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Association Between Life's Essential 8 Cardiovascular Health Metrics With Cardiovascular Events in the Cardiovascular Disease Lifetime Risk Pooling Project. 心血管疾病终生风险汇集项目中人生必备的 8 项心血管健康指标与心血管事件之间的关系。
IF 6.9 2区 医学 Pub Date : 2024-04-19 DOI: 10.1161/CIRCOUTCOMES.123.010568
Hongyan Ning, A. Perak, J. Siddique, J. Wilkins, D. Lloyd-Jones, N. Allen
BACKGROUNDThe American Heart Association recently launched updated cardiovascular health metrics, termed Life's Essential 8 (LE8). Compared with Life's Simple 7 (LS7), the new approach added sleep health as an eighth metric and updated the remaining 7 health factors and behaviors. The association of the updated LE8 score with long-term cardiovascular disease (CVD) outcomes and death is unknown.METHODSWe pooled individual-level data from 6 contemporary US-based cohorts from the Cardiovascular Lifetime Risk Pooling Project. Total LE8 score (0-100 points), LE8 score without sleep (0-100 points), and prior LS7 scores (0-14 points) were calculated separately. We used multivariable-adjusted Cox models to evaluate the association of LE8 with CVD, CVD subtypes, and all-cause mortality among younger, middle, and older adult participants. Net reclassification improvement analysis was used to measure the improvement in CVD risk classification with the addition of LS7 and LE8 recategorization based on score quartile rankings.RESULTSOur sample consisted of 32 896 US adults (7836 [23.8%] Black; 14 941 [45.4%] men) followed for 642 000 person-years, of whom 9391 developed CVD events. Each 10-point higher overall LE8 score was associated with lower risk by 22% to 40% for CVD, 24% to 43% for congenital heart disease, 17% to 34% for stroke, 23% to 38% for heart failure, and 17% to 21% for all causes of mortality events across age strata. LE8 score provided more granular differentiation of the related CVD risk than LS7. Overall, 19.5% and 15.5% of the study participants were recategorized upward and downward based on LE8 versus LS7 categories, respectively, and the recategorization was significantly associated with CVD risk in addition to LS7 score. The addition of recategorization between LE8 and LS7 categories improved CVD risk reclassification across age groups (clinical net reclassification improvement, 0.06-0.12; P<0.01).CONCLUSIONSThese findings support the improved utility of the LE8 algorithm for assessing overall cardiovascular health and future CVD risk.
背景美国心脏协会最近推出了更新的心血管健康指标,称为 "生命必需 8 项指标"(LE8)。与 "生命简约 7"(LS7)相比,新方法增加了睡眠健康作为第八项指标,并更新了其余 7 项健康因素和行为。更新后的 LE8 评分与心血管疾病(CVD)的长期预后和死亡之间的关系尚不清楚。我们分别计算了LE8总分(0-100分)、不含睡眠的LE8得分(0-100分)和先前的LS7得分(0-14分)。我们使用多变量调整 Cox 模型来评估 LE8 与心血管疾病、心血管疾病亚型以及年轻、中年和老年成人全因死亡率之间的关系。结果我们的样本包括 32 896 名美国成年人(7836 名[23.8%] 黑人;14 941 名[45.4%] 男性),随访时间为 642 000 人年,其中 9391 人发生了心血管疾病。LE8总分每提高10分,心血管疾病风险降低22%至40%,先天性心脏病风险降低24%至43%,中风风险降低17%至34%,心力衰竭风险降低23%至38%,各年龄段所有死因风险降低17%至21%。与LS7相比,LE8评分对相关心血管疾病风险的区分更为细致。总体而言,分别有 19.5% 和 15.5% 的研究参与者根据 LE8 和 LS7 分值进行了向上和向下重新分类,除 LS7 分值外,重新分类还与心血管疾病风险显著相关。在LE8和LS7类别之间增加重新分类可改善各年龄组的心血管疾病风险重新分类(临床净重新分类改善率为0.06-0.12;P<0.01)。
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引用次数: 0
Clinician Decision Support Tools: Advances in Lipid-Lowering Treatment Intensification. 临床医生决策支持工具:加强降脂治疗的进展。
IF 6.9 2区 医学 Pub Date : 2024-04-18 DOI: 10.1161/CIRCOUTCOMES.124.010884
F. Marvel, Jelani K Grant, Seth S Martin
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引用次数: 0
Beyond the Methods: Economic Stability and Cardiovascular Health. 方法之外:经济稳定与心血管健康。
IF 6.9 2区 医学 Pub Date : 2024-04-03 DOI: 10.1161/CIRCOUTCOMES.124.010823
Debra D Dixon, Eduardo J Sanchez
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引用次数: 0
Mapping Geographic Proximity to Cardiologists Across the United States. 绘制美国心脏病学家的地理位置。
IF 6.9 2区 医学 Pub Date : 2023-10-01 Epub Date: 2023-09-12 DOI: 10.1161/CIRCOUTCOMES.123.010133
Issam Motairek, Zhuo Chen, Mohamed H E Makhlouf, Salil Deo, Pedro R V O Salerno, Amgad Mentias, Khurram Nasir, Sanjay Rajagopalan, Sadeer G Al-Kindi
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引用次数: 0
From Manual to Modern: Accelerating Health Care Transformation With Automatized Electronic Medical Record Registries. 从手动到现代:用自动化电子病历登记加速医疗保健转型。
IF 6.9 2区 医学 Pub Date : 2023-10-01 Epub Date: 2023-09-13 DOI: 10.1161/CIRCOUTCOMES.123.010379
Khurram Nasir, Zulqarnain Javed
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引用次数: 0
Global Cardio Oncology Registry (G-COR): Registry Design, Primary Objectives, and Future Perspectives of a Multicenter Global Initiative. 全球心脏肿瘤登记处(G-COR):多中心全球倡议的登记处设计、主要目标和未来展望。
IF 6.9 2区 医学 Pub Date : 2023-10-01 Epub Date: 2023-09-13 DOI: 10.1161/CIRCOUTCOMES.123.009905
Arco J Teske, Rohit Moudgil, Teresa López-Fernández, Ana Barac, Sherry Ann Brown, Anita Deswal, Tomas G Neilan, Sarju Ganatra, Husam Abdel Qadir, Venu Menon, Aaron L Sverdlov, Richard K Cheng, Silvia Makhoul, Arjun K Ghosh, Sebastian Szmit, Vlad Zaha, Daniel Addison, Lili Zhang, Joerg Herrmann, Jun H Chong, Vivek Agarwala, Zaza Iakobishvili, Patricia Guerrero, Eric H Yang, Monika Leja, Nausheen Akhter, Avirup Guha, Tochukwu M Okwuosa, Carolina Carvalho Silva, Patrick Collier, Jeanne DeCara, Brenton Bauer, Carrie E Lenneman, Diego Sadler

