Risultati per: GPG: Versione 5.6.2.1 (Aprile 2021)

Circulation, Volume 148, Issue Suppl_1, Page A15755-A15755, November 6, 2023. Background/Hypothesis:Assisted reproductive technology (ART) and intrauterine insemination (IUI) may be associated with increased risk of adverse pregnancy outcomes (APOs) and contribute to future cardiovascular disease.Aims:To determine the joint association of ART/IUI and pre-pregnancy cardiometabolic factors with APOs in a national sample.Methods:We analyzed Natality Data from the National Vital Statistics System of the National Center for Health Statistics between 2016-2021. We used multivariable logistic regression to estimate the joint association of ART/IUI and pre-pregnancy cardiometabolic risk factors with APOs.Results:Among 21,625,155 deliveries, women who conceived with either ART (n=228,597) or IUI (n=136,630) were older, more likely White or Asian race, more educated, and less likely to smoke than those who conceived without fertility treatments. Compared to pregnancies conceived without fertility treatments and with no pre-pregnancy cardiometabolic risk factors, ART/IUI-conceived pregnancies were generally associated with increased risk of gestational diabetes, pregnancy induced hypertension, and eclampsia among both women with and without pre-pregnancy cardiometabolic risk factors (Table 1). Women who conceived with ART/IUI and had ≥ 2 cardiometabolic risk factors had the highest adjusted OR of gestational diabetes (2.45 [2.41, 2.67]), while those who conceived with ART/IUI and had pre-pregnancy diabetes had the highest adjusted OR of pregnancy induced hypertension (3.37 [3.00, 3.79]).Conclusions:Patients with pregnancies conceived by ART/IUI are at an increased risk of APOs, including gestational diabetes, pregnancy induced hypertension and eclampsia. The presence of pre-pregnancy cardiometabolic factors modestly increases this risk. Clinicians should consider targeted strategies to optimize the pre-pregnancy cardiometabolic health of women seeking infertility treatments.

Circulation, Volume 148, Issue Suppl_1, Page A13969-A13969, November 6, 2023. Background:While heart failure (HF) is a common disease worldwide with high health care costs and disease burden, the underlying causes vary widely by location. Estimates of how etiologies of HF vary globally will support clinical and public health practice, research, and related capacity building.Research Question and Goals:To provide, current, consistent and comparable estimates of etiology-specific HF prevalence as part of the Global Burden of Disease (GBD) Study 2021.Methods:We included all available population-representative data on prevalence, incidence, and mortality to estimate HF prevalence using DisMod-MR, a Bayesian geospatial model. We then estimated the proportion of HF due to each of 27 underlying etiologies using cause-specific mortality estimates, individual-level vital registration records with multiple cause of death information, and linked hospital-mortality data. These proportions were then multiplied by the estimates of HF prevalence to generate estimates of etiology-specific HF burden for all countries.Results:HF etiologies varied widely across the the seven GBD super-regions. Ischemic heart disease (IHD) was the most common underlying cause in all super regions except for Sub-Saharan Africa where hypertensive heart disease was the most common (Figure). Age-standardized prevalence of HF due to IHD ranged from 77.51 to 306.25 per 100,000 (Table).Conclusion:While IHD was the most common underlying cause of HF for most locations in 2021, there was substantial variability by location. Improved understanding of HF etiologies could guide tailored clinical and public health practice and research.

