Risultati per: Infezione da Helicobacter pylori: review

Circulation, Volume 150, Issue Suppl_1, Page A4145225-A4145225, November 12, 2024. Background:Sodium-glucose co-transporter two inhibitors (SGLT2i) have recently been included in heart failure (HF) guidelines due to their benefits in reducing mortality and hospitalization rates. However, the benefits of SGLT2i in patients with post-acute myocardial infarction (MI) remain controversial. Therefore, we aim to perform an updated systematic review and meta-analysis comparing SGLT2i with placebo in patients after an acute MI.Methods:We performed a systematic review and meta-analysis to determine the impact of SLGT2i in patients with post-acute MI with or without diabetes type II (DM II). We systematically searched Pubmed, Cochrane, and Embase for randomized controlled trials (RCTs) comparing SGLT2i and placebo in patients following an acute MI. The primary outcome assessed was (1) HF hospitalization. In this analysis, we also included the following secondary outcomes:(2) cardiovascular (CV) mortality and (3) MI recurrence. Risk Ratios(RRs) with 95% confidence interval (CI) were pooled across studies using a random effect model.Results:Our meta-analysis included ten RCTs comprising 25908 patients, of whom 14098 (54.4%) received SGLT2i therapy and 15078 (58.2%) had type II diabetes. The mean age was 62 years, and the mean follow-up was 21.2 months. In the pooled analysis, HF hospitalization was significantly lower in the SGLT2is group (RR 0.76; 95%CI 0.68,0.84; p

Circulation, Volume 150, Issue Suppl_1, Page A4146402-A4146402, November 12, 2024. Background:Previous clinical trials demonstrated the efficacy of beta-blockers (BB) after myocardial infarction (MI). However, the effects and safety of BB in patients with chronic obstructive pulmonary disease(COPD) after MI remain a mystery. Therefore, we conducted a systematic review and meta-analysis evaluating beta-blocker use after MI in patients with COPD.Methods:We performed a systematic review and meta-analysis of observational studies that included patients with COPD who received BB after an episode of MI. We searched through Pubmed, Cochrane, and Embase databases. Our primary efficacy outcome was (1) all-cause mortality, and our safety outcome was (2) COPD-related and respiratory adverse events. In our secondary analysis, we evaluated all-cause mortality in patients with a prior history of heart failure (HF). Statistical analysis was done using R Studio 4.3.2.Results:A total of 6 studies were included, encompassing 41840 patients, of whom 16561 (39.5%) were in the beta-blocker group. Most of the participants were male (65%) and the mean follow-up was 5.1 years. In the pooled analysis, all-cause mortality was significantly lower in the BB group (HR 0.81; 95% CI 0.66, 0.98; p = 0.03, Fig 1A). Our secondary analysis in the HF subgroup also showed a significant risk reduction in all-cause mortality(HR 0.80; 95% CI 0.66, 0.97; p = 0.02, Fig 1B.) Regarding COPD-related and respiratory adverse events, the analysis demonstrated a significantly lower incidence in the BB group (HR 0.79; 95% CI 0.74, 0.83; p

Circulation, Volume 150, Issue Suppl_1, Page A4139384-A4139384, November 12, 2024. Background:Recent evidence suggests a therapeutic role for ketosis in patients with heart failure (HF). However, little is known regarding the safety and effectiveness of a low carbohydrate ketogenic diet (LCKD) in patients with overweight or obesity and HF.Purpose:To examine the safety and effectiveness of a LCKD in patients with overweight or obesity and HF.Methods:A retrospective review from 2006-2024 was conducted of all patients with overweight or obesity and HF who followed a LCKD with clinical oversight for at least one year in a university health system. Changes in metabolic outcomes, echocardiographic measures, and medication use were assessed. Heart failure hospitalization (HFH) rates and rate ratios (RR) and all-cause mortality rates were calculated and stratified by HF classification.Results:A total of 125 patients met inclusion criteria, including 59 patients with HF with reduced ejection fraction (HFrEF) and 66 patients with HF with preserved ejection fraction (HFpEF). Patients lost a median (interquartile range) of 11.2 kg (-19.5, 4.4;p