Background: Global collaboration in cardio-oncology is needed to understand the prevalence of cancer therapy-related cardiovascular toxicity in different risk groups, practice settings, and geographic locations. There are limited data on the socioeconomic and racial/ethnic disparities that may impact access to care and outcomes. To address these gaps, we established the Global Cardio-Oncology Registry, a multinational, multicenter prospective registry.

Methods: We assembled cardiologists and oncologists from academic and community settings to collaborate in the first Global Cardio-Oncology Registry. Subsequently, a survey for site resources, demographics, and intention to participate was conducted. We designed an online data platform to facilitate this global initiative.

Results: A total of 119 sites responded to an online questionnaire on their practices and main goals of the registry: 49 US sites from 23 states and 70 international sites from 5 continents indicated a willingness to participate in the Global Cardio-Oncology Registry. Sites were more commonly led by cardiologists (85/119; 72%) and were more often university/teaching (81/119; 68%) than community based (38/119; 32%). The average number of cardio-oncology patients treated per month was 80 per site. The top 3 Global Cardio-Oncology Registry priorities in cardio-oncology care were breast cancer, hematologic malignancies, and patients treated with immune checkpoint inhibitors. Executive and scientific committees and specific committees were established. A pilot phase for breast cancer using Research Electronic Data Capture Cloud platform recently started patient enrollment.