Circulation, Volume 148, Issue Suppl_1, Page A16963-A16963, November 6, 2023. Introduction/background:Incidence and case fatality (CF) of acute coronary syndrome (ACS) have declined in the last decades, but cardiovascular disease remains one of the leading causes of death in the Western world. The knowledge of the current trends in incidence, mortality, and CF of ACS from Finland and even worldwide is sparse, though some studies have suggested slowed incidence decrease and even increase in younger age groups. Thus, we set out to investigate the changes in these event rates in Finland from 1996 to 2021.Research questions/hypothesis:To examine how the ACS burden has evolved in Finland from 1996 to 2021, especially after 2010.Methods/approach:We used Finnish country-wide registers, i.e., Hospital Discharges Register (HDR, from Care register for health care) and the National Causes of Death Register with complete coverage of non-fatal and fatal ACS events. We analyzed incidence and mortality rates, and CF, as well as the significance of their trends using negative binomial and logistic regression adjusting for age and sex.Results/data:Altogether, 186 489 non-fatal and 72 907 fatal incidents of ACS events were included in the analysis. ACS incidence decreased in men (Annual percentage change (APC) -2.0% [95% CI -2.2 to -1.8]) and in the older age groups of women (APC of 55-64-year-old -1.5% [-1.7 to -1.2] and65-74-year-old -3.3% [-3.5 to -3.1]), but the decrease in incidence slowed down over the last decade. Importantly, in 35-54-year-old women ACS incidence decrease halted (APC of 35-44-year-old 0.4% [-0.3 to 1.0] and 45-54-year-old 0.2% [-0.1 to 0.5]). ACS mortality and case-fatality declined steadily in both sexes and all age groups throughout the study period (APC of the mortality in men -4.5% [-4.7 to -4.3] and in women -5.1% [-5.3 to -4.7]. APC of the CF in men -2.7% [-2.9 to -2.6] and in women -3.4% [-3.6 to -3.2]).Conclusions:In concordance with other recent reports, we showed that the ACS mortality in both men and women was steadily decreasing. However, we observed that ACS incidence decline slowed down in older age groups and even halted in women aged 35-54. These alerting results emphasize the need for cardiovascular prevention, particularly in young and middle-aged women.

Circulation, Volume 148, Issue Suppl_1, Page A16425-A16425, November 6, 2023. Introduction:The incidence of new-onset hypertensive disorders of pregnancy (HDP) has increased in recent years. During the COVID-19 pandemic, blood pressure control worsened in non-pregnant populations. Therefore, we sought to examine whether the incidence of HDP changed with the onset of the COVID-19 pandemic.Methods:A serial cross-sectional study of nulliparous individuals aged 15-44 years with singleton live births was conducted using the National Center for Health Statistics Natality Data Files from 2018-2021. HDP was determined by the professional attendant at birth. Maternal social determinants of health (SDoH), including education level, Medicaid insurance, and rurality of residence, were self-reported. Interrupted time series analyses compared the monthly national incidence of HDP before (1/2018-2/2020) and during (5/2020-12/2021) the COVID-19 pandemic, overall and stratified by maternal SDoH, adjusting for seasonal autocorrelation.Results:The sample included 5,246,061 pregnant individuals (22.2% Hispanic, 7.4% non-Hispanic Asian, 13.3% non-Hispanic Black, 53.8% non-Hispanic White). The incidence of HDP was 9.22% in 1/2018 and 12.15% in 12/2021. The incidence of HDP increased before (0.07±0.01%/month) and during the pandemic (0.06±0.01%/month), with no acceleration after pandemic onset (p=0.66,Figure). There was no significant difference in monthly trends when stratified by maternal SDoH groups.Conclusions:Nearly 1 in 8 individuals in 2021 had a pregnancy complicated by new-onset HDP in the US. While the early COVID-19 pandemic was not associated with a significant acceleration, the incidence of HDP continues to steadily increase.

Circulation, Volume 148, Issue Suppl_1, Page A15662-A15662, November 6, 2023. Background:Considerable differences in premature cardiovascular disease (CVD) mortality rates exist across counties in the United States. Ecological examination and the association with county-level social vulnerability Indices (SVI) are limited.Aims: This study provides an updated analysis of age-adjusted premature CVD mortality rates and association with county-level SVI from 2018 to 2021.Methods:In this ecological cross-sectional study, we used United States county-level CVD mortality data from the Centers for Disease Control and Prevention (CDC) WONDER database (2018-2021) for non-elderly adults (

