Hospital Admissions For Myocardial Infarction Research Articles

Thermal Influence on the Heart: The Impact of Hot Weather on Cardiovascular Conditions.

Dear Editor, We are cognisant of the fact that cardiovascular diseases (CVDs) have a considerable impact on public healthcare systems. Cardiovascular disorders rank as the primary global reason of fatality, claiming an estimated 17.9 million lives in 2019, which equates to 32% of all global fatalities. The majority of these deaths, around 85 percent, result from heart attacks and strokes. Low- and middle-income countries tolerate the brunt of heart-related fatalities, accounting for over three quarters of all deaths attributed to these conditions. Additionally, out of the 17 million premature deaths caused by noncommunicable diseases in 2019, CVDs were responsible for 38 percent.1 The prevailing cardiovascular risk factors encompass increasing age, hypertension (commonly referred to as a double-edged sword), diabetes mellitus, tobacco use, obesity, dyslipidaemia, and stress.1,2 A sedentary lifestyle together with poor eating habits have also led to an increased rate of CVS-related illnesses.1 Often overlooked as a risk factor, experiencing high temperatures significantly adds to the increased occurrence of cardiovascular diseases. Multiple studies support the connection between extreme temperatures and heightened cardiovascular risks.2-5 Being exposed to higher temperatures can lead to intravascular volume depletion, haemoconcentration, a hypercoagulable state, electrolyte imbalance, and raised sympathetic activity, placing substantial stress on the heart, especially in individuals with pre-existing cardiovascular disease.3 To investigate cardiovascular mortality associations with extremes of temperatures, Barrak Alahmad et al. assembled daily counts of specific cardiovascular causes of death from 567 cities across 5 continents in overlapping periods ranging from 1979 to 2019, and the city-specific daily ambient temperatures were noted. The findings indicated that higher temperature extremes (99th percentile for heat and 1st percentile for cold) were linked to an increased probability of mortality from various cardiovascular conditions, including ischaemic heart disease, stroke, and heart failure.4 In a case-crossover study conducted using the England and Wales MINAP database, involving 24,861 participants (hospital admissions for myocardial infarction) during the warmest months (June to August) from 2003 to 2009, it was found that each 1-degree Celsius increase in temperature beyond the established threshold of 20 °C temporarily increased the risk of heart attack by 1.9 percent.5 The cardiovascular-related illness and fatalities are quite prevalent in Pakistan. Pakistan due to her geographical location, usually encounters summer temperatures ranging from 45 to 55 degrees Celsius across most areas of the country. ---Continue

Long-Term Exposure to Ambient PM2.5 and Hospitalizations for Myocardial Infarction Among US Residents: A Difference-in-Differences Analysis.

Background Air pollution has been recognized as an untraditional risk factor for myocardial infarction (MI). However, the MI risk attributable to long-term exposure to fine particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5) is unclear, especially in younger populations, and few studies have represented the general population or had power to examine comorbidities. Methods and Results We applied the difference-in-differences approach to estimate the relationship between annual PM2.5 exposure and hospitalizations for MI among US residents and further identified potential susceptible subpopulations. All hospital admissions for MI in 10 US states over the period 2002 to 2016 were obtained from the Healthcare Cost and Utilization Project State Inpatient Database. In total, 1 914 684 MI hospital admissions from 8106 zip codes were included in this study. We observed a 1.35% (95% CI, 1.11-1.59) increase in MI hospitalization rate for 1-μg/m3 increase in annual PM2.5 exposure. The estimate was robust to adjustment for surface pressure, relative humidity, and copollutants. In the population exposed to ≤12 μg/m3, there was a larger increment of 2.17% (95% CI, 1.79-2.56) in hospitalization rate associated with 1-μg/m3 increase in PM2.5. Young people (0-34 years of age) and elderly people (≥75 years of age) were the 2 most susceptible age groups. Residents living in more densely populated or poorer areas and individuals with comorbidities were observed to be at a greater risk. Conclusions This study indicates long-term residential exposure to PM2.5 could increase risk of MI among the general US population, people with comorbidities, and poorer individuals. The association persists below current standards.

Short-term effects of individual exposure to PM2.5 on hospital admissions for myocardial infarction and stroke: a population-based case-crossover study in Guangzhou, China.

