High-risk Population Research Articles

The Utility of Pre-Procedural Blood Tests in Neuraxial Blocks: A Retrospective Study in High-Risk Patients

Background/Objectives: The necessity and clinical utility of routine pre-procedural blood tests (PBTs) before neuraxial blockade remain controversial. This study evaluates the effectiveness of PBTs in identifying clinically significant conditions in an outpatient setting. Methods: This single-center retrospective study involved patients who received neuraxial blockades from January 2020 to August 2023. We extracted medical information and laboratory data from the electronic medical records during the pre-procedural period. Through a multivariate regression analysis, we identified patient factors associated with abnormal laboratory results. Results: Advanced age (OR, 1.021; p = 0.026) and a history of cancer (OR, 2.359; p = 0.016) were significantly associated with elevated CRP levels (>0.30 mg/dL). Severe hyperglycemia (≥200 mg/dL) was found in 24 patients (3.88%), with a history of cancer being a strong predictor (OR, 6.764; p < 0.001). No significant abnormalities were observed in PT or PTT. Reduced eGFR (<60 mL/min/1.73 m2) was detected in 8.62% of patients, despite no prior history of renal dysfunction. A multivariate analysis revealed that advanced age, hypertension, cancer, and coronary artery disease were significant predictors of abnormal PBT results, highlighting the importance of selective testing in high-risk patients. Conclusions: Routine PBTs are not universally required for all patients undergoing neuraxial blockade but can provide crucial information in high-risk populations. A selective testing approach based on individual risk factors is recommended to optimize patient safety and resource utilization. Future studies should aim to establish clear guidelines for targeted PBT use.

Assessing coronary artery stenosis exacerbated impact on left ventricular function and deformation in metabolic syndrome patients by 3.0 T cardiac magnetic resonance imaging

Abstract Background Metabolic syndrome (MetS) and coronary artery stenosis (CAS) independently increase the risk of cardiovascular events, while the impact of CAS on left ventricular (LV) function and deformation in MetS patients remains unclear. This study investigates how varying degrees of CAS exacerbate LV function and myocardial deformation in MetS patients. Methods One hundred thirty-one MetS patients who underwent CMR examinations were divided into two groups: the MetS(CAS−) group (n = 47) and the MetS(CAS+) group (n = 84). The MetS(CAS+) group was divided into MetS with non-obstructive CAS(NOCAS+) (n = 30) and MetS with obstructive CAS(OCAS+) group (n = 54). Additionally, 48 age- and sex-matched subjects were included as a control group. LV functional and deformation parameters were measured and compared among subgroups. The determinants of decreased LV global peak strains in all MetS patients were identified using linear regression. The receiver operating characteristic (ROC) curve and logistic regression model (LRM) evaluated the diagnostic accuracy of the degree of CAS for identifying impaired LV strain. Results Compared to MetS(CAS−), MetS(NOCAS+) showed a significantly increased LV mass index (p < 0.05). Global longitudinal peak strain was decreased gradually from MetS(CAS−) through MetS(NOCAS+) to MetS(OCAS+) (− 13.02 ± 2.32% vs. − 10.34 ± 4.05% vs. − 7.55 ± 4.48%, p < 0.05). MetS(OCAS+) groups showed significantly decreased LV global peak strain (GPS), PSSR and PDSR in radial and circumferential directions compared with MetS(NOCAS+) (all p < 0.05). The degree of CAS was independently associated with impaired global radial peak strain (GRPS) (β = − 0.289, p < 0.001) and global longitudinal peak strain (GLPS) (β = 0.254, p = 0.004) in MetS patients. The ROC analysis showed that the degree of CAS can predict impaired GRPS (AUC = 0.730) and impaired GLPS (AUC = 0.685). Conclusion Besides traditional biochemical indicators, incorporating CAS assessment and CMR assessment of the LV into routine evaluations ensures a more holistic approach to managing MetS patients. Timely intervention of CAS is crucial for improving cardiovascular outcomes in this high-risk population.

Canada needs a national COVID-19 inquiry now.

