CSD is performed in adults by operator preference. Demographic data, procedural indications, complications, and arrhythmia events (arrhythmic syncope, sudden cardiac arrest, appropriate shock) were collected. Arrhythmia events (AE) were compared before and after CSD in those with arrhythmia indications. Complications were compared in all subjects and in the subset with arrhythmia indications.Results:Between 2011 and 2023, 65 patients underwent 68 CSD procedures (39 B, 26 L, 3 R after initial L). As expected, BCSD patients were older [median 32 (IQR 21-48) years vs. 16 (6-38) years; P=0.002]. Overall complication rates were similar [BCSD 17/39 (44%) vs 12/29 (41%), P=0.85]; most were transient/minor. Complications that required intervention were rare (n=5) and only observed after BCSD. Forty CSD were for an arrythmia indication (18 B, 21 L, 1 R). AEs were reduced from a median of 3 (1-4) before CSD to 0 (0-1) after CSD (p

Circulation, Volume 150, Issue Suppl_1, Page A4137917-A4137917, November 12, 2024. Background:The Trial to Evaluate Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT) showed cardiovascular disease (CVD) benefits of semaglutide therapy in patients with preexisting CVD and overweight or obesity.Purpose:To estimate the number of US adults with CVD and overweight or obesity that may be eligible for semaglutide based on SELECT eligibility criteria and the number of preventable CVD events from semaglutide treatment based on observed CVD event reductions in SELECT.Methods:We included US adults from the National Health and Nutrition Examination Survey (NHANES) 2011-2020 who had eligibility criteria from SELECT. This included patients aged >45 years who had preexisting CVD and a BMI of >27kg/m2but no history of diabetes. Using NHANES sample weighting, we estimated the number of SELECT-eligible US adults and primary composite and secondary CVD endpoints that would occur based on SELECT treated and placebo published event rates, with the difference indicating the number of preventable events (and annualized based on mean 3.3-year follow-up).Results:Among 8783 (projected to 77.9 million [M]) adults with overweight or obesity, we estimated 493 (4.1 million) (5.61%) to fit SELECT eligibility criteria. Compared to SELECT trial participants, our sample had a higher proportion of Black participants and was older with higher levels of diastolic blood pressure, total, LDL and HDL-cholesterol, and lower BMI, HbA1c, eGFR and triglycerides. Prior myocardial infarction was less common, but stroke was more common in our sample. From SELECT semaglutide and placebo primary composite CVD event rates of 6.5% and 8.0%, respectively, we estimated 79949 and 98399 CVD events would occur annually, the difference being 18450 potentially preventable CVD events. Moreover, we similarly estimated 104,549 and 357,928 annual preventable cases of diabetes and pre-diabetes, respectively. The Figure shows the estimated number of primary and secondary CVD outcomes that could be prevented annually.Conclusion:Semaglutide may prevent many fatal and non-fatal CVD events, as well as incident cases of diabetes and pre-diabetes if provided to US adults meeting SELECT eligibility criteria. More efforts are needed to educate clinicians and patients on the benefits of semaglutide 2.4mg in those with preexisting CVD and overweight or obesity.

Circulation, Volume 150, Issue Suppl_1, Page A4144988-A4144988, November 12, 2024. Background:The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory marker predicting cardiovascular mortality (CVM) and all-cause mortality (ACM) among the general population. We aim to investigate this association in patients who underwent peritoneal dialysis (PD).Methods:We systematically reviewed articles from PubMed, Google Scholar, and Scopus until May 2024 on the association of ACM and CVM in patients with NLR following PD. We used a fixed effects model, 95% confidence intervals (CI), and I2statistics to pool unadjusted and adjusted hazard ratios (HR) and measure heterogeneity. Leave-one-out sensitivity analysis was employed to study how each study alters the overall effect of the studies. Multivariate meta-regression was utilized to identify influencing confounding factors. Quality assessment of the studies was done through the Joanna Briggs Institute (JBI) tool. For all results, a P value < 0.05 was considered significant.Results:Out of 160 articles screened, seven studies spanning from 2011 to 2023 with 4,350 patients, a mean age of 49.9 ± 15, and a median follow-up of four years were included in our meta-analysis. We found that higher NLR ( >2.88) was significantly associated with ACM (aHR: 1.09, 95% CI: 1.05–1.12, p2.88) and outcomes such as ACM and CVM. This association can help prevent deaths in the older population and encourage proper utilization of the elderly resources. Additionally, age was a significant potential confounder for ACM in patients who are receiving PD. Thus, caution should be taken when predicting mortality in the elderly population.

