Lower Mortality Research Articles

Association of Oral Microbiome Diversity and All-Cause Mortality in the General US Population and in Individuals With Chronic Diseases: A Prospective Cohort Study.

To investigate whether oral microbiome diversity is associated with all-cause mortality in the general US population and in individuals with chronic diseases. We included 8224 individuals with oral microbiome diversity data from the National Health and Nutrition Examination Survey (2009-2012), representing 164,000,205 US adults, using a survey-weighted analysis method. Cox regression analyses were performed to identify the association between oral microbiome diversity and all-cause mortality. During a survey-weighted mean follow-up period of 8.86 years, 429 all-cause deaths (survey-weighted number: 7,124,920) occurred in 8224 participants. Cox regression analysis revealed that higher oral microbiome diversity was significantly associated with a lower all-cause mortality risk. Significant differences in all-cause mortality risk were observed among the different clusters based on oral microbiome β-diversity (log-rank p < 0.001). Subgroup analyses revealed that the oral microbiome diversity was independently associated with all-cause mortality in individuals with diabetes mellitus and hypertension. A multivariate logistic regression model showed that current smoking and antibiotic use were significantly associated with lower oral microbiome α diversity. Higher oral microbiome diversity was significantly associated with a lower all-cause mortality risk in the general US population and in individuals with diabetes mellitus and hypertension.

The impact of door to extracorporeal cardiopulmonary resuscitation time on mortality and neurological outcomes among out-of-hospital cardiac arrest acute myocardial infarction patients treated by primary percutaneous coronary intervention

BackgroundFew previous studies evaluated the impact of time from the hospital arrival to the implementation of extracorporeal cardiopulmonary resuscitation (ECPR) (door to ECPR time) on outcomes among out-of-hospital cardiac arrest (OHCA) acute myocardial infarction (MI) patients. Methods50 patients with OHCA who received both ECPR and percutaneous coronary intervention (PCI) at Cardiovascular Division, NHO Osaka National Hospital were analyzed. Patients were divided into 2 groups according to the median of door to ECPR time. The primary outcome was all-cause death. Survival analyses were conducted to compare all-cause mortality at 90 days between 2 groups. Neurological outcome at 30 days was also compared between 2 groups using the Cerebral Performance Category (CPC). ResultsThe multivariable Cox proportional-hazards model showed that all-cause mortality at 90 days was significantly higher among patients with door to ECPR time ≥ 25 min compared with those with door to ECPR time < 25 min (adjusted hazard ratio [HR]: 3.14; 95 % confidence interval [CI]: 1.21–8.18). The proportion of patients with CPC at 30 days ≤ 2 was significantly higher among patients with shorter door to ECPR time (P = 0.048). ConclusionAmong patients with OHCA due to acute MI who received ECPR and PCI, the shorter door to ECPR time was associated with the lower mortality and favorable neurological outcomes.

Long-term outcomes and prognostic factors in dogs with meningoencephalitis of unknown origin and suspected necrotic lesions on magnetic resonance imaging: 37 cases (2007-2020).

To describe the long-term outcomes, overall survival, progression-free survival, and prognostic factors in dogs with necrotizing encephalitis (NE). 37 client-owned dogs clinically diagnosed with NE. All dogs underwent MRI and CSF analysis. Cox proportional hazards regression was used to examine factors related to the risk of relapse and death, including signalment, history, diagnostic investigation results, and treatments before the first relapse. The medians of the overall and progression-free survival times were 639 days (IQR, 342 to 1,482 days) and 233 days (IQR, 111 to 775 days), respectively. Overall survival was highly correlated with progression-free survival. Four dogs (11%) died or were euthanized within 3 months of diagnosis. Relapse within 6 months was associated with a shorter overall survival. However, no prognostic factors for overall survival were found. The category of patients with presenting clinical signs that lasted 29 days to 6 months (OR, 3.26; 95% CI, 1.35 to 7.90) was associated with a higher risk of relapse. Seizures were presented in 75.7% of dogs, with a recurrence rate of 100%. This report provides comprehensive follow-up information for dogs with NE, revealing a fair prognosis and low early mortality rate. Seizure is a very common clinical sign with a high recurrence rate.

‘Effectiveness of various sulbactam-based combination antibiotic therapy in the management of ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii in a tertiary care Health centre’

