Annual Mortality Research Articles

Understanding oral malignancies: 2 case reports

The clinical presentation, diagnosis, and management of several squamous cell carcinoma cases are covered thoroughly. Roughly 94% of all mouth malignancies are squamous cell carcinomas. Race, gender, and age group differences exist in annual incidence and mortality rates. This percentage is 7.7 per 100,000 in the US. Like other carcinomas, intraoral carcinoma is more common in older adults, especially in men. Individuals with oral SCC have often known about an abnormality in that area for four to eight months prior to seeking professional medical attention. Early growth is characterized by little discomfort, which may account for the delay in seeking professional assistance. The clinical manifestations of oral SCC include exophytic, endophytic, leukoplakic, and erythroplakic, all of which exhibit apparent surface alterations.Tobacco usage, excessive alcohol consumption, HPV infection, eating little fruits and vegetables, prolonged sun exposure, and having a compromised immune system are risk factors. Improving outcomes requires early discovery and treatment, which may include chemotherapy, radiation therapy, surgery, or a combination of these. In order to improve the prognosis for oral cancer, early identification and intervention are crucial. Survival risk from squamous cell carcinoma is often low. This article emphasis on the clinical presentation of oral malignancies.

Trends of extreme hyperbilirubinemia related infant mortality in select European countries (1990-2019).

Limited data exist on population-level mortality outcomes related to extreme neonatal hyperbilirubinemia (EHB) and this study examines trends in annual infant mortality rate (IMR) attributed to hemolytic and perinatal jaundice among Germany, France, Italy, Portugal, Greece and Spain from 1990 to 2019. Data on annual incident cases and disability-adjusted life years were collected from the 2019 Global Burden of Disease study. Live birth cohort data were sourced from UN World Population Prospects. We quantified temporal trends, with relative percent changes. Average annual percent changes (AAPCs) were evaluated using the Joinpoint Regression Program. EHB-related infant mortality decreased from 21.4 (95%CI: 16.1, 27.1) in 1990 to 4.2 (95%CI: 1.9, 7.6) per million live births in 2019. Germany demonstrated lowest AAPC of -3.2% (95% CI: -3.8, -2.5), while Portugal had the highest AAPC of -8.6% (95% CI -11.9, -5.1) in reducing infant mortality due to EHB. There were distinct divergences in the trajectories of declining EHB mortality among the studied countries. This study highlights a significant decline in infant mortality due to extreme hyperbilirubinemia, emphasizing the need for national surveillance and tailored guidelines to prevent bilirubin induced neurological damage. This cross-sectional analysis revealed a marked decline in infant mortality rates attributed to extreme hyperbilirubinemia across the selected European countries. The rates of decline varied significantly between countries, demonstrating notable heterogeneity in mortality trends when stratified by age at death. Implementing data-driven surveillance systems can optimize the alignment of equitable healthcare services, strengthen accountability measures, and identify critical operational inefficiencies. In the European Union, country-specific hyperbilirubinemia guidelines should be reinforced to ensure effective screening and post-discharge follow-up protocols that are tailored to risk burden and available healthcare resources.

The state of cancer care in Russia: malignant tumors of the skin (C44). Prevalence, quality of accounting, age characteristics, localization and histological structures (clinical and population study). Part 1.

This work represents a clinical-population study of the state of oncological care in Russia, focused on malignant skin neoplasms (C44). The study analyzes data on the prevalence of this disease, the quality of case accounting, age characteristics, and the localization and histological structure of tumors. The aim of this research is to continue the investigation into the patterns of prevalence of skin neoplasms (C44), assess the quality of primary accounting, and evaluate the impact of the coronavirus infection epidemic on analytical indicators of prevalence and patient survival. The conducted study confirmed the trend of increasing morbidity and decreasing mortality from skin neoplasms (C44) among the population of Russia and the Northwestern Federal District of the Russian Federation. A clear positive dynamics in the quality of accounting is observed. Special attention is given to the specifics of morbidity changes in neoplasms (C44) considering each age group of the population of Russia. At the population level, the age-specific mortality of patients is presented for each year of observation, analyzed in the context of five-year cohort groups. For the first time, a trend has been identified showing an increase in annual mortality from skin neoplasms (C44) after the sixth year of observation following the treatment of patients.

The state of cancer care in Russia: malignant tumors of the skin (C44). One- and five-years survival of patients, age characteristics. Part II.