Conclusions: We present the structure for a global collaboration. Information derived from the Global Cardio-Oncology Registry will help understand the risk factors impacting cancer therapy-related cardiovascular toxicity in different geographic locations and therefore contribute to reduce access gaps in cardio-oncology care. Risk calculators will be prospectively derived and validated.

背景:需要在心脏病学方面进行全球合作,以了解癌症治疗相关心血管毒性在不同风险群体、实践环境和地理位置的患病率。关于可能影响获得护理和结果的社会经济和种族/族裔差异的数据有限。为了解决这些差距,我们建立了全球心脏肿瘤登记处,这是一个多国、多中心的前瞻性登记处。方法:我们召集了来自学术和社区环境的心脏病专家和肿瘤学家,在第一个全球心脏肿瘤登记处进行合作。随后,对场地资源、人口统计和参与意向进行了调查。我们设计了一个在线数据平台来促进这一全球倡议。结果:共有119个网站回复了关于其实践和注册主要目标的在线问卷:来自23个州的49个美国网站和来自5大洲的70个国际网站表示愿意参与全球心脏肿瘤注册。站点通常由心脏病专家领导(85/119;72%),更常见的是大学/教学(81/119;68%),而不是社区(38/119;32%)。每个部位每月接受治疗的心脏肿瘤患者平均人数为80人。全球心内科注册中心在心内科护理方面的三大优先事项是乳腺癌症、血液系统恶性肿瘤和接受免疫检查点抑制剂治疗的患者。成立了执行委员会、科学委员会和专门委员会。使用研究电子数据采集云平台的癌症试点阶段最近开始了患者登记。结论:我们提出了全球合作的结构。来自全球心脏病登记处的信息将有助于了解影响不同地理位置癌症治疗相关心血管毒性的风险因素,从而有助于减少心脏病生态护理的获取差距。风险计算器将进行前瞻性推导和验证。
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引用次数: 0
Determinants and Outcomes Associated With Skilled Nursing Facility Use After Coronary Artery Bypass Grafting: A Statewide Experience. 冠状动脉搭桥术后熟练使用护理设施的影响因素和结果:全州经验。
IF 6.9 2区 医学 Pub Date : 2023-10-01 Epub Date: 2023-09-13 DOI: 10.1161/CIRCOUTCOMES.122.009639
Michael P Thompson, James W Stewart, Hechuan Hou, Hari Nathan, Francis D Pagani, Alphonse DeLucia, Patricia F Theurer, Richard L Prager, Robert B Hawkins, Donald S Likosky

Background: Skilled nursing facility (SNF) care is frequently used after cardiac surgery, but the patterns and determinants of use have not been well understood. The objective of this study was to evaluate determinants and outcomes associated with SNF use after isolated coronary artery bypass grafting.

Methods: A retrospective analysis of Medicare Fee-For-Service claims linked to the Society of Thoracic Surgeons clinical data was conducted on isolated coronary artery bypass grafting patients without prior SNF use in Michigan between 2011 and 2019. Descriptive analysis evaluated the frequency, trends, and variation in SNF use across 33 Michigan hospitals. Multivariable mixed-effects regression was used to evaluate patient-level demographic and clinical determinants of SNF use and its effect on short- and long-term outcomes.

Results: In our sample of 8614 patients, the average age was 73.3 years, 70.5% were male, and 7.7% were listed as non-White race. An SNF was utilized by 1920 (22.3%) patients within 90 days of discharge and varied from 3.2% to 58.3% across the 33 hospitals. Patients using SNFs were more likely to be female, older, non-White, with more comorbidities, worse cardiovascular function, a perioperative morbidity, and longer hospital lengths of stay. Outcomes were significantly worse for SNF users, including more frequent 90-day readmissions and emergency department visits and less use of home health and rehabilitation services. SNF users had higher risk-adjusted hazard of mortality (hazard ratio, 1.41 [95% CI, 1.26-1.57]; P<0.001) compared with non-SNF users and had 2.7-percentage point higher 5-year mortality rate in a propensity-matched cohort of patients (18.1% versus 15.4%; P<0.001).

