Search Results for: I numeri del cancro in Italia 2019

Circulation, Volume 150, Issue Suppl_1, Page A4145582-A4145582, November 12, 2024. Background:Previously described algorithms evaluated defibrillator biosignalsduring ongoing CPRto characterize the underlying rhythm and its physiologic phenotype. We hypothesized that a “smart” resuscitation strategy incorporating these algorithms could reduce CPR interruptions and better align rescuer actions with patient-specific physiology.Methods:In a cohort study of ventricular fibrillation OHCA from 2017-2019, rescuer actions (rhythm analysis, shock delivery, pulse check and medication administration) were extracted from EMS, audio, and defibrillator recordings. Previously validated algorithms were combined to assess both cardiac rhythm and physiologic measures. The combined smart algorithm was compared to observed clinical practice with respect to rhythm accuracy and CPR interruption. The frequency of potentially misdirected drug therapy, defined as epinephrine use with >50% probability of spontaneous pulse or antiarrhythmic use with a predicted rhythm of asystole or bradycardia, was determined. Low vitality physiologic phenotype was defined as a shockable rhythm with low probability of post-shock ROSC or a non-shockable rhythm with low probability of a pulse during a clinical pulse check. Vitality phenotypes were compared with respect to post-shock ROSC following shock delivery and pulse prevalence during pulse checks.Results:: Of 390 VF-OHCA cases, median age was 64, and 46% survived to hospital discharge. There were a median of 5 rhythm analyses, 3 shocks, and 2 pulse checks per case. The smart strategy achieved comparable shock accuracy (95% sensitivity, 98% specificity) to observed care while decreasing the median CPR interruption from 12 to 6 seconds. Of 597 epinephrine doses, the algorithm identified 17% (n=99) with predicted probability of ROSC over 50%. Of 248 antiarrhythmic doses, the algorithm predicted the rhythm was asystole or bradycardic organized in 9% (n=23). Following 1334 VF shocks, post-shock ROSC differed by phenotype: 4% (9/217) with low vitality versus 22% (244/1117) with high vitality (p

Circulation, Volume 150, Issue Suppl_1, Page A4132217-A4132217, November 12, 2024. Introduction:Many studies have evaluated outcomes after ventricular tachycardia (VT) ablation though few studies have evaluated outcomes past thirty days. This study aimed to determine which comorbidities are associated with one-year readmissions and mortality after VT ablation, including socioeconomic disadvantage (SED) via the Area Deprivation Index (ADI).Methods:Patients ages ≥18 were identified in the Healthcare Cost and Utilization Project State Inpatient Databases in New York and Florida from 2016-2019 with follow-up into 2020. These states were chosen due to availability for linkage of the 2020 ADI (1-100, higher scores representing more disadvantage). International Classification of Diseases 10 codes for VT and VT ablation were used. Patients undergoing pacemaker placement or with other arrhythmias were excluded. The risk of readmission and mortality was assessed using Cox proportional hazards first in an unadjusted fashion for each comorbidity in the Charlson Comorbidity Index. In addition to demographic variables, only significant variables from the unadjusted analysis were included in the final adjusted multivariable models.Results:1,798 patients met inclusion criteria. The readmission and mortality rates at one, three, and twelve months were 18.5%, 27.4%, 41.4% and 3.5%, 4.1%, 6.5%, respectively. Common diagnoses for readmission were VT (24.8%) and dyspnea/chest pain (10.7%). After adjustment, African American race, federal insurance, heart failure (CHF), vascular disease, renal disease (CKD), severe liver disease (SLD), and higher ADI were associated with increased risk for twelve-month readmissions. Federal insurance, CHF, cerebrovascular disease, dementia, peptic ulcer disease, CKD, and SLD were associated with increased risk for twelve-month mortality.Conclusion:CHF and CKD increased the risk of readmission and mortality. Recurrent VT was the most common cause of readmission. Patients of SED are at increased risk of readmissions within one year.