Circulation, Volume 148, Issue Suppl_1, Page A14644-A14644, November 6, 2023. Introduction:Atrial fibrillation (AF) is common among patients with symptomatic obstructive hypertrophic cardiomyopathy (soHCM), but the impact of AF on healthcare resource use (HCRU) and cost is not well studied.Hypothesis:Comorbid AF increases HCRU and cost among patients with soHCM.Aims:To assess HCRU and charges (per person per year [PPPY], in USD) for patients with vs without comorbid AF.Methods:Symphony medical and pharmacy claims data were assessed from 2016-2021 to identify (by ICD-10 code) adult patients with treatment-naïve soHCM in the United States. We defined symptomatic as fatigue, chest pain, syncope, dyspnea, heart failure, or palpitations within 3 months of index date and comorbid AF as AF within 3 months of index date. Patients entered the cohort once they received their index soHCM pharmacotherapy or soHCM surgery treatment; and were required to be on soHCM pharmacotherapy (beta-blockers, calcium channel blockers, or disopyramide) or to have had a procedure for soHCM (septal reduction therapy, pacemaker, or implantable cardioverter defibrillator).Results:Of 9490 patients with soHCM, 2681 (28.3%) had AF. For patients with vs without AF, median age was 68 years vs 63 years (p

Circulation, Volume 148, Issue Suppl_1, Page A12799-A12799, November 6, 2023. Background:Prior studies suggest variability in cardiac amyloidosis (CA) detection across the U.S. with underdiagnosis in some regions.Research Question:It is unknown whether geographic variation exists in the occurrence of CA amongst U.S. Veterans in a contemporary cohort.Method:This is a retrospective observational cohort study. CA was defined as ≥ 1 heart failure (ICD9/10) and ≥ 1 amyloidosis diagnosis. For geographic mapping the location was the state of the diagnosing Veterans Affairs (VA) facility. The population at risk was patients in each state with ≥1 VA encounter during the year. The outcomes were incidence and prevalence rates of CA at the state and U.S. Census regional level (per 100,000 patients). The data source was the VA Corporate Data Warehouse (MDClone ADAMS platform).Results:The incidence and prevalence rates of CA by region are shown in the Table, and by state in the Figure. There was an increase in incidence and prevalence in all regions in 2012 and 2021. In both years, incidence and prevalence were highest in the Northeast and lowest in the South.Conclusion:Despite increasing recognition of CA in the VA Health System, there is regional variation in incidence and prevalence in 2012 and 2021. VA facilities in the Midwest, West and especially the South may have differences in CA detection relative to those in the Northeast region. Further research into health system, provider, and patient factors leading to this variation is needed to ensure health equity and quality of care for patients with CA.

Circulation, Volume 148, Issue Suppl_1, Page A13956-A13956, November 6, 2023. Introduction:The demand for well-trained cardiologists is increasing, particularly in the US. Understanding trends in cardiology specialty applicants and match rates is crucial to address the demand-supply gap.Aim:Analyze the trends in cardiology specialty applicants and match rates between 2017 and 2021.Methods:Data from the NRMP and the ABIM websites were examined using chi-square tests to examine changes in match rates among different applicant types. Furthermore, we assessed the proportion of applicants matching at their first, second, third, or subsequent choices. Statistical analysis was conducted using IBM SPSS version 23.Results:There is a significant increase in the number of matched US MD applicants from 482 in 2017 to 549 in 2021 (p=0.0001). However, the match rate for US MD applicants experienced a decline from 89.8% in 2017 to 83.1% in 2021. The number of matched US DO applicants also significantly increased from 60 in 2017 to 103 in 2021 (p=0.0001), with the statistically significant change starting in 2020. We observed a decrease in an applicant’s probability of matching at their first choice from 52.7% to 45.3% after the virtual interviews season (p=0.001). In contrast, the probability of matching at a program beyond the third choice increased over time, rising from 152 in 2017 to 288 in 2021.Conclusions:This study highlights the increasing competitiveness of the cardiology match process. The observed trends in match rates underscore the challenges faced by different applicant groups, particularly after the implementation of a virtual interview format. Further investigation into these factors is warranted to better understand and address the disparities.

