Cardiovascular Disease Hospitalizations Research Articles

Association of the 2020 US Presidential Election With Hospitalizations for Acute Cardiovascular Conditions

Prior studies found a higher risk of acute cardiovascular disease (CVD) around population-wide psychosocial or environmental stressors. Less is known about acute CVD risk in relation to political events. To examine acute CVD hospitalizations following the 2020 presidential election. This retrospective cohort study examined acute CVD hospitalizations following the 2020 presidential election. Participants were adult members aged 18 years or older at Kaiser Permanente Southern California and Kaiser Permanente Northern California, 2 large, integrated health care delivery systems. Statistical analysis was performed from March to July 2021. 2020 US presidential election. Hospitalizations for acute CVD around the 2020 presidential election were examined. CVD was defined as hospitalizations for acute myocardial infarction (AMI), heart failure (HF), or stroke. Rate ratios (RR) and 95% CIs were calculated comparing rates of CVD hospitalization in the 5 days following the 2020 election with the same 5-day period 2 weeks prior. Among 6 396 830 adults (3 970 077 [62.1%] aged 18 to 54 years; 3 422 479 [53.5%] female; 1 083 128 [16.9%] Asian/Pacific Islander, 2 101 367 [32.9%] Hispanic, and 2 641 897 [41.3%] White), rates of hospitalization for CVD following the election (666 hospitalizations; rate = 760.5 per 100 000 person-years [PY]) were 1.17 times higher (95% CI, 1.05-1.31) compared with the same 5-day period 2 weeks prior (569 hospitalizations; rate = 648.0 per 100 000 PY). Rates of AMI were significantly higher following the election (RR, 1.42; 95% CI, 1.13-1.79). No significant difference was found for stroke (RR, 1.02; 95% CI, 0.86-1.21) or HF (RR, 1.18; 95% CI, 0.98-1.42). Higher rates of acute CVD hospitalization were observed following the 2020 presidential election. Awareness of the heightened risk of CVD and strategies to mitigate risk during notable political events are needed.

Associations between the triglyceride-glucose index and cardiovascular disease in over 150,000 cancer survivors: a population-based cohort study

BackgroundThe prevention of subsequent cardiovascular disease (CVD) is an essential part of cancer survivorship care. We conducted the present study to investigate the association between the TyG index (a surrogate marker of insulin resistance) and the risk of cardiovascular disease (CVD) events in cancer survivors.MethodsAdult cancer patients, who underwent routine health examinations during 2009–2010 and were survived for more than 5 years as of January 1, 2011, were followed for hospitalization of CVD (either ischemic heart disease, stroke, or heart failure) until December 2020. Cox model was used to calculate hazard ratios associated with baseline TyG index (loge [fasting triglyceride (mg) × fasting glucose (mg)/2]) for the CVD hospitalization.ResultsA total of 155,167 cancer survivors (mean age 59.9 ± 12.0 years, female 59.1%) were included in this study. A graded positive association was observed between TyG and CVD hospitalization. An 8% elevated risk for CVD hospitalization was observed for a TyG index of 8-8.4 (aHR 1.08 [95% CI 1.01–1.14]); 10% elevated risk for a TyG index of 8.5–8.9 (aHR 1.10 [95% CI 1.03–1.17]); 23% elevated risk for a TyG index of 9.0-9.4 (aHR 1.23 [95% CI 1.15–1.31]); 34% elevated risk for a TyG index of 9.5–9.9 (aHR 1.34 [95% CI 1.23–1.47]); and 55% elevated risk for a TyG index ≥ 10 compared to the reference group (TyG index < 8). Per 1-unit increase in the TyG index, a 16% increase in CVD hospitalization and a 45% increase in acute myocardial infarction hospitalization were demonstrated. Graded positive associations were evident for atherosclerotic CVD subtypes, such as ischemic heart disease, acute myocardial infarction, and ischemic stroke, but not for hemorrhagic stroke or heart failure.ConclusionsThe TyG index may serve as a simple surrogate marker for the risk stratification of future CVD events, particularly atherosclerotic subtypes, in cancer survivors.

Association between ambient temperature and cardiovascular disease hospitalisations among farmers in suburban northwest China