Circulation, Volume 150, Issue Suppl_1, Page A4137914-A4137914, November 12, 2024. Background:The Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes (SUSTAIN-6) trial showed cardiovascular disease (CVD) benefits of semaglutide therapy in patients with type 2 diabetes mellitus (T2DM).Purpose:To estimate the number of US adults with T2DM that may be eligible for semaglutide based on SUSTAIN-6 eligibility criteria and the number of preventable CVD events from semaglutide treatment based on observed CVD event reductions in SUSTAIN-6.Methods:We included US adults with T2DM from the National Health and Nutrition Examination Survey (NHANES) 2011– 2020 who had eligibility criteria from SUSTAIN-6. This included an HbA1c >7.0%, age >50 with established CVD, heart failure, or chronic kidney disease or an age >60 with at least one CVD risk factor. We estimated the number of primary composite and secondary CVD endpoints that would occur based on SUSTAIN-6 treated and placebo published event rates, with the difference indicating the number of preventable events (and annualized based on median 2.1 year follow-up time).Results:Among 5002 (projected to 34.0 million [M]) adults we identified with T2DM, we estimated 1,132 (6.9 million) (20.3%) to fit SUSTAIN-6 eligibility criteria. Compared to SUSTAIN-6 trial participants, our sample was slightly older, had a higher proportion of Black participants, shorter duration of diabetes, lower HbA1c and diastolic blood pressure, but similar body mass index and systolic blood pressure. Prior history of ischemic heart disease, myocardial infarction, and stroke were also less common in our NHANES sample. From SUSTAIN-6 semaglutide and placebo primary composite CVD event rates of 6.6% and 8.9%, respectively, we estimated 456,060 and 614,990 events would occur, respectively, for a total of 159,930 preventable CVD events, or 75,681 on an annualized basis. We similarly estimated annualized preventable events for secondary outcomes as shown in the Figure.Conclusion:Semaglutide may prevent many fatal and non-fatal CVD events if provided to US adults meeting SUSTAIN-6 eligibility criteria. More efforts are needed to educate the healthcare providers on the CVD benefits from newer diabetes therapies, including semaglutide.

Circulation, Volume 150, Issue Suppl_1, Page A4113188-A4113188, November 12, 2024. Introduction:Physical activity (PA) may be associated with a lower risk of atrial fibrillation (AF), but this relationship remains controversial. In particular, further research is needed on the association between changes in PA intensity and AF risk among older adults.Hypothesis:We hypothesized that an increase in PA intensity would be associated with a reduced risk of AF among older adults aged 65 years and older in South Korea.Aim:This cohort study aimed to evaluate the association between changes in metabolic equivalent tasks (METs)-min/week and the risk of AF in the elderly using a nationally representative database.Methods:We conducted a retrospective cohort study using the Korea National Health Insurance Service (KNHIS) database. This cohort included 1,726,697 individuals aged 65 years and older without a history of cardiovascular disease diagnosis who underwent two consecutive health screening examinations from 2009 to 2012. PA was defined as MET-min/week derived from two consecutive health examinations during 2009-2010 (1st period) and 2011-2012 (2nd period), respectively. The primary outcome was an AF diagnosis during the follow-up period from 2013 to 2021. We estimated the sub-distribution hazard ratio (sHR) and 95% confidence interval (CI) for the association of changes in PA intensity with AF using Fine-Gray sub-distribution hazard models after adjustment for covariates.Results:This study included 1,726,697 participants (mean age 71.08; 46.78% male). An increase in PA intensity was associated with a reduced risk of AF (P for trend

