Risultati per: GPG: Versione 5.6.2.1 (Aprile 2021)

Correction to Figure 4 Caption

The global dengue burden in children and adolescents is high and has been increasing from 1990 to 2021, even though the distribution patterns vary across different countries and territories. This study first reported the global disease burden and temporal trends of children and adolescents, which has significant implications for policymakers and public health officials, as it underscores the need for age- and region-specific strategies to mitigate the growing global burden of dengue.

Objectives
With a projected rise in care home residency and the disproportionate impact of epilepsy and seizures on older adults, understanding seizure-related needs in this population is crucial. Data silos and inconsistent recording of residence status make this challenging. We thus leveraged ambulance data to investigate seizure call-out incidence, characteristics, management and costs in care homes compared with the wider community.

Design
Retrospective analysis of dispatch data from a regional English ambulance service over four 9-month periods between 2014/2015 and 2021/2022. Suspected seizures in adults (≥16 years) were identified, with data on location, patient age, severity and management extracted. Incidence rates, trends over time and case characteristics were compared. Costs of ambulance response were estimated, and factors influencing emergency department (ED) conveyance were analysed using logistic regression.

Setting
North West Ambulance Service National Health Service Trust, serving an adult population of ~5.5 million.

Participants
Dispatch data for 98 752 suspected seizure cases.

Results
Care homes, accommodating ~0.8% of the regional population, accounted for 7.2% of seizure call-outs. Incidence was higher in care homes than the wider community (55.71 vs 5.97 per 1000 person/year in 2021/2022) and increased over time. Care home cases peaked around 8:00–9:00. Despite similar or lower severity, they had a higher ED conveyance rate (78.3% vs 70.6%). Conveyance likelihood was influenced by factors beyond severity: reduced in homes specialising in learning disabilities (adjusted OR=0.649) and increased in homes with nursing provision (adjusted OR=1.226). Care homes accounted for 7.26% of the £24 million cost.

Conclusions
This study highlights the growing seizure-related needs in care homes. Despite similar severity, most cases result in ED conveyance. Future research should examine the appropriateness and implications of these transfers, ensuring specialist services support the care home population effectively.

Global stroke burden increased substantially between 1990 and 2021, according to a study in The Lancet Neurology. In 2021, almost 12 million people had a new stroke event, an increase of 70% since 1990. Stroke-related deaths rose to more than 7 million, up by 44% since 1990, making it the third leading cause of death worldwide.

Circulation, Volume 150, Issue Suppl_1, Page A4145873-A4145873, November 12, 2024. Background:Recent studies have suggested performing coronary artery bypass grafting (CABG) within 24 hours of acute myocardial infarction increases mortality risk. However, the ideal timing after the first day remains unclear. This study aims to suggest an optimal timing of CABG in NSTEMI patients using the large National Inpatient Sample (NIS) database over a 5-year period.Methods:This retrospective cohort study analyzed survey-weighted NIS data over 2017-2021, including adult-age admissions with NSTEMI as the principal diagnosis who underwent CABG without prior transfer from another hospital. Patients were categorized into eight groups based on days from admission to CABG (0, 1, 2, 3, 4, 5, 6, and ≥7 days). Baseline characteristics were compared across groups. Multivariate regression analysis adjusted for multiple confounders to assess the association between Time-to-CABG and in-hospital mortality and stroke prevalence.Results:Table 1 presents the baseline characteristics across the eight groups, encompassing 142,200 included admissions (mean age 65.24 years; 26.78% female).In-Hospital Mortality:The adjusted odds ratios (OR) were less than one for groups 1 through 7 compared to group 0, indicating that immediate CABG (day 0) is associated with higher mortality risk. While the reduced odds in the day 1 group were not statistically significant, substantial and statistically significant reductions in mortality were observed between days 2 and 5 (OR: 0.624 – 0.609; p

