Higher Age Research Articles

Polymers marry with carbon nanospheres: A promising strategy to develop high-performance filtrate reducer

Polymeric filtrate reducers have limited uses under high temperature and salinity conditions. The incorporation of nanoparticles to polymeric networks is a popular and effective method for creating high-performance filtrate reducers. However, present nanofillers are costly, have negative environmental consequences, and are difficult or impossible to disseminate. Herein, a simple hydrothermal process using low-cost and renewable glucose as raw ingredients resulted in hydroxy-rich carbon nanospheres (CNs). After modification by acryloyl chloride, the CNs were copolymerized with acrylamide, 2-acrylamido-2-methylpropanesulfonic acid, and sodium p-styrene sulfonate. The obtained CNs-doped polymers (CAAS) were able to maintain high viscosity and colloidal stability even after salt contamination and high temperature aging. CAAS-based drilling fluids can tolerate temperatures of up to 240 °C under 30% NaCl conditions. The API filtration loss (FLAPI) and the high-temperature high-pressure filtration loss (FLHTHP) were 10 and 63.5mL, respectively. Considering the low-cost and renewable raw materials, high dispersibility and high compatibility of CNs as well as significant improvement in thermal-resistance and salt-tolerance, this work provides a simple yet effective approach to developing high-performance filtrate reducers for complex geological conditions.

Deep learning assisted prediction on main factors influencing shear strength of sintered nano Ag-Al joints under high temperature aging

Bonding strength of sintered nano silver (Ag) joints has been an important index for evaluating the reliability of power module packages, which has been reported to be influenced by many factors. However, it is hard to evaluate and predict those factors affecting bonding strength. With the help of artificial intelligence (AI), the utilization of AI tools to assist in finding science solutions has become a mainstream consensus. In this paper, we will show how to evaluate and predict those sintered nano Ag-Al bonded joints bonding strength with deep learning (DL) methods. Firstly, a reliable extended dataset was obtained using the conditional formal condition table generation Induction Network (CTGAN) based on the die shear test dataset of sintered Ag-Al interface shear strength with four different metallization layers under different high-temperature aging time. Subsequently, four DL models were adopted to predict the shear strength of Ag-Al interface under different metallization layers to evaluate the interface bonding strength, all with high level of determination coefficient (R2, above 0.99) and classification accuracy (above 85%). Last but not least, factors influencing the shear strength of Ag-Al interface were analyzed and ranked by weight analysis and SHapley Additive exPlanations (SHAP) method. This research could provide a novel perspective on understanding those factors affecting the shear strength of sintered nano Ag interconnect layer in power devices.

The Progression of Symptoms in Post COVID-19 Patients: A Multicentre, Prospective, Observational Cohort Study

Background: Although the coronavirus disease 2019 (COVID-19) pandemic is no longer a public health emergency of international concern, 30% of COVID-19 patients still have long-term complaints. A better understanding of the progression of symptoms after COVID-19 is needed to reduce the burden of the post COVID-19 condition. Objective: This study aims to investigate the progression of symptoms, identify patterns of symptom progression, and assess their associations with patient characteristics. Methods: Within the P4O2 COVID-19 study, patients aged 40–65 years were recruited from five Dutch hospitals. At 3–6 and 12–18 months post COVID-19, medical data were collected, and pulmonary function tests were performed. In between, symptoms were assessed monthly with a questionnaire. Latent class mixed modelling was used to identify symptom progression patterns over time, with multinomial logistic regression to examine associations with patient characteristics. Results: Eighty-eight patients (aged 54.4 years, 48.9% males) were included. Three trajectories were identified for fatigue and dyspnoea: decreasing, high persistent, and low persistent. The odds of “decreasing fatigue” was higher for never smokers and participants in the lifestyle intervention and lower for those having a comorbidity. The odds of “decreasing dyspnoea” was higher for moderate COVID-19 patients and lifestyle intervention participants and lower for males, mild COVID-19 patients, and those with a higher age. Conclusions: Three distinct trajectories were identified for fatigue and dyspnoea, delineating patterns of symptom persistence following COVID-19. Sex, age, smoking status, participation in lifestyle interventions and COVID-19 severity were associated with the likelihood of belonging to different trajectories. These findings highlight the heterogeneity of the long-term symptoms experienced by post COVID-19 patients and emphasise the importance of personalised treatment strategies.

Characterising impaired awareness of hypoglycaemia and associated risks through HypoA-Q: findings from a T1D Exchange cohort.

