Hospitalization For Coronary Heart Disease Research Articles

The cost-effectiveness of a digitally enabled telerehabilitation program delivered nationally to patients in Australia

Abstract Introduction Traditionally delivered cardiac rehabilitation (CR) programs have considerable benefits, yet access and participation remains low. Emerging digital health models offer promise in healthcare delivery, but their benefits and impact on healthcare utilization and cost-effectiveness are uncertain. We conducted a cost-effectiveness analysis of a telehealth program with a CR mobile app for post-hospitalization coronary heart disease (CHD) patients. Purpose To assess whether a digitally enabled CR program is cost-effective compared with a propensity matched usual care control group in the Australian health system. Methods Patients were recruited nationally, through a health insurer, following hospitalization for CHD. Participants received weekly telehealth consultations for up to 8 weeks, supplemented by use of an mHealth app. Using administrative private health insurance claims data, we assessed differences in hospital costs, mortality rates and bed days at 12-months post discharge. Incremental cost effectiveness ratios (ICERS) were calculated to determine the cost per deaths prevented and cost per bed days saved for the digital-CR group (n=133) compared with usual care (n=266). Results Among the cohort, 36% lived in regional/rural areas, 70% were male and the mean age was 68 years. The mean total hospital all cause readmission costs at 12-months were $1,488 AUD less in the digital-CR group ($16,411) compared to the usual care group ($17,899). Digital-CR had fewer total hospital days relative to the usual care group (median of 2 vs 3 days) and patients in the digital-CR group had a significantly lower mortality rate at 12-months post discharge. The ICERs were -$337 per 100 patient deaths prevented and -$3,033 per median bed days saved. Conclusion The implementation of a digital-CR program demonstrates cost-effectiveness for patients with CHD when compared to usual care. Thus, advocating for the widespread availability of digital-CR programs as an option for CHD patients following hospital discharge is warranted.

Variation in secondary prevention of coronary heart disease: the INTERASPIRE study.

INTERASPIRE is an international study of coronary heart disease (CHD) patients, designed to measure if guideline standards for secondary prevention and cardiac rehabilitation are being achieved in a timely manner. Between 2020 and 2023, adults hospitalized in the preceding 6-24 months with incident or recurrent CHD were sampled in 14 countries from all 6 World Health Organization regions and invited for a standardized interview and examination. Direct age and sex standardization was used for country-level prevalence estimation. Overall, 4548 (21.1% female) CHD patients were interviewed a median of 1.05 (interquartile range .76-1.45) years after index hospitalization. Among all participants, 24.6% were obese (40.7% centrally). Only 38.6% achieved a blood pressure (BP) < 130/80 mmHg and 16.6% a LDL cholesterol (LDL-C) of <1.4 mmol/L. Of those smoking at hospitalization, 48% persisted at interview. Of those with known diabetes, 55.2% achieved glycated haemoglobin (HbA1c) of <7.0%. A further 9.8% had undetected diabetes and 26.9% impaired glucose tolerance. Females were less likely to achieve the targets: BP (females 36.8%, males 38.9%), LDL-C (females 12.0%, males 17.9%), and HbA1c in diabetes (females 47.7%, males 57.5%). Overall, just 9.0% (inter-country range 3.8%-20.0%) reported attending cardiac rehabilitation and 1.0% (inter-country range .0%-2.4%) achieved the study definition of optimal guideline adherence. INTERASPIRE demonstrates inadequate and heterogeneous international implementation of guideline standards for secondary prevention in the first year after CHD hospitalization, with geographic and sex disparity. Investment aimed at reducing between-country and between-individual variability in secondary prevention will promote equity in global efforts to reduce the burden of CHD.

Self-care trajectories of patients with coronary heart disease: a longitudinal, observational study.