Some studies have investigated the effects of PM2.5 on cardiovascular diseases based on the population-average exposure data from several monitoring stations. No one has explored the short-term effect of PM2.5 on cardiovascular hospitalizations using individual-level exposure data. We assessed the short-term effects of individual exposure to PM2.5 on hospitalizations for myocardial infarction (MI) and stroke in Guangzhou, China, during 2014-2019. The population-based data on cardio-cerebrovascular events were provided by Guangzhou Center for Disease Control and Prevention. Average annual percent changes (AAPCs) were used to describe trends in the hospitalization rates of MI and stroke. The conditional logistic regression model with a time-stratified case-crossover design was applied to estimate the effects of satellite-retrieved PM2.5 with 1-km resolution as individual-level exposure. Furthermore, we performed stratified analyses by demographic characteristics and season. There were 28,346 cases of MI, 188,611, and 36,850 cases of ischemic stroke (IS) and hemorrhagic stroke (HS), respectively, with an annual average hospitalization rate of 37.2, 247, and 48.4 per 100,000 people. Over the six-year study period, significant increasing trends in the hospitalization rates were observed with AAPCs of 12.3% (95% confidence interval [CI]: 7.24%, 17.6%), 13.1% (95% CI: 9.54%, 16.7%), and 9.57% (95% CI: 6.27%, 13.0%) for MI, IS, and HS, respectively. A 10μg/m3 increase in PM2.5 was associated with an increase of 1.15% (95% CI: 0.308%, 1.99%) in MI hospitalization and 1.29% (95% CI: 0.882%, 1.70%) in IS hospitalization. A PM2.5-associated reduction of 1.17% (95% CI: 0.298%, 2.03%) was found for HS hospitalization. The impact of PM2.5 was greater in males than in females for MI hospitalization, and greater effects were observed in the elderly (≥ 65years) and in cold seasons for IS hospitalization. Our study added important evidence on the adverse effect of PM2.5 based on satellite-retrieved individual-level exposure data.

Effects of low-level air pollution exposures on hospital admission for myocardial infarction using multiple causal models

Myocardial infarctions have been associated with PM2.5, and more recently with NO2 and O3, however counterfactual designs have been lacking and argument continues over the extent of confounding control. Here we introduce a doubly robust, counterfactual-based approach that deals with nonlinearity and interactions in associations between confounders and both outcome and exposure, as well as a double negative controls approach that capture omitted confounders.We used data from over 4 million admissions for myocardial infarction in the US Medicare population between 2000 and 2016 and linked them by ZIP code of residence to high resolution predictions of annual PM2.5, NO2, and O3. We computed the counts of admissions for each ZIP code-year. In the doubly robust approach, we divided each pollutant into deciles, and for each decile, we fitted a gradient boosting machine model to estimate the effects of covariates, including the co-pollutants, on the counts. We used these models to predict, for all ZIP code-years, the expected counts had everyone be exposed in that decile. We also estimated the probability of being in that decile given all covariates, again with a gradient boosting machine, and used inverse probability weights to compute the weighted average rate of MI admission in each decile. In the negative control approach, for each pollutant, we fitted a quasi-Poisson model to estimate the exposure effect, adjusting for covariates including the co-pollutants, and negative exposure and outcome controls to control for unmeasured confounding.Each 1-μg/m3 increase in annual PM2.5 increased the admission for MI by 1.37 cases per 10,000 person-years (95% CI: 1.20, 1.54) in the doubly robust approach, and by 0.69 cases (95% CI 0.60, 0.78) using the negative control approach. Elevated risks were seen even below annual PM2.5 level of 8 μg/m3. Results for NO2 and O3 were inconsistent.

Changes in the care of acute cerebrovascular and cardiovascular conditions during the first year of the covid-19 pandemic in 746 hospitals in the USA: retrospective analysis

ObjectiveTo measure the impact of the covid-19 pandemic on admissions to hospital and interventions for acute ischemic stroke and acute myocardial infarction.DesignA retrospective analysis.Setting746 qualifying hospitals in the USA from...

The Impact of COVID-19 National Lockdown on Myocardial Infarction (MI) Hospitalizations in Northern Jordan.

