Risultati per: GPG: Versione 5.7.5 (Novembre 2021)

Circulation, Volume 150, Issue Suppl_1, Page A4139144-A4139144, November 12, 2024. Background:Iron deficiency anemia (IDA) affects approximately one-third of patients with systolic heart failure, yet comprehensive population-based analyses of its impact on in-hospital outcomes remain limited. This study seeks to examine how IDA influences in-hospital outcomes among individuals with decompensated systolic congestive heart failure (HFrEF).Methods:Using data from the National Inpatient Sample (NIS) database spanning from 2017 to 2021, this study identified patients hospitalized for decompensated systolic congestive heart failure (HFrEF) with a secondary diagnosis of IDA using ICD-10 codes such as I5020-23 and D500, D501, D508, D509. Propensity score matching (PSM) was then employed to create cohorts without and with IDA at a 1:3 ratio. Multivariate regression analyses were conducted to evaluate various outcomes, including in-hospital mortality, cardiogenic shock (CS), acute myocardial injury (AMI), cardiac arrest, ventricular tachycardia (VT), ventricular fibrillation (VF), length of stay (LOS), and total hospitalization charges. Furthermore, the utilization rate of mechanical ventilation and circulatory support, including intra-aortic balloon pump and extracorporeal membrane oxygenation, was evaluated in both cohorts.Results:Among 253,034 HFrEF hospitalizations, 16,200 (6.4%) had a secondary diagnosis of IDA. After PSM, multivariate regression analyses revealed no significant differences in the odds of cardiogenic shock (10% vs. 10%, p=0.86), in-hospital mortality (2.6% vs. 2.8%, p=0.71), and LOS (7.19 vs. 7.27 days) between the two groups. Additionally, the likelihood of cardiac arrest, ventricular arrhythmias, AMI, and utilization of mechanical ventilation and circulatory support did not reach statistical significance. However, patients with IDA and HFrEF had higher hospitalization charges ($85,516 vs. $93,000).Conclusion:HFrEF patients, with or without IDA, had similar odds of cardiogenic shock, in-hospital mortality, mechanical circulatory support utilization, as well as LOS. However, IDA with HFrEF correlated with higher hospitalization charges.

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 A4145765-A4145765, November 12, 2024. Background:The incidence burden of maternal hypertensive disorders has increased by 30% globally. This study analyzed the trends in prevalence and death rates from maternal hypertensive disorders across various states in the United States from 1990 to 2021.Methods:Using the Global Burden of Disease (GBD) database, we compared the following levels, stratified by state, between the beginning of 1990 and the end of 2021: hypertensive disorders of pregnancy, percentage prevalence change, mortality percentage change by age-standardized rates per 100,000 population, and age-stratified changes in the rate of incidence and mortality. The analysis was conducted using Microsoft Excel (16.7).Results:The analysis revealed notable interstate variability in the prevalence and death rates of maternal hypertensive disorders (Figure 1). Nevada exhibited the highest increase in prevalence (0.87%), followed by Hawaii (0.65%) and Idaho (0.54%). In contrast, Mississippi experienced the largest decrease in prevalence (-0.22%), followed by Louisiana (-0.20%) and Maine (-0.19%). Regarding death rates, the District of Columbia saw the most significant decrease (-0.67%), followed by New York (-0.45%) and New Jersey (-0.42%). Conversely, West Virginia had the highest increase in death rates (0.89%), followed by Alaska (0.52%) and Kentucky (0.51%). The analysis of Age stratified subgroups in each state showed the maximum increase in mortality change in the age group of 40–44 years, followed by 35–39 years, with West Virginia having the highest percentage change mortality rates (2.55%; age group 40–44 years) and District of Colombia showing a sharp decrease in the percentage mortality rates (-0.72%; age group 30-34 years). Incidence percentage changes showed similar patterns, with Virginia showing a (3.41%; 40–44 years), closely followed by New York (3.31%; 40–44 years).Conclusion:The data reveal significant disparities in both the prevalence and death rates of maternal hypertensive disorders across different states. Additionally, an increase in mortality and incidence rate changes of hypertension in pregnancy was observed in higher age groups, particularly among women aged 35–39 and 40–44. These findings highlight the need for tailored, state-specific public health strategies to effectively address targeted interventions for older age groups and mitigate the impact of maternal hypertensive disorders.