Cardiovascular disease (CVD) has become a severe public health and social issue in China. However, in northwest China, evidence on the association between ambient temperature and CVD hospitalisations in suburban farmers is somewhat limited. We collected CVD hospitalisations and meteorological data (2012-2015) in Zhangye suburbs and assessed the temperature-related risk and burden of admission by fitting a distributed lag nonlinear model to probe the relationship between ambient temperature and CVD hospitalisations among farmers in suburban northwest China. The results show that 23,921 cases of CVD admissions were recorded from 2012 to 2015. There was a "U-shaped" association between temperature and hospitalisations. Compared with the minimum admissions temperature (MAT) at 15.3°C, the cumulative relative risk (RR) over lag 0-21days was 1.369 (95% CI 0.980-1.911) for extreme cold temperature (1st percentile, -15°C), 1.353 (95% CI 1.063-1.720) for moderate cold (5th percentile, -11°C), 1.415 (95% CI 1.117-1.792) for extreme heat (99th percentile, 26°C), and 1.241 (95% CI 1.053-1.464) for moderate heat (95th percentile, 24°C). Female farmers were more susceptible to low and high temperatures than male farmers. Farmers aged ≥ 65years old were more sensitive to low temperatures, while farmers aged < 65years old were more sensitive to high temperatures. A total of 13.4% (3,208 cases) of the hospitalisation burden for CVD were attributed to temperature exposure, with the moderate range of temperatures accounting for the most significant proportion (12.2%). Ambient temperature, primarily moderate temperatures, might be an essential factor for cardiovascular-related hospitalisations among farmers in suburban northwest China.

The effect of apparent temperature on hospital admissions for cardiovascular diseases in rural areas of Pingliang, China.

There is a well-reported association between temperature and the relative risk (RR) of cardiovascular disease (CVD) in urban areas in China. However, insufficient research has been performed in rural areas. The aim of the study was to analyze the association between apparent temperature (AT) and the RR of CVD hospital admissions in rural areas of Pingliang, northwest China. Daily data and weather conditions were collected in Pingliang from 2014-2015. The median value of AT was selected to estimate the RR of CVD, and the distributed lag nonlinear model (DLNM) used to examine the relationship between AT and the RR of CVD admissions for up to 21 days. The results showed a nonlinear relationship between AT and the RR of CVD admissions. Regarding the heat effect, there was a protective effect. Meanwhile, the cold effect on the RR of CVD admissions appeared at day 0 and persisted until day 21, resulting in a cumulative RR of 2.304 (95%CI: 1.809-2.936) compared with the median value of AT, and the maximum RR appeared at about -5 °.The cumulative RR values of CVD on men and adults were more sensitive than those on women and elders in the cold effect. AT is associated with the hospitalization of CVD patients. Both gender and age factors were associated with the increase in RR of CVD admissions. More preventive measures should be taken to avoid this adverse effect.

Delirium prevention and management: Development and implementation of a non-pharmacological catalog of measures in the acute setting

Delirium prevention and management: Development and implementation of a non-pharmacological catalog of measures in the acute setting Abstract. Background: In October 2018, a new delirium management concept was developed in a university hospital for cardiovascular diseases. As part of a multi-professional approach, the previously established "Evidence-based Nursing working group (AK EBN)", consisting of academically qualified nurses from the hospital, was involved in the implementation process. Aim: The AK EBN aimed to identify effective non-pharmacological interventions to prevent and treat delirium and to establish how these interventions could influence delirium rates in hospital patients. Methods: The EbN method was employed to address the study question applying the PICO framework (Behrens & Langer, 2016) as the bases for systematic searches in different databases. Relevant studies were identified, data were extracted, displayed in tables and discussed within the AK using established critical appraisal tools for quality assessment. Results: Despite a heterogeneous study sample, results showed that there is meaningful evidence for the effectiveness of intervention bundles on the reduction of delirium rates. Bundles include for example, aspects of orientation and noise reduction. As a result, a catalogue of non-pharmacological interventions, communication aids, and a guide for involving caregivers in the prevention and treatment of delirium were developed. Additionally, continuing training events held by the participants of AK EBN were organized. Conclusions: To promote the successful implementation of projects in practice, the involvement of all stakeholders is important. As part of a skill-grade-mix, nurses made an important contribution in this multi-professional project.

Assessment of one-year risk of ischemic stroke versus major bleeding in patients with atrial fibrillation

