Cardiovascular Admissions Research Articles

Meta-Analysis and Metaregression of the Treatment Effect of Intravenous Iron in Iron-Deficient Heart Failure

BackgroundGuidelines recommend that intravenous iron should be considered to improve symptoms of heart failure (HF) and reduce the risk for HF admissions in patients after acute HF. ObjectivesThis study sought to analyze the effect of intravenous iron on cardiovascular (CV) death and HF admissions in a broad population of HF patients with iron deficiency and the relation with baseline transferrin saturation (TSAT). MethodsA systematic review of all published randomized controlled trials assessing the effect of intravenous iron in patients with iron deficiency and HF between January 1, 2000, and August 26, 2023, was performed. The overall treatment effect was estimated using a fixed effect model for: 1) CV death; 2) CV death and HF admission; 3) first HF admission; and 4) total HF admissions. Metaregression through a mixed effect model was used to explore the impact of baseline TSAT in case of heterogeneity among trial results. ResultsA total of 14 randomized controlled trials were identified in the systematic review and retained in the meta-analysis. Aggregate-level data were included on 6,624 HF patients, 3,407 of whom were randomized to intravenous iron and 3,217 to placebo. Treatment with intravenous iron resulted in a lower risk for CV death (OR: 0.867 [95% CI: 0.755-0.955]; P = 0.0427), combined CV death and HF admission (OR: 0.838 [95% CI: 0.751-0.936]; P = 0.0015), first HF admission (OR: 0.855 [95% CI: 0.744-0.983]; P = 0.0281), and total HF admissions (rate ratio: 0.739 [95% CI: 0.661-0.827]; P < 0.0001). Significant heterogeneity among trial results was observed for first and total HF admissions. Metaregression suggested that some of the heterogeneity was related to the baseline TSAT of the enrolled population, with trials enrolling patients with lower TSAT exhibiting a large effect size on HF-related events. ConclusionsThe totality of data suggests that treatment with intravenous iron reduces both CV death and HF-related events in a broad population with HF. A lower baseline TSAT might be important for the effect on HF-related events.

Effect of intravenous iron-carbohydrate complexes in patients with heart failure with reduced ejection fraction and iron deficiency: a meta-analysis of randomized controlled trials

Abstract Background Iron deficiency (ID) has been associated with having the potential to cause heart failure as well as worsening heart failure with reduced ejection fraction (HFrEF). Treatment with a target on ID has been shown to lead to improvement in heart failure patient outcomes. In this study, we performed a meta-analysis of the RCTs to more comprehensively evaluate the effectiveness of intravenous iron-carbohydrate complexes in HF patients with ID. Methods We conducted a systematic literature search on MEDLINE and EMBASE. The search terms included "iron," "iron deficiency," "iron complex," "iron-carbohydrate," "iron sucrose," "heart failure," "HFrEF," and "intravenous." Included studies met the following criteria: (i) a study was published in a peer-reviewed journal; (ii) a study design was a randomized controlled trial; (iii) study enrolled patients with HFrEF and ID, and (iv) a study evaluated intravenous iron-carbohydrate complex. The primary outcome was all-cause mortality during the follow-up. The secondary outcomes were cardiovascular (CV) mortality (deaths due to CV causes), CV admission (hospitalizations due to cardiovascular causes), and HF admission (first hospitalizations due to HF or hospitalizations due to HF worsening). Risk ratios (RRs) with 95% confidence intervals (95%CIs) were calculated with the event/total number in each study and synthesized by a random-effects model. Results We identified 926 articles by the initial database search and additional manual search and retrieved the full text of 18 articles for further review. We then excluded 3 sub-analyses of the included trials to avoid patients’ duplications. Finally, we included 15 RCTs with a total of 3,085 patients (the median or mean age, 62–75 years; female, 25-55%; median follow-up duration, 2–141 weeks). Intravenous iron-carbohydrate complexes were associated with lower risks of all-cause mortality, CV mortality, CV admission, and HF admission, though statistical significance was only observed in HF admission (Figure A-D). CV admission and HF admission provided substantial heterogeneity. Conclusion The results of this meta-analysis showed that intravenous iron-carbohydrate complex therapy in patients with HFrEF and ID was beneficial in lowering the risk of hospitalization due to heart failure. Physicians should be aware of the significance of ID when treating patients with HFrEF.

