Search Results for: I numeri del cancro in Italia 2019

Circulation, Volume 150, Issue Suppl_1, Page A4145173-A4145173, November 12, 2024. Introduction/Background:Understanding the relationship between neighborhood socioeconomic environment and cardiovascular outcomes is important to implement effective quality strategies to ensure health equity.Goals/Aims:To determine the association of neighborhood socioeconomic deprivation with 30-day mortality and readmission for patients admitted with common cardiovascular conditions.Methods/Approach:We examined claims data from fee-for-service Medicare beneficiaries aged >=65 with 1 year of preceding fee-for-service eligibility between 2017-2019 admitted for heart failure, valvular heart disease, ischemic heart disease, or cardiac arrhythmias. The primary exposure was the Area Deprivation Index, and outcomes were 30-day all-cause mortality and unplanned readmission. We used logistic regression models and adjusted for demographics, medical comorbidity burden, access to healthcare resources, and characteristics of admitting hospitals.Results/Data:A total of 2,064,426 admissions were included. Patients from socioeconomically deprived neighborhoods generally had higher observed mortality and readmission (Table 1). After full adjustment, neighborhood socioeconomic status was associated with increased 30-day mortality and readmission for all cardiovascular conditions studied. Unadjusted and sequentially adjusted models for 30-day mortality are shown in Table 2. Figure 1 visualizes the adjusted association between neighborhood deprivation and 30-day mortality and readmission.Conclusions:Neighborhood socioeconomic deprivation was independently associated with increased 30-day mortality and readmission for several common cardiovascular conditions.

Circulation, Volume 150, Issue Suppl_1, Page A4140272-A4140272, November 12, 2024. Introduction:Tricuspid regurgitation (TR) prevalence increases with age and is associated with higher mortality. Limited data exist regarding the prognostic relevance of TR among older adults in the general population.Objective:To estimate the prevalence of TR in late life, identify cardiac structural and functional measures associated with TR severity, and determine the prognostic relevance of TR severity.Methods:In the community-based Atherosclerosis Risk in Communities (ARIC) study, 3,046 participants underwent protocol echocardiography at the 7thstudy visit (2018-2019). TR severity was assessed qualitatively as none/trace, mild, moderate, or severe by a board-certified cardiologist. Dyspnea was assessed using the modified Medical Research Council questionnaire and post-Visit 7 mortality was ascertained through the National Death Index. Cross-sectional associations of TR severity with clinical characteristics, echocardiographic measures, and dyspnea were assessed using multivariable linear and logistic regression models. Associations with death were assessed using Cox proportional hazard models adjusted for demographics.Results:Mean age was 81±4 years, 58% were women, 25% reported Black race, and mean LVEF was 63±8%. TR prevalence was 30% mild, 9% moderate, and 1% severe. Greater TR severity was associated with older age, female sex, higher HF prevalence, and loop diuretic use. Greater TR severity was also associated with lower LVEF, worse LV diastolic function (higher LAVi, E/A, E/e’ septal), higher NT-proBNP, higher prevalence of moderate-severe mitral regurgitation, greater pulmonary artery systolic pressure, and larger RV size. Severe TR was associated with higher odds of moderate-severe dyspnea (OR:2.3 [1.2-4.5], p=0.012). During follow-up (median 2.1 years [IQR 1.7-2.5]), 192 participants died. Higher TR severity was associated with greater mortality (Figure). Compared to participants with none/trace TR, even mild TR was associated with a 64% greater mortality risk.Conclusion:TR is common in late life and is associated with greater left heart disease despite generally preserved LVEF. Greater TR severity, even when mild, is a marker of increased mortality. Longer follow-up is needed to determine whether this risk is independent of concomitant left heart dysfunction.

