Search Results for: I numeri del cancro in Italia 2019

Circulation, Volume 150, Issue Suppl_1, Page A4138609-A4138609, November 12, 2024. Background:Patient care experience is strongly associated with outcomes among individuals with cardiovascular disease. There is growing concern that the recent and precipitous rise in private equity acquisitions of US hospitals may worsen patient-centered care, and ultimately, cardiovascular outcomes. However, little is known about how private equity acquisitions of hospitals impact patient care experience.Research Question:To evaluate whether the acquisition of US hospitals by private equity firms was associated with changes in measures of patient-reported experience compared with matched control hospitals (not acquired by private equity) between 2007-2019.Methods:This cohort study identified 74 US acute care hospitals newly acquired by private equity firms and 298 matched control (non-acquired) hospitals from 2007 to 2019. CMS Hospital Compare files were used to obtain patient experience measure scores for each hospital from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) survey results. A quasi-experimental difference-in-differences design was used to evaluate changes in patient experience measures at private-equity acquired hospitals compared with matched control hospitals 3 years before vs 3 years after acquisition.Results:The percentage of patients rating hospitals as a 9 or 10 out of 10 at private equity acquired hospitals and control hospitals is shown in theFigure.There was a differential decrease in patient ratings (of 9 or 10 out of 10) at hospitals acquired by private equity firms compared with control hospitals (-2.4 percentage points [95% CI -3.9, -0.9]). A similar trend was seen in the percentage of patients that would definitely recommend the hospital, with a differential decrease at private equity-acquired hospitals relative to control hospitals (-2.2 percentage points [95% CI -3.6, -0.7]). For both measures, the relative decrease in patient care experience at private equity hospitals compared with control hospitals steadily grew with each subsequent year after acquisition.Conclusion:In this national study, patient-reported care experience worsened after private equity acquisition of US hospitals, which has important implications for cardiovascular care and outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4145992-A4145992, November 12, 2024. Introduction:Given the overlap in their risk factors, investigating the combined mortality trends of both chronic obstructive pulmonary disease (COPD) and acute myocardial infarction (AMI) represents a crucial yet understudied area.Methods:Using the CDC WONDER database, we queried mortality records from 1999 to 2019 among COPD-related deaths (ICD-10: J40, J41, J42, J43, J44) and AMI-related deaths (ICD-10: I21) in ≥ 45-years-old. Joinpoint regression analysis was utilized to assess trends in annual percentage change (APC) for underlying and contributing causes of death. Age-adjusted mortality rates (AAMR) were computed and compared cumulatively across subpopulation demographics.Results:Between 1999 and 2007, COPD and AMI mortality as underlying causes showed a notable decline (APC: -4.71, 95% CI: -6.09, -3.45), with a continued decrease from 2007 to 2020 (APC: -2.28, 95% CI: -2.61, -1.57). Conversely, as contributing causes, COPD and AMI demonstrated a downward trend from 1999 to 2009 (APC: -3.09, 95% CI: -4.22, -2.45), followed by a slower decline from 2009 to 2018 (APC: -1.52, 95% CI: -3.3, -0.93), and a slight increase from 2018 to 2020 (APC: 2.05, 95% CI: -1.18, 3.75). Gender-specific analysis revealed consistently higher AAMRs among males (458.8) than females (295.5), while Whites consistently had the highest AAMR (377.6) and Asians the lowest (145.9). Urbanization level played a role, with non-metropolitan areas consistently exhibiting higher AAMR (478.5) compared to metropolitan areas (353.1), with the Midwest showing the highest AAMR (396.1).Conclusion:The decline in COPD and AMI-related mortality reflects the success of public health initiatives targeting smoking cessation, improved air quality regulations, and advancements in cardiovascular care. The uptick in mortality rates from 2018 to 2020 underscores the necessity for ongoing vigilance and targeted interventions, especially in addressing disparities related to gender, race, and urbanization.

