Retrospective Analysis Research Articles

In February 2024, South Korea experienced a major healthcare disruption following the mass resignation of approximately 86% of resident physicians in protest of a government-led medical reform. In response, the government introduced a policy that centralized high-complexity operations in tertiary hospitals and redirected low-complexity procedures to general hospitals and clinics. However, the nationwide impact of this policy on surgical distribution and volume remains unclear. A retrospective analysis was performed using nationwide claims data from the Korean National Health Insurance Service, accessed via the Health Insurance Review and Assessment Service (HIRA). General thoracic surgery volumes from February to July 2023 (pre-crisis) were compared to the same period in 2024 (post-crisis) across tertiary hospitals (n=47), general hospitals (n=331), and smaller hospitals/clinics (n=37,888). Surgical complexity was categorized using relative value units (RVUs), which reflect procedural intensity and resource requirements. Overall thoracic surgery volume declined by 15% during the crisis. Tertiary hospitals reported a 22% reduction in procedures, while general hospitals and clinics recorded increases of 9% and 92%, respectively. High-complexity operations (≥30,000 RVUs) at tertiary hospitals fell by 22%, with only partial compensation by general hospitals. Low-complexity procedures (<30,000 RVUs) also decreased at tertiary hospitals but were not adequately redistributed. The 2024 healthcare crisis caused significant disruption to surgical capacity in South Korea. Although some redistribution occurred, the government's reallocation strategy did not fully achieve its intended goals. Recovery of pre-crisis surgical capacity, especially for high-complexity procedures, remains incomplete.

Introduction: Heart failure with preserved ejection fraction (HFpEF) commonly coexists with end-stage renal disease (ESRD, together increasing cardiovascular risk [1,2,3,4,5]. While SGLT2 inhibitors (SGLT2i) reduce HF hospitalizations and cardiovascular death in trials like EMPEROR-Preserved and DELIVER, patients with very low eGFR or on dialysis were excluded [6,7]. While trials are ongoing, data on SGLT2i in this high-risk population remain limited. Hypothesis: SGLT2i is associated with improved cardiovascular outcomes in HFpEF patients with ESRD. Methods: We conducted a retrospective cohort analysis of deidentified, aggregate patient data from the TriNetX research network. Patients with HFpEF and ESRD between age 18-85 were included. Patients were stratified by SGLT2i use and propensity matched by demographics, baseline cardiac risk factors, DM medications, and etiology of HFpEF. Outcomes were evaluated within 18-months from the HFpEF + ESRD diagnosis. Primary endpoints included acute decompensated heart failure (ADHF) events, all-cause mortality, hospitalizations for any cause, and emergency department visits for any cause. Z-tests were used to calculate risk difference and Cox regression was used to compute hazard ratios over an 18-month period. Results: The study cohort included 7,238 patients (n = 3,619 per group; mean age 65.3 ± 11.0 years; 40.9% female; 47.3% White). In time-to-event analysis, the SGLT2i group had reduced risk of all-cause mortality (HR=0.49, 95%CI 0.43-0.55, p&lt;0.001) and ADHF events (HR=0.72, 95%CI 0.67-0.77, p &lt; 0.001). At 18 months SGLT2i group had lower rates of all-cause mortality (11.8% vs. 24.4%; RD -12.6%, p &lt; 0.001), ADHF events (39.8% vs. 50.1%; RD -10.4%, p &lt; 0.001) [Figure 1], hospitalizations (51.3% vs. 65.0%; RD -13.8%, p &lt; 0.001) [Figure 1], and at least one ED visit (35.9% vs. 40.6%; RD -4.7%; p &lt; 0.001). Conclusion: In this retrospective propensity-matched analysis, SGLT2i use in HFpEF with ESRD was associated with reduced mortality, ADHF, hospitalizations, and ED visits. Further investigation is needed to clarify mechanisms and guide clinical recommendations.

Background: Dynamic changes in serum osmolality may reflect fluid imbalance, renal dysfunction, and neurohormonal activation, all of which are relevant in acute myocardial infarction (AMI). However, the prognostic significance of osmolality trajectories in AMI remains unclear. Objective: This study aims to investigate the predictive utility of dynamic osmolality trajectories with in-hospital clinical events in AMI. Methodology: A retrospective analysis is performed on the MIMIC-IV database. We included 2257 patients with AMI. The median age was 72.0 years (IQR 64.0–81.0), and 1,381 (61.18%) were male. Osmolality is calculated for each day from day 1 to at least day 7 of hospitalization. A Group-based trajectory modeling (GBTM) analysis was performed to identify distinct osmolality trajectories. Our primary outcome is in-hospital mortality, and secondary outcomes are the incidence of congestive heart failure and the incidence of AKI during hospital stay. The association between these trajectories and primary and secondary outcomes was assessed by Firth logistic regression analysis and further adjusted for potential confounders. Results: In GBTM analysis, we identified five different trajectories (trajectory 1: low stable-normal, trajectory 2: rapid-increasing, trajectory 3: moderate-increasing, trajectory 4: rapid-decline, trajectory 5: slow-decline). Trajectory 1 is taken as a reference for analysis. After adjusting for covariates, age, gender, temperature, respiratory rate, history of hypertension, hyperlipidemia, cardiogenic shock, AKI, COPD, status of PCI, CABG, beta-blocker, ACEI, and calcium channel blocker, trajectory 2 was strongly associated with higher in-hospital mortality (OR = 8.76, 95% CI: 3.95–19.75; p &lt; 0.001), followed by trajectory 3 (OR = 1.73, 95% CI: 1.20–2.50; p = 0.004). No significant associations were observed for Class 4 (OR = 0.89, 95% CI: 0.33–2.16; p = 0.81) or Class 5 (OR = 1.56, 95% CI: 0.97–2.49; p = 0.07). No significant association was found between osmolality trajectories and the incidence of CHF. Trends toward increased risk appeared in trajectory 5 (OR = 1.41, p = 0.051) and 3 (OR = 1.29, p = 0.055). All osmolarity trajectories were associated with higher AKI risk. Trajectory 4 (OR = 6.26), trajectory 2 (OR = 5.02), trajectory 3 (OR = 3.92), and trajectory 5 (OR = 3.70) (all p &lt; 0.001). Conclusion: Dynamic changes in plasma osmolality are a strong predictor of in-hospital clinical events in AMI patients.

