Risultati per: Linee guida ESC/ERS 2022 per la diagnosi e il trattamento dell'ipertensione polmonare

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Objective
To generate evidence about changes in the research and development (R&D) investment of Chinese chemical pharmaceutical companies before and after the implementation of the national pooled procurement, to respond to the concerns that significant price reductions might negatively affect R&D investment, and to facilitate the evidence-based decision-making for improvement of the national pooled procurement.

Methods
This retrospective study employed the fixed-effects models with robust SEs to analyse the changes in R&D investment intensities of 76 A-share listed Chinese chemical pharmaceutical companies before and after the procurement implementation in 2019. The analyses were based on a panel data set between 2013 and 2022. Subgroup analyses were conducted to account for the heterogeneity of the target companies. The bootstrap hypothesis test method was employed to assess potential variations across the different subgroups.

Results
Following the procurement implementation, the R&D investment intensity (RDI) of the target companies increased by 1.9% (p

Circulation, Volume 150, Issue Suppl_1, Page A4120515-A4120515, November 12, 2024. Background:Patients with heart failure (HF) often have difficulty obtaining life-saving medications due to coverage barriers, such as prior authorizations (PA) and high out of pocket (OOP) costs. To promote better insurance coverage of high value therapies, the AHA/ACC/HFSA added Value Statements to HF guidelines to inform policymakers about medication cost effectiveness. We assessed whether these guidelines influenced Medicare drug coverage policies for two life-saving, costly HF medications: angiotensin receptor neprilysin inhibitors (ARNI – guideline “high value”) and sodium glucose cotransporter 2 inhibitors (SGLT2i – guideline “intermediate value”).Methods:We performed an observational study of Medicare drug plans from 4/2020-4/2023 to assess for changes in ARNI and SGLT2i coverage after Value Statement publication (4/2022), and subsequent Medicare plan online update (10/2022). The primary outcome was any barrier to drug coverage (PA, tier ≥ 3 OOP cost-sharing, step therapy, or no coverage). Analysis utilized interrupted time series and difference-in-difference (DiD) approaches. DiD analyses used direct oral anticoagulants as a control due to similar cost and utilization as ARNI and SGLT2i, but with no Value Statement.Results:Among 7,396 Medicare drug plans, 94.3%-97.4% had coverage barriers to ARNI and 93.2%-96.6% to SGLT2i. The majority of barriers were due to tier ≥ 3 OOP cost-sharing requirements (ARNI: 94.3%-95.8%; SGLT2i: 93.2%-95.6%). Coverage barriers remained stable in 4/2022, and declined slightly in 10/2022 (Figure). In DiD analyses, the presence of a Value Statement was associated with a ~1 percentage point decline in coverage barriers for ARNI and SGLT2i.Conclusion:Coverage barriers to ARNI and SGLT2i were common and did not change much in response to Value Statements in HF Guidelines. Increased consideration for Value Statements by Medicare policy-makers is needed to meaningfully improve access to high value therapies.

Circulation, Volume 150, Issue Suppl_1, Page A4139309-A4139309, November 12, 2024. Background:Between 2011-2017, US rural adults experienced higher cardiovascular (CV) death rates than their urban counterparts, and rural-urban disparities in CV mortality widened. Little is known about these trends have evolved in the wake of the pandemic. In this study, we provide an updated analysis of rural-urban differences in CV mortality.Methods:We used CDC WONDER to obtain national death data from 2010-2022. CV cause of death was identified by ICD-10 codes I00-99. Large metro, small/medium metro, and rural areas were defined using the National Center for Health Statistics Urban-Rural Classification. We calculated age-adjusted mortality rates (AAMRs) per 100,000 population and compared 2022 vs. 2010 using rate differences and two-sample t-tests. We then fit a Poisson regression model to estimate annual percent change (APC), evaluating trends from 2010-2019 and 2019-2022 due to reversal in CV mortality observed after 2019. We included an interaction term to assess differential trends by rurality, and repeated the analysis for younger (age 25-64) and older (age >64) adults.Results:Between 2010-2022, AAMRs were consistently highest in rural areas (Figure 1, Table 1). AAMRs increased in rural areas (rate difference [RD] +3.4 [95% CI 0.4, 6.4]) but declined in urban areas (RD -23.8 [-25.3, -22.2]). This significant differential change was driven by a rise in AAMRs among younger, rural adults (RD +23.2 [21.2, 25.1). In contrast, older adults experienced a decline in AAMRs, though this reduction was greater in urban vs. rural areas (Table 2).From 2010-2019, overall APCs in AAMR decreased for all areas. However, when stratified by age, younger rural adults saw a significant increase (+1.0% [95% CI 0.5, 1.5]), while those in large metro areas did not (-0.2% [-0.5, 0.1]). Older adults saw a significant decrease across all areas.Between 2019-2022, the overall APC in AAMR increased significantly in rural areas (+3.1% [0.4, 6]), but in not large metro areas (+1.2% [-0.4, 2.9]). CV mortality rose in most subgroups, but younger rural adults experienced the largest increase (+4.2% [1.3, 7.1]) (Table 2).Conclusions:Between 2010-2022, CV mortality increased in rural areas and decreased in urban areas. Younger, rural adults experienced the most pronounced rise in CV death, while older, urban adults experienced the steepest decline. These findings highlight an urgent need to address widening rural-urban disparities, particularly among younger adults.