During COVID-19 lockdown periods, several studies reported decreased numbers of myocardial infarction (MI) admissions. The lockdown impact has not yet been determined in developing countries. The aim of this study was to investigate the impact that of the lockdown measures might have had on the mean number of MI hospital admissions in Northern Jordan. A single-center study examined consecutive admissions of MI patients during COVID-19 outbreak. Participants' data was abstracted from the medical records of King Abdullah University Hospital between 2018 and 2020. Mean and percentages of monthly admissions were compared by year and by lockdown status (pre-lockdown, lockdown, and post-lockdown time intervals). A total of 1380 participants were admitted with acute MI symptoms: 59.2% of which were STEMI. A decrease in number of MI admissions was observed in 2020, from 43.1 (SD: 8.017) cases per month in 2019 to 40.59 (SD: 10.763) in 2020 (P < 0.0001) while an increase in the numbers during the lockdown was observed. The mean number during the pre-lockdown period was 40.51 (SD: 8.883), the lockdown period was 44.74 (SD: 5.689) and the post-lockdown was 34.66 (SD: 6.026) (P < 0.0001 for all comparisons). Similar patterns were observed when percentages of admissions were used. Upon comparing the lockdown period both to the pre- and post-lockdown periods separately, we found a significant increase in MI admissions during the lockdown period. This suggests that lockdown-related stress may have increased the risk of myocardial infarction.

Hourly Valley Concentration of Air Pollutants Associated with Increased Acute Myocardial Infarction Hospital Admissions in Beijing, China

(1) Background: Acute myocardial infarction (AMI) imposes a great burden on global health. Few studies have demonstrated the effects of valley concentration of air pollutants on AMI hospital admissions. (2) Methods: Hospitalizations for AMI from 1 May 2014 to 31 December 2019 were analyzed. Generalized additive models (GAM) were used to quantify the exposure–response association between the hourly peak, mean, and valley concentration of six air pollutants and AMI hospital admissions. Stratification analyses were conducted to identify the susceptible population. (3) Results: Hourly peak, mean, and valley concentrations of PM2.5, PM10, SO2, NO2, and CO were significantly associated with AMI hospital admissions. Each 10-unit increase in the hourly valley concentration of them led to 0.50% (0.35–0.66%), 0.44 % (0.32–0.56%), 0.84% (0.47–1.22%), 1.86% (0.73–3.01%), and 44.6% (28.99–62.10%) excess risk in AMI hospital admissions, respectively. In addition, the effects of hourly valley concentration were larger than mean and peak concentrations. The effects in the female or older than 65 groups were larger than that in the male or younger than 65 groups. (4) Conclusions: PM2.5, PM10, SO2, NO2, and CO exposure contributed to increased AMI hospital admissions. Hourly valley concentration might be a more potent indicator of adverse cardiovascular events. Females and individuals older than 65 were more susceptible to ambient air pollutant exposure.

Effectiveness and safety of GLP-1 receptor agonists versus SGLT-2 inhibitors in type 2 diabetes: an Italian cohort study

BackgroundGLP-1 receptor agonists (GLP-1 RA) and SGLT-2 inhibitors (SGLT-2i) have shown to reduce the risk of major adverse cardiovascular events (MACE), death and worsening nephropathy when added to standard of care. However, these two dug classes differ in efficacy and safety. We compared the effectiveness and safety profile of GLP-1 RA and SGLT-2i in a large and unselected cohort of patients with type 2 diabetes resident in Lombardy from 2015 to 2020.MethodsUsing linkable administrative health databases, we included patients aged 50 years and older initiating GLP-1 RA or SGLT-2i. Clinical events were: death, hospital admission for myocardial infarction (MI), stroke, heart failure (HF), and renal disease as individual and composite outcomes (MACE-3: all cause-death, non-fatal MI, non-fatal stroke; MACE-4: MACE-3 plus unstable angina). Outcomes were evaluated separately in subjects with and without previous cardiovascular (CV) diseases. Treatments were compared using Cox proportional hazards regression model after Propensity Score Matching (PSM) in both intention-to-treat (ITT) and per protocol (PP) analyses. Serious adverse events were also evaluated.ResultsThe analysis comprised 20,762 patients per cohort. The ITT analysis showed a significant risk reduction for non-fatal MI (HR 0.77; CI 95% 0.66–0.90), MACE-3 (HR 0.91; CI 95% 0.84–0.98), and MACE-4 (HR 0.92; CI 95% 0.86–0.99) in GLP-1RA compared with SGLT-2i users, while no difference was reported in the incidence of HF hospitalization and stroke between the two cohorts. Similar benefits were found in the subgroup of patients without previous CV diseases only. PP analysis largely confirmed the main results. The incidence of serious adverse events was low in both cohorts (< 1%).ConclusionsGLP-1RA showed to be equally safe and more effective than SGLT-2i in reducing the risk of MACE-3, MACE-4 and MI. This study adds to the growing body of real-world evidence addressing the specific clinical properties of GLP-1RA and SGLT-2i in everyday practice to tailor treatment to the individual patient.