ObjectiveCarbapenem-resistant Acinetobacter baumannii (CRAB) is a common cause of ventilator-associated pneumonia (VAP). Some in vitro data favour various combination antibiotic therapy. However, there is a need for more in vivo studies for the management of VAP caused by CRAB. This retrospective study was done to evaluate the effectiveness of various combination antibiotic therapy including sulbactam on outcomes of VAP caused by CRAB. MethodsAdult patients (age ≥18 years) diagnosed with VAP caused by CRAB were included. Patients with polymicrobial infections were excluded from the study. Patients with CRAB associated VAP who were given sulbactam based antibiotic combinations were observed for outcomes. The primary outcome was 28-day mortality after diagnosis of VAP caused by CRAB. Reduction in serum HsCRP (High sensitivity C-reactive protein) during treatment and requirement of inotropes were the secondary outcomes. Outcomes were compared between various sulbactam based antibiotic combination therapies. ResultsA total of 103 patients were included. A total of 44 (42.7 %) patients received sulbactam and minocycline or sulbactam and polymyxin B dual antibiotic combination, and 59 (57.3 %) patients received sulbactam, polymyxin B and minocycline triple antibiotic combination. The percentage difference in 28 days mortality was 27.51 % (95 % CI 8.03 %–44.06 %; p = 0.005) in dual vs triple sulbactam based antibiotic combination therapy. The percentage difference in requirement of inotropes during therapy and HsCRP reduction after 7 days of therapy was 23.65 % (95 % CI 6.43 %–38.3 %; p = 0.007) and 25.1 % (95%CI 10.1 %–38.2 %; p < 0.001) respectively when compared between dual vs triple sulbactam based antibiotic combination therapy. ConclusionTreatment with sulbactam, polymyxin B and minocycline combination antibiotic therapy was associated with significantly lower 28-day mortality. Moreover, the lower requirement of inotropes during treatment and a significant reduction in HsCRP level favours this combination antibiotic therapy in VAP caused by CRAB.

Thriving under multiple stressors: performance of drought-tolerant perennials and their suitability for infiltration swales

Infiltration swales are considered an essential and multifunctional component of water-sensitive urban design. To maintain their functionality, a robust planting is required. However, species selection poses a major challenge due to the extreme site conditions. To identify stress-resistant species, container experiments with 60 perennial species native to Germany were used to investigate their performance and responses to multiple stressors typical for urban swales receiving traffic area runoff. As plant performance is more severely affected if multiple stressors occur rather than single ones, test plants were exposed to de-icing salts, cyclic flooding, and drought. Species were selected primarily for their drought tolerance, as it was assumed that their adaption to drought might also be advantageous for the other stressors. The resistance to drought was examined in a reference group and was approved for 90% of the experimental species. With a low mortality rate of < 25%, 72.2% of the species confirmed as drought tolerant also proved robust to the multiple stressors of an infiltration swale and are therefore recommended for use. Considering all experimental species, significant effects of the multiple stressors compared to the reference group were only found in mortality and a visual vitality score. Data on growth height, chlorophyll fluorescence, and phenology (e.g., flowering time) did not differ significantly between the groups. However, there were large species-specific variations to be considered and investigated in further research. The study serves as a basis for a resilient greening of urban infiltration swales with native species. It is essential to their implementation, as more research is needed to date.

Isolation, Molecular Characterisation, and Pathogenicity Analysis of a Novel Recombinant ALV-J Strain Isolated From Chinese Hetian Chickens.

Avian leukosis virus subgroup J (ALV-J) primarily affects poultry, particularly chickens, leading to tumourigenesis and immunosuppression, which results in substantial economic losses. It is important to note that ALV-J is commonly found in indigenous chicken breeds in China, and the virus's vertical transmission characteristics present a significant threat to the preservation of local chicken breeds. The study aimed to investigate the characteristics and effects of the recombinant ALV-J strain LY2021J, with a focus on its genetic composition and its potential influence on virulence and pathogenicity. LY2021J was isolated using DF-1 cells and validated by enzyme-linked immunosorbent assay (ELISA) and IFA. The proviral genome was amplified using segmented PCR and then spliced together using DNASTAR software. Genome-wide genes, including gag, pol, gp85, and long terminal repeat (LTR), were compared. Recombination sites were analysed using RDP5 and SimPlot software. Pathogenicity was evaluated by monitoring symptoms and conducting examinations on SPF chickens. The outbreak of ALV-J in China has caused significant economic losses in the poultry industry. Although largely controlled in white-feather broilers and egg-laying chickens, ALV-J has spread to yellow-feather broilers and local breeds. A strain, LY2021J, isolated from Hetian chickens, showed lower mortality despite severe dysplasia. Genetic analysis revealed high similarity between LY2021J and the Chinese strains JS14NT01 and NX0101, suggesting a shared origin. Recombination with strain ev-1 and specific 3' UTR deletions may explain LY2021J's reduced virulence. Continued monitoring and prevention strategies are essential to mitigate ALV-J's impact.

Impact of skilled nursing facility quality on Medicare beneficiaries with dementia: Evidence from vacancies.

People living with dementia are less likely to be admitted to high-rated nursing homes than people without dementia, despite their increased care needs. We investigated the effect of admission to nursing homes with higher staffing ratings on adverse outcomes for individuals with and without dementia post-hospitalization. Among Traditional Medicare beneficiaries discharged to nursing homes between 2011 and 2017, we examined the relationship between facility staffing star-ratings and short-term readmission and mortality using an instrumental variables approach to account for selection bias. The instrumental variables were the number of nearby vacant beds in high-rated facilities. Admission to a higher-rated nursing home lowered post-discharge mortality risk at 90 days and reduced 30- and 90-day readmission. Point estimates were larger for people with dementia. Findings underscore the need for enhancing direct care staffing in nursing homes and addressing access disparities, particularly for individuals with dementia who benefit significantly from high-quality care. We assessed how admission to nursing homes with higher staffing ratings impacted outcomes for individuals with and without dementia by exploiting variation in local bed vacancies as a source of quasi-random assignment. For both persons with and without dementia, adjusted short-term mortality and readmission rates were lower among those discharged to nursing homes with higher staffing ratings. Effects were larger for persons with dementia, indicating welfare loss from inequitable access to higher-rated nursing homes. Increasing staffing in nursing homes and reducing disparities for persons with dementia is essential for enhancing both equity and value.

Safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with previous TAVI; a systematic review and meta-analysis

Abstract Background Transcatheter Aortic Valve Implantation (TAVI) has gained ground in the management of severe aortic stenosis, even in low-surgical risk patients. However, TAVI prostheses, like bioprostheses, have a finite lifetime; thus, TAVI in patients with previous TAVI (TAVI-in-TAVI) rates are radically increased. Although data regarding TAVI indicate low mortality and stroke rates within the first year, TAVI-in-TAVI is less studied. Purpose The aim of the study is to systematically review and summarize available data regarding the safety and the outcomes of TAVI-in-TAVI. Methods This study was conducted according to the PRISMA guidelines. We systematically searched PubMed, SCOPUS, and Cochrane databases from their inception to February 10, 2024, for studies assessing the characteristics and outcomes of patients undergoing TAVI-in-TAVI. Primary endpoint of our systematic review and meta-analysis is the in-hospital, 30-days and 1-year mortality rates. Secondary endpoints comprised in-hospital, 30-days and 1-year stroke rates, in-hospital vascular complications, conversion to surgery, coronary compression or obstruction, and perforation with or without tamponade, and in-hospital and 30-days permanent pacemaker implantation (PPM) implantation. Endpoint definitions followed the Valve Academic Research Consortium 3 criteria. The cumulative incidence of primary and secondary endpoints and the corresponding 95% confidence intervals (CI) were estimated. A random effects model (DerSimonian-Laird) was used to account for heterogeneity among the included studies. Results Our meta-analysis included a total of 5 studies and 2,145 patients undergoing TAVI-in-TAVI, 72.9% (N=1,564) of whom were treated with a balloon-expandable valve. Our analysis showed that patients undergoing TAVI-in-TAVI had 3.7% (95% CI: 1.6%-5.9%), 3.9% (95% CI: 3%-4.7%) and 12.5% (95% CI: 11%-14%) in-hospital, 30-days and 1-year all-cause mortality, while stroke occurred in 1.8% (95% CI: 1.2%-2.4%), 2.1% (95% CI: 1.4%-2.9%) and 3% (95% CI: 2.3%-3.8%) of the patients in-hospital, 30-days and 1-year, respectively. Notalby, conversion to surgery, coronary compression/obstruction and perforation with or without tamponade occurred in &amp;lt;1% of the patients, while 6.1% (95% CI: 2.2%-9.9%) of the patients had vascular complications during the procedure. Considering the PPM implantation rates, patients had a 1.8% (95% CI: 1.2%-2.4%) for in-hospital and a 6.8% (95% CI: 5.2%-8.3%) for 30-days incidence. Conclusion Our systematic review and meta-analysis is the first to present that TAVI-in-TAVI has an acceptable safety profile with relatively low in-hospital, 30-days and 1-year mortality and stroke rates, comparable to the native-valve-TAVI. Taking into consideration that TAVI-in-TAVI might be the only therapeutic approach for an increasing number of patients, further studies are warranted to further assess its safety and efficacy and to provide additional procedural techniques.TAVI-in-TAVI mortality rates

Ezetimibe use and mortality after myocardial infarction: a nationwide cohort study

Abstract Background Inhibition of intestinal cholesterol absorption by ezetimibe improves outcomes after myocardial infarction (MI), yet real-world data on ezetimibe is lacking. Purpose To study usage and outcome impact of ezetimibe after MI. Methods Consecutive MI patients in Finland (2010-2018) were retrospectively studied (N=57,505; 65% men; mean age 69 years). Study data were combined from national registries. The median follow-up was 4.5 (IQR 2.8-7.1) years. Differences between groups were adjusted with multivariable regression. Ezetimibe use was studied with competing risk analyses. Median follow-up was 4.5 (IQR 2.8-7.1) years. Results The cumulative incidence of ezetimibe use was 3.7% at 90-days, 13.4% at 5-years and 19.8% at 10-years. Younger age was the strongest predictor for ezetimibe use (adj. sHR 6.67; CI 5.88-7.69 for patients aged &amp;lt;60 vs. ≥80 years). Women were more likely to use ezetimibe during follow-up than men. The average proportion of patients using ezetimibe during follow-up was 6.8%. (11.7% at 10-years). Ezetimibe was discontinued by 43.6% of patients during the follow-up. Patients with early ezetimibe after MI had lower all-cause mortality during follow-up (33.6% vs. 45.1%; adj. HR 0.77; CI 0.69-0.86; p&amp;lt;0.0001). Early ezetimibe use was associated with lower mortality irrespective of sex, age, atrial fibrillation, diabetes, heart failure, malignancy, revascularization, or statin use. Ongoing ezetimibe therapy during follow-up was associated with lower mortality in time-dependent analysis (adj. HR 0.53; CI 0.48-0.59; p&amp;lt;0.0001). Conclusion Ezetimibe is associated with lower risk of death after MI, but therapy use is limited and discontinuity is frequent.

