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

Circulation, Volume 146, Issue Suppl_1, Page A11773-A11773, November 8, 2022. Background:The impact of recreational marijuana use/cannabis use disorder (CUD) in elderly chronic kideney disease (CKD) patients remains unknown amidst the rising use of cannabis in the USA. We conducted a nationwide study to assess the impact of CUD on cardiovascular outcomes in these patients.Methods:We used National Inpatient Sample (2016-2019) and geriatric (≥65 years) admissions with CKD. We compared baseline characteristics, comorbidities and composite in-hospital outcomes [MACCE- all-cause mortality, acute myocardial infarction-AMI, cardiac arrest and acute ischemic stroke-AIS] between the age-matched (1:1 propensity score matching) CUD+ vs. CUD- cohorts.Results:Age-matched (median 70 years, p=0.998) geriatric CKD-CUD+ (n=34255) and CUD- (n=34225) cohorts were compared. CUD+ cohort often consisted of males (75.0 vs. 53.8%), blacks (35.9 vs 20.8%) and patients from lowermost income quartile (38.7 vs. 33.5%) (p

Circulation, Volume 146, Issue Suppl_1, Page A14473-A14473, November 8, 2022. Introduction:Dietary risk factors contribute to cardiovascular mortality. To the best of our knowledge, there are no studies comparing two first world countries with respect to cardiovascular deaths (CVD) and the impact of dietary risk factors. We sought to compare these parameters in Great Britain (GBR) and the United States of America (USA)Methods:A total of 33,041,416 patients with dietary risk factors and CVD from GBR and USA was obtained from the Global Burden of Disease Study between 1990 and 2016.The 30-year mean CVD was compared for all risk factors with the Welch Two sample t-test. Trends of CVD proportions of 30-years is as shown (Fig 1 and 2).Results:30-year mean cardiovascular death for all variables between GBR and USA was statistically significant (p< 0.05) with the exception of diet low in whole grains. Cardiovascular death with risk factors of diet low in PUFA, fruits, vegetable, nuts and seeds were measures where GBR had a higher 30-year mean CVD than the USA. Remaining factors contributed to higher CVD proportion in USA.Conclusions:A higher proportion of CVD was seen in the USA with dietary risk factors including low PUFA, processed meat, sweetened beverages, low legumes, high sodium and high trans-fatty acids when compared to GBR. Our study proves that there exists significant disparity in CVD proportions between two first world countries despite similar dietary risk factors.

Circulation, Volume 146, Issue Suppl_1, Page A10057-A10057, November 8, 2022. Introduction:Past studies have suggested that respiratory diseases are the most common cause of death among children with cerebral palsy (CP). At the same time, cardiovascular complications and cancer could be the leading killer among adult in those patients. The outcomes of cerebral palsy patients and risk factors following an episode of Acute Myocardial Infarction (AMI) have not been widely examined.Methods:A retrospective study via the 2019 National Inpatient Sample was conducted. Cases with CP diagnosis were retrieved via their appropriate ICD-10 codes (G80.0x). We also filtered to include patients with a principal diagnosis of AMI. Various categorical variables were compared via Chi-Square tests.Results:In 2019, 295 patients with cerebral palsy were admitted with AMI. CP patients were younger (mean age 63.20 vs. 66.93 years) and more common among Whites (86.0%), covered by Medicare (79.7%), and of ages >60 (66.1%). Compared to non-CP patients, CP patients also recorded more cases with depression (20.3% vs. 9.3%) and drug abuse (8.5% vs. 3.0%). However, they had less cases with smoking (28.8% vs. 49.3), obesity (13.6% vs. 21.0%), hyperlipidemia (59.3% vs. 68.6%), old myocardial infarct (8.5% vs. 16.6%), hypertension (78.0% vs. 82.8%), diabetes (35.6% vs. 41.2%), peripheral vascular disease (6.8% vs. 10.6%), acute kidney injury (10.2 % vs. 20.8%), ventricular tachycardia (6.8% vs. 7.2%), and paroxysmal atrial fibrillation (6.8% vs. 9.9%). Only 38.6% of CP patients underwent PCI.Conclusions:CP patients may present with AMI at a younger age and express a higher depression and drug abuse rate. Physicians and providers linked with their care should be encouraged to reach out to them for signs of depression and provide them with adequate facilities to seek treatment.