Circulation, Volume 150, Issue Suppl_1, Page A4131486-A4131486, November 12, 2024. Background:Cardiovascular disease (CVD) mortality in the U.S. younger population is on the rise. However, limited data is available on CVD-related mortality trends in this population.Aim:This study aimed to assess the temporal trends and demographic differences in CVD-related mortality among the U.S. youth.Methods:The CDC WONDER dataset was analyzed from 1999-2021 for CVD-related mortality in children and young adults (age

Circulation, Volume 150, Issue Suppl_1, Page A4127417-A4127417, November 12, 2024. Background:Atherosclerotic cardiovascular disease (ACVD) is the leading cause of mortality in the U.S, and increasing age is one of the greatest risk factors for the development and prognosis of ACVD. However, ACVD-related mortality trends in older adults have not yet been established.Aims:This study aims to highlight the annual trends and demographic differences in ACVD-related mortality among older adults in the U.S. from 1999 to 2021.Methods:The CDC WONDER multiple-cause of death database was examined from 1999 to 2021 for ACVD-related mortality in adults >65 years of age. Age-adjusted mortality rates (AAMRs) per 100,000 persons was calculated. Trends and annual percent changes (APCs) were calculated, and subsequently stratified by overall, sex, race/ethnicity, urbanization status, and census region.Results:Between 1999 and 2021, 9,307,495 ACVD-related deaths occurred among older adults in the U.S. AAMRs decreased from 1370.7 in 1999 to 803.5 in 2014 (APC, -3.64 [-3.89 to -3.46]), after which it gradually decreased to 741.3 in 2019 (APC, -1.24 [-2.54 to 0.19]), and then increased to 841.5 in 2021 (APC, 7.00 [3.92 to 9.18]). Men had consistently higher AAMRs than women from 1999 (AAMR men: 1754.1 vs women: 1122.2) to 2021 (AAMR men: 1169.6 vs women: 599.6). Non-Hispanic (NH) Black or African American older adults had the highest AAMR in 2020 (886.1), followed by NH White (849.4), NH American Indian/Alaska Native (752.5), Hispanics or Latino (718.3) and NH Asian or Pacific Islanders (494.4). AAMR also varied substantially by region (overall AAMR until 2020: Midwest 875.1; South 872.2; Northeast 801.0; West 789.2), and rural areas had higher ACVD-related mortality (993.5) than urban regions (954.7).Figure 1.Conclusion:Following a progressive decrease until 2019, ACVD-related mortality in U.S. older adults demonstrated a sharp increase in mortality in 2020 and 2021. The highest AAMRs were observed among Black or African American adults and men, and among patients living in the Midwestern and non-metropolitan areas. A targeted approach, with tailored strategies is required to counter the recent surge in ACVD-related mortality in older adults in the U.S.

