Higher Hospitalization Rates Research Articles

Usefulness of Point-of-Care Testing for Respiratory Viruses in a Pediatric Emergency Department Setting

Background: Respiratory tract infections (RTIs) are a leading cause of pediatric emergency department (PED) visits, especially in children under five. These infections are primarily viral, complicating diagnosis and management. This study assesses the impact of point-of-care (POC) rapid diagnostic tests for respiratory viruses on clinical and economic outcomes in a PED setting. Materials and Methods: A retrospective analysis of 1396 POC tests for RSV, adenovirus, and influenza A/B was conducted in the PED of the Giannina Gaslini Institute, Genoa, Italy, from December 2022 to April 2024. Demographics, blood tests, admissions, and readmission rates were evaluated. Statistical analyses were performed using appropriate tests for categorical and continuous variables. Results: Of the tests, 31.5% were positive for at least one virus. Positive patients were younger and had higher hospitalization rates (50.7% vs. 39.9%) but fewer blood tests (38.2% vs. 51.7%). Economic analysis indicated lower costs for virus-positive patients. RSV-positive patients showed a significant association with higher hospitalization rates (67.8%) and readmission within 72 h. Conclusions: POC testing significantly improves patient management in PEDs by enabling rapid diagnoses, reducing unnecessary tests and hospitalizations, and guiding appropriate treatment. This approach supports better resource allocation, crucial during peak seasons, and has implications for reducing antibiotic use and resistance. Further research is warranted to explore long-term impacts on patient outcomes and healthcare efficiency.

Evaluating Disparities in COVID-19 Clinical Outcomes Among Patients With Cirrhosis in North America and Europe-An International Registry Study.

Patients with decompensated cirrhosis have a higher risk of hospitalization, ICU admission, and death from COVID-19. The impact of demographics on these outcomes remains uncertain. The SECURE-Liver and COVID-Hep databases were utilized to evaluate disparities in COVID-19 outcomes. Patients were stratified by North American and European cohorts. Bivariate and multivariable logistic regression was performed. A total of 718 cirrhosis patients with COVID-19 were evaluated. In the North American cohort, Black patients had more comorbidities (CI: 1.86 vs. 1.83, p < 0.01), higher rates of hospitalization (77% vs. 85%, p < 0.01), ICU admission (27% vs. 40%, p = 0.05), and death (18% vs. 28%, p = 0.07). Hispanic patients had the lowest adverse outcome rates. In the European cohort, White patients had more comorbidities (CI; 1.63 vs. 1.31, p = 0.02), but non-White patients had higher hospitalization rates (82% vs. 67%, p = 0.01), ICU admissions (15% vs. 18%, p = 0.04), and lower mortality rates (28% vs. 34%, p = 0.01). Black patients in North America had higher hospitalization, ICU admission, and death rates. In the European subgroup, White patients had higher death rates than non-White patients. These disparities became statistically insignificant after adjusting for confounders, suggesting that non-liver-related comorbidities might increase the risk of adverse outcomes.

The NLRP3-inflammasome inhibitor MCC950 improves cardiac function in a HFpEF mouse model

Heart failure with preserved ejection fraction (HFpEF) is posing a significant medical challenge due to its growing prevalence, high hospitalization rates and limited response to current treatment options. Accumulating evidence suggests that a comorbidity-driven systemic pro-inflammatory state, including activation of the NLRP3 inflammasome, contributes to the pathogenesis of HFpEF. This study aimed to investigate the potential cardiac protective effects of the selective NLRP3 inhibitor MCC950, in a mouse model of HFpEF. HFpEF was obtained in 18–22 months old female mice using high-fat diet (HFD) and angiotensin II (AngII) infusion. Mice developed HFpEF and comorbidities such as obesity, type 2 diabetes, and hypertension. MCC950 was added to HFD and groups were treated for four weeks until the study endpoint. MCC950 treatment resulted in lower plasma IL-18 levels (-47.3 %), illustrating target engagement. First, we observed that MCC950 treatment improved left ventricular function, demonstrated by enhanced global longitudinal strain (GLS, 3.9 %, P<0.01) and reverse peak longitudinal strain (RPLSR, +46.8 %, P<0.05). Second, MCC950 reduced cardiac hypertrophy (cardiomyocyte size -19.5 %, P<0.001) and fibrosis (-32.5 %, P<0.05), accompanied by lower expression of pro-fibrotic genes. Finally, MCC950 treatment reduced macrophage infiltration in left ventricular tissue and attenuated macrophage accumulation in visceral adipose tissue, even more as compared to caloric restriction. Overall, this suggests that NLRP3 inhibition could be a promising treatment for HFpEF patients with a pro-inflammatory profile, potentially improving heart function, systemic inflammation, and metabolic parameters.

