Risultati per: I numeri del cancro in Italia 2019

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

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

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

Circulation, Volume 146, Issue Suppl_1, Page A13781-A13781, November 8, 2022. Introduction:Transcatheter mitral valve repair (TMVR) has evolved over the years, and early discharge strategies are being increasingly adopted. However, there is paucity of data on the outcomes and safety of same-day discharge (SDD) after TMVR.Methods:Data from the Nationwide Readmissions Database 2014 to 2019 were analyzed. International Classification of Diseases codes were used to identify adult patients admitted for elective TMVR. Patients who underwent uncomplicated TMVR were identified by excluding patients with periprocedural complications such as bleeding, vascular access site complications, pericardial complications, stroke, myocardial infarction, shock, or death before discharge. A 1:3 propensity score-matched analysis was performed to compare outcomes of patients undergoing SDD and different-day discharge (DDD). The primary outcome of interest was the 30-day unplanned readmission rate.Results:We identified 34,683 patients who received complication-free TMVR, of which 232 (0.67%) underwent SDD. There was a gradually rising trend of SDD after TMVR over the study period. The baseline characteristics of the unmatched and propensity-matched SDD and DDD groups are shown. Patients in SDD group did not have a significantly higher 30-day readmission rate (15.7% vs 14.8%, p = 0.82) compared to DDD group, but had significantly lower mean hospitalization costs ($33,060 vs $41,134, p

Circulation, Volume 146, Issue Suppl_1, Page A332-A332, November 8, 2022. Introduction:Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is often used in patients with cardiogenic shock. However, this strategy can lead to left ventricular (LV) distention, thus compromising myocardial recovery. Therefore, concomitant LV unloading with an Impella device (Abiomed, Danvers, MA) has gained a wide interest to promote LV recovery. We aimed to investigate the in-hospital outcomes of patients with myocardial infarction and cardiogenic shock undergoing VA-ECMO with Impella (ECPELLA) versus VA-ECMO alone.Methods:We conducted a retrospective cohort study using the 2019 National Inpatient Sample Database. Variables were identified using their International Classification of Diseases, 10th revision (ICD-10) codes. Descriptive bivariate and multivariate analyses were performed. A p-value

Circulation, Volume 146, Issue Suppl_1, Page A13841-A13841, November 8, 2022. Background:Considering preliminary reports suggesting associations between peripheral atherosclerotic disease (cannabis arteritis) and acute ischemic stroke (AIS) with cannabis use disorder (CUD), we sought to study the burden and impact of CUD on AIS risk and outcomes in the elderly with PVD.Methods:The National Inpatient Sample (2016-2019) was used to identify geriatric PVD admissions with vs. without CUD . We compared the burden and risk of AIS admissions with vs. without CUD and subsequent in-hospital mortality using adjusted multivariable regression analyses.Results:Of 5,115,824 total geriatric admissions with PVD (50.6% males, 77.5% white), 21,405 had CUD. The prevalence of DM was lower in the CUD cohort (19.7% vs 33.7%) with comparable rates of HTN and smoking between groups [Table 1]. Concomitant drug use was higher in CUD vs non-CUD cohort. There was AIS period prevalence of 5.2% in CUD vs 4.0% in non-CUD cohorts (p

Circulation, Volume 146, Issue Suppl_1, Page A14128-A14128, November 8, 2022. Introduction:Limited data exist on the in-hospital and readmission outcomes in sarcoidosis patients after surgical or transcatheter aortic valve replacement (SAVR/TAVR).Hypothesis:Sarcoidosis can lead to cardiac conduction abnormalities and cardiomyopathy which can lead to poor outcomes after aortic valve intervention (AVI). We hypothesize that SAVR/TAVR in sarcoidosis patients has the worst outcomes.Methods:The NRD was queried for all sarcoidosis patients who underwent SAVR/TAVR from 2016-2019. Our outcomes of interest were in-hospital mortality, in-hospital complications, and 30-day readmissions for heart failure and pacemaker implantation. Clinical outcomes were modeled using logistic regression for binary outcomes and linear regression for continuous outcomes.Results:We identified a total of 507,441 SAVR/TAVR hospitalizations of which 1429 were of sarcoidosis patients. Patients with sarcoidosis were younger (mean age 70.1 years vs 72.4 years) and had more women (48.3% vs 38.2%, p