Empagliflozin in patients post myocardial infarction rationale and design of the EMPACT-MI trial

Patients with acute myocardial infarction (MI) are at risk for developing heart failure (HF) and subsequently are at an increased risk of mortality. Sodium-glucose cotransporter-2 inhibitors have been proven to improve outcomes in patients with HF with reduced ejection fraction, and, in the case of empagliflozin, in HF with preserved ejection fraction even without diabetes, but their efficacy and safety in the post-MI population has not yet been evaluated. The EMPACT-MI trial will evaluate the safety and efficacy of empagliflozin compared with placebo in patients hospitalized for MI with or at high risk of new onset HF, in addition to standard care. EMPACT-MI is a streamlined, multinational, randomized, double-blind, placebo-controlled trial randomizing 5,000 participants at approximately 480 centers in 22 countries. Eligible patients presenting with spontaneous MI must have new signs or symptoms of pulmonary congestion requiring treatment or new left ventricular dysfunction (LVEF<45%), and at least 1 additional risk factor for development of future HF. Eligible and consenting patients are randomized to empagliflozin 10mg or placebo daily in addition to standard of care within 14 days of hospital admission for MI. The primary composite end point is time to first hospitalization for HF or all-cause mortality. EMPACT-MI will inform clinical practice regarding the role of empagliflozin in patients after an MI with high-risk for the development of future HF and mortality.

Association of sunshine duration with acute myocardial infarction hospital admissions in Beijing, China: A time-series analysis within-summer

BackgroundOver the years, various epidemiological studies found that acute myocardial infarction (AMI) often shows seasonal rhythm patterning, which is usually influenced by the variations of environmental factors, such as air pollution, ambient temperature, solar activity, relative humidity. However, there are few studies on the impact of sunlight-induced AMI especially in developing countries, and they had inconsistent results. This study aimed to examine within-summer variations in the temporal association between sun exposure and AMI. MethodsWe obtained hospitalization data for AMI of Beijing during 2013–2019. We used a distributed lag non-linear model (DLNM) combined with a quasi-Poisson regression model to estimate the non-linear lag effects of sunshine duration on AMI incidences. We evaluated the overall effect of AMI admissions with exposure to sunshine duration in the lag 0–21 days. ResultsA total of 45,301 AMI cases were enrolled in our study during summer (June–September). The minimum of the morbidity was during days with a sunshine duration of 3.9 h. We found significant and U-shaped associations between sunshine duration and AMI, and the overall estimated relative risk was 1.29 (95% CI: 1.02,1.62) and 1.69 (95% CI: 1.28,2.24) for short (1st percentile) and long (99th percentile) sunshine duration, respectively. The males and younger people (<65 years) were most susceptible to these effects. ConclusionOur results suggest that both short and long sunshine duration could increase the risk of AMI admissions, especially for males and younger people. We suggest that public health policymakers should fully consider the balance of the pros and cons of solar exposure, and provide appropriate public health recommendations accordingly to gain the greatest benefits from sunlight.

One year of Covid-19: French nationwide study of hospitalisation, 90-day readmission and mortality rates from myocardial infarction

BackgroundStudies reported a decrease in hospital admissions for myocardial infarction (MI) in early 2020 due to Covid19 crisis, but these were restricted to the early weeks of the pandemic.PurposeTo describe patient characteristics, in-hospital management and 90-day mortality of MI patients throughout the year 2020, in particular during periods of lockdowns.MethodsAll patients hospitalised for MI in France from 2017 to 2020 were selected from the national hospital discharge database. Incidence rate ratios were computed to analyze time trends in MI admissions and mortality rates and stratified by type of MI, sex, age, and period of admission. Characteristics and management of patients in 2020 were described and compared to 2017-19 (OR adjusted on temporality, sex, age)ResultsIn 2020, 94,747 patients were hospitalized for MI corresponding to a 6% decrease in MI admissions compared to 2017-19. This decrease was more significant during the first lockdown (−24%, P < 0.0001), in particular in week 13 (−40%) than during the second lockdown (−8%). Decreases in MI admissions were more pronounced and longer for NSTEMI, older people and for women. An increase in the rate of STEMI admissions was observed between the two 2020 lockdowns (+4%, P = 0.0005). Admission to a resuscitation unit and complications rates did not differ between 2017-19 and 2020. In early 2020, there was also a decrease in 90-days readmission. In 2020, the in-hospital and 90-days-out-of hospital mortality rates were 5.5% and 3.8%, compared to 5.7% and 3.6% in reference years. Globally and after adjustment, mortality rates did not differ in 2020 vs. 2017-19 (IRRin-hosp = 1.03[0.98;1.08], P = 0.19 - IRRout-hosp = 1.04[0.97;1.27], P = 0.21).ConclusionsThis nationwide study showed significant decrease in MI hospitalization during 2020, in particular during the first lockdown, with a slight STEMI increase during the summer. However, these trends were not associated with more cardiac complications or mortality.