In the first part of our study, we presented an analysis of the prevalence, quality of primary registration, annual mortality, and the peculiarities of changes in the localization and histological structure of malignant neoplasms (C44) of the skin. In the second part of our research, special attention will be focused on assessing the effectiveness of anti-cancer measures concerning observed and relative one-year and cumulative five-year survival rates in the Northwestern Federal District of Russia (NWFD). The database created in 2019 for the population cancer register (PCR) at the federal district level has significantly expanded the possibilities for conducting analytical research, including the potential to study rare tumors. In this work, we will pay special attention to the new opportunity to conduct an in-depth analysis of the dynamics of localization and histological structure. We will examine the survival of patients with skin neoplasms from any affected area (lips, ears, face, back, extremities, and other parts), which is not feasible when evaluating prevalence based on state reporting forms, not to mention calculating patient survival rates. The aim of this research is to study the patterns of one-year and five-year survival of patients with skin neoplasms (C44) taking into account the main parameters of the registration card. The conducted research revealed a positive trend in the one-year observed survival of patients with skin neoplasms (C44) in the Northwestern Federal District of the Russian Federation, which increased from 95.6% to 96.2% between 2000 and 2019, with higher rates for the female population at 96.3% and 96.9%, respectively. The specificity of the level and dynamics of individual age groups of patients was identified. For the first time, the one-year survival of patients with skin neoplasms was calculated based on detailed tumor localizations and the respective one-year survival rates, as well as the one-year survival calculated separately for each tumor histotype. The highest survival rate was observed for the histotype M-8090/3 at 97.4%, while the lowest was for M-8390/3 at 59.1%.

Abstract 4147608: Trends in Mortality and 30-Day Readmission Rates Among Heart Failure Patients Undergoing Cardiac Rehabilitation: A Nationwide Analysis from 2017 to 2020

Background: Heart failure (HF) is a significant public health concern, affecting approximately 6.2 million adults in the United States, with high mortality and readmission rates. Cardiac rehabilitation (CR) programs have been widely recognized as a crucial component of HF management, aiming to improve physical function, reduce symptoms, and enhance quality of life. Despite the established benefits of CR, there is a need to understand the trends in mortality and readmission rates among HF patients participating in these programs. We aim to analyze mortality and 30-day readmission rate trends among heart failure patients undergoing cardiac rehabilitation from 2017 to 2020 using NRD data. Hypothesis: We hypothesize a significant downward trend in mortality rates and significant yearly variation in 30-day readmission rates among heart failure patients undergoing cardiac rehabilitation. Methods: We analyzed NRD data from 2017 to 2020, including patients with ICD-10 codes I50 (heart failure) and Z5189 (cardiac rehabilitation). Trend analyses were performed using Ordinary Least Squares (OLS) regression for mortality rates and the Cochrane-Armitage test for binary data. Multivariate regression adjusted for age, sex, and comorbidities. Statistical analyses were conducted using STATA version 18. Results: From 2017 to 2020, annual mortality rates were 6.9% (95% CI: 0.95% to 12.85%), 5.5% (95% CI: 0.47% to 10.52%), 4.6% (95% CI: -0.51% to 9.68%), and 1.9% (95% CI: -1.90% to 5.74%), respectively. The mean age was 78 years, with 54% were female. OLS regression showed a significant downward trend in mortality (p = 0.025), while the Cochrane-Armitage test did not (p = 0.998). Multivariate regression also indicated a downward trend, though individual predictors were insignificant (p=0.576). For 30-day readmission rates from 2017 to 2020, annual margins were 21.5% (2017), 21.7% (2018), 18.0% (2019), and 34.3% (2020), showing significant yearly variation. Conclusion: Despite the varying range of 30-day readmission within the years of interest, there seems to be a significant downward trend in mortality for heart failure patients who underwent cardiac rehabilitation. Further studies are required to corroborate these findings as understanding CR program outcomes can help identify improvement areas, guide resource allocation, and inform healthcare policy decisions.