To determine if distinct trajectories of coronary heart disease (CHD) self-care behaviours could be identified, linked to differences in quality of life (QoL), and predicted based on baseline characteristics. A secondary analysis of a prospective, longitudinal, observational study. Patients with CHD answered questionnaires at study enrolment and six months later: Self-Care of Coronary Heart Disease Inventory (three subscales: maintenance, management, and confidence, scored 0-100, higher score = better self-care), Hospital Anxiety and Depression Scale, 12-Item Short Form Survey, 16-Item European Health Literacy Survey Questionnaire, and CHD Education Questionnaire. Latent growth mixture modelling was used to identify distinct self-care trajectories over time. On average, patients (n = 430, mean age 64.3 ± 8.9, 79% male) reported inadequate self-care (maintenance 61.6 ± 15.4, management 53.5 ± 18.5) at enrolment. Two distinct trajectories of self-care behaviours were identified: first, an 'inadequate-and-worsening' (IN-WORSE) trajectory (57.2%), characterized by inadequate self-care, improvement in maintenance (4.0 ± 14.5-point improvement, P < 0.001), and worsening of management over time (6.3 ± 24.4-point worsening, P = 0.005). Second, an 'inadequate-but-maintaining' (IN-MAIN) trajectory (42.8%), characterized by inadequate self-care, improvement in maintenance (5.0 ± 16.2-point improvement, P < 0.001), and stability in management over time (0.8 ± 21.9-point worsening, P = 0.713). In comparison, patients in the IN-WORSE trajectory had less favourable characteristics (including lower health literacy, knowledge, confidence) and significantly lower QoL. Not attending rehabilitation (OR 2.175; CI 1.020-4.637, P = 0.044) and older age (OR 0.959; CI 0.924-0.994, P = 0.024) predicted (IN-WORSE) trajectory inclusion. Two self-care trajectories were identified, both suboptimal. Rehabilitation predicted membership in the more favourable trajectory and some positive characteristics were identified among patients in that group. Therefore, interventions supporting these factors may benefit patients' self-care and QoL.

Association Between Air Pollution and Coronary Heart Disease Hospitalizations in Lanzhou City, 2013-2020: a Time Series Analysis.

Coronary heart disease (CHD) is one of the most serious public health problems. However, few studies have focused on the effects of exposure to particulate matter and gaseous air pollutants on CHD. This study aimed to explore the relationship between air pollutants and the number of hospitalized patients with CHD in Lanzhou, and we collected daily data on the number of hospitalized patients with CHD, daily air pollutants, and meteorological factors from 2013 to 2020. A distributed lag nonlinear model (DLNM) combined with a quasi-Poisson regression model was applied to evaluate the relationship between air pollutants and the number of hospitalized patients with CHD. The results indicated that the hysteresis effect of all pollutants except O38h reached its maximum at lag3, and the relative risk of coronary heart disease admission was 1.0014 (95%CI: 1.0004, 1.0023), 1.0003 (95%CI: 1.0000, 1.0006), 1.0020 (95%CI: 1.0004, 1.0035), and 1.0053 (95%CI: 1.0026, 1.0080) when PM2.5, PM10, NO2, and SO2 concentrations were increased by 10 μg/m3, respectively. Each 1 mg/m3 increase in CO concentration was associated with a relative risk of coronary heart disease; hospitalization risk was 1.1076 (95%CI: 1.0530, 1.1650). We observed a relative risk of 0.9991 (95%CI: 0.9986, 0.9999) for each 10 μg/m3 increase in O38h for coronary heart disease admission at lag1. Women and elderly were more susceptible to the impact of air pollution, and the impact was greater during cold seasons. Our results indicate that air pollution increased the risk of hospitalization for CHD in a short term. The research findings can provide strategic insights into the impact of current and future air pollution on CHD.

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

Abstract 12816: Changes in Self-Care and Quality of Life After Hospitalization for Coronary Heart Disease

Background: Self-care is an important part of secondary prevention for patients with coronary heart disease (CHD). But, we know little about how CHD self-care influences quality-of-life (QOL) over time. Hypothesis: Changes in CHD self-care would be associated with changes in QOL. Aims: Identify distinct trajectories of change in self-care following a hospitalization for CHD that were associated with significant differences in QOL over time. Methods: Longitudinal study (Iceland). Patients completed surveys at hospital discharge and 6 months later. Self-care was measured with the Self-Care of CHD Inventory (maintenance and management scores = 0-100, higher=better) and QOL was measured with the SF-12 (physical and mental QOL = 0-100, higher=better). Growth mixture modeling was used to identify trajectories of CHD self-care behaviors. Results: A total of 373 patients (mean age 64.3±8.9, 79% male) completed the study. Two trajectories of CHD self-care were identified. The first one (57.2% of the sample - solid line - “Inadequate and Worsening”) had comparatively worse self-care at both timepoints; maintenance improved but management got significantly worse over time (-6.3±24.4 points, p=0.005). The second trajectory (42.8% of the sample - dashed line - “Adequate and Maintaining”) had comparatively better self-care at both timepoints; maintenance improved significantly (+5.0±16.2 points, p&lt;0.001), and management was unchanged over time (+0.8±21.9 points, p=0.713). Participants in both trajectories had significant improvements in their physical and mental QOL (both p&lt;0.001) over time ( Fig. 1 ). Participants in the first trajectory had comparatively worse physical and mental QOL at both timepoints (all p&lt;0.05). Conclusion: Two distinct trajectories of self-care were identified and linked to significant differences in QOL following a hospitalization for CHD. Care models that focus on improving self-care skills might also improve QOL of patients with CHD.

