Risultati per: Analisi sull’uso dei farmaci anti-osteoporotici in sette database europei

Circulation, Volume 150, Issue Suppl_1, Page A4146081-A4146081, November 12, 2024. Background:Long QT Syndrome (LQTS) is an inherited arrhythmia syndrome that predisposes patients to sudden death. Prior studies on racial disparities in LQTS have shown similar number of cardiac events, but longer QTc in Black patients compared to non-Hispanic Whites (NHW). There is limited data on cardiac events in Hispanic children with LQTS. We hypothesized that Hispanic children with LQTS have worse outcomes compared to NHW children.Methods:This retrospective cohort study of the Pediatric Health Information System (PHIS) database included children ages 0 – 17 years hospitalized from 2013-2024 with an International Classification of Disease 9thor 10thedition code for LQTS listed in the first five admission diagnoses. Patients with congenital heart disease and chromosomal abnormalities were excluded. The primary predictor variable was race/ethnicity, with covariables including age, sex, and insurance type. Our primary outcome variable was a documented lethal arrhythmia, and secondary outcomes included pacemaker and/or implantable cardioverter defibrillator (ICD) placement. Chi-square was used to assess patient characteristics. Univariable mixed-effect log-binomial regression was used to assess risk of outcomes by characteristics using hospital as a random effect with multivariable models generated via backward elimination.Results:We identified 6,476 children (24% Hispanic, 76% NHW). Compared to NHW children, Hispanic children were more often male and presented earlier (median age 11y vs 13y, 25-75 IQR 6-15; p

Circulation, Volume 150, Issue Suppl_1, Page A4112775-A4112775, November 12, 2024. Aims and Background:Kaposi sarcoma (KS) is a vascular neoplasm caused by human herpesvirus. Despite its significance, there is limited data regarding the causes and mortality factors associated with KS, particularly concerning cardiovascular mortality rates and specific influencing factors.Methods:The Surveillance, Epidemiology, and End Results (SEER) database was used to gather data from 2000 to 2020. The primary endpoint was overall survival, assessed via log-rank analysis and Kaplan-Meier plots. Hazard ratios (HR) with 95% confidence intervals (CIs) were calculated using SAS v9.4, with significance set at p80 years) vs. 0-19 year age group (HR: 2.263; 95% CI: 1.068-4.795; p=0.033), non-Hispanic Black race vs. non-Hispanic White race (HR 1.492; 95% CI: 1.369-1.627; p=0.001), and visceral involvement vs. cutaneous KS (HR 1.709; 95% CI: 1.487-1.963; p=0.001) were factors associated with increased mortality. Females had a slightly lower long-term survival than males (p

Circulation, Volume 150, Issue Suppl_1, Page A4137925-A4137925, November 12, 2024. Introduction:Thoracic endovascular aortic repair (TEVAR) has emerged as a promising treatment option for patients with type B aortic dissection (TBAD). However, there is a lack of evidence regarding the long-term morbidity of initial TEVAR compared to optimal medical therapy (OMT) in acute uncomplicated TBAD (uTBAD).Objective:To evaluate real-world data(RWD) on the long-term outcome of Japanese patients with acute uTBAD using a nationwide claims database.Methods:This retrospective cohort study utilizes JMDC, a nationwide claims database under Japan’s universal healthcare system. We included patients who were initially hospitalized with a diagnosis of acute TBAD. We defined acute uTBAD by excluding those who died within one month, suffered aortic rupture, traumatic thoracic aortic injury, underwent open-chest surgery, experienced stroke or paralysis, or had less than six months of history in the JMDC. Patients who underwent TEVAR within three months of the index hospitalization (TEVAR group) were compared with those who received optimal medical therapy (OMT group). Propensity score (PS) matching was performed based on age, sex, and year of hospitalization. Using the Kaplan-Meier method, we calculated the cumulative rate of all-cause mortality and aorta-related events.Results:Of 18,445 patients diagnosed with aortic disease between January 2005 and December 2020, 641 were included in the study (OMT group: n=580, TEVAR group: n=61). After PS-matching, demographics of the groups (OMT_PSM: n=183 vs. TEVAR_PSM: n=61) were female (12.6% vs. 13.1%), median age (54 years [IQR, 48-60] vs. 54 years [IQR, 50-61]) and follow-up time (18 months [8-32] vs. 19 months [9-32]), respectively. Kaplan-Meier curves for the aortic-related events (Figure1, 2) are shown as long-term outcomes.Conclusions:This study successfully demonstrated that the estimated 5-year aortic-related event rate in acute uTBAD patients undergoing OMT is approximately 20%, demonstrating the relevance of the RWD source. However, the number of death events in the TEVAR and OMT groups was not sufficient to provide statistical power. Therefore, further studies are warranted to evaluate the long-term prognosis of initial TEVAR for uTBAD.