Abstract 4122008: Bayesian modeling to forecast mortality due to Ischemic Heart Disease, Stroke, and Peripheral Artery Disease in Brazil until 2040

Introduction: Atherosclerotic cardiovascular disease, specifically ischemic heart disease (IHD), stroke, and peripheral artery disease (PAD) together are among the leading causes of cardiovascular mortality in Brazil. As the obesity, hypertension, and diabetes rates in the Brazil continue to increase, projecting mortality rates related to these conditions are important for guiding health policy. Hypothesis: We hypothesized that there are differences in the future trends of IHD, stroke and PAD in Brazil. Aims: We sought to forecast the trends in IHD, stroke, and PAD in Brazil until 2040 to fill in this important knowledge gap and inform public health policy development. Methods: We collected the annual death counts for IHD, stroke, and PAD and the mid-year population estimates in 5-year age brackets (40 – 79 years) between 1990 and 2019 from the Global Burden of Disease. We calculated the annual crude and age-standardized mortality rates (per 100 000 residents) for IHD, stroke and PAD between 1990 and 2019. Using this observed data, we estimated the projected mortality rates for these conditions till 2040 using Bayesian age-period-cohort (BAPC) models. Results: Brazil`s population (aged 40-79 years) will increase by 237.5% between 1990 and 2040. Nationally, compared to 2019, the age standardized IHD mortality is projected to reduce by 31.66 % [2019: 131.13, 2040:89.6 (IQR: 65.83, 113.37)] and stroke rates are estimated to reduce by 16.75% [2019: 91.09, 2040: 75.83 (IQR: 51.68, 99.98)]. However, PAD rates are projected to increase by 1.2% in the same period [2019: 1.58, 2040: 1.66 (IQR: 1.24, 2.07)]. The age standardized IHD and stroke mortality rates will reduce in males and females. However, the age standardized PAD rates will increase in females [2019: 1.33, 2040: 1.48 (IQR: 1.06, 1.89), 11.28% difference] and remain reasonably constant among males. Conclusion: In Brazil, the age standardized rates for IHD and stroke mortality are projected to decline till 2040. However, PAD related mortality is likely to be an important issue among females. Our findings highlight the need for early and targeted interventions to address these potential cardiovascular health disparities.

Abstract 4116981: Sex- and Racial/Ethnic Mortality Trends Across Separate Time Periods Following Hospitalization for Acute Myocardial Infarction

Intro: Mortality for patients hospitalized with acute myocardial infarction (AMI) has improved over time, but sex- and racial/ethnic disparities remain. Whether disparities have changed over specific time periods following hospitalization is poorly understood. Aim: To assess mortality trends across separate time periods following incident AMI hospitalization by sex and race. Methods: Using Medicare fee-for-service data covering all patients with incident AMI hospitalizations from 2008 to 2018, we examined unadjusted mortality rates by sex and race/ethnicity for the following time periods: acute (in-hospital), post-acute (0-30 days after hospital discharge), short term (31 days to 1 year after discharge), and long term (1-3 years after discharge). Each period was considered separately (i.e., patients who died during one period were not counted in later periods). Results: We identified 768,084 patients hospitalized with incident AMI (mean age 81 years, 48% male, 87% White) between 2008-2018. Figures 1 and 2 show annual mortality rates and trends. From 2008-2018, men and women had similar in-hospital and post-acute mortality, but women had persistently higher short- and long-term mortality compared to men. In 2008, Black patients had higher mortality rates compared to White patients for every period studied. In-hospital mortality rates were similar by 2018 but remained higher for Black patients for every other time period. Conclusions: For incident AMI patients, mortality rates have improved across subgroups through 3 years after discharge. However, women have had persistently higher mortality rates 1-3 years following hospitalization compared to men, while Black patients have had persistently higher mortality rates 30 days – 3 years following hospitalization compared to White patients. These results suggest that opportunities to reduce sex- and race-based AMI disparities might be particularly effective in longitudinal outpatient care following hospital discharge.

Abstract 4138301: Burden of Hyperlipidemia, Cardiovascular Mortality, and COVID-19: A Retrospective-Cohort Analysis of US Data