Black Race is Associated with Decreased Exposure to Advanced Therapies and Worse Outcomes in Individuals with Ulcerative Colitis.

For people diagnosed with ulcerative colitis (UC), racial disparities exist both in access to medications and clinical outcomes. We used the TriNetX database for two population-based retrospective analyses with Black (n = 22,519) and Asian (n = 8,626) individuals with UC matched for age, sex, and ethnicity. Outcomes included mortality, medication prescriptions, and clinical encounters at 6 months and 10 years. At 6 months and 10 years after diagnosis, Black people had increased mortality (2.7% vs. 1.9% and 8.1% vs. 6.9%, p < 0.0001), were prescribed fewer UC-specific therapies (21.3% vs. 26.4% and 30% vs. 36%, p < 0.0001), had higher rates of emergency department visits (22.3% vs. 13.6% and 41.2% vs. 31.5%, p < 0.0001), and higher hospitalisation rates (30.1% vs. 25.8% and 42.6% vs. 39.9%, p < 0.0001). At 6 months, they had more opioid prescriptions (18.5% vs. 15.7%, p < 0.0001). Asian people had lower mortality at 10 years (5.6% vs. 7.7%, p < 0.0001), higher rates of UC-specific medications at 6 months (28.6% vs. 26.5%, p = 0.002), and more hospitalizations (38.8% vs. 27.7%, p < 0.0001 at 6 months and 50% vs. 42.2%, p < 0.0001 at 10 years). Black individuals with UC are prescribed fewer disease-specific therapies compared to White individuals and have increased hospitalizations and mortality. Black individuals have higher rates of opioid prescriptions. Opioids have been associated with increased complication rates in inflammatory bowel disease. These trends are not seen in Asian individuals. This reveals critical disparities in the care of Black people with UC with opportunity for targeted interventions.

An Automated Medicine Dispenser using IOT

Abstract—An Automated Medicine Dispenser using IoT is a part of IoT technology that takes on the challenge of medication non-adherence for daily medication schedules especially for aging population. Non-adherence to medication results in negative health outcomes, higher rates of hospitalizations, and consid- erable costs to healthcare. To ensure that medicine is delivered on time and accurately, the project integrates different hardware components such as a motor-driven dispensing mechanism. The project uses both audio and visual alerts to inform users when they should take their medication. This enables patients and caregivers, as well as clinicians care providers to instantly monitor medication adherence which is supported by the devices IoT connectivity. The dispenser is also designed to be easy-to-use and user friendly and aims at elderly patients who have a hard time managing the complexities of multi-medication schedules. The Dispenser offers a reliable solution for improving medication management. Index Terms—Automated Medicine Dispenser, IoT, medication adherence, elderly care, healthcare technology, real-time moni- toring.

