Cardiovascular Disease Hospitalizations Research Articles

Applying a multistate survival model to explore the role of fine particles in promoting frailty in the Medicare cohort.

Fine particle pollution is a well-established risk to human health. Observational epidemiology generally treats events as though they are independent of one another and so do not examine the role air pollution may play in promoting the progression of disease. Multistate survival models account for the complex pathway of disease to death. We employ a multistate survival model to characterize the role of chronic exposure to PM2.5 in affecting the rate at which Medicare beneficiaries transition to first hospitalization for cardiovascular disease and then subsequently death. We use an open cohort of Medicare beneficiaries and PM2.5 concentrations estimated with photochemical model predictions, satellite-based observations, land-use data, and meteorological variables. The multistate model included three transitions: (1) entry to cardiovascular hospital admission; (2) entry to death; and (3) cardiovascular hospital admission to death. The transition intensity was modeled using a Cox proportional hazards model. For a 1 µg/m3 increase in annual mean PM2.5, we estimate a nationally pooled hazard ratio of 1.022 (95% confidence interval [CI] = 1.018, 1.025) for the transition from entry to first cardiovascular hospital admission; 1.054 (95% CI = 1.039, 1.068) for the transition from entry to death; 1.036 (95% CI = 1.027, 1.044) for the transition from first cardiovascular hospital admission to death. The hazard ratios exhibited some heterogeneity within each of nine climatological regions and for each of the three transitions. We find evidence for the role of PM in both promoting chronic illness and increasing the subsequent risk of death.

A novel approach to accurately measuring the burden of hospitalisations for cardiovascular disease in people with diabetes: A pilot study.

To determine the reliability of hospital discharge codes for heart failure (HF), acute myocardial infarction (AMI) and stroke compared with adjudicated diagnosis, and to pilot a scalable approach to adjudicate records on a population-based sample. A population-based sample of 685 people with diabetes admitted (1274 admissions) to one of three Australian hospitals during 2018-2020 were randomly selected for this study. All medical records were reviewed and adjudicated. Cardiovascular diseases were the most common primary reason for hospitalisation in people with diabetes, accounting for ~17% (215/1274) of all hospitalisations, with HF as the leading cause. ICD-10 codes substantially underestimated HF prevalence and had the lowest agreement with the adjudicated diagnosis of HF (Kappa = 0.81), compared with AMI and stroke (Kappa ≥ 0.91). While ICD-10 codes provided suboptimal sensitivity (72%) for HF, the performance was better for AMI (sensitivity 84%; specificity 100%) and stroke (sensitivity 85%; specificity 100%). A novel approach to screen possible HF cases only required adjudicating 8% (105/1274) of records, correctly identified 78/81 of HF admissions and yielded 96% sensitivity and 98% specificity. While ICD-10 codes appear reliable for AMI or stroke, a more complex diagnosis such as HF benefits from a two-stage process to screen for suspected HF cases that need adjudicating. The next step is to validate this novel approach on large multi-centre studies in diabetes.

Detection of tetracycline and ampicillin resistant E. coli and Salmonella species from hospital wastewater

Escherichia coli (E. coli) and Salmonella spp. were found in hospital wastewater. The highest (E = (6.2 ± 1.8) x 109; S = (4.3 ± 2.2) x 109) and lowest (E = (1.4 ± 1.2) x 109; S = (1.1 ± 1.8) x 109) Total Viable Count (TVC) were in Shaheed Suhrawardy Medical College Hospital (SSMCH) and National Institute of Ophthalmology Hospital (NIOH), respectively. The overall occurrence of E. coli and Salmonella spp. was 80% and 87%, respectively, with 100% occurrence in SSMCH and National Institute of Cardiovascular Diseases Hospital (NICVDH) for Salmonella spp. (p ≤ 0.036). Prevalence of E. coli was low (72%) in winter (November - February). Both types of bacteria were resistant to Tetracycline whereas and 97.5% of E coli were resistant to ampicillin. Gentamycin was more effective than other antibiotics. Rational use of antibiotics is suggested, and hospital management practice should be followed as defined by the Joint Commission International for Hospital Accreditation.
 Bang. vet. 2023. Vol. 40, No. 1 – 2, 16 – 24

Cardiovascular disease hospitalizations among women who undergo fertility treatment