Circulation, Volume 150, Issue Suppl_1, Page A4140984-A4140984, November 12, 2024. Introduction:Heart failure (HF) is a prevalent medical condition, affecting approximately 6.7 million Americans. Patients with HF frequently experience comorbidities such as depression and anxiety, which can lead to diminished quality of life. According to the World Health Organization (WHO), palliative care may be beneficial for these patients in addressing their complex physical, mental, and social needs. Therefore, an assessment of palliative care involvement in HF patients is warranted to determine its impact on improving quality of life, alleviating symptoms such as dyspnea, depression, and anxiety.Hypothesis:The aim is to assess the impact of palliative care interventions on the quality of life, dyspnea, anxiety, and depression in patients with HF.Methods:A systematic review and meta-analysis were conducted on clinical trials retrieved from Scopus, Cochrane, PubMed, Embase, and Web of Science databases from their inception until March 2024. Studies reporting on the impact of palliative care interventions on the quality of life of patients with HF were included. The primary outcome was the effect on quality of life, while the effects on dyspnea, depression, and anxiety were secondary outcomes. Data from the studies were pooled using RevMan V5.4, and changes in the mean difference from baseline and confidence intervals (CI) were calculated for each outcome.Results:The meta-analysis included eleven studies, predominantly randomized controlled trials, with a total of 1662 participants, 812 of whom received palliative care interventions. The analysis revealed a significant improvement in the mean change from baseline within the intervention group compared to usual care. Specifically, the quality of life showed a mean difference change from the baseline of 1.35 (95% CI: 0.88 to 1.82), anxiety improved with a mean difference change from baseline of 0.30 (95% CI: 0.03 to 0.58), and dyspnea showed a mean difference change from baseline of 1.0 (95% CI: 0.74 to 1.26). However, there was no significant difference in the mean change from baseline for depression between both groups.Conclusion:Palliative care interventions are associated with significant improvements in quality of life, anxiety, and dyspnea in patients with heart failure compared to usual care. However, there is no significant impact on depression. These findings support the integration of palliative care into the management of heart failure patients to enhance their overall well-being.

Circulation, Volume 150, Issue Suppl_1, Page A4145162-A4145162, November 12, 2024. Background:Acute coronary syndrome (ACS) poses a significant global health burden despite advancements in its management. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, primarily used in type 2 diabetes mellitus (T2DM), have gained recent consideration as potential agents for ACS management due to their cardiovascular benefits beyond glycemic control. This study aimed to assess the effects of empagliflozin on left cardiac parameters in ACS patients.Methods:PubMed, Cochrane, Scopus, and Web of Science were searched thoroughly to identify relevant randomized controlled trials (RCTs) until June 1st, 2024. Continuous data were pooled using mean difference (MD) with a 95% confidence interval (CI) using R (Version 4.3).Results:Four RCTs involving 701 patients were included. Compared to placebo, empagliflozin significantly reduced left ventricular end-systolic volume index (LVESVi) (MD: -2.38, 95% CI: -3.95 to -0.80, p = 0.0032), left ventricular mass index (LVMi) (MD: -2.76, 95% CI: -4.95 to -0.56, p = 0.0137), and left ventricular filling pressure (E/e’) (MD: -0.59, 95% CI: -1.07 to -0.10, p = 0.0189). However, empagliflozin treatment did not yield a statistically significant change in left ventricular ejection fraction (LVEF) (MD: 1.21, 95% CI: -0.05 to 2.48, p = 0.0603), nor a significant change in left ventricular end-diastolic volume (LVEDV) (MD: -4.49, 95% CI: -14.24 to 5.26, p = 0.37), left ventricular end-systolic volume (LVESV) (MD: -5.19, 95% CI: -10.77 to 0.39, p = 0.0682), and left ventricular end-diastolic volume index (LVEDVi) (MD: -2.20, 95% CI: -4.59 to 0.19, p = 0.0718).Conclusion:Empagliflozin provides favorable effects on left cardiac structural parameters