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I consigli ai genitori degli esperti del Bambino Gesù in occasione della giornata mondiale dell’infanzia e adolescenza

Da martedì 19 a venerdì 22 novembre ad Ancona

Comunicato del 14/11/2024 n°30

Circulation, Volume 150, Issue Suppl_1, Page A4146319-A4146319, November 12, 2024. Backgrounds:The AHA introduced “Life’s Essential 8” (LE8) in 2022 as a comprehensive metric to facilitate detailed tracking and management of cardiovascular health (CVH) at the population level. However, the racial/ethnic differences in LE8, how these differences change over time, and the driving factors of LE8 in each subgroup remain unclear.Methods:We utilized data from the continuous NHANES from 2011 to 2020 to examine racial disparities and driving factors in the AHA’s LE8 among American adults. To ensure national representation, appropriate weights were applied. Survey-weighted and age-standardized trends in LE8 scores by racial and ethnic groups were analyzed using generalized linear models (GLMs). To identify the driving factors—specific metrics influencing the LE8 overall score—we calculated z-scores for all components. Then we used the spider chart to visualize the driving factors.Results:A total of 13,915 adult were included, of whom the mean age is 47.9 ± 0.37 years, 6,612 (47.55%) were women, 3,485 (14.63%) were Hispanics, 5,335 (69.74%) were non-Hispanic Whites, 3,464 (10.82%) were non-Hispanic Blacks, and 1,631 (4.81%) were Asians. From 2011-2020, the LE8 scores did not change significantly overall and across all racial groups (all p-trend > 0.10,Figure 1). During the study period, racial/ethnic disparity persisted with Asian adults consistently having the highest LE8 scores and Black adults having the lowest scores. Notably, the lower LE8 scores in Black adults were primarily driven by lower scores of diet, blood pressure, and sleep health, whereas the higher LE8 scores in Asian adults primarily driven by higher scores of diet, nicotine exposure, and BMI. The LE8 scores in White adults were primarily driven by blood glucose and physical activity and the LE8 score in Hispanic adults were primarily driven by blood pressure (Figure 2-A). In 2017-2020 (Figure 2-B), Black adults had the lowest scores for all LE8 components, except for blood lipids. In contrast, Asian adults had the highest scores in diet, physical activity, nicotine exposure, and sleep health. Throughout the study period, the racial/ethnic disparity in LE8 score did not change significantly (all p >0.10).Conclusion:We found persistent racial disparities in cardiovascular health among U.S. adults, with Black adults having the lowest LE8 scores in almost all components. The driving factors for LE8 scores varied by racial subgroups, emphasizing the need for targeted interventions.

Circulation, Volume 150, Issue Suppl_1, Page A4138426-A4138426, November 12, 2024. Background:Geographic inequities in cardiovascular mortality are pervasive in the US. Pandemic-related delays in screening and treatment, economic loss, and worsening social determinants may have widened geographic disparities in cardiometabolic health, particularly in states that were hardest hit by these spillover effects. Understanding changes in state-based inequities could inform targeted public health efforts to advance cardiovascular health.Questions:Did the prevalence of cardiometabolic risk factors (diabetes, hypertension, hyperlipidemia, obesity) and lifestyle factors (alcohol consumption, physical inactivity, tobacco use) change between 2011 and 2021? How did between-state differences change over this period?Methods:We included adults from the CDC’s Behavioral Risk Factor Surveillance System. Survey-weighted logistic regressions models were used to calculate age and sex-adjusted risk difference between states with the highest and lowest adjusted prevalence rates of each risk factor in 2011 and 2011, respectively. An interaction term for state and year was included to assess for differential changes in between-state disparities.Results:From 2011 to 2021, there were increases in the age- and sex-adjusted prevalence of diabetes (10.9% [95% CI, 10.7,11.0] to 12.4% [12.2,12.6]), hypertension (32.4% [32.1,32.7] to 33.7% [33.4,34.0]), and obesity (27.5% [27.2,27.7] to 33.1% [32.8,33.5]). Geographic inequities widened, with increases in the difference between states with the highest vs lowest prevalence of diabetes (5.7% [5.3,6.1] to 7.8% [7.3,8.3]), hypertension (14.2% [13.6,14.8] to 17.2% [16.4,17.9]) and obesity (14.3% [13.6,15.0] to (15.7% [14.7,16.7])(Table).The prevalence of alcohol consumption (18.0% [17.7,18.2] to 15.6% [15.3,15.8]), physical inactivity (25.7% [25.4,27.4] to 24.0% [23.6,23.7]), and tobacco use (44.9% [44.5,45.3] to 36.3% [35.8,36.8]) decreased, and between-state differences did not widen.Conclusion:In this national study, the prevalence of hypertension, obesity, and diabetes increased from 2011 to 2021, and state-based inequities widened. Our findings highlight the urgent need for public health interventions to address widening state-based disparities in cardiometabolic health.

Circulation, Volume 150, Issue Suppl_1, Page ASa901-ASa901, November 12, 2024. Introduction:In the United States, the incidence of in-hospital cardiac arrest (IHCA) ranges from 0.1-0.5% and most larger studies report about 20% of patients survive to hospital discharge. IHCA after cardiac surgery is unique because patients are often monitored closely and arrest etiologies are frequently reversible. This may contribute to improved survival, however current data on cardiac arrest outcomes that reflect the rapidly evolving landscape of cardiac surgery and intensive care are lacking.Aims:To identify the incidence, prognostic features, and outcomes of cardiac arrest following cardiac surgery at a single high-volume academic center.Methods:We identified all adult (≥18 years) patients who underwent cardiac surgery and experienced in-hospital cardiac arrest at our institution from 2011-2024 in our local Society of Thoracic Surgery database. The primary outcome was the incidence of cardiac arrest after cardiac surgery. In an exploratory analysis, we fit a multivariable logistic regression for death before discharge, adjusting for variables noted in Tables 1 and 2. All analyses were performed in R (Version 2024.04.1+748). A p value < .05 was considered significant. No adjustment for the family-wise error rate was made – all analyses should be considered hypothesis-generating.Results:Of 10,152 surgeries, 263 cases (2.6%) of postoperative cardiac arrest were identified. Survival to discharge occurred in 123 (50%) of cases. Median age was 67 (IQR 57-75) and 103 (39%) patients were female (Table 1). In adjusted analyses, death before discharge was significantly associated with use of extracorporeal membrane oxygenation (OR 3.52, CI 1.51-8.23, p=0.003), postoperative dialysis (OR 3.27, CI 1.57-6.77, p=0.001), pre-operative stroke (OR 2.28, CI 1.17-4.46, p=0.016), post-operative stroke (OR 3.01, CI 1.04-8.73, p=0.042), and age (OR 1.03, CI 1.01-1.05, p=0.016) (Figure 1). Survival to discharge was associated with placement of permanent pacing device (OR 0.30, CI 0.11-0.81, p=0.017).Conclusions:Incidence of IHCA after cardiac surgery is much higher than in the general inpatient population. However, survival to discharge is also common, suggesting that cardiac surgical patients have distinctly different outcomes after IHCA compared to other inpatient populations. In an exploratory analysis, we identified several factors associated with survival to hospital discharge after cardiac arrest which can be examined in future studies.

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This study assesses veterans’ dual enrollment in the Veterans Health Administration (VHA) and Medicare Advantage and VHA spending from 2011 through 2020.

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