Risultati per: GOLD 2019: le indicazioni nella terapia in fase stabile del paziente con BPCO

Circulation, Volume 146, Issue Suppl_1, Page A11755-A11755, November 8, 2022. Background:The burden of prediabetes (pDM) in smokers remains unknown. We aimed to analyze the burden and impact of prediabetes on AMI [Type 1/Type 2] hospitalizations in smokers and outcomes using a nationally representative sample.Methods:We queried the National Inpatient Sample (2019) to identify AMI-related hospitalizations in adult non-diabetic smokers with vs without pDM using ICD-10 codes. Demographics, comorbidities, and outcomes including major cardiovascular and cerebrovascular adverse events (MACCE) were compared between two cohorts.Results:Overall prevalence of pDM in hospitalized non-diabetic smokers in 2019 was 1.2% (46770/3880640). AMI cohort with pDM often had males (59.4% vs 54.6%), blacks (23 vs 17.7%), Hispanics (8.7 vs 6.4%), Asian/Pacific Islanders (2.7 vs 1%), patients from higher-income quartile (16.4 vs 12.6%), and higher rates of modifiable CVD risk factors. Adjusted multivariable analysis revealed higher risk of overall (aOR 1.73 [1.60-1.88]), T1MI (1.86 [1.70-2.03]) and T2MI (OR 1.39 [1.16-1.67]). The risk of overall AMI was 1.73 times higher in patients with vs. without prediabetes, which was comparable in male (aOR 1.73) and female (aOR 1.72) smokers, however, female smokers with prediabetes had higher T2MI risk (aOR F:1.55, M:1.30) vs. males. Black smokers with prediabetes have the highest risk of overall (aOR 1.85), T1MI (aOR 2.03) and T2MI (aOR 1.77). Among Hispanics, prediabetes increased the risk of overall (aOR 1.69) and T1MI (aOR 1.92) but not T2MI. Prediabetes increased the risk of T1MI (aOR 1.74) in Asians without any association with overall or T2MI[Table 1].Conclusions:Prediabetes independently increased the risk of overall AMI/T1MI/T2MI-related hospitalizations in non-diabetic smokers. Black smokers with prediabetes had the highest risk of AMI, T1MI and T2MI, and females had a higher risk of T2MI. This highlights the need for a tailored management of CVD risk by sex and race among smokers with prediabetes..

Circulation, Volume 146, Issue Suppl_1, Page A13455-A13455, November 8, 2022. Introduction:Intravascular Ultrasound (IVUS) is a catheter-based real-time imaging procedure that assists in both diagnosis and treatment during Percutaneous Coronary Intervention (PCI). Over the years, IVUS-guided PCI have become more popular. In this study, we aimed to analyze the trends of use of IVUS-guided PCI, adjusted in-hospital mortality, hospital length of stay (LOS) and inpatient cost over the years.Methods:Data were extracted from the National Inpatient Sample (NIS) 2014 through 2019 Database. The NIS was searched for PCI with and without IVUS in adult patients (age≥18) using ICD 9 and 10 codes. Outcomes of interest were utilization rates of IVUS during PCI, trend of adjusted in-hospital mortality, adjusted mean LOS and adjusted mean cost. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis.Results:Of 2,871,865 PCIs in 2014 through 2019, 201,075 (7.0%) were coupled with IVUS. The use of IVUS during PCI steadily increased from 6.2% in 2014 to 9.3% in 2019 (trend p

Circulation, Volume 146, Issue Suppl_1, Page A9455-A9455, November 8, 2022. Background:Research has shown mixed results when comparing in-hospital complications following atrial fibrillation ablation in women compared to men.Objectives:To better quantify sex differences and in-hospital outcomes in atrial fibrillation ablation procedures and identify factors associated with poorer outcomes.Methods:We queried the NIS database from 2016-2019 for hospitalizations with a primary diagnosis of atrial fibrillation ablation and excluded patients with any other arrhythmias, ICD/pacemaker placement. We assessed demographics, in-hospital mortality, and complications of women compared to men. Outcomes were adjusted for potential confounders using multivariable logistic regression analysis (Figure 1).Results:Admissions for atrial fibrillation were more common in females than males (849,050 versus 815,665; p