Circulation, Volume 150, Issue Suppl_1, Page A4146340-A4146340, November 12, 2024. Background:Iron deficiency anemia (IDA) is a common comorbidity in patients undergoing Transcatheter Aortic Valve Implantation (TAVI). This study investigates the differences in outcomes between TAVI patients with and without IDA, focusing on mortality, procedural complications, and baseline characteristics.Methods:A retrospective analysis was conducted using data from the National Inpatient Sample (NIS) from 2016 to 2021. The outcomes for patients undergoing TAVI with IDA were compared to those without IDA. Multivariate logistic regression was employed to analyze outcomes.Results:The study included 367,440 patients without iron deficiency anemia and 16,030 patients with iron deficiency anemia. Baseline characteristics showed a significant difference in gender distribution, with 47.15% of IDA patients being male compared to 56.4% in the non-IDA group (P < 0.0001). Racial distribution varied significantly (P < 0.0001), with a higher % of Black patients in the IDA group (6.16% vs. 3.97%).Patients with IDA had higher odds of heart block (OR: 1.146, 95% CI: 1.061-1.238, P = 0.001), bleeding (OR: 1.229, 95% CI: 1.115-1.355, P < 0.001), transfusion (OR: 2.487, 95% CI: 2.209-2.800, P < 0.001), prosthetic dysfunction (OR: 1.377, 95% CI: 1.053-1.801, P = 0.02), post-procedure shock (OR: 1.450, 95% CI: 1.180-1.782, P < 0.001), intra-procedure shock (OR: 1.562, 95% CI: 1.264-1.931, P < 0.001), dialysis (OR: 1.450, 95% CI: 1.044-2.015, P = 0.027), atrial fibrillation (OR: 1.115, 95% CI: 1.033-1.204, P = 0.005), cardiogenic shock (OR: 1.587, 95% CI: 1.283-1.963, P < 0.001), sepsis (OR: 1.541, 95% CI: 1.122-2.117, P = 0.008), respiratory failure (OR: 1.635, 95% CI: 1.462-1.828, P < 0.001), and myocardial infarction (OR: 1.684, 95% CI: 1.421-1.996, P < 0.001). Patients with IDA had a longer length of stay (Coefficient: 2.067, 95% CI: 1.798-2.337, P < 0.001) and higher total hospital charges (Coefficient: $23,107, 95% CI: $16,471-$29,742, P < 0.001) compared to those without IDA.Conclusions:Patients with IDA undergoing TAVI are at higher risk for several complications, including heart block, bleeding, transfusion, prosthetic dysfunction, post-procedure and intra-procedure shock, dialysis, atrial fibrillation, cardiogenic shock, sepsis, respiratory failure, and myocardial infarction compared to those without IDA. These findings underscore the need for targeted management strategies and further research to optimize outcomes for TAVI patients with iron deficiency anemia.

Circulation, Volume 150, Issue Suppl_1, Page A4148102-A4148102, November 12, 2024. Introduction:Ischemic stroke and renal failure frequently coexist, impairing patient outcomes. Comprehending this association is imperative in formulating a multidisciplinary methodology to augment patient outcomes and quality of life.Objective:We offer estimates showing the evolution of kidney dysfunction related ischemic stroke from 1990 to 2021. It will utilize disability-adjusted life years (DALYs), years of life lost (YLLs) and age-standardized death rates (ASDR) to find discrepancies overall survival outcomes in both sexes.Methods:Data on ASDR, DALY, and YLL were extracted from the GBD database. After examining global trends, we analyzed continents, socio-demographic index (SDI) and World Bank income level classification of countries. Using Joinpoint regression, the average annual percentage changes (AAPC) were determined.Results:The ASDR for kidney dysfunction related ischemic stroke showed a declining trend globally between 1990 and 2021. The ASDR was 7.29(95%UI: 4.68-10.07) in 1990 and dropped to 4.24 (AAPC: -1.73; 95% CI: -1.76 to -1.69) in 2021. DALYs dropped from 130.3(95%UI: 90.36-172.67) in 1990 to 82.1 (AAPC: -1.47; 95% CI: -1.50 to -1.44) in 2021. YLL had a consistent decline from 1980 to 2021, with an AAPC of -1.66 (95% CI: -1.69 to -1.62). High-middle and middle SDI region had higher death rates throughout the study period.Asia and America had lower ASDRs, whereas Europe and Africa had higher ASDRs across the board. Africa’s AAPC was -0.37 (95% CI: -0.4 to -0.32) between 1990 and 2021. Similarly, Europe’s AAPC of -2.85 (95% CI: -2.93 to -2.77) showed a decline from 1990 to 2021. Asia’s AAPC showed a drop, coming in at -1.19 (95% CI: -1.22 to -1.15). America’s AAPC was -1.97 (95% CI: -2.02 to -1.91).According to world bank income levels, upper-middle and lower-middle income countries had higher ASDRs.Conclusion:Due to similar risk factors and bidirectional effects, the combination of ischemic stroke and renal failure worsens patient outcomes. In order to effectively address the intricate interactions between various illnesses and enhance patient prognosis, an in-depth investigation of the reasons behind stark disparities in death rates is necessary.

