Search Results for: L’OMS lancia una piattaforma online per informazioni sui dispositivi medici

Circulation, Volume 150, Issue Suppl_1, Page A4139524-A4139524, November 12, 2024. Background:Clinical trial (CT) participation is paramount for the advancement of medical knowledge and clinical practice. However, there are significant gaps in the literature surrounding effective CT engagement, particularly for increasing CT awareness and knowledge. We seek to bridge these gaps by assessing the role internet use plays in improving access to health information, knowledge of, and participation in CTs.Objective:To examine the association between internet use and CT knowledge among US adults and the modalities adults seek to access the internet.Methods:We used HINTS 5, Cycle 4, a cross-sectional, nationally representative survey of American adults aged ≥18 years [range: 18–104 years] to conduct this analysis. Participants self-reported the use of internet and knowledge of CTs (none or little vs. higher knowledge). Multivariate logistic regression was used to estimate relative odds of higher knowledge of CTs (outcome) by internet use (exposure) in models adjusting for demographic, health-related, and socioeconomic factors. The analysis was stratified by different modalities of internet use to explore variations in knowledge acquisition. Analyses applied sample weights.Results:Among a weighted sample of 249,896,898 participants (mean [SD] age 47 [20.2] years, 50% women), 86% used the internet, and 10% reported higher CT knowledge. As shown in the figure, there were significantly greater odds of CT knowledge among adults using the internet in partially adjusted models. In fully adjusted models, this was no longer significant (OR 1.76, 95% CI 0.83-3.74). In analyses stratified by internet modalities, both mobile phone and home-based internet use were positively associated with higher knowledge about CT (OR=4.77, 95% CI=1.26-18.0).Conclusions:Mobile phone and home-based internet use show significant association with higher knowledge of CTs among adults. This underscores the importance of employing online platforms to engage potential participants. Investing in internet-based recruitment strategies could significantly augment the efficacy of CT recruitment efforts. Furthermore, a wider net should be cast for CT recruitment to ensure non-users of the internet get equitable access to information.

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.

Circulation, Volume 150, Issue Suppl_1, Page A4120332-A4120332, November 12, 2024. Introduction:Sleep apnea (SA) is often underrecognized and undertreated despite its high prevalence in the adult population and its association with adverse cardiovascular outcomes. There are limited estimates of national trends on cardiovascular mortality in older patients with sleep apnea. We aimed to assess the sex and race-related trends of ischemic heart disease (IHD) mortality in the older adults with SA using a large population-based database.Methods:We utilized the Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research (CDC WONDER) database which provides information from death certificates of all US residents according to the International Classification of Diseases, Tenth Revision (ICD-10). The demographic and mortality data were obtained for the United States population >65 years from 1999 to 2021. Ischemic heart disease (ICD-10 codes I20-I25) was listed as the underlying cause of death, and SA (G47.3) as a contributing cause of death. Age adjusted mortality rates (AAMRs) per 1,000,000 population were calculated by standardizing deaths to the year 2000 US population. We used Jointpoint Regression Program to analyze temporal trends in mortality from 2000 to 2021. Average annual percentage change (AAPC) with 95% CI were calculated to examine trends in AAMR over time.Results:Overall, AAMR of IHD mortality for patients with SA increased from 7.9 per 1,000,000 (95% CI, 6.9-8.8) in 1999 to 53.4 per 1,000,000 (95% CI, 51.4-55.4) in 2021 with an AAPC of 9.1% per year (95% CI, 8.8-9.5). Men had consistently higher AAMR than women throughout the study period (overall AAMR men: 45.51 (95% CI, 44.8-46.2); women: 12.5 (95% CI, 12.2-12.8). Both the groups had a similar increasing trend in AAMR, with men having a steeper increase. [AAPC men: 9.3% (95% CI, 8.5-10.8) versus AAPC women: 8.6%, 95% CI, 8.1-9.7]. Non Hispanic (NH) White population had the greatest AAMR throughout the study period, followed by NH Black and Hispanic or Latino. The NH White population had the largest increase in AAMR from 1999 to 2021 (AAPC 9.4%, 95% CI:8.9-10.1).Conclusion:In the United States, there has been a general increase in IHD mortality related to sleep apnea over the last two decades. This rising trend as noted in our analysis is concerning and underscores the need for more robust cardiovascular surveillance in these patients.