Research questionAre women who receive fertility treatment at increased risk of cardiovascular disease (CVD) hospitalization compared with women who do not? DesignA retrospective cohort study of all women registered for fertility treatment at Monash IVF between 1998 and 2014. This cohort was linked to the Victorian Admitted Episodes Dataset, which contains records of all hospital admissions in the Australian state of Victoria. Age- and Index of Relative Socioeconomic Disadvantage (IRSD)-adjusted relative risks of CVD hospitalization for women who did or did not undergo fertility treatment were determined using Poisson regression. Risks were calculated overall by CVD subtype and stratified by area-based social disadvantage using IRSD fifths, number of stimulated cycles and mean oocytes per cycle. ResultsOf 27,262 women registered for fertility treatment, 24,131 underwent treatment and 3131 did not. No significant difference was found in risk of CVD hospitalization between treated and untreated women overall (adjusted RR 0.93, 95% 0.82 to 1.05) or by CVD subtype. The admission risk for CVD was significantly lower in treated women who had a mean of fewer than five oocytes per cycle (adjusted RR 0.80, 95% CI 0.70 to 0.92) compared with untreated women. Treated women residing in areas within the second IRSD fifth were less likely to be hospitalized for CVD compared with untreated women (age-adjusted RR 0.66, 95% CI 0.49 to 0.89). ConclusionsFertility treatment is not associated with increased risk of CVD hospitalization. Lower risk among some subgroups of treated women may be explained by social disadvantage.

Presentation of hypoparathyroidism in Italy: a nationwide register-based study.

We sought to assess the clinical presentation of hypoparathyroidism (HypoPT) in Italy. We performed a nationwide study retrieving data from the hospital discharge ICD-9 codes database of the Italian Health Ministry, from 2007 through 2017. The codes corresponding to diagnosis of cardiovascular disease, cancer, infection, renal failure, psychiatric disease, upper airway tract infection and pneumonia, seizures, nephrolithiasis, cognitive impairment, cerebral calcifications, skin disorders, fracture, and cataract were retrieved when associated with the diagnosis of HypoPT (252.1). We excluded codes corresponding to diagnoses of cancer of the neck region. In-hospital mortality rate was calculated. We retrieved the same data from an age- and sex-matched non-HypoPT control population. Fourteen thousand five hundred seventy-nine hospitalizations for HypoPT and controls were analyzed. Hospitalization for cardiovascular disease, cancer, infection, renal failure, seizures, nephrolithiasis, cerebral calcifications (p < 0.0001), and cognitive impairment (p < 0.05) were more common in HypoPT compared to controls. Mean age of HypoPT with cardiovascular disease, cancer, and renal failure was younger compared to controls (p < 0.0001). The OR of hospitalization for cardiovascular disease, cancer, renal failure, seizures (OR 2, 40, 48 and1.6, respectively), and nephrolithiasis (OR 1.6) were significant in HypoPT compared to non-HypoPT. The OR of hospitalization for infection and cognitive impairment were significant only in HypoPT women (OR 1.3 and 2.3, respectively). In-hospital mortality rate was lower in HypoPT vs controls (0.5% and 3.7%; p < 0.0001). Hospitalizations for cardiovascular disease, cancer, and renal failure are more prevalent and occur at a younger age in HypoPT vs non-HypoPT. Hospitalizations for seizures and nephrolithiasis are frequent in HypoPT; those for infection and cognitive impairment are more common in HypoPT women.

Impact of telediagnostics on hospitalizations due to cardiovascular diseases: an approach in municipalities of Bahia State, Brazil

Hospitalization costs due to cardiovascular diseases are high. In 2019, for Bahia State, Brazil, alone, they exceeded BRL 153 million for the Brazilian Unified National Health System, surpassing the costs of cancer hospitalizations. This fact will show an upward trend with the increase in life expectancy in Brazil (7.3 years more by 2060). Introducing new technologies can mitigate the problem. This study analyzes the impact of telediagnostics in electrocardiogram on hospitalizations for cardiovascular diseases in 326 municipalities in Bahia from 2014 to 2020. Diff-in-diff estimator method was used for analysis of the periods before and after the implementation of telediagnostics in Bahia. Results show that the municipalities which introduced the new technology reduced cardiovascular diseases hospitalizations by 6 for each additional year. In the case of families benefiting from the Brazilian Income Transfer Program, the reduction was 3.26 hospitalizations, and 3.08 among municipalities with the specialized service. Hospitalization increase by 7.66 in the 30 to 59 age group and by 5.34 among men for each additional year. Results show a reduction of 1.15 hospitalizations for rheumatologic heart diseases and 1.39 among diabetic people. In terms of ethnicity/color, underreporting was identified in the conditions studied, resulting in more severe prognoses for blacks. Telediagnostics was effective in reducing this inequality by expanding access and reducing hospitalizations, playing a crucial role in public health and impacting mortality reduction. The theme, therefore, deserves further studies with different samples and sample periods.