Prevalence and independent predictors of Iron deficiency in Yemeni patients with congestive heart failure: a retrospective cross-sectional study

Heart failure (HF) constitutes a substantial burden on healthcare systems worldwide, contributing to elevated rates of mortality and morbidity. Iron deficiency (ID), both with and without concurrent anemia, has been identified in up to half of all patients with CHF and is associated with an increased risk of HF exacerbations, higher rates of hospitalization, and diminished quality of life. However, data from resource-limited settings remain limited. In this study, we reviewed 108 adult Yemeni patients with HF who also had concomitant ID, defined as serum ferritin concentrations of < 100 ng/mL or 100–299 ng/mL with transferrin saturation < 20%. The prevalence of ID among HF patients was determined, and independent predictors of ID were assessed using univariate and multivariate regression analyses. Anemia was present in 64 (59.3%), ID was observed in 65 (60.2%), and both anemia and ID were concurrently present in 44 (40.7%) patients. The mean ejection fraction among the study cohort was 34.2 ± 6.3%. Multivariate regression analysis identified New York Heart Association class III (OR: 4.46; 95% CI: 1.65–12.90, p = 0.004), presence of anemia (OR: 3.95; 95% CI: 1.51–11.23, p = 0.007), and an EF < 30% (OR: 9.42; 95% CI: 1.97–54.64, p = 0.007) as independent predictors of ID. These findings highlight the potential under-recognition of ID in patients with congestive HF, suggesting the need for routine assessment of iron status in this patient population.

Machine learning based risk factor analysis in the prognosis of heart failure

Abstract. Heart failure, one of the significant causes of death, poses challenges to healthcare systems due to its high hospitalization rates and substantial economic burden. This study explores the key factors predicting survival among heart failure patients by evaluating a variety of clinical, demographic, and lifestyle elements. Employing logistic regression, this analysis utilizes data from 299 patients at the Faisalabad Institute of Cardiology, each marked with 12 risk factors, and conducts a 10-fold cross-validation to ensure robustness. Results reveal that age, serum sodium, and serum creatinine levels are crucial predictors of mortality. Contrary to expectations, ejection fraction plays a lesser role. This study broadens our understanding of the complex risk factors linked to heart failure, helping to refine predictive models that could improve patient outcomes and reduce the economic pressures on healthcare systems, especially in regions facing financial difficulties. The study also highlights the potential role of lifestyle factors, such as dietary and physical activity patterns, in managing heart failure, suggesting a broader approach for future research and interventions.

Nirsevimab Effectiveness Against Medically Attended Respiratory Syncytial Virus Illness and Hospitalization Among Alaska Native Children - Yukon-Kuskokwim Delta Region, Alaska, October 2023-June 2024.

Respiratory syncytial virus (RSV) is a leading cause of hospitalization among young children. Historically, American Indian and Alaska Native (AI/AN) children have experienced high rates of RSV-associated hospitalization. In August 2023, a preventive monoclonal antibody (nirsevimab) was recommended for all infants aged <8 months (born during or entering their first RSV season) and for children aged 8-19 months (entering their second RSV season) who have increased risk for severe RSV illness, including all AI/AN children. This evaluation in Alaska's Yukon-Kuskokwim Delta region estimated nirsevimab effectiveness among AI/AN children in their first or second RSV seasons during 2023-2024. Among 472 children with medically attended acute respiratory illness (ARI), 48% overall had received nirsevimab ≥7 days earlier (median=91 days before the ARI-related visit). For children in their first RSV season (292), nirsevimab effectiveness was 76% (95% CI = 42%-90%) against medically attended RSV illness and 89% (95% CI = 32%-98%) against RSV hospitalization. For children in their second RSV season (180), effectiveness against medically attended RSV illness was 88% (95% CI=48%-97%). Nirsevimab is effective for preventing severe RSV illness among infants entering their first RSV season and children entering their second season with increased risk for severe RSV, including all AI/AN children.

