Risultati per: I numeri del cancro in Italia 2019

Circulation, Volume 146, Issue Suppl_1, Page A14768-A14768, November 8, 2022. Introduction:There are limited data on the contemporary hospitalization rate and 30-day readmission characteristics of unstable angina (UA).Methods:Using Nationwide Readmissions Database from 2016 to 2019, we identified UA hospitalizations based on ICD-10-CM codes and analyzed the rate, trend, timing, causes, and costs of 30-day readmissions after UA in the United States. Multivariable regression analysis was conducted to determine the predictors of 30-day readmission.Results:A total of 498,008 patients were hospitalized with UA, resulting in the in-hospital mortality of 0.4%. During the study period, a significant decrease in the temporal trend of UA hospitalization rate was observed (Figure 1). Among 458,823 patients who were discharged alive, 11.4% were readmitted within 30 days with a median time to readmission of 9 days. There was a significant reduction in the temporal trend of 30-day readmission rate (Figure 2). The most common cause of readmission and procedure during the readmission were recurrent UA and left heart catheterization, respectively. While cardiovascular comorbidities, including congestive heart failure and atrial fibrillation, were associated with an increased likelihood of 30-day readmission, the ischemic evaluation performed during index hospitalization was associated with decreased odds of readmission (Table). The mortality during the readmission was 2%. The cumulative costs of hospitalization were $30,729 vs. $14,998 for UA patients with and without readmission, respectively.Conclusions:The index hospitalization and early readmission rates of UA have decreased over time. About 1/10 of UA patients were readmitted within 30 days of discharge, primarily due to recurrent UA. The early readmission may be reduced by a timely ischemic evaluation following UA.

Circulation, Volume 146, Issue Suppl_1, Page A13438-A13438, November 8, 2022. Introduction:Physiologic assessment of intermediate coronary stenosis has shown superiority in guiding decision making when compared to angiographic assessment alone. Many recent trials have shown improved outcomes using resting or hyperemic indices for severity assessment. In this study, we aimed to analyze the trends of intravascular physiologic testing during percutaneous coronary intervention (PCI), adjusted in-hospital mortality, adjusted in-hospital stay and adjusted hospital cost.Methods:Data were extracted from the National Inpatient Sample (NIS) 2014 through 2019 Database. The NIS was searched for PCI with and without intravascular physiologic testing in adult patients (age ≥18) using ICD 9 and 10 codes. Outcomes of interest were utilization rates of intravascular physiologic testing during PCI, trend of adjusted in-hospital mortality, adjusted mean LOS and adjusted mean hospital cost. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis.Results:Of 2,871,865 PCIs in 2014 through 2019, 118,795 (4.1%) were coupled with intravascular physiologic testing. The use of intravascular physiologic testing during PCI steadily increased from 2.8% in 2014 to 5.0% in 2019 (trend p

Circulation, Volume 146, Issue Suppl_1, Page A14473-A14473, November 8, 2022. Introduction:Dietary risk factors contribute to cardiovascular mortality. To the best of our knowledge, there are no studies comparing two first world countries with respect to cardiovascular deaths (CVD) and the impact of dietary risk factors. We sought to compare these parameters in Great Britain (GBR) and the United States of America (USA)Methods:A total of 33,041,416 patients with dietary risk factors and CVD from GBR and USA was obtained from the Global Burden of Disease Study between 1990 and 2016.The 30-year mean CVD was compared for all risk factors with the Welch Two sample t-test. Trends of CVD proportions of 30-years is as shown (Fig 1 and 2).Results:30-year mean cardiovascular death for all variables between GBR and USA was statistically significant (p< 0.05) with the exception of diet low in whole grains. Cardiovascular death with risk factors of diet low in PUFA, fruits, vegetable, nuts and seeds were measures where GBR had a higher 30-year mean CVD than the USA. Remaining factors contributed to higher CVD proportion in USA.Conclusions:A higher proportion of CVD was seen in the USA with dietary risk factors including low PUFA, processed meat, sweetened beverages, low legumes, high sodium and high trans-fatty acids when compared to GBR. Our study proves that there exists significant disparity in CVD proportions between two first world countries despite similar dietary risk factors.