Circulation, Volume 146, Issue Suppl_1, Page A11767-A11767, November 8, 2022. Background:Traditional cardiovascular disease (CVD) risk factors can increase the risk of Atrial Fibrillation (AF) even in young adults. With rising trends in CVD in the Asian population, we aimed to assess the prevalence and disparities of major modifiable risk factors for CVD and AF in the young Asians hospitalized in the US.Methods:The National Inpatient Sample (2016-2019) was used to estimate the temporal trends in modifiable CVD risk factors among young (18-44 years) Asian hospitalizations and evaluated disparities by sex. Also, we assessed the prevalence of AF in young Asians hospitalized with vs. without atleast one CVD risk factor.Results:From 2016 through 2019, a total of 1,324,259 young Asian admissions (Male 85%, age 18-44 years) were analyzed, the highest increase was noted for Obesity (1.8%) followed by Diabetes (1.3%). Males demonstrated the most prominent prevalence of Obesity (2.1%) and Hypertension (1.7%) as compared to the female population (1.7% and 0.4%), respectively. The incidence of AF in patients with at least one CVD risk factor increased by 0.4% (males 0.9% vs females 0.15%), (OR 2.80, 95%CI 2.44-3.21, p

Circulation, Volume 146, Issue Suppl_1, Page A12155-A12155, November 8, 2022. Introduction:  Catheter ablation of ventricular tachycardia (CAVT) has emerged as a viable option in structural heart disease. Recent studies report differences in outcomes of CATV in ischemic (ICM) and non-ischemic (NICM) cardiomyopathy. We aimed to examine temporal trends and in-hospital outcomes of CATV in ICM and NICM.Methods:National Inpatient Sample 2016-2019 was queried using ICD-10 codes to identify adults with ICM or NICM who underwent CAVT. Temporal trends were assessed using logistic regression.Results:193895 CAVT were performed between 2016 and 2019. CAVT increased in numbers for both ICM [16415 in 2016 to 23030 in 2019 (P

Circulation, Volume 146, Issue Suppl_1, Page A12142-A12142, November 8, 2022. Introduction:After FDA approval in 2017, chimeric antigen receptor (CAR) T-cell therapy gained high popularity in various hematological malignancies.Hypothesis:There are no sex-based differences in in-hospital mortality and length of stay after CAR T-cell therapy.Methods andResults:From 2018 to 2019, using national inpatient sample, among a total of 14,189,303 hospitalizations (unweighted sample) 704 (0.01%) CAR T-cell therapy were performed, 306 in 2018 and 408 in 2019. Among the CAR T-cell therapy performed, 58.4% (n = 417) were males, 2.9% (n=21) had pulmonary edema, 0.6% (n=6) had acute decompensated heart failure, 3.08% (n=22) had supraventricular tachycardia, 3.36% (n=24) had ventricular tachycardia, 1.94% (n=14) had pericardial effusion (including chronic pericarditis or tamponade), 0.14% (n=1) had acute pericarditis, 0.14% (n=1) had non ST-segment elevation myocardial infarction, 3.64% (n=26) required pressors, 8.68% (n=64) had atrial fibrillation, 3.64% (n=26) had disseminated intravascular coagulation, 4.76% (n=34) required mechanical ventilation. 3.92% (n=28) died in the hospital and mean length of stay (LOS) was 20.5 days. The mean age for CAR T-cell therapy was 54 ± 18 years. Among CAR T cell therapy population, compared to males, females were similar in age (mean age: 54.6 vs. 54 years; p=0.606), had lower incidence of atrial fibrillation (4.38% vs 11.75%, p

Circulation, Volume 146, Issue Suppl_1, Page A9462-A9462, November 8, 2022. Background:There are concerns that transcatheter or surgical aortic valve replacement (TAVR/SAVR) procedures are preferentially available to White patients.Methods:We stratified Medicare beneficiaries hospitalized with principal diagnosis of AS between 2012 and 2019 (n=299,976) by self-reported race/ethnicity (Black, Hispanic, Asian, Native American, and White). We evaluated AVR rates within 6 months of index hospitalization and associated procedural outcomes, including 30-day and 1-year mortality, and discharge disposition. We fitted Cox-proportional hazard models for outcomes, adjusting for demographics and comorbidities using race/ethnicity subgroup-specific-stabilized inverse probability weights.Results:Within 6 months of an index admission for AS, 86.8% (122,457 SAVR; 138,026 TAVR) patients underwent AVR. Overall, compared with White people, Black [HR 0.87 (0.85-0.89)], Hispanic [0.92 (0.88 – 0.96)], and Asian [0.95 (0.91 – 0.99)] people were less likely to receive AVR (Figure). Among patients who were admitted emergently/urgently, White patients (41.1%, 95% CI 40.7-41.4) had a significantly higher AVR rate within 6 months compared with Black (29.6%, 95% CI 28.3-30.9), Hispanic (36.6%, 95% CI 34.0-39.3), and Asian patients (35.4%, 95% CI 32.3-38.9). AVR rates increased annually for all race/ethnicities. There were no significant differences in 30-day or 1-year mortality by race. Black people were significantly more likely to be discharged to a facility compared with others.Conclusion:Within 6 months of AS admission, AVR rates are lower for Black, Hispanic, and Asian people compared with White people. These race-based differences in ultimate treatment of AS likely represent complex issues across the diagnosis and management of AS, warranting a comprehensive reassessment of the entire care spectrum for disadvantaged populations.