Abstract 4139191: ETX-258 - A GalOmic™ siRNA for the Treatment of Heart Failure Following Myocardial Infarction

Introduction: Heart failure with reduced ejection fraction (HFrEF) remains a significant clinical challenge, evidenced by high hospitalization rates and five-year mortality. Current treatments are limited by side effects, poor patient compliance, and the necessity for gradual drug titration. These challenges highlight the need for new therapies that are both safe and effective in targeting the structural remodeling pivotal to disease progression post-myocardial infarction (MI). e-therapeutics (ETX) uniquely combines computation and RNAi to discover life-transforming medicines. ETX’s RNAi platform, GalOmic™, enables generation of specific, potent, and long-acting siRNA therapies that effectively silence novel gene targets in hepatocytes. This highly specific mechanism of action limits unwanted side effects, positioning it as a promising approach to HFrEF treatment. Methods: Potent siRNAs against a hepatic target with cardioprotective potential were designed in silico. Candidate siRNAs were screened in vitro in HEK293 cells and in vivo in C57BL/6J mice to select the lead GalOmic™ siRNA, ETX-258. MI was induced by ligation of the left anterior descending artery in C57BL/6J mice after which ETX-258 was injected subcutaneously weekly for 6 weeks. Eplerenone, a mineralocorticoid receptor antagonist which is part of the current treatment regimen for HFrEF, was used as a comparator. Cardiac function was assessed by echocardiography at 2-, 4- and 6-weeks post-MI. Cardiac damage and structural remodeling were evaluated using circulating biomarkers of cardiac function and histological assessment. Results: ETX-258 was selected as a highly active siRNA for the treatment of heart failure with a long duration of action. Post-MI treatment with ETX-258 significantly improved key echocardiographic parameters of cardiac function, including ejection fraction and total cardiac output, achieving results comparable to eplerenone. Additionally, both structural cardiac parameters and markers of damage and remodeling showed significant improvements, reaching similar levels in both ETX-258 and eplerenone-treated mice. Conclusions: High unmet need remains for HFrEF patients despite existing therapies. These results highlight the potential of ETX-258 to improve cardiac function and pathogenic structural remodeling post-MI. This, paired with the long duration of action and favorable safety profile of GalOmic™ siRNAs, makes ETX-258 a promising candidate for further clinical development.

Real-life effectiveness on overall survival of continued immune checkpoint inhibition following progression in advanced melanoma: estimation from the Melbase cohort.

The link between palliative care and oncology must continue to develop, taking into account advances in treatment.Immune checkpoint inhibition (ICI) for metastatic melanoma is associated with different types of response, making it difficult to assess the benefits to the patient. Some clinical trials suggest a survival advantage of ICI even in the absence of an objective radiographic response. The aim of this study is to assess the impact of continuing ICI after progression of the disease on the overall survival (OS) in a cohort of final-line metastatic melanoma patients. Clinical data from 120 patients with metastatic melanoma were collected via Melbase, a French multicentric biobank, prospectively enrolling unresectable melanoma. Two groups were defined: patients continuing final-line ICI at progression (treated) and patients stopping ICI at progression (controls). The primary end-point is the OS from progression. Propensity score weighting was used to correct for indication bias. From the 120 patients, 72 (60%) continued ICI. Median OS from progression was 4.2 months [95% confidence interval (CI) 2.6-6.27] in the treated group and median OS was 1.3 months (95% CI 0.95-1.74) in the control group (P < 0.0001). The calculated hazard ratio was 0.20 (0.13-0.33). Continued ICI was discovered to have an association with a higher rate of hospitalization at the end of life; more treatments received in the last 15 days of life and less utilization of specialist palliative care. This study discovered that patients with metastatic melanoma show a significant decrease in the instantaneous probability of mortality when they continue with finale-line ICI after progression.

Targeting PrfA from Listeria monocytogenes: A computational drug repurposing approach