Circulation, Volume 150, Issue Suppl_1, Page A4142403-A4142403, November 12, 2024. Introduction:M-TEER is a minimally invasive procedure for selected patients with symptomatic mitral regurgitation. Data about the safety of the procedure among post-CABG patients is limited.Methodology:We used the Nationwide Inpatient Sample data between January 2016 and December 2020 to identify M-TEER hospitalizations with history of CABG. Baseline characterestics including demographic data and comorbidities were identified. Primary outcomes were in-hospital all-cause mortality and net all cardiac periprocedural complications defined as a composite of acute myocardial infarction, pacemaker placement, cardiac tamponade, pericardiocentesis, pericardiotomy, pericarditis, and hemopericardium.Results:48,835 cases of M-TEER were identified during the study period, of whom 9,655 (19.78%) had prior CABG. Patients with prior CABG undergoing M-TEER were older (76 vs. 75 years, p

Circulation, Volume 150, Issue Suppl_1, Page A4132212-A4132212, November 12, 2024. Background:Atrial fibrillation or flutter (Afib/AFL) incidence rates continue to rise and are linked to significant mortality, particularly in older populations. Our analysis examines Afib/AFL mortality trends across different demographics and regions in the U.S. from 1999 to 2020, highlighting the importance of understanding these patterns.Aim:To guide preventive measures that alleviate the impact of Afib/AFL and identify high-risk populations and regions, we sought to quantify trends associated with Afib/AFL related mortality in the U.S.Methods:We conducted a comprehensive search of death certificates from 1999-2020 using Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database focusing on Afib/AFL mortality in adults with ICD-10 codes I48. Gender, race, geographical and urban-rural parameters were investigated by calculating annual percent change (APC) and age-adjusted mortality rates (AAMRs) per 100,000 persons using the Joinpoint Regression Program (Joinpoint V 4.9.0.0, National Cancer Institute).Results:A total of 2,581,488 deaths occurred in patients with Afib/AFL from 1999 to 2020. The AAMR displayed an abrupt rise from 2018 to 2020 (APC: 8.51; 95% CI: 4.84-10.47). Men consistently exhibited a higher AAMR (overall AAMR male: 79.4, 95% CI 79.3-79.6; female: 60.8, 95% CI 60.7-60.9). Non-metropolitan areas showed higher AAMRs than metropolitan areas (overall AAMR non-metropolitan areas: 74.9, 95% CI 74.7-75.1; metropolitan: 67.2, 95% CI 67.1-67.2). Disparities were also observed in AAMRs by region with the West region showing the highest mortality rate with a notable rise between 2010 and 2020 (APC: 3.70, 95% CI 3.30-5.37). Non-hispanic (NH) White population showed the highest mortality (overall AAMR: 74.2, 95% CI 74.1-74.3), followed by NH American Indian (AAMR: 50.3), NH Black (AAMR: 45.8), NH Asian (AAMR: 35.0) and Hispanic (AAMR: 37.9) populations.Conclusion:Mortality from Afib/AFL has risen from 1999 to 2020. Men, NH white populations, and residents in non-metropolitan areas and Western U.S. are at higher risk. Targeted interventions and strategic healthcare resource allocation are needed to address these disparities and improve outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4146872-A4146872, November 12, 2024. Introduction:Increased prevalence and incidence of heart failure has resulted in a significant rise in the number of patients progressing to advanced heart failure (AHF). Heart transplant improves morbidity and mortality in patients with heart failure refractory to medical therapy. We examined resource utilization as measured in 30-day readmission in a contemporary population utilizing the NRD database.Aim:We conducted a thorough analysis to identify trends in 30-day readmissions of HTs and analyze the associated costs.Methods:Using the National Readmission Database from 2010 to 2021, the study focused on new HT recipients. We evaluated various parameters, including readmission rates and the costs associated with 30-day readmissions. Patients aged