Circulation, Volume 150, Issue Suppl_1, Page A4146919-A4146919, November 12, 2024. Background:Delta-Like Ligand 4 (DLL-4) blockade with therapeutic monoclonal antibodies is an emerging cancer treatment targeting tumor angiogenesis. Inhibition of DLL-4 within the pulmonary vasculature allows for unopposed JAG-1-NOTCH3 signaling, leading to pulmonary vascular smooth muscle (vSMC) cell proliferation and the development of pulmonary arterial hypertension (PAH).Hypothesis:Clinical trials using DLL-4 inhibitors may show an increased incidence of PAH as a side effect of the drugs tested.Aims:Review the PAH incidence as an adverse outcome in DLL-4 inhibitor clinical trials.Methods:Clinicaltrials.gov was queried for studies on DLL-4 inhibition. Patient demographics, medication regimens, trial methodology, and outcomes were recorded. Adverse events were categorized according to National Cancer Institute Common Terminology Criteria for Adverse Events. PAH grades were defined as ranging from mild dyspnea (Grade 1) to life-threatening airway consequences or death (Grade 4-5). Degree of PAH was determined by the clinical trial investigators. Echocardiography and cardiac catheterization were most widely used as PAH diagnostic modalities.Results:Thirteen clinical trials (Phase: 1[n=3], 1a[n=1], 1b[n=6], 2[n=3]) from 2011-2023 investigating DLL-4 or DLL-4/VEGF inhibitors were included. The most common antibody used was Demcizumab(6), followed by Navicixizumab(2), Dilpacimab(2), ABL001(2), and Enoticumab(1). A total of 672 patients (median age 60, 52.5% female) underwent treatment. There were 74 new PAH cases reported (average incidence of 11.7%[± 5.8%]). Four of seventy-four PAH patients also manifested LHF. PAH grades 1-2 represented 81% (n=60) of cases, and 19% (n=14) were grades 3-5. PAH incidence was higher in combination DLL-4-VEGF inhibitor trials versus sole DLL-4 inhibitor trials (16.2% vs 7.9%). Phase 1 and 2 trials displayed similar PAH incidences (11.4% vs 13.0%). Resolution of PAH after drug cessation was reported in 46% of the studies.Conclusions:DLL-4 inhibition treatment for malignancies has demonstrated PAH as a side effect. These results are in accordance with our previous observation that unopposed JAG-1-NOTCH3 signaling, induces pulmonary vascular SMC proliferation and PAH. Discontinuation of DLL-4 inhibitors leads to resolution of disease. Further studies are needed to minimize PAH risk while optimizing oncological benefits of DLL-4 inhibitors before widespread utilization.

Circulation, Volume 150, Issue Suppl_1, Page A4141165-A4141165, November 12, 2024. Background:Current evidence supports the use of the Ross procedure (pulmonary autograft) in adults with aortic valve disease.Aims:To examine the ten-year clinical and echocardiographic outcomes following the Ross procedure using a tailored approach.Methods:This prospective cohort included 455 consecutive adults (333 male [73.1%]) with a median age of 50.0 years (IQR, 40.0-57.0) undergoing a Ross procedure at a single center. Patients with aortic aneurysms (37.4%), previous cardiac surgery (15.2%) and active endocarditis (5.7%) were included. The predominant lesion was aortic stenosis (AS) in 379 patients (83.3%) and aortic insufficiency (AI) in 76 patients (16.7%). The study period ranged from February 1, 2011, to December 31, 2019. Primary endpoints were cumulative incidence of any, autograft, or homograft reintervention, and time-related valve function (AI grades 0-4). The secondary endpoint was ten-year survival among Ross patients compared with that in the age- and sex-matched Canadian population. Median clinical follow-up was 6.0 years (maximum 13 years). Follow-up was 90% complete for clinical and 87% complete for echo follow-up.Results:Operative mortality was 0.4% (n=2). Both patients were operated among the first 100 cases. At 10 years, cumulative incidence of any aortic and/or pulmonary reintervention was 5.0% (95% CI, 2.3-9.4%); autograft reintervention 1.5% (0.5-3.4%); and homograft reintervention 3.4% (1.9-5.7%). In patients with preoperative AS, cumulative incidence of autograft reintervention was 1.8% at 10 years (0.6-4.1%), versus 0% in patients with preoperative AI (p=0.6) (Figure 1). At 10 years, cumulative incidence of AI grade >2 was 2.0% (0.9-4.2%), and did not differ between patients with preoperative AS or AI (p=0.9) (Figure 1). Ten-year survival was 96.5% (95% CI, 94.7-98.7%), translating to a relative survival of 100% (99.4-100%) compared to the matched general population.Conclusion:This study demonstrates that using a tailored surgical approach and contemporary perioperative management strategies, the Ross procedure is associated with excellent long-term valve function and freedom from reintervention in an all-comer adult patient population. Moreover, it translates into restored late survival, mimicking the general population. These results further support the notion that, in reference centers, the Ross procedure should be considered in adults needing valve replacement.