Humans can develop listeriosis by ingestion of foods contaminated with Listeria monocytogenes (L. monocytogenes), an opportunistic gram-positive ubiquitous bacterium. Whilst the non-invasive form of listeriosis may be asymptomatic or cause mild flu-like symptoms, the invasive form of listeriosis is life-threatening and is associated with high hospitalization and fatality rates. Current antibiotic-based therapies are still effective against listeriosis. However, multi-drug resistant L. monocytogenes strains have already been identified, which represents a new risk in the treatment of invasive listeriosis. Therefore, it is increasingly urgent to identify new compounds that do not target the conventional biochemical pathways disrupted by current antibiotics. Positive Regulatory Factor A (PrfA) is a well-studied transcription factor in L. monocytogenes that is responsible for activating a plethora of virulence factors. Targeting virulence factors is a promising strategy that is being considered to combat bacterial infections, hence targeting PrfA is both logical and attractive. In the present computational drug repurposing approach, a complete FDA-approved drugs dataset of more than 700 compounds was virtually screened by docking the drugs against the structure of PrfA. Three of the most promising top-scored FDA drug candidates were then simulated complexed to PrfA. Data from Molecular docking and Molecular Dynamics simulations suggest that Dutasteride binds PrfA, and as a result, may exhibit inhibitory activity against L. monocytogenes. The use of Dutasteride is safe in humans since it has been administered in the treatment of benign prostatic hyperplasia for decades. Its unique chemical scaffold may represent a valuable starting point for the rapid development of disruptive novel listeria-specific drugs that will be soon needed to combat multi-drug resistant L. monocytogenes strains.

Impact of Respiratory Syncytial Virus (RSV) in Adults 60 Years and Older in Spain.

Background/Objectives: Respiratory illnesses frequently lead to hospitalization in adults aged 60 and older, especially due to respiratory viral infectious (RVI). This study investigates hospitalization patterns and characteristics of RVI at HM Hospitals from October 2023 to March 2024; Methods: We retrospectively explored hospitalizations of patients aged 60 years and older with RVIs, gathering data on demographics, clinical profiles, comorbidities, and treatments. Outcomes included hospitalization, ICU admissions, and mortality, and independent factors associated with outcomes were identified using a multi-state model; Results: From October 2023 to March 2024, from a total of 3258 hospitalizations, 1933 (59.3%) were identified as positive for RVIs. Overall, SARS-CoV-2 was the most prevalent (52.6%), followed by influenza (32.7%), and RSV (11.8%). Most RVI involved single infections (88.2%). Hospitalization rates increased with age for SARS-CoV-2 (333.4 [95% CI: 295.0-375.2] to 651.6 [95% CI: 532.1-788.4]), influenza (169.8 [95% CI: 142.6-200.7] to 518.6 [95% CI: 412.1-643.1]), and RSV (69.2 [95% CI: 52.2-90.0] to 246.0 [95% CI: 173.8-337.5]), with SARS-CoV-2 showing the highest rate, followed by influenza and RSV. In the multi-state model, RSV infection significantly increased ICU admission risk (HR: 2.1, 95%, p = 0.037). Age on admission (HR: 1.1, 95%, p < 0.001) and Charlson score (HR: 1.4, 95%, p = 0.001) were associated with transitioning from admission to death. ICU to death risks included age at admission (HR: 1.7, 95%, p < 0.001); Conclusions: RVI in adults 60 years and older are associated with high hospitalization and mortality rates, primarily driven by influenza and SARS-CoV-2, followed by RSV. Age and comorbidities significantly impact disease severity, emphasizing the need for targeted prevention and management strategies for RSV in this vulnerable population.

Diabetes Control and Clinical Outcomes among Children Attending a Regional Paediatric Diabetes Service in Australia.

Australian children with diabetes commonly struggle to achieve optimal glycaemic control, with minimal improvement observed over the past decade. The scarcity of research in the rural and regional Australian context is concerning, given high incidence rates and prominent barriers to healthcare access in these areas. We conducted a retrospective audit of 60 children attending a regional Australian paediatric diabetes service between January 2020 and December 2023. The majority of patients had type 1 diabetes (n = 57, 95.0%); approximately equal numbers were managed with continuous subcutaneous insulin infusion (CSII) pumps vs. multiple daily injections (MDIs), whilst 88.3% (n = 53) also utilised continuous glucose monitoring (CGM). The mean age at last visit was 14.0 years (SD, 3.4), mean diabetes duration 5.8 years (SD, 4.6), and mean HbA1c level 8.1% (65.3 mmol/mol); only 36.8% achieved the national target of 7.5% (58 mmol/mol). Mean BMI-SDS was 0.8 (SD, 1.0); almost half (n = 27, 45.0%) were overweight or obese. Many patients had mental health conditions (31.7%), which were associated with higher hospitalisation rates (p = 0.007). The attendance rate was 83.2%, with a mean of 3.3 clinic visits per year (SD, 0.7); higher attendance rates were associated with increased CGM sensor usage (r = 0.395, p = 0.007 Overall, the diabetes service performed similarly to other clinics with regards to glycaemic control. Whilst achieving treatment targets and addressing comorbidities remains a challenge, the decent attendance and the high uptake of healthcare technologies is commendable. Further efforts are needed to improve diabetes management for this regional community.