A universal electronic consultation programme at the cardiology department after general practitioner referrals improves healthcare outcomes in patients with health failure

Abstract Background Electronic consultation (e-Consult) is an emerging health care innovation developed to address excess wait times for specialist care by enabling primary care physicians (PCPs) to obtain a specialist consultant’s expert opinion in a timely manner 1. A recent wait time report in England showed that in the first 7 months of 2017, 89.4% of patients waited up to 18 weeks to see a specialist. This result failed to meet their standard of 92% of patients waiting no more than 18 weeks for their consult 2. e-Consult services were shown to be effective in terms of providing faster access to specialist’s advice, with short response times (from 1 to 6 days) of the participating specialists and resulting in substantial avoidance of face-to-face referral visits 3. The recent ESC HF guideline made a "may be considered" recommendation for the use of home-based telemonitoring, according on a meta-analysis published in 2017 4,5. Nevertheless, never has been evaluated the impact on access to care and clinical outcomes of a clinician-to-clinician e-consult program as a first step for all the PCPs referrals to cardiologist in heart failure patients. Purpose We aimed to assess in patients with heart failure (HF) the clinical impact of the implementation of an outpatient care model that includes an initial e-consultation (from 2013 to 2021) and to compare it with a one-time in-person consultation model (from 2010 to 2012) for all the primary care physicians’ referrals to a cardiology department. Methods We selected 6,859 HF patients who visited the cardiology service at least once between 2010 and 2021: 4,851 were attended in e-consultation and 2,008 in one-time in-person consultations. Using an interrupted time series regression model, we analysed the impact of incorporating e-consultation into the health care model (started in 2013), and evaluated the elapsed time to cardiology care, cardiovascular (CV) and HF hospital admissions, and HF, CV and all-cause mortality. Results The interrupted time series regression model showed that the introduction of e-consultation substantially decreased waiting times to cardiology care (8.6 [8.7] vs 55.4 [79.9] days, p&amp;lt;0.001). and a reduction in the need for visits to the emergency department 1-year after e-consultation compared with the previous period (HR [IC95%]: 0.07 [0.05-0.08]). After e-consultation implantation, hospital admissions were reduced (RRi [IC95%]: 0,867 [0,875-0,838] for HF, 0,838 [0,825-0,856] for CV and 0,639 [0,635-0,651] all-cause), figure 1; and lower mortality (RRi [IC95%]: 0,981 [0,977-0,983] due to HF, 0,977 [0,970-0,980] for CV and 0,985 [0,984-0,985] for all-cause), figure 2. These results were maintained during the COVID-19 pandemic. Conclusion In HF patients, an outpatient care program that includes an e-consultation significantly reduced waiting times to cardiology care and was safe, with a lower rate of hospital admissions and mortality in the first year.Figure 1Figure 2

The impact of cancer on the risk of hospitalisation for bleeding among acute coronary syndrome patients: an analysis of the Virtual Cardio-Oncology Research Initiative (VICORI) database

Abstract Introduction Cardiovascular disease and cancer are common causes of morbidity and mortality. Significant advancements in treatment strategies for both disease entities have resulted in a growing population who live with both conditions. Myocardial infarction (MI) represents approximately 20% of all cardiovascular disease admissions in cancer patients and 10% of patients who present with an acute MI has cancer. Bleeding is a major concern in patients with cancer and an acute coronary syndrome (ACS). While dual antiplatelet therapy (DAPT) increases a patient’s bleeding risk, cancer patients are at a further increased risk. Cancer is a recognised risk factor associated with an increased bleeding risk after percutaneous coronary intervention (PCI), but blood dyscrasias, liver disease and multiple long-term conditions – all common to cancer patients – further exacerbate this risk. Prescribing DAPT post-ACS and post-PCI remains a challenge when balancing ischaemic and bleeding risks in this population. The VICORI database is the world’s first whole-country cardio-oncology research platform, linking data from the National Cancer Registration and Analysis Service, National Institute for Cardiovascular Outcomes Research and Hospital Episode Statistics [1]. Purpose To investigate the risk of hospitalisation for bleeding among ACS patients stratified by presence or absence of cancer. Methods This is an observational cohort study using linked data from the VICORI programme. We explored the risk of hospitalisation for bleeding following an ACS, in patients with and without cancer, identified between 2006–2019. Patients were followed up for one year from the date of their ACS. We used inverse probability weighting based on propensity scores to produce a balanced cohort of patients with and without cancer. Subgroup analyses were performed on patients with ST and non-ST-elevation MI alongside coronary stenting. Results Of 608,771 patients presenting with ACS, 9861 (1.6%) had cancer and 598,910 (98.4%) did not have cancer. Prostate (n=1753, 17.8%), colorectal (n=1548, 15.7%), lung (n=1543, 15.7%) and breast (n=607, 6.2%) cancers were the most common types of primary cancers. Relating to PCI, cancer patients received stents in only 35.4% (n=3,489) of cases, while non-cancer patients received stents in 55.5% (n=332,566) of cases. Bleeding events were more prevalent in cancer patients compared to non-cancer patients (n=779, 7.9% vs n=28,016, 4.7%). The rate (hazard) of hospitalisation for bleeding in the first year following ACS was higher in patients with cancer than those without (HR:1.46, 95%CI 1.36-1.57). Conclusion In this large real-world observational study, cancer patients had an increased risk of hospitalisation for bleeding after ACS compared to those without. Further work is needed to identify people with cancer who are at a high-risk of bleeding, optimal therapies, and the risk:benefit ratio of bleeding versus subsequent cardiovascular events.Incidence Rate of Bleeding in PatientsHazard Ratios for Bleeding

