Cardiovascular Hospitalization Rates Research Articles

Temporal Trend in Hospitalization Among Patients With Congenital Heart Disease: ADanish Nationwide Study.

The congenital heart disease (CHD) population is growing and aging. We aim to examine the impact by describing the temporal trend and causes of lifetime hospitalization burden among the CHD population. From the Danish National Patient Registry, 23 141 patients with CHD and their hospitalizations from 1977 to 2018 were identified, excluding patients with extracardiac malformation. Patients with CHD were categorized into major CHD and minor CHD, and each patient was matched with 10 controls by sex and year of birth. The rate of all-cause hospitalization increased over time from 28.3 to 36.4 hospitalizations per 100 person-years (PY) with rate difference (RD) per decade of 2.5 (95% CI, 2.0-3.1) hospitalizations per 100 PY for the patients with CHD, compared with the increase from 10.8 to 17.0 per 100 PY (RD per decade, 2.0 [95% CI, 1.8-2.2] per 100 PY) for the control group (RD for CHD versus control, P=0.08). The all-cause hospitalization rate remained constant for the major CHDs (RD per decade, -0.2 [95% CI, -1.2 to 0.9] per 100 PY) but increased for the minor CHDs (RD per decade, 5.2 [95% CI, 4.3-6.0] per 100 PY). For all patients with CHD, the cardiovascular hospitalization rate remained constant over time (RD per decade, 0.2 [95% CI, -0.3 to 0.6] per 100 PY) whereas the noncardiovascular hospitalization rate increased (RD per decade, 2.1 [95% CI, 1.6-2.7] per 100 PY). The length of all-cause hospital stays for all patients with CHD decreased from 2.7 (95% CI, 2.6-2.8) days per PY in 1977 to 1987 to 1.6 (95% CI, 1.6-1.7) days per PY in 2008 to 2018. Compared with previous decades, patients with CHD have an increasing hospitalization rate, similar to the general population, but a decreasing length of hospital stay. The increase in hospitalization rate was driven by noncardiovascular hospitalizations, with the patients with minor CHD being the key contributor to the increasing rate.

Relationship of Subendocardial Perfusion to Myocardial Injury, Cardiac Structure, and Clinical Outcomes Among Patients With Hypertension.

Coronary microvascular dysfunction has been implicated in the development of hypertensive heart disease and heart failure, with subendocardial ischemia identified as a driver of sustained myocardial injury and fibrosis. We aimed to evaluate the relationships of subendocardial perfusion with cardiac injury, structure, and a composite of major adverse cardiovascular and cerebral events consisting of death, heart failure hospitalization, myocardial infarction, and stroke. Layer-specific blood flow and myocardial flow reserve (MFR; stress/rest myocardial blood flow) were assessed by 13N-ammonia perfusion positron emission tomography in consecutive patients with hypertension without flow-limiting coronary artery disease (summed stress score <3) imaged at Brigham and Women's Hospital (Boston, MA) from 2015 to 2021. In this post hoc observational study, biomarkers, echocardiographic parameters, and longitudinal clinical outcomes were compared by tertiles of subendocardial MFR (MFRsubendo). Among 358 patients, the mean age was 70.6±12.0 years, and 53.4% were male. The median MFRsubendo was 2.57 (interquartile range, 2.08-3.10), and lower MFRsubendo was associated with older age, diabetes, lower renal function, greater coronary calcium burden, and higher systolic blood pressure (P<0.05 for all). In cross-sectional multivariable regression analyses, the lowest tertile of MFRsubendo was associated with myocardial injury and with greater left ventricular wall thickness and volumes compared with the highest tertile. Relative to the highest tertile, low MFRsubendo was independently associated with an increased rate of major adverse cardiovascular and cerebral events (adjusted hazard ratio, 2.99 [95% CI, 1.39-6.44]; P=0.005) and heart failure hospitalization (adjusted hazard ratio, 2.76 [95% CI, 1.04-7.32; P=0.042) over 1.1 (interquartile range, 0.6-2.8) years median follow-up. Among patients with hypertension without flow-limiting coronary artery disease, impaired MFRsubendo was associated with cardiovascular risk factors, elevated cardiac biomarkers, cardiac structure, and clinical events.

