Risultati per: Standard di cura nel diabete – 2022

Circulation, Volume 150, Issue Suppl_1, Page A4138218-A4138218, November 12, 2024. Background:The benefits of physical activity for health and well-being are well documented. Promoting physical activity is crucial for enhancing population health. Wearable devices play a significant role in tracking health-related activities and have been shown to enhance engagement in physical activities. While studies have identified sociodemographic patterns in wearable device usage, little is known about their impact on real-world outcomes, such as increased physical activity.Research Question:Is there a variation in achieving the recommended level of physical activity among wearable device users?Aim:To examine factors associated with achieving the recommended weekly minimum of 150 minutes of moderate-intensity physical activity among wearable device users.Methods:Data from the 2022 Health Information National Trends Survey (HINTS 6) of wearable device users (n = 1,718) were analyzed. We reported adjusted odds ratios from multivariable logistic regression of meeting recommended levels of physical activity.Results:Among the 1,718 participants who utilized wearable devices, 64.3% were female with a mean (M) age of 48.2 ± 0.36 years. The majority were White (58.1%), followed by Asian (18.4%). Among the wearable users, 54.8% met the recommended weekly minimum of 150 minutes of moderate-intensity physical activity. The age group of 65 to 74 years (OR, 1.96; 95% CI, 1.04, 3.69; p=0.04) was more likely to achieve 150 minutes of physical activity per week. However, Asian wearable users were less likely to achieve physical activity goals compared to other racial and ethnic wearable users (OR, 0.55; 95% CI, 0.31, 0.96; p=0.04). Additionally, individuals with a body mass index ≥30 kg/m2(OR, 0.54; 95% CI, 0.36, 0.79; P

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 A4147375-A4147375, November 12, 2024. Background:Atrial fibrillation is the most common cardiac arrhythmia in the United States. It is a tachyarrhythmia characterized by irregular electrical impulses in the atria. It poses a significant risk of stroke and is a major concern in cardiovascular health. Understanding mortality trends related to AF across racial groups is crucial for guiding targeted treatment strategies, particularly for marginalized populations.Methods:Data were obtained from the CDC WONDER database. Age-adjusted mortality rates for atrial fibrillation and flutter between 1999-2022 were calculated relative to the standard US population. Time trends were assessed using annual percentage change (APC) and average APC (AAPC), employing Joinpoint Regression Software (version 8.4.2, NCI). Monte Carlo permutation analysis was utilized to determine the most parsimonious trend.Results:In 2022, atrial fibrillation and flutter caused 28,932 deaths in the United States. Analyzing mortality trends from 1999 to 2022 across all racial groups revealed a significant increase in the average annual percentage change (AAPC) of 3.6% (95% CI 3.1-4.2, p

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

Circulation, Volume 150, Issue Suppl_1, Page A4141224-A4141224, November 12, 2024. Background:Glycated albumin (GA) has been demonstrated to be associated with adverse outcomes in patients with acute coronary syndrome (ACS). However, as a specific subgroup of ACS, a significant proportion of patients with ACS without standard modifiable cardiovascular risk factors (SMuRFs) are currently being identified. The prognostic value of serum GA for adverse events in such patients remains unexplored.Aims:This study aims to evaluate the prognostic value of GA in predicting adverse outcomes in patients with ACS without SMuRFs.Methods:This study involved 1,140 consecutive patients who were diagnosed with ACS without SMuRFs at the Beijing Anzhen Hospital between May 2018 and December 2020 and underwent coronary angiography. Each patient was followed up for a period of 35–66 months after discharge. The primary endpoint of this study was major adverse cardiovascular and cerebrovascular events (MACCEs) that included all-cause mortality, non-fatal myocardial infarction, non-fatal ischemic stroke, and ischemia-driven revascularization.Results:The average age of the study participants was 59.55 ± 10.98 years, and men accounted for 61.8%. The average GA level was 14.37 ± 2.42. The median follow-up duration was 48.3 months, during which 220 cases (19.3%) experienced MACCEs. In the fully adjusted model, with GA as a continuous variable, the hazard ratio (HR) for MACCEs in the high GA group was 1.069 (95% confidence interval (CI): 1.008, 1.133), the HR for ischemia-driven revascularization was 1.095 (95% CI: 1.021, 1.175), and the HR for all-cause mortality was 1.155 (95% CI: 1.021, 1.306), all with P values less than 0.05. Similarly, when GA was considered as a categorical variable, in the fully adjusted model, GA was associated with MACCEs, ischemia-driven revascularization, and all-cause mortality, with P values all less than 0.05. The restricted cubic spline curve showed that the relationship between GA and MACCEs was linear (p for non-linear = 0.079; p for overall association = 0.026). Furthermore, GA levels were correlated with poor prognosis in the subgroups of patients.Conclusion:Serum GA might be an independent predictor of all-cause death, ischemia-driven revascularization, and MACCEs in patients with ACS without SMuRFs.