Circulation, Volume 148, Issue Suppl_1, Page A14953-A14953, November 6, 2023. Introduction:Preterm birth (PTB) is a common adverse outcome in pregnancies complicated by hypertensive disorders of pregnancy (HDP). PTB and HDP are each associated with higher risk of cardiovascular disease (CVD) in both the pregnant individual and their offspring. Racial and ethnic disparities have been described individually in PTB and HDP but the frequency of PTB among individuals with HDP, and whether differences exist by maternal race and ethnicity, is not known.Methods:We used cross-sectional data from the National Center for Health Statistics and included nulliparous individuals aged 15-44 years with a singleton, live birth who had new-onset HDP (gestational hypertension or preeclampsia) in the US in 2020 and 2021. We calculated the frequency of PTB (gestational age < 37 weeks) among those with HDP (%), overall and stratified by self-reported maternal race and ethnicity group (American Indian/Alaskan Native [AIAN], non-Hispanic Asian/Pacific Islander [API], Hispanic, non-Hispanic Black [NHB], non-Hispanic White [NHW]). We compared the frequency of PTB in each racial and ethnic group to the referent group (NHW) with age-standardized rate ratios (aRR).Results:Among 302,817 individuals with HDP, 0.7% were AIAN, 0.8% API, 18.7% Hispanic, 15.5% NHB, and 57.2% NHW. The frequency of PTB among individuals with HDP was 17.6% (95% 17.4-17.8) in 2020 and 18.0% (17.8-18.2) in 2021. Significant racial and ethnic differences were observed in the frequency of PTB with HDP in 2020 and 2021 (Table). In 2021, compared with NHW individuals, AIAN (aRR 1.2 [1.0-1.4]), Hispanic (aRR 1.1 [1.1-1.2]), and NHB (aRR 1.4 [1.3-1.4]) individuals had a significantly higher risk of PTB with HDP.Conclusions:In 2020-2021, nearly 1 out of 5 nulliparous individuals with HDP also experienced PTB. Identifying and addressing drivers of racial and ethnic differences in the co-occurrence of PTB and HDP may offer an opportunity to mitigate disparities in intergenerational CVD risk.

Circulation, Volume 148, Issue Suppl_1, Page A18362-A18362, November 6, 2023. Background:Data regarding relative readmission rates following endovascular and surgical revascularization for chronic limb threatening ischemia (CLTI) are conflicting. Understanding comparative readmission rates may inform selection of the most appropriate revascularization modality for these patients.Research Question:What are the differences in 30-day readmission rates between endovascular and surgical interventions for CLTI?Methods:The 2012 to 2021 American College of Surgeons National Surgical Quality Improvement Program’s (NSQIP) Targeted Vascular Module was used to identify patients discharged alive after surgical or endovascular revascularization for CLTI. The primary outcome was 30-day readmission following the index procedure; secondary outcomes included survival, major re-intervention of the treated arterial segment, amputation, untreated loss of patency of bypass graft, bleeding requiring transfusion or re-intervention, major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Revascularization modality was related to 30-day readmission using multivariable logistic regression.Results:We identified 30,390 patients (mean age 69±11.5 years, male 62.8%, mean BMI 26.9±8.1 kg/m2, 61% Caucasian, 20.2% Black). When compared with endovascular therapy, surgical bypass was associated with higher 30-day readmission (13.3% vs. 8.6%, p =

Stroke, Ahead of Print. Background:Outreach campaigns have sought to reduce the burden of stroke by improving knowledge of stroke risk factors (RF) and warning signs (WS). We describe trends in stroke knowledge from 1995 to 2021.Methods:From 1995 to 2021, 6 separate surveys were conducted in the Greater Cincinnati Northern Kentucky Region. Temporal trends in RF/WS knowledge were analyzed using logistic regression adjusting for Race, sex, age, and education.Results:In 1995, 28.6% of participants (537/1880) could name ≥2 WS, compared with 50.6% (983/1944) in 2021 (trendP

This retrospective cohort study estimates stage-specific recurrence and melanoma-specific mortality rates, estimates absolute stage-specific risks of recurrence and mortality, and describes stage-specific recurrence patterns in Danish patients.