We are now in the fifth year of an ongoing pandemic, and Canada continues to experience significant surges of COVID-19 infections. In addition to the acute impacts of deaths and hospitalizations, there is growing awareness of an accumulation of organ damage and disability which is building a "health debt" that will affect Canadians for decades to come. Calls in 2023 for an inquiry into the handling of the COVID-19 pandemic went unheeded, despite relevant precedent. Canada urgently needs a comprehensive review of its successes and failures to chart a better response in the near- and long-term. While Canada fared better than many comparators in the early years of the COVID-19 pandemic, it is clearly still in a public health crisis. Infections are not only affecting Canadians' daily lives but also eroding healthcare capacity. Post-COVID condition is having accumulating and profound individual, social, and economic consequences. An inquiry is needed to understand the current evidence underlying policy choices, identify a better course of action on various fronts, and build resilience. More must be done to reduce transmission, including a serious public education campaign to better inform Canadians about COVID and effective mitigations, especially the benefits of respirator masks. We need a national standard for indoor air quality to make indoor public spaces safer, particularly schools. Data collection must be more robust, especially to understand and mitigate the disproportionate impacts on under-served communities and high-risk populations. General confidence in public health must be rebuilt, with a focus on communication and transparency. In particular, the wide variation in provincial policies has sown mistrust: evidence-based policy should be consistent. Finally, Canada's early success in vaccination has collapsed, and this development needs a careful post-mortem. A complete investigation of Canada's response to the pandemic is not yet possible because that response is still ongoing and, while we have learned much, there remain areas of dispute and uncertainty. However, an inquiry is needed to conduct a rapid assessment of the current evidence and policies and provide recommendations on how to improve in 2025 and beyond as well as guidance for future pandemics.

SARS-CoV-2 testing, test positivity and vaccination in social housing residents compared with the general population: a retrospective population-based cohort study

BackgroundThe consideration of unique social housing needs has largely been absent from the COVID-19 response, particularly in tailoring strategies to improve access to testing and vaccine uptake among vulnerable and...

Associations of Metabolic Dysfunction-Associated Fatty Liver Disease With Peripheral Artery Disease: Prospective Analysis in the UK Biobank and ARIC Study.

There is currently limited evidence comparing the association between metabolic dysfunction-associated fatty liver disease (MAFLD), nonalcoholic fatty liver disease (NAFLD), and the risk of peripheral artery disease (PAD). This study aims to analyze the associations of MAFLD and NAFLD with incident PAD. Two longitudinal studies, the UKB (UK Biobank) study (n=372 216) and the ARIC (Atherosclerosis Risk in Communities) study (n=4681), categorized participants into MAFLD/non-MAFLD groups and NAFLD/non-NAFLD groups. Subsequently, participants were classified into 4 groups: non-fatty liver disease, MAFLD-only, NAFLD-only, and both MAFLD and NAFLD groups. Cox proportional hazard model estimated associations of MAFLD/NAFLD status, subtypes, and liver fibrosis severity with PAD risk. The MAFLD group had a higher risk of incident PAD compared with the non-MAFLD group, and similarly, the NAFLD group had a higher risk compared with the non-NAFLD group. Among these 4 groups, the MAFLD-only group had the strongest association with the risk of incident PAD, while the NAFLD-only group was not independently associated. Diabetic MAFLD subtype was significantly associated with increased PAD risk, and higher level of liver fibrosis scores correlated with elevated PAD risk. Both MAFLD and NAFLD are significantly associated with an increased incidence of PAD, with stronger associations in MAFLD and diabetic MAFLD population. These findings emphasize that the need for screening and prevention strategies for PAD in this high-risk population is warranted. The assessment of MAFLD and its subtypes should be considered as an integral component of cardiovascular risk assessment.

Global vaccination against hepatitis E virus: position paper from the ESGVH-ESCMID.

Hepatitis E Virus (HEV) is a significant global health issue, impacting both low- and middle-income countries (LMICs) and industrialized nations. HEV genotypes 1 and 2, primarily transmitted through contaminated water, are endemic in LMICs, while genotypes 3 and 4 are zoonotically transmitted in industrialized regions. Acute HEV infection poses severe risks, particularly to pregnant women and immunocompromised individuals, while chronic HEV infection leads to serious complications in those with pre-existing liver disease and transplant recipients. The development of an HEV vaccine offers new prevention opportunities, though its availability and integration into global immunization programs remain limited. This position paper was developed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Viral Hepatitis Study Group (ESGVH) through an extensive review of clinical data, safety profiles, efficacy, and immunogenicity of HEV vaccines. The study group focused particularly on high-risk and special populations, synthesizing global health insights and incorporating recommendations from the Strategic Advisory Group of Experts (SAGE) to formulate strategies for wider HEV vaccination use. The position paper evaluates the efficacy and safety of HEV vaccines in both general and special populations. It identifies key barriers to the integration of HEV vaccines into routine immunization programs, including infrastructure limitations, costs, and vaccine accessibility. The paper also proposes strategies to overcome these challenges and improve vaccine distribution. Furthermore, it addresses ways to enhance public awareness and international cooperation to promote HEV vaccination efforts globally. ESGVH-ESCMID recommends HEV vaccination for high-risk groups, including women of childbearing age, patients with chronic liver diseases, and immunosuppressed individuals. Prioritizing investments in vaccine logistics, integrating diagnostics, and educational outreach can enhance uptake.