BackgroundPatients diagnosed with atrial fibrillation (AF) are at increased risk of stroke. Several guidelines to assess the risk of ischemic stroke and major bleeding in AF patients have been published. The CHA2DS2-VASc score has been adopted widely for predicting stroke within one year of the index AF diagnosis and is used to guide the prescription of anticoagulants. Anticoagulation therapy increases the risk of bleeding and scoring systems such as HAS-BLED assess the risk of major bleeding in anticoagulated patients. Despite these advances, no study has examined the risks of the two outcomes simultaneously. How patients’ fear of particular outcomes affects these risks also remains unknown. MethodsWe incorporated the risks of ischemic stroke and major bleeding within one year of the index AF admission as well as the fear of stroke and bleeding of each individual patient. The patients enrolled in this retrospective observational study were identified using hospital admission data from the Myocardial Infarction Data Acquisition System (MIDAS), a statewide database including all hospitalizations for cardiovascular disease in New Jersey. Probabilities of the outcomes (ischemic stroke, major bleeding, both, or neither within one year of the index AF admission) were estimated using multinomial regression with patient demographics and comorbidities (heart failure [HF], hypertension [HTN], diabetes mellitus [DM], anemia, chronic obstructive pulmonary disease [COPD], kidney disease [KD], prior stroke or transient ischemic attack [TIA]) as predictors. These estimates were used in a Deming regression to model the association of ischemic stroke and major bleeding in grouped patients. The assessment of the importance of each outcome was superimposed on the final model to arrive at a recommendation for anticoagulation therapy. ResultsThe results of the Deming regression indicated a positive relationship between ischemic stroke and major bleeding (slope = 1.67, 95% confidence interval [CI] 1.37 to 1.97). Estimates of the risks of the two outcomes and the lines of best fit from Deming regression were determined. This model for risk assessment of stroke and major bleeding within one year of the index AF hospital admission combined objective data and subjective assessment of the relative fear of stroke versus bleeding by each hypothetical patient on 0–100 scale. Examples with the fears of stroke versus major bleeding being equal (50-50) and a higher fear of stroke (80–20) are presented. ConclusionsThe new model for risk assessment of ischemic stroke and major bleeding within one year of the index AF hospital admission proposed in this work used objective, empirically driven measures, and subjective assessment of the outcomes’ importance for individual patients. Such models may assist physicians in their decision making regarding anticoagulation therapy.

Serum Low-Density Lipoprotein Cholesterol and Cardiovascular Disease Risk Across Chronic Kidney Disease Stages (Data from 1.9 Million United States Veterans)

In the general population, elevated low-density lipoprotein (LDL) cholesterol levels are an important risk factor for cardiovascular disease (CVD) and mortality; however, the association of LDL with mortality risk and cardiovascular events are less clear in chronic kidney disease (CKD). We sought to examine the relationship of LDL with mortality and rates of atherosclerotic cardiovascular disease (ASCVD) and non-atherosclerotic cardiovascular-related (non-ASCVD) hospitalizations across CKD stages. Our analytical cohort consisted of 1,972,851 United States veterans with serum LDL data between 2004 and 2006. Associations of LDL with all-cause and cardiovascular mortality across CKD stages were evaluated using Cox proportional hazard models with adjustment for demographics, comorbid conditions, smoking status, prescription of statins and non-statin lipid-lowering drugs, body mass index, albumin, high-density lipoprotein, and triglycerides. Associations between LDL and ASCVD and non-ASCVD hospitalizations were estimated using negative binomial regression models across CKD stages. The cohort consisted of 5% female, 14% Black, 29% diabetic, 33% statin-users, and 44% current smokers, with a mean patient age of 64 ± 14 years. Patients with high LDL (≥160 mg/dL) had a higher risk of all-cause and cardiovascular mortality as well as ASCVD and non-ASCVD hospitalization rates across all CKD stages compared with the reference (LDL 70 to <100 mg/dL). The associations with all-cause and cardiovascular mortality and ASCVD hospitalization rate were attenuated at higher CKD stages. These trends were reversed with amplification of the association of high LDL with non-ASCVD hospitalization at higher CKD stages. In conclusion, associations of LDL with mortality and both ASCVD and non-ASCVD hospitalizations are modified according to kidney disease stage.

Effect of apparent temperature on hospitalization from a spectrum of cardiovascular diseases in rural residents in Fujian, China

Cardiovascular disease (CVD) is a leading threat to global public health. Although associations between temperature and CVD hospitalization have been suggested for developed countries, limited evidence is available for developing countries or rural residents. Moreover, the effect of apparent temperature (AT) on the spectrum of cause-specific CVDs remains unknown. Based on 2,024,147 CVD hospitalizations for rural residents from eight regions in Fujian Province, China, during 2010–2016, a quasi-Poisson regression with distributed lag non-linear model was fitted to estimate the AT effect on daily CVD hospitalization for each region, and then pooled in a meta-regression that included regional indicators related to rural residents. Stratified analyses were performed according to the cause of hospitalization, sex and age groups. Finally, we calculated the fraction of CVD hospitalizations attributable to AT, as a reflection of the burden associated with AT. The heat effect appeared at lag 0–1 days, with 19% (95% CI, 11–26%) increased risk of CVD hospitalization, which was worse for ischemic heart disease, heart failure, arrhythmias and ischemic stroke. The decreased AT was associated with increase of hemorrhagic stroke at lag 0–28 days. People aged 65 and above suffered more from the heat effect on cardiovascular and cerebrovascular diseases. Regions with a lower gross value of agricultural production, rural residents’ per capita net income, number of air conditioners and water heaters were more susceptible. A large number of hospitalizations were attributable to heat for most subcategories. High AT level increased CVD hospitalization, and the subcategories had different susceptibilities. The effects were modified by individual and regional characteristics. These findings have important implications for the development of targeted interventions and for hospital service planning.