Comparison of the burden of familial hypercholesterolemia between two cohorts of French Canadians hospitalized 25 years apart for coronary heart disease

Familial hypercholesterolemia (FH) is associated with lifelong elevated plasma concentrations of low-density lipoprotein cholesterol (LDL-C) and high risk of premature coronary heart disease (CHD). Clinical recommendations and treatments have emerged to facilitate the management of FH patients. Their impact on the burden of FH is however not well documented. To compare the burden of FH between patients hospitalized for a CHD event 25 years apart in the French-Canadian founder population. Lipid profiles, cardiovascular risk factors, treatments and FH status of 2,029 patients consecutively hospitalized for an acute CHD event between 2017 and 2022 (2022 Cohort) were compared to those of 2,506 patients with angiographically-confirmed CHD who were admitted between 1995 and 1998 (1998 Cohort). At the time of admission, 24.6 % of CHD patients had LDL-C levels >5.0 mmol/L in 1998 compared to 1.4 % in 2022, and FH was diagnosed in 9.6 % of patients in the 1998 cohort compared to 5.5 % in 2022 (p<0.001). FH patients hospitalized for a CHD event were older in 2022 than in 1998 (p <0.001). The prevalence of premature CHD requiring a hospitalization significantly decreased from 1998 to 2022 (64.3% vs. 44.1 %, p<0.001). At the moment of admission, 18.2 % of FH patients had LDL-C concentration <2.0 mmol/L in 2022 vs 0 % in 1998 (p <0.001). Over 25 years, FH patients tend to be older and contribute to a lower proportion of hospitalizations for CHD in the French-Canadian founder population. Despite significant improvement in diagnosis and treatment, FH management remains however sub-optimal.

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

IntroductionMost climate-health studies focus on temperature; however, less is known about health effects of exposure to atmospheric moisture. Humid air limits sweat evaporation from the body and can in turn exert strain on the cardiovascular system. We evaluated associations of long-term exposure to summer specific humidity with cardiovascular disease (CVD), coronary heart disease (CHD) and cerebrovascular disease (CBV) hospitalization. MethodsWe built an open cohort consisting of ∼63 million fee-for-service Medicare beneficiaries, aged ≥65, living in the contiguous US (2000–2016). We assessed zip code level summer average specific humidity and specific humidity variability, based on daily estimates from the Gridded Surface Meteorological dataset (∼4km spatial resolution). To estimate associations of summer specific humidity with first CVD, CHD, and CBV hospitalization, we used Cox-equivalent Poisson models adjusted for individual and area-level socioeconomic status indicators, temperature, and winter specific humidity. ResultsHigher summer average specific humidity was associated with an increased risk of CVD, CHD, and CBV hospitalization. We found hazard ratios (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) in summer average specific humidity. Associations of summer average specific humidity were strongest for beneficiaries eligible for Medicaid and for beneficiaries with an unknown or other race. Higher summer specific humidity variability was also associated with increased risk of CVD, CHD, and CBV hospitalization. Associations were not affected by adjustment for temperature and regions of the US, as well as exclusion of potentially prevalent cases. ConclusionLong-term exposure to higher summer average specific humidity and specific humidity variability were positively associated with CVD hospitalization. As global warming could increase humidity levels, our findings are important to assess potential health impacts of climate change.

