Incidence Of Cardiovascular Hospitalization Research Articles

Cardiovascular disease and cancer in women with accreta and retained placenta: a longitudinal cohort study.

The association between placental detachment disorders and risk of chronic disease is unclear. We determined the association of placenta accreta and retained placenta with risk of future maternal cardiovascular disease and cancer. We tracked a longitudinal cohort of 541,051 pregnant women over a period of 13years (2006-2019) in Quebec, Canada. The main exposure measures were placenta accreta and retained placenta in any pregnancy. Outcomes included future hospitalizations for cardiovascular disease and cancer. Using Cox regression models adjusted for maternal characteristics, we estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association of accreta and retained placenta with cardiovascular disease and cancer at 13years. The incidence of cardiovascular hospitalization was 21.2 per 10,000 person-years for accreta and 23.4 per 10,000 for retained placenta with postpartum hemorrhage, compared with 20.3 per 10,000 for neither placental disorder. Cancer incidence followed a similar pattern, with rates highest for retained placenta with hemorrhage. Retained placenta with hemorrhage was associated with 1.19 times the risk of cardiovascular disease (95% CI 1.03-1.38) and 1.27 times the risk of cancer (95% CI 1.06-1.53). Retained placenta with hemorrhage was associated with heart failure (HR 1.84, 95% CI 1.04-3.27), cardiomyopathy (HR 1.88, 95% CI 1.03-3.43), and cervical cancer (HR 2.03, 95% CI 1.17-3.52). Accreta and retained placenta without hemorrhage were not associated with these outcomes. Retained placenta with hemorrhage may be a risk marker for cardiovascular disease and certain cancers later in life.

Short-term effects of air pollutants on hospitalization rate in patients with cardiovascular disease: a case-crossover study.

Considering the increasing rate of hospitalization due to the symptoms intensification, and the increasing trend of air pollution, this study aimed to determine the relationship between the amount of air pollutants and the incidence of cardiovascular disease leading to hospitalization. This case-crossover study was carried out on the data of admitted patients with cardiovascular disease such as hypertension, ischemic heart disease, and cerebrovascular disease in Urmia during 2011-2016. Weather data about air pollutants (NO2, PM10, SO2, and CO) were obtained from the meteorological department of Urmia. The data were coded for each patient and matched with the meteorological data for statistical modeling. The data were analyzed through STATA version 14. Conditional logistic regression was used to estimate the effects of air pollutants on cardiovascular disease adjusted to air temperature, relative humidity, and air pollutants. The final analysis was performed on 43,424 patients with cardiovascular disease using code I10-I99 including ischemic heart disease, hypertension, and cerebrovascular disease adjusted to air temperature and relative humidity. Of all pollutants, CO with each increase 10 μg/m3 had a meaningful relationship with the incidence of cardiovascular hospitalization. By selecting the window of exposure, 1, 2, and 6 days before admission, lag 6 (6 days) was the best estimation for exposure time in the patients with cardiovascular patients (OR 1.0056, CI 1.0041-1.007), and in the patients with ischemic heart disease (OR 1.000055, CI 1.000036-1.000075) and in the patients with hypertension (OR 1.000076, CI 1.00002-1.000132). Regarding cerebrovascular disease, no statistically significant association was observed. The results showed that only CO was associated with an increased risk of admission in patients with cardiovascular disease, ischemic heart disease, and hypertension, and there was no clear evidence for pollution effects on cerebrovascular diseases.

The Decrease in Hospitalizations For Heart Failure During the Covid-19 Pandemic: A Community and Academic Hospital Comparison Study