Association of Life's Essential 8 metrics with mortality outcomes in US cancer survivors

Abstract Aims The increased in global cancer survivors and treatment complications has created an unmet need for effective long-term health strategies. This study aimed to evaluate the relationship between LE8 and all-cause, cancer-specific, and non-cancer mortality in cancer survivors in the US. Methods A prospective cohort study was conducted using a nationally representative sample of cancer survivors, age 40 years or older (n = 2205), derived from the US. Cancer diagnoses were determined through face-to-face interviews, while health status was gauged using the LE8 score on a scale of 0-100. Multivariable Cox proportional hazards regression models were applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the associations of overall and individual component of LE8 with overall, cancer-specific, and noncancer mortality, respectively. Result Among the 2205 participants (mean [SE] age, 66.4 [0.4] years; 54.1% females; 87.4% non-Hispanic White ethnicity), the average LE8 score was 65.5 ± 0.4, with diet having the lowest (45.5 ± 1.0) and the highest scores attributed to sleep (85.1 ± 0.7). During the up to 5.7 years follow-up period, 526 deaths were documented, comprising 174 cancer-related, 123 cardiovascular disease-related, and 229 from other causes. A high LE8 score was linked to a 71% reduction in all-cause mortality risk (HR: 0.29, 95% CI: 0.16-0.54) as well as significant reduction in the risk of cancer deaths (HR: 0.34, 95% CI: 0.13-0.88) and non-cancer deaths (HR: 0.26, 95% CI: 0.13-0.52). Higher LE8 scores were still correlated with reduced mortality in cancer survivors without cardiovascular conditions, while adherence to certain health behaviors was tied to a lower death risk. Conclusions In this study, high LE8 scores, especially the health behaviors component, were strongly associated with extended life expectancy and lower mortality rates.

Impact of coronary CT angiography on the hospital outcome among patients admitted with AMI undergoing revascularization procedures in theUS

Abstract Background Coronary CT angiography (CCTA) is gaining popularity as a diagnostic modality for risk stratification among patients hospitalized with acute myocardial infarction (AMI). However, its impact on the hospital outcomes among this population of patients remains to be determined. Methods Using national inpatient sample database, admission cases with a diagnosis of AMI who underwent revascularization procedures were identified from 2016-2020. The prevalence of CCTA was determined among the patient population and stratified based on the type of AMI (STEMI vs. NSTEMI) and revascularization procedure (PCI vs. CABG). Hospital outcomes were compared among the study strata. Results A total of 862,064 admission cases for STEMI and 3,586,944 admission cases for NSTEMI were identified out of which 661,958 cases underwent revascularization procedures. The utilization of CCTA was roughly 10 times higher among AMI cases undergoing PCI than those undergoing CABG (0.5% vs. 0.06%, p&amp;lt;0.0001). Prior CCTA increased the odds of receiving PCI by 79.3 times and the odds of undergoing CABG by 2.8 times. Among STEMI patients undergoing PCI, prior CCTA was associated with a lower mortality rate and non-home disposition (13.8% vs. 21.2%, p&amp;lt;0.0001) compared to no CCTA (3% vs. 5.5%, p=0.01). For NSTEMI patients undergoing PCI, CCTA was associated with a lower non-home disposition (16.5% vs. 20.6%, p=0.003) but not a significantly lower mortality rate. CCTA did not demonstrate any statistically significant differences for AMI patients undergoing CABG. On the other hand, CCTA increased the cost of hospitalization by $15,130.7 for STEMI patients undergoing PCI, length of stay (9 days) and hospital cost for STEMI patients undergoing CABG ($302,802), and total hospital cost for NSTEMI patients undergoing PCI by $8,705. Conclusions Using CCTA helps in risk stratifying AMI patients for revascularization procedures, allocating PCI to those admitted with STEMI and CABG to those with NSTEMI. Although CCTA reduces the risk of death and non-home disposition among STEMI patients undergoing PCI, it also increases hospital charges for patients receiving revascularization procedures.