Suboptimal self-care trajectories of patients with coronary heart disease call for multiple levels of interventions: results from a longitudinal survey study

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): University of Akureyri Research Fund Landspitali University Hospital Science Fund. Background Self-care is an important part of secondary prevention for patients with coronary heart disease (CHD). But, we have limited knowledge about how self-care of CHD changes over time. The purpose of this prospective, longitudinal survey study was to determine if distinct trajectories of change in self-care behaviors could be identified following a hospitalization for CHD, and identify which characteristics are helpful in predicting trajectory membership. Methods Patients hospitalized acutely or electively for CHD were included in the study and completed questionnaires at hospital discharge and 6 months later. Self-care was measured with the Self-Care of Coronary Heart Disease Inventory, version 2.2 which consisted of 2 behavioral subscales (i.e., maintenance and management) that were standardized to range from 0-100 with higher scores indicating better self-care. Symptoms of anxiety and depression were assessed with the Hospital Anxiety and Depression Scale and health literacy with the Health Literacy Survey Questionnaire. Latent growth mixture modeling was used to identify distinct trajectories of CHD self-care behaviors over time. Results A total of 430 patients with CHD completed the study (mean age 64.3 ±8.9, 79% male). Overall, self-care was poor at enrollment (maintenance 61.6±15.4, management 53.5±18.5). Two trajectories of self-care behaviours were identified. The first "worse CHD self-care" trajectory (57.2% of the sample) had comparatively worse self-care maintenance and management at both enrollment and 6-month follow-up; self-care maintenance improved slightly (4.0±14.5-point improvement, p&amp;lt;0.001) but self-care management got worse (6.3±24.4-point worsening, p = 0.005) over time in this trajectory. The second "better CHD self-care" trajectory (42.8% of the sample) had comparatively better self-care maintenance and management at both enrollment and 6-month follow-up; self-care maintenance improved slightly (5.0±16.2-point improvement, p&amp;lt;0.001), and self-care management remained unchanged (0.8±21.9-point worsening, p = 0.713) in this trajectory (Figure 1). Predictors of fitting in the "worse CHD self-care" trajectory were older age, lower education, not having prior CHD hospitalizations, worse depression and anxiety symptoms, lower health literacy, and not participating in rehabilitation after hospitalization. Conclusion The determinants of change in CHD self-care overtime are complex and include multiple levels of potential intervention including health systems (e.g. rehabilitation) and individual care (e.g. red flags of poor literacy and affective symptoms). As such, care models which provide sufficient patient education, address mental health and focus on self-care management might help patients improve their self-care behaviour.Trajectories of self-care

Short-term effects of ambient ozone exposure on daily hospitalizations for circulatory diseases in Ganzhou, China: A time-series study

Adverse health effects of ambient ozone are getting widespread attention, but the evidence on the relationship between ozone levels and circulatory system diseases are limited and inconsistent. Daily data for ambient ozone levels and hospitalizations for total circulatory diseases and five subtypes in Ganzhou, China from January 1, 2016 to December 31, 2020 were collected. We constructed a generalized additive model with quasi-Poisson regression accounting for lag effects to estimate the associations between ambient ozone levels and the number of hospitalized cases of total circulatory diseases and five subtypes. The differences among gender, age, and season subgroups were furtherly assessed through stratified analysis. A total of 201,799 hospitalized cases of total circulatory diseases were included in the present study, including 94,844 hypertension (HBP), 28,597 coronary heart disease (CHD), 42,120 cerebrovascular disease (CEVD), 21,636 heart failure (HF), and 14,602 arrhythmia. Significantly positive associations were observed between ambient ozone levels and daily hospitalizations for total circulatory diseases and all subtypes except arrhythmia. Each 10 μg/m3 increase in ozone concentration, the risk of hospitalizations for total circulatory diseases, HBP, CHD, CEVD, and HF increased by 0.718% (95% confidence interval, 0.156%–1.284%), 0.956% (0.346%–1.570%), 0.499% (0.057%–0.943%), 0.386% (0.025%–0.748%), and 0.907% (0.118%–1.702%), respectively. The above associations remained significant after adjusting for other air pollutants. The risk of hospitalization for circulatory diseases was higher in warm season (May to October) and varied in gender and age subgroups. This study suggested that short-term exposure to ambient ozone may increase the risk of hospitalizations for circulatory diseases. Our findings reinforce the importance of reducing ambient ozone pollution levels for protecting public health.

Associations between short-term PM2.5 exposure and daily hospital admissions for circulatory system diseases in Ganzhou, China: A time series study.