Circulation, Volume 146, Issue Suppl_1, Page A9885-A9885, November 8, 2022. Introduction:Atrial septal defect (ASD) is one of the most common congenital cardiac defects. It can also allow paradoxical emboli to move into the cerebral vasculature leading to Acute Ischemic Stroke (AIS). As there is a lack of adequate information on the additional risk factors for mortality in ASD patients following AIS, we queried the largest inpatient database in the United States for answers.Methods:Patients with ASD were identified among patients of ages 25 and more admitted with a principal diagnosis of AIS ICD-10 code (I63.x) in 2019 from the National Inpatient Sample(NIS). Various patient characteristics and procedures were also studied. A Multivariate regression model adjusting for several factors allowed our study to further evaluate potential risk factors for mortality among ASD patients.Results:Our study found 551,385 cases of AIS, amongst which 19,670 (3.6%) also had a diagnosis of ASD. ASD patients had a higher risk of requiring mechanical thrombectomy (aOR 1.239, 95% CI 1.167- 1.316, p

Circulation, Volume 146, Issue Suppl_1, Page A9772-A9772, November 8, 2022. Introduction:Various factors can trigger events of Pulmonary Embolism(PE). Several studies have linked cardiac arrhythmias such as Paroxysmal Atrial Fibrillation (PAF) with a higher risk of multiple cardiovascular and pulmonary complications. As there is a paucity of data on the risk factors for an event of PAF among PE patients and the factors contributing to death, we conducted a retrospective analysis using the 2019 National Inpatient Sample(NIS).Methods:Our study focused on finding patients with a principal diagnosis of Pulmonary Embolism and a diagnosis of Paroxysmal Atrial Fibrillation. A multivariable regression model evaluated several risk factors for PAF incidence among PE patients and their possible mortality risks.Results:A total of 188,850 cases of PE were observed in our study, including 9,960 (5.3%) cases of PAF. Hyperlipidemia (aOR 1.348, 95% CI 1.290-1.409, p

Circulation, Volume 146, Issue Suppl_1, Page A13534-A13534, November 8, 2022. Introduction:Maternal shock is an important contributor to severe maternal morbidity and mortality. Although there is some data on hypovolemic shock in pregnancy, the literature on maternal shock is remarkably limited.Methods:Data from the National Inpatient Sample with delivery hospitalizations from 2009 to 2019 were used for the data extraction. Diagnosis codes from the International Classification of Diseases, 9thand 10th Revision for common cardiovascular disease (CVD) conditions, adverse pregnancy and fetal outcomes, and delivery complications including shock, were used. Multivariable logistic regression was performed to assess the predictors and outcomes associated with maternal shock.Results:A total of 41,573,217 delivery hospitalizations were analyzed, of which 13,217 were complicated by maternal shock. The trend of maternal shock was seen to rise from 20 to 45 per 100,000 hospitalizations over the study period (Fig 1A). Traditional cardiovascular risk factors and diseases (e.g., hypertension and heart failure) were significant predictors of maternal shock(Fig 1B). The presence of coagulopathy (Odds Ratio [OR]: 16.2, 95% CI: 15.4-17.0) and peripheral arterial disease (OR: 6.4, 95% CI: 4.9-8.2) were strong predictors of maternal shock. All-cause in-hospital mortality (3.82%), pre-eclampsia (10.78%) and cardiac arrest (5.69%), (all p

