Cardiovascular Disease Hospitalizations Research Articles

Synergistic effects of gaseous pollutants on hospital admissions for cardiovascular disease in Liuzhou, China.

Previous studies demonstrated that short-term exposure to gaseous pollutants (nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3)) had a greater adverse effect on cardiovascular disease. However, little evidence exists regarding the synergy between gaseous pollutants and cardiovascular disease (CVD). Therefore, we aimed to estimate the effect of individual gaseous pollutants on hospital admissions for CVD and to explore the possible synergistic effects between gaseous pollutants. Daily hospitalization counts for CVD were collected from January 1, 2014, to December 31, 2015. We also collected daily time series on gaseous pollutants from the Environment of the People's Republic of China, including NO2, SO2, and O3. We used distributed lag nonlinear models (DLNMs) to assess the association of individual gaseous pollutants on CVD hospitalization, after controlling for seasonality, day of the week, public holidays, and weather variables. Then, we explored the variability across age and sex groups. In addition, we analyzed the synergistic effects between gaseous pollutants on CVD. Extremely low NO2 and SO2 increase the risk of CVD in all subgroup at lag 7 days. The greatest effect of high concentration of SO2 was observed in male and the elderly (≥ 65 years) at lag 3 days. Greater effects of high concentration of O3 were more pronounced in the young (< 65 years) and female at lag 3 days, while the effect of low concentration of O3 was greater in male and the young (< 65 years) at lag 0 day. We found a synergistic effect between NO2 and SO2 for CVD, as well as between SO2 and O3. The synergistic effects of NO2 and SO2 on CVD were stronger in the elderly (≥ 65) and female. The female was sensitive to synergistic effects of SO2-O3 and NO2-O3. Interestingly, we found that there was a risk of CVD in the susceptible population even for gaseous pollutant concentrations below the National Environmental Quality Standard. The synergy between NO2 and SO2 was significantly associated with cardiovascular disease hospitalization in the elderly (≥ 65). This study provides evidence for the synergistic effect of gaseous pollutants on hospital admissions for cardiovascular disease.

Changes in the prognostic values of modern cardiovascular biomarkers in relation to duration of diabetes mellitus.

Based on the complex pathophysiology of type 2 diabetes and atherosclerosis we hypothesized a dynamic change in prognostic value of cardiovascular biomarkers over time. In this prospective study 746 patients with type 2 diabetes mellitus, being followed up for 60months were analysed. The primary endpoint was defined as unplanned hospitalization for cardiovascular disease or death. Beside others, especially the prognostic performance of the biomarkers of interest (GDF-15, NT-proBNP, hs-TnT) was evaluated in relation to quartiles of diabetes duration. In patients having a diabetes duration below 7years lnGDF-15 (HR 2.84; p<0.01) and lnhs-TnT (HR 2.96; p<0.01) were significant predictors of the primary endpoint. LnAge (HR 40.01; p<0.01) and lnNT-proBNP (HR 1.56; p=0.03) were significant predictors in patients with a diabetes duration between 7 and 12years. In the third quartile (diabetes duration 12-22years) lnurinary albumin to creatinine ratio (HR 1.25; p=0.005) and lnNT-proBNP (HR 2.13, p<0.001) predicted the endpoint. In patients with a diabetes duration above 22years, lnAge (HR 75.35; p=0.001) and lnNT-proBNP (HR 2.0; p<0.01) were the only significant predictors of the endpoint. Prognostic power of cardiovascular biomarkers changes dynamically in relation to duration of type 2 diabetes mellitus. In patients with shorter duration of the disease markers of subclinical cardiovascular dysfunction and inflammation perform better than markers of systemic advanced organ dysfunction and cardiovascular disease.