Circulation, Volume 146, Issue Suppl_1, Page A14528-A14528, November 8, 2022. Introduction:Environmental exposure has an important role in the development and progression of cardiovascular death (CVD). We studied the 30-year CVD in countries with similar risk factors comparing the environmental exposures.Methods:Populations with environmental risk factors (Table 1), who died between 1990 and 2019 in the GBR and USA were selected from GBD 2019 Study. The 30-year mean CVD death was compared using Welch’s t-test. Trends of the CVD deaths with pertaining risk factors over total CVD were estimated.Results:A total of 33,041,416 patients were analyzed. Mortality rates among lead and particulate matter pollution exposed populations were found to be significantly different. In lead exposure, the USA has observed more deaths (RR=0.024 vs. 0.014, p=

Circulation, Volume 146, Issue Suppl_1, Page A11742-A11742, November 8, 2022. Background:Inpatient outcomes in obese patients have been investigated, although regional inequalities in cardiac and cerebrovascular events in young obese patients have not been explored previously.Methods:The National Inpatient Sample 2019 was queried for young obese patients (18-44 years) in 4 regions (Northeast, Midwest, South, West) using ICD-10-CM codes. Baseline characteristics and comorbidities inpatient MACCE including all-cause mortality, AMI, cardiac arrest, and stroke were identified.Results:Young obese cohort (Total n: 1,285,775, median age: 33 years, females: 75.4%) often consisted of admissions in the South (41.1%), followed by the Midwest (22.3%), West (20.7%), and Northeast (20.7%). HTN and DM were more frequent in the Midwest (32.3% and 22.3%) and South (34.4% and 22.8%) respectively, with higher MACCE of South (3.3%) and Midwest (3%) as compared to Northeast (2.3%) and West (2.6%) regions. All regions had comparable median hospital stay (3 days); however, the admissions in the West and Northeast regions (USD 36861 and 31211) had a higher cost burden. After adjusting for sociodemographic and comorbidities, the odds of in-hospital MACCE were higher in the West (aOR 1.15 95%CI 1.02-1.29), and South (aOR 1.16 95%CI 1.04-1.29), (p

Circulation, Volume 146, Issue Suppl_1, Page A13230-A13230, November 8, 2022. Introduction:Contemporary data on the prevalence, trends, and outcomes of cardiovascular diseases (CVD) in pregnant patients are limited.Hypothesis:We aimed to analyze the prevalence, trends, and outcomes of CVD and their subtypes in hospitalized pregnant patients in the United States (U.S.).Methods:This retrospective population-based cohort study used the Nationwide Readmission Database to identify all hospitalized pregnant patients from January 1, 2010, to December 31, 2019. Pregnancy-associated hospitalizations were identified, and patients with missing information on the length of stay (LOS) and mortality were excluded. Main outcomes were prevalence and trend of CVD burden in pregnant patients.Results:39,212,104 hospitalized pregnant patients were identified: 4,409,924 with CVD (11.25%) and 34,802,180 without CVD (88.75%). The annual CVD burden increased from 9.49 % in 2010 to 15.54 % in 2019 (p