Introduction: Although both SGLT2 inhibitors and GLP-1 agonists have shown cardiovascular benefits in patients with type 2 diabetes mellitus (T2DM), their comparative effectiveness in heart failure, particularly when stratified by systolic and diastolic subtypes, remains uncertain. This study aims to provide real-world data to aid clinical decision making in this challenging clinical context. Methods: We retrospectively analyzed data from the TriNetX global federated health research network. Included were patients &gt;18 years with T2DM and heart failure who initiated either SGLT2 inhibitors or GLP-1 agonists. Cohorts were stratified by systolic and diastolic heart failure. Outcomes were assessed from 1 month to 1 year post-initiation. Propensity matching was done for age, gender, obesity, cardiovascular medications, HbA1c, and pro-BNP levels. Major adverse cardiac event (MACE) was defined as a composite of cardiac mortality, non-fatal cerebrovascular events, and non-fatal myocardial infarction. The renal composite was defined as: end stage renal disease requiring dialysis OR GFR &lt;65 mL/min/1.73 m 2 OR creatinine &gt;1.2 mg/dL. Risk difference (RD) with 95% CI was calculated using a two-proportion Z-test. Results: Systolic heart failure: 56,194 patients analyzed post-matching. GLP-1 users had lower rates of acute on chronic heart failure (RD=3.8%, CI=0.033–0.043, p&lt;0.0001), MACE (RD=3.2%, CI=0.027–0.036, p&lt;0.0001), and all-cause mortality (RD=1.1%, CI=0.008–0.013, p&lt;0.0001). SGLT2 inhibitors were superior for renal outcomes (RD=1.0%, CI=0.016–0.004, p&lt;0.0001). More GLP-1 users achieved HbA1c &lt;6.5% (RD=2.6%, CI=0.031–0.022, p&lt;0.0001). Diastolic Heart Failure: 72,109 patients analyzed. GLP-1 users again showed better outcomes: acute on chronic heart failure (RD=5.5%, CI=0.050–0.060, p&lt;0.0001), MACE (RD=2.8%, CI=0.024–0.031, p&lt;0.0001), and all-cause mortality (RD=1.4%, CI=0.012–0.016, p&lt;0.0001). SGLT2 inhibitors had better renal outcomes (RD=1.0%, CI=0.015–0.005, p&lt;0.0001), while GLP-1 users more frequently achieved HbA1c &lt;6.5% (RD=4.5%, CI=0.049–0.041, p&lt;0.0001). Conclusions: GLP-1 agonists demonstrate superior cardiovascular protection and lower all-cause mortality compared to SGLT2 inhibitors in patients with T2DM and heart failure, across both systolic and diastolic subtypes. In contrast, SGLT2 inhibitors show greater benefit in preserving renal function regardless of heart failure phenotype. Additionally, GLP-1 agonists were associated with improved glycemic control.

Background: The left ventricular epicardium is a common site of origin (SOO) among patients with idiopathic premature ventricular complexes (PVCs) undergoing catheter ablation procedures. Less is known about epicardial PVC ablation among patients with structural heart disease and cardiac scar. Objective: To report on the presence and impact of cardiac scar among patients with epicardial PVCs undergoing ablation procedures. Methods: In a retrospective analysis, patients with epicardial PVCs and delayed enhancement cardiac magnetic resonance imaging were included. Acute and long-term procedural outcomes were examined and stratified by the presence or absence of cardiac scar. Results: Twenty-nine patients were included (male 17/29(59%), age 55±14years, ejection fraction 48±12%, PVC burden 25±12%, ischemic cardiomyopathy (CM) n=3, non-ischemic CM n=7, PVC induced CM n=5). The SOO was left ventricular summit (n=20), great cardiac vein (n=2), cardiac crux (n=4), or basal anterolateral epicardium (n=3). Ablation within the CVS was limited by proximity to the coronary arteries (n=16), inaccessibility of ablation catheter (n=5), or elevated baseline impedance (n=2). LGE-CMR scar was present at the arrhythmia SOO in 14/29(48%) patients. LGE-CMR was detected in 4/15 (27%) patients with normal ejection fraction and no previously known structural heart disease. There were no differences in procedural, radiofrequency, or fluoroscopy times between patients with and without scar (p&gt;0.05). Ablation was successful in 20/29(69%) patients, the post-ablation PVC burden was 8±6% with no differences among those with or without cardiac scar (P&gt;0.05). Conclusion: Epicardial PVCs may be encountered in patients with and without structural heart disease, with LGE-CMR located at the PVC SOO in 48% of patients. Routine LGE-CMR detected cardiac scar in 27% of patients with epicardial PVCs and no previously known structural heart disease. Ablation is frequently limited by the proximity of the coronary arteries to the PVC SOO and challenges navigating within the CVS. Mapping and ablation in multiple cardiac chambers is often required to attain procedural success.