Circulation, Volume 150, Issue Suppl_1, Page A4144000-A4144000, November 12, 2024. Background:Immune checkpoint inhibitors (ICIs) have been associated with major adverse cardiovascular events (MACE) that carry high morbidity and mortality. Statins are widely used for the primary prevention of MACE in patients with a high risk of atherosclerotic cardiovascular disease. However, the impact of statins on MACE associated with ICIs remained unclear.Research QuestionIs stain use associated with a reduction in MACE in patients treated with ICI?AimTo assess the effectiveness of statins on the primary prevention of MACE in patients treated with ICI.Methods:We conducted a retrospective, propensity score-matched cohort study using the TriNetX Analytics Network database. We included all adult cancer patients who were treated with an ICI between March 2011 and March 2023. We excluded patients with a history of MACE, defined as a composite of myocardial infarction, myocarditis, pericarditis, and cardiovascular death. Patients who received statins prior to ICI initiation were compared to those who did not receive statins prior to the start of ICI therapy. The primary efficacy outcome was MACE. Secondary efficacy outcomes were indivicual MACE. The safety outcomes included all-cause mortality and adverse events associated with statins. Cox proportional hazard ratios (HR) werecalculated to compare study endpoints occurring within 1 year of ICI initiation between statins users and non-users.Results:Of 73,988 patients eligible for inclusion, 12,653 patients who received statins were matched to those who did not receive statins. The most common indication for an ICI was lung cancer (41%) and the most commonly administered ICI was pembrolizumab (50%). In a Cox proportional hazards analysis, patients on a statin were associated with a lower risk of MACE (HR, 0.83; 95% CI, 0.72-0.94) as compared to patients not on a statin. There was a reduction in the risk of myocardial infarction, cardiovascular death, and a lower trend of myocarditis among patients who received statins. Patients on a statin had a lower rate of all-cause mortality without an increase in adverse events.Conclusions:Statins were associated with a reduction in MACE and all-cause mortality among cancer patients receiving ICI therapy.

Circulation, Volume 150, Issue Suppl_1, Page A4136632-A4136632, November 12, 2024. Background:The impact of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) on long-term clinical outcomes has not been adequately evaluated yet.Methods:Among consecutive 14927 patients who underwent their first coronary revascularization in the CREDO-Kyoto PCI/CABG Registry Cohort-3 (2011-2013), the study population consisted of 1483 patients who underwent CABG after excluding those with prior AF. POAF was defined as newly documented AF during hospitalization for CABG. The primary outcome measure was all-cause death after discharge. The median clinical follow-up was 5.7 (interquartile range, 4.4-6.6) years.Results:POAF was observed in 337 patients (23%). Multivariable logistic regression analysis indicated that age >=75 years (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.24-2.10; P