Impact of cardiorenal syndrome on clinical outcomes of atrial fibrillation patients undergoing catheter ablation

Abstract Background Heart failure (HF) coexists with both atrial fibrillation (AF) and chronic kidney disease (CKD) and exacerbate each other. All of them are increasing in the aging society all over the world. Little is known regarding the impact of cardiorenal syndrome (CRS) on clinical outcomes of patients with AF undergoing catheter ablation (AFCA) in the real-world setting. Purpose In the present study, we investigated clinical outcomes of CRS patients with de novo AFCA. Method: Consecutive 494 patients (68.1±11.1 yrs, male 68.0%) undergoing de novo AF catheter ablation in our hospital from April 2019 to March 2021 were enrolled. CRS was defined as having both HF and CKD. HF was defined as having a history of HF admission and/or BNP≥100 pg/mL. CKD was defined as eGFR&amp;lt; 60 ml/min/1.73m2. The primary outcome was composite outcomes of; all-cause death, redo ablation, thromboembolisms, atherosclerotic cardiovascular disease (ASCVD) events, major bleeding, HF admission, and dialysis initiation. Result The incidence of primary outcome in CRS patients during median follow-up periods of 739.5 days was significantly higher than the non-CRS patients (54.9% in CRS vs. 30.3% in non-CRS; P&amp;lt;0.01, Figure 1). In CRS patients, all-cause death, ASCVD events, and HF admission were significantly worse (7.7% in CRS vs. 0.3% in non-CRS; P&amp;lt;0.01, 10.3% in CRS vs. 1.8% in non-CRS; P&amp;lt;0.01, 11.5% in CRS vs. 0.9% in non-CRS; P&amp;lt;0.01, respectively, Table), however redo ablation, thromboembolism, major bleeding and dialysis initiation were similar compared with non-CRS patients (10.3% in CRS vs. 14.5% in non-CRS; P=0.25, 1.3% in CRS vs. 0.6% in non-CRS; P=0.59, 5.1% in CRS vs. 2.1% in non-CRS; P=0.09, 1.3% in CRS vs. 0.3% in non-CRS; P=0.24, respectively, Table). The incidence of primary outcome in CRS patients was similar in those with ejection fraction (EF)≤40% and in those with EF&amp;gt;40% (47.6% in EF≤40% vs. 54.7% in EF&amp;gt;40%; P=0.48, Figure 2), however it was significantly higher in those with eGFR&amp;lt;45 compared with those with eGFR≥45 (74.8% in eGFR&amp;lt;45 vs. 26.2% in eGFR≥45+ P&amp;lt;0.01, Figure 3). Conclusion CRS patients with AFCA had significantly worse outcomes with more all-cause death, ASCVD events and HF admission compared with non-CRS patients. In the CRS patients undergoing AFCA, worse kidney function, rather than the cardiac systolic function, had a significant prognostic impact on the over-all clinical outcomes.

Does a digitally enabled telerehabilitation program reduce hospital admissions and length of stay for private health insurance patients in Australia?

Abstract Introduction Traditional cardiac rehabilitation (CR) programs are associated with reduced cardiovascular morbidity, hospital admissions and mortality. However, participation continues to be poor. Novel digital health models of care have emerged, providing a new frontier in healthcare delivery, but evidence for their impact on healthcare utilization is limited. We implemented and investigated a telehealth program complemented by a CR mobile app for patients following a hospitalization for coronary heart disease (CHD). Purpose To assess whether a digitally enabled CR program is equivalent to traditionally delivered CR (F2F-CR) and whether it reduces rehospitalizations and total hospital days compared to patients who did not undertake CR (no-CR). Methods Privately insured patients, following a hospitalization for CHD, were recruited nationally, across Australia, between October 2019 - 2020. Participants received weekly telehealth consultations for 8 weeks, supplemented by a CR mobile app. Using administrative private health insurance claims data, we assessed differences in 90-day and 12-month rehospitalizations and total hospital days for the digital-CR group (n=138) compared with a) F2F-CR (n=115) and b) no-CR (n=266). Results Among the cohort, 27% lived in regional/rural areas, 71% were male and the majority were aged over 60 years (83%). The digital-CR group had lower total hospital days relative to the no-CR group in the 12 months post index event (4.5 vs 7.2 days; mean difference 2.8 days; p=0.019; 95% CI: 5.1-0.5). Readmission rates were lower at 90 days and similar at 12 months post discharge in the digital-CR group compared with the no-CR group, although not statistically significant. There were 0.17 and 0.21 (p=0.43) readmissions per patient at 90 days post discharge and 1.08 and 1.07 (p=0.94) readmissions per patient within 12 months in the digital-CR group and no-CR group respectively. There were no significant differences for digital-CR relative to F2F-CR on any measures. Conclusion Rehospitalization rates were similar between the groups, whilst the digital-CR group had significantly fewer days in hospital than the no-CR group. Digital-CR may reduce the severity of rehospitalizations highlighted by fewer days in hospital. The digital-CR and F2F-CR outcomes were similar, confirming that digitally enabled CR programs provide similar benefits regarding reduced days in hospital, whilst providing additional benefits of improved access and choice. Digital-CR should be made widely available for cardiac patients post hospital discharge.Mean hospital days Digital-CR vs No-CRMean hospital days Digital-CR vs F2F-CR