Circulation, Volume 150, Issue Suppl_1, Page A4117310-A4117310, November 12, 2024. Introduction:Data is accumulating regarding the contemporary trends of mortality rates in patients with alcohol-related cardiomyopathy across the United States.Hypothesis:We hypothesized that with increased awareness about the adverse effects of alcohol on the cardiovascular system and the advancement of echocardiography in the early diagnosis of alcoholic cardiomyopathy, mortality rates may show a downward trend.Methods:This is a retrospective observational study that retrieved death certificates from the CDC WONDER (Center for Disease Control and Prevention’s Wide-ranging ONline Data for Epidemiological Research) database from 2001-2020. The mortality rate of alcohol-related cardiomyopathy using ICD code I42.6 (Alcoholic cardiomyopathy) was studied from 2001-2020. This study duration was further subdivided into five-year periods. We calculated the crude mortality rate and age-adjusted mortality rate per 100,000 for four U.S census regions (CR-1 Northeast, CR-2 Midwest, CR-3 South, CR-4 West).Results:The overall age-adjusted mortality rate remained at 0.1/100,000 deaths in four U.S census regions until 2015; however, in the last five years of the study period, AAMR(age-related mortality rate) increased from 0.1 to 0.2/100,000 deaths.Conclusions:The mortality trends associated with alcohol-related cardiomyopathy have not changed significantly over the past two decades. This can be explained by the larger number of people developing alcoholic cardiomyopathy due to the increase in global alcohol use in addition to the fact that more diagnosed patients are receiving earlier treatment with goal-directed medical therapy for cardiomyopathy. Limitations of this study include intrinsic weakness of the WONDER dataset (changes with ICD-9 to ICD-10 codes, and potentially miscoding) which needs further research.Discussion:This suggests that while mortality rates associated with alcohol-related cardiomyopathy remained relatively steady for most of the study period, there was a concerning uptick in the latter years. This could prompt further investigation into potential factors contributing to this increase, despite advancements in awareness and diagnostic techniques.

Circulation, Volume 150, Issue Suppl_1, Page A4144346-A4144346, November 12, 2024. Background:Stroke is a leading cause of death globally. Atrial fibrillation (AF) is an important modifiable risk factor for stroke. Ascertaining the burden of stroke in AF, its temporal trends and demographic disparities can inform public health policy measures.AimsTo describe national temporal trends of ischemic stroke-related mortality in patients with AF and identify any differences by gender, race, ethnicity, or region.Methods:In this cross-sectional analysis we used death certificate data from the national CDC Wide-Ranging ONline Data for Epidemiologic Research (WONDER) database for adults aged 35-84 years between 1999 and 2020. We queried for both ischemic stroke and AF as contributing or underlying cause of death. Crude and age-adjusted mortality rates (AAMR) were computed for the overall population and stratified by sex, race/ethnicity, geographic region, state, and rural/urban status. Joinpoint Regression Analysis software was used for trend analysis. Average annual percentage change (APC) in AAMR were computed using log-linear regression models.ResultsA total of 32,386 ischemic-stroke related deaths occurred in patients with AF between 1999 and 2020. Overall mortality trends were stable until 2014, sharply rose between 2014 and 2017 (APC 27.6% [95% confidence interval, CI, 18.8-33.4]), slowing down between 2017 and 2020 (APC 2.48 [95% CI, -4.81-7.03]). Overall AAMR per 100,000 was higher in men (1.00 vs 0.86 in women; Figure 1); Non-Hispanic Whites (0.98 versus 0.81 in Non-Hispanic Blacks and 0.70 in Hispanics; Figure 2), individuals in the Western census region (1.07 vs 0.95 in Southern, 0.92 in Midwestern and 0.78 in Northeast regions; Figure 3) and non-metropolitan areas (1.06 versus 0.91 in metropolitan). The rate of increase in AAMR over recent years was significantly greater in Black populations.Conclusion:Stroke mortality in AF rose sharply since 2014. Our findings underscore racial and geographic differences that exist in stroke-related deaths in the US.