Early versus Late Radiofrequency Catheter Ablation in Atrial Fibrillation: Timing Matters.

Background: Despite the progressive course of atrial fibrillation (AF), the optimal timing of radiofrequency catheter ablation (RFCA) during disease course is still unknown. We aimed to investigate the impact of early RFCA within a year after AF diagnosis on procedural outcomes. Methods: A single-center retrospective study was conducted on symptomatic AF patients (n = 130) referred for RFCA with a 16-month median follow-up. Patients were stratified based on the diagnosis-to-ablation time (DAT) into early (≤1 year) and late (>1 year) RFCA groups. Atrial arrhythmia recurrence after single RFCA was the primary outcome. Secondary outcomes included cardiovascular hospitalizations, AF progression, and antiarrhythmic drug (AAD) use. Results: Within a year of AF diagnosis, 33 patients (25.4%) underwent RFCA. In the early-RFCA group, 84.4% of patients did not have recurrent atrial arrhythmia, in contrast to 60.8% in the late-RFCA group (p = 0.039). Late RFCA (HR = 2.74, 95% CI = 1.062-7.052, p = 0.037) and AF recurrence during the blanking period (HR = 4.57, 95% CI = 2.38-8.57, p < 0.0001) were independent predictors of atrial arrhythmia recurrence on multivariate analysis. Compared to the late-RFCA group, the early-RFCA group had significantly lower rates of cardiovascular hospitalizations (18% vs. 42%, p = 0.023), AF progression (0.0% vs. 11.3%, p = 0.044), and AAD use (45.4% vs. 81.4%, p < 0.001). Conclusions: Early RFCA within a year of AF diagnosis is associated with less atrial arrhythmia recurrence, fewer cardiovascular hospitalizations, less AF progression, and less AAD use. DAT of more than one year and AF recurrence during the blanking period are independent predictors of atrial arrhythmia recurrence after single RFCA.

Abstract We071: Identifying Preventive and Therapeutic Effects of SGLT2 Inhibitor on Atrial Fibrillation

Background: The frequency and prevalence of atrial fibrillation (AF) and heart failure are expected to increase over time, which are expected to result in enormous medical expenses and socioeconomic losses. Previous studies have confirmed that SGLT2 inhibitor (SGLT2i) reduces cardiovascular mortality and hospitalization rates in heart failure patients. Also, follow-up studies have been reported that the use of SGLT2i reduces atrial fibrillation, and its administration is recommended in clinical practice guidelines. In spite of beneficial effects of SGLT2i on atrial fibrillation, the exact mechanism by which SGLT2i reduces atrial fibrillation has not been revealed. Methods: We performed experiments by creating an AF cell model using Ang II and an AF animal model using Acetylcholin-Calcium chloride. Fibrosis markers and calcium regulatory proteins were confirmed by Western blot, and the occurrence and burden of AF were evaluated by using a 1F catheter in animal models. Results: In our cell studies and animal experiments, the inhibitory effect of SGLT2i administartion on atrial fibrillation was confirmed. First, fibrosis markers tend to reduce in atrial fibrillation models treated with SGLT2i, compared to non-treated atrial fibrillation models. In addition, the phosphorylation of the calcium handling proteins, such as CaMKII, RyR2, and PLB, increased in the AF group, whereas the degree of phosphorylation in SGLT2i treated group decreased to the phosphorylation level in control group. Conclusion: In AF-induced cell and animal models, the effect of SGLT2i was shown to be highly effective against atrial fibrillation. In particular, the results indicate that administration of SGLT2i before inducing atrial fibrillation could bring out the preventive and therapeutic effects through amelioration of fibrosis and reduction of calcium handling proteins phosphorylation.