Background: Chronic Kidney Disease (CKD) and Ischemic Heart Disease (IHD)-related mortality is a significant burden among US adults. This study investigates trends in CKD and IHD-related mortality in adults aged 25 and older focusing on overall, geographic, and racial/ethnic disparities from 1999 to 2020. Methods: A retrospective analysis was conducted using death certificate data from the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region. Results: CKD and IHD-related mortality accounted for 552171 deaths among US adults aged 25+. Most deaths occurred at a medical facility (45.30%) and the patient’s home (19.90%). The overall AAMR decreased from 13.1 in 1999 to 10.8 in 2020, with an AAPC of -1.1378 (95 % CI: -4.1816 to 2.0028, p = 0.473276). It is worth noting from 2015 to 2020 the APC has been 6.1116 (95 % CI: 2.1479 to 10.2291, p = 0.005627) suggesting an acute rise. Racial/ethnic disparities showed the highest AAMRs in Blacks (19), followed by American Indians (15.7), Hispanics (12), Whites (10.6), and Asians (9.9). Over the years, racial stratification showed a decrease in mortality among all races. The most significant decrease was in Asians (AAPC: -4.0767, p = 0.000034) and Hispanics (AAPC: -3.8230, p = 0.000122). Geographically, AAMRs ranged from 5.6 in Nevada to 18.3 in West Virginia, with the highest mortality observed in the Midwest (AAMR: 12.4) followed by the West (AAMR: 11.4). Over the years, the mortality has been decreasing in all the regions with the most significant decline being in the Northeastern (AAPC of -2.3167, p = 0.000741) followed by the Western states (AAPC of -1.8062, p = 0.046572). Nonmetropolitan areas exhibited higher AAMRs (12.2) than metropolitan areas (11.4). Overall trends (1999 to 2020) show a decline in mortality for both metro and non-metro however from 2015 to 2020 the mortality has increased in both areas with a sharper increase in the non-metropolitan areas (APC: 7.2592, p = 0.001435) than in the metropolitan areas (APC: 5.9817, p = 0.008059). Conclusion: We believe better cardiorenal interventions are required to combat this acute rise of the IHD burden in CKD patients with a special focus on the Black and American Indian populations, the Midwest, and non-metropolitan areas.

Background: Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are guideline-directed therapy for heart failure with reduced ejection fraction (HFrEF), yet their utility in patients supported with left ventricular assist devices (LVADs) remains understudied. This study examined the association between SGLT2i use and clinical outcomes in LVAD recipients over a standardized 1-year follow-up. Methods: We queried the TriNetX Global Collaborative Network to identify adult patients with an LVAD (ICD-10 Z95.811 and procedure codes for insertion/revision). Patients were stratified based on exposure to SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin) post-implant. The primary outcome was all-cause mortality at 1 year. Secondary outcomes included hospitalizations, acute kidney injury (AKI), bloodstream infections (MSSA/MRSA), and device-related complications. Propensity score matching (1:1) was performed on demographics, comorbidities, and background medical therapy. Kaplan-Meier survival analysis was used to compare time-to-event outcomes. Results: After matching, 711 patients were included in each cohort. At 1 year, mortality was significantly lower in the SGLT2i group (8.0% vs. 24.2%; HR: 0.28 [95% CI: 0.21–0.38]; p &lt;0.001). SGLT2i use was also associated with reduced hospitalization (62.3% vs. 70.7%; HR: 0.59; p &lt;0.001), AKI (43.6% vs. 58.2%; HR: 0.56; p &lt;0.001), and bloodstream infections (10.7% vs. 15.7%; HR: 0.59; p =0.002). The SGLT2i group had a higher rate of device-related infection (26.7% vs. 20.3%; HR: 1.20; p =0.099), but this did not reach statistical significance in survival analysis. Conclusion: In this large real-world analysis, SGLT2 inhibitor use in LVAD patients was associated with markedly reduced 1-year mortality and improved cardiorenal and infectious outcomes. These findings suggest a potential role for SGLT2i in optimizing medical therapy in LVAD recipients, a population not included in pivotal HF trials. This retrospective analysis may be affected by residual confounding despite rigorous matching. Medication timing, dose, and adherence were not available, and cause-specific mortality could not be assessed. While a 1-year follow-up standardized time at risk, long-term effects remain unknown. Prospective validation is needed.

Background: Heart failure and vascular diseases remain leading causes of death in the United States. Although mortality declined in the early 2000s, recent years have raised concerns about a resurgence, particularly in certain demographic and geographic groups. Research Question: We investigated whether national mortality trends for heart failure and vascular disease in adults aged ≥55 years have shifted over time and whether these changes vary across demographic and geographic subgroups. Objective: To assess temporal trends in mortality from heart failure and vascular disease among U.S. adults aged ≥55 years from 1999 to 2019 and examine disparities by sex, race, region, and urbanization to inform targeted interventions. Methods: Death certificate data from the CDC WONDER database were analyzed for adults aged ≥55 years with heart failure (ICD-10: I50) and vascular disease (ICD-10: I70–I78) listed as causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Joinpoint regression was used to estimate annual percent changes (APCs) with 95% confidence intervals (CIs). Trends were stratified by demographic and geographic variables. Statistical significance was defined as p &lt; 0.05(*). Results: A total of 264,577 deaths were recorded, most occurring in medical facilities. APCs declined most among women [2001–2012; −6.77* (CI: −7.26 to −6.28)], non-Hispanic Whites [2001–2012; −6.18* (CI: −6.60 to −5.77)], the Midwest [2001–2012; −7.05* (CI: −7.74 to −6.35)], and urban areas [2001–2012; −6.14* (CI: −6.64 to −5.63)]. In contrast, rates rose among men [2012–2019; 1.92* (1.00 to 2.85)], Whites [2012–2019; 1.48* (0.66 to 2.31)], the South [7.68* (0.39 to 15.50)], and urban residents [1.68* (0.72 to 2.64)]. In 2019, AAMRs were highest among men [19.4 (18.96–19.88)], Black individuals [16.0 (15.12–16.89)], the West [17.4 (16.84–18.02)], and rural areas [17.6 (16.94–18.30)]. West Virginia had the highest state-level AAMR [29.5 (28.48–30.57)]. Conclusion: After a decade of decline, mortality from heart failure and vascular disease among U.S. adults aged ≥55 is rising. The increase is most evident in men, White and Black populations, urban centers, and southern and western regions. The concentration of deaths in institutional settings highlights the need for early prevention and expanded outpatient care. Targeted public health strategies are urgently needed to reverse these trends.

