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

Circulation, Volume 146, Issue Suppl_1, Page A11820-A11820, November 8, 2022. Introduction:The first-generation Watchman 2.5 (W2.5) is associated with several limitations, including the difficulty of implantation in complex LAA anatomies, peri device leak, device recapture and device-related thrombosis. The second-generation Watchman FLX (W-FLX) addressed those limitations with proven safety and efficacy of the device.Hypothesis:This meta-analysis compares the safety and efficacy of the Watchman FLX and 2.5 devices.Methods:The meta-analysis was conducted according to PRISMA guidelines. Studies were located through a search strategy utilizing PubMed, Google scholar and MEDLINE from inception to March 20, 2022, with a primary objective to compare the safety and efficacy of the W-FLX and W2.5. After setting inclusion and exclusion criteria, we identified three recently published observational studies.Results:Our analysis included 3 studies comprising 401 patients. New generation W- FLX is associated with less incidence of major-leak compared to the first-generation W 2.5, OR: 0.08 CI (0.06-0.12) 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

Circulation, Volume 146, Issue Suppl_1, Page A14142-A14142, November 8, 2022. Introduction:The COVID-19 pandemic’s impact on cardiovascular (CV) services globally was variable, with little data on trends from South Asia.Hypothesis:We hypothesized changes in trends of CV services delivery and procedure volumes from 2019-2022. We aimed to assess the pandemic’s impact at a Bangladesh tertiary cardiac centre.Methods:Data on patient visits, admissions, procedures and catheterization volumes were collected from January 2019 to February 2022. Differences for each month of the preceding year were expressed as a percentage (%Δ). Trends (2019 to 2022) were graphically depicted via line diagrams.Results:Significant reductions of cardiology services occurred in 2020, especially ER visits (Δ-59.5%; p

Circulation, Volume 146, Issue Suppl_1, Page A9856-A9856, November 8, 2022. Introduction:Cardiac arrest (CA) is the cessation of cardiac mechanical activity confirmed by the absence of signs of circulation. Data suggest that race and gender could impact the survival rate of CA (1,2). We aim to describe the temporal trend of the age-adjusted mortality rate of gender and race reported as any-mention cause of cardiac arrest death from 1990 to 2019.Methods:The United States statistics mortality data from the CDC WONDER database from 1999 to 2019 were used. The diagnosis of CA was stablished using the ICD-10 codes: I46.0, I46.1, I46.9 and I49.0. Mortality rate was calculated for all ages. Age-adjusted mortality rates per 100000 were calculated using 95% confidence intervals.Results:The study included 7435677 subjects with any-mention of CA death. Most deaths occurred in older individuals (90.7 % of the death reported in those 55 years or older). Cardiac Arrest deaths decreased from 138.1 in 1999 to 91.5 in 2019. Temporal trend depicted a gradual decline in the age-adjusted mortality rate per year (IRR 0.97 95 % CI 0.95 to 0.99). There was a progressive decrease mortality rate across both male (167.6 in 1999 to 110 in 2019 IRR 0.97 95% CI 0.96 to 0.98) and female (117.5 1999 to 76.5 in 2019 IRR 0.97 95% CI 0.96 to 0.98). The age-adjusted mortality rate was significantly higher in males compared to females (126.7 vs 91.3 IRR 1.39 95 % CI 1.27 to 1.52). There was a significant decrease in the mortality rate through 1999 to 2019 seen in all the races.Conclusions:There was an association in the CA mortality rate that persisted over the years favoring male over females. The Black race had the highest mortality rate among the races. American Native had the lowest mortality rate. The phenomenon underlying the race difference is not fully understood (3). Quality-improvement efforts have been associated with improvement of survival (4,5). The present data demonstrates a gradual decline of CA-related mortality associated with significant high gender and racial disparities.

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 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 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 A14273-A14273, November 8, 2022. Introduction:Several studies have shown obesity to be inversely associated with mortality, the so-called obesity paradox. Although being a major cardiovascular risk factor, patients with morbid obesity are often excluded in HFpEF-related trials. Thus, we aim to evaluate the impact of obesity on major adverse cardiovascular and cerebrovascular events (MACCE) in Hospitalized Geriatric Patients with HFpEF.Methods:We queried the National Inpatient Sample (2019) to identify the geriatric admissions (age ≥65 years) with HFpEF. Comorbidities and outcomes were compared between obese and non-obese patients using relevant ICD-10 codes. Adjusted odds and independent predictors of MACCE with obesity were assessed by multivariable regression controlling for confounders.Results:Of 1743940 geriatric admissions with HFpEF, 430395 (24.7%) were obese [median age 75[70-80], female 63.1%, white 77.1%]. The obese cohort often consisted of relatively younger, female, black patients and had higher rates of obstructive sleep apnea (34.1% vs. 10.9%), diabetes (50.3% vs. 31.3%), hyperlipidemia (62.9% vs. 56.6%), chronic lung disease (48.2% vs 38.4%) and depression (17.3% vs. 13.4%) than non-obese (p

Circulation, Volume 146, Issue Suppl_1, Page A15572-A15572, November 8, 2022. Background:In patients with intermediate severity stenosis in a coronary artery, FFR has become the gold standard to measure myocardial ischemia and facilitate the clinical decision regarding the need for revascularization. However, when compared to angiography, it is still underutilized in clinical practice to guide PCI. Our research investigates the difference in outcomes between angiography with versus without the measurement of FFR in real-world data.Methods:National readmission databases 2016-2019 were used to identify patients with CAD undergoing coronary angiogram with versus without FFR using ICD-10 codes. We excluded cases who had Acute Coronary Syndrome (ACS), revascularization by PCI or CABG in the index admission or was performed in the last 6 months of each year to allow time for follow-up. Primary outcomes of the study were 6-months ACS admissions, Secondary outcomes include 6-months revascularization by PCI or CABG and mortality. We matched both cohorts using propensity score matching (PSM) and performed logistic regression to compute the odds ratios (ORs) and corresponding 95% confidence intervals (CI).Results:Out of 1,039,508 angiography procedures done in the USA, 68,767 (6.6%) cases FFR were used, trends of FFR utilization are noted in figure 1. After propensity score matching, our cohort included 31,469 patients with angiography alone and 31,637 angiography with FFR. At six months of follow-up, there was no significant difference in readmission rates due to ACS, OR 0.84 (95%, 0.69-1.03, P=0.098) or revascularization by PCI/CABG, OR: 1.07 (95% CI, 0.92-1.23, P=0.39). However, there was a significant reduction in mortality in the FFR group compared to the angiography alone group OR 0.81 (95% CI, 0.69-0.94, P

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.

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

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.