Weather Impact on Acute Myocardial Infarction Hospital Admissions With a New Model for Prediction: A Nationwide Study.

Introduction: Cardiovascular disease is one of the leading causes of mortality worldwide. Acute myocardial infarction (AMI) is associated with weather change. The study aimed to investigate if weather change was among the risk factors of coronary artery disease to influence AMI occurrence in Taiwan and to generate a model to predict the probabilities of AMI in specific weather and clinical conditions.Method: This observational study utilized the National Health Insurance Research Database and daily weather reports from Taiwan Central Weather Bureau to evaluate the discharge records of patients diagnosed with AMI from various hospitals in Taiwan between January 1, 2008 and December 31, 2011. Generalized additive models (GAMs) were used to estimate the effective parameters on the trend of the AMI incidence rate with respect to the weather and health factors in the time-series data and to build a model for predicting AMI probabilities.Results: A total of 40,328 discharges were listed. The minimum temperature, maximum wind speed, and antiplatelet therapy were negatively related to the daily AMI incidence; however, a drop of 1° when the air temperature was below 15°C was associated with an increase of 1.6% of AMI incidence. By using the meaningful parameters including medical and weather factors, an estimated GAM was built. The model showed an adequate correlation in both internal and external validation.Conclusion: An increase in AMI occurrence in colder weather has been evidenced in the study, but the influence of wind speed remains uncertain. Our analysis demonstrated that the novel GAM model can predict daily onset rates of AMI in specific weather conditions.

Myocardial infarction throughout 1 year of the COVID-19 pandemic: French nationwide study of hospitalization rates, prognosis and 90-day mortality rates

BackgroundStudies reported a decrease in hospital admissions for myocardial infarction (MI) in early 2020 as a result of the coronavirus disease 2019 (COVID-19) crisis, mainly restricted to the beginning of the pandemic.AimsTo describe national trends in hospital admissions for MI in 2020, and to compare patient characteristics, in-hospital prognosis and 90-day mortality between patients who had an MI in 2020 and those admitted in 2017–2019.MethodsAll patients hospitalized for MI in France from 2017 to 2020 were selected from the national hospital discharge database. Analyses compared temporal trends in MI admissions, in-hospital cardiac complications and mortality rates in 2020 versus 2017–2019.ResultsIn 2020, 94,747 patients were hospitalized for MI, corresponding to a 6% decrease in MI admissions compared with 2017–19. This decrease was larger during the first lockdown (–24%; P < 0.0001) than during the second lockdown (–8%; P < 0.0001). Reductions in MI admissions were more pronounced and longer among patients with non-ST-segment elevation MI, older people and women. An increase in ST-segment elevation MI admissions was observed between lockdowns (+4%; P = 0.0005). Globally, and after adjustment for age, sex and calendar year, in-hospital and 90-day post-discharge mortality rates did not differ in 2020 versus 2017–19: incidence rate ratio (IRR)adjin-hospital 1.03, 95% confidence interval (CI) (0.98–1.08); IRRadj90-daypost-discharge 1.06, 95% CI (0.98–1.13).ConclusionsIn 2020, a significant decrease in MI admissions was observed, and was marked at the beginning of the year. This highlights the need to disseminate public information on the importance of maintaining care and regular medical follow-up. The effect of the COVID-19 crisis on acute and 3-month outcomes of patients hospitalized for MI appears limited. Nevertheless, monitoring of chronic MI complications and the impact on non-hospitalized patients should continue.

Effects of Russian tobacco control law on rates of hospital admissions for acute coronary events