Circulation, Volume 150, Issue Suppl_1, Page A4141564-A4141564, November 12, 2024. Introduction:Healthcare utilization in postoperative management and surveillance following endovascular aneurysm repair (EVAR) is an important factor in achieving long-term treatment success. However, factors associated with poor healthcare utilization have yet to be elucidated.Hypothesis:Disadvantaged patients have lower rates of surveillance and higher rates of emergency health service use than their counterparts.Aims:Examine rates of healthcare utilization stratified by age, sex, race, dual-enrollment in Medicare and Medicaid, and residence in a distressed community.Methods:We performed an observational retrospective cohort study of Medicare beneficiaries who underwent infrarenal EVAR with a bifurcated endograft between 2011-2019. We examined annual rates of post-operative surveillance (EVAR-related outpatient visits, surveillance imaging), use of emergency department (ED) visits, and hospital readmission across several disparity measures using Modified Poisson Regression models.Results:In 111,381 Medicare beneficiaries undergoing EVAR, comorbidities associated with poor postoperative surveillance were chronic kidney disease (aRR:1.06[1.04-1.07]), heart failure (1.10[1.09-1.11]), hyperlipidemia (1.16[1.14-1.19]), hypertension (1.09[1.07-1.12]), and ischemic heart disease (1.15[1.14-1.17]). For EVAR-related office visits, patients with worse post-operative care included those >85 years, female, Black, dual-enrolled, or living in distressed communities (Table 1). Similarly, less surveillance imaging was performed in patients >85 years, dual-enrolled, or living in distressed communities. There was a greater need for ER care or readmission among patients >85 years, female, Black, dual-enrolled, or living in distressed communities.Conclusions:Our study revealed patterns of disparities in post-procedure EVAR-related office visits and EVAR imaging studies, and greater use of emergency health services associated with patient age, sex, race, and socioeconomic status. These findings may suggest barriers in access to appropriate surveillance and care which could be addressed by targeting the identified groups for intervention efforts to improve EVAR surveillance.

Circulation, Volume 150, Issue Suppl_1, Page A4140051-A4140051, November 12, 2024. Background:Improved congenital heart disease (CHD) care allows >90% of patients to live into adulthood, but young adult CHD patients are challenged by managing their own care as well as the risk of other comorbidities that may increase healthcare resource utilization. There is limited data on hospitalizations of adolescents with CHD, specifically during the transition from pediatric to adult care.Hypothesis:We hypothesized that as adolescents age into adult care, utilization of healthcare resources will increase.Methods:We conducted a retrospective review of the Vizient® Clinical Data Base (national, administrative database) for admissions from 10/2019-12/2023 aged 10-29 years with ICD-10 codes for moderate or severe CHD and stratified into age categories (10-14, 15-19, 20-24 and 25-29 years). Data included: demographics, hospital outcomes, insurance status, costs and admissions through the Emergency Department (ED). Comparisons were made using ANOVA for normally distributed data and χ2for categorical data; Bonferroni test was used for post-hoc analysis. Ap-value

Circulation, Volume 150, Issue Suppl_1, Page A4146510-A4146510, November 12, 2024. Background:Chronic limb threatening ischemia (CLTI) is a condition that profoundly impacts individuals’ health status. As attempts are made to improve perfusion and promote limb salvage, the overall goal of CLTI disease management is also to make people feel better as reflected by their health status (symptoms, functioning, quality of life) evaluations. It is unknown how many individuals with CLTI rate their health status as meaningfully changed following endovascular or surgical revascularization 1 year after the procedure.Methods:Secondary data analyses as a pooled cohort of the endovascular and surgical arms for the Best Endovascular versus Best Surgical Therapy in Patients with CLI (BEST-CLI) trial was conducted. Patients were recruited from 150 international sites, during 2014-2019 and completed the generic Short Form-12, EQ-5D, and the peripheral artery disease (PAD)-specific Vascuqol prior randomization and at 1 year following randomization. Using distribution-based thresholds (0.5 standard deviation of baseline health status scores) for determining a minimally clinically important difference, a descriptive analysis was performed to rate 1-year health status responses as improved, remained the same, or worsened.Results:A total of 1,533 patients were included, (71.9% male, mean age 66.9 ± 9.7 years). For patients’ overall physical health status (SF-12 PCS, EQ-5D Index), between 50.1-57.9% rated themselves as improved. For overall mental status (SF-12 MCS), only 39.1-44.8% rated themselves as improved. MCID improvement rates for generic health status did not differ by treatment arm (P-values >.05). When looking at PAD-specific health status, 76.2-76.8% made clinically relevant improvements (endo vs. surgical, P-value 0.823) (Figure).Conclusion:The majority of individuals with CLTI achieve clinically meaningful PAD-specific health status improvements at 1 year, regardless of type of revascularization strategy. When it relates to their overall health status, less than ½ experience improvements, especially for their mental health status, 1 in 5 actually experiences worsening. Health status rehabilitation goals following CLTI revascularization may need to be broadened to not only include lower-limb related health status, but also aim to improve overall health status with integrated disease management approaches.