Circulation, Volume 150, Issue Suppl_1, Page A4125957-A4125957, November 12, 2024. Objective:Men who work in trade and labor occupations experience high rates of obesity and related cardiovascular disease due to high rates of sedentary leisure time and poor diet. Despite this, they are underrepresented in weight control programs. This pilot randomized trial evaluated the feasibility and acceptability of a 6-month program tailored to this occupational group versus a non-tailored standard-of-care behavioral weight loss program.Methods:Men with overweight or obesity working in trade and labor occupations were randomly assigned to either a tailored program or the DPP Group Lifestyle Balance program delivered via 16 one-hour virtual group sessions. In-person assessments were conducted at baseline, 3, and 6 months. Semi-structured interviews and self-report were used to assess the acceptability of the interventions. Feasibility was assessed using recruitment metrics and proportion group sessions and study assessments completed.Results:Participants (N = 28; median 44.0 years, interquartile range (IQR): 38.5-54.5), median 31.8 BMI, IQR 31.1-39.6) were recruited into the study over 7 months, and 71% and 79% were retained for assessments at 3 and 6 months, respectively. Overall, participants attended a median of 7 of the 16 group sessions (IQR 2.5-11.5). The tailored group completed a median of 11 of 16 weekly online progress reports (IQR 5-15). All participants reported that they would recommend the programs to other men and felt confident that they would continue using the strategies learned in the programs. Though the trial focused on feasibility rather than efficacy, median weight losses at 6 months were -3.0% in the tailored group (95% CI -9.3, -0.6) and -1.9% in the standard group (95% CI -7.4, 2.0).Conclusions:Results suggest that both the tailored and standard weight loss interventions were well received by this group, but engagement was low. Future research should focus on understanding how to increase engagement rather than exclusively tailoring the program to this occupational group to enhance this group’s involvement with cardiovascular disease prevention programs.

Circulation, Volume 150, Issue Suppl_1, Page A4139850-A4139850, November 12, 2024. Introduction:The incidence of Heart Failure (HF) has increased as the US population ages, with Chronic Renal Failure (CRF) being a common comorbidity and risk factor for mortality. This study aims to identify annual, gender, race, and geographical trends in CRF-related mortality in patients with HF for older adults.Methods:We used ICD-10 (International Classification of Diseases 10th Revision) codes to retrospectively analyze death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database between 1999-2020 for patients ≥65 years old with concomitant HF and CRF. Age-adjusted mortality rates (AAMRs) per 100,000 people and Annual Percentage Change (APCs) and their respective 95% Confidence Intervals (CI) were also calculated for patient data grouped according to year, gender, race, and geography.Results:From 1999-2020, 425,854 deaths occurred from CRF and HF in patients ≥ 65 years. The overall AAMR was 46.1 (95% CI: 46 to 46.3), with the APC from 1999-2020 being 2.96 (95% CI: 1.84 to 4.32). Males reported higher AAMRs than females (overall AAMRs: 62.1 vs 36.2). Stratifying data by race revealed NH (Non-Hispanic) Black or African American to have the highest AAMR (62.2) followed by NH American Indian or Alaska Native (52.5), NH White (45.5) and Hispanic or Latino (37.2), with the NH Asian or Pacific Islander race having the lowest AAMR (30). According to the census region, the highest AAMRs were reported in the Midwest (54.3), followed by the West (45.1) and South (43.4), with the lowest AAMRs in the Northeast (42.3). Furthermore, Non-Metropolitan areas revealed higher AAMRs when compared to Metropolitan areas (54.4 vs 43.3). The states in the top 90thpercentile were Indiana, Kentucky, Minnesota, North Dakota, and West Virginia. They had AAMRs nearly double those in the bottom 10th percentile, such as Arizona, Hawaii, Nevada, and New Mexico.Conclusion:Trends in CRF- and HF-related mortality in older adults have varied from 1999-2020, with the highest AAMRs being reported in men, NH Black or African Americans, Non-Metropolitan areas, and in the Midwest. Strategies to target precipitating events are necessary alongside further investigations to explain the trend variations.