Circulation, Volume 150, Issue Suppl_1, Page A4141915-A4141915, November 12, 2024. Introduction:Atrial remodeling in HFpEF typically results in impaired ventricular diastolic function, and the maintenance of sinus rhythm would be key to improve clinical outcomes in these patients. The CABANA trial provides limited evidence for the benefits of AF ablation in HFpEF patients. While observational studies suggest otherwise, the results of upcoming RCTs like AMPERE and CABA-HFPEF may offer deeper insights.Objective:This study examines the inpatient outcomes of hospitalized HFpEF patients with AF who underwent catheter ablationMethods:A retrospective analysis of a nationwide inpatient database from 2017 to 2019 was conducted. The study included patients diagnosed with both HFpEF and AF. A propensity score-matched cohort compared HFpEF and AF patients who underwent catheter ablation with those who did not.Results:Among 8.2 million HFpEF patients, 2.6 million had AF, and 24,015 underwent catheter ablation. Mortality was significantly lower in the ablation group compared to the control group (4.6% vs. 1.7% in unmatched cohort, 3.8% vs. 1.7% in matched cohort). The adjusted hazard ratio for mortality was 0.43 (95% CI: 0.34-0.55, p

Circulation, Volume 150, Issue Suppl_1, Page A4140823-A4140823, November 12, 2024. Background:Asians are the fastest-growing population in the United States (US). Cardiovascular disease (CVD) remains the leading cause of disability and death among persons of Asian heritage in the US. Certain groups of Asian heritage may be at disproportionately high risk of CVD and all-cause death.Hypothesis:We hypothesize that there is heterogeneity in CVD and all-cause death among disaggregated Asian heritage groups (Chinese, Filipino, and Asian Indian, and others) based on nativity status (US- vs Foreign-born).Methods:The study analyzed pooled data from the 1999-2018 National Health Interview Survey linked with the National Death Index. The outcomes were CVD death (disease of heart and cerebrovascular disease deaths, based on ICD-10) and all-cause death, in years, derived from the time of interview to the year of death or December 31, 2019 (last date of follow-up). Survey-weighted Cox regression models were used to explore differences in CVD and all-cause death among Asian heritage groups, controlling for covariates (age, sex, marital status, poverty-income ratio, and education).Results:The study included 37,104 Asian adults (21.8% Chinese, 33.5% Filipino, and 44.6% Asian Indians and others). Over a median follow-up of 11 years (Interquartile range: 7-15), there were 1.7 CVD deaths and 5.6 all-cause deaths per 1,000 person-years. The fully adjusted model revealed a 33% lower CVD death hazard among foreign-born Filipino adults (Hazard Ratio [HR]: 0.67; 95% Confidence Interval [CI]: 0.49–0.91) compared to their US-born counterparts. Similarly, for all-cause death, foreign-born Asian Indians exhibited a 40% lower hazard (HR: 0.60; 95% CI: 0.48-0.74), and Filipinos showed a 33% lower hazard (HR: 0.67; 95% CI: 0.51-0.88) when compared to their US-born counterparts.Conclusion:There was heterogeneity in CVD and all-cause death among Asian heritage groups. Overall, CVD and all-cause death were lower among foreign- than US-born adults specifically among Filipino and Asian Indian and others. These findings warrant the targeted implementation of evidence-based approaches to CVD prevention and promotion.

Circulation, Volume 150, Issue Suppl_1, Page A4143746-A4143746, November 12, 2024. Background:Necrotizing enterocolitis (NEC) is a rare comorbidity in infants with heart disease, specifically those with shunt-dependent congenital heart disease (SDCHD). We aimed to describe NEC incidence and cofactors in our center’s SDCHD population and diagnostic practice changes.Methods:A retrospective case-control study in patients who underwent first staged palliation for SDCHD between 1/1/2013 and 6/30/2022. Palliation procedures included stage one Norwood with a BTTS or RV to PA conduit, hybrid, BTTS only or PDA stent. Demographics, clinical factors, and diagnostics including abdominal ultrasound (AUS) were abstracted for subjects for 21 days after palliation. NEC was defined with Bell’s criteria from databases and AUS was assessed by chart review. Hierarchical logistic regression models assessed surgical era rates into three cohorts 2013-2016, 2017-2019, and 2020-2022. Groups were compared with Chi-square, Fisher’s exact test, Wilcoxon rank-sum tests, and trends over time with logistical regression.Results:Of 531 patients included, 77 (14.5%) had NEC. There was no association of NEC diagnosis with sex, race, and ethnicity, presence of genetic syndromes or extracardiac abnormalities. The primary and majority SDCHD diagnosis was hypoplastic left heart syndrome and variants (61%). On univariate analysis, risks significantly associated with NEC include younger gestational age, delayed sternal closure, catheter reintervention, ECMO, cardiac arrest, seizures, >/= moderate ventricular dysfunction, increased pre- and post-procedural VIS scores, and postoperative anemia. Logistic regression found a significant increase in NEC by year, with a 23% increase in odds for each increasing year across the time range (OR 1.23, 95% CI 1.12-1.36, p