Circulation, Volume 146, Issue Suppl_1, Page A12931-A12931, November 8, 2022. Introduction:The subcutaneous implantable cardioverter defibrillator (S-ICD) has emerged as an alternative to the transvenous ICD with comparable efficacy and complication rates in clinical trials. Adoption of this technology and real-world clinical experience are less well described.Methods:This was a retrospective descriptive cohort study using data from National Inpatient Sample (NIS) for calendar years 2016-2019. Outcomes were cardiovascular adverse events, all-cause mortality, 30-day readmission, and resource utilization in patients who had S-ICD implantation.Results:We identified 6655 patients who had S-ICD implantation between 2016-2019. S-ICD implant rates remained between 10-12% of total ICD implants in the US over the study period (Figure 1a), though hospital implant rates were widely distributed (Figure 1b). The mean (SD) age of the population was 56.1 ± 15.9 years, and 2002 patients (30.1%) were female. Median length of stay (IQR) was 6.0 (4.0, 10.0). Hospitalization costs were $ 245937.1 ± 206047.3. Adverse cardiovascular events associated with the hospitalization were: pericardial perforation/cardiac tamponade (0.2%), hemothorax/pneumothorax (1.1%), stroke/TIA (0.5%), cardiogenic shock (8.6%), cardiac arrest (11%), and vascular complications (1.3%). A total of 48 patients (0.7%) died. Non-elective readmission within 30 days post-procedure occurred in 15.7% of cases.Conclusion:S-ICD implant rates were stable over time but varied widely among hospitals. Hospitalization-associated adverse cardiovascular events may be more a reflection of the vulnerable population undergoing S-ICD implant than risk of the procedure.

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 A11848-A11848, November 8, 2022. Background:Despite major scientific advances in contemporary resuscitation, survival outcome in both in-hospital and out-of-hospital cardiac arrest (CA) patients remain dismal.Objective:How do individuals’ demographic and socioeconomic status, insurance status, and hospital characteristics play a role in survival following CA in patients living with human immunodeficiency virus (PLWH)?Methods:Using the ICD10 codes B20-B24 for HIV and ICD10 code I46 for CA, we queried the national inpatient sample from 2016 to 2019 to identify admission cases of PLWH with CA. Weighted data was analyzed using logistic regression model.Results:Out of 475,910 admissions for PLWH from 2016 to 2019, 4,650 cases had CA. Of these, 3,065 patients died during the course of hospitalization (65.9%). Although mortality rate decreased for both genders over time, the decline was steeper for females (72% in 2016 to 62% in 2019) compared to the males (68% in 2016 to 64% in 2019). Female gender was however associated with an increased odds of death compared to male (OR: 1.2, 95%CI: 1-1.3, p=0.03). Asian or Pacific Islanders were associated with a lower odds ratio for mortality (OR: 0.6, 95%CI: 0.3-1, p=0.04). Additionally, beneficiaries of all the insurance types had higher odds of mortality compared to Medicare beneficiaries (OR between 1.8 and 3). The odds of death decreased with increasing household income (OR between 0.7 and 0.9). Patients admitted to the hospitals of West South Central (OR:1.6) and Pacific Regions (OR:1.7) had a higher mortality rate as had those residing in areas with less than 250,000 populaces (OR: 1.7).Conclusion:Despite declining trend in mortality from CA among hospitalized PLWH, more than 60% of the cases die during their hospital stay. Female gender, lower household income, non-Medicare beneficiaries, and being a resident of smaller size population areas were associated with higher mortality among PLWH hospitalized with CA.