Risk of Cardiovascular Hospital Admission After Exposure to Fine Particulate Pollution

BackgroundHeavy fine particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) pollution events continue to occur frequently in developing countries. ObjectivesThe authors conducted a case-crossover study aimed at exploring the association between heavy PM2.5 pollution events and hospital admission for cardiovascular diseases. MethodsHospital admissions for cardiovascular diseases were observed by Beijing Municipal Commission of Health and Family Planning Information Center from 2013 to 2017. Air pollution data were collected from the Beijing Municipal Environmental Monitoring Center. Distinct definitions were used to identify heavy and extremely heavy fine particulate pollution events. A conditional logistic regression model was used. The hospital admission burdens for cardiovascular disease were also estimated. ResultsA total of 2,202,244 hospital admissions for cardiovascular diseases and 222 days of extremely heavy PM2.5 pollution events (PM2.5 concentration ≥150 μg/m3) were observed. The ORs associated with extremely heavy PM2.5 pollution events lasting for 3 days or more for total cardiovascular disease, angina, myocardial infarction, ischemic stroke, and heart failure were 1.085 (95% CI: 1.077-1.093), 1.112 (95% CI: 1.095-1.130), 1.068 (95% CI: 1.037-1.100), 1.071 (95% CI: 1.053-1.090), and 1.060 (95% CI: 1.021-1.101), respectively. The numbers and days of cardiovascular disease hospital admission annually related to extremely heavy PM2.5 pollution events lasting for 1 day or more were 3,311 (95% CI: 2,969-3,655) and 37,020 (95% CI: 33,196-40,866), respectively. ConclusionsHeavy and extremely heavy PM2.5 pollution events resulted in substantial increased hospital admission risk for cardiovascular disease. With higher PM2.5 concentration and longer duration of heavy PM2.5 pollution events, a greater risk of cardiovascular hospital admission was observed.

Effects of long-term average temperature and temperature variability on cardiovascular disease hospitalizations in the US Medicare population

BACKGROUND AND AIM: Numerous studies have shown short-term exposure to extreme temperature is associated with increased mortality and morbidity. Less is known about effects of long-term exposure to warm or cold temperatures. Our aim was to evaluate associations of long-term temperature exposure and temperature variability with cardiovascular disease (CVD) hospitalizations. METHODS: We constructed an open cohort consisting of all fee-for-service Medicare beneficiaries, aged ≥65, living in the contiguous US from 2000 through 2016 (~63 million individuals). We used data from the 4km Gridded Surface Meteorological dataset to assess the annual (January-December), summer (June-August), and winter (December-February) average temperature and temperature variability (standard deviation) for each year for each zip code. Cox-equivalent Poisson models were used to estimate associations with first CVD, coronary heart disease (CHD) or cerebrovascular disease (CBV) hospitalization, after adjustment for potential confounders (including individual and area-level SES indicators). RESULTS:Higher annual average and summer average temperatures were associated with an increased risk of CVD, CHD and CBV hospitalization. Lower winter average temperatures were associated with an increased risk of CVD and CHD hospitalization, but a decreased risk of CBV hospitalization. For CVD hospitalization, we found a HR of 1.07 (95%CI: 1.06, 1.07) per IQR increase (8.1°C) for annual average temperature, a HR of 1.03 (95%CI: 1.03, 1.04) per IQR increase (5.2°C) for summer average temperature, and a HR of 0.97 (95%CI: 0.97, 0.98) per IQR increase (11.7°C) for winter average temperature. Higher annual and winter temperature variability and lower summer temperature variability were associated with an increased risk for all outcomes. Associations were modified by age, race, air pollution and greenness. CONCLUSIONS:Warmer annual and summer average temperatures and cooler winter average temperatures were associated with an increased risk of CVD hospitalizations. Higher annual and winter temperature variability and lower summer temperature variability were also associated with increased risk. KEYWORDS: temperature, temperature variability, Cardiovascular diseases

Health Disparities Among Older Adults Following Tropical Cyclone Exposure in Florida, USA, 1999-2016