Circulation, Volume 150, Issue Suppl_1, Page A4142467-A4142467, November 12, 2024. Background:Despite profound disparities in stroke mortality, there is limited research on geographic variation across and within US racial and ethnic populations.Research Question/Hypothesis:Do geographic trends in stroke mortality vary across and within racial and ethnic populations living in the US? We hypothesized that changes in county-level stroke mortality would vary across and within racial and ethnic groups.Methods:We applied validated small-area estimation methods to US National Vital Statistics System death certificates to estimate stroke mortality rates by county (N=3110) and race and ethnicity (American Indian or Alaska Native [AIAN], Asian, Black, Hispanic or Latino [Latino], and White) from 2000-19. Mortality estimates were corrected for race and ethnicity misclassification on death certificates and age-standardized to the 2010 Census.Results:In 2019, age-standardized county-level stroke mortality rates per 100,000 ranged from 10.9 to 170.6 among AIAN, 11.8 to 96.9 among Asian, 17.4 to 179.7 among Black, 6.5 to 114.3 among Latino, and 14.5 to 139.7 among White populations. Despite stroke mortality declining nationally among all racial and ethnic populations, there were counties where mortality increased (AIAN: 15/474; Asian: 46/667; Black: 11/1488; Latino: 154/1478; White: 46/3051),Fig. Among these counties, median absolute increases were 3.5 (IQR 1.9-5.3; max: 26.8) among AIAN, 4.1 (1.1-5.4; max: 12.2) among Asian, 7.1 (1.0-10.2; max: 52.5) among Black, 2.4 (1.3-4.6; max: 18.3) among Latino, and 5.6 (1.9-12.3; max: 47.5) among White populations. Increased stroke mortality largely occurred in the Carolinas, Florida, and Georgia (72.4% of counties with increases) for all racial and ethnic groups except AIAN, which were mostly in Oklahoma (n=9). Geographic and temporal trends also varied across stroke type.Conclusions:Stroke mortality increased in over 200 counties nationally, with differential effects by race and ethnicity. Most increases occurred in the lower South Atlantic states. These findings underscore the importance of understanding drivers of stroke mortality disparities, as well as creating prevention and treatment strategies that target populations and places at high risk.

Circulation, Volume 150, Issue Suppl_1, Page A4122134-A4122134, November 12, 2024. Background:Aortic valve area planimetry (AVACT) is feasible on four-dimensional computed tomography (4D-CT) for grading aortic stenosis severity, with superior spatial but inferior temporal resolution to echocardiography, however its prognostic utility is not well-established. We evaluated the prognostic value of AVACTin patients with significant aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR).Methods:We studied 1035 native aortic valve stenosis patients (age 79.0±9.0 years, 429 (41.5%) women) undergoing TAVR during 2019-2020. AVACTand indexed to body surface area (AVAiCT) were retrospectively measured on contrast-enhanced 4D-CT at peak systole, and standard statistical analyses performed to evaluate its associations with all-cause mortality during follow-up.Results:Mean AVACTand AVAiCTwere 1.02±0.21 cm2and 0.53±0.12 cm2/m2respectively, with 240 (23.2%) deaths during mean follow-up of 2.1±0.9 years. Areas under curves and optimal thresholds for identifying severe aortic stenosis (defined as AVA