We aimed to: (1) externally validate the five-item Hypoglycaemia Awareness Questionnaire (HypoA-Q) impaired awareness subscale (HypoA-Q IA); (2) examine how impaired awareness of hypoglycaemia (IAH) relates to the risk of severe hypoglycaemia and level 2 hypoglycaemia; and (3) identify factors associated with IAH. Nationwide survey of T1D Exchange registrants was conducted to collect data on demographics, 6 month severe-hypoglycaemia history, hypoglycaemia awareness status (via HypoA-Q IA, the Gold instrument and the Clarke instrument) and continuous glucose monitor (CGM) measures. The Clarke hypoglycaemia awareness factor (Clarke-HAF) was calculated to exclude severe-hypoglycaemia history items. Analyses included Cronbach's α, Spearman correlations and logistic regression. Valid survey responses were collected from N=1580 adults with type 1 diabetes (median age, 44 years; 52% female participants; median HbA1c, 48 mmol/mol [6.5%]). Of these, 94% of participants were using CGMs and 69% were using hybrid closed-loop (HCL) systems; 30% had at least one severe-hypoglycaemia episode in the past 6 months. The HypoA-Q IA had satisfactory internal reliability (α=0.79) and construct validity. Higher HypoA-Q IA scores were independently associated with greater risk of severe hypoglycaemia (p<0.001), performing comparably to the Gold instrument and the Clarke-HAF instrument. HypoA-Q IA-determined IAH was independently associated with 88% higher odds of developing severe hypoglycaemia (p<0.001) and twofold higher odds for spending ≥1% of time in level 2 hypoglycaemia (p=0.011). Higher age and longer diabetes duration were associated with higher IAH risk (p<0.001). CGM and HCL use was associated with lower IAH risk (p<0.001). The HypoA-Q IA is a brief, valid and reliable tool for assessing IAH in today's technology-oriented era. IAH was independently associated with severe hypoglycaemia and level 2 hypoglycaemia in a cohort with high prevalence of advanced diabetes technology use and HbA1c within the recommended range. CGM and HCL use was related to lower IAH risk.

Work and disability benefit unraveled in chronic gastrointestinal patients

Abstract Background Persons with a chronic disease, such as chronic gastrointestinal and hepato-pancreatico-biliary (GI-HPB) disease, have a lower work participation (WP) than the healthy population. Instead, they might receive a disability benefit (DB). Positive Health (PH) is a newly developed, holistic view of health and comprises six dimensions: bodily functions, mental well-being, meaningfulness, quality of life, participation, and daily functioning. In this study we aim to determine whether the dimensions of PH relate to WP and DB in persons with GI-HPB. Methods GI-HPB patients attending the outpatient clinic of the Maastricht University Medical Center between 2019-2021 received validated questionnaires (Gastrointestinal Symptom Rating Scale, Short Nutritional Assessment Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Short Form-36, Disease Experience Questionnaire, EuroQol-5D-5L) and items regarding WP and DB. The relation between the six dimensions of PH, and WP and DB, were tested with univariate and multivariate statistics. Results 448 patients (Mage = 45 years; 69% female) were included. Univariate analysis revealed that, except for meaningfulness, all dimensions were significantly associated with WP (p≤.02) and DB (p≤.005). In multivariate analyses, lower age (p=.010), better general health (p=.044) and better physical functioning (p&amp;lt;.001) related to WP. Higher age (p=.002) and lower physical functioning (p=.011) related to DB. Conclusions Among GI-HPB patients, physical functioning related to both WP and DB. The chance of working was higher among younger patients and those with better general health while those with a higher age received DB more often. The PH concept was only partially relevant to work status and DB. Key messages • Within the dimensions of Positive health, work participation was associated with a lower age, a better general health and a better physical functioning. • Within the dimensions of Positive health, disability benefit was associated with higher age and lower physical functioning.

Joint associations of psychological distress and working conditions with sickness absence in Finland

Abstract Background Psychological distress has increased remarkably, especially among younger age groups, during the last years. Both psychological distress and exposure to strenuous working conditions are known risk factors for sickness absence (SA). We examined whether psychological distress and working conditions are jointly associated with SA periods of 1-7 days and 8+ days among young and midlife Finnish employees. Methods We linked survey data from the Helsinki Health Study cohort from 2017 (response rate 51.5%) with the employer’s SA register for the City of Helsinki, Finland (82% consented to the linkage; n = 3949, 80% women, age 19-39 years). Mean follow-up time was 2.1 years. We calculated rate ratios (RR) and 95% confidence intervals (CI) for SA periods of 1-7 days and 8+ days using negative binomial regression models among participants with and without psychological distress, and with and without exposure to strenuous working conditions. Psychological distress was measured with the emotional wellbeing subscale of RAND-36 (cut-off 60 points). Working conditions included physical and mental strenuousness of work and hours per day spent in heavy physical work. Results Participants with psychological distress and exposure to strenuous working conditions had the highest age- and gender-adjusted RRs for SA periods of ≥ 8 days (physically strenuous work: RR: 2.38, CI: 1.97-2.88; mentally strenuous work: RR: 2.08, CI: 1.72-2.53; ≥3 h per day spent in physical work: RR: 2.48, CI: 2.01-3.06), the interactions being additive. The associations were weaker for SA periods of 1-7 days. Adjusting for marital and employment status, education, alcohol use, smoking and body mass index only slightly attenuated these associations. Conclusions Psychological distress and exposure to strenuous working conditions were additively associated with SA. Both individual- and workplace-related risk factors for SA are important to be considered when planning preventive actions. Key messages • Young and early midlife Finnish employees with simultaneous psychological distress and exposure to strenuous working conditions had the highest rates of SA periods, the interactions being additive. • Both psychological distress and exposure to strenuous physical and mental working conditions should be considered when planning preventive actions to reduce employees’ SA.