Abstract P126: The 2020 Us Presidential Election, Sociopolitical Stress And Acute Cardiovascular Disease Hospitalizations

Background: Prior studies demonstrated a higher risk of acute cardiovascular disease (CVD) around population-wide psychosocial or environmental stressors. Less is known about the impact of sociopolitical events. The objective of the current study was to examine acute CVD hospitalizations following the 2020 presidential election. Methods: We examined hospitalizations for acute CVD around the 2020 presidential election, among adults enrolled in Kaiser Permanente Southern and Northern California, two integrated health care delivery systems that provide care for &gt;9 million persons. CVD was defined as hospitalizations for acute myocardial infarction (AMI), heart failure (HF) or stroke. Rate ratios (RR) and 95% confidence intervals (CIs) were calculated comparing rates in the five days following the 2020 election to the same five days two weeks prior. Results: Among 6,396,830 members ≥18 years, rates of hospitalization for CVD following the election (666 hospitalizations; rate = 760.5 per 100,00 person-years [PY]) were 1.17 times higher (95% CI 1.05, 1.31) compared to the same five days two weeks prior (569 hospitalizations; rate = 648.0 per 100,000 PY). (Table) RR for AMI, stroke, and HF were 1.42 (95% CI 1.13, 1.79), 1.02 (95% CI 0.86, 1.21) and 1.18 (95% CI 0.98, 1.42), respectively. Conclusions: Higher rates of acute CVD were observed following the 2020 presidential election. Awareness of the heightened risk of CVD and strategies to mitigate risk during significant sociopolitical events are needed.

Clinical Outcome and Medical Cost of Originator and Generic Antihypertensive Drugs: A Population-Based Study in Yinzhou, China.

Background: The substitution of generic drugs can effectively alleviate the rapid growth of drug costs; however, the clinical effectiveness and medical costs of originator products and generics were barely studied in China. Objectives: To compare the effectiveness of antihypertensive drugs and hypertension-related medical costs between originator and generic initiators in Yinzhou, China. Methods: We conducted a population-based retrospective cohort study using the Chinese Electronic Health Records Research in Yinzhou (CHERRY), from July 1, 2011, to December 31, 2018. Hypertension patients initiating with originator products were compared with patients initiating with generic counterparts. We used 1:1 propensity score matching to pair the two groups based on sociodemographic, clinical, and health service utilization variables. Cox proportional regression was adopted to compare the rate of hospitalization for hypertension-related cardiovascular disease between matched originator and generic initiators. Wilcoxon matched-pairs signed-rank test was used to compare annual hypertension-related medical costs. Results: Matched pairs (10,535) of patients were included in the comparative study of originator products and generics, corresponding to seven antihypertensive drugs including amlodipine, felodipine, nifedipine, irbesartan, losartan, valsartan, and metoprolol. The average age of patients included in the analysis was around 60 years (originator vs. generics initiators: from 59.0 vs. 59.1 years in losartan to 62.9 vs. 63.6 years in nifedipine). Higher hospitalization rates among originator initiators were observed for three calcium channel blockers (hazard ratio[95% CI]: amlodipine, 3.18[1.43, 7.11]; felodipine, 3.60[1.63, 7.98]; and nifedipine, 3.86[1.26, 11.81]; respectively). The remaining four out of seven drugs of the clinical endpoint estimates showed comparable outcomes between originator products and generics (hazard ratio[95% CI]: irbesartan, 1.19[0.50, 2.84]; losartan, 1.84[0.84, 4.07]; valsartan, 2.04[0.72, 5.78]; and metoprolol, 1.25[0.56, 2.80]; respectively). Higher median annual hypertension-related medical costs were observed in originator initiators (all p < 0.001), except for metoprolol (p = 0.646). Conclusion: We observed comparable or even better clinical outcomes and less medical cost associated with the use of antihypertensive generics compared to originator counterparts. This could help increase patient and provider confidence in the efficacy of generic medicines to manage hypertension diseases.

Severe Maternal Morbidity and Long-Term Risk of Cardiovascular Hospitalization.