Circulation, Volume 150, Issue Suppl_1, Page A4138714-A4138714, November 12, 2024. Backgrounds:The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommended the initiation of multiple supportive measures in patients at high risk for cardiac surgery associated acute kidney injury (CSA-AKI). Heart failure with preserved ejection fraction (HFpEF) was known as a critical risk factor for CSA-AKI.Purpose:Our study was designed to assess the effectiveness of KDIGO guidelines and the risk of CSA-AKI following coronary artery bypass grafting (CABG) among patients with HFpEF.Methods:This retrospective cohort study included 7420 patients undergoing CABG from 2019 to 2022, including 1960 patients with pre-operative HFpEF and 5460 patients without pre-operative HF as comparison. Implementation of the KDIGO guidelines consists of 6 measures in the first 72 hours after surgery, including avoidance of nephrotoxic agents, discontinuation of ACEi and ARB, implementation of advanced hemodynamic monitoring, avoidance of hyperglycemia, optimization of hemodynamics, and intensified monitoring of renal function. The primary outcome was in-hospital postoperative AKI according to the KDIGO criteria.Results:Among the included patients with HFpEF, 125 (6.4%) patients were classified as fully implementing the KDIGO guidelines. For the primary outcome, implementation of guidelines was associated with a significantly decreased risk of CSA-AKI (46.4% vs. 62.0%; OR, 0.591 [95% CI, 0.407-0.857]; p = 0.006). Meanwhile, implementation of guidelines had a greater preventive effect on CSA-AKI for HFpEF patients compared with non-HF patients (OR, 0.921 [95% CI, 0.759-1.118]; p = 0.405). Noticeably, we found that avoidance of hyperglycemia (OR, 0.737 [95% CI, 0.591-0.920]; p = 0.007) and optimization of hemodynamics (OR, 0.638 [95% CI, 0.508-0.802]; p < 0.001) were associated with lower incidence of CSA-AKI.Conclusions:Despite a lack of adherence to the KDIGO guidelines in patients undergoing CABG, implementation of the guidelines was found to be associated with a significantly lower risk of CSA-AKI for patients with HFpEF. Among the measures in the guidelines, avoidance of hyperglycemia and optimization of hemodynamics had stronger preventive effects for CSA-AKI.

Circulation, Volume 150, Issue Suppl_1, Page A4139964-A4139964, November 12, 2024. Background:Transthyretin amyloid cardiomyopathy (ATTR-CM) is estimated to occur in 120,000 US adults and remains underdiagnosed. However, awareness of ATTR-CM has improved following the introduction of new diagnostic tools and disease-modifying treatments. Hence, patients (pts) enrolled in contemporary clinical trials could be at an earlier stage of the disease than pts in past clinical studies.Aim:To assess temporal trends in the baseline risk of pts with ATTR-CM enrolled in clinical trials.Methods:Embase, MEDLINE, CENTRAL, and conference websites were searched on November 23, 2023, for peer-reviewed articles and abstracts. Randomized and single-arm clinical trials examining treatments for ATTR-CM were included, and baseline characteristics and outcomes in pts treated with placebo (PBO) were compared across studies.Results:We reviewed 39 publications derived from 4 randomized and 4 single-arm trials. Studies enrolled pts between 2008 and 2021, although 1 study (INOCARD, 2022) did not report years of enrollment. Several baseline characteristics were comparable across studies, including sex, age, race/ethnicity, genotype, and troponin I level. NYHA class at baseline varied with year of enrollment, with fewer NYHA class III pts in recent trials (Figure). Recent trials also showed a trend toward lower NT-proBNP levels (medians ranging from 1911-3178 pg/mL) and higher eGFR levels (means ranging from 54.7-69.0 mL/min/1.73 m2). In PBO groups, all-cause mortality (ACM) rates at 12 months dropped from 9% in ATTR-ACT (enrolled 2013-2015) to 6.9% in ATTRibute-CM (enrolled 2019-2020) and 5.6% in APOLLO-B (enrolled 2019-2021); ACM rates at 30 months dropped from 42.9% in ATTR-ACT to 25.7% in ATTRibute-CM.Conclusions:This systematic review found that disease-modifying treatments and diagnostic advances have led to earlier diagnosis of pts with ATTR-CM. Recent clinical trials appear to have enrolled pts with a better prognosis. Comparisons of results across these trials are limited and should acknowledge the potential impact of variability in baseline risks among trial populations.