Circulation, Volume 150, Issue Suppl_1, Page A4140673-A4140673, November 12, 2024. Background:Considering the high prevalence and comparable five-year mortality rates of heart failure with preserved ejection fraction (HFpEF) to heart failure with reduced ejection fraction (HFrEF), and the inconsistent results regarding prognostic biomarkers for HFpEF, we aim to systematically review studies evaluating the prognostic role of common kidney function markers in HFpEF.Methods:Following PRISMA guidelines, a systematic search was performed in online databases from inception to March 2024. Studies that primarily assessed the association of blood urea nitrogen (BUN), uric acid (UA), creatinine (Cr), estimated glomerular filtration rate (eGFR), and cystatin-C with HFpEF outcomes were included. A random-effects meta-analysis was conducted to pool the hazard ratios (HRs) and their 95% confidence intervals (CIs) for a 1-unit increase in markers or higher levels versus lower levels for the incidence of adverse events, including all-cause mortality, HF readmission, cardiac mortality, and composite outcomes.Results:Out of 2491 reviewed studies, 80 were included. A significant correlation between BUN levels and HFpEF outcomes, mainly HF readmission and all-cause mortality, was found. The meta-analysis showed that a 1-unit increase in BUN was linked to a higher hazard of these events (HR 1.02, 95% CI 1.01 to 1.03, P = 0.0003). A 1-unit increase in UA resulted in a higher incidence of adverse events (HR 1.13, 95% CI 1.05 to 1.21, P = 0.0005). Higher serum Cr levels were linked to increased all-cause mortality, with a 1-unit increase in Cr leading to a higher incidence of adverse events (HR 1.17, 95% CI 1.06 to 1.29, P = 0.0017). Higher eGFR values were associated with lower mortality and hospitalization (HR 0.99, 95% CI 0.98 to 0.99, P < 0.0001). The predictive value of cystatin-C was also demonstrated, with its increased levels correlating with higher mortality and readmission, showing a higher hazard ratio (compared to others) of 1.43 (95% CI 1.21 to 1.75, P < 0.0001). It appears that among continuous variables, cystatin-C works better to predict adverse outcomes in HFpEF (figure).Conclusion:Renal function biomarkers play a significant role in predicting HFpEF outcomes, aiding in better risk assessment and patient management.

Circulation, Volume 150, Issue Suppl_1, Page A4139839-A4139839, November 12, 2024. Introduction:Diabetes mellitus type 2 (T2DM) is an established risk factor for acute myocardial infarction (AMI). Current data suggests that mortality risk of AMI in diabetics remains significantly higher than non-diabetics. Therefore, we aim to examine the trends in AMI-related deaths among younger and older diabetic adults in the United States from 1999 to 2020.Methods:We used CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access mortality data from 1999 to 2020. AMI and T2DM-related deaths, age ≥ 35 years, were identified from multiple causes of death and were represented as age-adjusted mortality rates (AAMR) per 1,000,000 population using ICD codes for AMI including (I21.0-I21.9, I22.0-I22.1, I22.8-I22.9) and T2DM (E11.0-E11.9). Joinpoint regression was used to examine trends and annual percentage change (APC) overall and stratified by sex, race, and rural-urban distribution.Results:Between 1999-2020, 164,260 individuals died from AMI and T2DM with an overall AAMR of 43.2 (95% CI: 43, 43.4). AAMRs related to AMI and T2DM modestly increased from 42 in 1999 to 46.8 in 2005 (APC 2.84, 95% CI: 0.1, 8.43), followed by a significant decline to 38.8 in 2014 (APC -1.95, 95% CI: -4.17, -1.29), with subsequent significant increment to 52.2 in 2020 (APC 4.26, 95% CI: 2.73, 6.90). Men had higher AAMRs when compared to women (AAMRs men: 57.2; women: 32.5). After an initial rise from 1999-2003 in men and 1999-2005 in women, AAMRs declined in both men and women till 2014 (AAMRs men: 52; women: 28.3), followed by a significant rise till 2020 (AAMRs men: 71.5; women: 36.3). Among the race groups, AAMR was highest in American Indian or Alaska Natives (75.8), followed by Hispanics (56.4), Non-Hispanic (NH) Blacks (54.5), NH Whites (NHWs) (40.8), and lastly Asian or Pacific Islanders (38.2). According to the rural-urban classification, non-metropolitan areas demonstrated higher AAMRs than metropolitan areas (AAMRs: non metropolitan: 57.2; metropolitan: 40.3).Conclusion:Lesser urbanization, men, and American Indian or Alaska Natives are associated with higher mortality rates. Further in-depth research is needed to comprehend the underlying mechanisms interlinking AMI and T2DM and provide tailored interventions for mortality reduction among patients with concomitant AMI and T2DM.