Circulation, Volume 150, Issue Suppl_1, Page A4140776-A4140776, November 12, 2024. Introduction:Left Ventricular Assist Devices (LVADs) revolutionized the care of patients with advanced heart failure (AHF). Among AHF patients, atrial fibrillation (AF) is a common arrhythmia. Despite its prevalence, the impact of pre-existing AF on outcomes in post-LVAD recipients is poorly understood.Hypothesis:LVAD recipients with preexisting AF have higher all-cause mortality.Methods:This is a single-center, retrospective review of 573 LVAD recipients. Patients with LVADs implanted elsewhere, implants prior to 2011, implantation of an unconventional LVAD (e.g. artificial heart), and those with insufficient records were excluded. Univariate descriptive statistics and multivariate logistic&linear regression analyses of patient all-cause mortality, as appropriate, were performed using STATA. Significance was determined at alpha < 0.05.Results:Pre-implant AF was seen in 54% of LVAD recipients. Participants with AF were more likely to be male and older. They had higher rates of hyperlipidemia, prior stroke or TIA, prior CABG, pre-existing ICD at time of implant, and pre-LVAD sustained VT (Table 1). After a median follow-up time of approximately 2 years, 57% of patients died, 22% were transplanted, 9% were explanted, and 12% were lost to follow up. Irrespective of incidence of pre-LVAD AF, worse survival was seen in ischemic cardiomyopathy (HR 2.0 [1.5-2.7]), RV failure necessitating RVAD (HR 2.6 [1.9-3.6]), and pre-LVAD ICD shocks (HR 1.3 [1.0-1.7]). Pre-LVAD AF was associated with increased mortality (61% vs 47%, p= 0.001). This finding remained significant on multivariate analysis while controlling for other comorbidities (Table 2). Additionally, presence of AF was significantly associated with an increased occurrence of both post-implant VT (63% vs 43%, p

Circulation, Volume 150, Issue Suppl_1, Page A4143806-A4143806, November 12, 2024. Background:The American Heart Association Predicting Risk of Cardiovascular Disease Events (PREVENT) equations were recently developed to estimate risk of cardiovascular disease (CVD). Long-term risks of cardiovascular disease based on the PREVENT equations in the U.S. population are unknown.Methods:Using data on adults aged 30-79 years from the National Health and Nutrition Examination Survey between 2011 and 2020, we determined long-term risks of total CVD (atherosclerotic cardiovascular disease or heart failure) based on the PREVENT equations. Age-standardized and survey-weighted risk prevalence was determined with further stratification by age group, sex, race and ethnicity.Results:The study population included 14,256 participants representing 160.6 million U.S. adults (mean [SD] age 51.9 [11.2] years, 49.2% women, 66.4% non-Hispanic white, 9.8% non-Hispanic black, 5.7% non-Hispanic Asian and 14.8% Hispanic). Among adults aged 30-79 years, 9.6% had existing CVD and 20.2% were CVD-free but had intermediate or high (≥7.5%) 10-year risk of CVD. The prevalence of CVD-free US adults with low or borderline (

Circulation, Volume 150, Issue Suppl_1, Page ASa101-ASa101, November 12, 2024. Background:Emergency medical services clinicians commonly perform advanced airway management (AAM: i.e., supraglottic airway placement and endotracheal intubation) for out-of-hospital cardiac arrest (OHCA). Nevertheless, the heterogeneity of the treatment effect of prehospital AAM across age groups is still unclear.Aim:To determine the association between prehospital AAM and survival after OHCA, compared with no AAM, across age groups.Methods:This cohort study used the Resuscitation Outcomes Consortium Epidemiologic Registry database, a prospective OHCA registry at ten sites in the US and Canada from 2011 through 2015. Patients were stratified into ten sub-cohorts based on their first documented rhythm (shockable or non-shockable) and five age groups (0-9 years; 10-24; 25-44; 45-64; or ≥65) given the potential impact of rhythm and age on effect modification. To address resuscitation time bias, patients who received AAM during cardiopulmonary resuscitation (CPR) were sequentially matched with patients at risk of receiving AAM within the same minute based on time-dependent propensity scores. Matching was performed in each sub-cohort, and the matched sub-cohorts were integrated for the main analysis. The primary outcome was survival to hospital discharge.Results:Of the 44,403 eligible patients, 39,157 (88.2%) received prehospital AAM during CPR. After time-dependent propensity score sequential matching, 29,973 who received AAM were matched with patients who had not yet received AAM at the same minute. AAM was associated with survival: 5.4% vs 4.8%, risk ratio (RR) 1.40 (95% CI 1.30-1.51). The associations were similar toward better survival in both the shockable (RR 1.27 [95% CI 1.17-1.38]) and non-shockable (RR 1.75 [95% CI 1.53-2.01]) cohorts. There was no apparent heterogeneity of the treatment effect of AAM on survival in all age groups: 0-9 years, RR 1.07 (95% CI 0.45-2.56); 10-24 years, 1.61 (1.07-2.45); 25-44 years, 1.68 (1.35-2.10); 45-64 years, 1.33 (1.19-1.48); 65 years or older, 1.40 (1.23-1.59).Conclusions:In this study of the large multicenter OHCA registry in North America, prehospital AAM was associated with survival to hospital discharge regardless of the first documented rhythm. No apparent heterogeneity was found in the associations between AAM and survival among all age groups, suggesting that both pediatric and adult populations might benefit from prehospital AAM.