BACKGROUND AND AIM: As tropical cyclones (TCs) become more frequent and severe in much of the world, research is needed to identify subpopulations who are particularly vulnerable to their adverse health impacts. This study investigated whether hospitalization risks from TCs in Florida (FL), USA varied across age and sex. METHODS: We obtained county-level TC data for all storms in FL during the study period in which windspeed exceeded strong gale force winds (a 9 on the Beaufort scale or ~21m/s). We included hospitalization data among pay-per-service Medicare beneficiaries in FL for respiratory illnesses and cardiovascular disease (CVD), as well as 5 other broad causes, from 1999-2016. We used distributed lag non-linear mixed-effects models to estimate the relative risk (RR) for TC exposure by comparing hospitalizations occurring in TC-periods (from 2 days before to 7 days after) to matched non-TC-periods. We first quantified overall associations between TC exposure and cause-specific hospitalization risk. We then separately modeled associations between TC exposure and hospitalizations in subgroups defined by individual-level characteristics. RESULTS:Preliminary results show that TC exposure was associated with overall increased risk of respiratory hospitalizations (RR: 4.01, 95% CI: 2.91, 5.53) comparing TC to non-TC periods, but not CVD (RR: 0.79, 95% CI: 0.93, 1.09) hospitalizations, confirming that risk patterns in FL are similar to national patterns identified in previous studies. However, stratified models showed limited evidence of modification by individual-level characteristics for either respiratory or cardiovascular disease hospitalizations: we did not find differences in risk of hospitalization between men and women nor across age groups (65-74, 75-84, and ≥ 85 years). CONCLUSIONS:These findings contrast with those from other environmental exposures, including air pollution, whose effects have been shown to vary across different subgroups. To better understand the impact of TCs on population and subgroup health, future research should focus on understanding specific mechanisms and causal pathways. KEYWORDS: Natural disasters, environmental disparities, tropical cyclones, climate change, hospitalizations

Long-term exposure to specific humidity and cardiovascular disease hospitalizations in the US Medicare population

BACKGROUND AND AIM: Most studies that evaluate associations of weather on human health focus on temperature. Less is known about health effects of humidity. We evaluated associations of long-term exposure to specific humidity with cardiovascular disease (CVD), coronary heart disease (CHD) and cerebrovascular disease (CBV) hospitalization. METHODS: We constructed an open cohort consisting of all fee-for-service Medicare beneficiaries, aged ≥65, living in the contiguous US from 2000 through 2016 (~63 million individuals). We assessed zip code level annual (January-December), summer (June-August) and winter (December-February) average specific humidity and specific humidity variability (standard deviation) for each year, based on daily specific humidity estimates from the Gridded Surface Meteorological dataset (~4km spatial resolution). To estimate associations of specific humidity with first CVD, CHD and CBV hospitalization, we used Cox-equivalent Poisson models. RESULTS:After adjustment for individual and area-level indicators and temperature, higher annual and summer average specific humidity and lower winter average specific humidity were associated with an increased risk of CVD, CHD and CBV hospitalization. For summer average specific humidity, we found HRs of 1.07 (95%CI: 1.07, 1.08) for CVD hospitalization, 1.08 (95%CI: 1.08, 1.09) for CHD hospitalization and 1.07 (95%CI: 1.07, 1.08) for CBV hospitalization per IQR increase (4.0 g of water vapor/kg of dry air). Higher annual, summer and winter specific humidity variability were also associated with increased risk of CVD, CHD and CBV hospitalization. Associations of annual and summer average specific humidity were strongest for beneficiaries eligible for Medicaid and for beneficiaries with an unknown or other race. CONCLUSIONS:Among this cohort of US Medicare beneficiaries, higher annual and summer average specific humidity and higher annual, summer and winter specific humidity variability were positively associated with CVD, CHD, and CBV hospitalization. Associations were modified by race and Medicaid eligibility. KEYWORDS: humidity, cardiovascular diseases, climate

Long-term Exposure to Air Pollution and Temperature and Hospital Admissions with Cardiovascular Disease in the United States

BACKGROUND AND AIM: Both air pollution and temperature have been associated with cardiovascular disease. In this study, we look at these exposures simultaneously and assess their relationship with cardiovascular disease using causal methodology. METHODS: We looked at the relationship between long-term exposure to air pollution and temperature and hospital admissions with cardiovascular disease (CVD) among Medicare participants in the United States from 2000 to 2016. We assigned air pollution exposure, specifically PM2.5, NO2, and O3, based on residential zip code using aggregations from fine-scaled spatiotemporal prediction models. We assigned temperature based on the predictions of the gridMET dataset which estimates levels on a 4 km x 4 km scale. Daily exposures were averaged by calendar year to obtain annual, long-term estimates. Hospital admissions with CVD were identified using ICD-9 and ICD-10 codes. We adjusted for demographic and socioeconomic confounders. A difference-in-difference approach was used to calculate the estimate for each exposure of interest. We did this conditioning on zip code and looking at change in rate of hospitalizations within each zip code. We further used multi-pollutant models to adjust for confounding by other concurrent exposures. RESULTS:Higher warm-season temperature, NO2, and PM2.5 were associated with an increase in the rate of CVD hospital admissions in the US with rate ratios of 1.021 (95% CI: 1.021-1.022), 1.002 (95% CI: 1.002-1.002), and 1.012 (95% CI: 1.012-1.013), respectively for each unit increase in exposure. Higher cold-season temperatures decreased the rate of CVD admissions by 0.991% (95% CI: 0.977-1.006) for each Celsius degree increase. Ozone was also associated with a decrease in the rate of CVD admissions. CONCLUSIONS:Fine particulate matter, nitrogen dioxide, and warm-season temperature were associated with an increase in the rate of cardiovascular hospital admissions among the elderly in the US. KEYWORDS: Air Pollution, Temperature, Epidemiology, Cardiovascular Disease