Severe maternal morbidity is rising, yet the association with cardiovascular disease is not clear. We examined the risk of cardiovascular hospitalization up to 3 decades after having a pregnancy complicated by severe maternal morbidity. We analyzed a longitudinal cohort of 1 336 846 women who were pregnant between 1989 and 2019 in Quebec, Canada. The main exposure measure was severe maternal morbidity in any pregnancy, including severe preeclampsia, acute renal failure, sepsis, and other life-threatening conditions. Using time-varying Cox regression models, we compared the adjusted risk of hospitalization for cardiovascular disease up to 3 decades after pregnancy for women with severe maternal morbidity relative to women without severe morbidity. Five percent of women had severe maternal morbidity. Overall, there were 68 287 cardiovascular hospitalizations during 21 725 672 person-years of follow-up in the cohort. Compared with no morbidity, women with any severe morbidity had a greater risk of cardiovascular hospitalization (hazard ratio [HR], 1.77 [95% CI, 1.72-1.82]). The association was the greatest within the first year of delivery (HR, 4.42 [95% CI, 3.77-5.19]) but persisted beyond 15 years (HR, 1.44 [95% CI, 1.37-1.51]). Having a cardiac complication (HR, 5.37 [95% CI, 4.65-6.20]), cerebrovascular accident (HR, 3.82 [95% CI, 2.94-4.96]), or acute renal failure (HR, 2.60 [95% CI, 2.15-3.14]) during pregnancy was strongly associated with future cardiovascular hospitalization. Women with severe maternal morbidity have a greater risk of cardiovascular disease after pregnancy, both in the short and long term. These women may benefit from active surveillance for cardiovascular disease.

Rural-urban differences in associations between air pollution and cardiovascular hospital admissions in Guangxi, southwest China.

Epidemiological studies found that exposure to air pollution increases cardiovascular hospitalizations. However, studies on rural-urban differences in associations between hospitalizations for cardiovascular diseases and air pollution are limited. The generalized linear model (GLM) was applied to investigate the associations between cardiovascular hospitalizations and air pollution (SO2, NO2, PM2.5, PM10, CO, and O3) in Guangxi, southwest China, in 2015 (January 1-December 31). The relative risk of pollutants (SO2, NO2) on cardiovascular hospital admissions was significantly different between urban and rural areas. The effect of SO2 on cardiovascular hospitalizations was higher in urban areas than in rural areas at lag0 to lag3 and cumulative lag01 to lag03. In urban areas, there were positive associations between NO2 and cardiovascular hospitalizations at lag0, lag1 and cumulative lag01, lag02. In contrast, the effect of NO2 on cardiovascular hospitalizations was not significant in rural areas. Urban residents were more sensitive than rural residents to SO2 and NO2. Subgroup analyses showed statistically significant differences between rural and urban areas in the association between SO2 and NO2 and cardiovascular hospitalizations for males. For age groups, people aged ≥ 65 years appeared to be more vulnerable to SO2 and NO2 in urban areas. The effects of PM2.5 PM10, CO, and O3 on cardiovascular hospitalizations were consistently negative for all groups. Our findings indicated that there were rural-urban differences in associations between cardiovascular hospitalizations and air pollutants. In rural areas, the risk of cardiovascular hospitalizations was mainly influenced by SO2. Therefore, we expect to pay attention to protecting people from air pollution, particularly for those aged ≥ 65 years in urban areas.

Secondary Prevention Using Cholesterol-Lowering Medications in Patients with Prior Atherosclerotic Cardiovascular Disease Events: A Retrospective Cohort Analysis.

Background: Secondary prevention with lipid-lowering medications in patients with atherosclerotic cardiovascular disease (ASCVD) is known to reduce the risk of clinical events and death. Current guidelines codify recommendations for implementing secondary prevention in appropriate patients. However, in real-world practice, secondary prevention is frequently initiated only after the patient experiences a cardiovascular-related hospitalization. The impact of these delays is not well known.Objectives: To estimate the effects of delaying treatment on the risk of cardiovascular-related hospitalization and on costs for patients who meet the criteria for secondary prevention as specified in the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.Methods: This is a retrospective cohort analysis using Humana data. Eligible patients were categorized by treatment group: (1) patients who initiated treatment before an ASCVD-related hospitalization and (2) patients who either did not initiate treatment until after an ASCVD hospitalization or never initiated treatment. The associations between the timely initiation of cholesterol-lowering medications for secondary prevention and (1) the risk for an ASCVD hospitalization and (2) health-care costs over one year, were estimated using multivariate regressions.Results: A total of 272 899 secondary prevention patients were identified who met study selection criteria. Early treatment was associated with significant reductions in the risk of an ASCVD hospitalization at any time following the identification of the patient’s eligibility for secondary prevention (by 33% compared to those treated late or never, P<.0001), but was significantly associated with higher total cost over the first post-index year (by US $509, P<.001). Patients whose low-density lipoprotein cholesterol (LDL-C) levels were >130 mg/dL experienced higher ASCVD hospitalization risks, and also larger risk reductions if treated before an ASCVD hospitalization compared to patients with lower LDL-C levels who were treated late or never treated.Conclusions: More widespread implementation of the treatment policies specified in the 2013 ACC/AHA Guidelines for secondary prevention should significantly reduce cardiovascular disease hospitalizations and reduce costs.