Anxiety or depression in heart failure across the ejection fraction spectrum

Abstract Background Anxiety or depression are commonly described in patients with heart failure (HF) but few data exist on characteristics and clinical outcomes associated with anxiety or depression across the different HF phenotypes. Purpose To assess the prevalence of patient characteristics and clinical outcomes associated with anxiety or depression in patients with HF with preserved, mildly reduced and reduced ejection fraction (HFpEF, HFmrEF, and HFrEF). Methods Patients enrolled in the Swedish Heart Failure Registry between 2000-2021 were included. Self-reported anxiety or depression was collected using EuroQoL 5-dimensional questionnaire (EQ-5D) at baseline and follow-up visits. Anxiety or depression was categorized as "not anxious or depressed", "moderately anxious or depressed" or "severe anxious or depressed". The independent associations between baseline characteristics and presence of anxiety or depression were assessed by a multivariable multinominal regression analysis. Cox proportional hazards regressions were performed to model the time to first event according to levels of anxiety or depression. Outcomes included all-cause death and all-cause hospitalizations. Results A total of 45,247 patients were included among whom 58% reported none, 38% moderate and 5% severe anxious or depressed with similar distribution across the HF phenotypes (Figure). Several characteristics were associated with anxiety or depression with the strongest ones for severe versus none being higher NYHA class (OR 3.10 (2.77-3.47)), liver disease (OR 1.99 (1.56-2.55)), in-patient setting (OR 1.62 (1.43-1.84)), smoking (OR 1.75 (1.52-2.00)) while others were inversely related including male sex (OR 0.51 (0.46-0.56)), higher age (OR 0.60 (0.53-0.67)), referral to HF nurse clinic (OR 0.82 (0.72-0.94)) and higher income level (OR 0.68 (0.62-0.76)). The risk of all-cause death and all-cause hospitalizations increased with increasing levels of anxiety or depression across all HF phenotypes during 12 months of follow up. Severe anxiety or depression had a stronger association with all-cause death in hospitalized patients and all-cause hospitalizations in out-patients. Conclusion In this large contemporary cohort of patients with HF in a real-world setting, anxiety or depression was frequently and similarly distributed across all HF phenotypes. Higher NYHA class, liver disease and in-patient setting were strongly associated with the anxiety or depression while male sex, higher age, and higher income were inversely related with anxiety or depression. Anxiety or depression was significantly associated with worse outcomes at 12 months follow up.Proportion anxiety or depression

Impact of Covid19 on chronic respiratory diseases

Abstract Introduction This study was created to test the hypothesis that Covid19 pandemic may have influenced the increase in chronic respiratory diseases, particularly asthma, COPD, and mixed forms. This aspect does not seem to have been investigated previously in the literature. Methods The study population consisted of all residents in the province of Grosseto in the two study years (2019 and 2022) aged over 17 and under 90 (n. 368,326). For each of them, the presence of chronic lung disease (OUTCOME), Covid 19 positivity (between 2019 and 2022), age, sex, and Charlson index were reported in the database. To test the effect of the study variables on the identified outcomes (asthma, COPD, and mixed forms), a single-variable statistical analysis was conducted, followed by multiple logistic regression in which, in addition to the main variable, sex, age, and Charlson index were included to adjust the results, using STATA Vers. 17.0 Be-Basic Edition Results Multivariate statistical analyses showed that those who had COVID between 2019 and 2022 had a 75% higher risk of taking asthma therapy than those who did not (OR 1.75, p &amp;lt; 0. 001); all other variables were also significantly correlated with the outcome: fewer people were taking asthma therapy in the year 2022 than in 2019 (OR 0.89, p &amp;lt; 0.001); men had a lower risk (OR 0.79, p &amp;lt; 0.001); and those who had a higher CI had a higher risk (3.43, p &amp;lt; 0.001). In the study sample, 2.69% took asthma medication in the study years. Conclusions The Covid19 pandemic has had a significant impact on chronic respiratory diseases, especially asthma; patients with higher age and more comorbidities are more likely to develop asthma; males have a lower risk than females, and these data do not seem to have been analyzed in the scientific literature. Key messages • The Covid19 pandemic has had a significant impact on chronic respiratory diseases. • Patients with higher age and more comorbidities are more likely to develop asthma.

Factors Influencing Health Literacy among South Korean Adults: A Nationwide Study

Abstract Background Health literacy is crucial for health knowledge, behaviors, and outcomes, but research on health literacy has been limited to specific populations and settings in South Korea. This study aimed to identify factors influencing health literacy in a nationally representative sample of South Korean adults to inform public policies. Methods This cross-sectional study utilized data from the 2020 Korea Health Panel survey (10,262 adults aged 18-84 years). Sociodemographic factors (age, gender, education level, monthly household income, employment status, marital status, household characteristics, and region) and health (subjective health status, presence of chronic diseases, depression, and health insurance status) factors were examined. Health literacy was assessed using the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16). Linear regression analysis was performed to identify factors associated with health literacy. Results The mean health literacy score was 9.1 (SD 1.60), with significant differences across age groups (p &amp;lt; 0.001). Linear regression analysis (adjusted R2=0.287, F = 322.83, P &amp;lt; 0.001) revealed that higher age, female gender, lower education, lower household income, being single, living outside a metropolitan area, having chronic diseases, lower subjective health, depression, and being uninsured or receiving medical aid were significantly associated with lower health literacy (all p &amp;lt; 0.001). Conclusions This study identified several socio-economic and health-related factors significantly associated with health literacy among South Korean adults. The findings suggest that older individuals, who may require more time to understand and use health information, are particularly vulnerable to low health literacy. These results provide valuable insights for developing targeted interventions and public health policies aimed at promoting health literacy and successful aging in the context of a rapidly aging society. Key messages • Various socio-economic and health-related factors significantly influence health literacy among South Korean adults. • Older individuals are particularly vulnerable to low health literacy, which has implications for successful aging in a rapidly aging society.