Previous epidemiological studies have shown that both long-term and short-term exposure to fine particulate matters (PM2.5) were associated with the morbidity and mortality of circulatory system diseases (CSD). However, the impact of PM2.5 on CSD remains inconclusive. This study aimed to investigate the associations between PM2.5 and circulatory system diseases in Ganzhou. We conducted this time series study to explore the association between ambient PM2.5 exposure and daily hospital admissions for CSD from 2016 to 2020 in Ganzhou by using generalized additive models (GAMs). Stratified analyses were also performed by gender, age, and season. Based on 201,799 hospitalized cases, significant and positive associations were found between short-term PM2.5 exposure and hospital admissions for CSD, including total CSD, hypertension, coronary heart disease (CHD), cerebrovascular disease (CEVD), heart failure (HF), and arrhythmia. Each 10 μg/m3 increase in PM2.5 concentrations was associated with a 2.588% (95% confidence interval [CI], 1.161%-4.035%), 2.773% (95% CI, 1.246%-4.324%), 2.865% (95% CI, 0.786%-4.893%), 1.691% (95% CI, 0.239%-3.165%), 4.173% (95% CI, 1.988%-6.404%) and 1.496% (95% CI, 0.030%-2.983%) increment in hospitalizations for total CSD, hypertension, CHD, CEVD, HF, and arrhythmia, respectively. As PM2.5 concentrations rise, the hospitalizations for arrhythmia showed a slow upward trend, while other CSD increased sharply at high PM2.5 levels. In subgroup analyses, the impacts of PM2.5 on hospitalizations for CSD were not materially changed, although the females had higher risks of hypertension, HF, and arrhythmia. The relationships between PM2.5 exposure and hospitalizations for CSD were more significant among individuals aged ≤65 years, except for arrhythmia. PM2.5 had stronger effects on total CSD, hypertension, CEVD, HF, and arrhythmia during cold seasons. PM2.5 exposure was positively associated with daily hospital admissions for CSD, which might provide informative insight on adverse effects of PM2.5.

Association between air pollution exposure and coronary heart disease hospitalization in a humid sub-tropical region of China: A time-series study.

Emerging evidence has highlighted the possible links of environmental pollution with several cardiovascular diseases (CVDs). The current study aimed to explore the impact of short-term air pollution exposure on CHD hospitalization in Hefei. Data about the daily number of CHD admissions (from 2014 to 2021) were retrieved from the First Affiliated Hospital of Anhui Medical University. Air pollutants and meteorological data were obtained from the China Environmental Monitoring Station and the China Meteorological Data Service Center, respectively. The correlation between air pollution and CHD hospitalization was assessed using distributed lag non-linear model (DLNM) and Poisson generalized linear regression. In the single-pollutant model, NO2, O3, and CO strongly correlated with CHD hospitalization rate. Specifically, exposure to NO2 (lag0, relative risk [RR]: 1.013, 95%CI: 1.002-1.024, per 10 μg/m3 increase) and CO (lag13, RR: 1.035, 95%CI: 1.001-1.071, per 1 μg/m3 increase) revealed a positive correlation with an increased rate of CHD hospitalization. Interestingly, O3 had a protective association with hospitalization of CHD (lag0, RR: 0.993, 95%CI: 0.988-0.999, per 10 μg/m3 increase). Similar results, to those of the single-pollutant model, were revealed following verification using two-pollutant models. Subgroup analyses indicated that young people, women, and people in hot seasons were more susceptible to NO2 exposure, while the elderly, women, and people in cold seasons were more susceptible to O3. Furthermore, the elderly were more susceptible to CO exposure. Overall, exposure to NO2 and CO increases the rate of CHD hospitalization, but exposure to O3 shows a protective association with the rate of CHD hospitalization. Therefore, early preventive measures against air pollutants should be applied to protect vulnerable patients with CHD.

A Time Series Study for Effects of PM10 on Coronary Heart Disease in Ganzhou, China.

Objective: To investigate the effect of PM10 exposure in low concentration areas on the daily hospitalized patients with coronary heart disease. Methods: Daily air quality monitoring data, meteorological monitoring data and daily hospitalization data of coronary heart disease during 2019−2021 in Ganzhou, China were collected. Generalized additive model and distributed lag nonlinear model were used to evaluate the association between environmental PM10 and daily hospital visits for coronary heart disease. Stratified by sex and age to see their potential impact on this association. Results: PM10 exposure was correlated with an increased risk of hospitalization in coronary heart disease patients. Single-pollutant model analysis shows that at the day of lag1, for every 10 µg/m3 increase in PM10, the risk of coronary heart disease hospitalization increased by 1.69% (95%CI 0.39~3.00%); Subgroup analysis showed that females and older adults (>65 years) were more sensitive to PM10 exposure. In addition, in the dual-pollutant model, by adjusting other pollutants (including SO2, CO and O3), it was found that the relationship between PM10 exposure and coronary heart disease hospitalization was robust. And with changing the model’s degree of freedom was still robust. Conclusion: Short-term exposure to low concentrations of PM10 is associated with hospitalization for coronary heart disease. These results are important for local environmental public health policy development, so as to protect vulnerable populations.