Circulation, Volume 150, Issue Suppl_1, Page A4122048-A4122048, November 12, 2024. Introduction:Heart failure (HF) majorly affects the elderly, but can also affect the younger population. This study aims to examine the trends of HF-related deaths among reproductive-aged women in the United States (US).Method:We conducted a retrospective analysis using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, extracting data through ICD-10 codes I11, I13.0, I13.2, and I50 to find HF-related deaths among women aged 15-44 from 1999 to 2019. We examined demographic disparities in HF mortality rates over time, considering age, ethnicity, and geographic areas. Results were reported as age-adjusted mortality rate (AAMR) and 95% confidence interval (CI). Joinpoint regression assessed trend changes and annual percentage change (APC).Results:Between 1999 and 2019, a total of 43,683 women aged 15-44 died from HF in the US, with an AAMR of 3.5 per 100,000 (95% CI: 3.5-3.5). The AAMR increased from 2.6 in 1999 to 4.8 in 2019. Non-Hispanic Black women had the highest AAMR at 10.2, while Hispanics had the lowest at 1.8. Geographically, the South was the most affected region with an AAMR of 4.6, contributing to nearly half (48.9%) of all deaths. States including Massachusetts, Oregon, New Hampshire, and Minnesota had the lowest AAMRs. Rural areas showed a higher AAMR compared to urban areas (4.4 Vs. 3.3). The age group (35-44) accounted for the majority of deaths (73.7%).Conclusion:HF-related mortality among reproductive-aged women increased from 1999 to 2019, with the highest burden among non-Hispanic Black women and those in the Southern region. Enhancing access to care, particularly in rural areas, and implementing targeted prevention programs are vital to reducing mortality rates.

Circulation, Volume 150, Issue Suppl_1, Page A4140672-A4140672, November 12, 2024. Background:osteoporosis (OP) and aortic stenosis (AS) are common in the elderly population, conferring a heavy world burden. Several epidemiological studies show a correlation between AS and OP independent of aging. However, the molecular and cellular mechanisms underlying stenotic calcification and OP remain poorly understood. Herein, this study aimed to identify crosstalk genes between OP and AS and potential mechanism.Method:AS and OP datasets were downloaded from the GEO database and were performed Weighted Gene Co-Expression Network Analysis (WGCNA) to get common key genes, and differential expression analysis to get common differentially expressed genes (DEGs). We also analyzed the protein–protein interactions (PPIs) of the common key genes and DEGs using the NetworkAnalyst online tool to find the intersection of correlated genes in OP and AS, the top 20 genes in each algorithm were selected as the candidate genes and the genes were calculated by more than six algorithms at the same time were chosen as candidate genes. We downloaded genes related to AS in the Comparative Toxicogenomics Database (CTD) to get the intersection with candidate genes as hub genes. The hub genes were certified in another OP dataset and AS dataset downloaded from GEO respectively.Result:665 common Genes from WGCNA, which were enriched in the myeloid leukocyte activation, secretory granule membrane, cell adhesion molecules.13 of them were screened as candidate genes by 12 prediction algorithms in the Cytoscape. 161 common DEGs were differentiated in another AS database and OP database, which were enriched in natural killer cell mediated immunity, collagen-containing extracellular.19 genes were recognized as candidate genes by Cytoscape in the same way. 15 hub genes were selected by intersecting with candidate genes and genes downloaded from CTD as hub genes, including CD226, CD247, CD38, CD4, CD96, FCGR2B, GNG2, GRB2, GAMB, HSD17B6, ITGB2, KSD17B6, ITGB2, KLRB1, NGF, PECAM1, SDC1. The transcription factors hub genes interaction network was constructed using TRRUST. Hub genes were certified in another AS and OP dataset. CD4, GZMB, SDC1 are upregulated remarkably in AS dataset, whereas SDC1 and ITGB2 are downregulated and GZMB is upregulated in OP dataset.Conclusion:GZMB, SDC1may be potential hub genes in AS and OP, through bioinformatic analysis, we identified potential biomarkers and therapeutic targets for AS and OP, providing a theoretical basis for future studies.