The role of neighborhood on preterm birth among a high-risk group of birthing people in Boston, MA.

Preterm birth (PTB) is associated with adverse short- and long-term health. There are known racial, ethnic, and socioeconomic inequities in PTB. Because of historical de jure and modern-day de facto segregation and neighborhood divestment, neighborhoods are a source of structural racism and disenfranchisement and a potential target for policies and interventions to reduce PTB inequity. However, the role of neighborhoods on PTB, specifically among high-risk birthing people, is largely unexplored. The Boston Birth Cohort is a longitudinal birth cohort of birthing people-infant dyads at a safety-net hospital in Boston, MA between 2000 and 2018. The primary outcome was preterm birth at 35 weeks or prior. The primary predictor was neighborhood defined by census tract. We used generalized linear mixed effects models to test our hypothesis that neighborhood accounts for a signficiant proportion of PTB risk among socially at-risk birthing people. In multilevel models, neighborhoods were a significant predictor of preterm birth, yet accounted for only 3% of the variability in outcome. In models stratified by race, individual-level factors such as prior preterm birth, nativity status, and advanced birthing person age were significant predictors of PTB. Neighborhood is a significant, though small, predictor of preterm birth in a high-risk birthing population. These findings suggest that individual-level interventions, rather than neighborhood-level policies, may be more effective in reducing preterm birth among high-risk birthing populations.

Clinical characteristics and prognosis analysis of pseudomonas aeruginosa bloodstream infection in adults: a retrospective study.

Pseudomonas aeruginosa bloodstream infections (PA BSIs) in adults, especially those complicated by sepsis, are associated with high rates of morbidity and mortality. Early identification of risk factors for both mortality and sepsis-induced coagulopathy (SIC) is critical to optimizing patient management and improving outcomes. We conducted a retrospective analysis of 118 adult patients diagnosed with PA BSIs at the Affiliated Hospital of Xuzhou Medical University from January 2022 to February 2024. Univariate analysis was employed to identify significant clinical factors, followed by multivariate stepwise logistic regression to determine independent predictors of mortality and SIC. Based on these findings, nomogram models were constructed and evaluated using the area under the receiver operating characteristic curve (AUC), Bootstrap resampling, and calibration plots to assess model performance. Empiric sensitive antibiotic therapy (ESAT) (OR = 0.039, P < 0.001), coronary artery disease (CAD) (OR = 10.315, P = 0.010), and invasive mechanical ventilation (OR = 3.926, P = 0.020) emerged as significant predictors of mortality. In contrast, elevated C-reactive protein (CRP) (OR = 1.011, P = 0.003), procalcitonin (PCT) (OR = 1.030, P = 0.005), and lower hemoglobin levels (OR = 0.963, P = 0.004) were independently associated with SIC. The AUC of mortality prediction model is 0.908, while the SIC prediction model yielded an AUC of 0.817. The predictive models developed in this study demonstrate early identification of mortality rates and SIC risk in PA BSI patients, which may have the potential to guide timely therapeutic interventions and improve clinical outcomes in this high-risk population.

Early progressive mobility to improve neurodevelopment of infants with severe bronchopulmonary dysplasia at a level IV neonatal intensive care unit: a prospective cohort study.

To measure the feasibility of early progressive mobility (EPM) in intubated infants with severe bronchopulmonary dysplasia (BPD) and compare neurodevelopmental skill acquisition of these infants before and after implementation of a clinical EPM program. Single-center pre-post intervention prospective cohort study in a level IV Neonatal Intensive Care Unit (NICU) from 2019-2022. Bivariate tests compared EPM interventions and results of serial Test of Infant Motor Performance (TIMP) assessments in 32 intubated infants with severe BPD cared for during two epochs, before and after NICU-wide EPM implementation. Infants in epoch 2 experienced significantly more EPM interventions than infants in epoch 1. Infants in epoch 2 also had more advanced motor skills on the TIMP than infants in epoch 1. There were no unplanned extubations. We demonstrated successful implementation of EPM in this high-risk population with evidence of beneficial impacts on early motor development.