in ACS patients, as it was associated with reduced LVESVi, LVMi, and E/e’. This suggests a potential role for SGLT2 inhibitors as adjunctive therapy in ACS management, warranting further investigation into their mechanisms and long-term clinical outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4147545-A4147545, November 12, 2024. Introduction:Pulsed field ablation (PFA) is an adaptation of direct current ablation first used for catheter ablation in the 1980s. Expectations of a reduced risk profile led to the current resurgence in investment and interest in the technology as a potential alternative energy source for ablations to treat atrial fibrillation (AF). However, reports of adverse events, including new risks, are increasing.Research Question:How many adverse effects are reported with the use of newly available PFA systems?Aims:Quantify and describe the adverse events from PFA reported to date in the Food and Drug Administration’s (FDA) Manufacturer and User Facility Device Experience (MAUDE) database.Methods:We searched the U.S. FDA’s MAUDE database for all reports filed with the code “QZI”, which is the product code for PFA systems created with the first FDA approvals in February 2024. All reports from inception through April 2024 (a total of 3 months) were included in this review. Per manufacturer presentation in May 2024, approximately 1000 cases utilizing PFA had been captured in a post-market registry of the predominant commercially used technology, but the exact number of cases can not be determined from MAUDE data.Results:A total of 217 adverse events were reported over the first 3 months of US approval, with 91 of these considered patient injuries. These injuries included 10 cases of cardiac tamponade, 7 reports of postoperative arrhythmia, 6 instances of device-related tissue entrapment, 5 cases of hemolysis with impaired renal function, 5 cases of stroke or TIA, including both embolic and hemorrhagic, 3 cases of intraoperative heart block, 2 coronary spasms, and 2 cases of intraoperative ST elevation.(Figure)Of the 91 reported patient safety events, 46 required hospitalization, 13 cases required temporary pacing, 11 required pericardiocentesis, 4 required dialysis, 4 required cardiothoracic surgery, and 2 required cardioversion.Conclusions:A number of adverse events have been reported to the MAUDE database in the first 3 months of FDA approval of PFA. The cardiac electrophysiology community should remain vigilant to ensure that the benefit-risk profile remains acceptable for patient safety.

Circulation, Volume 150, Issue Suppl_1, Page A4142988-A4142988, November 12, 2024. Introduction:The latest expert consensus on catheter-based Left Atrial Appendage Occlusion (LAAO) suggests considering either transesophageal echocardiography (TEE) alone or the addition of Cardiac Computed Tomography Angiography (CCTA) for pre-procedural planning. However, evidence comparing the effectiveness of adding CCTA to regular TEE planning on procedural success is limited.Methods:We aimed to perform a systematic review and meta-analysis to determine the impact of adding CCTA to regular TEE for pre-procedural planning in patients undergoing LAAO. We systematically searched Cochrane, Embase, and Medline for observational studies and randomized controlled trials (RCTs) comparing TEE alone to TEE with the addition of CCTA. The primary endpoint was procedural success. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled across studies using a random-effects model.Results:Four studies were included in our meta-analysis, three of which were RCTs and one observational study, comprising a total of 824 patients, of whom 496 (60.2%) underwent additional CCTA. In the pooled analysis, procedural success was higher in the group with added CCTA (RR 1.10; 95% CI 1.01 – 1.19; p=0.022; I2=52%). A subgroup analysis of RCTs alone confirmed these findings, with a slightly higher magnitude of effect in benefit of the addition of CCTA, and with lower heterogeneity (RR 1.15; 95% CI: 1.06 – 1.25; I2 = 0%).Conclusions:In this meta-analysis comparing TEE alone vs TEE with the addition of CCTA for preprocedural planning of LAAO, the addition of CCTA was associated with a higher procedural success rate, and this finding was confirmed in a subgroup analysis of randomized data.