Association between the triglyceride-glucose index and 1-year major adverse cardiovascular events in patients with coronary heart disease and hypertension

BackgroundThe triglyceride-glucose (TyG) index has been proposed as a potential predictor of adverse prognosis of coronary heart disease (CHD). However, its prognostic value in patients with CHD and hypertension remains unclear. This study aimed to evaluate the association between the TyG index and the 1-year risk of major adverse cardiovascular events (MACEs) in patients with CHD and hypertension.MethodsThe data for the study were taken from the Hospital Information System database in China-Japan Friendship Hospital which contained over 10,000 cardiovascular admissions from 2019 to 2022. The Boruta algorithm was performed for feature selection. The study used univariable analysis, multivariable logistic regression analysis, and restricted cubic spline (RCS) regression to evaluate the association between the TyG index and the 1-year risk of MACEs in patients with CHD and hypertension.ResultsAfter applying inclusion and exclusion criteria, a total of 810 patients with CHD and hypertension were included in the study with a median TyG index of 8.85 (8.48, 9.18). Using the lowest TyG index quartile as the reference, the fully adjusted ORs (95% CIs) for 1-year MACEs for TyG index Q2, Q3, and Q4 were 1.001 (0.986 ~ 1.016), 1.047 (1.032 ~ 1.062), and 1.760 (1.268 ~ 2.444), respectively. After adjusting for all confounders, we found that those with the highest TyG index had a 47.0% increased risk of MACEs over the 1-year follow-up (OR 1.470, 95% CI 1.071 ~ 2.018). The results in the subgroup analysis were similar to the main analyses. RCS model suggested that the TyG index was nonlinearly associated with the 1-year risk of MACEs (P for nonlinear < 0.001).ConclusionThis study shows that the elevated TyG index is a potential marker of adverse prognosis among patients with CHD and hypertension and informs the development of clinical decisions to improve outcomes.

Abstract 19062: Prognostic Impact of Coronary Microvascular Dysfunction on Diastolic Dysfunction and Cardiovascular Events in Patients With Acute Coronary Syndrome

Introduction: Coronary microvascular dysfunction (CMD) has prognostic value in coronary artery disease. Hypothesis: CMD could have an influence on progression of diastolic dysfunction and occurrence of cardiovascular events in acute coronary syndrome (ACS). Methods: We prospectively enrolled ACS patients who underwent successful percutaneous coronary intervention (PCI). CMD was defined by index of microcirculatory resistance (IMR &gt;40) after PCI. Cardiac diastolic dysfunction was defined by echocardiographic parameters (early diastolic transmitral flow velocity/early diastolic mitral annular velocity, e’ velocity, tricuspid regurgitation velocity, and left atrial volume index). The primary end point was 1-year diastolic dysfunction and secondary end point was cardiovascular death or admission for heart failure during 5 years of follow-up. Results: Among 163 patients, 39 patients (23.9%) had CMD. Prevalence of 1-year diastolic dysfunction was increased during 1 year (baseline 29.4% vs. 1 year 46.0%). Progression rate of diastolic dysfunction during 1 year was significantly higher in CMD (40.3% vs. 64.1%, OR 2.64, p=0.008) (Figure). After adjustment with clinical variables, presence of CMD was strongly associated with progression of 1-year diastolic dysfunction (HR, 2.95, 95% CI 1.30 - 8.74, p=0.030). Risk of cardiovascular death or admission for heart failure was increased in CMD (37.9% vs. 7.1%; Log-rank test p=0.003) Conclusions: This study showed the association between presence of CMD and progression of diastolic dysfunction during 1 year, they might have synergistic influence on occurrence of cardiovascular events in ACS patients.