Association Between Air Pollution and Cardiovascular Disease Hospitalizations in Lanzhou City, 2013-2020: A Time Series Analysis.

Extensive evidence has shown that air pollution increases the risk of cardiovascular disease (CVD) admissions. We aimed to explore the short-term effect of air pollution on CVD admissions in Lanzhou residents and their lag effects. Meteorological data, air pollution data, and a total of 309,561 daily hospitalizations for CVD among urban residents in Lanzhou were collected from 2013 to 2020. Distributed lag non-linear model was used to analyze the relationship between air pollutants and CVD admissions, stratified by gender, age, and season. PM2.5, NO2, and CO have the strongest harmful effects at lag03, while SO2 at lag3. The relative risks of CVD admissions were 1.0013(95% CI: 1.0003, 1.0023), 1.0032(95% CI: 1.0008, 1.0056), and 1.0040(95% CI: 1.0024, 1.0057) when PM2.5, SO2, and NO2 concentrations were increased by 10μg/m³, respectively. Each 1mg/m3 increase in CO concentration was associated with a relative risk of cardiovascular hospitalization of risk was 1.0909(95% CI: 1.0367, 1.1479). We observed a relative risk of 0.9981(95% CI: 0.9972, 0.9991) for each 10μg/m³ increase in O3 for CVD admissions at lag06. We found a significant lag effects of air pollutants on CVD admissions. NO2 and CO pose a greater risk of hospitalization for women, while PM2.5 and SO2 have a greater impact on men. PM2.5, NO2, and CO have a greater impact on CVD admissions in individuals aged <65years, whereas SO2 affects those aged ≥65years. Our research indicates a possible short-term impact of air pollution on CVD. Local public health and environmental policies should take these preliminary findings into account.

Promoting eCo-responsibility, eCo-literacy, and eCo-centricity in emergency triAge Regarding climate changE consequences (I-CARE THE 3 Cs): study protocol

Background: Climate change, ambient air pollution, and non-optimal temperatures are recognized as a global health emergency. Many studies have highlighted increases in the number of emergency hospital admissions and hospitalizations for respiratory and cardiovascular diseases associated with non-optimal temperatures, unconventional gas reserves, particulate matter, grounded level O3, sulphur dioxide, or nitrogen dioxide exposure. Problem statement: According to the Swiss Health Observatory, 14% of the Swiss population used a hospital emergency department (ED) at least once in 2016, representing 1,7 million admissions or 4,718 admissions per day. In the face of evolving climate-associated reasons for presenting at the ED, the scales used for emergency triage are now proving insufficient for their task. It is becoming critical to introduce and implement more appropriate ED triage tools that incorporate risk factors such as ambient temperature and air pollution. It will also require raising nurses’ eco-literacy, eco-responsibility, and eco-centricity, which are currently rated as moderate to low, to ensure adaptation and/or mitigation in the face of this global threat. Future directions and perspectives for the nursing discipline: The nursing discipline must develop its eco-literacy, eco-responsibility, and eco-centricity to take social and professional responsibility for addressing the health-related impacts of climate change. To do so, the research project’s overall aim, which will be achieved in five stages, is to develop, pilot-test, and evaluate the feasibility of a complex nursing intervention named “Education Intervention promoting eCo-literacy, eCo-responsibility, and eCo-centricity in emergency triAge Regarding climate changE consequences (I-CARE the 3 Cs). The I-CARE the 3 Cs intervention aims to provide an adequate, effective, efficient, fair, safe, and patient-centered response to patients’ and nurses’ needs and to develop guidelines for dealing with the health consequences of climate change.