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 A15771-A15771, November 8, 2022. Introduction:Socioeconomic status impact cardiovascular disease outcomes. There is a paucity of data comparing age-standardized Gross Domestic Product (aGDP) and age-based proportion of CVD deaths (pCVD).Methods:We analyzed World Development Indicators and Global Burden of Disease 2019 study data. aGDP, CVD, total all-cause deaths, and their distribution amongst ‘High Income’ (HI), ‘Upper-Middle Income’ (UM), ‘Low-Middle Income’ (LM), and ‘Low Income’ (LI) countries from 2010-2019 was queried. ANOVA with Kruskal-Wallis Test followed by post-hoc analysis with Tukey test was conducted to examine the differences in pCVD among different income category countries based on age groups (Table 1b).Results:A total of 169,825,716 CVD (35.4%) were noted out of 478,797,297 total all-cause deaths globally. There was a significant difference comparing all income classes (p < 0.001) in age groups except between UM and LI in the age groups 15-49 and 50-69 (p = 0.885 and 0.261 respectively). In the age group 5-14, pCVD was higher in HI, UM, LM and LI classes (3.74%, 3.41%, 2.48 and 1.96%, p < 0.01). In age groups 15-49, pCVD was higher in UM and LM (17.70%, 17.50%), and lower pCVD in HI and LI classes (15.07% and 8.52%). At the age > 70, higher pCVD was seen in UM, followed by LM, LI, and HI (50.05%, 40.93%, 36.74% and 35.78% respectively, p < 0.001). The highest overall pCVD was observed in the UM class.Conclusions:Our study shows a statistically significant difference in pCVD between the World Bank classes of countries based on age groups. There is higher pCVD in HI, both-middle-income, and UM classes in the age groups 5-14,15-69, and >70 respectively, with overall pCVD being higher in UM class.

Circulation, Volume 146, Issue Suppl_1, Page A9462-A9462, November 8, 2022. Background:There are concerns that transcatheter or surgical aortic valve replacement (TAVR/SAVR) procedures are preferentially available to White patients.Methods:We stratified Medicare beneficiaries hospitalized with principal diagnosis of AS between 2012 and 2019 (n=299,976) by self-reported race/ethnicity (Black, Hispanic, Asian, Native American, and White). We evaluated AVR rates within 6 months of index hospitalization and associated procedural outcomes, including 30-day and 1-year mortality, and discharge disposition. We fitted Cox-proportional hazard models for outcomes, adjusting for demographics and comorbidities using race/ethnicity subgroup-specific-stabilized inverse probability weights.Results:Within 6 months of an index admission for AS, 86.8% (122,457 SAVR; 138,026 TAVR) patients underwent AVR. Overall, compared with White people, Black [HR 0.87 (0.85-0.89)], Hispanic [0.92 (0.88 – 0.96)], and Asian [0.95 (0.91 – 0.99)] people were less likely to receive AVR (Figure). Among patients who were admitted emergently/urgently, White patients (41.1%, 95% CI 40.7-41.4) had a significantly higher AVR rate within 6 months compared with Black (29.6%, 95% CI 28.3-30.9), Hispanic (36.6%, 95% CI 34.0-39.3), and Asian patients (35.4%, 95% CI 32.3-38.9). AVR rates increased annually for all race/ethnicities. There were no significant differences in 30-day or 1-year mortality by race. Black people were significantly more likely to be discharged to a facility compared with others.Conclusion:Within 6 months of AS admission, AVR rates are lower for Black, Hispanic, and Asian people compared with White people. These race-based differences in ultimate treatment of AS likely represent complex issues across the diagnosis and management of AS, warranting a comprehensive reassessment of the entire care spectrum for disadvantaged populations.

Circulation, Volume 146, Issue Suppl_1, Page A11767-A11767, November 8, 2022. Background:Traditional cardiovascular disease (CVD) risk factors can increase the risk of Atrial Fibrillation (AF) even in young adults. With rising trends in CVD in the Asian population, we aimed to assess the prevalence and disparities of major modifiable risk factors for CVD and AF in the young Asians hospitalized in the US.Methods:The National Inpatient Sample (2016-2019) was used to estimate the temporal trends in modifiable CVD risk factors among young (18-44 years) Asian hospitalizations and evaluated disparities by sex. Also, we assessed the prevalence of AF in young Asians hospitalized with vs. without atleast one CVD risk factor.Results:From 2016 through 2019, a total of 1,324,259 young Asian admissions (Male 85%, age 18-44 years) were analyzed, the highest increase was noted for Obesity (1.8%) followed by Diabetes (1.3%). Males demonstrated the most prominent prevalence of Obesity (2.1%) and Hypertension (1.7%) as compared to the female population (1.7% and 0.4%), respectively. The incidence of AF in patients with at least one CVD risk factor increased by 0.4% (males 0.9% vs females 0.15%), (OR 2.80, 95%CI 2.44-3.21, p