Therapeutic hypothermia after out-of-hospital cardiac arrest in comatose patients with acute myocardial infarction

Abstract Background Comatous survivors of out-of-hospital cardiac arrest (OHCA) have a high risk of death or poor neurological outcome. Therapeutic hypothermia is recommended for these patients after OHCA. However, there is a lack of data regarding outcomes of therapeutic hypothermia after OHCA in comatose patients with acute myocardial infarction (AMI). Purpose This study aimed to investigate the impact of therapeutic hypothermia on clinical outcomes in comatose patients who underwent primary percutaneous coronary intervention (PCI) for AMI after OHCA. Methods Using a prospective nationwide registry from 2016 to 2021, we examined 2,925 consecutive comatose patients experiencing OHCA in patients with AMI. These patients were categorized into groups receiving hypothermia treatment (n=624) and those without hypothermia treatment (n=2,301). The primary endpoint was the mortality rate upon discharge. The secondary endpoints were mortality rates at 6 or 24 hours, and neurological outcomes at hospital discharge. Results Overall, 624 (21.3%) patients were classified into the hypothermia group. This group showed a notably reduced mortality rate (hazard ratio [HR]: 0.68, 95% confidence interval [CI]: 0.58-0.78, p&amp;lt;0.001) after IPTW analysis (Figure 1). While the worse neurological outcome (as indicated by cerebral performance category [CPC] category 3-5) at hospital discharge was not significantly different between groups after IPTW analysis (odds ratio [OR]: 1.04, 95% CI: 0.93-1.15, p=0.499), early hypothermia within 180 minutes after hospital arrival showed significantly lower mortality rates (HR: 0.64, 95% CI: 0.44-0.95, p=0.027) and reduced occurrence of worse neurological outcome (OR: 0.75, 95% CI: 0.59-0.96, p=0.021) after IPTW analysis (Figure 2). Detailed hypothermia protocol including a targeted temperature of 33°C vs. 36°C or hypothermia duration of 48 hours vs. 24 hours did not significantly reduce the rate of death or poor neurological outcome at discharge. Conclusions Therapeutic hypothermia in OHCA patients complicating AMI was associated with lower mortality rates and comparable neurologic outcomes. However, early hypothermia within 180 minutes after hospital arrival showed significantly improved the mortality and neurological outcomes.all-cause deathAll-cause death and neurological outcome

Addressing disparities in the long-term mortality of non-ST segment myocardial infarction (NSTEMI) patients according to the presence of diabetes mellitus: a nationwide cohort study

Abstract Background Diabetes mellitus (DM) is an important risk factor for non−ST segment elevation myocardial infarction (NSTEMI). How DM is related to management and longer-term clinical outcomes in contemporary NSTEMI cohorts is not well described. Methods and Results We analysed data on 456,376 adults hospitalised with NSTEMI from the United Kingdom Myocardial Ischaemia National Audit Project (MINAP) registry, linked with Office for National Statistics (ONS) death registry. We compared outcomes and quality of care by DM status. People with DM were older (median age 74 vs. 73 years, p&amp;lt;0.001) and more commonly of Asian ethnicity (13% vs. 4%, p&amp;lt; 0.001). Those with DM underwent invasive coronary angiography (59% vs. 63%, p &amp;lt;0.001) or revascularization (PCI or CABG) (38% vs. 40%, p &amp;lt;0.001) less frequently. Mortality risks for people with DM were significantly higher at 30-days (HR: 1.06, CI; 1.04-1.09, p &amp;lt;0.001), 1-year, (HR: 1.17, CI; 1.15-1.18, p &amp;lt;0.001) and 5-years, (HR: 1.25, CI; 1.24-1.26, p &amp;lt;0.001), when compared to people without DM. In people with DM, higher-quality inpatient care, assessed by opportunity-based quality-indicator score category (OBQI; poor, fair, good or excellent), was associated with lower mortality rates (good: HR 0.70, CI 0.67-0.73, P&amp;lt;0.001; excellent: HR 0.59, CI 0.57- 0.62, P&amp;lt;0.001), when compared to people receiving poor quality care. In people with DM, "excellent-care", compared to those receiving poor quality care, was associated with the lowest mortality in diet-treated or insulin-treated subgroups (diet-treated: HR 0.55, CI 0.50-0.61, P&amp;lt;0.001)(insulin-treated: 0.60 CI 0.56-0.64, P&amp;lt;0.001). Conclusion People with DM experience wide disparities in inpatient care following NSTEMI. They have a higher risk of long-term mortality compared to people without DM, with some evidence that better quality inpatient care is linked to better survival.

Prevalence of cardiovascular complications and factors associated with higher case-fatality rate among hospitalized patients with sarcoidosis

Abstract Background Cardiovascular (CV) involvement is a serious complication of sarcoidosis with exaggerated morbidity and mortality. However, the prevalence of CV comorbidities and their case-fatality rate have not been established among hospitalized patients with sarcoidosis. Methods Using the National Inpatient Sample (NIS) database, hospitalized patients with a diagnosis of sarcoidosis were identified. The prevalence of each CV comorbidity and the associated case-fatality rate was determined among this population of patients. Results Data of 406,315 admission cases with a diagnosis of sarcoidosis was analyzed from 2016 to 2020. Of this, 13,950 patients (3.4%) had AMI (STEMI: 0.3% and NSTEMI: 2.3%), 121,515 patients (30%) had HF (HFrEF: 8% and HFpEF: 13%), 7,470 patients (1.8%) had CVA, 8,825 patients had sarcoid myocarditis (2.2%), 8,965 patients (5.6%) had PVD, 71,815 patients had Afib (17.7%), 46,775 patients (11.5%) had cardiorenal syndrome, and 3,905 patients (1%) developed cardiac arrest. Case-Fatality rate was the highest for sarcoidosis patients who developed cardiac arrest (61.4%), followed by STEMI (11.6%), NSTEMI (7.7%), and cardiac tamponade (7.8%). Increasing age (2% for each year), male gender (14% more than females), and black race (25%) but not economic status was associated with increased odds of death among patients with sarcoidosis. While PCI was associated with a lower mortality rate (aOR: 0.4, 95%CI:0.2-0.7, P=0.005), revascularization with CABG (aOR: 0.3, 95% CI: 0.1-1.2, P=0.08) did not reduce the mortality rate. Conclusion Atrial fibrillation, heart failure (HFpEF &amp;gt; HFrEF), and cardiorenal syndrome are the most common cardiovascular complications among hospitalized patents with sarcoidosis. However, case-fatality rate is significantly higher for other less prevalent cardiovascular comorbidities of sarcoidosis, which include cardiac arrest, acute myocardial infarction (STEMI &amp;gt; NSTEMI), and cardiac tamponade.