Abstract 18801: Impact of COVID-19 Pandemic on Cardiovascular Diseases Hospitalisation, Management and Mortality in Brazil

Introduction: The COVID-19 pandemic led to a reduction in cardiovascular (CVD) hospital admissions in many countries. We aimed to assess the effect of the COVID-19 pandemic on CVD hospitalizations, management, and mortality in Brazil. Methods: Hospitalization data for the years 2020 and 2021 for Brazil and regions were analyzed using the Datasus hospital admission system. We analyzed the number of hospitalizations, the number and proportion of intensive care unit (ICU) utilization, and the number and proportion of in-hospital deaths. The observed data were compared to the average of the previous three years (2017 to 2019). Absolute differences and risk ratios (RR) were calculated, with the RR obtained by dividing the observed values by the expected ones for each period studied. Results: There was a reduction in CVD hospital admissions, with 184,727 (95% CI 157,579 to 211,876) fewer hospitalizations than expected, representing a decrease of 16.2% (RR 0.838; 95% CI 0.836-0.839). There were two valleys of reduction in CVD hospitalizations, the first before the first peak of Covid-19 hospitalizations and the second simultaneous to the second peak of Covid-19 hospitalizations in 2021. There was a 9% decrease in the absolute number of CVD admissions in the ICU (RR 0.910; 95% CI 0.907-0.912), associated with a 4.7% absolute decrease in the number of CVD admissions that resulted in in-hospital deaths (RR 0.953; 95% CI 0.949-0.957). However, there was an 8.6% increase in the proportion of ICU admissions due to CVD (RR 1.086; 95% CI 1.084-1.088) and a significant increase of 14.4% in the proportion of admissions due to CVD that resulted in in-hospital death. Conclusions: Brazil′s data reveal that the Covid-19 pandemic reduced the number of CVD hospitalizations, but with a higher proportion of ICU use and higher in-hospital mortality.

Impact of a clinician-to-clinician electronic consultation in heart failure patients with previous hospital admissions.

To evaluate the impact of an outpatient care management programme that includes a clinician-to-clinician e-consultation on delay time in care, hospital admissions, and mortality in a high-risk group of patients with heart failure (HF) and previous episodes of HF hospitalization (HFH). We selected 6444 HF patients who visited the cardiology service at least once between 2010 and 2021. Of these, 4851 were attended in e-consult, and 2230 had previous HFH. Using an interrupted time series regression model, we analysed the impact of incorporating e-consult into the healthcare model in the group of patients with HFH and evaluated the elapsed time to cardiology care, HF, cardiovascular (CV), and all-cause hospital admissions and mortality, calculating the incidence relative risk (iRR). In the group of patients with HFH, the introduction of e-consult substantially decreased waiting times to cardiology care (8.6 [8.7] vs. 55.4 [79.9] days, P < 0.001). In that group of patients, after e-consult implantation, hospital admissions for HF were reduced (iRR [95%CI]: 0.837 [0.840-0.833]), 0.900 [0.862-0.949] for CV and 0.699 [0.678-0.726] for all-cause hospitalizations. There was also lower mortality (iRR [95%CI]: 0.715 [0.657-0.798] due to HF, 0.737 [0.764-0.706] for CV and 0.687 [0.652-0.718] for all-cause). The improved outcomes after e-consultation implementation were significantly higher in the group of patients with previous HFH. In patients with HFH, an outpatient care programme that includes an e-consult significantly reduced waiting times to cardiology care and was safe, with a lower rate of hospital admissions and mortality in the first year.

Differential Associations of A-/B-Type Natriuretic Peptides With Cardiac Structure, Function, and Prognosis in Heart Failure

BackgroundNatriuretic peptide (NP) elevations are prognostic in heart failure (HF), but relative atrial NP deficiency in acute HF has been suggested. ObjectivesThe authors compared plasma concentrations and relative strength of associations of A- and B-type NPs with cardiac structure/function and clinical outcomes in HF. MethodsMidregional pro–atrial natriuretic peptide (MR-proANP), B-type natriuretic peptide (BNP), and N-terminal pro–B-type natriuretic peptide (NT-proBNP) were measured in patients with compensated HF in a prospective, multicenter study. The primary outcome was a composite of HF-hospitalization or all-cause mortality. Secondary outcomes included individual primary outcome components and cardiovascular admission. ResultsAmong 1,278 patients (age 60.1 ± 12.1 years, 82% men, left ventricular ejection fraction [LVEF] 34% ± 14%), median concentrations of MR-proANP were 990 pg/mL (Q1-Q3: 557-1,563 pg/mL), NT-proBNP 1,648 pg/mL (Q1-Q3: 652-3,960 pg/mL), and BNP 291 pg/mL (Q1-Q3: 103-777 pg/mL). No subpopulation with inappropriately low MR-proANP (relative to BNP/NT-proBNP) was observed. Clinical event rates were similar for biomarker tertiles. Increments in MR-proANP exhibited steeper associations with concurrent shifts in left ventricular size, diastolic indexes and LVEF than BNP/NT-proBNP at baseline and serially (P < 0.05), and lower odds of beneficial left ventricular reverse remodeling: OR: 0.35 (95% CI: 0.18-0.70). In single-biomarker models, MR-proANP(log10) was associated with the highest hazard (4 to 6 times) for each outcome. In multimarker models, independent associations were observed for the primary outcome (MR-proANP and NT-proBNP), HF-hospitalization and cardiovascular admission (MR-proANP only), and all-cause mortality (NT-proBNP only) (P < 0.05). The discriminative value of MR-proANP was superior to BNP/NT-proBNP (HF-hospitalization) and BNP (primary outcome) (P < 0.05). ConclusionsMR-proANP was not inappropriately low relative to concurrent BNP/NT-proBNP values. Proportional increments in MR-proANP were more pronounced than for B-peptides for given decrements in cardiac structure/function. MR-proANP offered greater independent predictive power overall.