Circulation, Volume 146, Issue Suppl_1, Page A12931-A12931, November 8, 2022. Introduction:The subcutaneous implantable cardioverter defibrillator (S-ICD) has emerged as an alternative to the transvenous ICD with comparable efficacy and complication rates in clinical trials. Adoption of this technology and real-world clinical experience are less well described.Methods:This was a retrospective descriptive cohort study using data from National Inpatient Sample (NIS) for calendar years 2016-2019. Outcomes were cardiovascular adverse events, all-cause mortality, 30-day readmission, and resource utilization in patients who had S-ICD implantation.Results:We identified 6655 patients who had S-ICD implantation between 2016-2019. S-ICD implant rates remained between 10-12% of total ICD implants in the US over the study period (Figure 1a), though hospital implant rates were widely distributed (Figure 1b). The mean (SD) age of the population was 56.1 ± 15.9 years, and 2002 patients (30.1%) were female. Median length of stay (IQR) was 6.0 (4.0, 10.0). Hospitalization costs were $ 245937.1 ± 206047.3. Adverse cardiovascular events associated with the hospitalization were: pericardial perforation/cardiac tamponade (0.2%), hemothorax/pneumothorax (1.1%), stroke/TIA (0.5%), cardiogenic shock (8.6%), cardiac arrest (11%), and vascular complications (1.3%). A total of 48 patients (0.7%) died. Non-elective readmission within 30 days post-procedure occurred in 15.7% of cases.Conclusion:S-ICD implant rates were stable over time but varied widely among hospitals. Hospitalization-associated adverse cardiovascular events may be more a reflection of the vulnerable population undergoing S-ICD implant than risk of the procedure.

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 A13230-A13230, November 8, 2022. Introduction:Contemporary data on the prevalence, trends, and outcomes of cardiovascular diseases (CVD) in pregnant patients are limited.Hypothesis:We aimed to analyze the prevalence, trends, and outcomes of CVD and their subtypes in hospitalized pregnant patients in the United States (U.S.).Methods:This retrospective population-based cohort study used the Nationwide Readmission Database to identify all hospitalized pregnant patients from January 1, 2010, to December 31, 2019. Pregnancy-associated hospitalizations were identified, and patients with missing information on the length of stay (LOS) and mortality were excluded. Main outcomes were prevalence and trend of CVD burden in pregnant patients.Results:39,212,104 hospitalized pregnant patients were identified: 4,409,924 with CVD (11.25%) and 34,802,180 without CVD (88.75%). The annual CVD burden increased from 9.49 % in 2010 to 15.54 % in 2019 (p

Circulation, Volume 146, Issue Suppl_1, Page A12155-A12155, November 8, 2022. Introduction:  Catheter ablation of ventricular tachycardia (CAVT) has emerged as a viable option in structural heart disease. Recent studies report differences in outcomes of CATV in ischemic (ICM) and non-ischemic (NICM) cardiomyopathy. We aimed to examine temporal trends and in-hospital outcomes of CATV in ICM and NICM.Methods:National Inpatient Sample 2016-2019 was queried using ICD-10 codes to identify adults with ICM or NICM who underwent CAVT. Temporal trends were assessed using logistic regression.Results:193895 CAVT were performed between 2016 and 2019. CAVT increased in numbers for both ICM [16415 in 2016 to 23030 in 2019 (P

Circulation, Volume 146, Issue Suppl_1, Page A14528-A14528, November 8, 2022. Introduction:Environmental exposure has an important role in the development and progression of cardiovascular death (CVD). We studied the 30-year CVD in countries with similar risk factors comparing the environmental exposures.Methods:Populations with environmental risk factors (Table 1), who died between 1990 and 2019 in the GBR and USA were selected from GBD 2019 Study. The 30-year mean CVD death was compared using Welch’s t-test. Trends of the CVD deaths with pertaining risk factors over total CVD were estimated.Results:A total of 33,041,416 patients were analyzed. Mortality rates among lead and particulate matter pollution exposed populations were found to be significantly different. In lead exposure, the USA has observed more deaths (RR=0.024 vs. 0.014, p=