Circulation, Volume 150, Issue Suppl_1, Page A4140901-A4140901, November 12, 2024. Background:This meta-analysis aims to compare chest compression-only cardiopulmonary resuscitation (CO-CPR) with standard CPR (sCPR), which includes mouth-to-mouth ventilation, as potential strategies for managing out-of-hospital cardiac arrest (OHCA).Methods:We systematically searched various databases and registries such as MEDLINE, Embase, The Cochrane Library, and Clinicaltrials.gov to retrieve relevant studies. We used the revised Cochrane “Risk of bias” tool for randomized trials (RoB 2.0) to assess the risk of bias in included studies. Revman 5.4 was used to pool dichotomous outcomes under a random effects model.Results:A total of 4 RCTs were included in our meta-analysis. Our results indicate that CO-CPR was associated with a significantly increased survival to hospital discharge compared to sCPR (RR 1.22, 95% CI: 1.01 to 1.46) with minimal heterogeneity (I2= 0%). No significant difference was observed between the two groups regarding 1-day survival (RR 1.07, 95% CI: 0.94 to 1.23), survival to hospital admission with a good neurological outcome (CPC 1 or 2) (RR 1.10, 95% CI: 0.80 to 1.51), return of spontaneous circulation (RR 1.05, 95% CI: 0.95 to 1.17), and survival to hospital admission (RR 1.08, 95% CI: 0.93 to 1.25).Conclusion:This meta-analysis found that chest compression-only CPR (CO-CPR) significantly improves survival to hospital discharge compared to standard CPR for managing OHCA while yielding comparable results for other resuscitation outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4139264-A4139264, November 12, 2024. Introduction:Pulmonary vein isolation (PVI) is a catheter ablation (CA) technique employed as a treatment strategy for atrial fibrillation in young patients or those who do not respond to medical therapy. Techniques for PVI include radiofrequency (RFA) ablation and balloon cryoablation. The left atrial posterior wall has been recognized as a significant anatomical area involved in the onset and persistence of atrial fibrillation (AF). However, the impact of additional posterior wall isolation (PWI) during PVI remains uncertain.Research Question:What are the outcomes of pulmonary vein isolation compared to pulmonary vein isolation with adjunctive posterior wall isolation in patients with paroxysmal atrial fibrillation?Goals:To determine the efficacy of adjunctive posterior wall isolation in treating persistent AF.Methods:A systematic literature search was conducted on various databases (Pubmed/Medline, EMBASE, Google Scholar, Scopus) from inception until March 2024, to include studies comparing outcomes of patients undergoing management of paroxysmal AF with either PVI + concurrent PWI versus only PVI. Observational studies and Randomized Controlled Trials were included. Review Manager (v 5.3) was used for pooled analysis of included studies employing risk ratio (RR) as the effect measure (4).Results:We conducted a random-effects meta-analysis, pooling data from 5 studies with a total of 2,441 patients. Our analysis revealed a significant improvement in AF recurrence for the cryoablation technique with PVI+PWI (RR=0.56, 95% CI: 0.41, 0.76, I2=0%, p=0.0002) but no significant result was found for PVI+PWI in RFA (RR=1.37, 95% CI: 0.87, 2.18, I2=0%, p=0.18) for AF. For the recurrence of all arrhythmias, the risk ratios for cryoablation and RFA are 0.60 (95% CI: 0.46, 0.78, I2=0%, p=0.0001) and 1.17 (95% CI: 0.83, 1.65, I2=0%, p=0.37) respectively, significant in the case of cryoablation and non-significant for RFA.Conclusion:Concurrent PWI with PVI with the cryoablation technique in patients for the management of paroxysmal AF reduces the risk of recurrent AF. Due to the limited number of studies included, it is possible that the results were underpowered. Further prospective studies in the future are warranted.