Conclusions: The use of SNF care after isolated coronary artery bypass grafting was frequent and variable across Michigan hospitals and associated with worse risk-adjusted outcomes. Standardization of criteria for SNF use may reduce variability among hospitals and ensure appropriateness of use.

背景:心脏手术后经常使用熟练护理机构(SNF)护理,但其使用模式和决定因素尚不清楚。本研究的目的是评估孤立性冠状动脉搭桥术后使用SNF的相关决定因素和结果。方法:对2011年至2019年间密歇根州未使用SNF的孤立冠状动脉搭桥术患者的胸科医生协会临床数据相关的医疗保险服务费索赔进行回顾性分析。描述性分析评估了密歇根州33家医院SNF使用的频率、趋势和变化。多变量混合效应回归用于评估患者水平的SNF使用的人口统计学和临床决定因素及其对短期和长期结果的影响。结果:在我们的8614名患者样本中,平均年龄为73.3岁,70.5%为男性,7.7%为非白人。1920名(22.3%)患者在出院90天内使用了SNF,33家医院的SNF使用率从3.2%到58.3%不等。使用SNF的患者更有可能是女性、老年人、非白人,有更多的合并症、更差的心血管功能、围手术期发病率和更长的住院时间。SNF使用者的结果明显更糟,包括更频繁的90天再次入院和急诊就诊,以及较少使用家庭健康和康复服务。SNF使用者具有更高的风险调整后死亡率风险(风险比,1.41[95%CI,1.26-1.57]);PPC结论:在密歇根州的医院中,孤立性冠状动脉搭桥术后使用SNF护理的频率很高,而且变化很大,与更差的风险调整结果相关。SNF使用标准的标准化可以减少医院之间的可变性,并确保使用的适当性。
{"title":"Determinants and Outcomes Associated With Skilled Nursing Facility Use After Coronary Artery Bypass Grafting: A Statewide Experience.","authors":"Michael P Thompson, James W Stewart, Hechuan Hou, Hari Nathan, Francis D Pagani, Alphonse DeLucia, Patricia F Theurer, Richard L Prager, Robert B Hawkins, Donald S Likosky","doi":"10.1161/CIRCOUTCOMES.122.009639","DOIUrl":"10.1161/CIRCOUTCOMES.122.009639","url":null,"abstract":"<p><strong>Background: </strong>Skilled nursing facility (SNF) care is frequently used after cardiac surgery, but the patterns and determinants of use have not been well understood. The objective of this study was to evaluate determinants and outcomes associated with SNF use after isolated coronary artery bypass grafting.</p><p><strong>Methods: </strong>A retrospective analysis of Medicare Fee-For-Service claims linked to the Society of Thoracic Surgeons clinical data was conducted on isolated coronary artery bypass grafting patients without prior SNF use in Michigan between 2011 and 2019. Descriptive analysis evaluated the frequency, trends, and variation in SNF use across 33 Michigan hospitals. Multivariable mixed-effects regression was used to evaluate patient-level demographic and clinical determinants of SNF use and its effect on short- and long-term outcomes.</p><p><strong>Results: </strong>In our sample of 8614 patients, the average age was 73.3 years, 70.5% were male, and 7.7% were listed as non-White race. An SNF was utilized by 1920 (22.3%) patients within 90 days of discharge and varied from 3.2% to 58.3% across the 33 hospitals. Patients using SNFs were more likely to be female, older, non-White, with more comorbidities, worse cardiovascular function, a perioperative morbidity, and longer hospital lengths of stay. Outcomes were significantly worse for SNF users, including more frequent 90-day readmissions and emergency department visits and less use of home health and rehabilitation services. SNF users had higher risk-adjusted hazard of mortality (hazard ratio, 1.41 [95% CI, 1.26-1.57]; <i>P</i><0.001) compared with non-SNF users and had 2.7-percentage point higher 5-year mortality rate in a propensity-matched cohort of patients (18.1% versus 15.4%; <i>P</i><0.001).</p><p><strong>Conclusions: </strong>The use of SNF care after isolated coronary artery bypass grafting was frequent and variable across Michigan hospitals and associated with worse risk-adjusted outcomes. Standardization of criteria for SNF use may reduce variability among hospitals and ensure appropriateness of use.</p>","PeriodicalId":10301,"journal":{"name":"Circulation. Cardiovascular Quality and Outcomes","volume":" ","pages":"e009639"},"PeriodicalIF":6.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10979415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10225244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Psychosocial Stressors at Work and Coronary Heart Disease Risk in Men and Women: 18-Year Prospective Cohort Study of Combined Exposures. 工作中的心理社会压力与男性和女性患冠心病的风险:联合暴露的18年前瞻性队列研究。
IF 6.9 2区 医学 Pub Date : 2023-10-01 Epub Date: 2023-09-19 DOI: 10.1161/CIRCOUTCOMES.122.009700
Mathilde Lavigne-Robichaud, Xavier Trudel, Denis Talbot, Alain Milot, Mahée Gilbert-Ouimet, Michel Vézina, Danielle Laurin, Clermont E Dionne, Neil Pearce, Gilles R Dagenais, Chantal Brisson