Secondary Prevention Using Cholesterol-Lowering Medications in Patients with Prior Atherosclerotic Cardiovascular Disease Events: A Retrospective Cohort Analysis

Background: Secondary prevention with lipid-lowering medications in patients with atherosclerotic cardiovascular disease (ASCVD) is known to reduce the risk of clinical events and death. Current guidelines codify recommendations for implementing secondary prevention in appropriate patients. However, in real-world practice, secondary prevention is frequently initiated only after the patient experiences a cardiovascular-related hospitalization. The impact of these delays is not well known. Objectives: To estimate the effects of delaying treatment on the risk of cardiovascular-related hospitalization and on costs for patients who meet the criteria for secondary prevention as specified in the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Methods: This is a retrospective cohort analysis using Humana data. Eligible patients were categorized by treatment group: (1) patients who initiated treatment before an ASCVD-related hospitalization and (2) patients who either did not initiate treatment until after an ASCVD hospitalization or never initiated treatment. The associations between the timely initiation of cholesterol-lowering medications for secondary prevention and (1) the risk for an ASCVD hospitalization and (2) healthcare costs over one year, were estimated using multivariate regressions. Results: A total of 272 899 secondary prevention patients were identified who met study selection criteria. Early treatment was associated with significant reductions in the risk of an ASCVD hospitalization at any time following the identification of the patient’s eligibility for secondary prevention (by 33% compared to those treated late or never, P&lt;.0001), but was significantly associated with higher total cost over the first post-index year (by US $509, P&lt;.001). Patients whose low-density lipoprotein cholesterol (LDL-C) levels were &gt;130 mg/dL experienced higher ASCVD hospitalization risks, and also larger risk reductions if treated before an ASCVD hospitalization compared to patients with lower LDL-C levels who were treated late or never treated. Conclusions: More widespread implementation of the treatment policies specified in the 2013 ACC/AHA Guidelines for secondary prevention should significantly reduce cardiovascular disease hospitalizations and reduce costs.

Patients with a Combination of Atrial Fibrillation and Chronic Heart Failure in Clinical Practice: Comorbidities, Drug Treatment and Outcomes

Aim. To assess in clinical practice the structure of multimorbidity, cardiovascular pharmacotherapy and outcomes in patients with a combination of atrial fibrillation (AF) and chronic heart failure (CHF) based on prospective registries of patients with cardiovascular diseases (CVD).Materials and Methods. The data of 3795 patients with atrial fibrillation (AF) were analyzed within the registries RECVASA (Ryazan), RECVASA FP (Moscow, Kursk, Tula, Yaroslavl), REGION-PO and REGION-LD (Ryazan), REGION-Moscow, REGATA (Ryazan). The comparison groups consisted of 3016 (79.5%) patients with AF in combination with CHF and 779 (29.5%) patients with AF without CHF. The duration of prospective observation is from 2 to 6 years.Results. Patients with a combination of AF and CHF (n=3016, age was 72.0±10.3 years; 41.8% of men) compared with patients with AF without CHF (n=779, age was 70.3±12.0 years; 43.5% of men) had a higher risk of thromboembolic complications (CHA2DS2-VASc – 4.68±1.59 and 3.10±1.50; p&lt;0.001) and hemorrhagic complications (HAS-BLED – 1.59±0.77 and 1.33±0.76; p&lt;0.05). Patients with a combination of AF and CHF significantly more often (p&lt;0.001) than in the absence of CHF were diagnosed with arterial hypertension (93.9% and 83.8%), coronary heart disease (87.9% and 53,5%), myocardial infarction (28.4% and 14.0%), diabetes mellitus (22.4% and 7.7%), chronic kidney disease (24.8% and 16.2%), as well as respiratory diseases (20.1% and 15.3%; p=0.002). Patients with AF in the presence of CHF, compared with patients without CHF, were more often diagnosed with a permanent form of arrhythmia (49.3% and 32.9%; p&lt;0.001) and less often paroxysmal (22.5% and 46.2%; p&lt;0.001) form of arrhythmia. Ejection fraction ≤40% (9.3% and 1.2%; p&lt;0.001), heart rate ≥90/min (23.7% and 19.3%; p=0.008) and blood pressure ≥140/90 mm Hg (59.9% and 52.2%; p&lt;0.001) were recorded with AF in the presence of CHF more often than in the absence of CHF. The frequency of proper cardiovascular pharmacotherapy was higher, albeit insufficient, in the presence of CHF (64.9%) than in the absence of it (56.1%), but anticoagulants were prescribed less frequently when AF and CHF were combined (38.8% and 49, 0%; p&lt;0.001). The frequency of unreasonable prescription of antiplatelet agents instead of anticoagulants was 52.5% and 33.3% (p&lt;0.001) in the combination of AF, CHF and coronary heart disease, as well as in the combination of AF with coronary heart disease but without CHF. Patients with AF and CHF during the observation period compared with those without CHF had higher mortality from all causes (37.6% and 30.3%; p=0.001), the frequency of non-fatal cerebral stroke (8.2% and 5.4%; p=0.032) and myocardial infarction (4.7% and 2.5%; p=0.036), hospitalizations for CVD (22.8% and 15.5%; p&lt;0.001).Conclusion. Patients with a combination of AF and CHF, compared with the group of patients with AF without CHF, were older, had a higher risk of thromboembolic and hemorrhagic complications, they were more often diagnosed with other concomitant cardiovascular and chronic noncardiac diseases, decreased left ventricular ejection fraction, tachysystole, failure to achieve the target blood pressure level in the presence of arterial hypertension. The frequency of prescribing proper cardiovascular pharmacotherapy was higher, albeit insufficient, in the presence of CHF, while the frequency of prescribing anticoagulants was less. The incidence of mortality from all causes, the development of non-fatal myocardial infarction and cerebral stroke, as well as the incidence of hospitalizations for CVDs were higher in AF associated with CHF.