The Potential Therapeutic Prospect of PANoptosis in Heart Failure.

Heart failure (HF) represents a serious manifestation or advanced stage of various cardiac diseases. HF continues to impose a significant global disease burden, characterized by high rates of hospitalization and fatality. Furthermore, the pathogenesis and pathophysiological processes underlying HF remain incompletely understood, complicating its prevention and treatment strategies. One significant pathophysiological mechanism associated with HF is the systemic inflammatory response. PANoptosis, a novel mode of inflammatory cell death, has been extensively studied in the context of infectious diseases, neurodegenerative disorders, cancers, and other inflammatory conditions. Recent investigations have revealed that PANoptosis-related genes are markedly dysregulated in HF specimens. Consequently, the PANoptosis-mediated inflammatory response may represent a potential mechanism and therapeutic target for HF. This paper conducts a comprehensive analysis of the molecular pathways that drive PANoptosis. We discuss its role and potential therapeutic targets in HF, thereby providing valuable insights for clinical treatment and the development of novel therapies.

Six-month outcomes after a GP phone call during the first French COVID-19 lockdown (COVIQuest): a cluster randomised trial using medico-administrative databases

ObjectivesThe first COVID-19 lockdown raised concerns about reduced access to primary care, especially for people with chronic diseases particularly at risk in the absence of follow-up. However, the COVIQuest trial,...

Epidemiology and Treatment Patterns of Fistulising Crohn’s Disease in a large, real-world Australasian cohort

Background and AimsFistulising Crohn’s Disease (fCD) affects up to 50% of people with Crohn’s Disease (CD) over their lifetime. Despite this high prevalence, the burden of disease, treatment and natural history in the current biologic era are poorly described. This study explores demographic, disease and treatment factors in a real-world Australasian cohort. MethodA large real-world cohort of people with IBD under routine care was interrogated in August 2023. Current fCD was defined as fistula(e) on most recent clinical, radiologic or endoscopic investigation; prior fCD was defined as the resolution of fistula(e) on most recent documentation. ResultsOf 3075 people with CD, 7.4% had current and 10.1% prior fCD (n=224 & 311). Most patients were in Australia (77%), where 19.3% had current or previous fCD compared to 11% in New Zealand (p<0.001). Patients with current or previous fCD were younger compared to those without (p=0.003 & p<0.001). Males were more commonly affected (p=0.021). Current or prior fCD were more likely to be on biologic therapy (p<0.001), with anti-TNF agents most frequently utilised. Conversely, those without fCD were more likely on Ustekinumab or Vedolizumab compared to current and prior fCD groups. People with fistulising disease had higher hospitalisation rates, whilst the prior fCD cohort had longer hospital admissions and more frequently required surgical intervention. ConclusionPeople with fCD used more healthcare resources, making this an important area for further research into care gaps to improve outcomes and optimal treatment approaches.

Underestimated Incidence Rate of Pertussis in the Community: Results from Active Population-Based Surveillance in Yiwu, China.