Air pollution, mortality, and hospital admissions in Scotland: A 16 years register-based study

Abstract Background Air pollution is associated with poor health and higher mortality. However, studies that link high spatial resolution air pollution data for several pollutants to individual-level data over prolonged period (&amp;gt;10 years) and assess multiple health outcomes are limited. In this study, we investigated the association between 16-years exposure to air pollution and all-cause and cause-specific (cardiovascular, respiratory, cancer, infectious, and mental/behavioural disorders) mortality and hospital admissions in Scotland. Methods Individual-level data from the “Scottish Longitudinal Study” for 202,237 individuals (2002-2017) were linked to yearly concentrations of NO2, SO2, PM10, and PM2.5 pollutants at 1-Km2 spatial resolution using the individual's residential postcode. The association between air pollution and mortality and hospital admissions was examined using Cox Proportional-Hazards and multilevel mixed-effects negative binomial models, respectively. Results Increasing concentrations of PM2.5, PM10, and NO2 pollutants were associated with higher rates of all-cause, cardiovascular, respiratory, cancer, and infectious mortality and hospital admissions. Mortality from respiratory diseases increased by 6.2% (95%CI=2.8%−9.6%), 2.5% (95%CI=0.5%−4.5%), and 1.2% (95%CI=0.5%−1.9%) per 1 µg/m3 increase in PM2.5, PM10 and NO2 pollutants, respectively. Exposure to SO2 was mainly linked to mental/behavioural disorders mortality (HR = 1.05; 95%CI=1.02-1.07) and respiratory hospital admissions (IRR=1.02; 95%CI=1.01-1.03). Conclusions This study revealed a positive association between air pollution and mortality and hospital admissions in Scotland. Interventions on air pollution through stricter environmental regulations could help ease the mortality and hospital admission burden, for both physical and mental illness. Key messages • Air pollution is associated with a higher risk of mortality and hospital admissions for both physical and mental health-related outcomes. • Policymakers are urged to provide incentives for the usage of greener energy sources to reduce air pollution emissions.

Sex-stratified patterns of emergency cardiovascular admissions prior and during the COVID-19 pandemic

The COVID-19 pandemic has had a significant impact on global public health, with long-term consequences that are still largely unknown. This study aimed to assess the data regarding acute cardiovascular hospital admissions in five European centers before and during the pandemic. A multicenter, multinational observational registry was created, comparing admissions to the emergency departments during a 3-months period in 2020 (during the pandemic) with the corresponding period in 2019 (pre-pandemic). Data on patient demographics, COVID-19 test results, primary diagnosis, comorbidities, heart failure profile, medication use, and laboratory results were collected. A total of 8778 patients were included in the analysis, with 4447 patients in 2019 and 4331 patients in 2020. The results showed significant differences in the distribution of cardiovascular diseases between the two years. The frequency of pulmonary embolism (PE) increased in 2020 compared to 2019, while acute heart failure (AHF) and other cardiovascular diseases decreased. The odds of PE incidence among hospitalized patients in 2020 were 1.316-fold greater than in 2019. The incidence of AHF was 50.83% less likely to be observed in 2020, and the odds for other cardiovascular diseases increased by 17.42% between the 2 years. Regarding acute coronary syndrome (ACS), the distribution of its types differed between 2019 and 2020, with an increase in the odds of ST-segment elevation myocardial infarction (STEMI) in 2020. Stratification based on sex revealed further insights. Among men, the incidence of AHF decreased in 2020, while other cardiovascular diseases increased. In women, only the incidence of STEMI showed a significant increase. When analyzing the influence of SARS-CoV-2 infection, COVID-positive patients had a higher incidence of PE compared to COVID-negative patients. COVID-positive patients with ACS also exhibited symptoms of heart failure more frequently than COVID-negative patients. These findings provide valuable information on the impact of the COVID-19 pandemic on acute cardiovascular hospital admissions. The increased incidence of PE and changes in the distribution of other cardiovascular diseases highlight the importance of monitoring and managing cardiovascular health during and post pandemic period. The differences observed between sexes emphasize the need for further research to understand potential sex-specific effects of COVID-19 on cardiovascular outcomes.