Sacubitril with valsartan, a modern pharmacotherapy in heart failure - a literature review

Introduction and purpose: Heart failure is one of the most common cardiovascular diseases worldwide. It is an important factor leading to a reduced, health-related quality of life (HRQoL) not only because of its various symptoms but also due to loss of jobs or increase in medical expenses impairing the socioeconomic status of the sick. Nowadays scientists face this problem and are trying to invent specific pharmacotherapy that allows it to extend life and improve its quality. One of the elements of modern pharmacotherapy is the combination of sacubitril with valsartan. This work aims to evaluate the effect of this drug on the length and quality of life of patients with heart failure.Materials and methods: This article is a literature review based on publications from PubMed, Cochrane Library, ClinicalKey released since 2014, keywords included: sacubitril/valsartan; angiotensin receptor–neprilysin inhibitor; ARNI; heart failure.The state of knowledge: The use of sacubitril/valsartan drugs is an established agent used to reduce the risk of death from any cause in all patients with heart failure with reduced ejection fraction, death from cardiovascular causes and the rate of hospitalization due to exacerbation of symptoms. Some study analyses also indicate the utility of using sacubitril/valsartan in HFmrEF and HFpEF to reduce the rate of cardiovascular events and hospitalization because of heart failure.Conclusions: The use of sacubitril/valsartan is recognized to improve prognosis in patients with HFrEF. Evidence supporting its efficacy in the subgroup of patients with mid-range and preserved ejection fraction is still insufficient and requires further investigation.

Impact of the clinical frailty scale on long-term outcomes after transcatheter aortic valve implantation

BackgroundThe semiquantitative Clinical Frailty Scale (CFS) is reportedly a useful marker for predicting short- and mid-term mortality after transcatheter aortic valve implantation (TAVI). We assessed the long-term prognostic impact of CFS in patients with severe aortic stenosis undergoing TAVI. MethodsWe prospectively assessed patients undergoing TAVI in Kokura Memorial Hospital using a 9-level CFS and enrolled 1594 patients after excluding patients with CFS 8-9. The patients were divided into the low (CFS level, 1–3; N = 842), intermediate (4; N = 469), and high (5-7; N = 283) groups according to their CFS levels. ResultsIn the low, intermediate, and high groups, 3-year all-cause mortality rates were 17.4%, 29.4%, and 41.7% (P <0.001) and composite rates of cardiovascular mortality and heart failure hospitalization were 12.1%, 19.1%, and 23.9% (P <0.001), respectively. Multivariable analysis showed that higher frailty was independently associated with all-cause mortality (intermediate group: adjusted hazard ratio [HR], 1.63, 95% confidence interval [CI], 1.24–2.15, P <0.001; high group: adjusted HR, 2.18, 95% CI, 1.59–2.99, P <0.001) and composite of cardiovascular mortality and heart failure hospitalization (intermediate group: adjusted HR, 1.47, 95% CI, 1.04–2.08, P = 0.030; high group: adjusted HR, 1.66, 95% CI, 1.09–2.51, P = 0.018) and this result was consistent, irrespective of stratification based on age, sex, body mass index, left ventricular ejection fraction, Society of Thoracic Surgeons score, and New York Heart Association functional class without significant interaction. ConclusionsThe simple CFS tool predicts the long-term adverse outcomes post-TAVI.

Healthcare Resource Utilization, Costs, Clinical Events, and Treatment Patterns in Extreme High-Risk Patients for Cardiovascular Events Undergoing Lipoprotein Apheresis: A German Claims Data Analysis

Abstract Aim Insights into treatment patterns, clinical and economic burden of patients undergoing Lipoprotein apheresis (LA). 3 cohorts were characterized: newly treated [Cohort A], experienced [B], matched cohort [C, high CV risk without LA]. Method Clinical burden was assessed by cardiovascular-related hospitalizations and procedures. Economic and clinical outcomes were described over a 12-month baseline period up to 3 years after LA initiation. Results Absolute LA cases decreased from 1.7 to 1.1 per 100,000 patients. In Cohort A, rate of major cardiovascular hospitalizations decreased, while annual healthcare expenditure increased. Cohort B had significantly higher costs than C. Conclusion LA may be associated with a reduced frequency of myocardial infarction-related hospitalizations. However, it is expensive. Alternatives are needed to reduce its high economic burden.