Background: Psychosocial stressors at work, like job strain and effort-reward imbalance (ERI), can increase coronary heart disease (CHD) risk. ERI indicates an imbalance between the effort and received rewards. Evidence about the adverse effect of combined exposure to these work stressors on CHD risk is scarce. This study examines the separate and combined effect of job strain and ERI exposure on CHD incidence in a prospective cohort of white-collar workers in Quebec, Canada.

Methods: Six thousand four hundred sixty-five white-collar workers without cardiovascular disease (mean age, 45.3±6.7) were followed for 18 years (from 2000 to 2018). Job strain and ERI were measured with validated questionnaires. CHD events were retrieved from medico-administrative databases using validated algorithms. Marginal Cox models were used to calculate hazard ratios (HR) stratified by sex. Multiple imputation and inverse probability weights were applied to minimize potential threats to internal validity.

Results: Among 3118 men, 571 had a first CHD event. Exposure to either job strain or ERI was associated with an adjusted 49% CHD risk increase (HR, 1.49 [95% CI, 1.07-2.09]). Combined exposure to job strain and ERI was associated with an adjusted 103% CHD risk increase (HR, 2.03 [95% CI, 1.38-2.97]). Exclusion of early CHD cases and censoring at retirement did not alter these associations. Among 3347 women, 265 had a first CHD event. Findings were inconclusive (passive job HR, 1.24 [95% CI, 0.80-1.91]; active job HR, 1.16 [95% CI, 0.70-1.94]; job strain HR, 1.08 [95% CI, 0.66-1.77]; ERI HR, 1.02 [95% CI, 0.72-1.45]).

Conclusions: In this prospective cohort study, men exposed to job strain or ERI, separately and in combination, were at increased risk of CHD. Early interventions on these psychosocial stressors at work in men may be effective prevention strategies to reduce CHD burden. Among women, further investigation is required.