Circulation, Volume 150, Issue Suppl_1, Page A4144724-A4144724, November 12, 2024. Background:Paucity of evidence is available on sex-differences in the progression, left ventricular (LV) remodelling and long-term outcome in patients with native mild-to-moderate aortic stenosis (AS) and preserved LV ejection fraction (LVEF).Objectives:To assess the sex-differences in the progression, LV remodelling and long-term outcome of native AS.Methods:Baseline and follow-up echocardiographic data of patients with at least mild-to-moderate AS [aortic valve area(AVA)≤1.5 cm2, maximum aortic velocity(Vmax) ≥2.5 m/s or mean gradient(MG)≥25 mmHg] were prospectively collected between 2014 and 2019 and retrospectively analysed. Patients with LVEFmild were excluded. AS progression (analysed by annualized progression ratios in echocardiographic parameters), all-cause death, aortic valve replacement (AVR), were investigated stratifying for sex.Results:We included 677 patients with a mean age of 70.8±13.2 years, 258 (38.1%) women. During a median 5 years follow-up, 118(17.4%) deaths and 211(32.2%) AVR occurred. After inverse-propensity-weighting (IPW), men had faster progression rate of AS compared to women (MG: mean difference 1.77[1.10-2.43] mmHg/year, p

Circulation, Volume 150, Issue Suppl_1, Page A4146203-A4146203, November 12, 2024. Introduction:In 2019, 17.9 million people died from cardiovascular disease, 85% of which were due to acute myocardial infarction (AMI). Post-AMI congestive heart failure is increasing due to microvascular obstruction (MVO). MVO is the blockage of the microcirculation by atherothrombotic debris and tends to occur after coronary stenting for AMI. Current therapeutic strategies for MVO are not consistently effective.Aim:Our goal is to develop ultrasound (US)-targeted microbubble cavitation (UTMC) as a potential treatment for MVO.Methods:Initially, we demonstrated the efficacy of UTMC in a rat hindlimb model of MVO. Given these promising findings, in the current work, we expanded our investigation to a clinically relevant porcine model of myocardial MVO. On day 1, MVO was created in the left anterior descending (LAD) microcirculation and confirmed by myocardial contrast echocardiography (MCE). The MVO in the LAD bed was then treated with UTMC therapy during concurrent infusion of Definity®contrast agent. The therapeutic ultrasound (1.3 MHz center frequency, 1.3 MPa peak negative pressure, 1 ms pulse duration) was delivered with Philips EpiQ (with S5-1 probe). Cardiac MRI was obtained at 36 hours to measure infarct size and area of MVO. At 48 hours post UTMC therapy, MCE was repeated, and the animals were euthanized. Hearts were stained with Evans Blue/ TTC dyes and sectioned for analysis of infarct size. A total of 11 pigs, 5 Control (MVO, no treatment) and 6 UTMC (MVO, UTMC treatment) were done.Results:LAD angiographic flow was improved at 48 hours post UTMC treatment in comparison to control. MCE imaging revealed that the UTMC treatment significantly improved LV systolic performance, and LAD blood volume (Figure 1), as compared to control. MRI clips showed that UTMC ameliorated MVO and left ventricular (LV) segmental wall motion and ejection fraction (EF) also improved after UTMC treatment versus control. Infarct size was reduced as shown by both Evans Blue/TTC staining and MRI.Conclusions:Taken together, we demonstrated that UTMC significantly reduced infarct size, enhanced LAD microvascular perfusion and improved LV systolic performance, and should enable clinical translation of this promising therapy.