EFFECT OF DAPAGLIFLOZIN ON CARDIOVASCULAR OUTCOMES IN HFREF PATIENTS: IMPACT OF DIABETES MELLITUS TYPE 2 STATUS

Dapagliflozin has shown promise in the treatment of heart failure with reduced ejection fraction (HFrEF), but its effects in patients with and without diabetes remain unclear. Objective: This study aimed to assess the effects of dapagliflozin in HFrEF patients, both with and without diabetes. Methods: From January to July 2023, a six-month case-control study was conducted in the cardiology department of a Tertiary Care Hospital in Peshawar, Pakistan. All patients received an additional dose of dapagliflozin (10 mg) alongside their usual treatment plans. The primary outcome was a composite of heart failure exacerbation or cardiovascular death. Data analysis was performed using SPSS version 22. Results: Patients with diabetes mellitus type 2 (DMT2) exhibited a higher rate of cardiovascular death (22%) and hospitalization for heart failure (14.4%) compared to those without diabetes. The hospitalisation rate for heart failure was also higher in the DMT2 group (12.21%) than in the non-diabetic group (8.6%). Over the trial period, cardiovascular death occurred in 12.44% of patients with DMT2 compared to 7.30% in those without DMT2. Patients with diabetes experienced a significantly higher number of first and recurrent hospitalizations for heart failure and cardiovascular death compared to those without diabetes (32.45% vs. 19.20%, p=0.021). Conclusion: Dapagliflozin therapy in HFrEF patients demonstrated varying effects between those with and without diabetes. The study underscores the importance of personalised management strategies considering comorbid medical conditions. Despite dapagliflozin treatment, patients with both heart failure and diabetes continued to experience cardiovascular complications, highlighting the need for individualised treatment plans that account for a patient's complete medical profile.

Blood-based cardiometabolic phenotypes in atrial fibrillation and their associated risk: EAST-AFNET 4 biomolecule study.

Atrial fibrillation (AF) and concomitant cardiometabolic disease processes interact and combine to lead to adverse events, such as stroke, heart failure, myocardial infarction, and cardiovascular death. Circulating biomolecules provide quantifiable proxies for cardiometabolic disease processes. The aim of this study was to test whether biomolecule combinations can define phenotypes in patients with AF. This pre-specified analysis of the EAST-AFNET 4 biomolecule study assigned patients to clusters using polytomous variable latent-class analysis based on baseline concentrations of 13 precisely quantified biomolecules potentially reflecting ageing, cardiac fibrosis, metabolic dysfunction, oxidative stress, cardiac load, endothelial dysfunction, and inflammation. In each cluster, rates of cardiovascular death, stroke, or hospitalization for heart failure or acute coronary syndrome, the primary outcome of EAST-AFNET 4, were calculated and compared between clusters over median 5.1 years follow-up. Findings were independently validated in a prospective cohort of 748 patients with AF (BBC-AF; median follow-up 2.9 years).Unsupervised biomolecule analysis assigned 1586 patients (71 years old, 46% women) into four clusters. The highest risk cluster was dominated by elevated bone morphogenetic protein 10, insulin-like growth factor-binding protein 7, N-terminal pro-B-type natriuretic peptide, angiopoietin 2, and growth differentiation factor 15. Patients in the lowest risk cluster showed low concentrations of these biomolecules. Two intermediate-risk clusters differed by high or low concentrations of C-reactive protein, interleukin-6, and D-dimer. Patients in the highest risk cluster had a five-fold higher cardiovascular event rate than patients in the low-risk cluster. Early rhythm control was effective across clusters (Pinteraction = 0.63). Sensitivity analyses and external validation in BBC-AF replicated clusters and risk gradients. Biomolecule concentrations identify cardiometabolic subphenotypes in patients with AF at high and low cardiovascular risk.

Aerobic Exercise Attenuates Pressure Overload-Induced Myocardial Remodeling and Myocardial Inflammation via Upregulating miR-574-3p in Mice.