Imaging, biomarkers, and vascular cognitive impairment in China: Rationale and design for the VICA study.

Vascular cognitive impairment (VCI) is highly heterogeneous, with unclear pathogenesis. Individuals with vascular risk factors (VRF), cerebral small vessel disease (CSVD), and stroke are all at risk of developing VCI. To address the growing challenges posed by VCI, the "Vascular, Imaging and Cognition Association of China" (VICA) was established. VICA aims to recruit 10,000 participants, including 2000 with VRF, 3000 with CSVD, and 5000 stroke patients, to form a nationwide multicenter cohort. The study integrates clinical, neuroimaging, and multi-omics data to better understand VCI heterogeneity, improve disease prediction, and ensure timely diagnosis. VICA has screened 2045 eligible VRF participants from six communities in Wuhan, Shanghai, and Taizhou, along with 602 CSVD and 1269 stroke patients from 135 hospitals nationwide. Baseline enrollment and follow-up work are still ongoing. Establishing a high-quality longitudinal cohort is crucial for understanding VCI pathogenesis and developing novel markers for early screening and diagnosis. Establish a large-scale prospective longitudinal cohort comprising 10,000 participants, focusing on the high-risk population of vascular cognitive impairment (VCI) in China. Establish a nationwide three-tier medical network, make full use of resources, and achieve extensive enrollment of patients with cerebral small vessel disease and stroke patients. Utilize multimodal imaging and biomarkers to lay the foundation for constructing more-precise risk models. Introduce eye movement and gait analysis as new methods for assessing cognitive function. Use positron emission tomography to further investigate the interaction between vascular factors and neurodegeneration.

Abstract 4118242: Impact of Pregnancy on Individuals with Hypertrophic Cardiomyopathy: Long-Term Clinical Outcomes - Population-Based Study

Background: The effect of pregnancy on individuals with Hypertrophic Cardiomyopathy (HCM) is not well investigated. Objective: To assess the impact of pregnancy on all-cause mortality and clinical outcomes among individuals with HCM Methods: Using the TriNetX research network, we identified individuals within reproductive age ( ≥ 18-45 years) with a diagnosis of HCM between 2012 and 2022 (n=10,936). Patients were stratified based on pregnancy history into two groups (a) those with a history of pregnancy/high-risk pregnancy supervision and (b) those without a history of pregnancy or subsequent antenatal/pregnancy supervision encounters throughout the study period. Propensity-score matching resulted in 3,399 patients in each cohort. The primary outcome was all-cause mortality. Secondary outcomes include a composite of arrhythmic events (SCD and SCD equivalents), major adverse cardiovascular events (MACE), and acute heart failure (HF) exacerbation during 10 years of follow-up. Results: Pregnancy in patients with HCM was associated with a comparable risk of all-cause mortality (adjusted OR:0.89; 95% CI: 0.7-1.14; p =0.37) at 10 years follow-up. MACE and acute HF exacerbation outcomes were lower in the pregnancy group; however, the arrhythmic events (SCD) did not differ between groups (adjusted OR: 0.93, 95%CI: 0.73-1.18; p =0.55). Conclusion: Pregnancy in individuals with HCM was not associated with a higher risk of adverse outcomes at long-term follow-up. Further efforts are warranted to better understand the short-term outcomes in this high-risk population

Abstract 4132875: Living Address Environmental Biotope Affects the Risk of Coronary Obstruction and Myocardial Ischemia Detected by Coronary Computed Tomography