Circulation, Volume 150, Issue Suppl_1, Page A4144597-A4144597, November 12, 2024. Introduction:The National Survey of Children’s Health (NSCH) provides data for key measures of child health and well-being. The aim of this study is to characterize the cardiovascular health (CVH) status of youth with neurodevelopmental disabilities (NDD) compared to those without neurodevelopmental disabilities (non-NDD).Hypothesis:Youth with NDD are more likely to have poor CVH status compared to non-NDD youth.Methods:We compared the odds of poor CVH status in youth with NDD vs non-NDD, using 2021 NSCH data, according to a modified AHA Life’s Essential 8 (LE8) scoring system. Participants were identified as having NDD based on the Diagnostic and Statistical Manual of Mental Disorders and diagnosis of an intellectual, communication, autism spectrum, attention-deficit/hyperactivity, specific learning, or neurodevelopmental motor disorder, including Tic disorder. The CVH status of each youth was scored according to a modified LE8 score- range 0 to 100 points, with higher scores indicating good health. Individual scores were generated for sleep (sleep duration), smoking (smoking/exposure), diabetes mellitus (yes/no), obesity (BMI percentile), heart condition (yes/no), and dyslipidemia (yes/no). A composite CVH score was generated using scores for sleep, smoking, diabetes mellitus, and obesity. Logistic regression was used to analyze the relationship between NDD and CVH status. Propensity score techniques were applied to address the potential selection bias between NDD and non-NDD.Results:12,134 youth, 3 to 17 years of age, were identified as having NDD and 44,960 without. Compared to those with NDD, non-NDD participants were less likely to have age-inappropriate sleep duration (63.4 vs. 55.3,p

Circulation, Volume 150, Issue Suppl_1, Page A4139144-A4139144, November 12, 2024. Background:Iron deficiency anemia (IDA) affects approximately one-third of patients with systolic heart failure, yet comprehensive population-based analyses of its impact on in-hospital outcomes remain limited. This study seeks to examine how IDA influences in-hospital outcomes among individuals with decompensated systolic congestive heart failure (HFrEF).Methods:Using data from the National Inpatient Sample (NIS) database spanning from 2017 to 2021, this study identified patients hospitalized for decompensated systolic congestive heart failure (HFrEF) with a secondary diagnosis of IDA using ICD-10 codes such as I5020-23 and D500, D501, D508, D509. Propensity score matching (PSM) was then employed to create cohorts without and with IDA at a 1:3 ratio. Multivariate regression analyses were conducted to evaluate various outcomes, including in-hospital mortality, cardiogenic shock (CS), acute myocardial injury (AMI), cardiac arrest, ventricular tachycardia (VT), ventricular fibrillation (VF), length of stay (LOS), and total hospitalization charges. Furthermore, the utilization rate of mechanical ventilation and circulatory support, including intra-aortic balloon pump and extracorporeal membrane oxygenation, was evaluated in both cohorts.Results:Among 253,034 HFrEF hospitalizations, 16,200 (6.4%) had a secondary diagnosis of IDA. After PSM, multivariate regression analyses revealed no significant differences in the odds of cardiogenic shock (10% vs. 10%, p=0.86), in-hospital mortality (2.6% vs. 2.8%, p=0.71), and LOS (7.19 vs. 7.27 days) between the two groups. Additionally, the likelihood of cardiac arrest, ventricular arrhythmias, AMI, and utilization of mechanical ventilation and circulatory support did not reach statistical significance. However, patients with IDA and HFrEF had higher hospitalization charges ($85,516 vs. $93,000).Conclusion:HFrEF patients, with or without IDA, had similar odds of cardiogenic shock, in-hospital mortality, mechanical circulatory support utilization, as well as LOS. However, IDA with HFrEF correlated with higher hospitalization charges.