Objectives
This study aimed to compare the mental health status of patients with diabetes before and after the COVID-19 pandemic and to determine the effect of COVID-19 on their mental health status. This study was the first to investigate the relationship between diabetes and mental health in the Korean population during the COVID-19 pandemic.

Design
This retrospective cross-sectional study investigated the prevalence of mental health problems before (2018–2019) and during (2020–2021) the COVID-19 pandemic in individuals with diabetes aged 40 years or older who participated in the Korea National Health and Nutrition Examination Survey. Mental health problems were assessed using self-reported experiences of depression diagnosis, stress perception and suicide ideation. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Clinically significant depression requiring treatment was determined using an optimal cut-off score of 10 out of a total of 27 points.

Participants
There were 824 men and 763 women in the 2018–2019 survey and 882 men and 887 women in 2020–2021.

Results
In the unadjusted analysis, women had a statistically significantly higher prevalence of suicide ideation in 2020–2021 (2.9, 95% CI: 1.5 to 4.2) than in 2018–2019 (1.0, 95% CI: 0.4 to 1.7, but p

This survey study examines career choices of internal medicine residents from 2019 to 2021 and compares them with findings from a decade earlier.

Objectives
To assess socioeconomic and geographical factors associated with COVID-19 vaccine uptake in pupils attending state-funded secondary schools in England.

Design
Cross-sectional observational study.

Setting
State-funded schools in England.

Participants
Pupils aged 12–17 years attending state-funded schools in England for the academic year 2021/2022.

Outcome measures
Demographic, socioeconomic and geographical factors associated with vaccination uptake. We linked individual-level data from the English Schools Census to the National Immunisation Management System to obtain COVID-19 vaccination status of 3.2 million adolescents. We used multivariable logistic regression to assess demographic, socioeconomic and geographical factors associated with vaccination.

Results
By 9 January 2022, 56.8% of adolescents aged 12–17 years old had received at least one dose, with uptake increasing from 48.7% in those aged 12 years old to 77.2% in those aged 17 years old. Among adolescents aged 12–15 years old, there were large variations in vaccine uptake by region and ethnic group. Pupils who spoke English as an additional language (38.2% vs 55.5%), with special educational needs (48.1% vs 53.5%), eligible for free school meals (35.9% vs 58.9%) and lived in more deprived areas (36.1% in most deprived vs 70.3% in least deprived) had lower vaccine uptake. Socioeconomic variables had greater impact on the odds of being vaccinated than geographical variables. School-level analysis found wide variation in vaccine uptake between schools even within the same region. Schools with higher proportions of pupils eligible for free school meals had lower vaccine uptake.

Conclusions
We found large differences in vaccine uptake by geographical region and ethnicity. Socioeconomic variables had a greater impact on the odds of being vaccinated than geographical variables. Further research is required to identify evidence-based interventions to improve vaccine uptake in adolescents.

Objectives
To illustrate the utility of unsupervised machine learning compared with traditional methods of analysis by identifying archetypes within the population that may be more or less likely to get the COVID-19 vaccine.

Design
A longitudinal prospective cohort study (n=2009 households) with recurring phone surveys from 2020 to 2022 to assess COVID-19 knowledge, attitudes and practices. Vaccine questions were added in 2021 (n=1117) and 2022 (n=1121) rounds.

Setting
Five informal settlements in Nairobi, Kenya.

Participants
Individuals from 2009 households included.

Outcome measures and analysis
Respondents were asked about COVID-19 vaccine acceptance (February 2021) and vaccine uptake (March 2022). Three distinct clusters were estimated using K-Means clustering and analysed against vaccine acceptance and vaccine uptake outcomes using regression forest analysis.

Results
Despite higher educational attainment and fewer concerns regarding the pandemic, young adults (cluster 3) were less likely to intend to get the vaccine compared with cluster 1 (41.5% vs 55.3%, respectively; p