Background: Several studies reported positive associations between air and noise pollution exposure and coronary artery calcification, but environmental effects on coronary obstruction and flow remain largely unknown. Hypothesis: Distance to road and airport, air pollution, and residential green space are linked to coronary artery obstruction and myocardial ischemia. Low CV-risk patients develop coronary obstruction due to environmental factors, while high-risk patients are more prone to develop myocardial ischemia. Methods: Consecutive patients screened by coronary CT angiography for stable chest pain between 01/01/2019 and 31/12/2020 were included in a registry. Distance to airport and major road, and exposure to PM2.5, NO 2 and normalized difference vegetation index (NDVI) were modelled at patients’ living address. Risk of obstructive coronary artery disease (OCAD, stenosis ≥50%) and abnormal fractional flow reserve (FFR CT &lt;80%) was assessed using propensity score (PS)-adjusted logistic regression. Subgroup analysis was performed according to gender and Framingham CV-risk categories. Results: We enrolled 2620 patients, including 420 (16%) FFR CT analyses. OCAD was reported in 518 (20%) patients and abnormal FFR CT in 276 (11%). People with OCAD lived closer to the airport (10.841 [7.869-19.022] km vs. 12.297 [8.691-22.843] km, p&lt;0.001). Distance to airport decreased OCAD risk (OR 0.983, 95%CI 0.974-0.992, per 1 km) in univariate analysis, with the association present in male, female, and low-risk patients. After PS-adjustment, a trend of association was present between airport distance and abnormal FFR CT risk (OR 0.986, 95%CI 0.969-1.003, per 1 km). Road distance tended to decrease OCAD risk in univariate and PS-adjusted analysis, in the general (OR 0.928, 95%CI 0.808-1.309; and OR 0.928, 95%CI 0.840-1.021, per 1 km) and high-risk population. NO 2 exposure tended to increase OCAD risk in univariate analysis (OR 1.012, 95%CI 0.997-1.027, per 1 µg/m 3 ), with the association only present in female patients, and disappearance after PS-adjustment. PM2.5 exposure showed no associations, while NDVI tended to increase OCAD risk in low-risk patients after PS-adjustment. Conclusion: Residential distance to airport is the major risk component compared to other urban exposome factors studied in this epidemiological observation. Green space tends to exert a cardioprotective effect in low-risk patients, whereas living close to major road worsens the risk in high-risk patients

Abstract 4128369: Inpatient Mortality After Catheter Ablation for Atrial Fibrillation Among Heart Failure Patients: A 6-Year Nationwide Analysis

Background: Significant advancements have been made in the safety of catheter ablation for atrial fibrillation (AF) over the past decade. However, large-scale data regarding inpatient mortality among heart failure (HF) patients (HF with reduced ejection fraction [HFrEF] and HF with preserved ejection fraction [HFpEF]) who undergo AF ablation are lacking. Aim: To compare mortality rates and trends between patients with HF (HF group) and without HF (non-HF group) following AF catheter ablation. Methods: The National Inpatient Sample was utilized from January 2015 to December 2020 to identify the study population using the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification. The primary outcome was in-hospital mortality for patients with and without HF undergoing ablation for AF, and the secondary outcome was mortality in patients with HFrEF compared with those with HFpEF. Results: We evaluated 142,860 patients hospitalized for AF who underwent catheter ablation. Of these, 42.2% (n=60,334) had HF (29% HFrEF; 71% HFpEF). The HF cohort was older (69.7 years) and predominantly male (61.3%) compared with non-HF (66.7 years, P&lt;.001 and 55.7%, P&lt;0.00, respectively). Overall mortality in the HF group was 3-fold higher (1.6% vs 0.5%, P&lt;.001). Within the HF group, mortality in HFrEF was 1.8 times higher than in HFpEF (2.4% vs 1.3%, P&lt;.001). Over the study period, mortality rates declined in the HF cohort (Fig. 1A), both in HFrEF (from 4.1% to 2.2%, P=.012) and HFpEF (from 2.7% to 1.3%, P=.006) (Fig 1B). In non-HF, mortality rates remained relatively unchanged during the study period (from 1.4% to 1.6%, P=.344). Conclusion: Overall mortality following AF ablation is relatively low. Despite the higher mortality observed in patients with HF, the overall rate declined in both HFrEF and HFpEF over the study period. This reduction in mortality may reflect improvements in HF treatment and ablation techniques. Further research is needed to elaborate on the factors contributing to these trends and to develop targeted interventions to reduce mortality in this high-risk population.

Impact of major depressive disorder on breast cancer outcomes: a national retrospective cohort study.