Circulation, Volume 150, Issue Suppl_1, Page A4138603-A4138603, November 12, 2024. Introduction:Kawasaki disease (KD) is a pan-vasculitis that primarily affects children and rarely adults. Available data on adult-onset KD are based on case reports and case series, both of which are limited by small sizes. We aimed to characterize the epidemiology, presentation, hospital course, and outcomes of adult-onset KD published in the English literature from 1980 through 2023.Methods:We retrospectively reviewed and included published articles with a diagnosis of KD in patients age ≥18 years. We searched PubMed and Google scholar for case reports/series published in English using the keywords “adult”, “Kawasaki disease”, and “mucocutaneous lymph node syndrome”. We extracted data from individual articles onto an Excel spreadsheet for analysis. Outcomes of interest were the demographic characteristics of patients, clinical presentation and hospital course, management, and complications. Descriptive statistics were used to analyze the data.Results:A total of 137 patients from 29 countries were included in this study. The majority were male (90/137, 64.9%; M:F ratio 1.8) and the median age was 25 years (range, 18-68). The median time to clinical presentation was 5 days (range, 4-60). The main signs and symptoms were fever (95.7%), skin rash (92.9%), conjunctivitis (89.3%), extremity changes (84.3%), oral changes (85.7%), and cervical lymphadenopathy (73.7%). The majority of the patients had no co-morbidities (125/137, 91.2%). EKG changes were not reported in 48 patients (35%). In the remaining 89, 26 (29.2%) had normal EKG or sinus tachycardia, 9 (10.1%) had ST segment elevation, and 9 (10.1%) had arrythmias or abnormal EKGs. Pharmacotherapy included IVIG (80/137, 58.4%), Aspirin (105/137, 76.6%), steroids (31/137, 22.6%) and antibiotics (68/137, 49.6%). For complications, 18.2% (25/137) had aneurysms, 8% (11/137) had myocardial infarction, 10.9% (15/137) had myocarditis, 10% had pericarditis/pericardial effusion, and 10.9% (15/137) had KD shock syndrome. The median length of stay was 14 days (range, 1-60 days). Three patients (2%) died from KD.Conclusion:Adult-onset KD is rare and is associated with significant cardiovascular complications. Clinicians should have high index of suspicion for prompt diagnoses and initiate appropriate treatment to improve outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4140260-A4140260, November 12, 2024. Introduction:New therapies for resistant hypertension (RH), including renal denervation (RDN), have been studied.Aim:Access the safety and effectiveness of radiofrequency-based RDN vs pharmacological treatment for RH.Methods:A thorough literature search was conducted across PubMed, EMBASE, and the Cochrane databases, focusing on studies that compared the effects of radiofrequency-based RDN versus pharmacological treatment for RH. Treatment effects for binary and continuous endpoints were pooled and used, respectively, odds-ratio (OR) and mean differences (MD) with 95% confidence intervals (CI) to analyze continuous outcomes.Results:All the 10 included studies were randomized controlled trials, they involved 1.182 patients, and 682 received radiofrequency-based RDN. The follow-up period ranged from 6 to 84 months. Analysis revealed that the RDN group had a significant reduction in office systolic blood pressure (BP) (MD: -9.5 mmHg; 95% CI: -16.81 to -2.29; P=0.01), office diastolic BP (MD: -5.1 mmHg; 95% CI: -8.42 to -2.80; P

Circulation, Volume 150, Issue Suppl_1, Page A4144790-A4144790, November 12, 2024. Background:A prolonged PR interval has been demonstrated as a predictor of increased risk for incident atrial fibrillation (AF), coronary artery disease, heart failure, and pacemaker implantation.Purpose:We aim to investigate the impact of prolonged PR interval > 200 ms on AF recurrence after catheter ablation.Methods:We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through May 2024. We conducted a pair-wise and prognostic systematic review and meta-analysis with a reconstructed time-to-event data meta-analysis. All analyses were performed using R V. 4.3.1.Results:With the inclusion of four studies, our cohort comprised a total of 2,790 patients. Regarding pair-wise meta-analysis, PR