Risultati per: GPG: Versione 5.0 (25 Novembre 2019)

Circulation, Volume 146, Issue Suppl_1, Page A12316-A12316, November 8, 2022. Introduction:The frequency of GDM and pregnancy-related complications of GDM are increasing in the United States. Detection and treatment are important to manage GDM and reduce the risk of pregnancy-related complications. The objective of this analysis was to assess whether expanding Medicaid, a state-level policy change that enhances access to care, was associated with changes in rates of GDM and outcomes among those with GDM.Methods:Data from nulliparous individuals aged 20-44 years with a first live birth from 30 states between 2012-2019 were included from the National Center for Health Statistics. The primary outcome, age-standardized incidence of GDM, was compared between Medicaid expansion states (N=16) and Medicaid non-expansion states (N=14) using a quasi-experimental analysis with difference-in-differences (DID) models. DID models utilized multivariate linear regression with random intercepts for state (to adjust for unobserved state-level fixed effects), fixed effect for year, and adjustment for state-level covariates including demographics, and health and economic indicators. Secondary outcomes included GDM complicated by preterm birth (≤36 weeks) and high ( >4000 grams) or low (

Circulation, Volume 146, Issue Suppl_1, Page A9844-A9844, November 8, 2022. Epidemiological data on the relationship of particulate matter with a diameter of 2.5 micrometers or less (PM2.5) with heart failure (HF) hospitalizations and mortality in the US are limited. Prior studies have focused on the effects of daily PM2.5exposure and HF hospitalizations in specific geographic locales in the US. Since PM2.5varies by geography, this study aimed to evaluate the relationship between annual ambient PM2.5concentration levels and HF hospitalizations and death at a county level across the US. We performed a cross-sectional analysis of county level HF hospitalizations, mortality, and ambient PM2.5concentration levels across 3135 US counties nationwide with adjustments for county-level demographics, socioeconomic factors, comorbidities, and healthcare-associated behaviors. County PM2.5showed a moderate correlation with HF hospitalization among Medicare beneficiaries (r=0.41) and a weak correlation with the overall county HF mortality (r=0.08) (p-values < 0.01). There was an increase of 0.51 HF Hospitalizations/1,000 Medicare Beneficiaries and 0.74 HF deaths/100,000 residents for every 1 ug/m3increase in annual PM2.5concentration after adjustment for various county level covariates. The relationship between PM2.5concentration levels and both HF hospitalization and mortality remained significant after adjustment for county covariates. Additionally, the association between PM2.5and HF hospitalizations was comparable by metropolitan status of the counties. In conclusion, ambient PM2.5concentration level was associated with higher incidence of HF hospitalizations and deaths at the county level across the 3100 US counties. Future studies to examine policies aimed at reducing ambient particulate matter pollution and downstream effect of improving HF outcomes are warranted.

Circulation, Volume 146, Issue Suppl_1, Page A14114-A14114, November 8, 2022. Background:Heart failure (HF) is a global epidemic.Objectives:We assessed sex differences in HF across country income.Methods:Using Global Burden of Disease (GBD) data, we assessed sex differences in HF prevalence, etiology, morbidity, and temporal trends between 1990-2019 across 204 countries and territories and disaggregated results by country income (SDI or gross national income).Results:In 2019 there were 56.2 million (95% uncertainty interval [UI] 46.4-67.8 million) HF cases worldwide, with over half in females. HF morbidity was estimated at 5.1 million (95% UI 3.3-7.3 million) years lived with disability, distributed equally between the sexes. Overall, ischemic heart disease was the top cause of HF in males, and hypertensive heart disease the top cause in females. Between 1990-2019, there was an increase in total HF cases, but the age-standardized rate per 100,000 decreased by 7.1%, more so in males (9.1%) than females (5.8%). High-income regions experienced a 16.0% temporal decrease in age-standardized rates, from 877.5 to 736.8 per 100,000, while low-income regions experienced a 3.9% increase, from 612.1 to 636.0 per 100,000. Trend directionality was largely consistent in both sexes. Asia, sub-Saharan Africa, and Middle East experienced a temporal increase in age-standardized HF rates in both sexes, related to increasing ischemic heart disease. Globally, there was an increase in age-standardized HF rates due to calcific aortic valve disease and hypertensive heart disease, and a decrease due to ischemic heart disease, although regional and sex differences were noted.Conclusions:Age-standardized HF rates are increasing in the Middle East and low-SDI regions of the world, with sex differences in etiology and trends that offer targets for intervention.