Circulation, Volume 150, Issue Suppl_1, Page A4146312-A4146312, November 12, 2024. Introduction:Atrial Fibrillation (Afib) and Flutter ranks as the fifth leading cause of death among all cardiovascular diseases (CVD). Given the scarcity of consistent previous estimates, this study is the first to assess the burden of Afib and Flutter in the European Union (EU) over the past three decades, including the initial two years of the COVID-19 pandemic.Methods:Using global burden of disease study 2021 meta tool, we estimated prevalence, incidence, deaths, disability adjusted life years (DALYs), years lived with disability (YLDs) due to Afib and Flutter by age, sex, year and location across the 27 EU countries from 1990-2021.Results:The total number of prevalence rose from 5 million (95% uncertainty interval: 3.9-6.4 million) in 1990 to 8.6 million (7.2-10.3 million) in 2021. The total percentage of change (TPC) in deaths increased by 130% (110%-143%), and YLDs by 69% (56%-84%) from 1990-2021. Austria saw the highest increase in age-standardized incidence rates (ASIR) at 83%, followed by Czechia at 50%. Sweden experienced the largest rise in mortality rates (ASMR) at 93%, with Estonia at 35%, and in YLD rates (ASYLDR), Austria led with a 90% increase followed by Sweden at 49%. In terms of age, individuals aged 55 and older recorded the highest death toll at 70,269 (57,793-77,019) and the highest incidence at 607,960 (397,686-868,122) in 2021. Regarding gender, males showed an increased TPC in overall burden compared to females, with males observing an increase and females a decreasing trend in ASIR (5% vs -7%), ASMR (7% vs -4%), and ASYLDR (7% vs -5%) from 1990-2021.Conclusion:Deaths due to Afib and Flutter accounted for 4.26% of all CVD in EU. The escalating prevalence and mortality rates of Afib and Flutter across the EU highlight an urgent need for comprehensive healthcare strategies. Effective management should focus on bolstering preventive measures, advancing diagnostic techniques, and enhancing patient care frameworks, particularly for the aging demographic most at risk. Strategic collaboration across sectors, including innovative public health initiatives and policy reinforcement, is essential to curb this growing trend and safeguard public health.

Circulation, Volume 150, Issue Suppl_1, Page A4145765-A4145765, November 12, 2024. Background:The incidence burden of maternal hypertensive disorders has increased by 30% globally. This study analyzed the trends in prevalence and death rates from maternal hypertensive disorders across various states in the United States from 1990 to 2021.Methods:Using the Global Burden of Disease (GBD) database, we compared the following levels, stratified by state, between the beginning of 1990 and the end of 2021: hypertensive disorders of pregnancy, percentage prevalence change, mortality percentage change by age-standardized rates per 100,000 population, and age-stratified changes in the rate of incidence and mortality. The analysis was conducted using Microsoft Excel (16.7).Results:The analysis revealed notable interstate variability in the prevalence and death rates of maternal hypertensive disorders (Figure 1). Nevada exhibited the highest increase in prevalence (0.87%), followed by Hawaii (0.65%) and Idaho (0.54%). In contrast, Mississippi experienced the largest decrease in prevalence (-0.22%), followed by Louisiana (-0.20%) and Maine (-0.19%). Regarding death rates, the District of Columbia saw the most significant decrease (-0.67%), followed by New York (-0.45%) and New Jersey (-0.42%). Conversely, West Virginia had the highest increase in death rates (0.89%), followed by Alaska (0.52%) and Kentucky (0.51%). The analysis of Age stratified subgroups in each state showed the maximum increase in mortality change in the age group of 40–44 years, followed by 35–39 years, with West Virginia having the highest percentage change mortality rates (2.55%; age group 40–44 years) and District of Colombia showing a sharp decrease in the percentage mortality rates (-0.72%; age group 30-34 years). Incidence percentage changes showed similar patterns, with Virginia showing a (3.41%; 40–44 years), closely followed by New York (3.31%; 40–44 years).Conclusion:The data reveal significant disparities in both the prevalence and death rates of maternal hypertensive disorders across different states. Additionally, an increase in mortality and incidence rate changes of hypertension in pregnancy was observed in higher age groups, particularly among women aged 35–39 and 40–44. These findings highlight the need for tailored, state-specific public health strategies to effectively address targeted interventions for older age groups and mitigate the impact of maternal hypertensive disorders.