Circulation, Volume 150, Issue Suppl_1, Page A4140218-A4140218, November 12, 2024. Background:Prior data indicated a reduction in mortality among STEMI (ST-elevation myocardial infarction) patients with COVID-19 from 2020 to 2021 in the United States.Objective:To describe national trends and determinants of outcomes among STEMI patients with COVID-19 from 2020-2021.Methods:A retrospective cohort study was conducted using the 2020-2021 Nationwide Inpatient Sample of adults diagnosed with STEMI and COVID-19, assessing in-hospital mortality and the use of percutaneous coronary intervention (PCI), mechanical ventilation, and mechanical circulatory support (MCS).Results:The study included 6,195 STEMI patients with COVID-19 and revealed stable mortality (18% in 2020 to 21% in 2021,p=0.06). Demographic shifts occurred, with White patients increasing from 52% in 2020 to 66% in 2021 (p

Circulation, Volume 150, Issue Suppl_1, Page A4146565-A4146565, November 12, 2024. Introduction:Cardiovascular Disease (CVD) remains the primary cause of death and illness in the United States, incurring annual costs of $219 billion. Modifiable risk factors significantly contribute to the prevalence of CVD. This study is the first to estimate the burden of CVD attributable to high body mass index (HBMI) on CVD in the US over the past three decades, including the initial two years of the COVID-19 pandemic.Method:Using global burden of disease study 2021 standardized methodology, we estimated deaths, disability adjusted life years (DALYs), years lived with disability (YLDs) due to CVD attributable to HBMI by age, sex, year and location across the US from 1990-2021.Results:From 1990-2021, the total percentage change (TPC) in deaths attributable to CVD linked to HBMI increased by 54% (95% Uncertainty Interval: 36% to 92%), and YLDs soared by 159% (128% to 207%). In 2021, the highest number of deaths was recorded from ischemic heart disease at 85,522, followed by hypertensive heart disease at 43,430, stroke at 13,886, atrial fibrillation and flutter at 5,278, lower extremity peripheral arterial disease at 3,098, and aortic aneurysm at 1,295. Oklahoma exhibited the highest age-standardized mortality rate (ASMR) due to CVD from HBMI at 49.46 (33.57-68.08) per 100,000 person-years, with the lowest in Massachusetts at 16 (8.16-25.32) in 2021. Louisiana reported the highest YLDs rate at 72.58 (31.04-120.32). The age group 70-74 years old saw the highest number of deaths at 17,997, with the most years of life lost in the 60-64 age group at 430,068 and the highest YLDs in the 70-74 age group at 49,054. Males showed a greater increase in burden compared to females, with TPC in deaths at 65% vs. 42%, DALYs at 59% vs. 43%, and YLDs at 193% vs. 130% from 1990-2021.Conclusion:Deaths due to CVD attributable to HBMI accounted for 16.83% of all CVD related deaths in US in 2021. To combat this trend, it is essential to launch comprehensive health campaigns that leverage the power of e-health and mobile health technologies. These platforms should be utilized to disseminate evidence-based healthcare strategies and preventive measures. Furthermore, engaging influencers and celebrities in these campaigns can amplify the reach and impact, encouraging broader public adoption of healthier lifestyles. Such innovative and inclusive public health initiatives are crucial for reversing the rising trend in CVD-related health burdens.