Circulation, Volume 146, Issue Suppl_1, Page A267-A267, November 8, 2022. Introduction:Recently, multiple studies have demonstrated improvement in survival after out-of-hospital cardiac arrest (OHCA). However, outcomes after OHCA vary with region and city worldwide.Hypothesis:Differences of temporal trends in outcomes after OHCA between rural and urban regions in Japan were postulated.Methods:We included 98,496 patients (aged ≥18 years) using an All-Japan Utstein-style Registry who were witnessed by bystanders after OHCA of presumed cardiac origin between January 1, 2016 and December 31, 2019. Based on population density, patients were classified into urban (n=76,411, 28 prefectures with a population of ≥200 inhabitants/km2) and rural (n=22,085, 19 prefectures with a population of

Circulation, Volume 146, Issue Suppl_1, Page A289-A289, November 8, 2022. Introduction:Liver cirrhosis affects an estimated 1 in 400 adults in the US with significant morbidity and mortality. There is limited data on the incidence and outcomes of in-hospital cardiac arrest (IHCA) in liver cirrhosis-related hospitalizations.Methods:Using the appropriate international classification of disease codes, we queried the nationwide inpatient database to identify patients hospitalized with a primary diagnosis of liver cirrhosis who experienced IHCA and underwent cardiopulmonary resuscitation, between 2010 and 2019, We evaluated the temporal trends in the in-hospital outcomes using Cochrane -Armitage test, and factors associated with survival to hospital discharge using logistic regression analysis.Results:7,091,054 weighted liver cirrhosis hospitalizations were identified during the study period. The IHCA incidence rate was 1.4% with a mean age (SD) of 59 years (12) and males were predominantly affected (59.9%). There was an upward trend in IHCA incidence during the study period (1.3% in 2010 to 1.5% in 2019, p < 0.001). The overall survival to hospital discharge rate was 22.2%. No significant change in the mortality trend during the study period. Most of the survivors were discharged to a long-term acute care facility (46.4%) followed by home discharge without the need for home health (24.7%) and short-term acute facilities (12.6%). Factors associated with lower odds of survival to hospital discharge were age > 65 years OR 0.71, 95% CI 0.67 – 0.75, P < 0.001), Black (OR 0.94, 95% CI 0.91 - 0.99, P=0.012) and Hispanic race (OR 0.78, 95% CI 0.74 - 0.81, P < 0.001), and severe comorbidity index (OR 0.63, 95% CI 0.59 - 0.65, P < 0.001).Conclusion:Between 2010 and 2019, we found a slight increase in the IHCA incidence rate among patients hospitalized with liver cirrhosis. Only about one out of 5 patients survived hospital discharge, and this did not change during the study period. Low socioeconomic status and higher comorbidity burden were associated with lower odds of survival. More research is needed to identify strategies that may improve survival outcomes in IHCA among liver cirrhosis patients.

Circulation, Volume 146, Issue Suppl_1, Page A9772-A9772, November 8, 2022. Introduction:Various factors can trigger events of Pulmonary Embolism(PE). Several studies have linked cardiac arrhythmias such as Paroxysmal Atrial Fibrillation (PAF) with a higher risk of multiple cardiovascular and pulmonary complications. As there is a paucity of data on the risk factors for an event of PAF among PE patients and the factors contributing to death, we conducted a retrospective analysis using the 2019 National Inpatient Sample(NIS).Methods:Our study focused on finding patients with a principal diagnosis of Pulmonary Embolism and a diagnosis of Paroxysmal Atrial Fibrillation. A multivariable regression model evaluated several risk factors for PAF incidence among PE patients and their possible mortality risks.Results:A total of 188,850 cases of PE were observed in our study, including 9,960 (5.3%) cases of PAF. Hyperlipidemia (aOR 1.348, 95% CI 1.290-1.409, p

Circulation, Volume 146, Issue Suppl_1, Page A13781-A13781, November 8, 2022. Introduction:Transcatheter mitral valve repair (TMVR) has evolved over the years, and early discharge strategies are being increasingly adopted. However, there is paucity of data on the outcomes and safety of same-day discharge (SDD) after TMVR.Methods:Data from the Nationwide Readmissions Database 2014 to 2019 were analyzed. International Classification of Diseases codes were used to identify adult patients admitted for elective TMVR. Patients who underwent uncomplicated TMVR were identified by excluding patients with periprocedural complications such as bleeding, vascular access site complications, pericardial complications, stroke, myocardial infarction, shock, or death before discharge. A 1:3 propensity score-matched analysis was performed to compare outcomes of patients undergoing SDD and different-day discharge (DDD). The primary outcome of interest was the 30-day unplanned readmission rate.Results:We identified 34,683 patients who received complication-free TMVR, of which 232 (0.67%) underwent SDD. There was a gradually rising trend of SDD after TMVR over the study period. The baseline characteristics of the unmatched and propensity-matched SDD and DDD groups are shown. Patients in SDD group did not have a significantly higher 30-day readmission rate (15.7% vs 14.8%, p = 0.82) compared to DDD group, but had significantly lower mean hospitalization costs ($33,060 vs $41,134, p