Background: Hyperlipidemia (HLD) is a major risk factor for cardiovascular disease (CVD). Little is known regarding temporal variation in CVD mortality related to HLD. The COVID-19 pandemic added complexity to factors influencing CVD mortality. Question: What are the yearly trends and impact of the COVID-19 pandemic on HLD-related CVD mortality in the United States? Methods: Mortality and demographic data for adults were obtained from CDC repository from 1999-2020, using ICD-10 codes HLD (E78.0-E78.5) and CVD (I00-I99). Age adjusted mortality rates (AAMR) per 1,000,000 population was standardized to the 2000 US population. Log-linear regression models evaluated mortality shifts. Average annual percentage change (AAPC) from 1999-2019 was used to calculate projected AAMR in 2020, subsequently compared to actual 2020 death rates to estimate pandemic-attributed excess deaths. Results: A total of 483,155 HLD-related CVD deaths were recorded between 1999-2020. Despite the CVD mortality decline in general population, HLD-related CVD AAMR rose from 36.33 [95% CI, 35.52-37.13] in 1999 to 99.77 [98.67-100.87] in 2019. Ischemic heart diseases (AAMR 49.39) were the most common causes of death while hypertension had the highest annual mortality increase (AAPC +10.23%) in populations with HLD. Higher HLD-related CVD mortality was observed in males (AAMR 104.87) than females (AAMR 61.93), in those ≥75 years (AAMR 646.45) than 35-75 years (AAMR 54.11), in non-Hispanic (NH) (AAMR 82.49) than Hispanic (AAMR 58.98) populations, and in rural (AAMR 89.98) than urban (AAMR 78.94) regions. NH Black populations (AAMR 84.35) and Western US regions (AAMR 96.88) had the highest HLD-related CVD. The first year of COVID-19 pandemic resulted in 10.55% excess HLD-related CVD death, with the most prominent increase in the 35-75 years age group (14.23%), Hispanic (17.96%), Black (14.82%), and urban (11.68%) populations. Conclusions: Our study revealed an increase in HLD-related CVD mortality which was exacerbated by the COVID-19 pandemic. Higher CVD mortality disproportionately affected males, Black, elderly (≥75 years), and rural populations with HLD. Further research is needed to validate our findings and identify contributing factors.

Burden of Hyperlipidemia, Cardiovascular Mortality, and COVID-19: A Retrospective-Cohort Analysis of US Data.

Hyperlipidemia is a major cardiovascular disease (CVD) risk factor, but limited data on its mortality trends in CVD over time. We assessed annual hyperlipidemia-related CVD mortality trends in the United States, including the COVID-19 pandemic's impact. Mortality data were obtained from CDC repository between 1999 and 2020 among patients ≥15 years old, using ICD-10 codes hyperlipidemia (E78.0-E78.5) and CVD (I00-I99). Age-adjusted mortality rates (AAMR) per 1,000,000 population was standardized to the 2000 US population. Log-linear regression models were used to evaluate mortality shifts. Average annual percentage change (AAPC) from 1999-2019 was used to project 2020 AAMR, estimating pandemic-attributed excess deaths. From 1999 to 2020, 483,155 hyperlipidemia-related CVD deaths occurred. Despite a general CVD mortality decline, hyperlipidemia-related CVD AAMR rose from 36.33 in 1999 to 99.77 in 2019. Ischemic heart diseases (AAMR 49.39) were the leading cause while hypertension had the highest mortality increase (AAPC +10.23%). Mortality rates were higher in males (AAMR 104.87), non-Hispanic (AAMR 82.49), and rural populations (AAMR 89.98). Highest mortality was observed in Black populations (AAMR 84.35), those ≥75 years (AAMR 646.45), and Western US regions (AAMR 96.88). During the first pandemic year, deaths exceeded projections by 10.55%, with notable increases among ages 35-75 (14.23%), Hispanic (17.96%), Black (14.82%), and urban (11.68%) groups. Hyperlipidemia-related CVD mortality has risen over the past two decades, further heightened by the COVID-19 pandemic, with higher impact on males, Black Americans, the elderly, and rural residents. Further study is needed to understand contributing factors and mitigate disparities.

State adoption of paid sick leave and cardiovascular disease mortality among adults in the United States, 2008-2019.

Cardiovascular diseases (CVD) are the leading cause of death in the United States and may be prevented through improved working conditions. The United States does not guarantee paid sick leave (PSL) at the federal level. We used quasi-experimental event study methods to examine the relationship between state-level PSL policies and county-level CVD mortality among working-age adults aged 15 to 64 over time (2008 to 2019). We examined the annual CVD mortality rates in 1054 counties from all 50 states and Washington D.C.. In the Northeastern region of the United States, there were drops in the CVD mortality rate in all years after PSL was adopted. We found no effect of PSL in the Western United States with a strong presence of pretreatment effects, making the results for that region uninterpretable. Our results support the use of state-level PSL policies to reduce county-level CVD mortality rates in the Northeastern United States.