Circulation, Volume 150, Issue Suppl_1, Page A4136267-A4136267, November 12, 2024. Background:Out-of-hospital cardiac arrest (OHCA) continues to have a high mortality with an overall survivability to hospital discharge of less than 10%. Increased bystander cardiopulmonary resuscitation has resulted in better survival after OHCA. Some studies have tackled sociodemographic characteristics and rates of survival, but these are mostly localized studies with varied results. We investigated racial disparities in in-hospital mortality and mechanical circulatory support (MCS) use in OHCA.Methods:Retrospective cohort study based on the 2019-2020 National Inpatient Sample database of the Healthcare Utilization Project. Our population included patients 18 years or older with out-of-hospital cardiac arrest (OHCA) identified using ICD-10 codes. The primary risk factors examined were race/ethnicity categorized into White, Black, and Hispanic. The primary outcome was in-hospital mortality among patients with OHCA. The secondary outcome was mechanical circulatory support (MCS) use. Left ventricular assist device (LVAD), extracorporeal membrane oxygenation (ECMO), and intra-aortic balloon pump (IABP) were identified as MCS. Multivariate regression analysis was used to estimate the odds ratio.Results:During the study period, 26,640 hospitalizations with OHCA were identified, of whom 67,4% were White, 22,9% were Black, and 9,7% were Hispanic. The mean (SD) age of patients with OHCA was 65.2 (16) years old, and Black patients well as Hispanic patients had lower mean age compared to White patients (63.1 vs 63 vs 66.3 years old, p

Circulation, Volume 150, Issue Suppl_1, Page A4124182-A4124182, November 12, 2024. Background:Cardiovascular disease (CVD) has consistently been associated with higher depression symptoms and disorders. Conversely, fewer studies have shown that depression predicts risk of incident CVD and mortality.Objective:To examine the association of depression symptoms with incident major adverse cardiovascular events (MACE) among Hispanics/Latinos living in US.Methods:MACE-free Hispanic Community Health Study/Study of Latinos participants who underwent baseline evaluation between 2008-2011 (n=15,180) were included. MACE was defined as the composite of incident stroke, myocardial infarction (MI), or decompensated heart failure (HF), adjudicated using standard criteria up to year 2019. Depression symptoms were assessed at baseline with a 10-item Center for Epidemiological Studies Depression Scale (CES-D 10, range 0-30 points, 5 points increments), with clinically significant depression defined as CES-D 10 ≥10 points. The incident rate ratio (IRR) of MACE across CES-D 10 scores was determined using Poisson regression models, adjusting for baseline sociodemographic characteristics and Framingham Risk Scores. Analyses were weighted for complex survey design and non-response.Results:The mean age (95% CI) was 40.4 (39.9-40.9) years, and the mean CES-D 10 score was 8.4, 95%CI (7.2-9.5) for those with MACE vs 6.9, 95%CI (6.7-7.0) for individuals without MACE (p