Prevalence of cardiovascular comorbidities among hospitalized patients with hypertrophic cardiomyopathy and factors associated with a higher case-fatality rate

Abstract Background Hypertrophic cardiomyopathy (HCM) is proven to be a catalyst for sudden cardiac death among affected population. However, the prevalence of cardiovascular comorbidities (CVC) and their association with in-hospital mortality has not been established among hospitalized patients with HCM. Methods National Inpatient Sample (NIS) database was queried from 2016 to 2020 to identify hospitalized patients with a diagnosis of HCM. The prevalence of CVC and case-fatality rate was determined for this patient population using univariate analysis and multivariate logistic regression. Results Weighted data was analyzed for a total of 278,995 admission cases with HCM. Crude in-hospital mortality rate increased from 16.4% to 22.9% during the study period. Atrial fibrillation (42.1%), HFpEF (28.1%), and cardiorenal syndrome (16.6%) were the most common CVC among hospitalized patients with HCM. The case-fatality rate was the highest among HCM patients hospitalized due to cardiac arrest (41%) followed by cardiac tamponade (13.7%) and STEMI (10.2%). Increasing age (aOR: 1.02, 95%CI: 1.02-1.03, p&amp;lt;0.0001), Asian/Pacific Islander race (aOR: 1.7, 95%CI: 1.1-2.4-, p=0.007), cerebrovascular accident (aOR: 2.3, 95%CI: 1.7-3.01, p&amp;lt;0.0001), NSTEMI (aOR: 1.8, 95%CI: 1.3-2.4, p&amp;lt;0.0001), peripheral vascular diseases (aOR: 1.3, 95%CI: 1.03-1.6, p=0.03), cardiorenal syndrome (aOR: 1.4, 95%CI: 1.2-1.8, p&amp;lt;0.0001), and cardiac arrest (aOR: 26.6, 95%CI: 20.9-33.9, p&amp;lt;0.0001). Among HCM patients with acute myocardial infarction requiring revascularization procedures, in-hospital mortality rate was significantly lower among those undergoing PCI than CABG (8.5% vs. 37.5%, p=0.008 for STEMI and 1.8% vs. 4.9%, p=0.04 for NSTEMI). Conclusions Mortality rate among hospitalized patients with HCM has been slightly on the rise over the last half century. Although aging population might be a contributing factor, comorbid end-organ damages including CVA, NSTEMI, and cardiorenal syndrome have demonstrated substantial association with in-hospital mortality in addition to cardiac arrest. For HCM patients requiring revascularization procedures, PCI seems to be associated with a lower mortality rate than its competitor CABG.

Comparative Analysis of Osteoarthritis Therapeutics: A Justification for Harnessing Retrospective Strategies via an Inverted Pyramid Model Approach

In this review, we seek to explore two distinct approaches to the clinical management of OA: a prospective approach, addressing primarily one’s genetic predisposition to OA and generating early intervention options, and the retrospective approach, aimed at halting or reversing OA progression post-symptom onset. The clinical management of OA remains challenging, largely due to the limited availability of preventative treatments and failure of existing therapies to modify or reverse the underlying pathophysiology. The prospective approach involves the identification of genetic markers associated with OA and utilizes in vitro and in vivo models to characterize the underlying disease mechanism. Further, this approach focuses on identifying genetic predispositions and unique molecular subtypes of OA to develop individualized treatment plans based on patient genotypes. While the current literature investigating this strategy has been notable, this approach faces substantial challenges, such as extensive time burdens and utilization of extensive genetic testing that may not be economically feasible. Additionally, there is questionable justification for such extensive investigations, given OA’s relatively low mortality rates and burden when contrasted with diseases like specific forms of cancer, which rely heavily on the prospective approach. Alternatively, the retrospective approach primarily focuses on intervention following symptom onset and aims to utilize novel therapeutics to slow or reverse the inflammatory cascade typically seen in disease progression. These treatments, like Hippo pathway inhibitors, have shown initial promise in halting OA progression and alleviating OA symptomology by modulating cellular processes to preserve articular cartilage. In comparison to the prospective approach, the retrospective strategy is likely more cost-effective, more widely applicable, and does not necessitate thorough and invasive genetic screening. However, this approach must still be weighed against the typical natural history of disease progression, which frequently results in total knee arthroplasty and unacceptable outcomes for 15–20% of patients. From a comparative analysis of these two approaches, this review argues that the retrospective strategy, with ideally lower time and economic burden and greater accessibility, offers a more reasonable and effective solution in the context of OA management. Using a similar approach to other management of chronic diseases, we suggest an “Inverted Pyramid” model algorithm, a structured research and development regimen that prioritizes generating widely effective therapies first, with subsequent refinement of treatments based on the development of patient resistance to these therapies. We argue that this strategy may reduce the need for total knee arthroplasty while improving patient outcomes and accessibility.