Establishing whether women with major depressive disorder (MDD) who develop breast cancer (BC) have poor outcomes is key to optimizing care for this population. To address this, we examined associations between MDD and BC recurrence and mortality. Using medical record data from the Veterans Affairs Healthcare System, we established a retrospective cohort of women with local or regional stage invasive BC between 2010 and 2019 and followed through 2022. We used a two-year window to identify women diagnosed with MDD prior to BC diagnosis. We used multivariable Cox-proportional hazards regression to estimate associations between MDD and BC recurrence and mortality while accounting for competing-risks and adjusting for sociodemographic, clinical, lifestyle, and tumor characteristics. We identified 6,051 women with BC, of whom 1,754 (29%) had MDD. The mean age at BC diagnosis was 57 years (standard deviation = 11). In multivariable analyses, women with MDD had a 37% (hazard ratio (HR)=1.37; 95% confidence interval (CI): 1.19-1.57) higher risk of recurrence and a 30% (HR = 1.30; 95% CI: 1.02-1.64) higher risk of BC mortality. The association between MDD and recurrence was stronger among women with estrogen receptor-positive BC. In secondary analyses, there were significant interactions between MDD and multiple exposures with respect to recurrence, including current smoking, substance abuse, and non-receipt of screening mammography. Women with MDD had inferior BC outcomes compared to women without a history of MDD. Research is needed to investigate underlying mechanisms linking depression to BC progression and evaluate interventions to improve outcomes in this high-risk population.

Abstract 4138303: Stress Hyperglycemia Ratio Predicts MACE and All-cause Mortality in Acute Coronary Syndrome Patients: A Meta-Analysis Comparing Patient with Diabetes Mellitus and Non-Diabetes Mellitus

Background: A higher stress hyperglycemic ratio (SHR) has been reported to be associated with adverse cardiac outcomes. However, the role of SHR in predicting clinical outcomes by comparing patients with and without diabetes mellitus is yet to be explored. Objective: To evaluate the prognostic value of the SHR for predicting major adverse cardiovascular (MACE) and all-cause mortality in ACS patients with and without diabetes mellitus. Methods: Per PRISMA guidelines, we comprehensively reviewed PubMed, Google Scholar, and SCOPUS for eligible studies reporting on SHR and its association with MACE (8 studies) and all-cause mortality (7 studies) in ACS patients. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a binary random-effects model, with results displayed as forest plots. Heterogeneity was assessed using I2 statistics, and a leave-one-out sensitivity analysis was performed. P&lt;0.05 was considered significant. Results: A total of 15 studies with 45,774 patients with ACS were included in the analysis. The majority of patients were males (72.6%) with a mean age of 62.8 years. High SHR was associated with higher odds of MACE (1.93 [1.54–2.42]) and all-cause mortality (1.91 [1.58–2.31]) (Fig. 1). Subgroup analysis revealed increased odds of all-cause mortality (1.69 [1.34–2.11] for patients with diabetes vs 2.12 [1.65–2.71] for patients without diabetes) and MACE (1.60 [1.30–1.97] for patients with diabetes vs 1.44 [1.28–1.62] for patients without diabetes), all p&lt;0.01. (Fig. 2). Additionally, the leave-one-out sensitivity analysis demonstrated that excluding any particular study did not significantly affect outcomes (p&lt;0.05). Conclusions: In patients with ACS, SHR is an independent predictor of MACE and all-cause mortality, irrespective of diabetes status. Strict glycemic control strategies may improve outcomes in this high-risk population. These findings underscore the importance of early recognition and management of stress hyperglycemia in ACS patients.

Mercury Levels in Hair of Pregnant Women in Tumbes, Peru: A Cross-Sectional Study.

Mercury, a potent toxin that poses serious risks to human health, particularly for pregnant women and young children, is widely present due to artisanal and small-scale gold mining (ASGM), which impacts water quality. The objective of this study was to evaluate methylmercury exposure among pregnant women in communities downstream from ASGM sites. We characterized hair total mercury (THg) concentrations among 148 pregnant women across 24 communities in the Tumbes region of Peru, downstream from ASGM sites in Ecuador. Using purposeful sampling, we classified communities into three exposure risk zones: Puyango-Tumbes River watershed, Coast, and Zarumilla. The mean THg concentration was 2.08 µg/g ± 1.36, with 45% of participants (67/148) exceeding UNEP/WHO exposure limits (>2.0 µg/g). The median was 1.84 with an interquartile range (IQR) from 1.01 to 2.83. Median THg levels were significantly higher in the Puyango-Tumbes River region (2.72 µg/g; IQR: 1.66-3.55) compared with Zarumilla (1.61 µg/g; IQR: 0.67-2.63; P = 0.001) and to the Coast (1.71 µg/g; IQR: 1.13-2.50; P = 0.01), suggesting that living close to the Puyango-Tumbes River may be associated with a higher mercury exposure risk. After controlling for potential confounders, individuals in the Puyango-Tumbes watershed exhibited a significant 57% higher expected geometric mean of hair THg compared with Zarumilla (95% CI: 0.1-146.2%). These findings underscore the importance of identifying high-risk regional populations and ongoing biomonitoring of the Puyango-Tumbes River watershed.