1064 Risks of hospitalization for cardiovascular disease in the first year after delivery of twin pregnancies

1064 Risks of hospitalization for cardiovascular disease in the first year after delivery of twin pregnancies

Assessment of Non-Ischemic Chest Pain and its Association with Socio-Demographic Characteristics among Post Percutaneous Coronary Interventions (PCI) Patients

The most common procedure used in cardiovascular medicine is percutaneous coronary intervention (PCI) that can create some physiological complications, such as decreasing heart rate, mechanical issues, and cardiac arrest among patients. Objective: To determine the frequency of non-ischemic chest pain and its relation with socio-demographic features amongst post PCI patients in a tertiary care hospital in Karachi. Methods: This analytical cross-sectional study was led at National Institute of Cardiovascular Diseases (NICVD) Hospital, Karachi. A total of 195 patients with Post PCI non-ischemic chest pain were recruited by using the Numerical rating scale (NRS). Non-probability purposive sampling technique was used and permission was taken from Institutional Review Board (IRB) of DUHS and Ethical Review Committee (ERC) of NICVD. Data were analyzed by using SPSS Version-26.0. Percentages and frequency were used for categorical variables while, a chi-square test was applied to check the associations of non-ischemic chest pain with demographic features of the patients. Results: In this study, 63.60% of the participants were male. Most of the participants (75.4%) were married. Non-ischemic chest pain was found significantly associated with age, gender, marital status, history of disease and drug history with p-values &lt;0.001, 0.001, &lt;0.001, &lt;0.001, &lt;0.001 respectively. The majority of the participants (90.26%) were suffered with non-ischemic chest pain. Conclusions: This study revealed that majority of the patients suffered with non-ischemic chest pain and moderate pain level was prevailing in the majority of the post PCI patients.

Association between air quality index and effects on emergency department visits for acute respiratory and cardiovascular diseases.

Several studies suggest that air pollution, particularly PM2.5, increases morbidity and mortality, Emergency Department (ED) visits, and hospitalizations for acute respiratory and cardiovascular diseases. However, no prior study in Southeastern Asia (SEA) has examined the effects of air pollutants on ED visits and health outcomes. This study focused on the association of the Air Quality Index (AQI) of PM2.5 and other pollutants' effects on ED visits, hospitalization, and unexpected deaths due to acute respiratory disease, acute coronary syndrome (ACS), acute heart failure (AHF), and stroke. We conducted a retrospective study with daily data from ED visits between 2018 and 2019 at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand. The AQI of air pollution data was collected from outdoor air quality from the Smoke Haze Integrated Research Unit and the Air Quality Index Visual Map. A distributed lag, non-linear and quasi-Poisson models were used to explore the relationship between air quality parameters and ED visits for each disease. 3,540 ED visits were recorded during the study period. The mean daily AQI of PM2.5 was 89.0 ± 40.2. We observed associations between AQI of PM2.5 and the ED visits due to ACS on the following day (RR = 1.023, 95% confidence interval [CI]: 1.002-1.044) and two days after exposure (RR = 1.026, 95% CI: 1.005-1.047). Also, subgroup analysis revealed the association between AQI of PM2.5 and the ED visits due to pneumonia on the current day (RR = 1.071, 95% CI: 1.025-1.118) and on the following day after exposure (RR = 1.024, 95% CI: 1.003-1.046). AQI of PM2.5 associated with increased mortality resulted from ACS on lag day 3 (OR = 1.36, 95% CI: 1.08-1.73). The AQI of PM10 is also associated with increased ED visits due to COPD/asthma and increased hospitalization in AHF. In addition, the AQI of O3 and AQI of NO2 is associated with increased ICU admissions and mortality in AHF. Short-term PM2.5 exposure escalates ED visits for ACS and pneumonia. PM10's AQI associates with COPD/asthma ED visits and AHF hospitalizations. AQI of O3 and NO2's link to increased ICU admissions and AHF mortality. Urgent action against air pollution is vital to safeguard public health.