Exercise training can promote cardiac rehabilitation, thereby reducing cardiovascular disease mortality and hospitalization rates. MicroRNAs (miRs) are closely related to heart disease, among which miR-574-3p plays an important role in myocardial remodeling, but its role in exercise-mediated cardioprotection is still unclear. A mouse myocardial hypertrophy model was established by transverse aortic coarctation, and a 4-week swimming exercise training was performed 1 week after the operation. After swimming training, echocardiography was used to evaluate cardiac function in mice, and histopathologic staining was used to detect cardiac hypertrophy, myocardial fibrosis, and cardiac inflammation. Quantitative real-time polymerase chain reaction was used to detect the expression levels of miR-574-3p and cardiac hypertrophy markers. Western blotting detected the IL-6 (interleukin-6)/JAK/STAT inflammatory signaling pathway. Echocardiography and histochemical staining found that aerobic exercise significantly improved pressure overload-induced myocardial hypertrophy (n=6), myocardial interstitial fibrosis (n=6), and cardiac inflammation (n=6). Quantitative real-time polymerase chain reaction detection showed that aerobic exercise upregulated the expression level of miR-574-3p (n=6). After specific knockdown of miR-574-3p in mouse hearts with adeno-associated virus 9 using cardiac troponin T promoter, we found that the protective effect of exercise training on the heart was significantly reversed. Echocardiography and histopathologic staining showed that inhibiting the expression of miR-574-3p could partially block the effects of aerobic exercise on cardiac function (n=6), cardiomyocyte cross-sectional area (n=6), and myocardial fibrosis (n=6). Western blotting and immunohistochemical staining showed that the inhibitory effects of aerobic exercise on the IL-6/JAK/STAT pathway and cardiac inflammation were partially abolished after miR-574-3p knockdown. Furthermore, we also found that miR-574-3p exerts cardioprotective effects in cardiomyocytes by targeting IL-6 (n=3). Aerobic exercise protects cardiac hypertrophy and inflammation induced by pressure overload by upregulating miR-574-3p and inhibiting the IL-6/JAK/STAT pathway.

Increasing cardiovascular hospitalization rates among young and middle-aged adults in the USA suggest a need for multi-faceted solutions.

Increasing cardiovascular hospitalization rates among young and middle-aged adults in the USA suggest a need for multi-faceted solutions.

Morbidity in Patients with Chronic Adrenal Insufficiency - Cardiovascular Risk Factors and Hospitalization Rate Compared to Population Based Controls.

Patients with adrenal insufficiency (AI) have been found to have increased cardiovascular morbidity, partly associated with nonphysiologic glucocorticoid replacement. We included two separate cohorts (cohort 1 n=384 patients, cohort 2 n=180 patients) of patients with chronic primary and secondary AI under standard replacement therapy and compared them to two age- and sex-matched population-based studies (SHIP-TREND/DEGS). Odds ratios with 95% CI for hypertension, hyperlipidemia/HLP, type 2 diabetes/T2DM, obesity, and hospitalization with adjustment for confounders were evaluated by logistic regression. Patient cohort 1 had significantly lower ORs for obesity [0.4 (0.3-0.6), p<0.001] and hypertension [0.5 (0.3-0.6), p<0.001] compared to SHIP-TREND and for obesity [0.7 (0.5-0.9), p=0.01], hypertension [0.4 (0.3-0.5), p<0.001] and HLP [0.4 (0.3-0.6), p<0.001] compared to DEGS. In cohort 2, ORs were significantly lower for HLP compared to both SHIP-TREND [0.4 (0.2-0.7), p=0.001] and DEGS [0.3 (0.2-0.5), p<0.001] and for hypertension [0.7 (0.4-0.9), p=0.04] compared to SHIP-TREND. In patients with SAI from cohort 2, ORs for DM2 [2.5 (1.3-4.9) p=0.009], hypertension [2.5 (1.4-4.5), p=0.002] and obesity [1.9 (1.1-3.1), p=0.02] were significantly higher compared to DEGS, whereas ORs for HLP were significantly lower compared to both SHIP [0.3 (0.1-0.6), p=0.002] and DEGS [0.3 (0.1-0.6), p<0.001]. In most of our AI patients treated with conventional glucocorticoid doses, the risk for T2DM, obesity, hypertension, and HLP was not increased. The number of hospitalizations was significantly higher in AI patients compared to controls, which might reflect increased susceptibility but also a more proactive management of concomitant diseases by physicians and patients.

A case-crossover study of ST-elevation myocardial infarction and organic carbon and source-specific PM2.5 concentrations in Monroe County, New York.