Circulation, Volume 150, Issue Suppl_1, Page A4139909-A4139909, November 12, 2024. Background:Along with in-person (IP) monitoring, remote monitoring (RM) is recommended for patients with a cardiac implantable electronic device (CIED) to improve clinical outcomes.Hypothesis:Rurality will adversely impact the delivery of both RM and IP monitoring as part of comprehensive CIED care.Aims:To define and compare CIED monitoring patterns among patients with a CIED in rural and urban geographies.Methods:All Medicare fee-for-service beneficiaries (2011-2021) with history of CIED implantation were included based on relevant CPT codes. Demographic characteristics were reported by implant year and stratified by rurality based on beneficiary rural-urban commuting area code. All IP and RM events in the year following implant were tabulated based on CPT and ICD-9/10 procedure codes and similarly stratified by geography.Results:Approximately 23% of the de novo CIED implants (approximately 150,000/year) were among patients living in rural areas. The mean age was 79-80 years across the study period and was slightly higher (

Circulation, Volume 150, Issue Suppl_1, Page A4138840-A4138840, November 12, 2024. Introduction:Atrial fibrillation (AF) is a common and symptomatic arrhythmia which can be resistant to conventional endocardial catheter ablation. The Hybrid Convergent procedure, combining initial surgical AF ablation with a concurrent or staged endocardial catheter-based component, offers a potential solution for refractory cases. While effective as a de novo treatment for persistent AF, outcomes of this procedure in patients who failed prior catheter ablation remains uncertain. Our aim was to evaluate its efficacy and safety in this patient group.Methods:We conducted a single-center retrospective cohort study involving consecutive patients selected for the Hybrid Convergent procedure between May 2019 and October 2022 at a single center in Perth, Western Australia. Eligible patients had symptomatic AF and failed prior catheter ablation and antiarrhythmic drugs. The primary outcome was single procedure freedom from atrial arrhythmias, on or off antiarrhythmic drugs at 12 months. Overall follow-up freedom from AF, 12-month AF burden, complications and reinterventions were also recorded.Results:Sixty-two patients underwent both stages of the Hybrid Convergent procedure. All received concomitant thoracoscopic left atrial appendage exclusion. Of these, 46 (74.2%) were male, 27 (45.3%) had paroxysmal AF, and 15 (24.2%) had implantable loop recorders (ILRs). The mean duration since AF diagnosis was 9.5±7.1 years, with a median of 3 prior catheter ablations for AF. The median follow-up was 25.9 (13-48) months. After 12 months, 36 (62.9%) patients remained free from any atrial arrhythmia (figure 1). At this time point, 47 (75.8%) patients had an atrial arrhythmia burden of less than 5%. For the overall follow-up period, 32 (51.6%) patients maintained freedom from any atrial arrhythmia. Among patients with ILRs, the 12 month atrial arrhythmia free survival was 36.6%, compared with 64.4% in those without ILRs. Nine patients required repeat catheter ablation. There was one major complication.Conclusions:Our initial experience with the Hybrid Convergent procedure demonstrates sustained effectiveness and safety for patients with paroxysmal or persistent AF who have previously failed catheter ablation strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4115139-A4115139, November 12, 2024. In the real world only about 20 % of patients with ASCVD are at the target range, as shown by the SANTORINI trial (1). Therefore, there is still a great need for the improvement of lipid-lowering therapy (LLT).Our Lipid Registry was set up as a retrospective study including patients who visited our outpatients ward focusing on lipid-lowering therapy (LLT). The indications were: low-density lipoprotein cholesterol (LDL-c) > 130 mg/dL in LLT- naive patients with acute coronary syndrome (ACS), coronary artery disease (CAD) not on optimal LLT, familial hypercholesterolemia and LLT intolerance. We collected baseline characteristics as well as laboratory parameters of these patients during their visits. The dual LLT (high-potency statin and ezetimibe) was initiated in every patient during the hospitalization, if not contraindicated, as target variable we used non-HDL-C.In total 181 patients were included, of which 136 (75.1%) patients visited our clinic for control purposes. Patients who didn’t visit the clinic were predominantly men and had no or few pre-experiences with LLT. Fourty-one (36.9%) patients had a BMI >30, 126 (92.6%) of patients had CAD of which 85 (63%) had the diagnosis of a recent ACS. Arterial hypertension was present in 78.7% and diabetes mellitus type 2 in 23.5% of cases. At the 1stvisit to our LLT department 4-6 weeks after dismission from the hospital, 86 patients (61.9%) reached the recommended (ESC/EAS 2019) non-HDL-C goal. At the 2ndvisit (8-12 weeks after index hospitalization), 117 patients (86.2%) and at the 3rdvisit 120 patients (88.2%) reached their target. The analysis of patients initially presenting with ACS showed that 60 (69.8%) of them after 4-6 weeks and 77 (90.6%) patients after 8-12 weeks reached the recommended non-HDL-c goal. Among the study population 108 (79.4%) of patients, and 81 (95.3%) of ACS patients received dual LLT immediately during the index event. After the first visit, 31 (36.5%) of ACS patients needed the addition of the third lipid-lowering drug to achieve the recommended goal (see attached tables).Our strategy for managing hyperlipidemia in patients with a very-high cardiovascular risk showed high achievement of the non-HDL-C goal as recommended by the recent ESC guidelines in contrast to real-world data. We were able to demonstrate, that the strategy based on the idea to treat high-CV risk patients early and strong is the way to reach the treatment goal in a high percentage of patients (2).