Change in coronary heart disease hospitalization after chronic disease management: a programme policy in China.

This study aims at examining changes in coronary heart disease (CHD) hospitalization associated with a novel county-scale chronic disease management (CDM) programme policy implemented in March 2019 in China during the 13th Five-Year period (2016-2020). The CDM programme was designed to improve the health of populations with chronic diseases by means of an integrated way involving both county-level public hospitals and primary care institutes. Data originated from the medical files of CHD inpatients discharged from a secondary hospital from January 2017 to December 2020. A total of 6111 CHD patient records were collected. Univariate and multivariate regression analyses were performed to assess changes in hospitalization direct medical costs and length of stay of CHD patients. The mean direct medical cost of CHD hospitalization was 8419.73 Yuan, and the mean length of stay was 7.57 days. Results suggested that the implementation of CDM reduced hospitalization direct medical cost and bed days by about 23% (1956.12 Yuan at means) and 11.5% (almost 1 day at means), respectively. In addition, a further decreasing trend in medical costs over time was associated with chronic disease management. It is implied that chronic disease management is an effective way of relieving the medical and financial burden of hospitalization.

Abstract 12446: Effectiveness of a Digital Health Enabled Cardiac Rehabilitation Program in Reducing Recurrent Events For Private Health Insurance Patients in Australia

Introduction: Secondary prevention programs are paramount to avoid cardiovascular disease morbidity and mortality. However, they are underutilized. Technology-enabled programs provide a new frontier to break down access barriers and enhance health service delivery. We implemented a telehealth program using a cardiac rehabilitation (CR) mobile app for privately insured patients following a hospitalization for coronary heart disease. Hypothesis: It was hypothesized that patients participating in a digitally-enabled CR program would have improved health behaviors and less recurrent events at 30-days to 12-months post discharge compared with propensity matched controls. Methods: Eligible patients received the Smart-CR mobile app, supplemented with telehealth consultations. Clinical and lifestyle changes, psychological well-being, quality of life and medication adherence were assessed at the beginning and 8-weeks following participation in the program. Using propensity matching methods, we compared rehospitalization and mortality rates of the digital-CR group (n=160) with a traditionally delivered CR group (n=115) and patients who did not undertake any form of CR (n=266). Results: Among 160 patients (35% regional/remote, 70% male and 78% aged over 60 years), physical activity levels increased from 128 minutes/week to 300 minutes/week and systolic blood pressure decreased by 5 mmHg. There were improvements in most other clinical, behavioral and lifestyle risk factors, including functional capacity, depression, anxiety, and quality of life. At 60 days, digital-CR reduced cardiac-related readmissions by 52% (RR 0.48; 95% CI: 0.24 to 0.93) compared to no CR. At 90 days, traditional CR decreased all cause readmissions by 36% (RR 0.64; 95% CI: 0.44 to 0.94) compared to non-attendance to CR. There were no other pairwise differences between groups at 30, 60 or 90 days. Health economic analyses and extended outcomes to 12 months post hospitalization are in process. Conclusion: A remotely delivered, technology-enabled CR program was effective in reducing hospital readmissions and improving cardiovascular risk. A randomized controlled trial is underway to test the generalizability of these findings in community participants.

Primary small intestinal extranodal NK/T cell lymphoma, nasal type with kidney involvement: a rare case report and literature review

BackgroundExtranodal NK/T cell lymphoma, nasal type (EN-NK/T-NT) is a rare and aggressive type of non-Hodgkin’s lymphoma. EN-NK/T-NT seldom occurs in the gastrointestinal tract, and renal involvement is relatively rare.Case presentationHere we report a case of primary small intestinal EN-NK/T-NT with kidney involvement. We present the case of a 71-year-old female who was admitted to our hospital for coronary heart disease with a fever of unknown origin. Laboratory examination showed renal impairment and PET/CT showed a locally thickened wall of the small intestine, abnormally increased FDG metabolism in the right lower abdomen, and multiple slightly high-density masses with abnormal increased FDG metabolism in the right kidney. The gross specimen showed a grayish-white lump located in the ileum approximately 15 cm away from the ileocecum, and two grayish-white lumps located in the upper and lower poles of the right kidney, respectively. The pathological diagnosis was EN-NK/T-NT. The patient died approximately 10 months after the operation.ConclusionEN-NK/T-NT is a rare type of non-Hodgkin’s lymphoma and may develop insidiously, with fever as the only clinical manifestation. The disease was found to be difficult to diagnose in the early stage, resulting in a highly aggressive clinical course and short survival time.