interval > 200 ms was significantly associated with an increased incidence of AF recurrence compared to PR interval ≤ 200 ms (RR: 1.50 with 95% CI [1.33, 1.70], P< 0.01). Regarding adjusted prognostic meta-analysis, PR interval > 200 ms was significantly associated with a 92% increase in the risk of AF recurrence compared to PR interval ≤ 200 ms (HR: 1.92 with 95% CI [1.61, 2.30], P< 0.01). Our reconstructed Kaplan Meier showed that a PR interval > 200 ms was significantly associated with a 65% increase in the risk of AF recurrence compared to a PR interval ≤ 200 ms (HR: 1.65 with 95% CI [1.42, 1.92], P< 0.00001) over 120 months follow-up.Conclusion:Our meta-analysis concluded that a prolonged PR interval greater than 200 ms is a significant predictor of AF recurrence after catheter ablation, reflecting atrial remodeling, and since the PR interval can be easily measured by a surface 12-lead ECG, patients with a prolonged PR interval may require additional treatment strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4139998-A4139998, November 12, 2024. Background:Post coronary artery bypass surgery atrial fibrillation (Post-CABG AF) was reported to have variable incidence ranging from 10 to 40% and also noted to have a significant risk of stroke and all-cause mortality. This systematic review evaluated the incidence and adverse outcomes of post-CABG AF.Methods:The search period was from 1 January 2010 to September 30, 2023. We conducted a literature search in PubMed of English language, peer-reviewed manuscripts. We included observational and experimental studies among patients who underwent CABG and developed new-onset atrial fibrillation. We analyzed the overall incidence of new-onset AF, 30-day mortality, and adverse outcomes, including cerebrovascular accidents.Results:Thirty-two manuscripts, including findings from two randomized controlled trials conducted among patients with post-CABG new onset atrial fibrillation were reviewed, comprising of 150,788 patients. Of these, 39,327 (26%) developed new-onset post-CABG AF. The median age of patients with new onset post-CABG is 67.5 (IQR 66-69) years, with 52.5% males. The average incidence of cerebrovascular accidents calculated from four manuscripts was 6.26% and 3.38% among patients with and without new-onset AF post-CABG, respectively, with RR 1.92 (95% CI 1.69 – 2.18). Four studies described 30 days of mortality risk, which averaged at 3.05% and 1.46% among patients with and without new-onset AF post-CABG, respectively, with RR 2.08 (95% CI 1.77,2.45).Conclusion:This systematic analysis shows a higher incidence of post-CABG new-onset AF, along with a significant increase in 30-day mortality risk and incidence of cerebrovascular accident when compared to patients who did not develop new-onset AF postoperatively. We propose further studies on determining solutions for post-CABG AF.

Circulation, Volume 150, Issue Suppl_1, Page A4146232-A4146232, November 12, 2024. Background:Kidney transplant is the most common transplanted organ in the world. However, the efficacy of transplants from deceased donors with acute kidney injury (AKI) before transplantation is a matter of debate. For this reason, we performed a meta-analysis to assess the outcomes of kidney transplants from deceased donors with AKI when compared to non-AKI deceased donors.Methods:We systematically searched MedLine, Embase, and Cochrane databases for studies comparing kidney transplants from deceased donors with AKI compared to those without AKI. The endpoints were Acute Rejection (AR), Delayed Graft Function (DGF), and Graft Failure (GF). We calculated event prevalence with risk ratios for binary outcomes, along with 95% confidence intervals (CI). Statistical analysis was performed using R version 4.3.2. A random-effects model was used for all outcomes, and heterogeneity was assessed with Cochrane’s Q and I2 statistics.Results:We included 10 retrospective cohort studies, that comprised 68,619 patients, where 33,623 (49%) were females after we disposed of major overlapping populations. We found that the overall risk of AR, DGF, and GF to be respectively (RR 0.93; 95% CI: 0.88 to 0.98; p