Circulation, Volume 150, Issue Suppl_1, Page ASu702-ASu702, November 12, 2024. Background:Survival after an in-hospital cardiac arrest (IHCA) varies markedly across hospitals in the U.S. Whether hospitals with IHCA survival also excel in ‘preventing’ IHCA remains unclear.Methods:Using 2013-2019 data from the Get-With-The-Guidelines–Resuscitation (GWTG-R) registry linked with Medicare and American Hospital Association data, we identified all patients >65 years with IHCA at participating hospitals. Using two-level hierarchical multivariable regression models, we calculated hospital rates of IHCA incidence, adjusted for case-mix index, and risk-standardized survival to discharge (RSSR) for IHCA, adjusted for patient and cardiac arrest variables. We also examined the association of IHCA incidence and RSSR with hospital variables.Results:Among >10 million admissions at 335 hospitals during 2013-2019, 77676 patients experienced an IHCA. The median hospital rate of IHCA incidence was 6.9 per 1000 admissions, and the median case-survival rate among those with IHCA was 21.9%. After case-mix adjustment, the median IHCA incidence was 7.9 per 1000 admissions with considerable variation across hospitals: IQR: 5.8-10.3 per 1000 admissions, range 1.2 to 25.4 per 1000 admissions. The median RSSR for IHCA was 22.3%, which varied from 11.5% to 35.7% across hospitals (IQR: 19.5%-24.9%). There was a weak negative correlation between risk-adjusted hospital IHCA incidence and its RSSR (rho = -0.11; p = 0.037) (Figure 1). Adjustment for hospital variables attenuated the negative association between IHCA incidence and RSSR (rho = -0.08; p = 0.13). The nurse-patient ratio was the only modifiable factor significantly associated with lower IHCA incidence (OR = 0.97; p = 0.004) and higher RSSR (OR = 1.05; p