Circulation, Volume 146, Issue Suppl_1, Page A9444-A9444, November 8, 2022. Background:Uncertainty exists whether a higher CHA2DS2VASc risk score is associated with poorer in-hospital outcomes than a lower risk score following Left Atrial Appendage Occlusion (LAAO) procedures.Methods:The National Inpatient Sample (NIS) was queried for all hospitalizations with primary atrial fibrillation or flutter from 2016 to 2019 with codes for percutaneous left atrial appendage occlusion device placement. Cohorts with high (CHA2DS2VASc ≥5) and low (CHA2DS2VASc 5) and 49.39% had low score (< 5) (table 1). All patients received the Watchman device. The primary outcome of in-hospital mortality was not statistically different between high and low risk (0.18% vs. 0.12%, OR: 1.53, 95% CI: 0.59-3.96, p=0.37), a finding that did not change when adjusted for comorbidities in multivariate analysis (adjusted OR: 1.44, 95% CI: 0.55-3.62, p=0.46). In the high-risk group, total complication rates were similar (adjusted OR: 1.16, 95% CI: 0.97-1.38, p=0.09) as was ischemic stroke (adjusted OR: 2.05, 95% CI: 0.82-5.13, p=0.13) while systemic embolism (adjusted OR: 5.09, 95% CI: 1.08-23.99, p=0.04) and major bleeding requiring transfusion (adjusted OR: 3.84, 95% CI: 1.41-10.42, p=0.08) were higher after adjusting for confounders in multivariable analysis (figure 1).Conclusion:This study demonstrates that the LAAO procedure had similar short-term outcomes between high and low-risk patients in a study of real-world patients.

Circulation, Volume 146, Issue Suppl_1, Page A14430-A14430, November 8, 2022. Introduction:Advanced heart failure therapies and heart transplantation (HTx) have been underutilized in women. Therefore, we aimed to explore the clinical characteristics and outcomes of HTx by sex.Methods:We conducted a retrospective analysis of adult discharges from the National Inpatient Sample (NIS) between 2012 and 2019. International Classification of Disease (ICD) procedure codes were used to identify those who underwent HTx.Results:A total of 20,180 HTx hospitalizations were identified from 2012-2019. Among them, 28% were female. Women undergoing HTx were younger (mean age 51 vs. 54.5 years, p

Circulation, Volume 146, Issue Suppl_1, Page A9455-A9455, November 8, 2022. Background:Research has shown mixed results when comparing in-hospital complications following atrial fibrillation ablation in women compared to men.Objectives:To better quantify sex differences and in-hospital outcomes in atrial fibrillation ablation procedures and identify factors associated with poorer outcomes.Methods:We queried the NIS database from 2016-2019 for hospitalizations with a primary diagnosis of atrial fibrillation ablation and excluded patients with any other arrhythmias, ICD/pacemaker placement. We assessed demographics, in-hospital mortality, and complications of women compared to men. Outcomes were adjusted for potential confounders using multivariable logistic regression analysis (Figure 1).Results:Admissions for atrial fibrillation were more common in females than males (849,050 versus 815,665; p

Circulation, Volume 146, Issue Suppl_1, Page A13162-A13162, November 8, 2022. Background:There is limited data on the burden and impact of Pulmonary hypertension (PHTN) in geriatric patients with prior revascularized MI. This study aims to explore the burden, trends, and impact of secondary PHTN on the survival of elderly patients with established CVD risk.Methods:We used the National Inpatient Sample (2016-2019) to identify geriatric (≥65 years) hospitalizations with prior revascularized MI (PCI or CABG) by using ICD-10 codes and divided them into two groups: with secondary PHTN and without secondary PHTN (GPRMI-PHTN+ VS. GPRMI-PHTN-). We then compared the two groups’ morbidity, mortality, and associated outcomes.Results:Of 2265900 GPRMI patients that were included in the study, 169942 (7.5%) had secondary PHTN (median 76 [70-82]). The PHTN cohort often had females (42.5% vs 33.7%) and blacks (10.8% vs 7.7%) than the cohort without PHTN (p