Background: Adults with congenital heart disease (ACHD) are surviving longer due to medical advancements, but remain at risk for complications like heart failure and sudden cardiac death. Lifelong follow-up in specialized clinics is critical, though adherence is often low. Socioeconomic status (SES) is known to influence healthcare access; however, its impact on ACHD populations remains understudied. Understanding SES barriers to clinic attendance could inform strategies to enhance outcomes in this group. Hypothesis: We investigated whether SES indicators—smoking, alcohol use, drug use, marital status, employment, and insurance—predict clinic follow-up among ACHD patients. We hypothesized that socioeconomic factors would significantly influence adherence to follow-up. Methods: A retrospective analysis was conducted on 2,069 adults with ACHD using electronic health records from a single academic health system. The primary outcome was attendance at one follow-up visit at the ACHD clinic (Yes/No). Predictor variables were binarized for analysis. Logistic regression models were used to assess both unadjusted and adjusted associations, with interaction terms evaluated based on theoretical rationale. Model fit was assessed using AIC, lack-of-fit tests, and multicollinearity diagnostics. Results: Out of 2,069 patients, only 463 (22.4%) attended follow-up. In adjusted models, non-smokers had greater odds of follow-up (OR 0.49; 95% CI: 0.36–0.66; p &lt; 0.0001). Patients without partners were more likely to follow up than those in relationships (OR 0.39; 95% CI: 0.29–0.52; p &lt; 0.0001). Insurance coverage correlated positively with follow-up (OR 1.45; 95% CI: 1.08–1.95; p = 0.015). Drug use, alcohol use, and employment were not independently linked to follow-up, but significant interaction effects were found between smoking and alcohol use (p = 0.009) and smoking and marital status (p = 0.030). Conclusion: Follow-up care in ACHD patients is often inadequate, affected by socioeconomic and behavioral factors. Smoking, lack of insurance, and relationship status are associated with a lower likelihood of follow-up. Interactions between smoking, alcohol use, and relationship status complicate their effects. Findings highlight the need for multidisciplinary interventions, including patient education, social support, and care navigation, to enhance engagement and outcomes in the ACHD population.

Background: This study investigates trends in acute MI-related mortality in adults aged 65 and older with CKD, focusing on overall, geographic, and racial disparities from 1999 to 2020. Methods: A retrospective analysis was conducted using death certificate data from the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region. Results: Acute MI in older (65+) patients with CKD accounted for 98349 deaths in the US. Most deaths occurred at a medical facility (57.30%). The overall AAMR for acute MI in older CKD patients decreased from 14.4 in 1999 to 8.5 in 2020, with an AAPC of -3.0286 (95 % CI: -4.2853 to -1.7555, p = 0.000083). Overall, the burden is higher in males (AAMR: 14.9) than in females (AAMR: 7.9) . Over the years mortality declined in both males (AAPC: -2.9094, 95% CI: -4.0724 to -1.7323, p = 0.000053) and females (AAPC: -3.2648, 95% CI: -4.5673 to -1.9445, p = 0.000054). Racial/ethnic disparities showed the highest AAMRs in Blacks (20.8), followed by American Indians (15.4), Hispanics (13.3), Asians (12.1), and Whites (9.3). Over the years, racial stratification showed a decrease in mortality in all races. The most significant decrease was in Blacks (AAPC: -5.5259, p &lt; 0.000001) and Asians (AAPC: -5.3397, p &lt; 0.000001). Geographically, AAMRs ranged from 4.1 in Nevada to 17.3 in North Dakota, with the highest mortality observed in the West (AAMR: 11.1) followed by the Midwest (AAMR: 10.9) . The mortality has been decreasing in all the regions with the most significant decline being in the Northeast (AAPC of -3.3588, p = 0.000031). Nonmetropolitan areas had higher AAMRs (11.8) than metropolitan areas (10.5). Overall trends show a decline in mortality for nonmetropolitan (AAPC of -1.5479, p = 0.028573) and metropolitan areas (AAPC of -3.3185, p = 0.000024). Conclusion: The overall mortality burden from acute MI in patients above 65 with CKD has declined over the years. Males have a much higher burden than females with a decline in both sexes over the years. Racial stratification shows a higher burden on Blacks and American Indians and a decline in all races over the years. The Western states bear a significantly higher burden. Non-metropolitan areas have a higher burden. We believe these trends and disparities should be addressed via targeted policymaking.