Circulation, Volume 150, Issue Suppl_1, Page A4140042-A4140042, November 12, 2024. Background:Abundant evidence has suggested that individuals with poor Cardiovascular-kidney-metabolic (CKM) health are at a heightened risk of adverse cardiovascular events. In patients with coronary heart disease, a considerable proportion has concurrent CKM, which warrants further attention.Purpose:This study aimed to evaluate the prognostic significance of inflammatory and non-insulin-based insulin resistance biomarkers in patients with confirmed CHD and CKM syndrome.Methods:Among 10724 consecutive patients admitted to our center for CHD in 2013, 9716 patients who met the diagnostic criteria for CKM syndrome were included in this study. The endpoint was the major cardiac and cerebrovascular event (MACCE). The optimal cut-offs of the indicators were determined by the receiver operating characteristic analysis.Results:During a median follow-up of 5.05 years, 2019 cases of MACCEs were observed. At baseline, the mean age of the overall cohort was 58.4 ± 10.3 years, and 7467 (76.9%) patients were male. Multivariable Cox regression analysis revealed that elevation of any inflammatory biomarkers levels [including white blood cells, neutrophils, monocytes, platelets, neutrophil-to-platelet ratio, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic inflammatory response index, systemic inflammatory index, pan-immune-inflammation value (PIV) and high-sensitivity C-reactive protein] was significantly associated with an increased risk of 5-year MACCE (allP

Circulation, Volume 150, Issue Suppl_1, Page A4145979-A4145979, November 12, 2024. Introduction:Ischemic heart disease (IHD), driven predominantly by modifiable risk factors such as high fasting plasma glucose (FPG), remains a leading cause of morbidity and mortality worldwide. In the United States, understanding the state-specific burden of IHD attributable to high FPG is critical for tailoring effective public health strategies.Method:Using Global Burden of Disease tool, we estimated Deaths, DALYs (disability adjusted life years), YLDs (years lived with disability) due to IHD attributable to FPG across the US by age, sex, year and location from 1990-2019.Results:Between 2010-2019, the annual percentage change (APC) showed a significant increase in deaths rose by 17% (95% Uncertainty Interval [UI]: 10-25%), DALYs by 19% (11-26%), and YLDs by 21% (12-30%). In terms of age-standardized mortality rates (ASMR), Vermont saw the largest increase at 9%, followed by South Dakota at 8%. Conversely, New York exhibited the most substantial decrease in ASMR, declining by 11%. The YLDs rate saw its most considerable rise in the District of Columbia, up by 12%, with Wyoming following at a 7% increase. In 2019, Oklahoma recorded the highest ASMR at 43.06 (25.18-67.9) cases per 100,000, whereas Mississippi had the highest YLDs rate at 786 (495-1160). Over the last three decades, older age groups experienced a heavier burden. A gender comparison revealed an increasing trend in females compared to males, with APC in deaths for males versus females at 32% vs. 37%, DALYs at 21% vs. 25%, and YLDs at 94% vs. 116% from 1990-2019.Conclusion:IHD attributable to high FPG accounted for 34.19% of all IHD deaths in 2019, underscoring the urgent need for public health policies that promote outdoor activities and regular exercise among youth, and discourage the consumption of processed foods to foster healthier lifestyles and mitigate this significant health burden.

Circulation, Volume 150, Issue Suppl_1, Page A4148170-A4148170, November 12, 2024. Background:Cardiovascular disease is an important cause for mortality in cancer patients and cancer is a primary cause of non- cardiac mortality in patients with heart failure. With an estimated 17 million cancer survivors in the US, with numbers only expected to increase and a projected 8 million heart failure patients by 2030, these diseases have a tremendous impact on healthcare costs. The aim of this study is to determine the hospital resource utilization in patients with heart failure and cancer.Methods:This is a retrospective cohort study using the Agency of Healthcare Research and Quality’s National Readmission Database (NRD) for the year 2019. Patients with a principal discharge diagnosis of heart failure were stratified into two groups based on presence of cancer. Weighting of patient level observations was implemented to obtain national level estimates. The primary outcome was 30-day all-cause hospital readmission. The secondary outcomes analyzed were 30- day mortality rate, mean length of stay and mean cost of hospitalization. The five most common causes of readmission were also determined.Results:53, 219 weighted heart failure hospitalizations had cancer, while 996,566 did not have cancer. Patients with cancer had a significantly higher rate of 30-day readmission rate (25.6 % vs 22.1%; OR: 1.22; p