Abstract Background The Russian tobacco control law (TCL), implemented nationwide, aims to reduce smoking-related morbidity and mortality. However, its effects may vary among Russian regions. We aimed to assess the effects of TCL on rates of hospital admissions (HA) for angina pectoris (AP) and myocardial infarction (MI) in the Russian Federation (RF) and 10 Russian regions in relation to enforcement of the TCL. Methods We analysed HA rates for AP and MI to compare the periods before and after TCL in 2013, adjusting for possible confounders and long-term trends. Models were based on time-series of annual HA in the RF and 10 Russian regions during the years 2005-2019. We used interrupted time-series design and Poisson regression model with calculation of risk ratio (RR) and 95%CI. Regions were compared by means of TCL implementation scale (TCIS), developed based on the results of Russian TC policy evaluation survey in 10 Russian regions (n = 11625). We analysed the relationship between the TCL measures implementation scores and RR of reduction of HA for AP and MI after the TCL by means of Spearman's rank correlation and linear regression models. Results Results showed a 16.6% decrease in HA rates for AP (RR 0.83 95% CI 0.74-0.93) and 3.5% - for MI (RR 0.96 95% CI 0.96-0.97) after the TCL introduction in RF and effects of various magnitude in the regions. Regions with higher TCIS scores, i.e. better enforcement of full TCL package had greater reduction in HA rates for AP (rsp = −0.627 95%CI−1.05;−0.199; p=.004); with better enforcement of smoke-free policies - grater reduction in HA rates for MI (rsp = −0.793 95%CI−1.08;−0.506, p&amp;lt;.001). Both HA rates for AP and MI correlated with the higher scores for help to quit tobacco use (rsp = −0.56 95%CI −1.1; −0.01, p=.045), (rsp = −0.74 95%CI−1.12;−0.36, p=.027). Conclusions TCL leads to a decrease of HA for AP and MI with sustained effect. Differences in the magnitude of these effects in the regions are related to the extent of enforcement of TC measures. Key messages Tobacco control legislative measures may lead to reduction of hospital admission rates for acute coronary events. The effect of tobacco control law on hospital admission rates for acute coronary events may vary in relation with the extent of enforcement of tobacco control measures.

Use of health and aged care services in Australia following hospital admission for myocardial infarction, stroke or heart failure

BackgroundCardiovascular diseases (CVD), including myocardial infarction (MI), stroke and heart failure (HF) are the leading cause of death amongst the older population worldwide. The aim of this study is to investigate trajectories of use of health and aged care services after hospital admission for MI, stroke or HF among community-dwelling people not previously receiving aged care services.MethodsThe study population comprised people aged 65+ years from the 45 and Up Study with linked records for hospital stays, aged care services and deaths for the period 2006–14. Among those with an index hospital admission for MI, stroke or HF, we developed Sankey plots to describe and visualize sequences and trajectories of service use (none, re-hospitalization, community care, residential care, death) in the 12 months following discharge. We used Cox proportional hazards models to estimate hazard ratios (HRs), for commencing community care and entering residential care (and the other outcomes) within 3, 6 and 12 months, compared to a matched group without MI, stroke or HF.ResultsTwo thousand six hundred thirty-nine, two thousand five hundred and two thousand eight hundred seventy-three people had an index hospitalization for MI, stroke and HF, respectively. Within 3 months of hospital discharge, 16, 32 and 29%, respectively, commenced community care (multivariable-adjusted HRs: 1.26 (95%CI:1.18–1.35), 1.53 (95%CI:1.44–1.64) and 1.39 (95%CI:1.32–1.48)); and 7, 18 and 14%, respectively, entered residential care (HRs: 1.25 (95%CI:1.12–1.41), 2.65 (95%CI:2.42–2.91) and 1.50 (95%CI:1.37–1.65)). Likewise, 26, 15 and 28%, respectively, were rehospitalized within 3 months following discharge (multivariable-adjusted HRs: 4.78 (95%CI:4.31–5.32), 3.26 (95%CI:2.91–3.65) and 4.94 (95%CI:4.47–5.46)).ConclusionsOlder people hospitalized for major CVD may be vulnerable to transition-related risks and have poor health trajectories, thus emphasizing the value of preventing such events and care strategies targeted towards this at-risk group.

Effectiveness and Safety of Non-Vitamin K Oral Anticoagulants in Non-Valvular Atrial Fibrillation Patients: Results of A Real-World Study in a Metropolitan Area of Northern Italy.