Circulation, Volume 150, Issue Suppl_1, Page A4145182-A4145182, November 12, 2024. Background:Ischemic heart disease (IHD) continues to be a major contributor to global mortality. Metabolic risk factors are known to be the leading drivers of IHD burden. Our study aims to explain the trends in Metabolic Risk Factors (MRF) associated IHD mortality by utilizing Global Burden of Disease Study data spanning over three decades from 1990 to 2021.Method:MRF associated IHD mortality rates in the United States from 1990 to 2021 were sourced from the Global Burden of Diseases 2021 database. Monte Carlo permutation analysis utilizing JointPoint Regression Software (version 4.9.0.1, NCI) was employed to estimate the time trends, using annual percentage change (APC) and average annual percentage change (AAPC) metrics. Initially, these trends were assessed for the overall population. Analysis was then stratified by gender, evaluating age-adjusted rates separately for males and females. Further stratification involved, assessing age-specific trends within two distinct age groups: younger adults (20-54 years) and older adults ( >55 years).Results:A statistically significant decline in overall mortality was noted, with a moderate decline occurring during the decade 1990 to 2001 (APC= -2.2, p

Circulation, Volume 150, Issue Suppl_1, Page A4144702-A4144702, November 12, 2024. Background:Gender disparities in outcomes for patients undergoing Transcatheter Aortic Valve Implantation (TAVI) with concomitant chemotherapy remain under-explored. This study investigates these disparities, focusing on mortality, procedural complications, and baseline characteristics.Methods:We conducted a retrospective analysis using data from the National Inpatient Sample (NIS) from 2016 to 2021. Gender differences in outcomes were examined in patients undergoing TAVI who have also received chemotherapy. Multivariate logistic regression was utilized for outcomes. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, with statistical significance determined by P-values.Results:The study included 7,275 patients, comprising 3,375 males and 3,900 females. The mean age was similar between males (76.19 years) and females (75.81 years). Outcome analysis revealed no significant gender difference in in-hospital mortality (OR: 1.63, 95% CI: 0.464-5.725, P = 0.445), heart block (OR: 1.061, 95% CI: 0.849-1.326, P = 0.6) or vascular injury (OR: 1.065, 95% CI: 0.572-1.981, P = 0.841). However, females had significantly higher odds of bleeding (OR: 1.601, 95% CI: 1.161-2.207, P = 0.004) and respiratory failure (OR: 1.792, 95% CI: 1.028-3.126, P = 0.04). Additionally, females had higher odds of sudden cardiac arrest (OR: 8.181, 95% CI: 1.092-61.26, P = 0.041) but lower odds of atrial fibrillation (OR: 0.689, 95% CI: 0.543-0.875, P = 0.002) and arrhythmia (OR: 0.537, 95% CI: 0.344-0.837, P = 0.006). Length of stay was longer for females (Coefficient: 0.515, 95% CI: 0.137-0.893, P = 0.008), but total charges did not differ significantly between genders (Coefficient: 2321, 95% CI: -10371.11-15013.54, P = 0.72).Conclusions:Significant gender disparities exist in specific procedural outcomes for patients undergoing TAVI who have also received chemotherapy. Females were at higher risk for bleeding, respiratory failure, and sudden cardiac arrest, while having lower rates of atrial fibrillation and arrhythmia compared to males. These findings highlight the necessity for gender-specific risk assessment and management strategies to improve outcomes for patients undergoing TAVI with chemotherapy.