Circulation, Volume 150, Issue Suppl_1, Page A4146248-A4146248, November 12, 2024. Introduction:Lower Extremity Peripheral Arterial Disease (PAD) ranks as the leading cause of incidence among all cardiovascular diseases (CVD) in the United States. Due to a significant lack of data on the overall burden of PAD, this pioneering study investigates the trends of PAD over the past three decades in the US, including the initial two years of the COVID-19 pandemic.Method:We estimated prevalence, incidence, deaths, and disability-adjusted life years (DALYs) due to PAD by age, sex, year and location across the US from 1990-2021 using the global burden of disease 2021 methodology. Results were presented in absolute counts and age-standardized rate (per 100,000 person-years)Results:From 1990 to 2021, the overall prevalence of PAD in the US rose from 8.6 million (95% uncertainty interval: 7.4-10 million) to 14.9 million (13.4-16.6 million). The total percentage change (TPC) in deaths increased by 93% (82%-102%), and DALYs by 87% (79%-96%). Pennsylvania recorded the highest increase in age-standardized incidence rate (ASIR) at 3%, followed by Delaware at 2%. Kansas saw the highest death rate (ASMR) increase at 20%, with Kentucky close behind at 19%. The 65-69 age group had the highest incidence count at 265,188, while the 85-89 age group saw the most deaths at 1,827, and the 70-74 age group recorded the most DALYs at 36,772 in 2021. Males experienced a higher increase in TPC across incidence, deaths, and DALYs compared to females, with figures at 85% vs 56%, 104% vs 85%, and 99% vs 76%, respectively.Conclusion:While deaths due to Peripheral Arterial Disease (PAD) constituted only 1.22% of all cardiovascular-related fatalities in the US in 2021, the growing burden of the disease highlights a critical area for public health focus. Although mortality rates remain relatively low, the high incidence compared to other cardiovascular diseases suggests the need for targeted prevention and early intervention strategies. Strengthening awareness, improving diagnostics, and enhancing treatment accessibility can help mitigate the rising impact of PAD and improve cardiovascular health outcomes nationwide.

Circulation, Volume 150, Issue Suppl_1, Page A4146785-A4146785, November 12, 2024. Background:Dementia is a prevalent comorbidity in patients undergoing the transcatheter edge-to-edge repair (TEER) procedure of the mitral valve. This study compares outcomes of mitral valve TEER in patients with and without dementia, utilizing data from the National Inpatient Sample (2016-2021)Methods:We conducted a retrospective cohort study on 48,085 patients without dementia and 3,125 with dementia undergoing mitral valve TEER. Multivariate logistic regression was employed to compare outcomes, adjusting for potential confounders. Primary outcomes included mortality and major complications, while secondary outcomes encompassed specific procedural complications.Results:Patients with dementia were older (mean age: 80.896 vs. 76.69 years, p-value

Circulation, Volume 150, Issue Suppl_1, Page A4127417-A4127417, November 12, 2024. Background:Atherosclerotic cardiovascular disease (ACVD) is the leading cause of mortality in the U.S, and increasing age is one of the greatest risk factors for the development and prognosis of ACVD. However, ACVD-related mortality trends in older adults have not yet been established.Aims:This study aims to highlight the annual trends and demographic differences in ACVD-related mortality among older adults in the U.S. from 1999 to 2021.Methods:The CDC WONDER multiple-cause of death database was examined from 1999 to 2021 for ACVD-related mortality in adults >65 years of age. Age-adjusted mortality rates (AAMRs) per 100,000 persons was calculated. Trends and annual percent changes (APCs) were calculated, and subsequently stratified by overall, sex, race/ethnicity, urbanization status, and census region.Results:Between 1999 and 2021, 9,307,495 ACVD-related deaths occurred among older adults in the U.S. AAMRs decreased from 1370.7 in 1999 to 803.5 in 2014 (APC, -3.64 [-3.89 to -3.46]), after which it gradually decreased to 741.3 in 2019 (APC, -1.24 [-2.54 to 0.19]), and then increased to 841.5 in 2021 (APC, 7.00 [3.92 to 9.18]). Men had consistently higher AAMRs than women from 1999 (AAMR men: 1754.1 vs women: 1122.2) to 2021 (AAMR men: 1169.6 vs women: 599.6). Non-Hispanic (NH) Black or African American older adults had the highest AAMR in 2020 (886.1), followed by NH White (849.4), NH American Indian/Alaska Native (752.5), Hispanics or Latino (718.3) and NH Asian or Pacific Islanders (494.4). AAMR also varied substantially by region (overall AAMR until 2020: Midwest 875.1; South 872.2; Northeast 801.0; West 789.2), and rural areas had higher ACVD-related mortality (993.5) than urban regions (954.7).Figure 1.Conclusion:Following a progressive decrease until 2019, ACVD-related mortality in U.S. older adults demonstrated a sharp increase in mortality in 2020 and 2021. The highest AAMRs were observed among Black or African American adults and men, and among patients living in the Midwestern and non-metropolitan areas. A targeted approach, with tailored strategies is required to counter the recent surge in ACVD-related mortality in older adults in the U.S.