Abstract 4145834: Comparison of 30-Day Outcomes of TAVR vs. SAVR in Patients with Prior CABG: A Meta-Analysis

Introduction: Managing severe aortic stenosis in patients with a history of coronary artery bypass grafting (CABG) is challenging. Traditionally, surgical aortic valve replacement (SAVR) was the standard treatment, but transcatheter aortic valve replacement (TAVR) offers a less invasive alternative. This meta-analysis compares the 30-day outcomes of TAVR versus SAVR in patients with prior CABG. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. Studies comparing TAVR and SAVR in patients with prior CABG were included. The primary outcomes were 30-day (cardiovascular) CV mortality, all-cause mortality, stroke, and myocardial infarction. Heterogeneity was assessed using the Chi-squared test and I-squared statistic. P value &lt;0.05 was considered statistically significant. Results: Nine studies with a total of 8,487 patients were included for the 30-day outcomes. The pooled odds ratio (OR) for 30-day CV mortality was 1.00 (95% CI: 0.48-2.06), with no significant difference between TAVR and SAVR (p=0.99). For 30-day all-cause mortality, the pooled OR was 0.75 (95% CI: 0.51-1.10), also showing no significant difference between TAVR and SAVR (p=0.14). The pooled OR for 30-day myocardial infarction was 0.34 (95% CI: 0.09-1.27), indicating no significant difference between TAVR and SAVR (p=0.11). However, the pooled OR for 30-day stroke was 0.67 (95% CI: 0.50-0.90), showing a significantly lower incidence with TAVR compared to SAVR (p=0.007). Detailed results in Figure 1. Conclusion: In patients with a history of CABG, TAVR appears to have comparable 30-day outcomes to SAVR in terms of CV mortality, all-cause mortality, and myocardial infarction. However, TAVR is associated with a significantly lower incidence of 30-day stroke. These findings suggest that TAVR may be a safer option in the short term for this high-risk patient population. Further research is needed to confirm these results in larger, randomized controlled trials.

Abstract 4138273: Acceptability and Gain of Knowledge of Community Educational Tools About Rheumatic Heart Disease Integrated With Screening In Low-Income Settings

Background: Rheumatic heart disease (RHD) causes 305,000 premature annual deaths, and education is one of the strategies to diminish disease burden. International RHD foundations aim do provide preventive and control efforts for RHD. We aimed to assess the acceptability and gain of knowledge of a series of education flipcharts presented during screening programs in high-burden areas of Brazil. Methods: Four flipcharts (“Introduction to rheumatic fever (RF) and RHD”, “RHD and pregnancy”, “RHD and surgery” and “RHD community awareness”) were developed over 3 years and taught during 36 months to patients, community, health and education professionals in Minas Gerais state. Training included in-person interactions and virtual workshops. Pre and post-training questionnaires were applied through an online and printed surveys in 2021 and 2022, and post-education evaluations were conducted from January 2023 to April, 2024. Results: Flipchart training was successfully delivered to 112 education professionals, 574 health providers and 598 community members (N=1284): 899 (70%) were enrolled in primary care, and 1109 (86%) responded the surveys. Among respondents of the survey for health and education professionals (N=589), 240 (41%) had been educated about RHD in the previous year. 569 (96%) learned any new information; the content was all new for 21 (4%). Nearly all professionals reported that flipcharts could improve patients’ lives (571, 97%) and felt confident to use the tool with someone with no knowledge about RHD (533, 91%); 86% of the teachers said they would use flipcharts as educational tools. In the survey for community / schoolchildren (N=520) only 128 (25%) respondents had previous education on RHD, 510 (98%) reported that learned new information, and content was completely new for 242 (47%). A total of 430 (83%) individuals reported that they will discuss RHD with families and community. All qualitative written reports were positive. In 2021/2022, 218/485 (45%) health and education professionals responded the pre/post questionnaire. Knowledge about RHD increased after training: RF as the cause of RHD (56% vs 86%), use of Benzathine Penicillin G (50% vs 97%), frequency of antibiotic prophylaxis (32% vs 90%) and overall moderate or expert understanding of RF or RHD (30% vs 82%). Conclusion: Flipchart educational sessions about RHD had a very positive acceptability in high-risk Brazilian populations, with remarkable gain of knowledge for health professionals.