Circulation, Volume 150, Issue Suppl_1, Page A4128457-A4128457, November 12, 2024. Background:The U.S. population has seen a dramatic increase in the burden of hypertension (HTN) among younger adults. However, HTN-related mortality trends among younger adults have not been investigated.Aim:We examined the trends and demographic differences in HTN-related mortality among younger adults in the U.S.Methods:Data from the CDC WONDER database was examined from 1999 to 2021 for HTN-related mortality in adults between 15 to 45 years of age. The International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes employed were as follows: I10-I15 (hypertensive diseases). Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated and stratified by year, sex, race/ethnicity, urbanization status and census region.Results:Between 1999 and 2021, 201,860 HTN-related mortalities occurred among younger adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC, 35.3 [20.6 to 44.5]), after which it steadily increased to 9.4 in 2019 (APC 3.1, [2.7 to 3.5]), and sharply increased to 13.9 in 2021 (APC 22.3; 95% CI 15.1 to 26.4). Men had consistently higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). Non-Hispanic (NH) Black or African American young adults had the highest AAMR in 2020 (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islanders (5.0). AAMR also varied substantially by region (overall AAMR: South 9.3; Midwest 6.4; West 5.8; Northeast 5.4), and rural areas had higher HTN-related mortality (8.5) than their urban counterparts (7.0).Figure 1.Conclusion:Following a steady increase until 2019, HTN-related mortality increased among young adults between 2020 and 2021. The highest AAMRs were observed among men and Black or African American young adults, and people residing in the Southern and non-metropolitan areas. This emphasizes the necessity of tailored interventions to mitigate the burden and reduce the current disparities in HTN-related mortality among young adults in the U.S.

Circulation, Volume 150, Issue Suppl_1, Page A4144666-A4144666, November 12, 2024. Background:There is limited data on the safety and efficacy of ventricular tachycardia (VT) ablation in patients with chronic kidney disease (CKD). We examined the outcomes of patients with CKD undergoing VT ablation in a nationally representative cohort of patients.Methods:The National Inpatient Sample Database (NIS) was analyzed from 2018 to 2021 to identify patients ≥18 years old with VT undergoing ablation. Patients with atrial fibrillation, atrial flutter, supraventricular tachycardia, or pre-excitation syndrome were excluded. Patients were divided into those with CKD and without CKD. A multivariable logistic regression model was utilized to assess the association of CKD with in-hospital mortality and outcomes after adjusting for confounders.Results:Our cohort included 1608 VT ablation procedures, of which 428 (27%) were performed on CKD patients. Mean age was 63 (±13) years, 318 (19%) were female, and 1194 (74%) were White. 1475 (92%) of the procedures were done at an urban teaching hospital, and 1240 (77%) at a private non-profit hospital. On multivariable analysis, CKD was associated with significantly higher odds of death (adjusted odds ration [aOR]: 3.43; 95% confidence interval [CI]: 1.79-6.5; p=0.0002), acute decompensated heart failure (aOR: 3.1; 95% CI 2.24-4.56; p

Circulation, Volume 150, Issue Suppl_1, Page A4144731-A4144731, November 12, 2024. Introduction:In 2021, India reported an estimated 166,017 deaths related to Rheumatic Heart Disease (RHD). Since 2010, the Indian government has implemented various initiatives to reduce this burden. The Indian Council of Medical Research (ICMR) launched the “Jai Vigyan Mission Mode Project,” focusing on raising awareness, early detection, treatment, and infrastructure strengthening. The National Programme for Prevention&Control of Cancer, Diabetes, Cardiovascular Diseases&Stroke (NPCDCS) and Rashtriya Bal Swasthya Karyakram (RBSK) programs have established NCD clinics and cardiac care units, conducted health education campaigns, and trained medical staff for RHD prevention and control. Key initiatives include using RHD registers, regular penicillin prophylaxis, and promoting early diagnosis and treatment. The development of the low-cost Sree Chitra Valve has also increased treatment affordability. This study aims to evaluate the impact of these government efforts on reducing RHD-related mortality in India.Methods:Data from the Global Health Data Exchange (GHDx) for the 2021 Global Burden of Disease was analyzed to assess the global burden of RHD cases from India and the death rates per 100,000 population between 2010 and 2021 and predictive models adopted for estimates till 2030.Results:Between 2010 and 2014, the global mortality linked to RHD from India increased from 45.23% to 46.94%, then decreased gradually to 44.47% in 2021. Our predictive model estimates that India will contribute around 40.96% of global RHD deaths by 2030. Initially, the age-standardized RHD death rate per 100,000 population was lower among females than males, but it rose higher than males from 2013 onwards. A continuous reduction in the rate was observed in females from 2013 to 2021. Meanwhile, a declining trend was seen among males and combined (male + female) over the study period. By 2030, the overall death rate per 100,000 population is estimated to reach 9.23 (95% CI 7.24-11.22)(Figure 1).Conclusion:Our study confirms the downward trend of RHD mortality rates in India, likely linked to the multiple health initiatives. This highlights the need for sustained public health efforts to continue reducing RHD mortality.