Who are the superheroes? A cross-sectional study on the determinants of healthy ageing

Abstract People who reach old age while enjoying good physical and mental health are, in a sense, ‘superheroes’ (of health): in fact, they not only have a relatively low impact on health care spending but are also advantaged in playing an active role in society and achieving their aspirations (and perhaps helping others to do so). The aim of this study was to assess the prevalence and determinants of being ‘physical superheroes’ (i.e., lacking the 10 major chronic conditions plus obesity), ‘mental superheroes’ (i.e., lacking major mental symptoms) and ‘superheroes’ (i.e., both mental and physical superheroes). We used data from a telephone-based cross-sectional study (LOST in Lombardia) conducted in November 2020 (i.e., during the COVID-19 pandemic) on a representative sample of 4,400 adults aged ≥65 years from the Lombardy region, Northern Italy. All the participants provided data both during and before the COVID-19 pandemic. Mental and physical superheroes were 59.0% and 17.6%, respectively. Superheroes were 12.8% overall, 15.1% among men and 11.1% among women; 20.2% among individuals aged 65-69 years, 11.3% among 70-74, 10.0% among 75-79, and 8.3% among ≥80 years. Multivariable analysis showed that, besides female sex, higher age, and disadvantaged socio-economic status, ever tobacco smoking (adjusted odds ratio, aOR=0.71), alcohol drinking (aOR=0.77), and physical inactivity (p for trend&amp;lt;0.001) were inversely related to being superheroes. Participants with feelings of hopelessness showed an extremely low presence of “superheroes” (OR = 0.17). The COVID-19 pandemic reduced by 16.3% the proportion of superheroes. Given a steadily ageing population, public health policies should aim to ensure that people reach old age in the best possible state of health by preventing risky behaviours and paying special attention to inequalities derived from economic and social factors.

N-terminal prohormone of brain natriuretic peptide predicts recurrent cardiovascular events in patients with acute coronary syndrome both in the acute and post-discharge setting: a TRACER substudy

Abstract Background N-terminal prohormone of brain natriuretic peptide (NT-proBNP) is a circulating peptide released by the heart in response to increased wall tension and stretching, for example, occurring during myocardial and/or atrial dysfunction. NT-proBNP is a diagnostic and prognostic marker in patients with heart failure but might also have prognostic utility in the acute phase of patients with acute coronary syndrome (ACS) and at one month after ACS. Purpose To assess the prognostic value of NT-proBNP over time in patients with ACS both in the acute setting and when re-assessed after one month. Methods The TRACER study randomized 12,944 patients with non-ST-segment elevation ACS (NSTE-ACS) to treatment with vorapaxar vs. placebo. Plasma samples for biomarker analyses were obtained at randomization (median 21 hours after hospital admission) in 6,800 patients and at an outpatient visit after one month in 5,313 patients. NT-proBNP was analysed using the Elecsys electrochemiluminescence immunoassays method. The primary composite endpoint in this substudy was the one-year risk of cardiovascular (CV) mortality, myocardial infarction, or ischaemic stroke. Associations between continuous natural log-transformed NT-proBNP levels and outcomes were assessed using Cox regression models accounting for study treatment and established risk factors. Results The median concentration of NT-proBNP during hospitalization for ACS and after one month was 496 ng/L and 264 ng/L, respectively. Higher age, female sex, a history of heart failure, and lower body mass index were independently associated with higher levels of NT-proBNP among patients in the acute setting, with renal disease also being an important factor after one month. The composite outcome of CV mortality, MI, or ischaemic stroke occurred in 901 patients (incidence rate 10.1 per 100 person-years) included at baseline and in 381 patients (incidence rate 5.4 per 100 person-years) included at one month. Higher circulating levels of NT-proBNP were independently associated with a higher risk of the composite endpoint at baseline (adjusted hazard ratio with 95% confidence interval comparing the third vs. the first sample quartile: 1.25 [1.03 – 1.51]) and at one month (1.56 [1.15 – 2.11]) (Figure 1 and 2). Incorporating NT-proBNP at baseline into a model with other established risk factors increased the concordance index of the multivariable model from 0.656 to 0.660 (p &amp;lt; 0.001), and after one month, from 0.711 to 0.733 (p &amp;lt; 0.001). These findings remained consistent across the various components of the composite endpoint. Conclusions In patients with ACS, the level of NT-proBNP is an indicator of increased risk of CV outcomes both in the acute setting and, even more pronounced, one month after the index ACS. Measuring NT-proBNP provided incremental prognostic information beyond established risk factors, both in the acute and post-discharge settings.Fig 1.NT-proBNP quartile groupsFig 2.NT-proBNP and CV outcome

Comparative analysis of post-PCI fractional flow reserve and quantitative flow ratio in predicting long-term Target Vessel Failure and hard endpoints