Circulation, Volume 146, Issue Suppl_1, Page A15756-A15756, November 8, 2022. Introduction:United States is facing an increasing shortage of primary care physicians (PCP) and health care demands. However, data on the relationship between PCP availability and burden of cardiovascular mortality (CVM) and related disparities, is limited.Hypothesis:Herein, we evaluate the nationwide impact of county PCP levels on CVM in overall and within disparate populations stratified by age, sex, and race/ethnic subgroups.Methods:PCP is calculated as the ratio of PCPs to the population, using data from National Center for Health statistics. Age-adjusted CVM rates (ACVM) between 2011 to 2019, were obtained using CDC database. Behavioral Risk Factor Surveillance was utilized to acquire county characteristics and confounders. Poisson linear mixed model was employed.Results:Of 3143 U.S. counties, 2900 counties (62% white; 51% female; 14% aged ≥65) had data available on ACVM and PCP.In a multivariate model adjusted for demographics, CV risk, socioeconomic, and environmental factors, higher PCP levels significantly associated with lower ACVM (Standardized IRR: 0.979; 95% CI: 0.972 to 0.986), which translates to 4.8 fewer CV deaths each year (AYD). This effect was relatively higher in middle-aged [45-64] (IRR: 0.967) versus elderly [≥65] (IRR: 0.980), males (IRR: 0.981) versus females (IRR: 0.972), and within Whites (IRR: 0.976). Notably, the relative impact of PCP was greatest in [45-64] Whites (IRR: 0.963), while the absolute impact was highest amongst ≥65 males with 36 fewer CV deaths each year. (Figure).Conclusions:Higher PCP supply is robustly associated with lower ACVM, and that beneficial effect is most evident amongst both age and sex subgroups as well as non-Hispanic whites. Moreover, this association is significantly independent of potential confounders that have a plausible association with CVM. Therefore, population-level strategies to promote primary care access, are imperative for reducing the burden of CVM and promoting health equity.

Circulation, Volume 146, Issue Suppl_1, Page A10072-A10072, November 8, 2022. Introduction:Sarcoidosis involves many organs in the body, including the heart, thus triggering various cardiovascular dysrhythmias and complications. We sought to analyze the cardiovascular events seen in these patients.Methods:The 2019 National Inpatient Sample (NIS) is one of the most extensive inpatient databases in the United States. It was used to explore and identify patients diagnosed with sarcoidosis and a valid entry for the variable “Sex”. Hospitalizations associated with several cardiac events were also examined (reported as cases per 100 males or females), and their occurrences were compared between males and females. Multiple logistic regression adjusted to non-cardiac characteristics allowed us to estimate the adjusted odds ratio (aOR) of the cardiovascular events in females relative to males.Results:We found 84,640 cases of sarcoidosis (61.5% females, and 38.5% males). Females were less likely to present with supraventricular tachycardia (2.1 vs. 2.4, aOR 0.804, p

Circulation, Volume 146, Issue Suppl_1, Page A11761-A11761, November 8, 2022. Background:Acute myocardial infarction (AMI) in elderly patients who have previously undergone coronary artery bypass grafting (CABG) poses a diagnostic and therapeutic complexity. There is limited data on cardiovascular and mortality outcomes for this population.Methods:Using the National Inpatient Sample (NIS) from 2016-2019, we identified patients over 65 years with a prior CABG presenting with AMI, excluding those with a history of percutaneous coronary intervention. After assessing baseline characteristics, we analyzed trends in cardiovascular disease (CVD) risk and all-cause in hospital mortality (ACM) while stratifying for gender and race. Pearson’s chi-squared test was utilized to compare the CVD variables.Results:There were 266,365 hospitalizations included in the study with a median age of 77 years. They were predominantly males(69.5%), of Caucasian origin (81.7%), Medicare enrollees (91.4%) and were admitted in urban teaching hospitals (67.2%) located in the South of the US (39.5%) as non-elective cases (93.8%). Between 2016-19, Hyperlipidemia (HLD), smoking(Sm), and obesity(Ob) showed an increasing trend in males (2.8%, 1.3%, and 2% respectively) and females (2.1%, 2.4%, and 2% respectively), whereas hypertension (HTN) decreased by 4.5% in males and 6.3% in females.The length of stay remained constant at 4 days and the average cost of stay was 58963.5 USD. HTN among all races decreased from 2016 to 2019 except for Native Americans. HLD and obesity exhibited an upward trend among all races. Hispanics and Asians/Pacific Islanders(PI) had a consistent downtrend in mortality rates, with Native Americans showing the biggest drop in mortality rate (6.9%). All-cause mortality decreased from 2016 to 2019 by 1.4% except for Blacks which has increased by 2.6%, overtaking Asian/PI. All p