Using social security number to identify sub-populations vulnerable to the health impacts from extreme heat in Florida, U.S.

BackgroundSome socioeconomically vulnerable groups may experience disproportionately higher risk of extreme heat illness than other groups, but no study has utilized the presence/absence of a social security number (SSN) as a proxy for vulnerable sub-populations. MethodsThis study focused on the warm season from 2008 to 2012 in Florida, U.S. With a total number of 8,256,171 individual level health outcomes, we devised separate case-crossover models for five heat-sensitive health outcomes (cardiovascular disease, dehydration, heat-related illness, renal disease, and respiratory disease), type of health care visit (emergency department (ED) and hospitalization), and patients reporting/not reporting an SSN. Each stratified model also considered potential effect modification by sex, age, or race/ethnicity. ResultsMean temperature raised the odds of five heat-sensitive health outcomes with the highest odds ratios (ORs) for heat-related illness. Sex significantly modified heat exposure effects for dehydration ED visits (Males: 1.145, 95 % CI: 1.137–1.153; Females: 1.110, 95 % CI: 1.103–1.117) and hospitalization (Males: 1.116, 95 % CI: 1.110–1.121; Females: 1.100, 95 % CI: 1.095–1.105). Patients not reporting an SSN between 25 and 44 years (1.264, 95 % CI: 1.192–1.340) exhibited significantly higher dehydration ED ORs than those reporting an SSN (1.146, 95 % CI: 1.136–1.157). We also observed significantly higher ORs for cardiovascular disease hospitalization from the no SSN group (SSN: 1.089, 95 % CI: 1.088–1.090; no SSN: 1.100, 95 % CI: 1.091–1.110). ConclusionsThis paper partially supports the idea that individuals without an SSN could experience higher risks of dehydration (for those 25–45 years), renal disease, and cardiovascular disease than those with an SSN.

Effects of diurnal temperature range on cardiovascular disease hospital admissions in farmers in China's Western suburbs.

Cardiovascular disease (CVD), reported to relate with climate change, is the leading cause of global mortality and morbidity. Since the relevant information is quite limited from suburbs and countryside in developing and underdeveloped countries, there are no studies that focused on morbidity through diurnal temperature range (DTR) for these regions. This is the first study to evaluate the short-term effect of DTR on CVD hospital admission in suburban farmers, as well as to identify vulnerable subpopulations. Daily time series data of CVD hospital admissions on suburban farmers of Qingyang, China, and meteorological data from 2011 to 2015 were collected, and a distributed lag non-linear model (DLNM) combined with a quasi-Poisson generalized additive regression model (GAM) was used to examine the exposure-response relationship and delayed effect between DTR and CVD hospital admissions. Stratified analyses by age and gender were performed and extreme DTR effects were examined. Non-linear relation between DTR and CVD hospital admissions was observed, and whether DTR lower or higher than the reference (13 °C, 50th percentile) had adverse effect while lower DTR have slightly higher impact. Also, both extreme low and extreme high DTR had adverse effect. Besides, adults (age < 65) and males were more vulnerable to the effects of DTR compared with the old (age ≥ 65) and females, respectively. This study provides evidence that not only high DTR but also low DTR had adverse effects on CVD which should be paid attention to. Adults and males were more vulnerable among suburban farmers. The results are inconsistent with the studies from urban and indicate differences between urban and suburban residents. Multiple factors such as occupations, risk awareness, and lifestyles could have a significant influence on CVD morbidity, and further study is needed to explore more evidence.

Air pollution and cardiovascular disease hospitalization - Are associations modified by greenness, temperature and humidity?