Abstract Background The role of functional assessment after angiographically acceptable post-PCI result is debatable. Purpose We sought to investigate the correlation between Fractional Flow Reserve measured directly after drug eluting stent (DES) implantation (post-PCI FFR) and post-PCI Quantitative Flow Ratio (post-PCI QFR), clarify their relationship with clinical parameters, and long-term target vessel failure (TVF: cardiac death (CD), non-fatal target vessel myocardial infarction (MI) and target vessel revascularisation (TVR)), and a composite of CD and MI (CD/MI). Method Coronary arteries that underwent post-PCI FFR measurement at our centre between 2012 and January 2021 were consecutively included in this registry. Post-PCI QFR was calculated blinded to the post-PCI FFR value. We analysed the influence of LAD vs. (non-LAD) location, gender, age, hypertension, diabetes mellitus, hyperlipidemia, indication (acute (ACS) vs. chronic coronary syndrome), stent diameter, in-stent restenosis (ISR) vs. de novo lesion category, estimated glomerular filtration rate, proximal vs. distal lesions, severe aortic stenosis, atrial fibrillation during the procedure (AF), and prior myocardial infarction in the supply area (prior MI) on post-PCI FFR and QFR. Optimal cut-off was determined by ROC curves. Results A total of 400 coronary arteries were analysed. LAD location (p&amp;lt;0.001), male gender (p=0.0029) and smaller stent diameter (p=0.0073) proved to be predictors of a lower post-PCI FFR. LAD location (p=0.001), ISR (p=0.02), distal location (p=0.0019), AF (p=0.042) and prior MI (p=0.029) were predictors of a lower post-PCI QFR. There was a systematic bias in post-PCI QFR compared to post-PCI FFR (bias 0.0614, 95% CI, 0.053 - 0.069). During a median follow-up of 45 months, 31 CD, 20 MI and 35 TVR occurred. Follow-up was complete in 100%. There was a significant inverse correlation between post-PCI FFR and TVF (p&amp;lt;0.001) as well as between post-PCI QFR and TVF (p=0.045). In-stent restenosis (p=0.014) and prior MI (p=0.002) were also predictors of higher TVF rate. The predictors of CD/MI were lower post-PCI FFR (p&amp;lt;0.001), smaller stent diameter (p=0.03), higher age (p=0.031) and ACS indication (p=0.048), whereas post-PCI QFR was not. The best post-PCI FFR cut-off to predict TVF was 0.87 (p&amp;lt;0.0001). There was no single optimal post-PCI QFR cut-off to predict TVF. Conclusion Post-PCI QFR shows a systematic bias compared to post-PCI FFR. Post-PCI FFR is a significant predictor of TVF as well as CD/MI, whereas post-PCI QFR predicts TVF. No significant correlation between post-PCI QFR and CD/MI could be demonstrated. Our findings underscore the importance of considering multiple clinical parameters in predicting long-term outcomes. The best post-PCI FFR cut-off to predict TVF was 0.87. However, there was no single, universally applicable post-PCI QFR threshold to predict TVF.

The Health-Employment-Longevity Nexus: Implications for Retirement Age Policies in European Countries

Abstract Background Advances in medical knowledge and technology have led to increased general and healthy life expectancy in Europe. Combined with declining fertility rates, these trends have resulted in an aging population. Many European countries have been reluctant to adjust the retirement age, putting pension funds and Pay-As-You-Go social insurance systems at risk. Linking entitlement age to life expectancy could mitigate this risk and extend working life, but such policies are politically unpopular. This study investigates the empirical relationship among self-perceived health, employment, job quality, and life expectancy in the European context. Methods The study analyzes the determinants of self-rated health using the SHARE database, combined with general and healthy life-expectancy data from EUROSTAT and, where missing, the WHO, focusing on European countries. Results In Europe, both past and present employment improve self-rated health. Job quality has a detrimental effect on self-rated health for women and a positive effect on men. Life expectancy and healthy life expectancy raise self-rated health, while poverty rates negatively affect it. Job quality is widespread among European women, and its negative effect on health rises with age. For European men, job quality has a positive effect, peaking around age 56. The effects of employment and job quality on self-rated health are simultaneous. In European countries with an elasticity &amp;gt;1, healthy life expectancy rises faster than general life expectancy at higher ages, suggesting an improved ability to work at older ages. This finding indicates that adjusting the retirement age could be a powerful tool for improving the sustainability of social insurance systems in Europe. Conclusions For younger European women, it may be rational to set higher retirement-age increments and put them on a declining course as they age, considering the gender-specific age dynamics and job quality effects on health. Key messages • In Europe, employment and job quality significantly influence self-rated health, with gender-specific effects that vary with age and impact retirement age policies. • Adjusting retirement age in line with healthy life expectancy could improve the sustainability of European social insurance systems, considering health-employment dynamics.

Ventricular-arterial coupling as assessed by the PWV/GLS ratio in the general population: reference values, correlates and predictive value