Circulation, Volume 150, Issue Suppl_1, Page A4139309-A4139309, November 12, 2024. Background:Between 2011-2017, US rural adults experienced higher cardiovascular (CV) death rates than their urban counterparts, and rural-urban disparities in CV mortality widened. Little is known about these trends have evolved in the wake of the pandemic. In this study, we provide an updated analysis of rural-urban differences in CV mortality.Methods:We used CDC WONDER to obtain national death data from 2010-2022. CV cause of death was identified by ICD-10 codes I00-99. Large metro, small/medium metro, and rural areas were defined using the National Center for Health Statistics Urban-Rural Classification. We calculated age-adjusted mortality rates (AAMRs) per 100,000 population and compared 2022 vs. 2010 using rate differences and two-sample t-tests. We then fit a Poisson regression model to estimate annual percent change (APC), evaluating trends from 2010-2019 and 2019-2022 due to reversal in CV mortality observed after 2019. We included an interaction term to assess differential trends by rurality, and repeated the analysis for younger (age 25-64) and older (age >64) adults.Results:Between 2010-2022, AAMRs were consistently highest in rural areas (Figure 1, Table 1). AAMRs increased in rural areas (rate difference [RD] +3.4 [95% CI 0.4, 6.4]) but declined in urban areas (RD -23.8 [-25.3, -22.2]). This significant differential change was driven by a rise in AAMRs among younger, rural adults (RD +23.2 [21.2, 25.1). In contrast, older adults experienced a decline in AAMRs, though this reduction was greater in urban vs. rural areas (Table 2).From 2010-2019, overall APCs in AAMR decreased for all areas. However, when stratified by age, younger rural adults saw a significant increase (+1.0% [95% CI 0.5, 1.5]), while those in large metro areas did not (-0.2% [-0.5, 0.1]). Older adults saw a significant decrease across all areas.Between 2019-2022, the overall APC in AAMR increased significantly in rural areas (+3.1% [0.4, 6]), but in not large metro areas (+1.2% [-0.4, 2.9]). CV mortality rose in most subgroups, but younger rural adults experienced the largest increase (+4.2% [1.3, 7.1]) (Table 2).Conclusions:Between 2010-2022, CV mortality increased in rural areas and decreased in urban areas. Younger, rural adults experienced the most pronounced rise in CV death, while older, urban adults experienced the steepest decline. These findings highlight an urgent need to address widening rural-urban disparities, particularly among younger adults.

Circulation, Volume 150, Issue Suppl_1, Page A4124005-A4124005, November 12, 2024. Background:Sex and racial differences in the outcomes of patients with acute coronary syndrome (ACS) persist and could be related to the differences in management including high-potency P2Y12 inhibitors.Aim:This study aims to examine the contribution of social determinants of health on the association between sex and racial differences in the prescription of high-potency P2Y12 inhibitor upon discharge.Methods:Patients with ACS undergoing percutaneous coronary intervention (PCI) from the American Heart Association Get With The Guidelines®–Coronary Artery Disease Registry between October 2019 to December 2022 were included. Multivariable hierarchical models were used to assess whether there are differences in high-potency P2Y12 inhibitors (i.e., ticagrelor or prasugrel) prescription at discharge adjusting for race/ethnicity, insurance, age, social vulnerability index (SVI), zip code designation, and medical history. Analyses were performed in women and men separately.Results:Among 135,153 patients with ACS who underwent PCI, 59.8% were discharged on a high-potency P2Y12 inhibitor. Compared with men, women were less likely prescribed high-potency P2Y12 inhibitor (66.9% vs 72%), and this pattern did not change during the study period (P=0.50) (Figure). There was a significant interaction between sex and race for high-potency P2Y12 inhibitor prescription (P< 0.05). Among women, the likelihood of high-potency P2Y12 inhibitors prescription was not significantly different across different race/ethnicities. However, in men, non-Hispanic Blacks and Hispanics had lower odds of high-potency P2Y12 inhibitors prescription compared with non-Hispanic Whites among men after adjusting for all covariates.Conclusions:In this large contemporary observational analysis of patients with AMI undergoing PCI, women were less likely prescribed a high-potency P2Y12 inhibitor upon discharge. Among women, the likelihood of high-potency P2Y12 inhibitors prescription was not significantly different across different race/ethnicities; however, in men, non-Hispanic Blacks and Hispanics had lower odds of high-potency P2Y12 inhibitors prescription. Further efforts should be directed to minimize these sex and racial disparities.