Abstract 4138353: Disparities in coronary artery disease-related mortality among patients with obesity in the United States from 1999-2020

Introduction: Coronary artery disease (CAD) is the third leading cause of death in the US for adults aged &gt;35 years. Almost half of the adult US population has obesity, which predisposes to atherosclerosis and may lead to poor prognosis in CAD. We aim to identify CAD-related mortality trends in patients with obesity in the US stratified by age, sex, race, and geographical location. Methods: The CDC-WONDER database was used to extract death certificate data for adults aged ≥25 years. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and temporal trends were delineated by calculating annual percent change (APC) and the average APC (AAPC) in the rates using JoinPoint regression analysis. Results: From 1999 to 2020, a total of 182,436 CAD-related deaths occurred in individuals with obesity. The AAMR increased consistently from 1999 to 2018 (APC: 4.48) and surged thereafter till 2020 (APC: 13.91). The AAMR for males (4.91) was almost double that of females (2.76). Non-Hispanic (NH) American Indians or Alaska Natives displayed the highest AAMR (5.37) while NH Asians or Pacific Islanders displayed the lowest (0.88). NH Blacks or African Americans displayed an AAMR of 5.06, followed by NH Whites (3.88) and Hispanics or Latinos (2.6). AAMRs also varied substantially by region (Midwest: 4.09; West: 4; Northeast: 3.67; South: 3.53). States with the highest AAMRs were Vermont and Oklahoma. Non-metropolitan regions exhibited a higher AAMR (4.42) than metropolitan regions (3.64). The adults aged 65-74 years exhibited the greatest CMR (8.99). Conclusion: We observed increasing trends in CAD-related deaths in adults with obesity throughout the study period. The highest mortality was exhibited by males and NH American Indians or Alaska Natives, residents of the Midwest and non-metropolitan areas, and individuals aged 65-74 years. Better healthcare practices and lifestyle modifications should be promoted in these high-risk populations to reduce the CAD-related mortality rates in adults with obesity.

Abstract 4130622: Neonatal Outcomes of Hypertensive Women Across US Races: 2016-2022

Background: Maternal hypertension, a major pregnancy complication, can adversely affect newborn health. We aim to evaluate the racial and ethnic disparities in neonatal outcomes among hypertensive pregnant women in the United States. Methods: Using data from the CDC WONDER Natality database, we conducted a retrospective cohort study focusing on live births to hypertensive mothers from 2016 to 2022. Neonatal outcomes, including NICU admissions, low birth weight, infant mortality, and assisted ventilation, were analyzed by calculating rates [95% CIs] per 1000 live births across maternal racial/ethnic groups and the US Census Bureau's regional classification: Northeast, Midwest, South, and West. Results: We analyzed 2,336,679 live births to hypertensive women (23% pre-pregnancy; 77% gestational). This cohort comprised: 0.2% infants born to Native Hawaiian/other Pacific Islander women (NH/PI), 0.9% to American Indian/Alaska Native women (AI/AN), 3.8% to Asian American women (AA), 19.6% to Hispanic/Latino women (H/L), 20.0% to Black/African American women (BA), and 55.4% to White American women (WA). Infant mortality rates were highest in BA (3.6 [3.5, 3.8]), followed by AA (2.1 [1.8, 2.4]), AI/AN (2.1 [1.6, 2.7]), H/L (1.9 [1.8, 2.0]), NH/PI (1.9 [1.0, 3.3]), and lowest in WA (1.5 [1.4, 1.6]). Similarly, NICU admission rates were highest in BA (217.2 [216.1, 218.4]) and lowest in WA (156 [155.4, 156.6]). Assisted ventilation rates were highest in NH/PI (131.8 [123.4, 140.7]) and lowest in AA (87.8 [86.0, 89.7]). Low birth weight rates were highest in BA (235.1 [233.9, 236.3]) and lowest in WA (121.8 [121.2, 122.4]). The Midwest had the highest rates for NICU admissions in NH/PI (254.2 [217.2, 295.2]), assisted ventilation in AI/AN (143.8 [133.2, 155.1]), and mortality in BA (4.1 [3.7, 4.5]). The South had the highest rate of low birth weight for BA (244.4 [242.9, 246.0]). Conclusion: Significant racial and regional disparities exist in neonatal outcomes among hypertensive women in the US. BA mothers consistently experienced the poorest outcomes, while WA mothers had the best. Further research is crucial to understand the reasons behind these disparities and develop targeted interventions for high-risk populations.