Ultra-sensitive troponin-I and incident coronary heart disease, stroke, heart failure, cardiac arrhythmias, arterial aneurysms and venous thromboembolism hospitalizations

Abstract Background Cardiac troponin I (cTnI) as measured by high-sensitive assays has been related to incident cardiovascular disease events (CVD) in the community. With the advent of ultra-sensitive assays, it is now possible to detect troponin I at very low concentration, far below the classical threshold of 1.9 pg/mL. However, the clinical relevance of these low concentrations for predicting CVD is largely unknown. Purpose To examine the association of cTnI as low as 0.013 pg/mL with incident cardiovascular disease events (CVDs) in the primary prevention setting. Methods cTnI was analyzed in the baseline plasma (2008–2012) of CVD free volunteers from the Paris Prospective Study III using for the first time a novel ultra-sensitive immunoassay (Simoa Troponin-I 2.0 Kit, Quanterix, Lexington) with a limit of detection (LOD) of 0.013 pg/mL. Incident CVD hospitalizations for coronary heart disease, stroke, arrhythmias, venous thromboembolism, arterial aneurysms and heart failure were validated by critical review of the hospital records. Hazard ratios were estimated per log-transformed standard deviation (SD) increase of cTnI in Cox models using age as the time scale. The added value (gain in discriminatory capacity) of cTnI for CVD risk prediction was examined by calculating the Harell's C-index boostraped difference of the SCORE 2 risk model with and without cTnI. Results There were 9503 CVD free participants (40% women) aged 59.6 (6.3) years at baseline. cTnI was detected in 99.6% of the participants (median value = 0.63 pg/mL, interquartile range [IQR] 0.39–1.09). After a median follow-up of 8.34 years (IQR, 8.0–10.07), 516 participants suffered 612 events. In fully-adjusted analysis, higher cTnI (per 1 SD increase of log cTnI) was significantly associated with CVD events combined (n=516, HR= 1.21; 1.06; 1.39). In univariate Cox analysis and compared to each single established risk factor, cTnI had the highest discrimination capacity for incident CVD events (C-index=0.6349) (Figure 1). Adding log cTnI to the SCORE 2 algorithm increased significantly albeit moderately discriminatory capacity (C-index 0.698 vs. 0.685; boostraped C index difference: 0.0135 (95% CI: 0.0131; 0.0138)). Conclusion cTnI concentrations as measured by a novel ultra-sensitive immunoassay is associated with a significant increased risk of incident CVD events in the primary prevention setting. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): ANR: French National Research AgencyEurope: Horizon 2020

Comparison over 25 years of the burden of familial hypercholesterolemia on hospitalizations for coronary heart disease in a French-Canadian founder population

Abstract Background Over the last 25 years, effective treatments, such as potent statins, ezetimibe and PCSK9 inhibitors have gradually emerged to treat heterozygous familial hypercholesterolemia (FH) and guidelines have been progressively developed internationally to promote FH health surveillance, early diagnosis and optimal clinical management. However, the impact of these measures on the burden of FH is not well documented. Although recent genetic and epidemiological studies suggest that the prevalence of familial hypercholesterolaemia (FH) is approximately twice than initialy expected (1:250) (1), it remains significantly higher among French Canadians (FC) (2,3). Purpose To compare over 25 years the management and burden of FH among patients hospitalized for an acute coronary heart disease (CHD) event in a FC founder population with a high prevalence of FH. Methods Lipid profiles, cardiovascular risk factors, lipid management and FH status of 2,029 FC patients consecutively hospitalized for an acute CHD event between 2017 and 2022 (2022 Cohort) were compared to those of 2,506 patients with angiographically-confirmed CHD who were admitted between 1995 and 1998 (1998 Cohort) (4). FH status was based on molecular, Simon Broome or FH Canada (5) criteria. Statistical comparisons were made using Chi-square and Student's t-tests for independent samples. Results Over a 25-year interval, most patients hospitalized for CHD were men (74.5% in 1998 vs 73.4% in 2022). At the time of admission, 23.0% of CHD patients had LDL-Cholesterol levels &amp;gt;5.0 mmol/L in 1998 compared to 1.3% in 2022 (p&amp;lt;0.001). FH was diagnosed in 9.6% of patients in the 1998 cohort compared to 5.5% in 2022 (p&amp;lt;0.001). Overall, the prevalence of obesity, type 2 diabetes and uncontrolled hypertension tended to be higher in 1998, including in FH (p&amp;lt;0.05). The proportion of FH patients hospitalized for CHD who were treated with a statin or a combination of lipid-lowering agents at the moment of admission was 28.4% in 1998 compared to 61.2% in 2022 (p&amp;lt;0.001). FH patients hospitalized for CHD were significantly older in 2022 than in 1998 (59.03±11.17 vs 50.14±11.32 years; p&amp;lt;0.001). Accordingly, the prevalence of premature CHD requiring an hospitalization significantly decreased from 1998 to 2022 in FH (64.3% vs. 44.1%, p&amp;lt;0.001). Conclusions Over a 25-year period, FH patients hospitalized for CHD tend to be older and contribute to a lower proportion of hospitalizations. Despite significant improvement in treatment, FH diagnosis and management remain sub-optimal, even in a founder population where FH represents a significant population burden. Funding Acknowledgement Type of funding sources: None.