State of oncology care in Russia: pancreatic cancer (C25). Diagnosis, prevalence, quality of patient registration, and annual mortality. Part 1. (clinical-population study)

The study focuses on pancreatic cancer (C25), a malignant neoplasm arising from the ductal epithelium or glandular tissue of the pancreas, which accounts for 3% of the overall cancer incidence in Russia. The rates of incidence and mortality are rising, with the number of newly registered patients in Russia being lower than the number of recorded deaths, although the one-year mortality rate among patients is decreasing. The direct cause of pancreatic cancer (C25) remains unknown. Risk factors for developing this condition include genetics, smoking, alcohol abuse, a sedentary lifestyle, excessive meat consumption, and a lack of plant-based foods in the diet. Diseases associated with a high risk of this pathology include long-standing chronic pancreatitis, newly diagnosed type 2 diabetes in individuals aged 50-70, and cystic neoplasms of the pancreas. The aim of the study is to examine the patterns of incidence and mortality, the quality of patient registration, the characteristics of tumor localization, and the histological structure of pancreatic cancer (C25). The study will also track the nature of annual mortality among patients and explore the possibilities, methods, and techniques of modern diagnosis and treatment for these patients. The research confirmed the significant burden of pancreatic cancer (C25), primarily due to the late detection of this disease. The study provided sufficient material to analyze age-related risk factors, as well as the patterns of incidence and mortality in the population. It also examined and presented mortality rates among patients, including during the first year of observation.

Perinatal deaths in twin and singleton infants in Ireland: A comparison of characteristics and causes.

Twin pregnancies are associated with significantly higher perinatal mortality (PM) rates compared to singletons, primarily due to complications like fetal growth restriction, preterm birth, and congenital anomalies. This study aimed to compare the characteristics associated with PM in twin pregnancies and compare maternal and obstetric factors and cause of death among twins and singletons in the Republic of Ireland. Data spanning 2011 to 2022 from the National Perinatal Epidemiology Centre's annual perinatal mortality clinical audit included 4494 perinatal deaths. Maternal characteristics, antenatal care factors and cause of death were analysed with relative risk calculated using national Hospital In-Patient Enquiry data. Pearson's chi-squared tests studied the difference between mortality in twins and singletons. Twins accounted for 10.4% of all perinatal deaths, despite representing only 3.6% of total births. The PM rate for twins was 17.3 per 1000 births, 3.1 times higher than for singletons. Early neonatal deaths (ENNDs) were more frequent in twins (54.2%), while stillbirths predominated among singletons (68.6%). Younger maternal age and lower BMI were associated with higher PM risks in twins. A considerable proportion of twin deaths with major congenital anomalies or birth before 28weeks gestation occurred in non-tertiary hospitals, suggesting limitations in referral pathways to centres with appropriate neonatal expertise. Twin pregnancies pose a higher risk of perinatal mortality, particularly among younger mothers and preterm births. The findings highlight the need for updated guidelines that prioritise early risk assessment, targeted interventions, and improved referral systems.

Liana versus tree seedling responses to spatial and temporal variation in dry season severity

AbstractLianas are key components of tropical forests, particularly at sites with more severe dry seasons. In contrast, trees are more abundant and speciose in wetter areas. The seasonal growth advantage (SGA) hypothesis postulates that such contrasting distributions are produced by higher liana growth relative to trees during seasonal droughts. The SGA has been investigated for larger size classes (e.g., ≥5 cm diameter at 1.3 m, dbh), but rarely for seedlings. Using eight annual censuses of >12,000 seedlings of 483 tree and liana species conducted at eight 1‐ha plots spanning a strong rainfall gradient in central Panama, we evaluated whether liana seedlings had higher growth and/or survival rates than tree seedlings at sites with stronger droughts. We also tested whether an extreme El Niño drought during the study period had a more negative effect on tree compared to liana seedlings. The absolute density of liana seedlings was similar across the rainfall gradient, ranging from 0.32 individuals/m2 (0.20–0.49, 95% credible interval [CI]) at the driest end of the gradient and 0.27 individuals/m2 (0.13–0.51 95% CI) at the wettest end of the gradient. The relative density of liana seedlings compared to tree seedlings was higher at sites with stronger dry seasons (0.27, 0.21–0.33, 95% CI), compared to wetter sites (0.12, 0.04–0.20 95% CI), due to lower tree seedling densities at drier sites. However, liana seedlings did not grow or survive better than tree seedlings in drier sites compared to wetter sites. Tree seedlings were more negatively impacted in terms of mortality by the extreme El Niño drought than liana seedlings, with an increase in annual mortality rate of 0.013 (0.003–0.025 95% CI) compared to lianas of −0.009 (−0.028 to 0.008 95% CI), but not growth. Our results indicate that lianas do not have a SGA over trees at the seedling stage. Instead, higher survival of liana versus tree seedlings during severe droughts or differences in liana versus tree fecundity or germination across the rainfall gradient likely explain why liana seedlings have higher relative densities at drier sites.