Circulation, Volume 150, Issue Suppl_1, Page A4143813-A4143813, November 12, 2024. Background:Non-ST elevation acute coronary syndrome (NSTE-ACS) is a leading cause of cardiovascular morbidity, with variable mortality across age groups. Older patients exhibit higher in-hospital mortality and often experience delayed percutaneous coronary intervention (PCI) owing to comorbidities. Large-scale data on PCI and inpatient mortality trends are limited.Aim:To evaluate inpatient mortality rates of NSTE-ACS treated with PCI over a 15-year period, comparing trends based on age groups.Methods:We used the National Inpatient Sample from 2005 to 2019 to identify the study population using the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification. The primary outcome was the PCI trend of NSTE-ACS among age groups. The secondary outcome was in-hospital mortality. Multivariate logistic regression and adjustment for sex, race, and Charlson comorbidity index score were used.Results:We evaluated 6,645,610 patients hospitalized in the United States for NSTE-ACS. Of these, 2,291,282 (34.4%) underwent PCI; mean age was 64.8 years, and 34.3% were female. PCI rates increased in all age groups during the study period; however, they remained significantly lower in patients above 80 years of age. The rate of PCI increased from 38% to 44.7% in the 18-64 years age group, from 29.1% to 43.1% in the 65-79 years age group, and from 15.6% to 31.7% in those 80 years and older during the study period (P

Circulation, Volume 150, Issue Suppl_1, Page A4141948-A4141948, November 12, 2024. Background:Structural racism has emerged as an important contributor to poor health outcomes. Historic redlining, the previously legal practice of systematically denying credit access and insurance, resulted from Home Owners’ Loan Corporation (HOLC) residential security maps graded on a color coded scale (A (Green)=Best; B (Blue); C (Yellow); D (Red)=Hazardous), hence the term redlining. The goal of this study was to investigate the direct and indirect relationships between historic redlining and prevalence of diabetes in a national sample.Methods:We combined census tract level data across multiple sources: a) diabetes prevalence from CDC PLACES 2019 database, b) HOLC grade from Mapping Inequality project, and c) incarceration risk, poverty, housing, education, employment, job environment, economic mobility, and demographics, from Opportunity Insights database. The assignment of redlining to present-day census tract was done based on overlap with historically HOLC graded areas. The final analytic sample consisted of 9,590 US census tracts. Structural equation modeling was then used to investigate direct and indirect relationships between redlining and diabetes prevalence through possible mediators of health care access, community resources, social capital, and social risk. Stata v16 was used for the analysis and analyses were adjusted for population.Results:Higher prevalence of diabetes was directly associated with more redlining within a census tract (0.28, p

Circulation, Volume 150, Issue Suppl_1, Page A4125999-A4125999, November 12, 2024. SGLT-2 receptor inhibitors (SGLT-2i) have been shown to reduce cardiovascular mortality and hospitalisations for heart failure (HF) in patients with HF with reduced ejection fraction (HFrEF) and to have a nephroprotective role in patients with chronic kidney disease (CKD). However, the available evidence in patients older than 75 years and with CKD is limited.We conducted a retrospective, single-centre study including patients aged >75 years diagnosed with HFrEF (defined as ejection fraction

Circulation, Volume 150, Issue Suppl_1, Page A4145362-A4145362, November 12, 2024. Background:Women have historically had higher mortality following STEMI than men. The difference in mortality is in part related to higher bleeding rates in women when compated to men. Little is known about the mortality differences in women versus men in the current era of radial first and other bleeding avoidance stategie for PCI.Methods:We queried in the NNE database to identofy all PCI cases between 2019 and 2023. From the dataset, patients who underwent PCI for an indication of STEMI were identified, and demographic as well as procedural variables were collected. Patients with shock prior to PCI were excluded. In-hosptial outcomes were assessed including bleeding and need for transfusion. Mortality was obtained from discharge vital status. Standard statisical methods were used to assess significance of differences, using STATA for calculations.Results:A total of 22,681 pateints were identified who underwent PCI between 2019 and 2023. Of these, 4,356 (19.2%) underwent PCI for STEMI and did not have shock. Of the patients with STEMI, 3,198 (73.4%) were men and 1,158 (26.6%) were women. When compared with men, women tended to be older, have smaller BSA, and similar BMI. Procedurally, the percent radial cases and IIBIIIA receptor inhibitor use were similar between men and women. In-hospital mortalty was 3.3% for women and 1.7% for men (p