Circulation, Volume 150, Issue Suppl_1, Page A4138225-A4138225, November 12, 2024. Background:Timely transfer for PCI is paramount in the management of STEMI. This has been shown to reduce myocardial damage, optimize reperfusion therapy and mitigate the post procedural complications associated with PCI. This study’s aim was to describe the in-hospital outcomes associated with acute inter-hospital transfer of patients with STEMI for PCI in comparison with patients directly admitted to a primary PCI center.Methods:The National Inpatient Sample (NIS) was used to identify patients who underwent PCI for STEMI between the years 2016-2021. Based on several transfer indicators, primarily admitted patients and patients with acute inter-hospital transfer were identified. Logistic and linear regression models were used to analyze the primary outcome of in-hospital mortality and secondary outcomes of length of hospital stay, hospital charge, and occurrences of post-procedure complications.Results:Observations were weighted to obtain a national estimate of 748,430 patients with known transfer status who underwent PCI for STEMI. Of these, 625,520 patients were primarily admitted at PCI centers and 122, 910 patients were transferred from non-PCI centers. The mean age of patients with STEMI undergoing PCI was 62 years, and 72 % of the patients were male. There was no significant difference in mortality between patients transferred and patients primarily admitted for PCI due to STEMI. However, patients transferred had longer hospital stay and significantly higher healthcare cost, with a mean difference of 0.72 days (95% CI: 0.65 – 0.81 days, p-value

Circulation, Volume 150, Issue Suppl_1, Page A4142312-A4142312, November 12, 2024. Introduction:Patients with cancer have a higher risk for both arterial and venous thromboembolism. Furthermore, this population subset has an increased risk of bleeding when treated with anticoagulation. Left atrial appendage occlusion devices (LAAODs) have emerged as an alternative to oral anticoagulation in patients at high risk for bleeding events. There is a paucity of data regarding the efficacy of LAAODs in cancer patients. In our study, we investigated the readmission rates, predictors, and causes of readmission after LAAODs placement in patients with underlying malignancy.Methods:The National Readmission Database for 2016, 2018, and 2020 was queried to identify hospitalized adults for LAAOD placement with a history of cancer. Multivariate logistic and linear regression analyses were used to adjust for possible confounders.Results:A total of 566 patients were hospitalized for LAAOD placement and had a history of different malignancies with 563 discharged alive. Within 90 days from discharge, 141 patients (25%) were readmitted. Exacerbation of Congestive heart failure (CHF) (7.9%), Sepsis (6.7%), Lower GI bleeding (4.3%), Iron deficiency anemia (3.8%), unspecified gastrointestinal hemorrhage (3.1%), and paroxysmal Atrial fibrillation (2.6 %) were most common causes of readmissions. Independent predictors of readmission included female sex (aOR 1.68, 95% CI: 1.07 – 2.63, P=0.022), acute kidney injury (aOR 4.6, 95% CI: 1.5-8.4, P=0.008), and anemia (aOR 1.71, 95% CI: 1.08-2.7, P=0.023).Conclusion:Predictors of readmission included female sex, anemia, and acute kidney injury during index admission. The most common causes of readmission included Exacerbation of CHF, Sepsis, Lower GI bleeding, and Iron deficiency anemia. Addressing readmission causes and predictors is needed to prevent such a high rate of readmissions after LAAODs placement in cancer patients.