Was Palaeolake Messel a death-trap? Insight from modern bat drownings and decay experiments

AbstractThe Messel Pit is an ancient maar lake that preserves an ecosystem from the last greenhouse phase of Earth’s climate with exceptional fidelity. There are two main competing hypotheses to explain the occurrence of animal fossils at Messel: asphyxiation in layers of heavy, toxic gases like carbon dioxide, and death following ingestion of surface water contaminated by cyanobacterial toxins. Both hypotheses imply mortality much higher than the null hypothesis of accidental death, for instance by drowning. We tested these hypotheses amongst bats by recourse to a unique survey on bats that drowned in modern swimming pools. We further conducted experiments on the fate of fresh bat carcasses that simulate drowning. Finally, we estimated the annual rate of bat fossil production at Messel. Overall, there are few good surveyed predictors of whether bats drown in swimming pools: most physical parameters like pool size or the height and distance of obstructions were not associated with mortality, although pool liner type would be a good candidate parameter for future study. In our experiments, carcasses with water-filled lungs tend to sink more quickly than those with air-filled lungs; all carcasses that initially sink “bloat and float” at shallow depths, but all floaters eventually disarticulate and sink within days to weeks. Our estimates of annual bat mortality at Palaeolake Messel are of the same order of magnitude as mortality in swimming pools. Mass mortality horizons for vertebrates are very rare at Messel. In sum, our quantitative analyses provide no evidence that bat mortality at Messel rises above background levels.

Analysis of Mortality Causes and Locations in Veterans with ALS: A Decade Review.

BACKGROUND Amyotrophic lateral sclerosis (ALS) is a motor neuron disease that leads to rapid degeneration of nerves in the brain and spinal cord, with eventual loss of voluntary movements, including breathing. This retrospective study of medical record data from 105 US veterans diagnosed with ALS at the Oklahoma City VA Medical Center between 2010 and 2021 aimed to identify patient demographics, and the causes and places of death for these veterans. MATERIAL AND METHODS Data from 105 US veterans diagnosed with ALS by the El Escorial criteria and supported by neurophysiology testing was reviewed. The information about the place and cause of death was obtained from each patient's care provider and death certificate. Crude mortality rates (per 100 person-years) and standardized mortality ratios (SMRs) were calculated for the causes of death, by sex, age group, and location of death. RESULTS During the 11-year follow-up period, 80 (76.2%) veterans with ALS died. The mean (SD) follow-up time was 4.53 (4.55) years. Most of the deaths were due to respiratory failure and pneumonia (n=43, mortality rate=9.21 per 100 person-years). Most patients died at home (n=71, 88.7%). The annual crude mortality rate was 16.7 and the all-cause death SMR was 25.63 (95% CI, 20.32-31.55). CONCLUSIONS This study's findings are that in veterans with ALS, the main cause of death is respiratory disease (failure). The main location of death was the home, with their family members. The all-cause mortality rate among veterans with ALS was 26 times greater than for the general Oklahoma population.

Integrating information from historical data into mechanistic models for influenza forecasting.

Seasonal influenza causes significant annual morbidity and mortality worldwide. In France, it is estimated that, on average, 2 million individuals consult their GP for influenza-like-illness (ILI) every year. Traditionally, mathematical models used for epidemic forecasting can either include parameters capturing the infection process (mechanistic or compartmental models) or rely on time series analysis approaches that do not make mechanistic assumptions (statistical or phenomenological models). While the latter make extensive use of past epidemic data, mechanistic models are usually independently initialized in each season. As a result, forecasts from such models can contain trajectories that are vastly different from past epidemics. We developed a mechanistic model that takes into account epidemic data from training seasons when producing forecasts. The parameters of the model are estimated via a first particle filter running on the observed data. A second particle filter is then used to produce forecasts compatible with epidemic trajectories from the training set. The model was calibrated and tested on 35 years' worth of surveillance data from the French Sentinelles Network, representing the weekly number of patients consulting for ILI over the period 1985-2019. Our results show that the new method improves upon standard mechanistic approaches. In particular, when retrospectively tested on the available data, our model provides increased accuracy for short-term forecasts (from one to four weeks into the future) and peak timing and intensity. Our new approach for epidemic forecasting allows the integration of key strengths of the statistical approach into the mechanistic modelling framework and represents an attempt to provide accurate forecasts by making full use of the rich surveillance dataset collected in France since 1985.