Circulation, Volume 150, Issue Suppl_1, Page A4146291-A4146291, November 12, 2024. Background:Circulatory diseases represent the primary cause of mortality in the US. Comprehending trends and potential disparities in the prevalence of circulatory conditions, such as angina pectoris (AP), myocardial infarction (MI), hypertension (HTN), and coronary heart disease (CHD), is essential for forming public health strategies.Aim:To investigate trends in the prevalence of circulatory conditions, including AP, MI, HTN, and CHD among US adults from 2019 to 2022.Methods:Prevalence percentages for all available circulatory diseases from the Centers for Disease Control and Prevention’s National Health Interview Survey (NHIS) database were retrieved for patients aged >18 years from 2019 to 2022. Annual Percentage Changes (APCs) along with their respective 95% CIs were calculated using regression analysis with Join point. The data was stratified by year, gender, age, race, nativity, veteran status, social vulnerability, employment status, metropolitan statistical area (MSA) status and census region.Results:Between 2019 and 2022, HTN was steadily the most prevalent, staying relatively constant at 27.0% (95% CI: 26.4, 27.7) in 2019 and 27.2% (95% CI: 26.5, 27.8) in 2022. Males consistently had higher prevalence than females with significant increases noted from 2019 to 2022 (APC: 1.0234). Black or African American had the highest prevalence (34.4% in 2022). The South (30.1% in 2022) and the West (22.5% in 2022) had respectively the highest and lowest rates. The second highest prevalence was seen in CHD increasing from 4.6% (95% CI: 4.3, 4.9) in 2019 to 4.9 (95% CI: 4.7, 5.2) in 2020. Males consistently exhibited a higher prevalence than females, with both genders showing significant increases in recent years (Male APC: 3.1448) (Female APC: 2.0165). For MI, a slight decrease was noted from 3.1% (95% CI:2.9, 3.4) in 2019 to 3.0% (95% CI:2.7, 3.2) in 2022. White individuals exhibited the highest prevalence (3.3% in 2022). AP had the lowest overall prevalence staying relatively consistent (1.7% in 2019 and 1.6% in 2022) (Figure 1).Conclusion:Significant trends (Figure 2) in most common circulatory diseases have been identified. Targeted interventions are imperative, particularly for high-risk demographics such as males, older adults, veterans, and unemployed individuals.

Circulation, Volume 150, Issue Suppl_1, Page A4142044-A4142044, November 12, 2024. Background:Myocarditis is a dreaded complication of immune-checkpoint inhibitor (ICI) therapy but challenging to diagnose. There are no published data comparing the two leading diagnostic criteria for ICI myocarditis and their association with cardiovascular events.Methods:Patients treated with ICI and cardiac Troponin (cTnT) measurements thereafter at a tertiary institution from 2011 to 2022 were identified. Charts were reviewed for ICI-related myocarditis according to the Bonaca et. al criteria and the ESC-ICOS guideline criteria. A propensity matched control group was identified of patients treated with ICI but without developing myocarditis. Medical records were reviewed for baseline characteristics and long-term outcomes, including cardiac death, MACE (myocardial infarction, TIA/stroke, new heart failure diagnosis), and arrhythmias (V-tach, A-fib, complete heart block).Results:A total of 59 patients were identified as having a diagnosis of ICI-related myocarditis per Bonaca criteria (16 having definite, 13 probable and 30 possible myocarditis), and 47 met the ESC-ICOS guideline criteria. Mean age was 73.1±10.2 years, 60.1% were male, median follow-up was 2.5 years. ICI-related myocarditis as diagnosed by both diagnostic criteria had prognostic value for cardiac death (HR 13.94, 95%CI 1.84-105.64, p=0.011 per Bonaca, HR 6.22, 95%CI 1.77-21.88, p=0.004 per ESC-ICOS), MACE, (HR 3.17, 95%CI 1.34-7.47, p=0.008 per Bonaca, HR 2.97, 95%CI 1.37-6.45, p=0.006 per ESC-ICOS), and arrhythmias (HR 1.93, 95%CI 1.10-3.38, p=0.022 per Bonaca, HR 2.09, 95%CI 1.21-3.60, p