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 A4144260-A4144260, November 12, 2024. Introduction:The diversity of the healthcare workforce is essential for equitable and effective patient care. This comprehensive report analyzes the representation trends among cardiovascular fellows in the US over an 18-year period, focusing on gender, racial, and ethnic representation.Methods:Utilizing data from the National Graduate Medical Education Census, this study analyzes trends in representation across gender, race, and ethnicity among cardiovascular medicine fellows. It examines the expansion of cardiology programs and fellow positions in specialties, assessing the evolution of diversity between 2005 and 2022 using J point trend analysis software.Results:Growth Trends in Cardiology Specialties (2005-2022): Cardiology exhibited significant growth, with an AAPC of 2.6% for programs and 2.0-3.2% for fellow positions. IC showed an AAPC of 2.0% for programs and 2.8% for fellow positions. EP had a lower AAPC for programs (1.7%) but a higher rate for fellow positions (5.2%).Gender Disparities: Women constituted 22% in CVM, 12.3% in EP, and 11% in IC. Despite these disparities, there was a promising increase in the representation of women over time, with a higher AAPC for women compared to men, indicating a shift towards greater gender diversity.Racial and Ethnic Composition and Trends: White and Asian fellows accounted for over 70% of the total, while Black and Hispanic fellows made up less than 12%. The representation of White fellows decreased significantly, while Black fellows showed a significant increase in CVM. Hispanic fellows did not exhibit a significant increase and even showed a decrease in IC.Medical School Backgrounds: USMDs comprised the majority of fellows, but DOs displayed the highest growth rate, particularly in EP (AAPC of 7.9%). IMGs had the highest AAPC in IC at 4%.Conclusion:Our analysis revealed continued racial and gender disparities in the cardiology specialty. This report calls for concerted efforts from academic institutions, healthcare organizations, and policymakers to implement effective strategies for diversity and inclusion, reflecting the aim of creating a workforce that mirrors the diversity of the population it serves.

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 A4130622-A4130622, November 12, 2024. Background:Maternal hypertension, a major pregnancy complication, can adversely affect newborn health. We aim to evaluate the racial and ethnic disparities in neonatal outcomes among hypertensive pregnant women in the United States.Methods:Using data from the CDC WONDER Natality database, we conducted a retrospective cohort study focusing on live births to hypertensive mothers from 2016 to 2022. Neonatal outcomes, including NICU admissions, low birth weight, infant mortality, and assisted ventilation, were analyzed by calculating rates [95% CIs] per 1000 live births across maternal racial/ethnic groups and the US Census Bureau’s regional classification: Northeast, Midwest, South, and West.Results:We analyzed 2,336,679 live births to hypertensive women (23% pre-pregnancy; 77% gestational). This cohort comprised: 0.2% infants born to Native Hawaiian/other Pacific Islander women (NH/PI), 0.9% to American Indian/Alaska Native women (AI/AN), 3.8% to Asian American women (AA), 19.6% to Hispanic/Latino women (H/L), 20.0% to Black/African American women (BA), and 55.4% to White American women (WA). Infant mortality rates were highest in BA (3.6 [3.5, 3.8]), followed by AA (2.1 [1.8, 2.4]), AI/AN (2.1 [1.6, 2.7]), H/L (1.9 [1.8, 2.0]), NH/PI (1.9 [1.0, 3.3]), and lowest in WA (1.5 [1.4, 1.6]). Similarly, NICU admission rates were highest in BA (217.2 [216.1, 218.4]) and lowest in WA (156 [155.4, 156.6]). Assisted ventilation rates were highest in NH/PI (131.8 [123.4, 140.7]) and lowest in AA (87.8 [86.0, 89.7]). Low birth weight rates were highest in BA (235.1 [233.9, 236.3]) and lowest in WA (121.8 [121.2, 122.4]). The Midwest had the highest rates for NICU admissions in NH/PI (254.2 [217.2, 295.2]), assisted ventilation in AI/AN (143.8 [133.2, 155.1]), and mortality in BA (4.1 [3.7, 4.5]). The South had the highest rate of low birth weight for BA (244.4 [242.9, 246.0]).Conclusion:Significant racial and regional disparities exist in neonatal outcomes among hypertensive women in the US. BA mothers consistently experienced the poorest outcomes, while WA mothers had the best. Further research is crucial to understand the reasons behind these disparities and develop targeted interventions for high-risk populations.