Pregnancy Complications and Risk of Cardiovascular Disease Later in Life: A Nationwide Cohort Study.

BackgroundThe aim of this study was to investigate the associations between pregnancy complications and cardiovascular mortality and hospitalizations of cardiovascular disease (CVD) after adjustment for major confounding.Methods and ResultsIn a nationwide register‐based cohort study, women with singleton births between 1973 and 2014 were included from the Swedish Medical Birth Register. Outcomes of mortality and hospitalizations of CVD were collected from the Cause of Death Register and the National Inpatient Register. The cohort was followed from the date of the first delivery until death or end of follow‐up, whichever occurred first. The pregnancy complications studied were preeclampsia or eclampsia, gestational hypertension, gestational diabetes, preterm birth, small for gestational age, and stillbirth. Among the 2 134 239 women (mean age at first pregnancy, 27.0 [SD, 5.1] and mean parity 1.96 [SD, 0.9]), 19.1% (N=407 597) had 1 of the studied pregnancy complications. All pregnancy complications were associated with all‐cause and cardiovascular mortality and hospitalization for CVD (ischemic heart disease, ischemic stroke, and peripheral artery disease) after adjustment for major confounding in a Cox proportional hazard regression model. The adjusted hazard ratio for cardiovascular mortality was 1.84 (95% CI, 1.38–2.44) for preterm birth and 3.14 (95% CI, 1.81–5.44) for stillbirth.ConclusionsIn this large cohort study, pregnancy complications were associated with all‐cause mortality, cardiovascular mortality, and hospitalizations for CVD, also after adjusting for confounding, including overweight, smoking, and comorbidities. The study highlights that less established pregnancy complications such as preterm birth and stillbirth are also associated with cardiovascular mortality and CVD.

A comparison of the effect of diurnal temperature range and apparent temperature on cardiovascular disease among farmers in Qingyang, Northwest China.

Climate change is increasing the incidence of extreme weather events which have a significant impact on public health. Cardiovascular diseases (CVDs) are the number one cause of death globally (40%). Apparent temperature (AT) and diurnal temperature range (DTR) have been extensively used to evaluate the effects of temperature on cardiovascular disease (CVD). However, the relevant information is quite limited from analysis and comparison of effects and differing pathogenesis of DTR and AT on CVD especially in less-developed, rural areas of China. This is the first attempt to analyze different effects between AT and DTR on CVD using distributed lag nonlinear modeling (DLNM) in rural area. Data on CVD hospital admission in Qingyang (Northwest China) in 2014-2017 originated from the New Rural Cooperative Medical System (NRCMS) of Gansu Province, and meteorological variables were provided by the Meteorological Science Data Sharing Service. Both AT and DTR had significant nonlinear and delayed impacts on hospital admissions for CVD. DTR had a stronger and more persistent effect on CVD incidence than AT. Females were more affected by high AT and low DTR than were males, while males were more vulnerable to low AT and high DTR. Temperature effects were not significantly different between people above and below 65years of age. These findings provide local public health authorities with reference concerning sensitive temperature indices for susceptible populations with a view to improve CVD preventive strategies in rural areas.

Impact of the COVID-19 pandemic on hospital admissions for cardiovascular diseases in a large Brazilian urban center.