Circulation, Volume 150, Issue Suppl_1, Page A4134851-A4134851, November 12, 2024. Introduction:Atherosclerosis (ATH) is a major risk factor for cerebrovascular disease (CEVD), with persistent mortality disparities. Our study aims to identify vulnerable regions and demographics in the US adult population with pre-existing ATH at risk of CEVD.Methods:CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was used to access National Vital Statistics System data from 1999 to 2020. ATH-related CEVD was identified using CEVD as the underlying cause of death and ATH as a contributing cause of death. Results were presented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC).Results:A total of 325,408 CEVD occurred in patients with ATH from 1999 to 2020 (AAMR = 6.9, 95% CI: 6.8-7). Increased mortality rates were observed in males (AAMR = 6.3) as compared to females (AAMR = 5.1) (Figure, Panel A). AAMRs were highest in Non-Hispanic Whites [NHW] (5.7, 95% CI: 5.7 – 5.8), followed by non-Hispanic blacks [NHB] (5.5, 95% CI: 5.4 – 5.5), Hispanics (4.1, 95% CI: 4.0 – 4.1) and non-Hispanic American Indian/Alaska Native [NH-AIAN] (3.6, 95% CI: 3.4 – 3.8). Non-Hispanic Asian/Pacific Islander [NH-API] had the lowest mortality rates (3.4, 95% CI: 3.4 – 3.5). Region-wise analysis revealed that mortality rates were highest in the West (6.4, 95% CI: 6.3-6.4) and Midwest (6.2, 95% CI: 6.1-6.2). The South reported the rate of 5.5 (95% CI: 5.5-5.6), while the Northeast had the lowest rate (4.4, 95% CI: 4.3-4.4). Mortality rates were consistently higher in rural areas (6.1, 95% CI: 6.0-6.1) compared to urban areas (5.3, 95% CI: 5.3-5.4) throughout the study period. Overall AAMR rose from 9.0 in 1999 to 10.4 in 2001, then steadily declined before increasing to 3.6 from 2016 to 2020 (APC: 0.41). After an initial decline, AAMR increased in men (APC: 1.09) from 2016 and in women (APC: 5.09) from 2018. AAMR also increased among NH-API (APC: 8.9) and NHB (APC: 8.3) from 2018 onwards, and NHW (APC: 0.1) from 2016 (Figure, Panel B).Conclusions:Our study reveals significant mortality disparities from CEVD in patients with ATH, identifying males, NHW, and residents in the West and Midwest as particularly at increased risk. Rural areas consistently show higher mortality rates than urban areas. These findings highlight the need for targeted interventions and strategic provision of healthcare resources to improve outcomes for vulnerable populations.