Abstract Purpose Ventricular-arterial coupling (VAC) reflects global cardiovascular efficiency. We may assess VAC state non-invasively by combining the non-invasive gold standards for arterial stiffness (carotid-femoral pulse wave velocity or PWV) and left ventricular systolic function (LV global longitudinal strain or GLS). To gain insight in the clinical value of the PWV to GLS ratio, we conducted a general population study to determine its reference values, clinical correlates and predictive value. Methods We measured PWV by applanation tonometry and GLS by echocardiography in 1026 individuals (mean age 50.3 years; 52% women). We derived age- and sex-specific reference values for PWV/GLS from a low-risk subsample. Clinical correlates of PWV/GLS were determined by stepwise regression. We calculated multivariable-adjusted hazard ratios (HR) for incident cardiovascular (CV) events (median follow-up time: 10.1 years). Results Upper limits of normality for PWV/GLS varied with sex and age, ranging from 0.41 m/sec% in young women up to 0.64 m/sec% in older men. Higher PWV/GLS correlated with male sex and higher age, heart rate, pulse pressure, mean arterial pressure and left ventricular mass (P&amp;lt;0.05 for all). On a continuous scale, only GLS was a significant predictor of CV events after adjustment (HR per 1% decrease: 1.24; P=0.0030). A PWV/GLS ratio above the median (&amp;gt;0.37 m/sec%) did predict future CV events after adjustment (HR versus below median: 2.02; P=0.0067). However, abnormal PWV/GLS defined by reference limits or by cutoffs from literature did not independently predict CV events (P≥0.31 for all). Conclusion Age- and sex-specific reference values for PWV/GLS were reported. PWV/GLS relates to age, sex and blood pressure. In contrast to GLS, PWV/GLS does not hold value for CV event prediction in the community.

Factors associated with 30-day mortality in patients receiving mechanical circulatory support for cardiogenic shock

Abstract Introduction Mechanical circulatory support (MCS) is often deployed in patients with refractory cardiogenic shock complicating acute myocardial infarction (AMI-CS). Nevertheless, the mortality rate in these patients remains utterly high, around 50%. Purpose The aim of this study was to identify patient characteristics associated with 30-day mortality in patients receiving MCS for AMI-CS. Methods In the Netherlands, all patients undergoing percutaneous coronary intervention (PCI) are prospectively entered in the Netherlands Heart Registration (NHR). Additional data were retrieved for all CS patients between 2017-2021 in 14 Dutch hospitals, including MCS usage. Survivors and non-survivors amongst MCS treated patients were compared to identify patient characteristics associated with 30-day mortality. In addition, multivariate logistic regression analysis on imputed data was performed to quantify these associations in adjustment for confounders. Results MCS was deployed in 516 (23.3%) of all AMI-CS patients. MCS patients had a mean age of 64.2 (± 12.5) years and 74.6% were male. An intra-aortic balloon pump (IABP) was used in 49.0% of the patients. Impella, extracorporeal membrane oxygenation (ECMO) and multiple devices were used in 18.2%, 13.2% and 18.4% respectively. The overall 30-day mortality rate was 55.0%. At baseline, MCS survivors were younger (62.8 vs 65.2, p=0.03), had diabetes less often (18.4 vs. 28.0, p=0.02), and presented with a higher mean arterial pressure (MAP) (77.9 vs. 71.7, p&amp;lt;0.01). An out-of-hospital cardiac arrest (OHCA) preceded in 34.3% of the survivors versus 42.0% of the non-survivors (p=0.09). Survivors also had lower admission levels of lactate (5.0 vs. 7.8, p&amp;lt;0.01), glucose (12.1 vs. 15.2, p&amp;lt;0.01) and creatinine (94 vs. 115, p&amp;lt;0.01). Multivessel disease (MVD) was present less frequently in survivors compared to non-survivors (62.1% vs. 74.2%, p&amp;lt;0.01). In-hospital cardiac arrest (IHCA) occurred less often in survivors both prior to PCI (8.2% vs. 18.0%, p&amp;lt;0.01) and during PCI (22.8% vs. 34.6%, p&amp;lt;0.01). After multivariate logistic regression, higher age (OR 1.04, 95%CI: 1.02-1.05), resuscitation prior to (OR 2.11, 95 %CI: 1.09-4.09) or during PCI (OR 1.58, 95% CI: 1.01-2.47) and the presence of MVD (OR 2.07, 95% CI: 1.32-3.25) were independently associated with 30-day mortality in AMI-CS patients who received MCS. Conclusion In AMI-CS patients who received MCS, older age, the occurrence of an IHCA prior to or during PCI, and the presence of MVD were independently associated with an increased 30-day mortality.Figure 1.Table 1.

Predictor of wasted implantable cardioverter defibrillator for secondary prevention

Abstract Background ICD is the first line treatment to prevent sudden cardiac death from recurrence of VT/VF. However, patients with organic heart disease have many comorbidities, and some patients die without history of appropriate ICD therapy in lifetime. Purpose The aim of this study is to examine the predictors of death without appropriate ICD therapy in lifetime, among ICD patients for secondary prevention with organic heart disease. Methods We enrolled consecutive patients implanted with ICD/CRT-D for secondary prevention between 2000 and 2022. We excluded patients without organic heart disease, and alive patients without history of appropriate ICD therapy. Inappropriate candidate (Wasted-group) for defibrillator was defined as the patient who died without history of appropriate ICD therapy or died within one year from appropriate ICD therapy. Appropriate candidate (Appropriate-group) was defined as the patient who had been alive over one year from appropriate ICD therapy (Wasted-group:36, Appropriate-group:131). Results During a follow-up of 8.3 ± 5.3 years, a total of 93 (56%) patients died, including 6 (4%) patients died within one year from ICD/CRT-D implantation. Among the 36 patients of Wasted-group, 28 patients died without history of appropriate ICD therapy. Higher age, ischemic cardiomyopathy, non-ARVC, a past history of VF, diabetes mellitus, and higher serum creatinine was the predictor of Wasted-group (P&amp;lt;0.05). Wasted ICD risk score was constructed with the summation of these predictors for predicting candidates of Wasted-group. When the Wasted ICD risk score was ≥3, positive predictive value and negative predictive value were 39.7% and 89.4%, respectively (AUC=0.77, P&amp;lt;0.001). Conclusion Patients with a Wasted ICD risk score &amp;lt;3 is likely to receive appropriate ICD therapy in lifetime. Therefore, Wasted ICD risk score might be useful to decide to need for ICD therapy, regarding elderly patients who would be hesitant to have ICD implanted.Wasted ICD risk score