Background:Studies have observed associations between long-term air pollution and cardiovascular disease hospitalization. Little is known, however, about effect modification of these associations by greenness, temperature and humidity.Methods:We constructed an open cohort consisting of all fee-for-service Medicare beneficiaries, aged ≥ 65, living in the contiguous US from 2000 through 2016 (∼63 million individuals). We assigned annual average PM2.5, NO2 and ozone zip code concentrations. Cox-equivalent Poisson models were used to estimate associations with first cardiovascular disease (CVD), coronary heart disease (CHD) and cerebrovascular disease (CBV) hospitalization.Results:PM2.5 and NO2 were both positively associated with CVD, CHD and CBV hospitalization, after adjustment for potential confounders. Associations were substantially stronger at the lower end of the exposure distributions. For CVD hospitalization, the hazard ratio (HR) of PM2.5 was 1.041 (1.038, 1.045) per IQR increase (4.0 μg/m3) in the full study population and 1.327 (1.305, 1.350) per IQR increase for a subgroup with annual exposures always below 10 μg/m3 PM2.5. Ozone was only positively associated with CVD, CHD and CBV hospitalization for the low-exposure subgroup (<40 ppb). Associations of PM2.5 were stronger in areas with higher greenness, lower ozone and Ox, lower summer and winter temperature and lower summer and winter specific humidity.Conclusion:PM2.5 and NO2 were positively associated with CVD, CHD and CBV hospitalization. Associations were more pronounced at low exposure levels. Associations of PM2.5 were stronger with higher greenness, lower ozone and Ox, lower temperature and lower specific humidity.

Impact of diurnal temperature range on hospital admissions for cardiovascular disease in Jiuquan, China

Diurnal temperature range (DTR) is a critical indicator that reflects the intra-day variability of temperature. In this study, we used Poisson regression with a distributed lag non-linear model (DLNM) to fit the exposure-response relationship between DTR and cardiovascular disease (CVD) hospital admissions and assess the lag effect simultaneously. The CVD and meteorological data were collected from January 1, 2014 to December 31, 2015. A non-linear relationship was found between DTR and CVD hospital admissions, and DTR had a prolonged lag period of up to 21 days. The impact of low DTR was significantly more deleterious than that of high DTR. Stratified analysis revealed that male and the elderly people (≥ 65 years old) were more vulnerable to low DTR exposure than female and adult (<65 years old), and there were no significant differences in both gender and age subgroups for high DTR exposure. Thus, evaluating the impact of DTR on CVD hospital admissions could help in the development of effective preventive measures for local public health departments.

Are competing-risk models superior to standard Cox models for predicting cardiovascular risk in older adults? Analysis of a whole-of-country primary prevention cohort aged ≥65 years.

Both cardiovascular disease (CVD) risk and deaths from non-CVD causes, which may preclude a CVD event, increase with age. We evaluated whether accounting for the competing risk of non-CVD death improves the performance of CVD risk-prediction equations in older adults. All New Zealanders aged ≥65 years in 2012 without a prior CVD hospitalization were identified by anonymized linkage of eight routinely collected national health data sets. Sex-specific equations estimating the 5-year risk of a fatal or non-fatal CVD event were constructed using standard Cox and Fine-Gray (competing-risk) approaches. The pre-specified predictors were: age, ethnicity, deprivation level, diabetes, atrial fibrillation and baseline preventive pharmacotherapy. Model performance was evaluated by assessing calibration and discrimination in the overall cohort and in ethnic and age-specific subgroups. Among 360 443 people aged ≥65 years with 1 615 412 person-years of follow-up, 14.6% of men and 12.1% of women had a first CVD event, whereas 8.5% of men and 7.6% of women died from a non-CVD cause. Standard Cox models overestimated the mean predicted the 5-year CVD risk by ∼1% overall and by 5-6% in the highest risk deciles. The mean predicted CVD risk from the Fine-Gray models approximated the observed risk overall, although slight underestimation occurred in some subgroups. Discrimination was similar for both models. In a whole-of-country primary prevention cohort aged ≥65 years, standard Cox models overestimated the 5-year CVD risk whereas the Fine-Gray models were generally better calibrated. New CVD risk equations that take competing risks into account should be considered for older people.

Association between glycemic control and cardiovascular events in older Japanese adults with diabetes mellitus: An analysis of the Japanese medical administrative database.