Cardiovascular risk prediction in a New Zealand cohort of patients with known cardiovascular disease - a regional individual patient-level data linkage study

Abstract Background National health databases have been underutilised in the development of cardiovascular disease (CVD) risk prediction equations for people with known CVD, yet can inform population level practice and policy—including identification of health equity gaps, high-risk groups, and high-risk localities. With the recent introduction of novel and expensive preventive cardiovascular drugs, stratifying risk in patients with prior CVD could be required to inform cost-effective use of these medications in the future. Purpose We sought to develop 5-year CVD risk equations in adults with known history of CVD in Aotearoa New Zealand, using data from administrative health databases and characterize distribution of risk according to sex. Methods All people above 18 years of age with a history of CVD hospitalization, living in the Auckland and Northland regions of Aotearoa New Zealand (approximately one-third of the national population) on 1 January 2014 were included. Participants were followed for 5 years (31 December 2018) or until death or the outcome of interest, being any fatal or non-fatal CVD hospitalization (ischemic heart disease, heart failure, ischemic stroke, or peripheral artery disease) during follow-up. Sex-specific 5-year CVD risk prediction equations were developed using multivariable Fine and Gray models taking competing risk of non-cardiovascular death into account. Predictor variables included were age; ethnicity; deprivation level; time since most recent CVD hospitalization, history of smoking, heart failure, atrial fibrillation, chronic renal disease, and diabetes mellitus; use of anti-thrombotic, blood pressure-lowering, and lipid-lowering drugs; and blood levels of glycosylated hemoglobin (HbA1c), non-HDL cholesterol, and creatinine. Results The cohort comprised 42,130 men (median age: 68 years [interquartile range (IQR): 59–76]) and 31,717 women (median age: 70 years [IQR: 60–78]) with 12,875 and 8,734 observed events during follow-up, respectively. Sex-specific 5-year CVD risk prediction equations with excellent calibration (accuracy) were developed (Figure 1). Increasing age; high deprivation level; more recent CVD hospitalization; history of smoking, heart failure, atrial fibrillation, chronic renal disease, diabetes mellitus; use of blood-pressure lowering drugs; and high blood levels of HbA1c, non-HDL cholesterol, or creatinine were predictors of elevated risk. There was a wide range of predicted 5-year risk, with 15% of men and 24% of women having a predicted risk below 15%, and 24% and 20%, respectively, having a predicted risk of 40% or above (Figure 2). Conclusion This study demonstrates that it is possible to develop accurate CVD risk prediction equations from administrative health databases for patients with known CVD. Marked heterogeneity in 5-year risk of a subsequent CVD event emphasise that the current ‘one size fits all’ approach to secondary prevention of CVD requires review.Figure 1Figure 2

Abstract 14868: Association Between Social Vulnerability Index and Cardiovascular Disease Outcomes Among New York State Counties

Introduction: Cardiovascular disease (CVD) is the leading cause of death and poses a significant economic burden in the USA. Social Vulnerability Index (SVI) is a tool developed by the Centers for Disease Control and Prevention (CDC) to assess social vulnerability to disasters. The relationship between SVI and CVD outcomes in New York State (NYS) has not been explored. Our aim is to examine the association between county-level SVI and CVD hospitalization and mortality rates in NYS. Methods: Hospitalization and mortality rates for CVD and its subtypes (heart diseases, coronary heart disease, heart attack, congestive heart failure, and stroke) between 2016 and 2018 were obtained from the NYS Community Health Indicator Reports. The SVI is based on 4 subindices: Socioeconomic Status, Household Composition &amp; Disability, Minority Status &amp; Language, and Housing Type &amp; Transportation. Higher SVI indicates greater vulnerability. We examined the CDC SVI 2018 data for NYS. The associations between CVD and its subtypes outcomes and SVI and its 4 subindices were analyzed by negative binomial regression. Results: Among counties, Bronx had the highest SVI (most vulnerable) and Saratoga had the lowest SVI (least vulnerable). Counties with higher SVI were associated with worse CVD outcomes. (hospitalization, incidence rate ratio [IRR]: 1.205 [95%CI: 1.035-1.402], per 1-unit increase; mortality, 1.201 [1.093-1.320]). Regarding the 4 subindices, Socioeconomic Status and Household Composition &amp; Disability were independently associated with CVD mortality (1.137 [1.000-1.292] and 1.201 [1.066-1.354]). Minority Status &amp; Language was independently associated with CVD hospitalization. (1.344 [1.130-1.599]).There was no association between Housing Type &amp; Transportation and CVD outcomes. Conclusions: County-level SVI was associated with CVD outcomes in NYS. This underscores the need for improved prevention strategies and targeted interventions for CVD in vulnerable areas.