Background: Coronary artery disease and sepsis are common conditions, and both contribute significantly to mortality among adults in the United States. This study investigates trends and demographic disparities in mortality rates due to CAD in septic patients from 1999 to 2023. Methods: A retrospective analysis was conducted using CDC WONDER data to investigate the trends in mortality associated with CAD (ICD codes: I20-I25) in patients with sepsis (ICD A02.1, A20.7, A22.7, A26.7, A32.7, A42.7, A40–A41, B37.7) among adults aged ≥ 25 years. Joinpoint regression was used to calculate age-adjusted mortality rates (AAMR) per 100,000 individuals and corresponding annual percentage changes (APC) with 95% confidence intervals. Data were stratified by year, sex, race, age, region, and state. Results: From 1999 to 2023, CAD in septic individuals caused 503,189 deaths . The overall AAMR declined from 10.5 to 7.9 (AAPC: -1.2%, 95% CI: -2.0 to -0.4, p &lt; 0.003). Men had higher AAMRs than women (men: 13.3; women: 8.8) in 1999 to (men: 11.0; women: 5.6) in 2023, with decline for both sexes (Men: AAPC: -1.2%, p &lt; 0.006; Women: AAPC: -1.8%, p&lt;0.001). AAMRs by race decreased from 1999 to 2023: NH Blacks (16.9 to 9.1), NH American Indians (9.2 to 9.3), Hispanics (12.1 to 7.2), NH Asians (8.6 to 5.4), NH Whites (9.9 to 8.0), with NH Blacks showing the largest decline (AAPC: -2.63%, p &lt; 0.001). AAMRs remained stable in adults 25–44 (0.2 to 0.3) and declined modestly in ages 45–64 (3.7 to 3.1) but dropped significantly in those ≥65 (47.1 to 34.3; AAPC: -1.33%, p = 0.002). Regionally, AAMR declined in the Northeast (13.0 to 6.7), Midwest (9.6 to 7.1), South (11.0 to 9.1), and West (8.2 to 7.6), with the steepest decline in the Northeast (AAPC: -2.7%, p &lt; 0.000001). State-level AAMRs ranged from 1.4 (Maine) to 14.4 (Kentucky) in 2023. Conclusion: This analysis reveals significant demographic and racial disparities in mortality due to CAD among adults with sepsis in the United States. Despite an overall decline in AAMR over the past two decades, the burden remains disproportionately high among older adults, men, and NH Black individuals, with striking regional variation. These findings underscore the urgent need for targeted, equity-focused interventions to address these disparities and improve coronary health outcomes in vulnerable septic populations.

Introduction: Cerebrovascular Disease accounted for more than 5 million deaths in last two decades in the U.S. population. The combined impact of cerebrovascular disease and Alzheimer’s on mortality remains insufficiently demonstrated. This study seeks to evaluate temporal shifts in mortality of adult U.S. population with dual effect of these conditions. Research Question: How have mortality trends among the adult U.S. population evolved from 1999 to 2023 across various demographic and geographic factors? Methods: A retrospective analysis was conducted using CDC WONDER database in adults aged &gt;55 years with cerebrovascular disease (ICD-10: I60-I69) as major cause and Alzheimer’s (G30) as a contributing factor. Age-adjusted Mortality rates per 100,000 population were calculated across different demographic and geographic variables. We assessed Annual percentage changes (APCs) using Bayesian Information Criterion (BIC) approach in Joinpoint regression (JPR) analysis. ARIMA models with Box-Cox transformation were fitted after ADF/KPSS tests. Results: Both conditions reported 72,991 deaths from 1999-2023 in adults aged &gt;55 years with mean annual AAMR of 4.44. The rate is projected to decline to 2.24 (95% CI: -2.14 to 4.07) till 2030 (RMSE: 0.278; Ljung-box p: 0.817). Annual mortality trends displayed consistent decline over the study period with most significant from 2020 to 2023 with APC value of -9.39 (95% CI: -16.71 to -4.82; p=0.00). Females accounted for 70.1% of total deaths, showing an unusual inflection from 2013-20 with APC of 1.86 (95% CI: 0.14-7.47; p=0.03). Male, non-Hispanics and Whites exhibited notable decline in mortality trends with APCs of -10.6 (95% CI: -17.08 to -6.79; p=0.00), -8.89 (95% CI: -16.1 to -4.7; p=0.00) and -9.03 (95% CI: -15.79 to -4.47; p=0.00) from 2020-2023, respectively. CENS R2: Midwest and CENS R3: south observed significant down-trending curve in mortality trends with APC of -5.76(95% CI: -11.86 to -2.16; p=0.008) and -13.79(95% CI: -19.64 to -9.08; p=0.00) from 2020-2023, respectively. Noncore (non-metro: 5.73) and Vermont (7.5) stood highest in terms of AAMR across the whole study period. Among all deaths, 52.32% deaths occurred in nursing homes. Conclusion: Our study revealed consistent decline in mortality trends over the study period, however, significant disparities exist in females, 2013-Urbanization levels and states which suggest the implementation of targeted interventions and sustained healthcare strategies.