ABSTRACTAims/IntroductionThe relationship between glycated hemoglobin (HbA1c) and cardiovascular events in older adults was investigated using a Japanese administrative medical database.Materials and MethodsAnonymized medical data on patients with diabetes mellitus aged ≥65 years for the period from January 2010 to December 2019 were extracted from the EBM Provider database. The primary end‐point was a composite of cardiovascular events, whereas the other end‐points included severe hypoglycemia and fracture. The association between cardiovascular events and HbA1c at the index date (i.e., approximately 10 months after initial diabetes mellitus diagnosis) was evaluated using the Cox proportional hazards model.ResultsAmong the 3,186,751 patients in the database, 3,946 older adults with diabetes mellitus were eligible for inclusion and were subsequently grouped according to HbA1c quartiles at the index date. Cardiovascular events occurred in 142 patients. Patients with HbA1c in the highest quartile had significantly higher risk of hospitalization for cardiovascular disease than those with HbA1c in the lowest quartile (hazard ratio 1.948; 95% confidence interval 1.252–3.031, P = 0.003). However, the events risk was similar across subgroups with HbA1c <7.2%. The incidence of hypoglycemia and fracture was not significantly associated with the level of glycemic control.ConclusionsAmong older adults with diabetes mellitus, those with poor glycemic control were at higher risk for cardiovascular events compared with those with better glycemic control. However, strict glycemic control had no effect on cardiovascular risk in patients with HbA1c <7.2%.

82-LB: Total Costs of Care in Patients with T2D and Cardiovascular Disease: A Comparative Cohort Study (OFFSET)

Introduction: Approximately one third of patients with T2D have cardiovascular disease (CVD). The 2019 ESC and ADA/EASD guidelines recommend glucagon-like peptide-1 receptor agonists (GLP-1 RAs) as either first- or second-line antidiabetic medication in these patients. We aimed to investigate the budget implications of treating patients with CVD with GLP-1 RAs rather than standard of care (SoC). Methods: GLP-1 RA-naive adults (≥ 18 years old) with T2D in the IBM MarketScan® database who had a claim for an antidiabetic medication (index date) within 6 months after their first hospitalization for CVD were included. Costs of care per month over the 365 days post-index were compared for those who initiated a GLP-1 RA post-hospitalization versus those with a claim for any other antidiabetic medication (SoC). Results: Prior to hospitalization, total costs were similar for the two groups. After hospitalization and treatment initiation, adjusted mean total costs were lower, although not significantly, for patients receiving a GLP-1 RA compared with SoC. This was driven by significantly lower inpatient and outpatient costs and significantly higher drug costs (Figure). Conclusions: These findings suggest that the added cost of treating patients with T2D with GLP-1 RAs is offset by significantly lower inpatient and outpatient care costs after CVD hospitalization, resulting in budget neutrality against SoC. Disclosure M. Evans: Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk A/S. A. Chandramouli: Employee; Self; Novo Nordisk. M. Faurby: Employee; Self; Novo Nordisk A/S. K. S. Matthiessen: Employee; Self; Novo Nordisk A/S. P. Mogensen: Consultant; Self; Novo Nordisk. S. Verma: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk, Sanofi, Research Support; Self; AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, EOCI Pharmacomm Ltd., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk, Sanofi, Sun Pharmaceutical Industries Ltd., Toronto Knowledge Translation Working Group. Funding Novo Nordisk A/S

Costs and healthcare utilisation of patients with chronic kidney disease in Spain

BackgroundData about the impact of chronic kidney disease (CKD) on health care costs in Spain are scarce This study was aimed to evaluate cumulative costs and healthcare utilisation in CKD in Spain.MethodsObservational, retrospective, population-based study, which included adults who received care for CKD between 2015 and 2019. Healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019.ResultsWe identified 44,214 patients with CKD (year 2015: age 76.4 ± 14.3 years, 49.0% women, albumin-to-creatinine ratio 362.9 ± 176.8 mg/g, estimated glomerular filtration rate 48.7 ± 13.2 mL/min/1.73 m2). During the 2015–2019 period, cumulative CKD associated costs reached 14,728.4 Euros, being cardiovascular disease hospitalizations, particularly due to heart failure and CKD, responsible for 77.1% of costs. Total medication cost accounted for 6.6% of the total cost. There was a progressive decrease in cardiovascular disease hospital costs per year (from 2741.1 Euros in 2015 to 1.971.7 Euros in 2019). This also occurred with cardiovascular and diabetic medication costs, as well as with the proportion of hospitalizations and mortality. Costs and healthcare resources use were higher in the DAPA-CKD like population, but also decreased over time.ConclusionsBetween 2015 and 2019, costs of patients with CKD in Spain were high, with cardiovascular hospitalizations as the key determinant. Medication costs were responsible for only a small proportion of total CKD costs. Improving CKD management, particularly with the use of cardiovascular and renal protective medications may be helpful to reduce CKD burden.