Long-term outcomes in women with a history of peripartum cardiomyopathy

Abstract Background Peripartum cardiomyopathy (PPCM) remains an important cause of cardiac-related maternal morbidity and mortality in previously healthy young women. Data on the long-term clinical course of PPCM are sparse. In this study, we report the long-term outcomes in patients with PPCM. Methods and Results Long-term follow-up (median 9.6, min 5, and max 24 years) was available in 72 women with PPCM followed in a cardio-obstetrics clinic. Five-year follow-up data were available for 19 PPCM patients, 10-year follow-up data for 24 PPCM patients, and more than 15 years of follow-up data for 24 PPCM patients. Seven patients were lost to cardiac follow-up but are known to be alive. The mean age at diagnosis was 35 ± 7 years, and 85% were Caucasian. The mean parity was 2.2 ± 1.3, and gravidity was 2.7 ± 1.7. Twin pregnancies were reported in 13% of cases. Pre-eclampsia was present in 25% of the patients and the development of hypertension in the long-term was documented in 18%. The mean LVEF was 34.5 ± 9.9% at diagnosis. One-year LVEF data were available in 72 patients: 54 patients (75%) experienced LV recovery (LVEF≥ 50%). After 1 year, the mean LVEF was 53.4± 8.2%. Among patients remained with LV&amp;lt;50% at one year (n=10) no LV function recovery was reported at long-term follow-up. At a median follow-up of 9.6 years (n=66) mean LVEF was 52.1±10.4%, nine patients had a reduction in LVEF (&amp;lt;50%) function in the long-term follow-up with a mean LVEF of 46.1± 2.1%. Out of 72 PPCM patients, 3 patients developed arrhythmia, in one woman coronary artery disease occurred and 7 underwent pacemaker implantation. Almost half of patients (n=65) remained with long term treatment of b-blockers, 38% received medications for hypertension or heart failure. No cases of myocardial infarctions, cardiovascular death, or heart transplantations were reported. Two women died during follow-up: one with normal LVEF died from breast cancer, and another patient with reduced LVEF and severe diabetes. The cause of her death remained unclear. During follow-up, 30 women had ≥ 1 subsequent pregnancy (SSP), and there was no reduction in their mean LVEF before SSP 57.0 ± 5.4% and at long-term follow-up was 59.6± 1.3% (p=ns). Conclusion Our study demonstrates favorable long-term outcomes with high and stable recovery rates with low mortality rates, and no impact of subsequent pregnancies on the clinical course of the condition. Nevertheless, persisting or new diagnosis of hypertension and use of cardiovascular medications were noted in the long term follow up.

Incidence, patient characteristics, and treatment patterns of U.S. active-duty service members diagnosed with COVID-19-associated VTE in the outpatient setting

Abstract Background Venous Thromboembolism (VTE) is a well-established complication of acute coronavirus disease 2019 (COVID-19) infection. We sought to clarify the incidence, patient characteristics, and treatment patterns of VTE within United States active-duty service members (ADSM) diagnosed with COVID-19 infection in the outpatient setting. Methods Our team conducted a multicenter retrospective review of the outpatient healthcare records for all U.S. ADSM diagnosed COVID-19-associated VTE between January 1, 2020, and April 30, 2022. The data was obtained from the COVID-19 surveillance case list maintained by the Armed Services Health Surveillance Division (ASHSD) of the U.S. Defense Health Agency (DHA). The Defense Medical Surveillance System (a database containing inpatient and outpatient electronic medical records for active-duty service members) was used to capture all appropriate medical encounters using ICD-10 coding for venous thromboembolic events within 365 days of COVID-19 diagnosis. Chart review for data adjudication was performed by the physician investigator team. Results Among 365,788 ADSM who were diagnosed with COVID-19 in the outpatient setting, a total of 159 patients were identified as having COVID-19-associated VTE. The overall incidence rate of VTE was 43.47 per 100,000 people within 365 days of diagnosis (90-day incidence rate of 32.5/100,000). The median time from COVID-19 diagnosis to VTE was 23 days (IQR 13-87). Of 159 patients, 33 (20.7%) were diagnosed with DVT, 143 (90%) with PE, and 20 (12.5%) with both PE and DVT. The median age was 30 years old (IQR 23-38). The majority of patients were male (85%). 49% were white. The most common medical comorbidity was obesity (33%), 11% had a history of active tobacco use, and 9.4% of patients had a prior VTE diagnosis. Only 34% of patients were vaccinated for COVID-19 prior to their diagnosis (35 Pfizer–BioNTech, 13 Moderna, and 4 other). 148 (93%) of patients were treated with a direct oral anticoagulant, 10 (6.2%) were treated with low molecular weight heparin, and 1 (0.8%) was treated with a vitamin K antagonist. 96 (60.3%) required hospitalization with 4 (2.5%) requiring subsequent thrombectomy. None experienced major bleeding events. Only 2 (1.3%) of the patients died within 22 days from VTE diagnosis. The remaining 98.7% were alive at 875 days (SD 230) of follow-up. Conclusion The incidence of venous thromboembolism in active-duty military patients with COVID-19 was rare, affecting mostly unvaccinated, minority men in their 30s with risk factors such as obesity, prior VTE, and prior tobacco use. Of the women with VTE, 54% were non-white minorities. While VTE diagnosis was associated with a low mortality rate, the majority of patients required hospitalization.