Circulation, Volume 150, Issue Suppl_1, Page ASu603-ASu603, November 12, 2024. Background:Coronary artery disease is a common cause of out-of-hospital cardiac arrest (OHCA). Early recognition myocardial infarction (MI) and initiating appropriate therapy has been shown to improve outcomes in OHCA. While early coronary intervention is part of guidelines-based care, the implementation of these recommendation in actual US practice remains poorly described.Objectives:This study aims to characterize patients presenting with OHCA and MI in a cohort from 4 hospitals, to assess care of these patients in actual practice.Methods:We employed a database of OHCA patients admitted to four hospitals within the University of Pennsylvania Hospital System between 01/2019-12/2023. For this study, we included all patients that were diagnosed with STEMI during emergency department evaluation, and collected demographic, arrest, coronary angiographic, and ECG data from electronic health records. SAS was used for statistical analysis.Results:A total of 43 MI cases were included; mean age was 60.6±11.8 y, 65% male, mean BMI 30.0±6.3, 58.1% African American, 27.9% White or Caucasian, and 16.3% had a medical history of myocardial infarction. 74.4% were witnessed, and 44.2% received bystander CPR[BA1]. Initial shockable rhythm was present in 34.9%. 38 survived to hospital admission, and 9 were discharged alive. The first obtained 12-lead ECG (median time to ECG: 13min, (IQR: 3.5-26.5)) found that ST-segment elevations were present in 88.4%, ST-segment depressions in 44.2%, T-wave inversions in 4.7%, QT prolongation in 9.3%, and wide QRS in 18.6%. Sinus rhythm was most common (41.9%), followed by junctional rhythm (9.3%). Left and right bundle branch blocks (4.3% and 7%, respectively) and AV block (7%) were recorded. Coronary angiography (median time to angiography: 1.95hr (IQR: 1.3-4.2)) was performed in 29 patients and revealed that left anterior descending artery (28.6%) was the most common location for a culprit lesion, followed by the right coronary artery (21.4%), and left circumflex artery (10.7%). Notably, in 21.4% of cases, no culprit lesion was identified. 13 patients underwent angioplasty with stent, 4 received balloon angioplasty, and 1 underwent aspiration thrombectomy.Conclusion:This study highlights important attributes of OHCA patients presenting with MI. This paves the way for larger studies comparing ECG and coronary angiography findings between MI and control populations to help identify and improve acute care for OHCA MI patients.

Circulation, Volume 150, Issue Suppl_1, Page ASa502-ASa502, November 12, 2024. Background:Hyperuricemia is frequently seen in patients after cardiac arrest. Persistent hyperuricemia during a cellular energy crisis is believed to result from the breakdown of nucleotides into uric acid (UA) and indicates an insufficient restoration of adenosine triphosphate (ATP) synthesis.Hypothesis:Early reduction in serum UA level, UA clearance (UA-CL), is associated with survival after cardiac arrest.Aims:The study examined the association between UA-CL and 30-day survival following out-of-hospital cardiac arrest (OHCA).Methods:This was a prospective, multicenter, observational study of OHCA cases conducted from 2019 to 2021. The study included adult non-traumatic OHCA patients whose UA levels were measured upon hospital arrival (UA-0h) and 24 hours after cardiac arrest (UA-24h). The proportional change from UA-0h to UA-24h was represented as UA-CL (%). The primary outcome was 30-day survival. An association between UA-CL and 30-day survival was investigated using restricted cubic spline regression and multivariable logistic regression analysis fitted with generalized estimating equations adjusted for patient characteristics, pre-hospital information, resuscitation variables, and within-institution clustering.Results:Among a total of 9,909 OHCA patients, 375 patients were included in the analysis. Compared to the non-survivors (N=166), the survivors (N=209) had more cases of witnessed arrests, bystander CPR, initial shockable rhythms, cardiogenic arrests, and a shorter duration of cardiac arrest. However, there was no difference in UA-0h between survivors and non-survivors (median 7.5 [IQR: 6-9] mg/dL, 7.4 [6-9] mg/dL, respectively; P=0.72). In contrast, UA-CL was significantly higher among the survivors compared to non-survivors (21 [3-42]%, 2.5 [-16-26]%, respectively; P