背景:工作中的心理社会压力源,如工作压力和努力-回报失衡(ERI),会增加冠心病(CHD)的风险。ERI表示努力和获得的回报之间的不平衡。关于联合暴露于这些工作压力源对冠心病风险的不利影响的证据很少。本研究在加拿大魁北克的一个前瞻性白领队列中考察了工作压力和ERI暴露对CHD发病率的单独和综合影响。方法:对六千四百六十五名没有心血管疾病的白领(平均年龄,45.3±6.7)进行了18年的随访(从2000年到2018年)。工作压力和ERI采用经验证的问卷进行测量。使用经验证的算法从医疗管理数据库中检索CHD事件。边际Cox模型用于计算按性别分层的危险比(HR)。采用多重插补和逆概率权重来最大限度地减少对内部有效性的潜在威胁。结果:3118名男性中,571人首次发生冠心病。暴露于工作紧张或ERI与调整后的49%的CHD风险增加相关(HR,1.49[95%CI,1.07-2.09])。工作紧张和ERI的联合暴露与调整后103%的CHD危险增加相关(HR2.03[95%CI、1.38-2.97])。排除早期CHD病例和退休时审查并没有改变这些关联。在3347名妇女中,265人首次发生冠心病。研究结果不确定(被动工作HR,1.24[95%CI,0.80-1.91];主动工作HR,1.16[95%CI;0.70-1.94];工作紧张HR,1.08[95%CI:0.66-1.77];ERI HR,1.02[95%CI:0.72-1.45])。结论:在这项前瞻性队列研究中,单独或联合暴露于工作紧张或ERI的男性患冠心病的风险增加。对男性工作中的这些心理社会压力源进行早期干预可能是减少冠心病负担的有效预防策略。需要对妇女进行进一步调查。
{"title":"Psychosocial Stressors at Work and Coronary Heart Disease Risk in Men and Women: 18-Year Prospective Cohort Study of Combined Exposures.","authors":"Mathilde Lavigne-Robichaud, Xavier Trudel, Denis Talbot, Alain Milot, Mahée Gilbert-Ouimet, Michel Vézina, Danielle Laurin, Clermont E Dionne, Neil Pearce, Gilles R Dagenais, Chantal Brisson","doi":"10.1161/CIRCOUTCOMES.122.009700","DOIUrl":"10.1161/CIRCOUTCOMES.122.009700","url":null,"abstract":"<p><strong>Background: </strong>Psychosocial stressors at work, like job strain and effort-reward imbalance (ERI), can increase coronary heart disease (CHD) risk. ERI indicates an imbalance between the effort and received rewards. Evidence about the adverse effect of combined exposure to these work stressors on CHD risk is scarce. This study examines the separate and combined effect of job strain and ERI exposure on CHD incidence in a prospective cohort of white-collar workers in Quebec, Canada.</p><p><strong>Methods: </strong>Six thousand four hundred sixty-five white-collar workers without cardiovascular disease (mean age, 45.3±6.7) were followed for 18 years (from 2000 to 2018). Job strain and ERI were measured with validated questionnaires. CHD events were retrieved from medico-administrative databases using validated algorithms. Marginal Cox models were used to calculate hazard ratios (HR) stratified by sex. Multiple imputation and inverse probability weights were applied to minimize potential threats to internal validity.</p><p><strong>Results: </strong>Among 3118 men, 571 had a first CHD event. Exposure to either job strain or ERI was associated with an adjusted 49% CHD risk increase (HR, 1.49 [95% CI, 1.07-2.09]). Combined exposure to job strain and ERI was associated with an adjusted 103% CHD risk increase (HR, 2.03 [95% CI, 1.38-2.97]). Exclusion of early CHD cases and censoring at retirement did not alter these associations. Among 3347 women, 265 had a first CHD event. Findings were inconclusive (passive job HR, 1.24 [95% CI, 0.80-1.91]; active job HR, 1.16 [95% CI, 0.70-1.94]; job strain HR, 1.08 [95% CI, 0.66-1.77]; ERI HR, 1.02 [95% CI, 0.72-1.45]).</p><p><strong>Conclusions: </strong>In this prospective cohort study, men exposed to job strain or ERI, separately and in combination, were at increased risk of CHD. Early interventions on these psychosocial stressors at work in men may be effective prevention strategies to reduce CHD burden. Among women, further investigation is required.</p>","PeriodicalId":10301,"journal":{"name":"Circulation. Cardiovascular Quality and Outcomes","volume":" ","pages":"e009700"},"PeriodicalIF":6.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d4/fb/hcq-16-e009700.PMC10573112.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10675116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
2023 AHA/ACC Clinical Performance and Quality Measures for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures. 2023 AHA/ACC冠状动脉血运重建的临床表现和质量指标:美国心脏病学院/美国心脏协会绩效指标联合委员会的报告。
IF 6.9 2区 医学 Pub Date : 2023-09-01 Epub Date: 2023-07-27 DOI: 10.1161/HCQ.0000000000000121
Gregory J Dehmer, Cindy L Grines, Faisal G Bakaeen, Dorian L Beasley, Theresa M Beckie, Jack Boyd, Joaquin E Cigarroa, Sandeep R Das, Rebecca L Diekemper, Jennifer Frampton, Connie N Hess, Nkechinyere Ijioma, Jennifer S Lawton, Binita Shah, Nadia R Sutton
{"title":"2023 AHA/ACC Clinical Performance and Quality Measures for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures.","authors":"Gregory J Dehmer,&nbsp;Cindy L Grines,&nbsp;Faisal G Bakaeen,&nbsp;Dorian L Beasley,&nbsp;Theresa M Beckie,&nbsp;Jack Boyd,&nbsp;Joaquin E Cigarroa,&nbsp;Sandeep R Das,&nbsp;Rebecca L Diekemper,&nbsp;Jennifer Frampton,&nbsp;Connie N Hess,&nbsp;Nkechinyere Ijioma,&nbsp;Jennifer S Lawton,&nbsp;Binita Shah,&nbsp;Nadia R Sutton","doi":"10.1161/HCQ.0000000000000121","DOIUrl":"10.1161/HCQ.0000000000000121","url":null,"abstract":"","PeriodicalId":10301,"journal":{"name":"Circulation. Cardiovascular Quality and Outcomes","volume":" ","pages":"e00121"},"PeriodicalIF":6.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9937623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association Between Prenatal Diagnosis and Age at Surgery for Noncritical and Critical Congenital Heart Defects. 非危重和危重先天性心脏缺陷的产前诊断与手术年龄的关系。
IF 6.9 2区 医学 Pub Date : 2023-09-01 Epub Date: 2023-08-04 DOI: 10.1161/CIRCOUTCOMES.122.009638
Joyce L Woo, Christina Laternser, Brett R Anderson, William A Grobman, Michael C Monge, Matthew M Davis