Circulation, Volume 146, Issue Suppl_1, Page A13534-A13534, November 8, 2022. Introduction:Maternal shock is an important contributor to severe maternal morbidity and mortality. Although there is some data on hypovolemic shock in pregnancy, the literature on maternal shock is remarkably limited.Methods:Data from the National Inpatient Sample with delivery hospitalizations from 2009 to 2019 were used for the data extraction. Diagnosis codes from the International Classification of Diseases, 9thand 10th Revision for common cardiovascular disease (CVD) conditions, adverse pregnancy and fetal outcomes, and delivery complications including shock, were used. Multivariable logistic regression was performed to assess the predictors and outcomes associated with maternal shock.Results:A total of 41,573,217 delivery hospitalizations were analyzed, of which 13,217 were complicated by maternal shock. The trend of maternal shock was seen to rise from 20 to 45 per 100,000 hospitalizations over the study period (Fig 1A). Traditional cardiovascular risk factors and diseases (e.g., hypertension and heart failure) were significant predictors of maternal shock(Fig 1B). The presence of coagulopathy (Odds Ratio [OR]: 16.2, 95% CI: 15.4-17.0) and peripheral arterial disease (OR: 6.4, 95% CI: 4.9-8.2) were strong predictors of maternal shock. All-cause in-hospital mortality (3.82%), pre-eclampsia (10.78%) and cardiac arrest (5.69%), (all 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 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 A9912-A9912, November 8, 2022. Introduction:Respiratory distress and complications are the leading causes of death among Amyotrophic Lateral Sclerosis (ALS) patients. However, several studies have reported multiple cardiovascular complications linked with heart rate and rhythm. We, therefore, aim to investigate cardiovascular involvement among ALS patients further.Methods:Data from the 2019 National Inpatient Sample from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ), and partners were analyzed to estimate the presence of multiple cardiovascular events in patients with a diagnosis of Amyotrophic Lateral Sclerosis in the United States via their respective ICD-10 codes. The risk of cardiopulmonary resuscitations and mortality rates were also estimated via multivariate regression models, accounting for different variables.Results:We identified 12,865 cases of ALS in the United States. Different cardiac arrhythmias were recorded, such as supraventricular tachycardia (2.1%), ventricular tachycardia (1.7%), ventricular fibrillation (0.2%), and paroxysmal atrial fibrillation (3.8%), and long QT syndrome (0.6%). Several cases of heart blocks were also observed as 0.4% had a first degree, 0.3% had a second degree, and 0.3% had third-degree atrioventricular blocks. 10.7% also had a diagnosis of heart failure, and 565 (4.4%) patients had an old myocardial infarct. Finally, we found 160 (1.2%) cases of cardiopulmonary resuscitation, which had a higher risk of occurring among diabetics (aOR 1.922, 95%CI 1.383-2.670, p

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 A13816-A13816, November 8, 2022. Introduction:Previous studies from India reported management of hypertension (diagnosed: 45%, treated: 13%) among adults 15-49 years, a fraction of those suffering from disease. This study aimed to provide nationally-representative estimates of (i) the proportion of all adults (18+ years) with prehypertension and hypertension (HTN), and (ii) the heterogeneity in their cascade of care by natal sex, age, and urbanicity.Methods:Using data from non-pregnant women (n = 959,468) and men (n = 935,829) in the National Family Health Survey-V (2019-21), we estimated the sex-specific prevalence of prehypertension and HTN (see footnotes ofFigure), and among adults with HTN, the self-reported care cascade (ever screened, diagnosed, taking medication, under control defined by normotension). All estimates incorporated the complex survey design and were stratified by urban versus rural or by age group (18-39, 40-64, 65+).Results:Nationally, the prevalence of prehypertension and HTN were 19.1% (95%CI: 18.9,19.2) and 27.7% (95%CI: 27.5, 27.8) respectively. The prevalence of prehypertension was similar in urban areas (vs rural) among men (%; 23.2 vs 21.7) and women (%; 16.7 vs 16.1). Prevalence of HTN was higher in urban areas (vs rural) among men (%; 30.9 vs 27.2) and women (28.8 vs 26.2). Both prehypertension and HTN were higher with increasing age. Prevalence of screening in the total population was 56%, and was higher in urban areas, among women and higher with age. Among those with HTN, only 40%, 23%, and 10% being diagnosed, taking medication, and under control, respectively. Diagnosis, treatment and control were higher in urban areas, women, and older age groups (Figure).Conclusions:Despite the high prevalence of hypertension, there is a high unmet need at each step of care cascade nationally, especially in rural adults. Moreover, the prevalence of prehypertension is high in rural areas, and those under 40 years, requiring a comprehensive approach for prevention and management.