Background: New oral anticoagulant agents (NOACs) are valid alternatives for vitamin K antagonists (VKA) in patients with non-valvular atrial fibrillation (NVAF) for stroke prevention. In clinical practice, NOACs users may differ from patients enrolled in clinical trials in age or comorbidities, and thus it is a critical issue to evaluate the effectiveness and safety of NOACs in the real-world. Accordingly, we assessed two-year overall mortality and hospital admissions for myocardial infarction, stroke or bleeding in patients with NVAF users of NOACs compared to warfarin-treated patients. Methods: This is a population-based retrospective new user active comparator study. All atrial fibrillation patients who were naïve and not switcher users of oral anticoagulants from January 2017 to December 2019 were included (n = 8543). Data were obtained from the electronic health records of the Milan Agency for Health Protection, Italy. Two-year risks for overall mortality, myocardial infarction, stroke and bleeding were computed using Cox models. Age, sex, number of comorbidities, use of platelet aggregation inhibitors and Proton pump inhibitors and area of residence were used as confounding factors. We also controlled by indication bias-weighting NOACs and warfarin users based on the weights computed by a Kernel propensity score. Results: For all NOACs, we found a decrease in the risks compared with warfarin for mortality (from −25% to −49%), hospitalization for myocardial infarction (from −16% to −27%, statistically significant for apixaban, edoxaban and rivaroxaban) and ischemic stroke (from −23% to −41%, significant for dabigatran and apixaban). The risk of bleeding was decreased for rivaroxaban (−33%) and numerically but not significantly for the other NOACs. Conclusions: After two years of follow-up, in comparison with warfarin, NOACs users showed a significant reduction of overall mortality (all NOACs), hospital admission for myocardial infarction (apixaban and edoxaban), ischemic stroke (dabigatran) and bleeding (rivaroxaban).

Associations of statin adherence and lipid targets with adverse outcomes in myocardial infarction survivors: a retrospective cohort study

ObjectivesTo examine associations between statin adherence and lipid target achievement in myocardial infarction (MI) survivors, and their associations with mortality and recurrent MIs.DesignRetrospective cohort study using linked clinical records within...

Source-specific fine particulate matter and hospitalization due to myocardial infarction

BACKGROUND AND AIM: The association between fine particulate matter (PM2.5) air pollution and cardiovascular outcomes is well-established. PM2.5 is a heterogeneous mixture of chemical constituents and its composition can vary by air pollution source. To evaluate whether PM2.5 from certain sources may be differentially associated with cardiovascular disease, we examined the association between same-day exposure to source-specific PM2.5 and risk of hospital admission for myocardial infarction (MI) in New York City (NYC). METHODS: We applied Absolute Principal Components Analysis to identify sources of PM2.5 pollution using data from three NYC monitors. We used data from the New York Department of Health Statewide Planning and Research Cooperative System on daily city-wide counts of MI admissions (2007–2015). We examined associations between same-day exposure to source-specific PM2.5 and MI admissions in a time-series analysis, using a quasi-Poisson regression model and adjusting for temperature, relative humidity, day of week, and seasonal and long-term time trends. RESULTS:We identified six sources of PM2.5 pollution: 1) traffic emissions, 2) salt, 3) crustal dust, 4) secondary/regional sulfate and nitrate, 5) road dust, and 6) industrial emissions. In adjusted models, an interquartile range (IQR) increase in PM2.5 from crustal dust was associated with a 0.68% increase in the rate of hospitalization for MI, on average (95% CI: 0.12, 1.25%). We observed a 1.01% (95% CI: -0.11, 2.16%) and a 0.62% (95%CI: -0.13, 1.36%) increase in MI admission rates per one IQR increase in traffic-related and regional PM2.5, respectively. We observed no association with PM2.5 from other sources. CONCLUSIONS:Identifying particularly toxic sources of PM2.5 can lead to maximally efficient policies. In our NYC study we identified crustal dust and traffic-related PM2.5 as potentially toxic sources for cardiovascular disease. KEYWORDS: Air pollution, Particle components, Particulate matter, Cardiovascular diseases, Mixtures analysis, Short-term exposure

In- and out-of-hospital mortality for myocardial infarction during the first wave of the COVID-19 pandemic in Emilia-Romagna, Italy: A population-based observational study.

BackgroundThe COVID-19 pandemic has put several healthcare systems under severe pressure. The present analysis investigates how the first wave of the COVID-19 pandemic affected the myocardial infarction (MI) network of Emilia-Romagna (Italy).MethodsBased on Emilia-Romagna mortality registry and administrative data from all the hospitals from January 2017 to June 2020, we analysed: i) temporal trend in MI hospital admissions; ii) characteristics, management, and 30-day mortality of MI patients; iii) out-of-hospital mortality for cardiac cause.FindingsAdmissions for MI declined on February 22, 2020 (IRR -19.5%, 95%CI from -8.4% to -29.3%, p = 0.001), and further on March 5, 2020 (IRR -21.6%, 95%CI from -9.0% to -32.5%, p = 0.001). The return to pre-COVID-19 MI-related admission levels was observed from May 13, 2020 (IRR 34.3%, 95%CI 20.0%-50.2%, p<0.001). As compared to those before the pandemic, MI patients admitted during and after the first wave were younger and with fewer risk factors. The 30-day mortality remained in line with that expected based on previous years (ratio observed/expected was 0.96, 95%CI 0.84–1.08). MI patients positive for SARS-CoV-2 were few (1.5%) but showed poor prognosis (around 5-fold increase in 30-day mortality). In 2020, the number of out-of-hospital cardiac deaths was significantly higher (ratio observed/expected 1.17, 95%CI 1.08–1.27). The peak was reached in April.InterpretationIn Emilia-Romagna, MI hospitalizations significantly decreased during the first wave of the COVID-19 pandemic. Management and outcomes of hospitalized MI patients remained unchanged, except for those with SARS-CoV-2 infection. A concomitant increase in the out-of-hospital cardiac mortality was observed.FundingNone.