Circulation, Volume 150, Issue Suppl_1, Page A4146104-A4146104, November 12, 2024. Background:There is substantial imbalance between the prevalence and treatment of overweight/obesity. Team-based remote care programs have shown promise in closing healthcare delivery gaps for several cardiometabolic disorders, but whether this strategy can enhance the uptake of guideline-directed therapy for weight management remains uncertain.Methods:In this quality improvement program, we developed and deployed a remote, patient navigator and pharmacist-led, pharmacotherapy-oriented weight management intervention (Supplementary Anti-Obesity Integration into a Longitudinal Weight Loss [SAIL] program). SAIL was conducted within the Partnerships for Reducing Overweight and Obesity with Patient-Centered Strategies 2.0 (PROPS 2.0) program, an ongoing 12-month digital health program pairing an online weight management program (RestoreHealth; HealthFleet, Inc.) with personalized support from health coaches. After 6 months, PROPS 2.0 participants who did not experience weight reduction were offered possible enrollment in SAIL. Pharmacists, enabled by a collaborative drug therapy management program, prescribed, titrated, and monitored anti-obesity medications (AOM) with physician (cardiologist) supervision.Results:Overall, 2,540 invitations for participation in SAIL were sent to the 5,061 patients enrolled in PROPS 2.0, of whom 200 responded. Of the respondents, 98 (49%) were eligible for SAIL, and 75 patients were enrolled. Based randomly by enrollment period, 45 patients participated without a remote physician visit, while 30 had a video telemedicine visit. Among the 75 program participants, 70 (93%) received a prescription for AOM (29/30 with a visit vs. 41/45 without; P=0.64). After a median follow-up of 143 days (IQR 79-193), 61/70 were taking prescribed AOM (26/29 with a visit vs. 35/41 without; P=0.73) (Figure).Conclusion:This study extends prior experiences leveraging remote, team-based care, emphasizing the potential of this approach to enhance weight management. Given the dramatic cardiometabolic detriments of prolonged exposure to overweight and obesity, innovative approaches are necessary to meet demand. Remote and team-based care are proven methods to improve care and outcomes and may provide a novel model for delivering care for overweight and obesity. Further studies are needed to ascertain the effectiveness of this strategy on weight-related health outcomes.

Circulation, Volume 150, Issue Suppl_1, Page ASu1107-ASu1107, November 12, 2024. Introduction:Opioid overdose (OD) is a growing cause of cardiac arrest in the US, spurred by the rise of illegally manufactured fentanyl and analogs. Naloxone is a reversal agent that can be administered by bystanders. Intra-nasal (IN) naloxone is now widely available in pharmacies across the US. Despite increasing access, minority populations remain disproportionately affected by drug overdose deaths. There are many free online opioid OD educational videos. Digital media can be a powerful tool for mass education, but the effectiveness is unknown.Research Question and Aims:The goal of this study was to evaluate online opioid overdose videos for content and gender/racial representation.Methods:We performed an online search with the query “how to give Narcan” (popular term for IN naloxone). Results were limited to the first 52 Google, 50 YouTube, and 60 TikTok videos. Exclusion criteria included: animal victim, duplicate, or no mention of naloxone. For each video, 2 reviewers evaluated content and identified the race and gender of featured characters. Disagreements were resolved through consensus. The race and gender of featured characters was compared using a two proportion z-test. Inter-rater reliability (IRR) for each data point was calculated using the arithmetic mean of Cohen’s kappa.Results:Of 121 videos, the majority (87.6%) mentioned naloxone as a treatment for opioid OD; 62.8% provided instruction on how to administer IN naloxone, and 4.1% featured a testimonial. Only 43.0% provided a realistic visual demonstration of IN naloxone administration; 25.6% showed a realistic re-enactment of opioid overdose, and even fewer (19.0%) showed the dramatic response to naloxone. IRR was high for all categories.Videos predominantly featured white compared to non-white-appearing characters in both the victim (75.5 v. 17.8%, p< 0.00001) and rescuer roles (72.5 v 21.6%, p