National early warning score predicts 90 days all-cause mortality among patients with acute heart failure

Abstract Background Acute heart failure (AHF) is defined as new-onset or worsening of symptoms and signs of heart failure including symptoms or signs related to congestion and volume overload. Patients presenting with AHF are a heterogeneous group as AHF is not a specific disease but a shared clinical presentation of different cardiac abnormalities. Due to the heterogeneity of the patient population, a prognostic tool is needed to identify AHF patients with a high risk of death. The National Early Warning Score (NEWS) is a system for scoring the vital signs that are measured at the patient's bedside and is developed to predict acute mortality within 24 hours. The NEWS has previously been used to evaluate all cost mortality for patients admitted to the Emergency Department (ED). There is limited data regarding the role of the NEWS in predicting adverse outcomes in patients with acute heart failure. Purpose To evaluate NEWS measured at the ED and clinical outcomes in patients with AHF. Methods This prospective, observational cohort study included consecutive patients with AHF admitted through the emergency department (ED) at a large public hospital from 10 March 2020 to 31 March 2022 and had a follow-up period of 365 days. Trained cardiologists assessed all patients for the presence of AHF. According to the cut-off value for the NEWS, high-risk groups are defined by a NEWS score &amp;gt; 7. The patients were categorized into two groups, high-risk and low-risk, depending on the scores they received from the NEWS assessment. The primary outcome was all-cause mortality at 90 days. We used multivariable Cox regression (hazard ratios [HRs]) to compare survival, adjusting for age, sex, smoking, known heart failure (HF), and lactate levels at admission. Results In the study period from March 10, 2020, to March 31, 2022, 408 patients were identified with AHF. Upon arrival to the ED, the median first NEWS was 4 (IQR 2-6). 323 patients were categorized in the low-risk group and 69 patients in the high-risk group. 16 patients had missing values upon arrival at the ED. The high-risk group exhibited significantly faster heart rate, lower saturation, and higher oxygen demand compared. A Kaplan-Meier plot revealed a statistically significant difference in all-cause mortality over 90 days between low-risk and high-risk groups among AHF patients (log rank, p-value &amp;lt; 0.001). After multivariable adjustment, NEWS&amp;gt;7 (HR, 1.69; CI, 1.18 to 2.45) (p-value= 0.004) and higher age (HR, 1.04; CI 1.03 to 1.07) were statistically associated with higher all-cause mortality (p &amp;lt;0.001). Conclusion In this prospective, observational cohort study of AHF patients presenting at the ED an initial NEWS &amp;gt;7 was associated with a significant all-cause mortality after 90 days.GRAPHIC ABSTRACT

Alcohol related emergencies among adolescents admitted in a referral acute-care center for adults in Genoa, northwest Italy

Abstract Background As a result of underage drinking, adolescents have an increased risk of physical, mental, emotional, and social harm. Methods In order to assess the emergencies for alcohol use, data of the emergency department (ED) of San Martino Hospital - the referral acute-care center for adults in Genoa, Northwest Italy - was analyzed retrospectively. 330 records of 320 adolescents visiting the ED between 2014 and 2023 were considered. Results The median age of access was 16 (IQR 2), 54.8% were males, 17.4% had foreign nationalities, and the average blood alcohol concentration (BAC) was 1.8 g/L (SD 0.7), with 14.7% testing positive for other substances (6.1% benzodiazepines and 11.2% other drugs). 16.8%, 46.6% and 36.6% were assigned an emergency, urgent, and not-urgent acuity code. 2.8% had a repeated episode, 3.4% had to be removed for inappropriate behavior, 7.8% left spontaneously, 13.1% were hospitalized for additional care (5.5% in the Psychiatry ward). The average length of stay was 1.24 days (SD 5.86). Multivariable logistic regression showed that higher age, an emergency code and the use of other substances were positively associated with hospitalization [ORs 1.74 (95%CI 1.1-2.7), p 0.01; 7.1 (95%CI 2.2-22.4) p &amp;lt; 0.001; and 15.6 (95%CI 6.8-35.6) p &amp;lt; 0.001, respectively]. Admission in Psychiatry, in particular, was strongly associated with the use of other substances [OR 11.8 (95%CI 3.8-36.6), p &amp;lt; 0.001]. Multivariable linear regression showed that, in comparison with other access reasons, accidents and decreased consciousness were associated with higher BAC [beta 0.6 (95%CI 0.1-1.1), p 0.01; beta 0.8 (95%CI 0.3-1.2) p &amp;lt; 0.001]. Length of stay, however, was associated with lower BAC [beta -0.2 (95%CI -0.3 -0.01), p 0.04]. Conclusions In Italy, binge drinking affects 120,000 adolescents aged 11-17. Our findings highlight the harm of this practice and support the need for prompt interventions to reduce the onset and prevalence of adolescent alcohol use.