Circulation, Volume 150, Issue Suppl_1, Page A4144604-A4144604, November 12, 2024. Introduction:Breast cancer and cardiovascular disease are significant global health concerns for women. Our study is a significant advancement in understanding cardiomyopathy risks associated with breast cancer in the U.S. population. Unlike previous studies focusing mainly on treatment-related cardiomyopathy, our research identifies risks across various cardiomyopathy subtypes in breast cancer patients. This novel approach reveals the intricate relationship between different cardiomyopathies and breast cancer, filling a crucial gap in existing medical research. Moreover, by considering racial disparities, our study offers vital insights into the differential health impacts on diverse demographic groups, enhancing our knowledge of the interplay between these medical fields.Methodology:The research was conducted as a retrospective cohort analysis using data from the National Inpatient Sample (NIS) spanning 2016 to 2019. It targeted female patients over 18 with a diagnosis of breast cancer, carcinoma in situ, or a personal history of breast cancer. Case identification relied on ICD-10 codes. A pivotal aspect of the methodology was implementing propensity score matching to ensure balanced comparison groups, considering variables like age, race, hypertension, and diabetes. Statistical analysis involved logistic regression, Chi-Square tests, and T-tests, executed using 9.4 SAS software.Results:The study compared 589,940 breast cancer patients with an equal number of controls, matched demographically. Comorbidity prevalence was similar in both groups, with slight variations in myocardial infarction and heart failure history. Breast cancer patients exhibited a higher prevalence of cardiomyopathy (4.0% vs. 3.2%), with an increased adjusted odds ratio (OR) especially for dilated, restrictive, and drug-related cardiomyopathies. Interestingly, they had lower odds of obstructive and hypertrophic cardiomyopathy. Racial disparities were evident, with Black patients facing higher risks for most cardiomyopathies, while Hispanic and Asian or Pacific Islander patients showed varied risks. Similar patterns were observed in the control group.Conclusion:The findings highlight a significant link between breast cancer and an elevated risk of cardiomyopathy, advocating for the integration of cardiovascular monitoring into breast cancer management.

Circulation, Volume 150, Issue Suppl_1, Page A4140072-A4140072, November 12, 2024. Introduction:Icosapent ethyl (IE), an ethyl ester derivative of eicosapentanoic acid (EPA), and omega-3 acid ethyl esters, an ethyl ester derivative of both EPA and docosahexaenoic acid (DHA), are approved as adjunct to statin therapy for reducing MACE in patients with elevated triglyceride levels. There are concerns regarding atrial fibrillation (AF) risk associated with IE. This study aims to assess the incidence of AF while receiving IE versus omega-3-acid ethyl esters (DHA/EPA), both alongside baseline statin therapy.Methods:In this retrospective cohort study, we used data from the Merative MarketScan Commercial Claims and Medicare Supplemental Databases (2013-2021). Adult patients on statin therapy who initiated either IE or DHA/EPA were identified using outpatient dispensing records. Patients with an AF diagnosis during the one-year baseline period were excluded. Patients were followed for up to two years to assess the incidence of AF. Censoring occurred if there was treatment discontinuation, switching between treatments, end of enrollment, or end of the study. Patients experiencing events or being censored within the first 30 days were also excluded. Propensity score matching was used to create comparable groups, with exact matching on time periods (2013-2015, 2016-2018, and 2019-2021). Using Cox proportional hazard regression model, we calculated hazards ratio of the onset of AF for IE versus DHA/EPA.Results:The analytic cohort consisted of 17,638 matched pairs. Patients in both groups had a median age of 56 years. Male patients accounted for a 65.7% of the IE group and 64.5% of the DHA/EPA group. Baseline cardiovascular risk factors were well matched between both groups. The 2-year cumulative incidence of AF for IE and DHA/EPA groups were 5.322% and 3.994%, respectively, resulting in a HR of 1.257 [95% CI,1.159-1.364], p=0.0032. (Figure 1)Conclusions:IE is associated with a higher risk of AF compared to DHA/EPA combined products, indicating the need for careful risk-benefit discussion between clinicians and patients considering IE therapy.