Previous work reported increased rates of cardiovascular hospitalizations associated with increased source-specific PM2.5 concentrations in New York State, despite decreased PM2.5 concentrations. We also found increased rates of ST elevation myocardial infarction (STEMI) associated with short-term increases in concentrations of ultrafine particles and other traffic-related pollutants in the 2014-2016 period, but not during 2017-2019 in Rochester. Changes in PM2.5 composition and sources resulting from air quality policies (e.g., Tier 3 light-duty vehicles) may explain the differences. Thus, this study aimed to estimate whether rates of STEMI were associated with organic carbon and source-specific PM2.5 concentrations. Using STEMI patients treated at the University of Rochester Medical Center, compositional and source-apportioned PM2.5 concentrations measured in Rochester, a time-stratified case-crossover design, and conditional logistic regression models, we estimated the rate of STEMI associated with increases in mean primary organic carbon (POC), secondary organic carbon (SOC), and source-specific PM2.5 concentrations on lag days 0, 0-3, and 0-6 during 2014-2019. The associations of an increased rate of STEMI with interquartile range (IQR) increases in spark-ignition emissions (GAS) and diesel (DIE) concentrations in the previous few days were not found from 2014 to 2019. However, IQR increases in GAS concentrations were associated with an increased rate of STEMI on the same day in the 2014-2016 period (Rate ratio [RR] = 1.69; 95% CI = 0.98, 2.94; 1.73 μg/m3). In addition, each IQR increase in mean SOC concentration in the previous 6 days was associated with an increased rate of STEMI, despite imprecision (RR = 1.14; 95% CI = 0.89, 1.45; 0.42 μg/m3). Increased SOC concentrations may be associated with increased rates of STEMI, while there seems to be a declining trend in adverse effects of GAS on triggering of STEMI. These changes could be attributed to changes in PM2.5 composition and sources following the Tier 3 vehicle introduction.

Rehabilitation of COVID-19 convalescents and its impact on cardiovascular endpoints: propensity score matching analysis

Due to the large number of complications and decreased quality of life after coronavirus disease (COVID-19), physical and psychological rehabilitation of patients is relevant. However, the effectiveness of rehabilitation on endpoints has not yet been demonstrated.Aim. To determine the effectiveness of different rehabilitation options in hospitalized patients with COVID-19 on the development of long-term adverse cardiovascular events 1 year after discharge.Material and methods. In a single-center, non-randomized observational study, 3 groups of patients were formed after hospitalization with COVID-19: I — with telemedicine rehabilitation (n=118), II — with rehabilitation in a specialized department (n=46) and III — without rehabilitation (n=175). After 1-year followup, groups were compared regarding following endpoints: cardiovascular mortality, myocardial infarction, stroke, pulmonary embolism, atrial fibrillation and cardiovascular hospitalization. Propensity score matching analysis was used to optimize differences between comparison groups.Results. Rehabilitation after hospitalization of patients with COVID-19, both in the hospital and remotely for 1 year, helps to reduce cardiovascular hospitalization rate. In addition, remote rehabilitation reduces cardiovascular mortality.Conclusion. Both rehabilitation options reduce the incidence of cardiovascular hospitalization compared to no rehabilitation.

Spatiotemporal distribution characteristics and influencing factors of the rate of cardiovascular hospitalization in Ganzhou city of China.

The objective of this study was to analyze hospitalization rates for cardiovascular diseases (CVD) in Ganzhou City, Jiangxi Province of China from 2015 to 2020 and to uncover the spatiotemporal distribution characteristics and influencing factors, and thus to provide reference for the prevention and control of CVD and public health resources planning. The hospitalization data for CVDs from 2016 to 2020 was obtained from the First Affiliated Hospital of Gannan Medical University, and ArcGIS 10.8, SaTScan 9.5, and Matlab 20.0 were used to analyze the spatial autocorrelation, spatiotemporal scan statistics, and potential affecting factors of the hospitalization rates. The hospitalization rate for CVDs in Ganzhou City showed a slightly increasing trend from 2016 to 2020, with higher rates in winter and summer than that in spring and autumn, and the individuals aged 61 and above constitute a higher proportion compared to other age groups. Additionally, there was a positive correlation between hospitalization rates for CVDs and the counties and districts in Ganzhou City, with high-high aggregation areas mainly distributed in Nankang District, the western urban area of Ganzhou City. The spatial scan analysis identified three different types of significant aggregation areas: high-risk, low-risk, and middle-risk areas. The high-risk area was mainly centered around Zhanggong District or Shangyu County in the central and western regions, with a disease hospitalization rate 2-3 times higher than the rest areas. The study also found that environmental meteorological factors such as the annual average concentration of NO2, O3, average annual temperature, and annual maximum temperature diurnal range had a significant positive effect on hospitalization rates for CVDs in Ganzhou City, with O3 concentration and average annual temperature having significant positive indirect spatial spillover effects. Winter and summer are the seasons with high hospitalization rate of cardiovascular diseases. County residents aged 61 and above are the higher-risk population that needs to pay more attention on for prevention and control of CVD in Ganzhou City, which exhibits significant spatiotemporal clustering. The urban areas of Zhanggong and Nankang in Ganzhou City are the key areas for prevention and control of CVD. The hospitalization rate of CVD in Ganzhou City is influenced by the aforementioned four environmental meteorological factors, with the annual maximum temperature diurnal range showing the most significant positive direct effect.