Circulation, Volume 150, Issue Suppl_1, Page A4128457-A4128457, November 12, 2024. Background:The U.S. population has seen a dramatic increase in the burden of hypertension (HTN) among younger adults. However, HTN-related mortality trends among younger adults have not been investigated.Aim:We examined the trends and demographic differences in HTN-related mortality among younger adults in the U.S.Methods:Data from the CDC WONDER database was examined from 1999 to 2021 for HTN-related mortality in adults between 15 to 45 years of age. The International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes employed were as follows: I10-I15 (hypertensive diseases). Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated and stratified by year, sex, race/ethnicity, urbanization status and census region.Results:Between 1999 and 2021, 201,860 HTN-related mortalities occurred among younger adults in the U.S. The AAMR increased from 2.8 in 1999 to 5.0 in 2001 (APC, 35.3 [20.6 to 44.5]), after which it steadily increased to 9.4 in 2019 (APC 3.1, [2.7 to 3.5]), and sharply increased to 13.9 in 2021 (APC 22.3; 95% CI 15.1 to 26.4). Men had consistently higher AAMRs than women from 1999 (AAMR men: 3.6 vs women: 1.9) to 2021 (AAMR men: 18.9 vs women: 8.8). Non-Hispanic (NH) Black or African American young adults had the highest AAMR in 2020 (30.2), followed by NH American Indian/Alaska Natives (29.6), NH White (9.9), Hispanics or Latino (9.3) and NH Asian or Pacific Islanders (5.0). AAMR also varied substantially by region (overall AAMR: South 9.3; Midwest 6.4; West 5.8; Northeast 5.4), and rural areas had higher HTN-related mortality (8.5) than their urban counterparts (7.0).Figure 1.Conclusion:Following a steady increase until 2019, HTN-related mortality increased among young adults between 2020 and 2021. The highest AAMRs were observed among men and Black or African American young adults, and people residing in the Southern and non-metropolitan areas. This emphasizes the necessity of tailored interventions to mitigate the burden and reduce the current disparities in HTN-related mortality among young adults in the U.S.

Circulation, Volume 150, Issue Suppl_1, Page A4148102-A4148102, November 12, 2024. Introduction:Ischemic stroke and renal failure frequently coexist, impairing patient outcomes. Comprehending this association is imperative in formulating a multidisciplinary methodology to augment patient outcomes and quality of life.Objective:We offer estimates showing the evolution of kidney dysfunction related ischemic stroke from 1990 to 2021. It will utilize disability-adjusted life years (DALYs), years of life lost (YLLs) and age-standardized death rates (ASDR) to find discrepancies overall survival outcomes in both sexes.Methods:Data on ASDR, DALY, and YLL were extracted from the GBD database. After examining global trends, we analyzed continents, socio-demographic index (SDI) and World Bank income level classification of countries. Using Joinpoint regression, the average annual percentage changes (AAPC) were determined.Results:The ASDR for kidney dysfunction related ischemic stroke showed a declining trend globally between 1990 and 2021. The ASDR was 7.29(95%UI: 4.68-10.07) in 1990 and dropped to 4.24 (AAPC: -1.73; 95% CI: -1.76 to -1.69) in 2021. DALYs dropped from 130.3(95%UI: 90.36-172.67) in 1990 to 82.1 (AAPC: -1.47; 95% CI: -1.50 to -1.44) in 2021. YLL had a consistent decline from 1980 to 2021, with an AAPC of -1.66 (95% CI: -1.69 to -1.62). High-middle and middle SDI region had higher death rates throughout the study period.Asia and America had lower ASDRs, whereas Europe and Africa had higher ASDRs across the board. Africa’s AAPC was -0.37 (95% CI: -0.4 to -0.32) between 1990 and 2021. Similarly, Europe’s AAPC of -2.85 (95% CI: -2.93 to -2.77) showed a decline from 1990 to 2021. Asia’s AAPC showed a drop, coming in at -1.19 (95% CI: -1.22 to -1.15). America’s AAPC was -1.97 (95% CI: -2.02 to -1.91).According to world bank income levels, upper-middle and lower-middle income countries had higher ASDRs.Conclusion:Due to similar risk factors and bidirectional effects, the combination of ischemic stroke and renal failure worsens patient outcomes. In order to effectively address the intricate interactions between various illnesses and enhance patient prognosis, an in-depth investigation of the reasons behind stark disparities in death rates is necessary.