Circulation, Volume 146, Issue Suppl_1, Page A267-A267, November 8, 2022. Introduction:Recently, multiple studies have demonstrated improvement in survival after out-of-hospital cardiac arrest (OHCA). However, outcomes after OHCA vary with region and city worldwide.Hypothesis:Differences of temporal trends in outcomes after OHCA between rural and urban regions in Japan were postulated.Methods:We included 98,496 patients (aged ≥18 years) using an All-Japan Utstein-style Registry who were witnessed by bystanders after OHCA of presumed cardiac origin between January 1, 2016 and December 31, 2019. Based on population density, patients were classified into urban (n=76,411, 28 prefectures with a population of ≥200 inhabitants/km2) and rural (n=22,085, 19 prefectures with a population of

Circulation, Volume 146, Issue Suppl_1, Page A14142-A14142, November 8, 2022. Introduction:The COVID-19 pandemic’s impact on cardiovascular (CV) services globally was variable, with little data on trends from South Asia.Hypothesis:We hypothesized changes in trends of CV services delivery and procedure volumes from 2019-2022. We aimed to assess the pandemic’s impact at a Bangladesh tertiary cardiac centre.Methods:Data on patient visits, admissions, procedures and catheterization volumes were collected from January 2019 to February 2022. Differences for each month of the preceding year were expressed as a percentage (%Δ). Trends (2019 to 2022) were graphically depicted via line diagrams.Results:Significant reductions of cardiology services occurred in 2020, especially ER visits (Δ-59.5%; p

Circulation, Volume 146, Issue Suppl_1, Page A15611-A15611, November 8, 2022. Introduction:Aortic Stenosis (AS) is increasingly recognized as one of the underdiagnosed manifestations of cardiac amyloidosis (CA) and existing literature shows conflicting evidence on the impact of CA on AS.Methods:A retrospective analysis of 2016-2019 NIS was conducted to identify hospitalizations (Age≥18) who underwent TAVR using ICD-10 codes. Existing literature was reviewed to select variables before conducting a univariate screen and balancing between groups with CA vs without CA. Propensity score weights were generated using Doubly robust estimation, and IPTW matching was done. The ATET was calculated by extrapolating propensity weights and using weighted multivariate analysis.Results:Out of 227,200 TAVR, only 245 (1.1%) had a concomitant diagnosis of CA. Hospitalizations with CA had a mean age of 80.49, 71.43% males, 82.98% white, 12.77% black, and others. Analysis total of 3,205 deaths, CA was associated with lower odds of mortality (OR 0.25, p 0.00). Factors associated with increased mortality in TAVR were age, HTN, low household income, elixhauser comorbidity index, mechanical vent >24 hrs, Shock on pressors/device, Pericardial effusion/tamponade, AKI, ESRD on HD, and Acute stroke. Out of 17,590 pacemakers (PPM) implantations, CA was associated with lower odds of getting a PPM (OR 0.13, P 0.00). Factors increasing the risk of getting a PPM were high degree AV block, age, male sex, DM, and ventricular arrhythmias. A total of 4280 acute strokes occurred, and CA was not associated with increased risk following TAVR (OR 0.46, p 0.38). Factors increasing the acute stroke risk after TAVR were age, mechanical vent >24hrs, and anemia. 3460 valve complications occurred, and CA was not associated with increased risk (paravalvular leak, displacement, infection, breakdown, and others) (OR 10.20, p 0.16). A significant risk factor for valve complications after TAVR was the presence of pericardial effusion/tamponade.Conclusions:The presence of CA does not result in poor outcomes in TAVR. Limitations of our study are a small sample, retrospective analysis, and lack of cardiac imaging data. Further studies that eliminate our study’s limitations are required to conclusively evaluate the impact of CA in patients who undergo TAVR.