Weather temperature and the incidence of hospitalization for cardiovascular diseases in an aging society

Weather temperatures affect the incidence of cardiovascular diseases (CVD), but there is limited information on whether CVD hospitalizations are affected by changes in weather temperatures in a super-aging society. We aimed to examine the association of diurnal weather temperature changes with CVD hospitalizations. We included 1,067,171 consecutive patients who were admitted to acute-care hospitals in Japan between April 1, 2012 and March 31, 2015. The primary outcome was the number of CVD hospitalizations per day. The diurnal weather temperature range (DTR) was defined as the minimum weather temperature subtracted from the maximum weather temperature on the day before hospitalization. Multilevel mixed-effects linear regression models were used to estimate the association of DTR with cardiovascular hospitalizations after adjusting for weather, hospital, and patient demographics. An increased DTR was associated with a higher number of CVD hospitalizations (coefficient, 4.540 [4.310–4.765]/°C change, p < 0.001), with greater effects in those aged 75–89 (p < 0.001) and ≥ 90 years (p = 0.006) than among those aged ≤ 64 years; however, there were no sex-related differences (p = 0.166). Greater intraday weather temperature changes are associated with an increased number of CVD hospitalizations in the super-aging society of Japan, with a greater effect in older individuals.

Impact of diurnal temperature range on cardiovascular disease hospital admissions among Chinese farmers in Dingxi (the Northwest China)

BackgroundDiurnal temperature range (DTR) has been widely applied in exploring its effect on cardiovascular disease (CVD). However, few studies have investigated the correlations between DTR and CVD in poor rural areas in China. This study aimed to examine the association between DTR and CVD in rural China.MethodsA distributed lag nonlinear model was used to evaluate the relationship between DTR and CVD risk among farmers living in the city of Dingxi (Northwest China) in the period from January 1, 2016 to December 31, 2019.ResultsWe observed nonlinear M-patterns between the relative risk (RR) of DTR (reference: median DTR, 12 °C) and CVD hospitalizations in all subgroups. The peak RR of CVD was noticed at DTR of 6 °C (total: 1.418; men: 1.546; women: 1.403; young: 1.778; old: 2.549) and 17 °C (total: 1.781; men: 1.937; women: 1.712; young: 2.233; old: 1.798). The adverse effect of DTR on CVD risk was more pronounced in females (RR 1.438) and elderly (RR 2.034) than males (RR 1.141) and younger adults (RR 1.852) at the extremely low (5th, 4 °C) DTR. The reverse was observed at the extremely high DTR (95th, 19 °C) (male: 1.267; females: 0.993; young: 1.586; old: 1.212).ConclusionsDTR is associated with CVD morbidity. This association was more pronounced in women and elderly, but men and younger peoples at extremely high DTR (19 °C). Future measures should take DTR into account to prevent CVD among susceptible populations.

Cardioprotective effects of alendronate bisphosphonate in patients with ischemic heart disease associated with type 2 diabetes mellitus and osteoporosis