Circulation, Volume 150, Issue Suppl_1, Page A4134079-A4134079, November 12, 2024. Background:Several area-level indices exist that integrate a variety of social drivers of health. However, whether certain indices better capture neighborhood-level variability in cardiovascular-kidney-metabolic (CKM) outcomes is not well known.Aims:We sought to examine the associations of census tract-level indices of social disadvantage with CKM outcomes.Methods:Exposures for the analysis included seven indices of social disadvantage (ADI, COI, EJI, NDI, SDI, SREI, SVI) based on census tract-level data from the 2010-2019 American Community Survey (ACS) and census tract-level median household income from the 2015-2019 ACS data. Outcomes included the census tract-level prevalence of CKM outcomes (obesity, hypertension, diabetes, hyperlipidemia, chronic kidney disease, coronary heart disease [CHD], and stroke) from the 2019 Behavioral Risk Factor Surveillance System. All indices and median income were standardized, and we used linear regression to examine the associations between each census tract-level social measure and CKM outcomes, adjusted for population size and median age. Next, we calculated the △r2in adjusted models for the association of median income with each CKM outcome when each index was added.Results:Among 65,476 US census tracts, median (IQR) population size was 4068 (2969, 5374), age was 39 years (35, 44), and household income was $58,870 (44276, 79802). Median income as well as each index was significantly associated with census tract-level prevalence of each CKM outcome assessed (p < 0.05). The r2(Panel A) and △r2values (Panel B) varied for each of the social measures and CKM outcomes, with higher r2values when each index was individually added to median income compared with income alone. For example, for CHD, the r2ranged between 0.39 to 0.67 and △r2ranged from 0.01 to 0.10.Conclusions:Neighborhood-level measures of social disadvantage are differentially associated with CKM outcomes, with a large proportion of the variability explained by median income. Identifying the advantages and disadvantages of each index and comparison with median income can inform the prioritization of measures for specific outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4138150-A4138150, November 12, 2024. Background:Radiation therapy (RT) has resulted in significant improvements in breast cancer outcomes, but cardiac morbidity remains an important concern. We evaluated the changes in cardiac function after breast RT and the relationship between cardiac dose metrics and echocardiography-derived measures of cardiac function.Methods:We performed detailed quantitation of radiation cardiac dose metrics and echocardiographic measures of cardiac function in a prospective longitudinal cohort study of racially diverse women with breast cancer treated at a quaternary healthcare system. Radiation cardiac dose metrics included whole heart, left ventricle (LV), right ventricle (RV) and left anterior descending artery (LAD). Echocardiographic measures included LV ejection fraction (LVEF), longitudinal strain, circumferential strain, E/e’, ventricular-arterial coupling, and RV fractional area change. The mean change in echocardiogram measures from pre-RT, and 6, 12, 24, 36 months post-RT, and the association between cardiac dose metrics and echocardiogram measures, were estimated by repeated measures multivariable linear regression via generalized estimating equations. Analyses were stratified by treatment site (right versus bilateral/left).Results:303 participants (33% African American) received adjuvant RT between 2010-2019, and had an echocardiogram performed within three months prior to the start of and after RT. The median mean heart dose (MHD) was 1.19 Gy (Q1-Q3, 0.75-2.61). LVEF increased over time (pre-RT 52.1% to 53.6% at 3 years; p = 0.004), and consistent with this, ventricular-arterial coupling decreased (pre-RT 1.02 to 0.93 at 3 years; p = 0.03). MHD was significantly associated with systolic and diastolic function measures, but the effect sizes were small. For each IQR increase in MHD, there was a 0.31% (95% CI 0.04, 0.57) worsening in longitudinal strain. The maximum LAD dose was associated with multiple echocardiographic parameters, including LVEF (-0.85, 95% CI: -1.58, -0.13), longitudinal strain (0.62, 95% CI: 0.17, 1.08), and circumferential strain (0.64, 95% CI: 0.00, 1.28) for bilateral/left-sided RT.Conclusion:Modern breast RT was not associated with a clinically important effect on echocardiographic measures of cardiac systolic and diastolic function over a median follow-up of two years. Our findings provide clinically actionable guidance and reassurance regarding the cardiac safety of RT for breast cancer patients in the modern era.