Circulation, Volume 146, Issue Suppl_1, Page A11920-A11920, November 8, 2022. Introduction:Due to dramatic advance in the development of highly active antiretroviral therapy, patients living with human immunodeficiency virus (HIV) (PLWH) have gained a near-normal life expectancy. As a result, cardiovascular diseases are now the most common causes of mortality among PLWH.Objectives:We aimed to investigate if HIV positive status affect the outcomes of PLWH hospitalized with acute myocardial infarction (AMI) or heart failure (HF) in the United States.Methods:Using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), we queried the national inpatient sample database to identify admission cases with AMI or HF between 2016 and 2019. Then, we stratified the AMI and HF cases according to their HIV status. Weighted data was analyzed to compare mortality rate, frequency of home disposition (HD), length of stay, and total hospital charges between HIV positive and HIV negative patients for AMI and HF admission cases.Results:Data pertaining to a total of 28,484,087 admissions was analyzed. Of this, there were 896,702 cases of AMI and 4,154,918 cases of HF. HIV status was positive in 0.24% and 0.32% of AMI and HF patients, respectively.Conclusion:HIV positive status is associated with a longer length of stay and total hospital charged among hospitalized patients with AMI or HF. While PLWH admitted with AMI have a higher mortality rate than HIV negative counterparts, the HIV status does not seem to impact the outcome of HF patients. Additionally, PLWH seem to be more frequently discharged home than HIV negative patients.

Circulation, Volume 146, Issue Suppl_1, Page A14128-A14128, November 8, 2022. Introduction:Limited data exist on the in-hospital and readmission outcomes in sarcoidosis patients after surgical or transcatheter aortic valve replacement (SAVR/TAVR).Hypothesis:Sarcoidosis can lead to cardiac conduction abnormalities and cardiomyopathy which can lead to poor outcomes after aortic valve intervention (AVI). We hypothesize that SAVR/TAVR in sarcoidosis patients has the worst outcomes.Methods:The NRD was queried for all sarcoidosis patients who underwent SAVR/TAVR from 2016-2019. Our outcomes of interest were in-hospital mortality, in-hospital complications, and 30-day readmissions for heart failure and pacemaker implantation. Clinical outcomes were modeled using logistic regression for binary outcomes and linear regression for continuous outcomes.Results:We identified a total of 507,441 SAVR/TAVR hospitalizations of which 1429 were of sarcoidosis patients. Patients with sarcoidosis were younger (mean age 70.1 years vs 72.4 years) and had more women (48.3% vs 38.2%, p

Circulation, Volume 146, Issue Suppl_1, Page A9885-A9885, November 8, 2022. Introduction:Atrial septal defect (ASD) is one of the most common congenital cardiac defects. It can also allow paradoxical emboli to move into the cerebral vasculature leading to Acute Ischemic Stroke (AIS). As there is a lack of adequate information on the additional risk factors for mortality in ASD patients following AIS, we queried the largest inpatient database in the United States for answers.Methods:Patients with ASD were identified among patients of ages 25 and more admitted with a principal diagnosis of AIS ICD-10 code (I63.x) in 2019 from the National Inpatient Sample(NIS). Various patient characteristics and procedures were also studied. A Multivariate regression model adjusting for several factors allowed our study to further evaluate potential risk factors for mortality among ASD patients.Results:Our study found 551,385 cases of AIS, amongst which 19,670 (3.6%) also had a diagnosis of ASD. ASD patients had a higher risk of requiring mechanical thrombectomy (aOR 1.239, 95% CI 1.167- 1.316, p

Il totale dei casi dall’inizio della pandemia in Italia è di 23.322.522

Il totale dei casi rilevati dall’inizio della pandemia in Italia è di 23.322.522

Il totale dei casi rilevati dall’inizio della pandemia in Italia è di 23.322.522

This cross-sectional analysis estimates the proportion of health care spending contributed by prescription drugs as well as examines spending for retail and clinician-administered prescriptions.

This retrospective study examines trends in urinary catheter use in US emergency departments between 2002 and 2019.

This Viewpoint discusses the use of hallucinogens to treat alcohol use disorder.