Circulation, Volume 150, Issue Suppl_1, Page A4138294-A4138294, November 12, 2024. Introduction:In 2019, Icosapent Ethyl became the first US Food and Drug Administration (FDA) approved medication for reducing cardiovascular risk beyond cholesterol-lowering therapy in high-risk patients. It was approved specifically as an adjunct to maximal tolerated statin therapy to reduce cardiovascular risk in adult patients with elevated triglyceride (TG) levels. The National Lipid Association now has a Class I recommendation for the use of icosapent ethyl (4 g/d) to reduce cardiovascular risk in patients with TG > 150 mg/dl.Methods:We analyzed available data from Medicare Part D prescription drug events published from the year 2018 to 2022. All data were de-identified and made publicly available. All costs were adjusted for inflation and represented in 2022 US dollars.Results:The number of Medicare Part D beneficiaries prescribed Icosapent Ethyl increased from 141,336 to 303,971 (215%) between 2018 and 2022 (Fig. A) and the number of claims increased from 704,334 to 1,527,133 (216%) (Fig. B). The total spending increased from $278 million to $787 million (282%) within the same timeframe (Fig. C). The average spending per claim has increased from $396 to $515 (130%) (Fig. D) and the average spending per beneficiary has also increased from $1976 to $2591 (131%) (Fig. E) between 2018 and 2022.Discussion:We observed a marked increase in the use of icosapent ethyl from 2018 to 2022. We can see a sharp rise of 187% in beneficiaries from 2018 to 2019 following FDA approval. The total number of claims and total spending also increased by 181% and 200%, respectively, from 2018 to 2019. The average spending per claim and average spending per beneficiary has increased from 2018 to 2022. It also demonstrates the cost burden to Medicare with the use of such lipid-lowering agents. Many Medicare plans include icosapent ethyl as a Tier 4 drug, which is the second most expensive drug tier.Limitations:The pattern of data used may not be generalizable to other payer demographics. Policy changes can affect the comparability of data over different periods.Conclusion:Our data highlights the increasing use of icosapent ethyl as a cardiovascular risk-reduction medication in the Medicare population. There has been a steady increase in the number of claims and beneficiaries since the approval of icosapent ethyl with an increase in average spending from 2018 to 2022.

Circulation, Volume 150, Issue Suppl_1, Page A4137531-A4137531, November 12, 2024. Introduction:Cardiac sarcoidosis (CS) often results in systolic heart failure (HF) and responds favorably to guideline directed medical therapy (GDMT). A multidisciplinary team approach to HF care is recommended but few published examples exist in CS patients.Methods:We queried an institutional registry of 599 CS patients (2000-2023) for patients with index LVEF < 50% (within 90 d of index CS evaluation) and follow-up TTE within 11-36 months. In our CS medication therapy management (MTM) program (started 1/8/2019), pharmacists conduct independent visits with CS patients (in person or remote), discuss GDMT tolerance and symptoms, review monitoring laboratory studies, and adjust GDMT (ACEi/ARB/ARNi, beta-blocker, MRA, and/or SGLT2i) via collaborative practice agreement with the CS cardiologists. Patients were classified as MTM (≥1 MTM encounter) or NMTM patients (0 encounters). We compared (1) GDMT, (2) cardiac remodeling, and (3) clinical outcomes (event free survival to first heart failure hospitalization, LVAD, heart transplant, or death).Results:Nineteen percent (113/599) CS patients met inclusion criteria (34% female, 92% white, median age 57 y, 19% definite CS, 58% probable CS, 31% presumed CS), with 44 MTM (median 11.5 encounters, IQR 11) and 69 NMTM patients. Both MTM and NMTM patients were on a median 2 GDMT agents at index evaluation (p=0.21). At follow-up (median 19 mo MTM, 15 mo NMTM, p=0.05), MTM patients were on more GDMT agents than NMTM (median 3.0 vs 2.0, p