Circulation, Volume 150, Issue Suppl_1, Page A4139892-A4139892, November 12, 2024. Background and Purpose:Specific populations of older adults in the United States are experiencing worsening trends in the incidence and prevalence of acute coronary syndrome (ACS). This study examined trends in ACS-related mortality among older adults in the United States.Methods:The CDC-WONDER (Centers for Disease Control and Prevention Wide-ranging OnLine Data for Epidemiologic Research) database was used to track deaths due to ACS in adults aged ≥ 65 years from 1999 to 2020. 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:Altogether, 3,017,769 deaths occurred due to ACS and the overall ACS-related AAMR was 327.5 from 1999 to 2020. Following an initial period of rapid decrease in mortality rates from 1999 to 2011 (APC: -5.98; 95% CI: -6.40 to -5.65), the rate of decline halved from 2011 to 2020 (APC: -3.02; 95% CI: -3.62 to -2.19). Men had consistently higher AAMRs (410.6) than women (267.8). In racial and ethnic groups, the Non-Hispanic (NH) Black or African American population had both the highest total AAMR (374.4) and was one of the two ethnicities that displayed increasing trends from 2018-2020 (APC: 4.74; 95% CI: 0.30 to 7.10). The second ethnic group with increasing trends was Hispanic or Latino (2018-2020 APC: 9.27; 95% CI: 3.22 to 13.16). Significant geographic disparities were observed, with nonmetropolitan areas having consistently higher AAMRs (433.5) than metropolitan areas (304.1). States in the top 90th percentile (District of Arkansas, Kentucky, Mississippi, Missouri, South Dakota, and Tennessee) had almost double the AAMRs than states in the bottom 10th percentile (Alaska, Colorado, Hawaii, Minnesota, Montana, and Nevada).Conclusion:Despite an overall decrease in mortality, the deceleration of decline since 2011is concerning. Men, NH Black/African American populations, and residents of nonmetropolitan areas displayed the highest burden of ACS-related mortality. Focused strategies are required to prevent and manage ACS in older adults to mitigate the rising levels of ACS-related mortality.

Circulation, Volume 150, Issue Suppl_1, Page A4146038-A4146038, November 12, 2024. Background:Tricuspid regurgitation (TR) is a common valvular heart disease, and associated with increased cardiovascular mortality. Adverse events from surgical treatment of severe TR are limiting this approach.Aim:To analyze the outcomes of using surgical and transcatheter TV interventions across the United States.Methods:We used The National Inpatient Sample (NIS) data base and included data between January 1, 2011 and December 31, 2020. We selected patients who underwent Transcatheter tricuspid valve intervention (TTVI), surgical TR repair (STVr), and surgical TR replacement (STVR). TTVI patients were propensity-matched 1:1 to STVr and STVR using nearest neighbor matching. Analyses were conducted using STATA version 17.Results:Between 2011 and 2020, a total of 98,202 TV interventions were identified. Of these, 1,830 (1.9%) underwent TTVI, 76,747 (78.2%) underwent STVr and 19,625 (19.9%) underwent STVR. Patients receiving TTVI were older, more likely to be white and to be treated at a teaching hospital. STVR accounted for the highest proportion of TV procedure-related deaths overall, followed by surgical TV replacement, and lastly, TTVI. In our PSM analysis, STVr and STVR were associated with increased inpatient mortality (7% vs 2.3%, 11.6% vs 2.4%, respectively), when compared to TTVI (p