Introduction: Thoracic radiotherapy plays a fundamental role in the treatment of various malignancies, including breast cancer, lung cancer, and lymphoma. However, thoracic irradiation has been associated with an elevated risk of cardiovascular complications, particularly coronary artery disease. Despite this known association, limited data exists regarding how prior thoracic irradiation influences clinical outcomes in patients hospitalized with acute myocardial infarction (AMI). This study aims to evaluate the effect of prior thoracic irradiation on clinical outcomes in patients hospitalized with AMI. Methods: A retrospective analysis was conducted using the National Inpatient Sample database from 2017 to 2022. ICD-10 codes were used to identify patients admitted with a primary diagnosis of “Acute Myocardial Infarction.” Of these patients, further stratification was performed to identify patients with a prior history of radiation therapy to the thorax. Multivariate logistic regression analysis was performed to calculate adjusted odds ratios (aOR) for binary outcomes, accounting for covariates, while linear regression was employed for continuous outcomes. The primary outcome of interest was in-hospital mortality, while secondary outcomes included total cost of hospitalization and length of stay. Results: A total of 3,705,829 patients admitted for a primary diagnosis of AMI were identified. Of these patients, 4749 were identified as having previous thoracic irradiation. Logistic regression showed a significantly increased risk of in-hospital mortality for patients with prior thoracic irradiation (aOR: 1.30, 95% CI: 1.02-1.66, p=.036) when compared to those without. Linear regression showed lower adjusted total hospitalization costs by $25,270.34 (95% CI: -32,269.37– -18,271.31, p&lt;.001) as well as a decrease in adjusted length of stay by 1.05 nights (95% CI: -1.33 – -0.77, p&lt;.001). Conclusion: Our findings reveal that patients with a history of thoracic irradiation had a significantly increased risk of in-hospital mortality following AMI. Potential contributors to this increased risk include radiation-induced microvascular dysfunction, accelerated atherosclerosis, and myocardial fibrosis. Further research is needed to better understand these mechanisms and to develop tailored management strategies aimed at improving survival outcomes in this high-risk population.

Background: POAF is a prevalent complication, occurring in 30-50% of patients undergoing cardiac surgery [1]. Although women are less likely to develop this complication, women with POAF have an elevated long-term mortality rate compared to men [2]. The pathogenesis of POAF is multifactorial, with local and systemic inflammation playing key roles [3]. Resolvins mediate the active process of inflammatory resolution, which aims to terminate inflammation and restore tissue function [4]. We hypothesize that inflammatory resolution is dysregulated in patients with POAF, with a stronger association observed in female patients. Methods: A retrospective analysis was conducted in a cohort of 405 patients who underwent open-heart surgery with CPB. Resolvin D1 and D2 serum levels were measured in blood samples collected preoperatively, postoperatively, and daily in the ICU. Medical records were reviewed for POAF diagnosis. After exclusion of patients with longstanding AF, patients undergoing heart transplantation, and those with incomplete resolvin measurements, the analysis included 319 patients. Due to censored resolvin data and repeated measurements, a mixed-effects Tobit regression was conducted, using the statistical software “R”. The regression was adjusted for known POAF risk factors. An interaction term was used to assess whether the association between POAF and RvD1 or RvD2 levels varies by gender. Results: In this cohort, 51% of patients developed POAF during hospitalization, with a comparable incidence observed in male and female patients. POAF patients had significantly higher levels of RvD1 (MR:1.19, 95% CI: 1.09-1.31, p&lt;0.001) and significantly lower levels of RvD2 (MR: 0.80, 95% CI: 0.72-0.90, p&lt;0.001) during the perioperative period when compared to patients without POAF. The increase in RvD1 associated with POAF was 22% smaller in males than in females (p=0.012). A marginal interaction between POAF and sex was observed for RvD2, with males showing a slightly greater difference (p=0.054). Conclusions: The findings of our study suggest that inflammatory resolution is dysregulated in patients with POAF, marked by higher RvD1 and lower RvD2 levels. The association between POAF and RvD1 is stronger in females, indicating an exaggerated RvD1 response to POAF. Further research is needed to determine whether this sex-specific alteration in the resolution pathway contributes to the observed differences in long-term mortality between male and female POAF patients.

Background: Studies have revealed Gender-based differences in the management and outcomes of myocardial infarction (MI), with women often facing a poorer prognosis compared to men. Our study aims to analyze the gender based disparities in the clinical outcomes and the overall utilization of mechanical circulatory support (MCS) devices among patients with myocardial infarction (MI). Methods: A retrospective analysis was carried out using data from the National Inpatient Sample, focusing on patients admitted with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) between 2016 and 2022. The study examined the use of mechanical circulatory support (MCS) devices, which included intra-aortic balloon pumps (IABP), percutaneous left ventricular assist devices (pLVAD), and extracorporeal membrane oxygenation (ECMO). It also assessed in-hospital mortality rates, stratified by Gender, among patients with myocardial infarction. Results: Among 2,604,638 patients hospitalized with myocardial infarction, significant disparities were observed between men and women in both clinical presentation and management. Women were more likely to present with NSTEMI and had a higher prevalence of premature coronary artery disease (34.8% vs. 20.8%, p &lt;0.001). In contrast, men were more likely to present with STEMI (27.1% vs. 19.7%, p &lt;0.001). Despite the higher prevalence of NSTEMI in women, they underwent fewer invasive procedures compared to men, including coronary angiography (68.5% vs. 76.4%, p &lt;0.001), percutaneous coronary intervention (44.6% vs. 56.6%, p &lt;0.001), and coronary artery bypass grafting (6.5% vs. 11.0%, p &lt;0.001). The overall use of mechanical circulatory support devices in men vs women (6.1% vs 4.2%, p &lt;0.001), with intra-aortic balloon pumps (IABP)(4.4% vs 3.1%, p &lt;0.001), extracorporeal membrane oxygenation ECMO (0.3% vs 0.2%, p &lt; 0.001), and percutaneous left ventricular assist devices (pLVAD)(1.8% vs 1.2%, p &lt;0.001), use lower in women. Notably, in-hospital mortality was significantly higher among women compared to men (5.5% vs. 4.7%, p &lt;0.001). Conclusion: There are significant gender based disparities in the management and outcomes of myocardial infarction. Women are less likely to receive invasive procedures and advanced device support, even though they experience higher in-hospital mortality rates. These findings highlight the urgent need for more equitable care strategies to address these inequities and to improve outcomes.