Circulation, Volume 150, Issue Suppl_1, Page A4136009-A4136009, November 12, 2024. Introduction:Since individual adherence/persistence studies for heart failure (HF) guideline-directed medical therapy (GDMT) have mainly focused on single classes or had limited sample sizes, providing inconclusive estimates, a comprehensive analysis is needed to understand the magnitude of the problem.Hypothesis:Adherence and persistence to HF GDMT are suboptimal and are associated with increased risks of HF admission and mortality.Aims:To generate estimates of real-world HF medication adherence and persistence and associated clinical outcomes.Methods:We conducted a systematic review and meta-analysis, searching PubMed, EMBASE, and CINAHL for observational studies on adherence and persistence in HF GDMT from inception to 9/25/23. We evaluated bias using the Newcastle-Ottawa Scale. Primary outcomes were adherence and persistence rates using a restricted maximum-likelihood model. Adherence was summarized as the mean proportion of days covered (PDC) and medication possession ratio (MPR), proportion of patients with good adherence (PDC/MPR≥80%), and persistence. Secondary outcomes were all-cause mortality and HF readmission with summary hazard ratios (HRs) and 95% confidence intervals (CI) estimated. Heterogeneity and publication bias were assessed using Cochran’s Q, I squared statistics, funnel plots, and Egger’s tests, while subgroup analyses explored variations across studies.Results:The 48 studies included comprised 1,614,985 patients (mean age 71; 57% men). The overall mean PDC/MPR was 76%, with good adherence of 54%, and persistence rates of 60%. Renin-angiotensin-aldosterone system inhibitors had the highest mean PDC/MPR of 78%, good adherence of 56%, and persistence of 64%, while mineralocorticoid receptor antagonists (MRAs) had the lowest at 71%, 47%, and 49% respectively. Nonadherence/nonpersistence to GDMT was associated with a higher rate of mortality (HR 1.27 [95% CI 1.19–1.35]) and HF admission (HR 1.25 [95% CI 1.14-1.37]).Conclusions:Suboptimal adherence/persistence to HF GDMT is common, with only half of patients showing good adherence. Given the association with worse clinical outcomes, clinicians should prioritize identifying barriers to and addressing nonadherence/nonpersistence to HF GDMT, particularly with MRAs.

Circulation, Volume 150, Issue Suppl_1, Page A4115399-A4115399, November 12, 2024. Background:Endovascular Aortic Aneurysm Repair (EVAR) has emerged as a less invasive approach to aneurysm repair. However, the optimal anesthesia modality for elective cases—general or local-regional—remains uncertain. This meta-analysis compares the outcomes of local-regional versus general anesthesia (GA) for abdominal EVAR.Methods:We searched MEDLINE, Embase, and Cochrane databases for studies comparing local-regional and general anesthesia for EVAR up to May 2024. Following the PRISMA protocol, 1,796 articles were screened. Endpoints included 30-day mortality, type I endoleaks, length of hospital stay (LHS), and Intensive Care Unit (ICU) admissions. A random-effects model with odds ratios (OR) and 95% confidence intervals (CI) was used for binary endpoints and mean difference (MD) for continuous endpoints. Heterogeneity was assessed using Q and I2 statistics. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach evaluated the quality of evidence.Results:Sixteen cohort studies, encompassing 70,654 patients treated with EVAR after excluding overlapping populations, were included. All groups had similar demographics, American Society of Anesthesiologists physical status, and aneurysm type. The mean age was 73.6 years, and 88.1% were male. Local-regional anesthesia was associated with significantly lower 30-day all-cause mortality (OR 0.74; 95% CI 0.55 to 0.99; p=0.049; I2=0, Figure A), shorter LHS (MD -0.72 days; 95% CI -1.29 to -0.15; p=0.01; I2=87%), and less ICU admissions (OR 0.53; 95% CI 0.31 to 0.93; p=0.027; I2=98%). There was no increase in endoleaks in the local-regional group (OR 0.78; 95% CI 0.55 to 1.09; p=0.143; I2=29%, Figure B). The GRADE rated this evidence as moderate certainty and high importance.Conclusion:Local-regional anesthesia may be preferable to general anesthesia for EVAR, as it reduces 30-day mortality, ICU admissions, and hospital stay length without increasing the risk of type I endoleaks.