Circulation, Volume 150, Issue Suppl_1, Page A4139850-A4139850, November 12, 2024. Introduction:The incidence of Heart Failure (HF) has increased as the US population ages, with Chronic Renal Failure (CRF) being a common comorbidity and risk factor for mortality. This study aims to identify annual, gender, race, and geographical trends in CRF-related mortality in patients with HF for older adults.Methods:We used ICD-10 (International Classification of Diseases 10th Revision) codes to retrospectively analyze death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database between 1999-2020 for patients ≥65 years old with concomitant HF and CRF. Age-adjusted mortality rates (AAMRs) per 100,000 people and Annual Percentage Change (APCs) and their respective 95% Confidence Intervals (CI) were also calculated for patient data grouped according to year, gender, race, and geography.Results:From 1999-2020, 425,854 deaths occurred from CRF and HF in patients ≥ 65 years. The overall AAMR was 46.1 (95% CI: 46 to 46.3), with the APC from 1999-2020 being 2.96 (95% CI: 1.84 to 4.32). Males reported higher AAMRs than females (overall AAMRs: 62.1 vs 36.2). Stratifying data by race revealed NH (Non-Hispanic) Black or African American to have the highest AAMR (62.2) followed by NH American Indian or Alaska Native (52.5), NH White (45.5) and Hispanic or Latino (37.2), with the NH Asian or Pacific Islander race having the lowest AAMR (30). According to the census region, the highest AAMRs were reported in the Midwest (54.3), followed by the West (45.1) and South (43.4), with the lowest AAMRs in the Northeast (42.3). Furthermore, Non-Metropolitan areas revealed higher AAMRs when compared to Metropolitan areas (54.4 vs 43.3). The states in the top 90thpercentile were Indiana, Kentucky, Minnesota, North Dakota, and West Virginia. They had AAMRs nearly double those in the bottom 10th percentile, such as Arizona, Hawaii, Nevada, and New Mexico.Conclusion:Trends in CRF- and HF-related mortality in older adults have varied from 1999-2020, with the highest AAMRs being reported in men, NH Black or African Americans, Non-Metropolitan areas, and in the Midwest. Strategies to target precipitating events are necessary alongside further investigations to explain the trend variations.

Circulation, Volume 150, Issue Suppl_1, Page A4144346-A4144346, November 12, 2024. Background:Stroke is a leading cause of death globally. Atrial fibrillation (AF) is an important modifiable risk factor for stroke. Ascertaining the burden of stroke in AF, its temporal trends and demographic disparities can inform public health policy measures.AimsTo describe national temporal trends of ischemic stroke-related mortality in patients with AF and identify any differences by gender, race, ethnicity, or region.Methods:In this cross-sectional analysis we used death certificate data from the national CDC Wide-Ranging ONline Data for Epidemiologic Research (WONDER) database for adults aged 35-84 years between 1999 and 2020. We queried for both ischemic stroke and AF as contributing or underlying cause of death. Crude and age-adjusted mortality rates (AAMR) were computed for the overall population and stratified by sex, race/ethnicity, geographic region, state, and rural/urban status. Joinpoint Regression Analysis software was used for trend analysis. Average annual percentage change (APC) in AAMR were computed using log-linear regression models.ResultsA total of 32,386 ischemic-stroke related deaths occurred in patients with AF between 1999 and 2020. Overall mortality trends were stable until 2014, sharply rose between 2014 and 2017 (APC 27.6% [95% confidence interval, CI, 18.8-33.4]), slowing down between 2017 and 2020 (APC 2.48 [95% CI, -4.81-7.03]). Overall AAMR per 100,000 was higher in men (1.00 vs 0.86 in women; Figure 1); Non-Hispanic Whites (0.98 versus 0.81 in Non-Hispanic Blacks and 0.70 in Hispanics; Figure 2), individuals in the Western census region (1.07 vs 0.95 in Southern, 0.92 in Midwestern and 0.78 in Northeast regions; Figure 3) and non-metropolitan areas (1.06 versus 0.91 in metropolitan). The rate of increase in AAMR over recent years was significantly greater in Black populations.Conclusion:Stroke mortality in AF rose sharply since 2014. Our findings underscore racial and geographic differences that exist in stroke-related deaths in the US.