Effects of ambient air pollutants on cardiovascular disease hospitalization admission

Effects of ambient air pollutants on cardiovascular disease hospitalization admission

Estimation of historical daily airborne pollen concentrations across Switzerland using a spatio temporal random forest model

High concentrations of airborne pollen trigger seasonal allergies and possibly more severe adverse respiratory and cardiovascular health events. Predicting pollen concentration accurately is valuable for epidemiological studies, in order to study the effects of pollen exposure. We aimed to develop a spatiotemporal machine learning model predicting daily pollen concentrations at a spatial resolution of 1 × 1 km across Switzerland between 2000 and 2019. Daily pollen concentrations for five common, highly allergenic pollen types (hazel, alder, birch ash, and grasses) were available from fourteen measurement sites across Switzerland. We considered several predictors such as elevation, species distribution, wind speed, wind direction, temperature, precipitation, relative humidity, satellite-observed Normalized Difference Vegetation Index, and land-use (CORINE, Landsat satellite) to explain variation in pollen concentration. We employed feature engineering techniques to encode categorical variables and fill in missing values. We applied a random forest machine learning model with 5-fold cross-validation. The 5th–99th percentiles for concentrations of hazel, alder, birch, ash, and grass pollen at the pollen monitoring stations were 0–298, 0–306, 0–1153, 0–800, and 0–290 pollen grains/m3, respectively. The results of a predictive model for these concentrations yielded overall R2 values of 0.87, 0.84, 0.89, 0.88, and 0.91, and temporal root mean squared errors (RMSEs) of 16.07, 16.72, 69.04, 41.50, and 22.45 pollen grains/m3. An analysis of predictor variable importance indicates that the average national daily pollen concentration is the most important predictor of pollen concentrations for all pollen types. Furthermore, meteorological variables including temperature, total precipitation, humidity, boundary layer height, wind speed, and wind direction, as well as date and satellite features, are important factors in pollen concentration prediction. These spatiotemporal pollen models will serve to estimate individual residential pollen exposure for epidemiological studies. Resulting estimates will enable us to study respiratory and cardiovascular mortality and hospital admissions in Switzerland.

Association of hypoxic burden metrics with cardiovascular outcomes in heart failure and sleep-disordered breathing.

Heart failure (HF) and sleep-disordered breathing (SDB) frequently coexist. We aimed to compare the prognostic value of different nocturnal hypoxic burden metrics in hospitalized HF patients. HF patients underwent polygraphy screening for SDB in this prospective cohort. Hypoxic burden metrics assessed using pulse oximetry included time<90% oxygen saturation (T90), proportion of total recording time<90% oxygen saturation (TRT90), oxygen desaturation index (ODI), and mean oxygen saturation (meanSO2 ). The prespecified endpoints were the composite of cardiovascular death or admission for worsening HF. This study included 764 hospitalized HF patients, 16.5% and 36.6% of whom had obstructive and central sleep apnoea, respectively. With a median follow-up time of 2.2years, endpoint events occurred in 410 (53.7%) patients. In univariate and multivariate analyses, T90, TRT90, and meanSO2 were substantially associated with the composite outcome, whereas ODI was not. After multivariate Cox model adjustment, patients with 5.0≤T90≤52.0min [hazard ratio (HR) 1.32, 95% confidence interval (CI): 1.02-1.71, P=0.034] or T90>52.0min (HR 1.56, 95% CI: 1.21-2.02, P=0.001) had a greater risk of the composite outcome than those with T90<5.0min. The TRT90 and T90 results were similar. Compared with meanSO2 >95%, meanSO2 <93% (HR 1.47, 95% CI: 1.16-1.88, P=0.002) was correlated with adverse outcomes. The hypoxic burden metrics T90, TRT90, and meanSO2 , but not ODI, were independent predictors of cardiovascular death or readmission for worsening HF. Indicators of duration and severity, not just the frequency of nocturnal hypoxaemia, should be valued and considered for intervention to improve outcomes in HF patients.

Association between wildfire, respiratory and cardiovascular disease admission: Mediating effect of air pollutants in Korea

Association between wildfire, respiratory and cardiovascular disease admission: Mediating effect of air pollutants in Korea

Pattern of cardiovascular admission diagnoses during the month of Ramadan: a single center experience