Associations of Adipocytokines with The Development of Cardiovascular Events in Young People.

The study is an epidemiological cohort study. The analysis included 1240 people aged 25-44 years. The endpoint was combined and included: death from cardiovascular disease, myocardial infarction, probable myocardial infarction, acute cerebrovascular accident, hospitalization for cardiovascular disease, and revascularization. Adipocytokines were determined with a MILLIPLEX panel. In the examined population, 1.7% of cases of cardiovascular events were detected during cohort observation, of which 28.6% were fatal events. In men, cardiovascular endpoints were recorded 4.3 times more often than in women (17 (81%) vs. 4 (19%), p = 0.003). In individuals with cardiovascular events, arterial hypertension (2.6 times), diabetes mellitus (8.6 times), and overweight/obesity (1.5 times) were more often recorded compared to individuals without cardiovascular events. For tumor necrosis factor-alpha (TNFa), the threshold value was 2.5 pg/mL, with sensitivity assessment (Se) at 85.7% and specificity (Sp) at 83.3%. For amylin, the threshold value was 10.5 pg/mL, with Se at 73.7% and Sp at 67.0%. For pancreatic polypeptide (PP), the threshold value was 43.7 pg/mL, with Se at 85.7% and Sp at 56.7%. A method for assessing the risk of cardiovascular events in young people includes determining the levels of amylin, PP, and TNFa in blood serum. The cut-off points for predicting cardiovascular events were levels of amylin above 10.5 pg/mL, PP above 43.7 pg/mL, or a decrease in TNFa below 3.8 pg/mL.

Abstract 14168: A Randomised Open-Label Controlled Trial of a Remote Cardiac Rehabilitation System With Wearable Medical Devices - An Interim Report of the TELE-REHA Trial

Introduction: Outpatient cardiac rehabilitation (CR) prevents recurrence after cardiac surgery or cardiac catheterisation, but participation rate of outpatient CR is low. Although attempts at remote CR have been investigated with advances in equipment, they have not yet reached the stage of social implementation, and it is not clear whether remote CR can be an alternative to outpatient CR. Objective: The aim of this study was to confirm the safety and efficacy of remote CR management using wearable devices feasible in Japan, and to implement the device early in society. Primary outcome: All-cause death, cardiovascular events, EFs, e/e', BNPs, CRPs, PeakVO2, VE-VCO2 slop, muscle mass; secondary outcome: EQ5D. Subjects: Patients discharged home after hospitalization for cardiovascular diseases. Study design: A single-centre, randomised, open-label, parallel-group study was conducted to evaluate the efficacy and safety of wearable device (Apple Watch)-based Remote-CR versus Outpatient-CR. In Remote-CR group, ECG and SpO2 are measured by Apple Watch before and after exercise. Biweekly health information, weight, blood pressure, heart rate, electrocardiogram (ECG) and EQ5D are automatically transmitted by the app. Tele-nursing was provided by trained nurses on a bi-weekly basis, based on the health information provided by the app. For both groups, the intervention period was 90 days, and blood sampling, ECG, cardiopulmonary exercise testing (CPX), and body composition testing were performed at the end of the study. Results: A total of 110 cardiovascular patients were randomly divided into Remote-CR group and Outpatient-CR group. The background of the two groups was similar. Though the PeakVO2 and EQ5D scores after the CR program were not significantly improved in Outpatient-CR group, those were significantly improved in Remote-CR group (P=0.02). The dropout rate from CR program was lower in Remote-CR group than Outpatient-CR group. No significant incident occurred in both group. Conclusions: Remote-CR is expected to be as effective as Outpatient-CR and safe for patients after cardiac treatment, and can provide a relapse prevention programme for those who are difficult to attend.