Circulation, Volume 150, Issue Suppl_1, Page A4147256-A4147256, November 12, 2024. Introduction:Studies suggest a complex relationship between body mass index (BMI) and percutaneous coronary intervention (PCI) outcomes. However, the effect of obesity on in-hospital outcomes of PCI with mechanical circulatory support (MCS) for acute myocardial infarction complicated by cardiogenic shock (AMICS) has not been established.Objective:To characterize outcomes of PCI with MCS for AMICS in patients with and without obesity.Methods:In the National Inpatient Sample (NIS) 2016-2020, we identified patients with AMICS treated with MCS with obesity (BMI 30.0-39.9) or normal BMI (20.0-24.9). The primary outcome was in-hospital mortality. Secondary outcomes included cardiac arrest, stroke, acute kidney injury, bleeding, acute respiratory failure, palliative consults, hospital length of stay (LOS), and total charges. Multivariate logistic regression models adjusted for baseline characteristics and estimated odds ratios (ORs) with 95% confidence intervals (CIs).Results:5270 patients met study criteria (4870 obese). Obese and normal weight patients had a mean age of 69.8 vs. 63.5 years and male sex 78.1% vs. 71.3%. Obese patients had more hypertension, diabetes, dyslipidemia, and previous myocardial infarction (Table 1A). There was no difference in mortality [OR 0.84, CI (0.41-1.71), P=0.623] or the secondary outcomes (Table 1B). Normal weight was associated with longer LOS (13.0 vs. 8.5 days) and higher charges ($325,926.3 vs. $294,629.1).Conclusion:There were no significant differences in in-hospital mortality or secondary outcomes between obese and normal-weight AMICS patients treated with PCI and MCS. PCI with MCS may be performed safely in AMICS patients with and without obesity.

Circulation, Volume 150, Issue Suppl_1, Page A4142450-A4142450, November 12, 2024. Introduction:M-TEER is a minimally invasive procedure for selected patients with symptomatic mitral regurgitation. It remains unknown whether the concomitant C-CTO would affect the outcomes of M-TEER procedure.Methodology:We used the Nationwide Inpatient Sample Data between January 2016 and December 2020 to identify M-TEER hospitalizations with concomitant C-CTO. Baseline characteristics including demographic data and comorbidities were identified. Primary outcomes were in-hospital all-cause mortality and net all cardiac periprocedural complications defined as a composite of acute myocardial infarction, pacemaker placement, cardiac tamponade, pericardiocentesis, pericardiotomy, pericarditis, and hemopericardium.Results:48,835 cases of M-TEER were identified during the study period, of whom 700 patients (1.5%) had the diagnosis of C-CTO. The mean age of M-TEER patients was not significantly different between the two groups (76 vs. 75 years, p=0.11), however the CTO cohort had more males (66.72% vs. 53.41%, p=0.002), and more comorbisities as; previous myocardial infarction (32.14% vs.15.66%, p= 0.0003), peripheral artery disease (32.1% vs. 22.67%, p=0.03), complicated hypertension (80% vs. 68.6%, p= 0.001) and renal failure (52.8% vs. 37.3%, p= 0.0007). A higher percentage of M-TEER procedures in patients with CTO were performed in elective setting (62.8% vs. 46.5%, p=0.0008). M-TEER among patients with CTO was associated with a higher incidence of net all periprocedural cardiac complications (21.4% vs. 13.4%, p=0.04) with however similar in-hospital mortality between both groups (3.57% vs. 2.35%, p=0.46). The results remained consistent on adjusted analysis; M-TEER-CTO cohort had higher odds of net all cardiac periprocedural complications (aOR 1.83 ,95% CI (1.17-2.84), p=0.007) with no difference in in-hospital mortality (aOR 1.54, 95 %CI (0.52-4.56), p =0.43). M-TEER utilization in CTO patients was associated with higher costs ($270,385 vs. $237,190 p=0.05), however, no significant difference in mean length of stay (5.8 vs. 4.8 days, p 0.17)Conclusions:In patient undergoing M-TEER, concomitant C-CTO increases the risk of net all cardiac periprocedural complications with no significant increase in mortality