Circulation, Volume 150, Issue Suppl_1, Page A4140571-A4140571, November 12, 2024. Introduction:The HEART score, developed over 15 years ago, aimed to guide the disposition decision for patients presenting to the emergency department (ED) with chest pain. A main concern for these patients is avoiding a missed myocardial infarction (MI). The original studies to develop the HEART score relied on an older generation of troponin assays, however high-sensitivity troponin assays are now widely used and have greatly enhanced the detection of MI. There is uncertainty in the utility of using the HEART score in the current era.Question:Can high-sensitivity troponin assays rule out risk of MI and death in patients with a moderate or high HEART score?Methods:We analyzed patients presenting to the University of Florida Shands Hospital, a tertiary medical center, with chest pain, high-sensitivity troponin I levels below the 99th percentile, and moderate or high-risk HEART score; 4-6 and 7+, respectively. Patients were recruited from June 2019 to December 2023. The HEART score was collected prospectively as part of our chest pain registry. We calculated the negative predictive value (NPV) for the outcomes of MI and cardiovascular death or death from an unknown cause at 30 days.Results:We included 1329 patients. The average age was 58.9 years and 52.7% were women. High sensitivity troponin I was negative (

Circulation, Volume 150, Issue Suppl_1, Page A4141103-A4141103, November 12, 2024. Introduction:Atrial fibrillation (AF) decreases sports performance in athletes, and ablation is associated with a greater improvement in performance compared to medication. Endurance sports predispose males to AF more than females. However, once AF develops, it is unknown whether its impact in female athletes differs from that of males.Aims:To investigate the impact of AF and AF treatments in female versus male athletes.Methods:An internet-based survey, initiated via StopAfib.org, queried the impact of AF and treatment modalities on sports performance, training, and symptoms. Responses were categorized by reported sex. Reported performance (rated in comparison to personal best), frequency of training, and competition engagement were compared before the onset of AF symptoms versus when symptoms were at their worst, between males and females. These outcomes were similarly compared in relation to participants’ AF treatments.Results:Between 5/13/2019 and 2/29/2020, 219 female and 772 male athletes, 40% of whom were less than 60s years old, answered the survey. Development of AF was associated with declining reported sports performance, competition, and training frequency, with no significant difference between genders. Ablation in both males and females was associated with greater reported improvement in sports performance than the use of medications. Among 141 female athletes and 509 male athletes who have taken medication currently and/or in the past, 52% and 40% reported side effects, respectively. The most prevalent side effects for both males and females were fatigue/low energy and decreased athletic performance.Conclusion:Once AF develops, the impact on decreasing sports performance is similar in females and males. Both genders similarly reported more improvement with ablation than medications, which were frequently and similarly associated with side effects for females and males.

Circulation, Volume 150, Issue Suppl_1, Page A4144025-A4144025, November 12, 2024. Introduction:Heparin is widely used as anticoagulant in hospitals. It is considered a mainstay of therapy in ST-elevation and non-ST elevation myocardial infarction and is included in the ACLS management of these conditions. Heparin-induced thrombocytopenia (HIT) is a potentially life-threatening immune mediated prothrombotic disorder as a consequence of heparin exposure. This is caused by the production of antibody-heparin/PF4 immunocomplex, which causes platelet activation and aggregation. This study aims to determine the effect of HIT on mortality in patients with non-ST elevation myocardial infarction (NSTEMI).Research Questions/Aims:Given the significant morbidity of myocardial infarction, research is needed to identify factors which increase morbidity and mortality. This study aims to determine the mortality of NSTEMI patients with and without HIT.Methods:Data was analyzed from available ICD-10 codes from 2016 to 2020. Patients greater than 18 years with ICD-10 codes for NSTEMI with and without HIT were included. The mortality rates were compared between HIT-positive and HIT-negative NSTEMI patients. Patient demographic, clinical, and hospital characteristics were summarized using means and standard deviations for continuous variables, and proportions with 95% confidence intervals for categorical variables. Logistic regression ascertained the odds of binary clinical outcomes relative to patient and hospital characteristics. Multiple logistic regression was used to ascertain the likelihood of the outcome (Odds Ratios (95% CI)) occurring between the characteristics. Analyses were conducted following the implementation of population discharge weights. All p-values were calculated as 2-sided, with a significance level set at p