The resurgence of pertussis in China underscores the urgency of active surveillance to complement the passive surveillance system. Active surveillance for pertussis was conducted from 1 June 2021 to 31 May 2022, at Yiwu, Zhejiang province of China. Patients with suspected pertussis were further confirmed as pertussis cases by PCR and culture. The incidence rate of pertussis in the community was estimated. The overall estimated incidence of pertussis was 108.3 per 100,000 (95% CrI: 91.7-126.4). Children aged 4-5 years had the highest incidence (1154.3 per 100,000 [95% CrI: 817.4-1553.5]), followed by infants aged 1 year (836.1 per 100,000 [95% CrI: 434.0-1308.8]). Infants aged 0-4 months had the highest hospitalization rate among the pertussis patients (>50.0%). Although the incidence was low in elderly aged ≥ 60 years, the hospitalization rate was rather high (6.7%). Active surveillance in this study revealed a higher burden of pertussis in Yiwu, China, compared to passive surveillance. Children aged 4-5 years are the dominant population group at risk of pertussis. Infants aged ≤ 4 months are the most vulnerable pertussis patients that require hospitalization treatment. Our results highlight the urgency of large-scale active surveillance of pertussis in China.

Burden of systemic inflammation and associated health outcomes in adults with atherosclerotic cardiovascular disease managed in routine care

Abstract Background The burden and outcomes of inflammation in people with atherosclerotic cardiovascular disease (ASCVD) are poorly defined, particularly beyond the controlled settings of trials and research cohorts. Methods We conducted a longitudinal observational study of adults with ASCVD undergoing C-reactive-protein (CRP) testing in routine healthcare in Stockholm, Sweden. After excluding CRP tests associated with acute illness and patients with medications/conditions that bias CRP interpretation, the systemic inflammation of participants was defined over a 3-month ascertainment window. Baseline determinants of CRP≥2 mg/L were explored with logistic regression, and baseline CRP categories were compared via Poisson and Cox regression for subsequent healthcare resource utilization and occurrence of major adverse cardiovascular events (MACE), heart failure hospitalization, and all-cause death. Result After applying inclusion/exclusion criteria, we identified 84,399 adults with ASCVD with a mean age of 71 years and of which 54% were men. In total, 60% had CRP≥2 mg/L. At baseline, female sex, older age, lower kidney function, albuminuria, diabetes, hypertension, and recent anemia, were associated with CRP≥2 mg/L. Conversely, the use of RASi, antiplatelets, and lipid-lowering therapy were associated with lower odds. Over a median follow-up of 6.4 years and compared to people with CRP &amp;lt;2 mg/L, those with CRP≥2 mg/L had a higher rate of hospitalizations, days spent in hospital, outpatient consultations, and dispensed medications during follow-up (P&amp;lt;0.05 for all). They also had a higher rate of MACE [adjusted hazard ratio (HR), 1.30; 95% CI, 1.27–1.33], heart failure hospitalization [1.24; 1.20–1.39], and all-cause death [1.35; 1.20–1.30]. Results were consistent across subgroups and more granular CRP categories, and robust to the exclusion of extreme CRP values or early events. Conclusions Two in three adults with ASCVD have systemic inflammation. A CRP≥2 mg/L is associated with excess healthcare resource utilization as well as increased rates of MACE, heart failure, and death.

Heart failure burden among adults with congenital heart disease

Abstract Background Adult congenital heart disease (ACHD) is associated with high rates of healthcare utilization and mortality. Data on Heart failure (HF) burden among ACHD patients are limited. Purpose To study the association between HF and healthcare utilization and mortality among ACHD patients in the community. Methods The retrospective cohort study comprised 11,653≥ 18 year old ACHD patients insured by two large Israeli healthcare providers between January 2007 and December 2011. We used multivariable Cox proportional hazard and negative binomial models to study the associations of HF with mortality and healthcare utilization, respectively. Inverse treatment probability weighting accounted for drug indication. Results ACHD-HF patients (N=908; 7.8%) were older (median: 69 vs. 45 years), more likely men (53% vs. 45%), with complex congenital heart disease (14% vs. 4%), and higher comorbidity rates than ACHD patients without HF. HF was associated with higher healthcare utilization. Compared to patients without HF, ACHD-HF patients had higher adjusted relative rates (RR) of primary care (1.26, 95% confidence interval [CI]: 1.17-1.3), and cardiology clinic visits (1.9, 95% CI: 1.7-2.0), higher hospitalization rates (RR=2.0, 95% CI: 1.7-2.1), and higher risk of death (mortality hazard ratio [HR]: 1.9, 95% CI: 1.5-20.) over the study period. Among ACHD-HF patients, Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, and diuretics were associated with a lower mortality risk (treated vs. untreated HR=0.56, 95% CI: 0.48-0.65; HR=0.7, 95% CI: 0.6-0.8; HR=0.84, 95% CI: 0.73-0.97; respectively). Conclusions HF presents a major burden on ACHD patients and health care systems. Drugs recommended to the general HF patient population are also associated with lower risk of hospitalization and mortality in ACHD patients. Clinical trials are needed to establish the benefit of HF pharmacotherapy in ACHD patients.Age adjusted ACHD patient survival by HF