Abstract Background Fasting Ramadan has been linked to favorable health profile, yet some unhealthy behaviors were shown to affect the progression of cardiovascular diseases during the holy month. Purpose To detect the prevalent diagnoses of cardiovascular admissions during the month of Ramadan and to compare them to the admission diagnoses during the rest of the year. Methods This retrospective observational study included all patients who were admitted to the Cardiology department and the Coronary Care Unit from April 2019 to May 2022, with 4 Ramadan months included. The median number of specific cardiac admission diagnoses during Ramadan months were compared to the median number of similar admission diagnoses during the other months of the year. Results The number of patients admitted during the 4 year-study period were 8170 patients, 14.6% of them (n = 1194 patients) were admitted during the 4 Ramadan months. All cardiovascular diagnoses were comparable during Ramadan admissions as compared to the rest of the year, Table. There was a trend towards higher cardiovascular admission rates during Ramadan in almost all diagnoses except for unstable angina, infective endocarditis and pericardial diseases. Conclusions The pattern of specific cardiovascular disease admission during Ramadan was not different from the pattern of admission during the rest of the year. Yet, there were numerically higher cardiovascular admissions during the 4 Ramadan months. Table Comparison of the median number of admission diagnoses in the 4 Ramadan months and the monthly average of the 4 years Ramadan months Median (range) Monthly average of the 4 years Median (range) P value IHD 145.5 (63) 106 (74) 0.486 * CCS 39.5 (35) 17 (11) 0.057 * ACS 107.5 (71) 89 (83) 0.686 - STEMI 49.5 (34) 39 (24) 0.343 - NSTEMI 41 (46) 39.5 (56) 1.0 - UA 8.5 (8) 10 (4) 0.686 ADHF &amp; cardiogenic shock 113.5 (111) 56 (37) 0.486 Arrhythmia 43.5 (39) 34 (10) 0.343 - AF 18.5 (22) 22.5 (5) 0.686 - SVT 9.5 (15) 6 (9) 0.486 - AFL 6 (12) 2.5 (2) 0.2 - CHB 4 (5) 3.5 (3) 0.686 IE 10.5 (7) 14 (6) 0.2 PE 3 (11) 2.5 (1) 0.686 Pericardial disease 2 (6) 6 (11) 0.2 Hypertensive urgency &amp; emergency 12 (23) 9.5 (7) 1.0 IHD, ischemic heart disease; CCS, chronic coronary syndrome; ACS, acute coronary syndrome; STEMI, ST elevation myocardial infarction; NSTEMI, non-ST elevation myocardial infarction; UA, unstable angina; ADHF, acute decompensated heart failure; AF, atrial fibrillation; SVT, supraventricular tachycardia; AFL, atrial flutter; CHD, complete heart block; IE, infective endocarditis; PE, pulmonary embolism. Additional Content An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.

Air pollution, mortality, and hospital admissions in Scotland: A 16 years register-based study

BackgroundAir pollution is associated with poor health and higher mortality. However, studies that link high spatial resolution air pollution data for several pollutants to individual-level data over prolonged period (&gt;10 years) and assess multiple health outcomes are limited. In this study, we investigated the association between 16-years exposure to air pollution and all-cause and cause-specific (cardiovascular, respiratory, cancer, infectious, and mental/behavioural disorders) mortality and hospital admissions in Scotland.&#x0D; MethodsIndividual-level data from the “Scottish Longitudinal Study” for 202,237 individuals (2002-2017) were linked to yearly concentrations of NO2, SO2, PM10, and PM2.5 pollutants at 1-Km2 spatial resolution using the individual’s residential postcode. The association between air pollution and mortality and hospital admissions was examined using Cox Proportional-Hazards and multilevel mixed-effects negative binomial models, respectively.&#x0D; ResultsIncreasing concentrations of PM2.5, PM10, and NO2 pollutants were associated with higher rates of all-cause, cardiovascular, respiratory, cancer, and infectious mortality and hospital admissions. Mortality from respiratory diseases increased by 6.2% (95%CI=2.8%-9.6%), 2.5% (95%CI=0.5%-4.5%), and 1.2% (95%CI=0.5%-1.9%) per 1 µg/m3 increase in PM2.5, PM10 and NO2 pollutants, respectively. Exposure to SO2 was mainly linked to mental/behavioural disorders mortality (HR=1.05; 95%CI=1.02-1.07) and respiratory hospital admissions (IRR=1.02; 95%CI=1.01-1.03).&#x0D; ConclusionsThis study revealed a positive association between air pollution and mortality and hospital admissions in Scotland. Interventions on air pollution through stricter environmental regulations could help ease the mortality and hospital admission burden, for both physical and mental illness.

Effects of apparent temperature on cardiovascular disease admissions in rural areas of Linxia Hui Autonomous Prefecture

Cardiovascular disease (CVD) is a major threat to public health worldwide. The relationship between CVD and temperature has been widely reported in developed countries and regions. However, there are few studies of severe CVD in poor rural areas of developing countries. Therefore, this study aimed to explore the relationship between CVD and apparent temperature (AT) in a rural area of Linxia Hui Autonomous Prefecture, China. Daily CVD admission data and meteorological data were collected from Linxia between 2014 and 2015. The media of AT was used as the reference temperature to estimate the cumulative relative risk (RR) of CVD admission. The distributed lag non-linear models were used to examine the association between AT and cumulative RR of CVD admission at lag 0–21 days. In Linxia, high AT (20 °C) had a persistent adverse effect on cumulative RR of CVD admissions, and the RR increased with increasing lag days. Cold (− 10 °C) had a protective effect on the first and later lag days (lag 0–14 and lag 0–21). Adults (aged < 65 years) and females were more susceptible to the effects of heat than males and the elderly (aged ≥ 65 years). In Linxia, China, extremely high AT is an important risk factor for CVD hospitalizations in suburban and rural populations.