Ivabradine and Blood Pressure Reduction: Underlying Pleiotropic Mechanisms and Clinical Implications

Elevated heart rate (HR) is a well-recognized but somewhat neglected risk factor among the healthy population and various cardiovascular pathologies (1). High HR is fraught with a spate of detrimental cardiovascular consequences including immense myocardial oxygen demand in reduced diastolic perfusion time (2) and low, oscillatory vascular shear stress with high tensile stress triggering endothelial dysfunction (3). Although beta-blockers (BBs) are considered to be the cornerstone treatment of elevated HR in various cardiovascular pathologies, they are associated with negative inotropy, a number of side effects, and undesirable metabolic actions limiting their usage (4, 5). Thus, new approaches to HR reduction are being continuously sought out. The inhibition of the If current in the sinoatrial node (SAN) seems to offer a promising approach to the reduction of elevated HR. Indeed, the SAN's pacemaker cells are inherently capable of cyclic variations of the resting membrane potential necessary for spontaneous depolarization. The SAN's spontaneous slow diastolic depolarization is administered by a mixed sodium/potassium inward current, known as an If current, through the “funny” (f)-channel (6). Structurally, the f-channel belongs to hyperpolarization-activated, cyclic nucleotide-gated (HCN) channels and is activated by both hyperpolarization in the diastolic voltage range and intracellular cyclic adenosine monophosphate (7). Ivabradine selectively inhibits the If current, thus reducing the steepness of SAN's diastolic depolarization, ensuing diastole prolongation without affecting action potential duration or inducing negative inotropy (7, 8). Several studies have assessed ivabradine's efficacy in clinical settings. In the SHIFT study, the investigation of 6,558 patients with systolic heart failure (HF) during a median 22.9 month follow-up period revealed that the addition of ivabradine to an established HF therapy significantly reduced the primary composite endpoint of hospital admission for worsening HF or cardiovascular death. Considering the results of the SHIFT study, ivabradine is recommended for patients with systolic HF and HR above 70 bpm despite an evidence-based optimal medical therapy (with or without BB) to reduce the composite endpoint of hospitalization and mortality (9, 10). The BEAUTIFUL study comprised 10,917 systolic HF patients with HR above 70 bpm suffering from stable coronary artery disease (CAD), and the primary endpoint was a composite of cardiovascular death and hospital admission for acute myocardial infarction or HF. Although neither the primary endpoint nor the cardiovascular death rate improved, ivabradine reduced the secondary endpoints of hospital admissions for myocardial infarction and coronary revascularization (11). However, in the SIGNIFY study involving 19,102 patients with stable CAD but without HF, ivabradine did not reduce the compound primary endpoint of cardiovascular death and myocardial infarction (12). Hypertension, however, is a substantially different condition, and data regarding ivabradine's effect on peripheral blood pressure (BP) in a hypertensive population are scanty. Yet ivabradine's interference with central BP (CBP) was indicated in several studies. Lopatin and Vitale (13) reviewed five studies analyzing ivabradine's effect on CBP in patients with CAD: two studies reported a neutral effect, while in two other studies and in one study, ivabradine decreased and increased CBP, respectively. In 12 normotensive patients with stable CAD and HR ≥ 70 bmp, a 3 week ivabradine treatment reduced brachial systolic and diastolic BP, while the HR reduction did not increase central aortic BP (14). Moreover, in patients with arterial hypertension and CAD treated with ivabradine, the increase in HR between resting conditions and early recovery post exercise showed a trend toward correlation with the radial augmentation index (15). Besides ivabradine's HR-reducing action, which is considered to be a principal mechanism of its benefit, ivabradine exerts a number of pleiotropic effects, some of which may partly be HR independent (16, 17) and some of which are still emerging.