IntroductionDuring the novel coronavirus (COVID-19) pandemic, the incidence of cardiovascular hospitalizations has been observed to decrease. The patient behavior, clinician behavior and pathophysiological contributors are currently unclear. We sought to determine if the pattern of heart failure (HF) hospitalizations was the same between 1 Academic Hospital with Advanced HF and Transplant services and 2 Community Hospitals, within a single health system in Massachusetts (MA).MethodsThe 3 hospitals, Academic/Advanced HF Hospital A, Community Hospital B and Community Hospital C, are all located within 30-mile radius and share many clinical protocols, although HF hospitalizations at Academic/Advanced HF Hospital A include advanced HF therapy referrals and patients listed for heart transplantation. We retrospectively reviewed the weekly adult hospitalizations for HF, defined as patients ≥18 years discharged with a principal diagnosis of HF per ICD-10 coding (I110, I130, I132, I50 subsets) across the 3 hospitals, between January 1 and April 26 in 2019 and 2020. The weekly hospitalization volumes for 2019 and 2020 were displayed as a bar graph, alongside the total MA COVID-19 diagnosis and key dates in the pandemic response, for each hospital.ResultsThe volume of weekly hospitalizations for HF in March and April 2020 were lower at all 3 hospitals, as compared to 2019 (Figure 1). At Academic/Advanced HF Hospital A, the reduction in weekly HF hospitalizations began in mid-February, prior to the MA ‘state of emergency’ declaration effective March 11 and the ‘stay at home’ order effective March 24, 2020. Conversely, at Community Hospitals B and C the reduction in hospitalizations for HF (compared to 2019) occurred closer to the ‘stay at home’ order. The date on which each hospital formally ramped down non-urgent outpatient visits and procedures occurred first for Academic/Advanced HF Hospital A, but HF hospitalization volume reduction still appeared to precede this announcement.ConclusionThe decrease in hospitalizations for HF during the COVID-19 pandemic began in an Academic/Advanced HF Hospital before the MA ‘state of emergency’ and ‘stay at home’ orders, but around the time of the ‘state of emergency’ order in 2 affiliated Community Hospitals. This observation suggests that the factors driving HF volume during a pandemic may differ across patient populations and hospitals, even within the same region.

Uterine rupture and long-term cardiovascular hospitalization of the offspring

Background Uterine rupture is associated with severely adverse maternal and neonatal outcomes. The association between uterine rupture and long-term cardiovascular hospitalization of the offspring has not been investigated yet. Methods In a population-based cohort study, the incidence of cardiovascular related hospitalizations was compared between singletons born to mothers with and without uterine rupture in the current pregnancy. Cardiovascular hospitalization up to the age of 18 years was assessed according to a predefined set of ICD-9 codes associated with offspring hospitalization. Multiple gestations, perinatal deaths, lacking prenatal care, and children with congenital malformations or chromosomal abnormalities were excluded from the study. A Kaplan–Meier survival curve was used to assess cumulative incidence of cardiovascular hospitalization of the offspring. A Cox proportional hazards model was performed to control for confounders. Results During the study period, 238,622 newborns met the inclusion criteria, of which 0.053% (n = 127) were born to mothers with uterine rupture in the current pregnancy. Children born to mothers with uterine rupture had significantly higher rates of cardiovascular related hospitalization (Kaplan–Meier’s survival curve log-rank test, p=.005). Conclusion Being born following uterine rupture is an independent risk factor for long-term pediatric cardiovascular hospitalization. Highlights Uterine rupture is a risk factor for long-term pediatric cardiovascular related hospitalization. Rising rate of CS potentially associate to long-term offspring cardiovascular disease. Cardiovascular surveillance is needed for newborns delivered after uterine rupture.

Effects of extreme temperatures on cardiovascular emergency hospitalizations in a Mediterranean region: a self-controlled case series study

BackgroundCold spells and heatwaves increase mortality. However little is known about the effect of heatwaves or cold spells on cardiovascular morbidity. This study aims to assess the effect of cold spells and heatwaves on cardiovascular diseases in a Mediterranean region (Catalonia, Southern Europe).MethodsWe conducted a population-based retrospective study. Data were obtained from the System for the Development of Research in Primary Care and from the Catalan Meteorological Service. The outcome was first emergency hospitalizations due to coronary heart disease, stroke, or heart failure. Exposures were: cold spells; cold spells and 3 or 7 subsequent days; and heatwaves. Incidence rate ratios (IRR) and 95% confidence intervals were calculated using the self-controlled case series method. We accounted for age, time trends, and air pollutants; results were shown by age groups, gender or cardiovascular event type.ResultsThere were 22,611 cardiovascular hospitalizations in winter and 17,017 in summer between 2006 and 2013. The overall incidence of cardiovascular hospitalizations significantly increased during cold spells (IRR = 1.120; CI 95%: 1.10–1.30) and the effect was even stronger in the 7 days subsequent to the cold spell (IRR = 1.29; CI 95%: 1.22–1.36). Conversely, cardiovascular hospitalizations did not increase during heatwaves, neither in the overall nor in the stratified analysis.ConclusionsCold spells but not heatwaves, increased the incidence of emergency cardiovascular hospitalizations in Catalonia. The effect of cold spells was greater when including the 7 subsequent days. Such knowledge might be useful to develop strategies to reduce the impact of extreme temperature episodes on human health.