Background: Hypertensive emergency (HE) is a life-threatening condition that poses a significant risk for increased morbidity and mortality. It is not known with certainty how a state of declining health, namely with frailty, affects in-hospital outcomes for patients admitted for HE. Herein, we aim to quantify the impact of frailty on in-hospital outcomes for adults admitted for HE and determine whether this association remains consistent across all adult age groups. Methods: Retrospective analysis was conducted using the National Inpatient Sample database from 2016 to 2022 with STATA18 statistical software. ICD-10 codes were used to identify patients with a primary diagnosis of HE and age at admission. Frailty was assessed using the Hospital Frailty Risk Score, with a score &gt;5 indicating frailty. Multivariate logistic and linear regression analysis was performed to calculate adjusted odds ratios (aOR) while accounting for covariates. The impact of frailty was analyzed for all adults admitted with HE, with subgroup analyses performed for younger (&lt;65 years) and older (≥65 years) patients. Results: Out of 337,335 patients admitted for HE, 48.6% were classified as frail and 51.4% classified as non-frail. The frail group had a higher average age (60.23 vs 57.93; p&lt;.001) and were predominantly female (53% vs 47%; p&lt;.001). Logistic regression showed frail patients had a significantly higher risk of in-hospital mortality (aOR 6.755, CI 4.577-9.967, p&lt;.001), where similar trends can be seen for additional outcomes such as intracerebral hemorrhage, acute kidney injury, and GI hemorrhage demonstrated in Table 1. Moreover, linear regression showed frail patients experienced an increased adjusted mean length of stay by 1.812 nights (95% CI, 1.751-1.874; p&lt;.001) and higher adjusted mean total charges by $17,649.41 (95% CI, 16,825.38-18,473.44; p&lt;.001). Subgroup analysis stratified by age 65 demonstrated that frailty was still significantly associated with worse outcomes in both age groups (Table 2). Conclusion: Clinical outcomes are significantly worse with higher resource utilization in frail patients versus non-frail patients admitted for HE. This study demonstrates that the impact of frailty transcends chronological age and challenges the notion that frailty is limited to geriatric populations. Clinicians should be vigilant about assessing the role of frailty in HE to gain crucial clinical insight to enhance patient well-being and appropriate resource allocation.

Background: Patients undergoing percutaneous left atrial appendage occlusion (LAAO) for atrial fibrillation often have comorbid diabetes and obesity. GLP-1 receptor agonists provide benefit in patients with these comorbid conditions. The impact of GLP-1 receptor agonists on outcomes in patients undergoing LAAO occlusion has not been previously assessed. Research Questions: GLP-1 receptor agonists may contribute to improved outcomes in patients undergoing percutaneous LAAO compared to those not receiving GLP-1 therapy. Methods: A retrospective analysis using the TriNetX network identified adults who underwent LAAO over the past 20 years. Patients were grouped as GLP-1 receptor agonist users or non-users within three months before or any time after the procedure. The primary outcome was a three-component MACE, comprising all-cause mortality, stroke, and major bleeding. Secondary outcomes included myocardial infarction and heart failure exacerbation. These were assessed using odds ratios (ORs), with statistical significance at p &lt; 0.05. Kaplan–Meier curves and log-rank tests were used for time-to-event survival analysis. Results: A total of 4,382 patients (2,191 in each group) were included after propensity score matching. The mean age was 71.6 years, with 57% identified as male. At one-year follow-up, patients in the GLP-1 group exhibited significantly lower odds of MACE (OR: 0.64; 95% CI: 0.56–0.73; p &lt; 0.001). Kaplan–Meier analysis for MACE supported these findings, showing a hazard ratio of 0.66 (95% CI: 0.59–0.74) with a log-rank p-value of &lt;0.001 (Figure 1). GLP-1 users also had significantly reduced odds of all-cause mortality (OR: 0.42; 95% CI: 0.31–0.56; p &lt; 0.001), major bleeding (OR: 0.64; 95% CI: 0.54–0.74; p &lt; 0.001), myocardial infarction (OR: 0.78; 95% CI: 0.62-0.97; p=0.025), and heart failure exacerbation (OR: 0.65; 95% CI: 0.56–0.77; p &lt; 0.001). However, no significant differences were observed in the odds of stroke (OR: 0.87; 95% CI: 0.70–1.09; p=0.220) between the two groups (Figure 2). Conclusions: GLP-1 receptor agonist therapy was associated with a significantly lower risk of MACE, primarily driven by reductions in mortality and bleeding. These findings suggest a beneficial role for GLP-1 receptor agonists in patients undergoing percutaneous LAAO.

