Clinical Cardiology最新文献

Objective: To evaluate the safety, short-term and mid-term occlusion performance of the Absnow fully biodegradable atrial septal occluder in pediatric patients.

Background: The Absnow Occluder, an innovative fully biodegradable closure for ASD, has shown its safety and effectiveness in initial animal studies and preclinical trials.

Methods: As one of the participating multicenter research institutions, our organization conducted interventional closure procedures on 10 pediatric patients with atrial septal defects employing the Absnow fully biodegradable occluder between November 2018 and May 2019. Subsequently, we conducted a clinical follow-up spanning 4 years.

Results: The immediate success rate of the operation was 100% (10/10). The effective closure rates at immediate, 1 day, 1 month, 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years post-operation were, respectively, 100%, 90%, 100%, 100%, 100%, 100%, 80%, 80%, and 70%. The cumulative incidence of complications at 1 year, 2 years, 3 years, and 4 years post-operation were 0%, 20%, 20%, and 30%, respectively. No severe complications, such as device dislodgment, high-degree atrioventricular block, or vascular complications, occurred during the 4-year follow-up. Nevertheless, two patients experienced substantial residual shunting due to occluder degradation or umbrella displacement, and underwent further intervention.

Conclusion: This study further confirmed the short-to-mid-term safety and acceptable efficacy of the Absnow fully biodegradable atrial septal occluder based on a 4-year follow-up. The late-occurring residual shunts with device degradation have an important impact on its long-term efficacy.

Introduction: Atrial fibrillation (AF) is the most common and persistent type of arrhythmia that frequently co-exists with chronic ischemic heart disease (IHD), increasing the risk of adverse cardiovascular outcomes and mortality. We aim to analyze chronic IHD-related mortality trends in patients with AF from 1999 to 2023 in the United States (U.S.).

Methods: Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database was used to conduct a retrospective analysis of death records of adults (aged 65 ≤) with chronic IHD as the underlying cause and co-existent AF as a contributing cause of death. Age-adjusted mortality rates (AAMR) per 100 000 population and annual percent changes (APC) in age-adjusted mortality rates were determined and measured across different demographics and geographies in the U.S.

Results: AF was recorded in almost 460,196 deaths caused by chronic IHD. The AAMR increased from 38.2 in 1999 to 52.2 in 2023, showing a prominent increase shift from 2010 to 2023 (APC: 2.72). Recorded AAMR in Males (54.8) was doubled that of females (33.2), while a top AAMR of 44.7 was seen in non-Hispanic (NH) Whites was doubled that of other racial/ethnic groups. Geographically, AAMR was higher in non-metropolitan areas (43.3) and the Northeast region (42.8).

Conclusions: Proper resource distribution and more targeted interventions are needed to address the rising trends in chronic IHD mortality among AF patients across different geographic and demographic groups.

Background: Despite overwhelming evidence of clinical benefit for patients with heart failure (HF), the uptake of guideline-directed medical therapies (GDMT) has been slow. Collaborative approaches are critically needed to improve alignment between evidence and clinical practice. Many strategies proposed to improve GDMT implementation have been either ineffective or too resource-intensive to implement at scale across different practice contexts. Furthermore, most existing approaches focus primarily on patients with HF and reduced EF, despite growing evidence for effective pharmacologic therapy in those with HF and mildly reduced or preserved ejection fraction (HFpEF).

Hypothesis: Based on this experience, we designed the Cooperative Program for ImpLementation of Optimal Therapy in Heart Failure (COPILOT-HF) study (NCT05734690).

Methods: This is a pragmatic, randomized, open-label intervention trial to compare a comprehensive, remote, navigator-led, algorithm-driven strategy for optimization of GDMT prescribing in patients with HF across the full spectrum of ejection fraction with a control intervention focused on patient and provider education regarding the importance of GDMT optimization.

Results: The primary efficacy endpoint of the study is the proportion of patients receiving optimal HF treatment at 3 months. Additional outcomes of interest include the proportion of patients with optimal HF therapy at 6 months and 12 months as well as health resource utilization, including hospitalizations and deaths.

Conclusions: COPILOT-HF will evaluate the effectiveness of an early implementation of a remote pharmacist-led medication titration strategy across the HF spectrum.

Objective: Hypertension is a key risk factor for aortic dissection (AD). AD, if left untreated, carries significant mortality rates. Our aim is to analyse trends in mortality due to AD in adults with primary hypertension in the United States (US).

Methods: We used the CDC WONDER database to extract mortality data for patients with primary hypertension who died due to AD. Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) were extracted per 100 000 persons. Annual percentage changes (APCs) and average APCs (AAPCs) in AAMRs and CMRs were calculated using Joinpoint regression.

Results: From 1999 to 2020, a total of 13 128 deaths due to AD were reported in patients with primary hypertension in the US. Males displayed a higher overall AAMR (0.3) than females (0.2) throughout the study period. Slight regional variations were observed, with the West showing the highest overall AAMR (0.4), followed by the Midwest (0.3), and the Northeast and South (0.2). In urban areas, AAMRs were higher than in rural areas until 2008. From 2009 to 2020, AAMRs remained stable in urban areas (0.3) but increased in rural areas from 2010 to 2020 (4.7). The highest state-level AAMRs were observed in Hawaii, Oregon, and Oklahoma.

Conclusion: Significant differences were observed in AAPCs compared to AD-related mortality trends in the general population. Mortality trends revealed an initial decline followed by a gradual rise. Clinicians should focus on high-risk groups and raise awareness about the disease in these populations.