Circulation, Volume 150, Issue Suppl_1, Page A4144702-A4144702, November 12, 2024. Background:Gender disparities in outcomes for patients undergoing Transcatheter Aortic Valve Implantation (TAVI) with concomitant chemotherapy remain under-explored. This study investigates these disparities, focusing on mortality, procedural complications, and baseline characteristics.Methods:We conducted a retrospective analysis using data from the National Inpatient Sample (NIS) from 2016 to 2021. Gender differences in outcomes were examined in patients undergoing TAVI who have also received chemotherapy. Multivariate logistic regression was utilized for outcomes. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, with statistical significance determined by P-values.Results:The study included 7,275 patients, comprising 3,375 males and 3,900 females. The mean age was similar between males (76.19 years) and females (75.81 years). Outcome analysis revealed no significant gender difference in in-hospital mortality (OR: 1.63, 95% CI: 0.464-5.725, P = 0.445), heart block (OR: 1.061, 95% CI: 0.849-1.326, P = 0.6) or vascular injury (OR: 1.065, 95% CI: 0.572-1.981, P = 0.841). However, females had significantly higher odds of bleeding (OR: 1.601, 95% CI: 1.161-2.207, P = 0.004) and respiratory failure (OR: 1.792, 95% CI: 1.028-3.126, P = 0.04). Additionally, females had higher odds of sudden cardiac arrest (OR: 8.181, 95% CI: 1.092-61.26, P = 0.041) but lower odds of atrial fibrillation (OR: 0.689, 95% CI: 0.543-0.875, P = 0.002) and arrhythmia (OR: 0.537, 95% CI: 0.344-0.837, P = 0.006). Length of stay was longer for females (Coefficient: 0.515, 95% CI: 0.137-0.893, P = 0.008), but total charges did not differ significantly between genders (Coefficient: 2321, 95% CI: -10371.11-15013.54, P = 0.72).Conclusions:Significant gender disparities exist in specific procedural outcomes for patients undergoing TAVI who have also received chemotherapy. Females were at higher risk for bleeding, respiratory failure, and sudden cardiac arrest, while having lower rates of atrial fibrillation and arrhythmia compared to males. These findings highlight the necessity for gender-specific risk assessment and management strategies to improve outcomes for patients undergoing TAVI with chemotherapy.

Circulation, Volume 150, Issue Suppl_1, Page A4145182-A4145182, November 12, 2024. Background:Ischemic heart disease (IHD) continues to be a major contributor to global mortality. Metabolic risk factors are known to be the leading drivers of IHD burden. Our study aims to explain the trends in Metabolic Risk Factors (MRF) associated IHD mortality by utilizing Global Burden of Disease Study data spanning over three decades from 1990 to 2021.Method:MRF associated IHD mortality rates in the United States from 1990 to 2021 were sourced from the Global Burden of Diseases 2021 database. Monte Carlo permutation analysis utilizing JointPoint Regression Software (version 4.9.0.1, NCI) was employed to estimate the time trends, using annual percentage change (APC) and average annual percentage change (AAPC) metrics. Initially, these trends were assessed for the overall population. Analysis was then stratified by gender, evaluating age-adjusted rates separately for males and females. Further stratification involved, assessing age-specific trends within two distinct age groups: younger adults (20-54 years) and older adults ( >55 years).Results:A statistically significant decline in overall mortality was noted, with a moderate decline occurring during the decade 1990 to 2001 (APC= -2.2, p