Circulation, Volume 150, Issue Suppl_1, Page A4146016-A4146016, November 12, 2024. Introduction:Atrial Fibrillation is the most common arrhythmia, causing an irregular and rapid heart rate. This occurs due to electric and structural remodeling of the atria, which creates the rapidly discharging foci.Aims:This study aims to explore the national mortality trends resulting from Atrial Fibrillation and Flutter in the United States from 1999-2022 while also studying the discrepancies among the various socio- demographic groups.Methods:The death certificate data from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiological Research (CDC Wonder) database were explored to investigate the Atrial fibrillation and flutter mortality from 1999 to 2022, focusing on the Age-Adjusted Mortality Rate (AAMR) per 1,000,000 individuals. We employed Joinpoint Regression Analysis to compute Annual Percent Changes (APC) with a 95% Confidence Interval. The data was further stratified into epidemiological groups of age, gender, ethnicity, and census region.Results:There was a steady rise in mortality from 1999 to 2017 (APC: 2.96), followed by a rapid surge in mortality trends from 2017 to 2022 (APC: 7.35). The mortality rate rose fairly equally among both genders over the years, with males having a slightly steeper incline (Male AAPC: 4.27, Female AAPC: 3.43). African Americans had the greatest number of deaths due to atrial fibrillation and flutter and the greatest rise was during recent years from 2017 to 2022 (APC: 9.64). The atrial fibrillation and flutter related mortality was the greatest among 25-34-year-olds, with the mortality decreasing among the older populations. All US Census regions had similar mortality rates and trends.Conclusion:This study reveals an overall rise in mortality associated with atrial fibrillation and flutter. It also highlighted disparities across gender, age, and geographic regions. These findings emphasize the need for further research and the development of targeted interventions to reduce mortality and alleviate the burden of this debilitating condition.

Il numero 1 al mondo per l’iniziativa ‘Un ace per la ricerca’

Objective
To characterise telehealth use, reasons for using or not using telehealth and the factors associated with telehealth use among US adults with diabetes.

Design
A cross-sectional study.

Setting
Data were sourced from the 2022 Health Information National Trends Survey.

Participants
US adults aged 18 years or older with self-reported diagnosis of diabetes (both type 1 and type 2).

Primary and secondary outcomes
Past 12-month utilisation of telehealth services, modality (eg, video, voice only), overall perception of quality of care, perceived trust in healthcare system and patient-centred communication score.

Results
In an analysis of 1116 US adults with diabetes, representing 33.6 million individuals, 48.1% reported telehealth use in the past year. Telehealth users were likely to be younger, women, with higher income, and urban dwellers. Older adults (≥65 years) were less likely to use telehealth compared with those aged 18–49 years (OR 0.43, 95% CI 0.20 to 0.90). Higher income and more frequent healthcare visits were predictors of telehealth usage, with no significant differences across race, education or location. Across respondents with telehealth usage, 39.3% reported having video-only, 35.0% having phone (voice)-only and 25.7% having both modalities. The main motivations included provider recommendation, convenience, COVID-19 avoidance and guidance on in-person care needs. Non-users cited preferences for in-person visits, privacy concerns and technology challenges. Patient-reported quality-of-care outcomes were comparable between telehealth users and non-users, with no significant differences observed by telehealth modality or area of residence (metro status).