Circulation, Volume 150, Issue Suppl_1, Page A4135835-A4135835, November 12, 2024. Introduction:Cardiovascular disease (CVD) is rising in prevalence in India with economic development and the adoption of a Western lifestyle.Hypothesis:The increase in incidence and prevalence of CVD is possibly due to a rise in the incidence of risk factors like diabetes mellitus (DM), hypertension, hyperlipidemia, lack of physical activity and obesity, among various other causes.Aims:1. To estimate the prevalence of DM in the community of Calcutta schoolteachers2. To examine the relationship between the prevalence of DM and CVD risk as assessed by the different traditional CVD risk factors (age, sex, hypertension, current smoking, DM, and hyperlipidemia).Methods:We recruited 4,150 schoolteachers from 400 schools in Calcutta, India between June, and August 2019 with approval of the Tufts IRB and the local Ethics Committee. Participants were asked questions about their different risk factors to ascertain their cardiovascular risk by the ASCVD risk calculator. Baseline values (total cholesterol 170 mg/dL, HDL-C 50 mg/dL, no DM) were used when a participant’s glycemic status or lipid profile was not available. Based on the risk score, participants were stratified as mild (10%) risk for developing ASCVD. A total of 240 participants were randomly selected from a stratified sample of the participants for evaluation for diabetes using HbA1c. DM was diagnosed when the Hb A1 C was 6.5% or more.Results:The mean age of the participants was 44 years, and 41% were male. Out of a total of 4,150 participants, 85.7% (3,558) were in the low-risk for CVD category, 9.0% (374) were moderate-risk, and 5.3% (218) were high-risk. Among the 240 screened for DM, 17.1% (41) were found to have the condition, and 41.3% (99) were pre-diabetic. There was no significant difference in prevalence of DM between men and women in the overall study population and in the mild risk group. However, more women in the medium risk group and more men in the high-risk group were found to be diabetic (p value

Circulation, Volume 150, Issue Suppl_1, Page A4141328-A4141328, November 12, 2024. Introduction:Diagnosis of exercise-induced pulmonary hypertension (EIPH) or exercise-induced heart failure with preserved left ventricular ejection fraction (E-HFpEF) is challenging due to a lack of consensus. The 2022 ESC/ERS guidelines define EIPH as mean (m) PAP/CO > 3 mmHg/L/min, and E-HFpEF as PCWP/CO > 2 mmHg/L/min, a revision of the previous criteria of mPAP ≥ 30 mmHg and PCWP ≥ 25 mmHg.Hypothesis:We investigated the role of exercise RHC in identifying EIPH and E-HFpEF in a group of patients with dyspnea and correlated the rest echo findings with the E-RHC results. We hypothesized that the resting echo parameters can help identify patients with EIPH and E-HFpEF using 2022 ESC/ERS definitions.Methods:A cohort of patients with dyspnea and normal LVEF with E-RHC data from 2016-2019 was included. Patients were categorized into Groups (g) A-E (Fig 1-T1) according to the 2018 WSPH definition of PH. Echo, hemodynamic, and clinical data were collected. The ESC/ERS 2022 guidelines were used to identify EIPH and E-HFpEF. Echo parameters were retrospectively analyzed by logistic regression analysis.Results:200 patients were included. The mPAP and PCWP, but not PVR, significantly increased post-exercise in all groups. Over 50% of patients in each group had evidence of at least grade I LV diastolic dysfunction on rest Echo (Fig 1). PVs/PVd was significantly lower (0.8±0.3) and E/e’ higher (15±7.9) in g-C (Post-Cap) compared to g-A (No-PH), B (Pre-Cap) and E (undifferentiated). In g-A and g-E, 46.8% and 73% demonstrated EIPH, with 87% and 100% showing a mPAP≥30 mmHg respectively. The prevalence of E-HFpEF in g-A, g-B, and g-E was 45%, 50%, and 63% respectively. Only 34%, 42%, and 56% of subjects in g-A, g-B and g-E demonstrated E-PCWP ≥ 25 mmHg. Echo parameters that predicted E-HFpEF included E and E/e’; E/e’ also predicted EIPH (Fig 1).Conclusions:In this study, Echo features of advanced LV diastolic dysfunction including decreased PVs/PVd and increased E/e’ were associated with post-capillary PH. Rest E/e’ and E (LV rapid inflow velocity) may predict E-HFpEF. Exercise RHC may have utility in the evaluation of patients with suspected subclinical PH and HFpEF, but larger prospective designs are warranted