Postoperative heart valve infection, when and which bacteria: a nationwide cohort study

Abstract Background In patients undergoing heart valve surgery, subsequent bacteremia and infective endocarditis are feared events due to the associated high mortality. Knowledge on the incidence and specification of bacteremia following left-sided valve surgery are sparse and may have implications for prophylactic strategies and follow-up. Purpose To examine the six months incidence of bacteremia and infective endocarditis following left-sided heart valve surgery. Methods In the period from January 2010 to December 2021 all patients undergoing left-sided valve surgery were identified using Danish nationwide registries. Patients were followed until a maximum of six months, end of study, emigration, death, or outcome of interest (i.e., bacteremia or infective endocarditis). Cumulative incidence curves were computed with death as a competing risk stratified on bacterial species and for subgroups of interest: type of valve surgery, age, and sex. Results A total of 14,305 patients were included in the study. The majority of the study population were male (68.6%), and the median age was 70.2 years (25th-75th percentile 62.0-76.0 years). In total, 10,469 (73.2%) of the study population underwent aortic valve surgery, 3,497 (24.5%) underwent mitral valve surgery, while 339 (2.4%) underwent surgery on both valves. The cumulative incidence of bacteremia at six months of follow-up was 2.4% (95% CI 2.2-2.7%), Figure 1. For the overall study population, the most frequently occurring bacteremia was with Coagulase-negative Staphylococci (28%) and Staphylococcus aureus (14%). Within 30 days 0.35% of the patients had bacteremia with coagulase-negative staphylococci while this was 0.68% at six months of follow-up. For Staphylococcus aureus this was 0.19% and 0.34%, respectively. The cumulative incidence of infective endocarditis at six months of follow up was 1.0% (95% CI 0.8-1.2%). The majority of the infective endocarditis incidents were blood culture negative (27%) or caused by Enterococci (19%), Streptococci (17%) or Coagulase-negative Staphylococci (17%) while Staphylococcus aureus accounted for 14%. In crude analysis, simultaneous surgery on the mitral and aortic valve was associated with a statistically significant higher rate of bacteremia (P=0.004). Similarly, higher age was associated with a statistically significant higher rate of bacteremia (P&amp;lt;0.001). On the contrary, in crude analysis, no difference in the risk of bacteremia was found between sexes (P=0.9). Conclusions Bacteremia following left-sided heart valve surgery occurred in little over 2%. The majority was with Staphylococci, and half of these occurred within 30 days of the surgery. There is a continued need to optimize prophylactic strategies.

Exploration of vitamin D hydroxy metabolites C3 epimers in cardiovascular patients: comparative cross-sectional study

Abstract Background Research on vitamin D deficiency has recently surged in popularity. This issue has been acknowledged as a widespread problem, often called a "pandemic", and approximately 90% of the Polish population suffers from vitamin D deficiency. The 3-epi-25(OH)D2 and 3-epi-25(OH)D3 metabolites are stereoisomers of 25(OH)D2 and 25(OH)D3 metabolites, and they may be accidentally measured when determining 25(OH)D levels and result in overestimating metabolite concentrations. Purpose Our study aims to identify vitamin D hydroxy metabolites (25-hydroxyvitamin D2, 25-hydroxyvitamin D3, and their epimers 3-epi-25-hydroxyvitamin D2 and 3-epi-25-hydroxyvitamin D3) in patients with cardiovascular disease and healthy volunteers. To our knowledge, no similar studies have been conducted on this topic. Method We included 27 adult patients with venous thrombosis (fourteen males and thirteen females, aged 64.11±14.84 years) and 35 healthy volunteers (thirty-three females and two males, aged 36.37±12.29 years). We used our validated UPLC-MS/MS method to measure the concentrations of 25(OH)D2, 25(OH)D3, 3-epi-25(OH)D2, and 3-epi-25(OH)D3. Statistica 13.3 with Plus Kit 3.0 was used for the statistical assessment. Normal variables were represented as mean and standard deviation, and non-normal variables as the median and interquartile range. A P-value &amp;lt; 0.05 was considered statistically significant for all tests. Results Patients had significantly lower levels of epi-25(OH)D2 than the healthy control group (0.6 [0.4] ng/mL vs. 2.2 [1.3-4.3] ng/mL, p = 0.004). Similarly, they exhibited significantly lower levels of %epi-25(OH)D2 (8.6 [6-22.3] % vs. 39.4 [18.5] %, p = 0.035). Females had higher levels of 25(OH)D3 than males (26.5 [16.2-37.9] ng/mL vs. 18.8 [7.5] ng/mL, p = 0.04). They also exhibited higher levels of total 25(OH)D3 (30.3 [15.6] ng/mL vs. 19.4 [7.8] ng/mL, p = 0.016). Higher age (OR 1.12, 95% CI 1.07 to 1.18), being male (OR 17.77, 95% CI 3.54 to 89.3), and lower % 3-epi-25(OH)D2 (OR 0.92, 95% CI 0.84 to 0.998) were univariate predictors for patients with venous thrombosis. Conclusion: Demographic factors within a given population may affect the 25(OH)D3 concentration. The results indicate that vitamin D epimeric metabolites, particularly epi-25(OH)D2, and their percentage were different in patients compared to healthy volunteers. Additional studies involving a larger population are necessary to fully comprehend the relationship between these vitamin D epimeric metabolites and cardiovascular health