Circulation, Volume 150, Issue Suppl_1, Page A4140555-A4140555, November 12, 2024. Background:Psychological stress and poor sleep quality are interrelated and disproportionately affect adults who have multiple risk factors of cardiovascular disease (CVD). Sleep hygiene practices, such as maintaining an optimal household environment and engaging in healthy bedtime behaviors, are essential to sleep health. These practices may also impact psychological stress; however, their relationships remain under-studied. This study aimed to examine the associations among sleep hygiene practices, sleep quality, and psychological stress in adults with multiple CVD risk factors.Methods:Adults diagnosed with hypertension and type 2 diabetes completed an online survey (N = 300). Psychological stress and sleep quality were assessed using the Perceived Stress Scale 4 and the Pittsburgh Sleep Quality Index, respectively. A sleep hygiene instrument was used to examine 8 individual factors focusing on negative household environment (safety, physical comfort, temperature, and light) and poor in-bed behaviors (watching TV, playing video games, using screens, and eating). Multiple regression was employed to examine the association of each sleep hygiene factor with sleep quality and psychological stress. Subsequently, mediation analyses were conducted to examine the mediating role of sleep in the association between the composite sleep hygiene score and psychological stress.Results:Of the sample, 78% reported poor sleep quality and 44% reported high psychological stress. Individual sleep hygiene factors (e.g., unsafe household and eating at bedtime), as well as the composite sleep hygiene score, were significantly associated with poorer sleep quality and higher psychological stress. Sleep quality partially mediated the association between the composite sleep hygiene score and psychological stress (Indirect effect: 0.183; 95% bootstrap confidence interval: 0.057-0.339).Conclusions:The findings showed strong links between sleep hygiene practices, sleep quality, and psychological stress. Although causality cannot be inferred, current evidence suggests that promoting sleep hygiene education and implementing strategies to enhance sleep quality may alleviate psychological burdens in adults with multiple CVD risk factors.

Circulation, Volume 150, Issue Suppl_1, Page A4141129-A4141129, November 12, 2024. Background:There is a scarcity of data regarding trends in substance use (SU) and mortality related to ischemic heart disease (IHD) in the United States (US).This study aims to evaluate deaths linked to SU+IHD in the US by utilizing the CDC Wide-ranging Online Data for Epidemiologic Research database (CDC WONDER).Methods:The CDC WONDER database was used to access the mortality data of adults aged ≥25 from 1999 to 2020. Both substance use and IHD were mentioned as contributing or underlying causes of death. Results, presented as age-adjusted mortality rates (AAMR) per 100,000 population, underwent Joinpoint regression for trend analysis and annual percentage change (APC).Results:Between 1999 and 2020, a total of 236,832 deaths were attributed to IHD among patients with substance use (AAMR = 4.9, 95% CI: 4.91-4.95). The overall AAMR depicted a consistent rising trend from 3.29 in 1999 to 7.91 in 2020.Throughout the study period, males consistently exhibited higher overall AAMRs compared to females (Male: 8.3 vs Female: 1.9). Among racial/ethnic groups, non-Hispanic American Indian [NH-AI] individuals had the highest AAMRs (10.9, 95% CI: 10.6-11.3), followed by non-Hispanic blacks [NHB] (6.5, 95% CI: 6.5-6.6), non-Hispanic Whites [NHW] (5.0, 95% CI: 5.0-5.1), and Hispanics (3.5, 95% CI: 3.4-3.5). Notably, non-Hispanic Asian/Pacific Islander [NH-API] individuals had the lowest AAMR (1.2, 95% CI: 1.1-1.2). Regionally, the West reported the highest mortality rates (6.3, 95% CI: 6.3-6.4), followed by the Midwest (4.8, 95% CI: 4.8-4.9) and the South (4.6, 95% CI: 4.6-4.7), while the Northeast reported the lowest mortality rate (3.9, 95% CI: 3.9-4.0). Moreover, when comparing urbanization status, metropolitan areas had a higher AAMR value compared to metropolitan areas in 1999, however this trend sharply reversed to non-metropolitan areas having a higher AAMR in 2020 (1999 non-metro: 3.1 vs. metro: 3.3; 2020 non-metro: 9.2 vs. metro: 7.6).Conclusion:Our findings underscore a troubling rise in IHD related mortality among substance users in the US. Addressing gender, racial/ethnic, and regional disparities is crucial for targeted interventions to reduce mortality rates and improve cardiovascular health outcomes.