Circulation, Volume 150, Issue Suppl_1, Page A4146355-A4146355, November 12, 2024. Background:Ischemic heart disease (IHD) is the leading cause of death in the European Union (EU). Understanding variations by sex, income, and geography can help in tailoring effective public health policies.Methods:We conducted a cross-sectional analysis of IHD using the Global Burden of Disease Study Database to examine trends in sex specific age-standardized mortality rate (ASMR)-to-age-standardized prevalence rate (ASPR) ratio (ASMR-to-ASPR index) per 100,000 inhabitants/year across the EU from 2005 to 2019.Results:Men showed higher ASMR than women. However, the ASMR-to-ASPR index was notably higher in women than in men indicating that women who develop IHD have a higher risk of dying from the disease compared with their male counterparts. Despite a significant decline in ASMR across EU from 2005 to 2019 both among women and men, sex disparities in ASMR-to-ASPR index persisted with a women-to-men ratio ranging from 1.05 to 1.36. No significant relationship was found between country-specific ASMR or country income status and ASMR-to-ASPR index. Examples include Romania which displayed higher ASMR (men: 219.87, women: 143.54) compared with Germany (men: 107.22, women: 60.76), yet with smaller differences in ASMR-to-ASPR index between women and men (Romania: 6.54% vs 5.85%; ratio: 1.12 and Germany: 4.79% vs 3.80%; ratio: 1.26).Conclusions:Mortality from IHD has decreased substantially among EU countries. However, the declines were accompanied by a persistently higher ASMR-to-ASPR index in women, indicating significant potential for further gains in closing the gender gap in IHD mortality.

Circulation, Volume 150, Issue Suppl_1, Page A4139107-A4139107, November 12, 2024. Background:Given its chronicity and high hospitalization burden, heart failure (HF) requires close coordinated care. Health Information Exchange (HIE) systems can improve care by enabling seamless information sharing between healthcare providers and patients. We evaluated whether hospitals that have invested in more comprehensive HIE access for patients have better risk-standardized post-discharge outcomes after HF hospitalization.Methods:We defined a range of contemporary HIE services at all US acute care hospitals using the American Hospital Association (AHA) Information Technology (IT) Annual Survey (2022). HIE services included mobile access to health records, the ability to import, export, and update health records online, and the option to share patient-generated data with the health system, representing health measurements and data generated from smart devices (A). We identified each hospital’s corresponding 30-day excess days in acute care (EDAC) for HF – a risk-standardized metric of all acute care needs in the post-hospitalization period from the Centers for Medicare&Medicaid Services Quality Report (2019-2022) and examined the association between HIE services and 30-day EDAC for HF using multivariable linear regression.Results:There were 2,581 US hospitals (22% rural, 9% teaching, with a median bedsize of 162 [IQR 76, 307]) in the AHA-IT survey, with a median EDAC of 5.9 (IQR -8.6, 20.9) days for HF. The vast majority (99%) of hospitals had online health record portals, but access to specific HIE services varied widely across hospitals (B): 84% offered access via mobile application, 86% allowed data import, 55% data export to other health systems, and 77% online data updates, with fewer than half (47%) allowing patients to share patient-generated health data. After accounting for differences in hospital characteristics, only hospitals with HIE configured to enable patients to share their personal health data directly with the health system had significantly lower risk-standardized 30-day EDAC for HF (-3.9, 95% CI -1.04, -3.48) (C).Conclusions:Hospitals with HIE services that include the sharing of patient-generated data have significantly better risk-standardized post-hospitalization outcomes for HF. There is a need to evaluate the role of broader access to bidirectional data sharing as a strategy to enhance care and outcomes at hospitals treating patients with ongoing post-discharge needs.