Worse long term prognosis in new onset HFpEF treated in HF clinics compared to HFrEF and HFmrEF patients; reflecting need for effective treatment in HFpEF. Results from the Stockholm PREFERS Study

Abstract Background/Introduction Few contemporary studies are available for long term outcome in patients with new onset heart failure (HF) of the three 3 phenotypes; HF with preserved ejection fraction (HFpEF), mildly reduced (HFmrEF) and reduced EF (HFrEF). The Stockholm PREFERS study (Preserved and Reduced Ejection Fraction Epidemiological Regional Study) included new onset HF patients between 2014-18. Purpose To report and compare long term outcomes for patients with new onset HFpEF, vs HFmrEF and HFrEF. Methods Totally 547 patients, HFpEF n = 137 (25%), HFmrEF n = 61 (11%) and HFrEF n = 349 (64%) were included and followed to end of August 2021. Time to total and cardiovascular (CV) mortality and CV mortality and first HF hospitalizations were compared by log rank test and Cox regression models. All patients were followed at hospital-based HF clinics for guideline directed information and treatment. HFpEF patients were recommended optimal treatment for comorbidities including hypertension, diabetes, ischemic heart disease and atrial fibrillation, and RAAS-inhibition or diuretics. Primary endpoint: CV mortality and HF hospitalizations. Results Mean age was 76 (HFpEF), 71 (HFmrEF) and 67 (HFrEF) years (p&amp;lt;0.001). Female sex 49% (HFpEF), 30% (HFmrEF) and 30% (HFrEF) (p&amp;lt;0.001). Median follow up was 3.8 years (IQR 3.0;4.7). Median EF was 55%, 45% and 30% in HFpEF, HFmrEF, and HFrEF, respectively (p&amp;lt;0.001). All-cause mortality was 13% (n = 70), and CV mortality 7.3% (n = 40). The overall CV hospitalization rate was 13.9% (n = 76). The combined endpoint of CV mortality and HF hospitalizations was 21.2% (n = 116) and higher in HFpEF compared to HFrEF (Univariate Hazard ratio (HR) 2.3 (95% CI 2.0-2.5, p&amp;lt;0.001) and vs HFmrEF (HR 2.5; 2.1-2.6, p&amp;lt;0.001). In analysis adjusted for age, sex and diabetes, HFpEF had worse outcome vs HFrEF and HFmrEF (HR 1.5; 0.2-2.0, p&amp;lt;0.05). Conclusions New onset HFpEF patients have worse long term outcome vs new onset HFrEF and HFmrEF patients. There is a need for effective evidence based treatment in HFpEF.Figure 1

Abstract 13874: N Terminal Pro-Brain Natriuretic Peptide Levels and Benefits of Chronic Total Occlusion Revascularization