Twin pregnancy: is it a risk factor for long-term cardiovascular disease?

Objective: To investigate whether twin pregnancy increases the risk for long-term maternal cardiovascular disease (CVD).Study design: A retrospective population-based cohort study compared the incidence of long-term CVD in a cohort of women with and without a previous twin delivery.Setting: Deliveries occurred between the years 1988 and 2012.Patients: Patients who had a twin birth between years 1988 and 2012 were included in the study, patient that had a singleton delivery included in the control group.Main outcome measures: CVD was divided into four categories according to severity and type. Kaplan–Meier survival curve was used to estimate cumulative incidence of cardiovascular hospitalizations. Cox proportional hazards model was used to estimate the adjusted hazard ratios (HR) for CVD.Results: During the study period, there were 100 387 women that met the inclusion criteria, 4.6% (n = 4647) delivered twins at least once during the period. The incidence of CVD was 1% in women who had a twin delivery and 1.12% in women who had a singleton delivery. There was no difference in the cumulative incidence of cardiovascular hospitalizations among women who had twin deliveries as compared with singletons. When performing a Cox proportional hazard model, a history of twin delivery did not increase the risk for long-term maternal cardiovascular hospitalizations (adjusted HR = 1.0, 95% CI = 0.8–1.1, p = 0.698).Conclusions: Twin pregnancy is not associated with an increased risk for long-term maternal CVD.

The proposed new classification of coronary microcirculation as the predictor of the heart failure progression in idiopathic dilated cardiomyopathy.

The appropriate condition of the coronary microcirculation is essential for proper cardiac muscle activity. The understanding of the pathological microcirculation changes in different stages of idiopathic dilated cardiomyopathy (IDCM) could provide a reliable background for proper therapeutic decisions and prognosis. The study population consisted of 116 patients (86.2% males, mean age 50.4±13.2 years) with IDCM and heart failure. In samples from left ventricular endomyocardial biopsy, the coronary microcirculation was evaluated by staining with hematoxylin and eosin, Masson's trichrome, and anti-CD34 antibody. The microvessel density (MVD) was calculated. Also, the electron microscopic evaluation of the extracellular matrix capillaries was performed. Samples were assigned to one of four types according to the microcirculation condition: 1, normal microvessels (MVs) (18 patients); 2, mostly normal, some MVs with slightly decreased lumen diameter and thickened wall, absent/mild intravascular fibrosis, and MVD decrease (37 patients); 3, MVs with moderately decreased lumen diameter and thickened wall, moderate intravascular fibrosis, and MVD decrease (45 patients); and 4, MVs with significantly decreased lumen diameter and thickened wall, significant intravascular fibrosis, and MVD decrease (16 patients). Taking all types of the proposed classification into consideration, in type 4, clinical (incidence of New York Heart Association 3 and 4, dyspnea on exertion, pulmonary congestion) and echocardiographic (left atrial and right ventricular diameter, left ventricular mass and ejection fraction, tricuspid annular plane systolic excursion, early diastolic mitral annular velocity measured at the interventricular-septal annulus [E'med], ratio of early diastolic mitral inflow velocity to E'med) parameters were worst. Only atrial fibrillation, diabetes, tricuspid annular plane systolic excursion, and the type of the microcirculation significantly correlated with the incidence of cardiovascular hospitalizations in the linear regression models. The condition of the coronary microcirculation corresponds with the heart failure progression in patients with IDCM.