Circulation, Volume 150, Issue Suppl_1, Page A4144822-A4144822, November 12, 2024. Background:The relationship between anion gap (AG) and short-term mortality in intensive care unit (ICU) sepsis patients complicated by pulmonary hypertension (PH) remains unclear.Methods:Retrospective analysis of incident sepsis patients complicated by PH first admitted to ICU in MIMIC database (2008 to 2019) were enrolled. Short-term outcomes include in-hospital mortality and 28-day mortality. According to the AG value (17.0 mmol/L), patients were divided into high and low AG groups. The Kaplan-Meier survival curve was used to compare the cumulative survival rates of the high and low groups using the log-rank test. Multivariable Cox regression analyses were constructed to assess the relationship between AG and short-term outcomes in sepsis patients complicated by PH.Results:2012 sepsis patients with pulmonary hypertension were included. The in-hospital mortality rates (11.4%) and 28-day mortality rates (12.8%) in the high AG group were higher than those in the low AG group (5.0% or 7.2%, respectively;P< 0.001). The Kaplan-Meier curve showed that the in-hospital and 28-day cumulative survival rates were lower in the high AG group than that in the low AG group (P< 0.001). Multivariable Cox regression analysis confirmed that elevated AG was an independent risk factor of in-hospital mortality, 28-day mortality, length of stay in ICU and hospital. The relationship between elevated AG and in-hospital mortality remain stable after subgroups analyses.Conclusions:Elevated serum AG is associated with increased risk-adjusted short-term mortality in sepsis patients complicated by PH, and it may remind clinicians to identify patients with poor prognosis as early as possible.

Circulation, Volume 150, Issue Suppl_1, Page A4141272-A4141272, November 12, 2024. Aims:This study aimed to analyze two decades of consecutive mortality data to investigate the association between cancer and cancer with heart failure across the United States (US), discerning patterns and disparities in mortality rates.Methods:Data were obtained from the multiple cause of death files using CDC WONDER spanning 1999 to 2020; ICD-10 codes were used to identify cancer and cancer with heart failure related deaths in adults aged ≥25. Demographic and regional distributions of mortality were analyzed. Joinpoint regression analysis was used to determine trends in age-adjusted mortality rates (AAMR) to estimate annual percentage changes (APC).Results:Between 1999 and 2020, 14,309,991 cancer-related deaths occurred in the US out of which 612,346 were associated with cancer and heart failure. The overall AAMR per 100,000 for cancer-related deaths decreased from 353.9 in 1999 to 260.9 in 2020 characterized by an annual percentage change (APC) of -1.60 spanning from 1999 to 2018, and an APC of 0.58 thereafter till 2020. AAMR per 100,000 for heart failure and cancer-related deaths decreased from 16.1 to 14.0, with varied APCs, declining from 1999 to 2013, reaching a minimum AAMR of 11 followed by a rise from 2013 to 2020. For cancer related only, men accounted for 52.7% of deaths, compared to 47.3% for women. Similarly, cancer with heart failure had mortality higher in males. Non-Hispanic (NH) White and Hispanic populations had the highest AAMRs for cancer related mortality while NH White and NH American Indian or Alaskan Native had the highest mortality in cancer with heart failure. Regional differences were observed, with the most cancer-related deaths observed in the South while the most cancer with heart failure related deaths occurred in the Midwest. State-wise stratification further supported the difference.Conclusions:Cancer-related mortality is decreasing while cancer with heart failure related mortality is increasing following initial decline. The highest AAMRs were observed for cancer related mortality among NH White population, men, people living in the South; and non-metropolitan US while cancer with heart failure had highest mortality in NH White population, men, people living in Midwest; and non-metropolitan areas. The findings underscore the need for focused interventions aimed at reducing mortality related to cancer and cancer with heart failure, particularly among vulnerable populations.