Circulation, Volume 146, Issue Suppl_1, Page A12160-A12160, November 8, 2022. Introduction:The role of sex-based differences in the outcomes after principal percutaneous coronary intervention (PCI) in octogenarians is not well studied.Hypothesis:There are no differences in outcomes of PCI in octogenarians based on sex.Methods and Results:From 2016 to 2019, 37,147 hospitalizations (unweighted sample) for principal PCI procedures were identified. Among the principal PCI procedures performed, 44.9% (n = 16,660) were performed in females, and 55.2% (n = 20,487) in males (p < 0.001), 82.4% in Whites, 5.4% in Blacks, 6.4% in Hispanics, and 2.6% in Asians. 20,986 (56.5%) principal PCI hospitalizations had a Charlson comorbidity index (CCI) of three or higher. The mean age for Octogenarians was 83.6 ± 2.7 years. Compared to males, the females were slightly older (mean age: 83.8 vs. 83.5; p < 0.001), had higher prevalence of diabetes mellitus (20.5% vs 18%, p

Circulation, Volume 146, Issue Suppl_1, Page A15771-A15771, November 8, 2022. Introduction:Socioeconomic status impact cardiovascular disease outcomes. There is a paucity of data comparing age-standardized Gross Domestic Product (aGDP) and age-based proportion of CVD deaths (pCVD).Methods:We analyzed World Development Indicators and Global Burden of Disease 2019 study data. aGDP, CVD, total all-cause deaths, and their distribution amongst ‘High Income’ (HI), ‘Upper-Middle Income’ (UM), ‘Low-Middle Income’ (LM), and ‘Low Income’ (LI) countries from 2010-2019 was queried. ANOVA with Kruskal-Wallis Test followed by post-hoc analysis with Tukey test was conducted to examine the differences in pCVD among different income category countries based on age groups (Table 1b).Results:A total of 169,825,716 CVD (35.4%) were noted out of 478,797,297 total all-cause deaths globally. There was a significant difference comparing all income classes (p < 0.001) in age groups except between UM and LI in the age groups 15-49 and 50-69 (p = 0.885 and 0.261 respectively). In the age group 5-14, pCVD was higher in HI, UM, LM and LI classes (3.74%, 3.41%, 2.48 and 1.96%, p < 0.01). In age groups 15-49, pCVD was higher in UM and LM (17.70%, 17.50%), and lower pCVD in HI and LI classes (15.07% and 8.52%). At the age > 70, higher pCVD was seen in UM, followed by LM, LI, and HI (50.05%, 40.93%, 36.74% and 35.78% respectively, p < 0.001). The highest overall pCVD was observed in the UM class.Conclusions:Our study shows a statistically significant difference in pCVD between the World Bank classes of countries based on age groups. There is higher pCVD in HI, both-middle-income, and UM classes in the age groups 5-14,15-69, and >70 respectively, with overall pCVD being higher in UM class.

Circulation, Volume 146, Issue Suppl_1, Page A14682-A14682, November 8, 2022. Introduction:Data suggests that women with hypertrophic cardiomyopathy (HCM) have worse clinical outcomes than men. However, data from large multi-center studies on gender differences in patients who undergo septal myectomy (SM) is scarce.Methods:The National Inpatient Database was queried from 2011- 2019 for relevant ICD-9 and -10 diagnostic and procedural codes. We compared baseline characteristics and in-hospital outcomes of patients with HCM who underwent SM stratified according to male vs. female gender. A p-value