Deep-learning-based natural-language-processing models to identify cardiovascular disease hospitalisations of patients with diabetes from routine visits’ text

Writing notes is the most widespread method to report clinical events. Therefore, most of the information about the disease history of a patient remains locked behind free-form text. Natural language processing (NLP) provides a solution to automatically transform free-form text into structured data. In the present work, electronic healthcare records data of patients with diabetes were used to develop deep-learning based NLP models to automatically identify, within free-form text describing routine visits, the occurrence of hospitalisations related to cardiovascular disease (CVDs), an outcome of diabetes. Four possible time windows of increasing level of expected difficulty were considered: infinite, 24 months, 12 months, and 6 months. Model performance was evaluated by means of the area under the precision recall curve, as well as precision, recall, and F1-score after thresholding. Results showed that the proposed NLP approach was successful for both the infinite and 24-month windows, while, as expected, performance deteriorated with shorter time windows. Possible clinical applications of tools based on the proposed NLP approach include the retrospective filling of medical records with respect to a patient’s CVD history for epidemiological and research purposes as well as for clinical decision making.

Association of Cognitive Impairment with Subsequent Cardiovascular Disease (CVD) Hospitalization: A Prospective ESKD Cohort Study

Association of Cognitive Impairment with Subsequent Cardiovascular Disease (CVD) Hospitalization: A Prospective ESKD Cohort Study

Cardiovascular Hospitalizations and Hospitalization Costs in Japan During the COVID-19 Pandemic.

Background: During the COVID-19 pandemic, cardiovascular hospitalizations decreased and in-hospital mortality for ST-elevation myocardial infarction and heart failure increased. However, limited research has been conducted on hospitalization and mortality rates for cardiovascular disease (CVD) other than ischemic heart disease and heart failure. Methods and Results: We analyzed the records of 530 certified hospitals affiliated with the Japanese Circulation Society obtained from the nationwide JROAD-DPC database between April 2014 and March 2021. A quasi-Poisson regression model was used to predict the counterfactual number of hospitalizations for CVD treatment, assuming there was no pandemic. The observed number of inpatients compared with the predicted number in 2020 was 88.1% for acute CVD, 78% for surgeries or procedures, 77.2% for catheter ablation, and 68.5% for left ventricular assist devices. Furthermore, there was no significant change in in-hospital mortality, and the decrease in hospitalizations for catheter ablation and valvular heart disease constituted 47.6% of the total decrease in annual hospitalization costs during the COVID-19 pandemic. Conclusions: Cardiovascular hospitalizations decreased by more than 10% in 2020, and the number of patients scheduled for left ventricular assist device implantation decreased by over 30%. In addition, in response to the COVID-19 pandemic, annual cardiovascular hospitalization costs were reduced, largely attributed to decreased catheter ablation and valvular heart disease.

Empagliflozin and colchicine in patients with reduced left ventricular ejection fraction following ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: a study protocol for a randomized, double-blinded, three-arm parallel-group, controlled trial

BackgroundPatients with acute myocardial infarction are at greater risk for chronic heart failure and mortality. Currently, there is limited evidence supporting the beneficial effects of sodium-glucose cotransporter-2 inhibitors on cardiovascular outcomes in non-diabetic patients with reduced left ventricular ejection fraction following acute myocardial infarction. Furthermore, the clinical effects of the combination of standard-dose sodium-glucose cotransporter-2 inhibitors with colchicine and high-dose sodium-glucose cotransporter-2 inhibitors in this setting have not been evaluated yet.MethodsA prospective, double-blinded, parallel-group, placebo control randomized trial will be carried out at Shahid Madani Heart Center, the largest teaching referral hospital for cardiovascular diseases, affiliated with Tabriz University of Medical Sciences. A total of 105 patients with reduced left ventricular ejection fraction (≤ 40%) following the first episode of ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention with stent insertion will be randomized 1:1:1 to receive empagliflozin 10 mg daily, a combination of empagliflozin 10 mg daily and colchicine 0.5 mg twice daily, or empagliflozin 25 mg daily for 12 weeks. The primary outcomes are changes in the New York Heart Association functional classification and high-sensitivity C-reactive protein from the randomization through week 4 and week 12.DiscussionThe present study will be the first trial to evaluate the efficacy and safety of early treatment with the combination of standard-dose empagliflozin and colchicine as well as high-dose empagliflozin in non-diabetic patients with reduced left ventricular ejection fraction following ST-elevation myocardial infarction. The results of this research will represent a significant step forward in the treatment of patients with acute myocardial infarction.Trial registrationClinical trial ID: IRCT20111206008307N39. Registration date: 27 October 2022.Graphical

Effects of ambient air pollutants on cardiovascular disease hospitalization admission

Effects of ambient air pollutants on cardiovascular disease hospitalization admission