Circulation, Volume 150, Issue Suppl_1, Page A4141933-A4141933, November 12, 2024. Introduction:Supraventricular tachycardia (SVT) is known to affect children and teenagers predominantly but can also occur in adults. However, due to a presumed good disease outcome, fatality rates of SVT in adults (above 25 years) are yet to be explored.Aim:This study aims to shed light on the mortality trends of SVT in the adult population across the United States from 1999 to 2020.Methodology:The CDC WONDER database was used to identify SVT-related deaths using ICD-10 code I47.2 in adults (above 25 years) from 1999 to 2020. The reported data was in the form of crude rate and age-adjusted mortality rate (AAMR) per 100,000 individuals and was stratified by year, ten-year age groups, gender, races, census region, census division, states, and rural-urban division. The Joinpoint regression was then used to determine the changes in trends and annual percentage change (APC).Results:From1999 to 2020, 31,036 (AAMR=0.6) SVT-related deaths were reported. AAMR showed an initial steep decline from 0.9 in 1999 to 0.5 in 2011 (APC -5.11 [95% CI -6.08 to -4.14]), followed by a gradual increase till 2020 (0.8) (APC 5.14 [95% CI 3.41 to 6.90]). The crude death rates increased with age and were reported to be highest in ages greater than or equal to 85 (9.1); the trend showed a steep decrease from 1999 (12.4) to 2008 (7.9) (APC -4.35 [95% CI -5.36 to -3.33]), followed by a gradual decline till 2017 (7.8) (APC -0.66 [95% CI -2.04 to 0.73]), and ultimately rising sharply till 2020 (10.6) (APC 9.23 {95% CI 3.32 to 15.47]). Among races, Blacks and Whites displayed the highest mortality (0.7). Blacks showed an initial decrement from 1999 (1.0) to 2017 (0.6) (APC -2.71), followed by a rise back to 1.0(2020) (APC 19.58), while whites showed an initial fall (0.9 (1999) to 0.6 (2008), APC -4.91), followed by no change till 2017 (APC 0.18), and ultimately rise to 0.9 in 2020 (APC 13.66). Although no significant gender or geographical variations were observed, more deaths were seen in rural areas (1.0) than in Urban (0.6).Conclusion:Following an initial decline, the incidence of SVT-related mortality has been increasing over the years, pre-dominantly among the 85+ age group, Blacks, and rural populations. However, due to a limited understanding of the epidemiology of SVT in adult populations, more extensive research is needed to formulate better preventive and management strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4146633-A4146633, November 12, 2024. Background:Catheter-Directed Interventions (CDIs) for Acute Pulmonary Embolism (PE) have been present for years but their use is limited due to paucity of data especially in patients with cancer. We examine the safety and efficacy of CDIs in patients with high-risk PE and cancer.Methods:Nationwide Readmissions Database (2016-2021) was used to analyze cancer patients presenting with high-risk PE (HR-PE) (shock, pressor or mechanical circulatory support requirement). Patients who received systematic thrombolysis were excluded. Mahalanobis Distance Matching within the Propensity Score Caliper was used to match patient who received CDIs vs those who were treated with anticoagulation alone. Inverse Probability weighting (IPW) was utilized, and Pearson’s chi-squared test was applied to the PSM-2 matched cohorts to compare outcomes.Results:Among 265,196 hospitalization of cancer patients with HR-PE, X were treated with systemic thrombolysis and 795 (0.3%) of the patients underwent CDI.After propensity matching (N: 421 in each group), patients receiving CDI had a significantly lower mortality (33% vs. 41.8%, aOR:0.76 (95% CI, p: 0.008); However, bleeding complications including major bleeding (10.7% vs 6.2%, aOR:1.97 (95% CI, p: 0.018) was higher in patients receiving CDIs. No difference was observed in the risk of intracerebral hemorrhage (p >0.05). Readmission rates were similar at 30-day and 90-day intervals (p >0.05). From 2016-2021, mortality associated with HR-PE in cancer has not changed significantly (p >0.05); however, mortality in patients undergoing CDIs has decreased from (43.8% to 22.6%, p-trend: 0.0004). There has been increasing use of mechanical thrombectomy (MT) over thrombolysis in recent years.Conclusion:CDIs for HR-PE in cancer patients are associated with significant reduction in mortality and associated with higher bleeding. Mortality has decreased across the years for patients undergoing CDIs with higher utilization of MT.