Conclusions
Around half of US adults with diabetes used telehealth services in the past year. Patient-reported care quality was similar for telehealth and in-person visits. However, further efforts are needed to address key barriers to telehealth adoption, including privacy concern, technology difficulties, and care coordination issues.

Introduction
In female patients diagnosed with gynaecological cancer, the main priority is treating cancer itself. However, a significant number of these patients develop lower limb lymphoedema (LLL), with its incidence strongly influenced by the diagnostic cut-off (a difference in leg circumference between both legs of 5% or 10%). LLL significantly impacts patients’ quality of life (QoL) due to functional impairment, the daily time investment required for treatment, financial costs and affected body image. Additionally, it increases the risk of cellulitis, often leading to hospitalisation for intravenous antibiotics. Timely recognition and acknowledgement of symptoms are crucial first steps in improving the QoL for these women. LLL is a common and irreversible complication following treatment for gynaecological cancer. Despite its clinical significance, there are limited prospective studies investigating LLL incidence, risk factors, early detection and clinical course in this patient population. Therefore, the objective of this observational cohort study is to investigate the incidence rate of stage 0–1 or stage 2–3 LLL based on the International Society of Lymphology criteria in the first 2 years after gynaecological cancer treatment. The embedded randomised control study (RCT) examines the added value of prophylactic compression garments (class II) to standard care in preventing irreversible lymphoedema after gynaeco-oncological therapy.

Methods and analysis
In June 2022, two university hospitals in Belgium initiated a multicentre observational cohort study, which also includes an embedded RCT. The study aims to enrol 400 patients before they begin cancer treatment or within 14 days of starting chemotherapy, radiotherapy or surgery. This cohort will be followed for up to 2 years. The embedded RCT will focus on patients who develop clinical lymphoedema stage 0–1 within the first 12 months following their initial cancer treatment. A total of 196 patients will be randomised into two groups: the intervention group (98 patients), receiving usual care plus prophylactic compression garments (compression class 2 (CCL2): 23–32 mm Hg), and the control group (98 patients), receiving only usual care. The RCT aims to assess the impact of adding prophylactic compression garments to standard care on further deterioration. Assessments will be conducted at baseline, and at 3, 12 and 24 months after initial cancer treatment. An additional assessment (T-visit) will be provided if there is a transition to LLL stage 0–1 or from stage 0–1 to stage 2–3 LLL, based on follow-up findings or patient initiative, using the predictive value of a validated self-report lower extremity questionnaire. This questionnaire is part of a lymph diary app provided to all patients. The primary outcome of the observational study is to determine the incidence rate of stage 0–1 or stage 2–3 LLL in the first 2 years after gynaecological cancer treatment. The primary outcome of the RCT is to evaluate the effect of wearing CCL2 preventive garments to avoid progression to higher-stage lymphoedema in patients who develop LLL within 1 year of treatment. Key secondary outcomes of the observational study include the timing of the development of LLL, risk factors for developing LLL and the impact of LLL on QoL and sexuality, as well as the evaluation of screening and diagnostic tools. The secondary outcomes of the RCT include tolerance and compliance with wearing the preventive compressive garments, the impact of the garments on limb volume and the patient’s time and financial investment.

Ethics and dissemination
The study was approved by the Ethics Committee of the two academic hospitals: the University Hospital of Ghent in September 2021 and the University Hospital of Leuven in December 2021. Approval has been granted for the study protocol, informed consent forms and other related documents by the main Ethics Committee of Ghent (BC-09915) and the local Ethics Committee of Leuven (S65724). All patients will provide written informed consent before participating in the trial. The results will be shared through peer-reviewed journals and presentations.

Trial registration number
NCT05469945.