Clinical characteristics, resource use, and diagnostic accuracy of natriuretic peptides in cancer patients presenting with acute dyspnea to the Emergency Department

Abstract Background Previous studies suggest that dyspnea is a common presenting symptom in cancer patients and 6% of patients hospitalized for acute heart failure (AHF) have a history of cancer [1]. However, the clinical characteristics and diagnostic accuracy of natriuretic peptides in patients with active or past cancer presenting to the emergency department (ED) with acute dyspnea is largely unknown. Purpose We aimed to evaluate (1) the characteristics of patients presenting with acute dyspnea, (2) the prevalence of AHF, (3) the time to discharge and hospitalization rate, and (4) the diagnostic accuracy of natriuretic peptides (BNP and NT-proBNP) and the recommended algorithm to diagnose AHF in patients with and without cancer [2]. Methods Patients presenting with acute dyspnea to the ED were prospectively enrolled in a multicenter diagnostic study. Patient characteristics, including cancer status was prospectively assessed. Final diagnosis was centrally adjudicated by two independent cardiologists using all individual patient information including cardiac imaging, natriuretic peptides and follow-up data. Discrimination was assessed using the area under the curve (AUC). Results Among 2153 patients, 474 (22.0%) had cancer. Cancer patients were older, more frequently smokers, presented more often with productive cough and less often with paroxysmal nocturnal dyspnea, and had a higher prevalence of previous pulmonary embolism. Prevalence of AHF was 44.9% vs 51.0% in patients with and without cancer, respectively (P = 0.02), although it was the most frequent final adjudicated diagnosis for both groups. Cancer patients had a higher prevalence of pneumonia (18.1% vs 14.4%, P = 0.046) and lower prevalence of psychogenic hyperventilation (1.9% vs 5.2%, P = 0.002). Cancer-related dyspnea accounted for up to 30.4% of final diagnoses. Length of stay in the ED was similar in the two groups, although cancer patients had a higher hospitalization rate (85.0% vs 79.0%, P = 0.004) and the hospitalization was longer (median 9 vs 7 days, P&amp;lt;0.001). The diagnostic accuracy of NT-proBNP was high in cancer patients, but significantly lower compared to non-cancer patients (AUC 0.90 vs 0.93; P=0.02). The diagnostic accuracy of BNP was very high and comparable between groups (0.94 vs 0.95. P=0.40, Figure 1). In cancer patients, the AHF NT-proBNP algorithm maintained a very high safety for ruling out AHF but had lower efficacy with more patients remaining in the gray zone compared with patients without cancer (28.9% vs 18.9%, respectively; P&amp;lt;0.01, Figure 2). Conclusions Patients with cancer presenting with dyspnea have lower prevalence of AHF. Hospitalization rates are increased. The diagnostic performance of NT-proBNP, but not of BNP, is reduced. The efficacy of the NT-proBNP algorithm is reduced with more patients triaged to the grey zone and so is rule-in performance, possibly leading to overdiagnosis and mistreatment.Diagnostic accuracy of BNP and NT-proBNPNT-proBNP ESC algorithm