INTRODUCTION: The COVID-19 pandemic has had a great impact on the behavior of individuals and the organization of health systems. This study analyzed the COVID-19 pandemic’s effect on public hospitalizations for cardiovascular diseases (CVD) in a large city in Brazil, Belo Horizonte, MG, with approximately 2.5 million inhabitants. METHODS: In a time-series analysis, this study used administrative data from the national “Hospital Information System” from 2010 to February 2020 to estimate the expected number of hospitalizations for CVD by month during the COVID-19 pandemic in Belo Horizonte in 2020 using the Auto-Regressive Integrated Moving Average model. For CVD, this study compared the expected number of hospital admissions, intensive care use, deaths during hospitalization, and mean length of stay with the observed number during the period. RESULTS: There were 6,517 hospitalizations for CVD from March to December 2020, a decrease of 16.3% (95% CI: 4.7-25.3) compared to the projected. The number of intensive care hospitalizations for CVD fell 24.1% (95% CI 13-32.7). The number of deaths also decreased (17.4% [80% CI: 0 - 0.30]), along with the reduction in hospitalizations, as did the length of stay for CVD hospitalizations. These reductions, however, were not significant. CONCLUSIONS: Hospitalizations for CVD were 16.3% lower than expected in a large Brazilian city, possibly due to the fear of getting infected or going to hospitals. Public campaigns informing how to proceed in case of CVD show that prompt urgent attention is essential to mitigate the indirect effects of the pandemic on CVD.

Predictive Risk Models to Identify Patients at High-Risk for Severe Clinical Outcomes With Chronic Kidney Disease and Type 2 Diabetes.

Introduction/Objective:Predictive risk models identifying patients at high risk for specific outcomes may provide valuable insights to providers and payers regarding points of intervention and modifiable factors. The goal of our study was to build predictive risk models to identify patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) at high risk for progression to end stage kidney disease (ESKD), mortality, and hospitalization for cardiovascular disease (CVD), cerebrovascular disease (CeVD), and heart failure (HF).Methods:This was a retrospective observational cohort study utilizing administrative claims data in patients with CKD (stage 3-4) and T2D aged 65 to 89 years enrolled in a Medicare Advantage Drug Prescription plan offered by Humana Inc. between 1/1/2012 and 12/31/2017. Patients were enrolled ≥1 year pre-index and followed for outcomes, including hospitalization for CVD, CeVD and HF, ESKD, and mortality, 2 years post-index. Pre-index characteristics comprising demographic, comorbidities, laboratory values, and treatment (T2D and cardiovascular) were evaluated and included in the models. LASSO technique was used to identify predictors to be retained in the final models followed by logistic regression to generate parameter estimates and model performance statistics. Inverse probability censoring weighting was used to account for varying follow-up time.Results:We identified 169 876 patients for inclusion. Declining estimated glomerular filtration rate (eGFR) increased the risk of hospitalization for CVD (38.6%-61.8%) and HF (2-3 times) for patients with eGFR 15 to 29 mL/min/1.73 m2 compared to patients with eGFR 50 to 59 mL/min/1.73 m2. Patients with urine albumin-to-creatinine ratio (UACR) ≥300 mg/g had greater chance for hospitalization for CVD (2.0 times) and HF (4.9 times), progression to ESKD (2.9 times) and all-cause mortality (2.4 times) than patients with UACR <30 mg/g. Elevated hemoglobin A1c (≥8%) increased the chances for hospitalization for CVD (21.3%), CeVD (45.4%), and death (20.6%). Among comorbidities, history of HF increased the risk for ESKD, mortality, and hospitalization for CVD, CeVD, and HF.Conclusions:The predictive models developed in this study could potentially be used as decision support tools for physicians and payers, and the risk scores from these models can be applied to future outcomes studies focused on patients with T2D and CKD.

A Statewide Study of Cardiovascular Outcomes in Patients with Ankylosing Spondylitis

Numerous studies have shown that ankylosing spondylitis is associated with an increased risk of cardiovascular disease including heart failure, acute myocardial infarction, stroke, transient ischemic attack, and cardiovascular mortality. This may be a direct result of inflammation or an indirect one from the use of anti-inflammatory drugs needed to treat ankylosing spondylitis, or from the coexistence of traditional risk factors. This is a retrospective case-control study of the occurrence of cardiovascular events in ankylosing spondylitis patients and matched controls. Data was obtained from the Myocardial Infarction Data Acquisition System, a statewide database containing hospitalizations for cardiovascular diseases in New Jersey. Two types of analyses were performed: unadjusted and adjusted for comorbidities. The odds ratio of developing heart failure in the ankylosing spondylitis group vs. matched controls was 1.59 (95% CI 1.44 - 1.76, p &lt; 0.001) in the unadjusted model and 1.31 (95% CI 1.18 - 1.47, p &lt; 0.001) after adjustment for hypertension, diabetes mellitus, acute kidney failure/chronic kidney disease, chronic liver disease, chronic obstructive pulmonary disease, and hyperlipidemia. Similarly, risks of myocardial infarction and cardiovascular mortality in ankylosing spondylitis patients were significantly higher in both, unadjusted and adjusted models while odds ratio for transient ischemic attack became non-significant after the adjustment. Ankylosing spondylitis is associated with increased rates of the cardiovascular disease that are probably due of pathophysiologic changes attendant to the disease, as well as the presence of the comorbidities.