Circulation, Volume 146, Issue Suppl_1, Page A11848-A11848, November 8, 2022. Background:Despite major scientific advances in contemporary resuscitation, survival outcome in both in-hospital and out-of-hospital cardiac arrest (CA) patients remain dismal.Objective:How do individuals’ demographic and socioeconomic status, insurance status, and hospital characteristics play a role in survival following CA in patients living with human immunodeficiency virus (PLWH)?Methods:Using the ICD10 codes B20-B24 for HIV and ICD10 code I46 for CA, we queried the national inpatient sample from 2016 to 2019 to identify admission cases of PLWH with CA. Weighted data was analyzed using logistic regression model.Results:Out of 475,910 admissions for PLWH from 2016 to 2019, 4,650 cases had CA. Of these, 3,065 patients died during the course of hospitalization (65.9%). Although mortality rate decreased for both genders over time, the decline was steeper for females (72% in 2016 to 62% in 2019) compared to the males (68% in 2016 to 64% in 2019). Female gender was however associated with an increased odds of death compared to male (OR: 1.2, 95%CI: 1-1.3, p=0.03). Asian or Pacific Islanders were associated with a lower odds ratio for mortality (OR: 0.6, 95%CI: 0.3-1, p=0.04). Additionally, beneficiaries of all the insurance types had higher odds of mortality compared to Medicare beneficiaries (OR between 1.8 and 3). The odds of death decreased with increasing household income (OR between 0.7 and 0.9). Patients admitted to the hospitals of West South Central (OR:1.6) and Pacific Regions (OR:1.7) had a higher mortality rate as had those residing in areas with less than 250,000 populaces (OR: 1.7).Conclusion:Despite declining trend in mortality from CA among hospitalized PLWH, more than 60% of the cases die during their hospital stay. Female gender, lower household income, non-Medicare beneficiaries, and being a resident of smaller size population areas were associated with higher mortality among PLWH hospitalized with CA.

Circulation, Volume 146, Issue Suppl_1, Page A12316-A12316, November 8, 2022. Introduction:The frequency of GDM and pregnancy-related complications of GDM are increasing in the United States. Detection and treatment are important to manage GDM and reduce the risk of pregnancy-related complications. The objective of this analysis was to assess whether expanding Medicaid, a state-level policy change that enhances access to care, was associated with changes in rates of GDM and outcomes among those with GDM.Methods:Data from nulliparous individuals aged 20-44 years with a first live birth from 30 states between 2012-2019 were included from the National Center for Health Statistics. The primary outcome, age-standardized incidence of GDM, was compared between Medicaid expansion states (N=16) and Medicaid non-expansion states (N=14) using a quasi-experimental analysis with difference-in-differences (DID) models. DID models utilized multivariate linear regression with random intercepts for state (to adjust for unobserved state-level fixed effects), fixed effect for year, and adjustment for state-level covariates including demographics, and health and economic indicators. Secondary outcomes included GDM complicated by preterm birth (≤36 weeks) and high ( >4000 grams) or low (

Circulation, Volume 146, Issue Suppl_1, Page A9912-A9912, November 8, 2022. Introduction:Respiratory distress and complications are the leading causes of death among Amyotrophic Lateral Sclerosis (ALS) patients. However, several studies have reported multiple cardiovascular complications linked with heart rate and rhythm. We, therefore, aim to investigate cardiovascular involvement among ALS patients further.Methods:Data from the 2019 National Inpatient Sample from the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ), and partners were analyzed to estimate the presence of multiple cardiovascular events in patients with a diagnosis of Amyotrophic Lateral Sclerosis in the United States via their respective ICD-10 codes. The risk of cardiopulmonary resuscitations and mortality rates were also estimated via multivariate regression models, accounting for different variables.Results:We identified 12,865 cases of ALS in the United States. Different cardiac arrhythmias were recorded, such as supraventricular tachycardia (2.1%), ventricular tachycardia (1.7%), ventricular fibrillation (0.2%), and paroxysmal atrial fibrillation (3.8%), and long QT syndrome (0.6%). Several cases of heart blocks were also observed as 0.4% had a first degree, 0.3% had a second degree, and 0.3% had third-degree atrioventricular blocks. 10.7% also had a diagnosis of heart failure, and 565 (4.4%) patients had an old myocardial infarct. Finally, we found 160 (1.2%) cases of cardiopulmonary resuscitation, which had a higher risk of occurring among diabetics (aOR 1.922, 95%CI 1.383-2.670, p