Circulation, Volume 146, Issue Suppl_1, Page A9444-A9444, November 8, 2022. Background:Uncertainty exists whether a higher CHA2DS2VASc risk score is associated with poorer in-hospital outcomes than a lower risk score following Left Atrial Appendage Occlusion (LAAO) procedures.Methods:The National Inpatient Sample (NIS) was queried for all hospitalizations with primary atrial fibrillation or flutter from 2016 to 2019 with codes for percutaneous left atrial appendage occlusion device placement. Cohorts with high (CHA2DS2VASc ≥5) and low (CHA2DS2VASc 5) and 49.39% had low score (< 5) (table 1). All patients received the Watchman device. The primary outcome of in-hospital mortality was not statistically different between high and low risk (0.18% vs. 0.12%, OR: 1.53, 95% CI: 0.59-3.96, p=0.37), a finding that did not change when adjusted for comorbidities in multivariate analysis (adjusted OR: 1.44, 95% CI: 0.55-3.62, p=0.46). In the high-risk group, total complication rates were similar (adjusted OR: 1.16, 95% CI: 0.97-1.38, p=0.09) as was ischemic stroke (adjusted OR: 2.05, 95% CI: 0.82-5.13, p=0.13) while systemic embolism (adjusted OR: 5.09, 95% CI: 1.08-23.99, p=0.04) and major bleeding requiring transfusion (adjusted OR: 3.84, 95% CI: 1.41-10.42, p=0.08) were higher after adjusting for confounders in multivariable analysis (figure 1).Conclusion:This study demonstrates that the LAAO procedure had similar short-term outcomes between high and low-risk patients in a study of real-world patients.

Circulation, Volume 146, Issue Suppl_1, Page A13162-A13162, November 8, 2022. Background:There is limited data on the burden and impact of Pulmonary hypertension (PHTN) in geriatric patients with prior revascularized MI. This study aims to explore the burden, trends, and impact of secondary PHTN on the survival of elderly patients with established CVD risk.Methods:We used the National Inpatient Sample (2016-2019) to identify geriatric (≥65 years) hospitalizations with prior revascularized MI (PCI or CABG) by using ICD-10 codes and divided them into two groups: with secondary PHTN and without secondary PHTN (GPRMI-PHTN+ VS. GPRMI-PHTN-). We then compared the two groups’ morbidity, mortality, and associated outcomes.Results:Of 2265900 GPRMI patients that were included in the study, 169942 (7.5%) had secondary PHTN (median 76 [70-82]). The PHTN cohort often had females (42.5% vs 33.7%) and blacks (10.8% vs 7.7%) than the cohort without PHTN (p

Circulation, Volume 146, Issue Suppl_1, Page A13438-A13438, November 8, 2022. Introduction:Physiologic assessment of intermediate coronary stenosis has shown superiority in guiding decision making when compared to angiographic assessment alone. Many recent trials have shown improved outcomes using resting or hyperemic indices for severity assessment. In this study, we aimed to analyze the trends of intravascular physiologic testing during percutaneous coronary intervention (PCI), adjusted in-hospital mortality, adjusted in-hospital stay and adjusted hospital cost.Methods:Data were extracted from the National Inpatient Sample (NIS) 2014 through 2019 Database. The NIS was searched for PCI with and without intravascular physiologic testing in adult patients (age ≥18) using ICD 9 and 10 codes. Outcomes of interest were utilization rates of intravascular physiologic testing during PCI, trend of adjusted in-hospital mortality, adjusted mean LOS and adjusted mean hospital cost. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis.Results:Of 2,871,865 PCIs in 2014 through 2019, 118,795 (4.1%) were coupled with intravascular physiologic testing. The use of intravascular physiologic testing during PCI steadily increased from 2.8% in 2014 to 5.0% in 2019 (trend p

Circulation, Volume 146, Issue Suppl_1, Page A13451-A13451, November 8, 2022. Introduction:Persons who conceived through Assisted Reproductive Technology (ART) have an increased risk of obstetric-associated complications.Hypothesis:ART is associated with increased acute cardiovascular (CV) complications during delivery admissions.Methods:We used data from the National Inpatient Sample (2008-2019) while utilizing ICD-9 or ICD-10 codes to identify delivery hospitalizations and ART procedure.Results:A total of 45,867,086 weighted delivery cases were identified, of which 0.24% were among individuals who conceived through ART (n=108,542). Persons with an ART history were older at the time of delivery (median 35 vs. 28 years, p