Determinants associated with medical-related long-term care service use among community-dwelling older adults in Taiwan

IntroductionMedical-related long-term care (LTC) service use among community-dwelling older adults in Taiwan is resource-intensive, and planning is essential to promote aging-in-place. MethodsAdministrative data from 4/1/2017 to 11/26/2019 among more than 14,000 residents were analyzed with generalized estimating equations (GEEs) to identify determinants of medical-related LTC service use. ResultsOlder adults using medical-related LTC services tended to be younger (79.9 vs. 80.7; p<.0001), male (42.7% vs. 38.5%; p<.0001), multi-morbid (3.1 vs. 2.5; p<.0001), and higher mean activities of daily living (ADL) disability (8.2 vs. 4.2; p<.0001), instrumental ADL (IADL) disability (11.0 vs. 9.1; p<.0001), and hospitalizations (1.1 vs. 0.4; p<.0001). Significant determinants of medical-related LTC services include age, education, stroke, coronary heart disease, diabetes, vision impairment, ADL disability, and prior hospitalization. DiscussionThe success of LTC 2.0 will depend on ADL support and care coordination to manage chronic conditions such as diabetes, vision impairment, coronary heart disease, and stroke.

The short-term effects and burden of particle air pollution on hospitalization for coronary heart disease: a time-stratified case-crossover study in Sichuan, China

BackgroundCoronary heart disease (CHD), the leading cause of death globally, might be developed or exacerbated by air pollution, resulting high burden to patients. To date, limited studies have estimated the relations between short-term exposure to air pollution and CHD disease burden in China, with inconsistent results. Hence, we aimed to estimate the short-term impact and burden of ambient PM pollutants on hospitalizations of CHD and specific CHD.MethodsPM10 and PM2.5 were measured at 82 monitoring stations in 9 cities in Sichuan Province, China during 2017-2018. Based on the time-stratified case-crossover design, the effects of short-term exposure to particle matter (PM) pollution on coronary heart disease (CHD) hospital admissions were estimated. Meanwhile, the linked burden of CHD owing to ambient PM pollution were estimated.ResultsA total of 104,779 CHD records were derived from 153 hospitals from these 9 cities. There were significant effects of PM pollution on hospital admissions (HAs) for CHD and specific CHD in Sichuan Province. A 10 μg/m3 increase of PM10 and PM2.5 was linked with a 0.46% (95% CI: 0.08, 0.84%), and 0.57% (95% CI: 0.05, 1.09%) increments in HAs for CHD at lag7, respectively. The health effects of air pollutants were comparable modified by age, season and gender, showing old (≥ 65 years) and in cold season being more vulnerable to the effects of ambient air pollution, while gender-specific effects is positive but not conclusive. Involving the WHO’s air quality guidelines as the reference, 1784 and 2847 total cases of HAs for CHD could be attributable to PM10 and PM2.5, separately. The total medical cost that could be attributable to exceeding PM10 and PM2.5 were 42.04 and 67.25 million CNY from 2017 to 2018, respectively.ConclusionsThis study suggested that the short-term exposure to air pollutants were associated with increased HAs for CHD in Sichuan Province, which could be implications for local environment improvement and policy reference.