Background: The management of chronic total occlusion (CTO) remains a subject of debate, as the mortality benefit from revascularization remains controversial. Whether specific populations gain a survival benefit from CTO revascularization remains unknown. Purpose: In this prospective study of patients with stable coronary artery disease (CAD), we investigated whether patients with CTO have higher adverse event rates and higher N terminal pro-brain natriuretic peptide (NT pro-BNP) levels than patients without CTO. We also investigated whether a higher NT pro-BNP level predicts adverse events in patients with CTO and whether those with elevated NT pro-BNP levels have a survival benefit from revascularization. Methods: In 2,253 patients with significant CAD ( &gt; 50% coronary luminal stenosis) undergoing cardiac catheterization, all-cause mortality, cardiovascular mortality and the composite of cardiovascular death, myocardial infarction and heart failure hospitalization rates were evaluated. Unadjusted and adjusted Cox proportional and Fine and Gray sub-distribution hazard models were performed to determine the association between NT pro-BNP level and event rates. Results: Patients with CTO had higher incident event rates by &gt; 20% and had higher NT pro-BNP levels than those without CTO (median 230.0 vs. 177.7 pg/mL, p=&lt;0.001). In patients with CTO, every doubling of NT pro-BNP level was associated with &gt; 25% greater risk of adverse events. In patients with elevated NT pro-BNP level (&gt; 125 pg/mL), CTO revascularization was associated with &gt;50% lower adverse event rates than those without CTO revascularization (adjusted cardiovascular death hazard ratio 0.24, 95% confidence interval 0.07 - 0.81). Among patients with low NT pro-BNP level (&lt; 125 pg/mL), event rates were similar in those with and without CTO revascularization. Conclusion: Patients with CTO have higher adverse event rates than those with significant CAD without CTO. NT pro-BNP levels are higher in patients with CTO and higher levels portend a worse prognosis. Moreover, NT pro-BNP levels can help identify individuals who may benefit from CTO revascularization.

Abstract 12331: Cardiovascular Hospitalizations and Mortality Among Young Adults Aged 25 to 64 Years in the United States

Introduction: Declines in cardiovascular mortality have stagnated in the United States since 2011. There is growing concern that these patterns may reflect worsening cardiovascular health in younger populations. However, little is known about how the burden of acute cardiovascular hospitalizations and mortality have changed in young adults. Aim: To evaluate cardiovascular hospitalizations (AMI, heart failure, ischemic stroke) and in-hospital mortality among adults 25-64 years, overall and by income-level, as well as population-level cardiovascular mortality. Methods: We determined age-standardized cardiovascular hospitalization rates from 2012 to 2019, and fit quasi-Poisson and quasi-binominal regression models to compare hospitalizations and mortality between low- and higher-income young adults. Results: Between 2012 and 2019, age-standardized AMI hospitalization rates increased modestly among young adults from 162.0 (161.4, 162.6) to 163.7 (163.3, 164.2) per 100,000 (p&lt;0.001). In contrast, there were significant increases in heart failure (163.9 [163.3, 164.5] to 231.5 [231.0, 232.0], p&lt;0.001) and ischemic stroke hospitalizations (92.3 [91.8, 92.8] to 110.2 [109.9, 110.6], p&lt;0.001). Across all 3 conditions, low-income adults experienced a more pronounced rise in hospitalizations, and the gap between the low- and higher-income groups widened (p-interaction&lt;0.001), while in-hospital mortality decreased for heart failure and stroke. Population-level cardiovascular mortality rates increased in the subgroup of young adults aged 45-64 years (162.5 to 168.3 per 100,000, p&lt;0.001), particularly in the low-income population. Conclusions: There has been an alarming increase in cardiovascular hospitalizations and population-level cardiovascular mortality among young adults over the past decade in the US, with evidence of widening disparities between low- and higher-income populations.

Antifibrotic effects of sodium-glucose cotransporter 2 inhibitors in patients with heart failure

Heart failure (HF) is an urgent public health problem worldwide. A fundamental role in HF progression is played by fibrosis, which causes structural myocardial and vascular changes. In this regard, it seems relevant to search for pathogenetically justified HF therapy, aimed at slowing the myocardial fibrosis progression. The results of EMPA-REG OUTCOME study showed that glucose-lowering drugs, namely sodium-glucose cotransporter 2 (SGLT2) inhibitors, have a positive effect on HF course, reducing cardiovascular mortality and hospitalization rate of patients for decompensated HF. Large-scale studies showed the antifibrotic properties of SGLT2 inhibitors. The review article presents the results of experimental studies on the use of SGLT2 inhibitors in animals. A number of mechanisms for the implementation of the antifibrotic properties of SGLT2 inhibitors affecting the cardiovascular system have been described. It seems relevant to further study SGLT2 inhibitors in clinical trials in order to identify and correct the pathogenetic mechanisms of myocardial fibrosis.

Morbidity in patients with chronic adrenal insufficiency - cardiovascular risk factors and hospitalization rate compared to population based controls

Morbidity in patients with chronic adrenal insufficiency - cardiovascular risk factors and hospitalization rate compared to population based controls