Epidemiological profile and mortality of infective endocarditis over the past decade: a systematic review and meta-analysis of 133 studies comprising 132,355 cases

Abstract Background Understanding the epidemiology of infective endocarditis (IE) is crucial in the context of an aging population, increased comorbidities, and the heightened occurrence of healthcare-associated cases. Comprehensive data on causative agents, affected valves, and associated mortality are essential for current clinical practice. Methods This systematic review was conducted according to the PRISMA guidelines. A random effects model meta-analysis was conducted. Eligible studies reporting outcomes on IE were identified through a search of the PubMed/Medline database from 2010 to 2021. Results One hundred-thirty-three studies with 132,584 patients from six continents were included in the analysis. The most common causative agents of IE were Staphylococci species in 36% of cases, followed by Streptococci species in 26% of cases and Enterococci species in 10% of cases. Of the studies providing further speciation, the predominant species was Staphylococcus aureus with an incidence of 29%, followed by Viridans Streptococcus with an incidence of 12%. We found an in-hospital/30-day mortality of 17% (CI: 16%-19%) from 109 studies worldwide. In the subgroup analysis, the highest mortality rates were observed in Latin America 33% (CI: 28%-38%) and Africa 25% (CI: 21%-30%), while the lowest mortality rates were reported in Oceania 13% (CI: 8%-19%), followed by North America 14% (CI: 11%-18%), Asia 15% (CI: 12%-18%), and Europe 17% (CI: 16%-19%). The aortic valve was affected in 46% of cases, followed by the mitral valve in 43%. Tricuspid valve IE and multivalvular IE were identified in 7% and 14% of the cases, respectively. Conclusion Our study highlights the shift in epidemiological profile of IE over the last decade with S. aureus identified as the most common causative microorganism of IE in almost one third of cases. IE remains a highly morbid and fatal condition with high mortality rates even in tertiary and high-expertise centers worldwide. While left-sided IE is by far more common, right-sided IE and multivalvular IE are not rare entities and should be considered early in the differential of patients presenting with suspected IE to decrease the risk of future complications.Global burden of infective endocarditis.

Guideline-directed medical therapy and in-hospital mortality in acute coronary syndrome patients with advanced renal dysfunction

Abstract Background It is unclear whether early (initiated within 24 hours of admission) guideline-directed medical therapy [GDMT, i.e., the combined use of β-blocker, angiotensin converting enzyme inhibitor/angiotensin receptor blocker, dual antiplatelet drugs and statin] could benefit acute coronary syndrome (ACS) patients with advanced renal dysfunction [estimated glomerular filtration rate (eGFR) &amp;lt; 30 mL/min/1.73 m2]. Objectives The purpose of this study was to verify whether GDMT could improve in-hospital mortality in ACS patients with advanced renal dysfunction. Methods This study included 3,288 and 3,520 ACS patients with admission with advanced renal dysfunction from the CNEDSSP and CCC-ACS cohorts, respectively. Multivariable-adjusted analysis and propensity score matching (PSM) were employed to assess the impact of GDMT on in-hospital mortality. Results In a pooled analysis of the CNEDSSP and CCC-ACS cohorts, early GDMT was associated with significantly lower in-hospital mortality (relative ratio [RR]: 0.62, 95% CI: 0.47 to 0.81). PSM revealed an attenuation of the association of in-hospital mortality with early GDMT in ACS patients, with statistically significant associated reductions observed only in myocardial infarction (MI) patients (hazard ratio [HR]: 0.45, 95% CI: 0.27 to 0.75 in CNEDSSP cohort; HR: 0.48, 95% CI: 0.27 to 0.84 in CCC-ACS cohort). A random-effect pooled analysis for MI patients with admission advanced renal dysfunction demonstrated a 56% lower in-hospital mortality among GDMT users (RR: 0.44, 95% CI: 0.31 to 0.65). Conclusions This nationwide study highlights that early GDMT is associated with a reduced risk of in-hospital mortality in ACS patients (particularly in MI patients) with advanced renal dysfunction.