Introduction: Pulmonary hypertension (PH) is a life-threatening, progressive disease with non-specific symptoms, often leading to delayed diagnosis. Early identification of World Health Organization Group 1 (Pulmonary Arterial Hypertension, PAH) and Group 4 (Chronic Thromboembolic Pulmonary Hypertension, CTEPH) is essential, as effective therapies can improve outcomes. Hypothesis: An electrocardiogram-based AI algorithm for PH detection (ECG-AI PH) may enable earlier diagnosis and reduce healthcare utilization, including hospitalizations and procedures. Methods: Retrospective analysis used a de-identified data platform of &gt;7M clinical records from a multistate integrated health system. Adult precapillary PH patients (mPAP &gt;20 mmHg, PVR &gt;2 WU, PCWP ≤15 mmHg) were identified as PAH or CTEPH based on ICD codes, use of approved therapies, or surgical interventions (for CTEPH) between 2002 and 2024. ECG-AI PH was applied to ECGs within 30 days of diagnostic right heart catheterization, using a 5:1 randomly sampled PH-negative control cohort. Training set patients were excluded. Clinical event frequency was compared between two intervals: from first possible PH symptom (dyspnea, syncope, chest pain, fatigue, lower limb swelling) to diagnosis, and from symptom onset to first positive ECG-AI PH prediction. Results: A total of 1882 PAH and 359 CTEPH patients met inclusion criteria. Of these, 1340 PAH and 258 CTEPH patients had symptom codes prior to diagnosis. Both groups showed prolonged intervals from symptom onset to diagnosis, with multiple diagnostic procedures and hospitalizations (Figure). ECG-AI PH performance evaluation on the test set included 647 PAH and 152 CTEPH patients. ECG-AI PH achieved AUCs of 0.90 and 0.89 for PAH and CTEPH, sensitivities of 80.3% and 76.8%, and specificities of 83.4% and 82.4%. Among those tested, 576 PAH and 95 CTEPH patients had a positive ECG-AI PH prediction after symptom onset but before diagnosis. Compared to the current patient journey, the interval between initial symptoms and a positive output from ECG-AI PH was shorter and had fewer diagnostic tests/visits. Conclusion: ECG-AI PH demonstrated strong performance in detecting PAH and CTEPH. It may reduce diagnostic delays, support earlier PH-focused screening (e.g., echocardiograms evaluating the right heart), enable earlier intervention, and reduce pre-diagnosis healthcare burden, benefitting both patient outcomes and healthcare system efficiency.

Background: In the United States, Cardiovascular Disease (CVD) is a leading cause of mortality, particularly among individuals with sleep disorders. This national analysis (1999–2020) identifies racial, ethnic, and demographic disparities by analyzing mortality patterns to guide targeted interventions. Aim: To analyze mortality trends in cardiovascular diseases among U.S. adults with sleep disorders, considering socio-demographic variables. Methods: A retrospective analysis was conducted using the CDC WONDER database death certificates from 1999 to 2020 to assess mortality related to CVD in people with sleep disorders for individuals aged 15 to 85+. The population was identified through the International Classification of Diseases, Tenth Revision (ICD-10) codes: I00–I99 for cardiovascular diseases and G47 for the spectrum of sleep disorders. Age-adjusted mortality rates (AAMRs) per 100,000 persons were analyzed and stratified by year, sex, race, census region, and 10-year age group-based classification. AAMR trends across the years were assessed using Joinpoint regression (Version 5.4.0, National Cancer Institute) to determine the annual percent change (APC) and the average annual percent change (AAPC). Results: Between 1999 and 2020, a total of 195,408 cardiovascular diseases (CVD)–related deaths were recorded, with an overall trend showing an increase in age-adjusted mortality rates (AAMRs) from 1.02 per 100,000 in 1999 to 6.87 in 2020, exhibiting consistent fluctuations over the study period. Males consistently demonstrated higher AAMRs compared to females (Females: 4.42 in 2020; Males: 9.92 in 2020). Stratification by race and region showed that Non-Hispanic Black individuals had the highest AAMR, with the trend surging in 2018–2020 (APC: 20.66), while the Midwest recorded the highest rates among all census regions. Ten-year age group stratification indicated that individuals aged ≥85 years had the highest crude mortality rates, contributing disproportionately to the overall national trend. Conclusion: Our analysis reveals a consistent increase in cardiovascular mortality among U.S. adults with sleep disorders, especially in obstructive sleep apnea, with an emerging trend in narcolepsy. Pronounced disparities by race and region were observed. These findings necessitate targeted public health interventions addressing sleep health and cardiovascular risks, to reduce mortality and alleviate the debilitating effects of this association.

Background: We aimed to evaluate whether and to what extent left ventricular ejection fraction (LVEF) mediates the relationship between late gadolinium enhancement (LGE) and sudden cardiac death (SCD) in patients with old myocardial infarction (OMI), and to assess this mediation effect in subgroups based on LVEF≤35% and&gt;35% according to implantable cardioverter-defibrillator (ICD) selection criterion. Methods: A retrospective analysis was conducted on 410 patients with OMI (mean age: 56.6±10.5 years, 88.2% male) who underwent cardiac MR. The endpoint for SCDs included SCD, aborted SCD, and appropriate ICD shocks. The effect of LGE on LVEF was quantified using linear regression models. The effects of both LGE and LVEF on SCDs were assessed using Cox regression models. Mediation analysis was used to decompose the total effect of LGE on SCDs into direct and indirect (mediated through LVEF) effects. Results: Over a mean follow-up of 5.8±1.8 years, 41 patients (10.0%) experienced SCDs. LGE was significantly associated with lower LVEF (β=-0.19, p&lt;0.001). Both LGE and LVEF independently predicted SCDs (sHR=1.03, p=0.005; sHR=0.95, p=0.002, respectively). Mediation analysis showed that LVEF accounted for 24.6% of the total effect of LGE on SCDs (p=0.04). This mediation effect was 63.2% in patients with LVEF&gt;35% (p=0.02), while no mediation was observed in patients with LVEF≤35% (p=0.64). Conclusions: LVEF partially mediated the effect of LGE on the incidence of SCDs, accounting for less than a quarter of the total effect. This highlights the critical role of LGE assessment in SCD prevention strategies, regardless of LVEF levels.