Introduction. Diabetes mellitus, cardiovascular diseases and osteoporosis are linked by common pathophysiological mechanisms.Objective. To evaluate the effect of alendronate bisphosphonate on cardiovascular outcomes in comorbid patients with ischemic heart disease (CHD) associated with type 2 diabetes mellitus (type 2 diabetes) and osteoporosis during a two-year follow-up.Materials and methods. A total of 112 women with comorbid pathology including osteoporosis, coronary artery disease, and type 2 diabetes were examined. The patients' condition was assessed at baseline and prospectively for 24 months with a combined endpoint assessment, including: mortality, readmission for cardiovascular diseases, the development of myocardial infarction (MI), stroke, atrial fibrillation. Women were divided into groups: group 1 (n = 59) included patients who received basic therapy for IHD and type 2 diabetes, group 2 (n = 53) included patients who, in addition to basic therapy for coronary artery disease and diabetes Type 2 was prescribed alendronic acid preparation.Results and discussion. According to the results of two-year follow-up, the patients were divided into two subgroups: patients with a favorable (n = 61) and unfavorable course of coronary artery disease (n = 51). At the same time, during prospective observation, the following was assessed: the frequency of hospitalizations for cardiovascular diseases, the dynamics of the functional class (FC) of exertional angina, the development of MI, stroke, atrial fibrillation, and mortality. A significant association of alendronate therapy with a favorable course of ischemic heart disease (OR = 0.26; 95% CI = 0.18-0.57; p = 0.008), a decrease in the risk of MI (OR = 0.32; 95% CI = 0.11-0.87; p = 0.018) and worsening of FC of exertional angina (OR = 0.4; 95% CI = 0.17-0.91; p = 0.014).Conclusion. Long-term (24 months) use of alendronate is an effective and safe method for the treatment of associated cardiovascular pathology, represented by coronary artery disease, type 2 diabetes and osteoporosis in postmenopausal women, reducing the risk of MI, worsening of FC of exertional angina. These results suggest a more aggressive prescription of alendronate for osteoporotic patients at very high cardiovascular risk.

Association of PM2.5 exposure with hospitalization for cardiovascular disease in elderly individuals in Japan

Although exposure to particulate matter with aerodynamic diameters ≤ 2.5 µm (PM2.5) influences cardiovascular disease (CVD), its association with CVD-related hospitalizations of super-aged patients in Japan remains uncertain. We investigated the relationship between short-term PM2.5 exposure and CVD-related hospitalizations, lengths of hospital stays, and medical expenses. We analyzed the Japanese national database of patients with CVD (835,405) admitted to acute-care hospitals between 2012 and 2014. Patients with planned hospitalizations and those with missing PM2.5 exposure data were excluded. We classified the included patients into five quintiles based on their PM2.5 exposure: PM-5, -4, -3, -2, and -1 groups, in descending order of concentration. Compared with the PM-1 group, the other groups had higher hospitalization rates. The PM-3, -4, and -5 groups exhibited increased hospitalization durations and medical expenses, compared with the PM-1 group. Interestingly, the hospitalization period was longer for the ≥ 90-year-old group than for the ≤ 64-year-old group, yet the medical expenses were lower for the former group. Short-term PM2.5 exposure is associated with increased CVD-related hospitalizations, hospitalization durations, and medical expenses. The effects of incident CVDs were more marked in elderly than in younger patients. National PM2.5 concentrations should be reduced and the public should be aware of the risks.

Cost-Comparison Analysis of a Physician-Delivered Step-Count Prescription Strategy

BackgroundIncrements of 1000 steps/d predict cardiovascular disease (CVD) event reductions. In adults with type 2 diabetes and/or hypertension, our Step Monitoring to Improve Arterial Health (SMARTER) trial demonstrated a physician-delivered step-count prescription strategy to increase steps by more than this amount over 1 year, compared to usual care. In the present analysis, we aimed to determine the costs of the intervention compared to usual care, incorporating 1-year intervention costs and projected savings from lower CVD hospitalizations over the subsequent 5 years. MethodsWe considered Canadians aged 55 to 74 years with type 2 diabetes and/or hypertension. Using time estimates from our trial, we computed nursing costs corresponding to patient support time over 1 year, and pedometer costs for an anticipated 50% of patients without a smartphone. We estimated the number of CVD hospitalizations, the reduction expected with a mean 1000 steps/d increase, and the associated savings. We calculated the net cost (savings), the proportion of patients with their own device required for cost neutrality, and costs (savings) if all patients needed to be provided with a device. ResultsAt an average intervention cost of $51.28/patient, the total cost would be $168 million. With an estimated 8875 CVD events prevented, $208 million would be saved. This savings would result in ~$40 million in net savings with 50% device ownership, cost neutrality with 25% device ownership, and ~$42 million in net costs if all patients required the healthcare system to provide a device. ConclusionsAt current levels of smartphone ownership, adoption of the SMARTER strategy is cost-saving to cost-neutral from the healthcare system perspective.