Trends in heart failure mortality in Sweden between 1997 and 2022.

Data from US have shown a reversal in the improvement of heart failure (HF)-related mortality over the last ~10 years. It is unknown whether these trends generalize to European universal healthcare systems. We assessed temporal trends in (i) HF-related mortality in the overall national population; and (ii) all-cause mortality following an incident HF diagnosis, overall and stratified by ejection fraction (EF), in Sweden between 1997 and 2022. Annual mortality rates with a HF diagnosis as underlying cause were extracted from the Cause of Death Register. All-cause mortality following incident HF was assessed in two HF cohorts derived from the National Patient Register (NPR) and the Swedish HF Registry (SwedeHF). Temporal trends were presented as average annual percentage change (AAPC). Between 1997 and 2022, age-adjusted HF-related mortality in the general population declined from 33.4 to 23.8 per 100 000 individuals (AAPC -2.15%, p < 0.001). In the HF cohort from NPR (n = 423 092), all-cause mortality at 1, 3, and 5 years following a first diagnosis of HF was 25%, 46%, and 58%, respectively, in 2022; 1-year mortality declined (AAPC -1.10%, p < 0.001) over time regardless of age or sex. In SwedeHF (n = 63 753), the decline in 1-year mortality was less steep with increasing EF (AAPC -2.64%, p < 0.001; -2.30%, p = 0.062; and -2.16%, p = 0.032 in EF <40%, 40-49%, and ≥50%, respectively). Heart failure-related mortality has declined over the last ~25 years in Sweden. All-cause mortality in patients with HF has also declined, more in HF with reduced than preserved EF, mirroring the different availability of life-saving treatments across the EF spectrum.

Reduced stroke volume by resting 2-dimensional echocardiography negatively affects survival in patients with abnormal ejection fraction

Abstract Background Abnormal (&amp;lt;50%) ejection fraction (EF) is a cornerstone of risk stratification and therapy, but also an imperfect proxy of left ventricular (LV) cardiac pump function, better assessed with stroke volume (SV). Aim To assess the value of SV in stratifying risk of patients with abnormal EF. Methods In a prospective, observational, multicenter study, we recruited 746 patients (age 66± 11 years, 536 males, 72%, 359 with previous myocardial infarction, 48%) with chronic coronary syndromes (CCS) and EF &amp;lt;50% referred for resting transthoracic echocardiography with technically successful 2-dimensional volumetric echocardiography in 17 accredited laboratories. We quantitatively assessed LV end-diastolic volume (EDV) and end-systolic volume (ESV) by Simpson’s biplane method. EF (EDV-ESV/EDV) and SV (EDV-ESV) were calculated from LV volumes. The outcome end-point was all-cause death. Results EF was 39±9%, SV 48±20 ml. There were 100 all-cause deaths during a median follow-up of 796 days (interquartile range 420-1286 days). Receiver-operating curve analysis identified SV≤31.4 ml/b as the best cut-off for predicting mortality. At multivariable analysis, after adjustment for age and prior myocardial infarction, EF &amp;lt;40% and SV ≤31.4 ml/b were significantly associated with decreased survival (HR 2.09, 95%, confidence intervals 1.09-4.01, p=0.024). The annual mortality was lowest (3.19%) in the group with mildly reduced (40-49%) EF and normal (&amp;gt;31.4 ml) SV, and highest (8.30%) in patients with both reduced EF and abnormal SV: see figure. Conclusion Patients with CCS and abnormal EF are a prognostically heterogeneous group, and the mortality rate is almost 3-times worse in patients with reduced EF and abnormal SV compared to patients with mildly reduced EF and normal SV. A simple resting volumetric two-dimensional echocardiography can offer an efficient risk stratification, beyond EF, with no extra imaging or analysis time.Figure

Changing patterns in clinical, echocardiographic and haemodynamic characteristics, and management strategies that may be translated to improved survival in pulmonary hypertension