Circulation, Volume 150, Issue Suppl_1, Page A4147580-A4147580, November 12, 2024. Background and Aims:Hypertension stands as the foremost preventable cause of premature mortality and is expected to have a global burden of up to 55%. Here we aim to examine the trends in age-standardized death rates (ASDR), years of life lost (YLL), and disability-adjusted life years (DALY) for alcoholic hypertension, pinpoint the vulnerable populations, and raise awareness about the global health burden of alcohol-related hypertension.Methods:Data on alcohol-related hypertension was extracted from the Global Burden of Diseases 2021 study, including ASDR, YLL, and DALY from 1990 to 2021. The dataset was globally divided and categorized by continents and World Bank income levels. Joinpoint regression was performed to determine annual percentage change (APC) and average annual percentage change (AAPC) from 1990 to 2021.Results:Globally, the age standardized death rates (ASDR) for alcohol-related hypertension had an overall decline from 1990-2021. In 1990, ASDR was 1.12 (95% UI 0.72-1.6) and it declined to 0.94 in 2021 (AAPC=-0.54; 95% CI -0.57 to -0.50). Although the overall trend is declining, some prominent spikes in mortality rate were observed, with the most prominent one seen from 2006-2010 (APC=1.38; 95% CI 1.04-1.82). Globally, the disability-adjusted life-years (DALYs) rate was 23.75 in 1990 and it decreased to 18.86 in 2021 (AAPC=-0.73; 95% CI -0.76 to -0.69). From 1990 to 2021, the age standardized years of life lost (YLL) showed a continuous drop with an AAPC of -0.78 (95% CI -0.81 to -0.75). In continent-wise analysis, North America and Europe had higher ASDRs while Asia and Africa had lower ASDRs. From 1990 to 2021, North America and Europe had AAPC of 0.44 (95% CI 0.36 to 0.53) and AAPC of 0.23 (95% CI 0.16 to 0.31) respectively. Conversely, the AAPCs for Africa and Asia showed significant decline and were -0.16 (95% CI -0.19 to -0.15) and -1.37 (95% CI -1.41 to -1.33) respectively. According to World Bank income levels, upper-middle income countries had declining death rates while lower-middle and lower-income countries had increasing death rates throughout.Conclusion:Alcohol-related hypertension remains a global health concern. While overall trends show a decline in mortality rates, spikes and variations across continents and income levels highlight the need for targeted interventions.

Circulation, Volume 150, Issue Suppl_1, Page A4146785-A4146785, November 12, 2024. Background:Dementia is a prevalent comorbidity in patients undergoing the transcatheter edge-to-edge repair (TEER) procedure of the mitral valve. This study compares outcomes of mitral valve TEER in patients with and without dementia, utilizing data from the National Inpatient Sample (2016-2021)Methods:We conducted a retrospective cohort study on 48,085 patients without dementia and 3,125 with dementia undergoing mitral valve TEER. Multivariate logistic regression was employed to compare outcomes, adjusting for potential confounders. Primary outcomes included mortality and major complications, while secondary outcomes encompassed specific procedural complications.Results:Patients with dementia were older (mean age: 80.896 vs. 76.69 years, p-value