Abstract Background and aims In this retrospective analysis of a single-center series on pulmonary hypertension (PH), we aimed to evaluate clinical, echocardiographic, and hemodynamic characteristics, management strategies, morbidity, and mortality in PH subgroups across three consecutive periods. Methods The study included 1071 patients enrolled in the Evaluation of Pulmonary Hypertension Risk factors Associated with Survival study (EUPHRATES). In reference to enrollment time, patients were assessed in three periods ; before 2016, the era of primarily monotherapy or sequential combinations; between 2016 and 2019, post-approval and reimbursement of macitentan in our country, marking a shift towards more proactive sequential combinations; and after 2019, signifying the initiation of earlier sequential combinations with selexipag in pulmonary arterial hypertension (PAH). The ESC/ERS 2022 risk scoring, COMPERA 2.0 and REVEAL lite 2 models were used for risk predictions. Composite endpoint (CEP) definitions were adopted from the SERAPHIN and GRIPHON trials. Annual incidence curves for mortality and CEP were evaluated, but 2020 analysis was adjusted to account for the possible adverse effects of the COVID-19. Results During the 1st, 2nd and 3rd periods, 481, 352, and 238 patients with PH were diagnosed, respectively. Incident cases comprised 91% of them. Idiopathic PAH (IPAH), PAH-associated with congenital heart diseases (CHD-PAH), PAH-associated with connective tissue diseases (CTD-PAH), group II, III, IV and V PH were documented in 24 %, 28 %, 4.6 %, 4.3 %, 11%, 27 % and 0.7 % of patients, respectively. Age and female dominance remained unchanged. Incidences of Group 1 PH and CHD-PAH decreased while IPAH, drug-associated PAH, and Group II and IV PH increased across three periods (p-values varying from &amp;lt;0.001 to 0.03). Although baseline functional class became worse (p=0.013), six-minute walk distance, N-terminal pro brain natriuretic peptide and risk scores showed no change (p=NS). Baseline echo and hemodynamic measures became better, and triple combinations increased after 2019 (p&amp;lt;0.001 for all). For overall PH, rates of all-cause mortality and CEPs at 1st, 2nd and 3rd periods were 52 % and 59 %, 30 % and 35 %, and 11 % and 13 %, respectively (p&amp;lt; 0.001, for all). Mortality rates for 1st, 2nd and 3rd periods were 36 %, 38 % and 26 % in IPAH, 60 %, 28 % and 13 % in CHD-PAH, 55 %, 22% and 22% in CTD-PAH, 38 %, 38% and 24 % in group IV PH, respectively (p&amp;lt; 0.001, for all). Mortality curves showed sudden increases in 2020, but excluding 2020, a steady improvement in the annual mortality was evident. Conclusions Our findings suggest a trend towards better clinical, echocardiographic, and hemodynamic presentations and improved survival in the PAH subgroups, and Group IV PH across the three periods that might be attributed to more proactive management strategies favouring earlier initiation of combinations.

Prognostic significance of coronary flow velocity reserve in patients with peripheral arterial disease

Abstract Background Patients with lower extremity peripheral arterial disease (PAD) have a higher risk of cardiovascular events. Stress echocardiography (SE) based on regional wall motion abnormality (RWMA) is imperfect for risk stratification in PAD, but it can be complemented with an assessment of coronary flow velocity reserve (CFVR) in the mid-distal left anterior descending coronary artery. Purpose To assess the value of SE with RWMA and CFVR to predict survival in PAD. Methods In a retrospective analysis of prospectively acquired data in an observational, multicenter study, we recruited 359 patients (age 69±8 years, 240 [67%] males) with PAD referred for dipyridamole SE in 3 accredited laboratories. We assessed RWMA and CFVR (abnormal value &amp;lt;2.0). All patients were followed up for a median of 4.7 (interquartile range: 2.0 to 8.2 years). All-cause death was the outcome end-point. Results The positivity rate was 37/359 (10%) for RWMA and 159/359 (44%) for CFVR. During follow-up, 97 (27%) deaths were registered. At multivariable analysis, inducible RWMA and/or CFVR &amp;lt;2.0 (HR 2.58, 95% CI 1.65-4.04; p&amp;lt;0.0001), age ≥70 years, diabetes, dialysis treatment, and ejection fraction ≤50% were associated with decreased survival. The annual mortality was 7.4% in patients with RWMA and/or CFVR &amp;lt;2.0 and 2.7% in those with no RWMA and CFVR &amp;gt;2.0 (Figure, p&amp;lt;0.0001). Conclusion In patients with PAD, SE shows more than 4-fold higher prevalence of abnormal CFVR compared to RWMA. The prognostic value of CFVR outperforms RWMA, showing the importance of coronary microvascular dysfunction and diffuse, subcritical coronary atherosclerosis in determining the outcome.