Background: The relationship between the prenatal diagnosis of congenital heart defects (CHDs) and age at CHD surgery is poorly understood, despite the known relationships between age at surgery and long-term outcomes. The objective of this study was to determine the associations between prenatal diagnosis of CHD and age at surgery, and whether these associations differ for critical and noncritical CHDs.

Methods: This is a cohort analysis of patients aged 0 to 9 years who received their initial cardiac surgery at Ann & Robert H. Lurie Children's Hospital of Chicago between 2015 and 2021 with prenatal diagnosis as the exposure variable. All data were obtained from the locally maintained Society of Thoracic Surgeons Congenital Heart Surgery Database at Lurie Children's Hospital. We used multivariable fixed effects regression models to estimate the strength of the association of prenatal diagnosis with age at surgery among patients with critical (surgery ≤60 days) and noncritical (surgery >60 days) CHDs.

Results: Of 1131 individuals who met inclusion criteria, 532 (47%) had a prenatal diagnosis, 428 (38%) had critical CHDs, 533 (47%) were female, and the median age at surgery was 119 days (interquartile range, 11-309 days). After controlling for demographics, comorbidities, and surgical complexity, the mean age at surgery was significantly younger in those with prenatally versus postnatally diagnosed critical CHD (7.1 days sooner, P<0.001) and noncritical CHDs (atrial septal defects [12.4 months sooner, P=0.037], ventricular septal defects [6.0 months sooner, P<0.003], and noncritical coarctation of the aorta [1.8 months sooner, P=0.010]).

Conclusions: Younger age at CHD surgery, which is associated with postsurgical neurodevelopmental and physical outcomes, is significantly associated with prenatal CHD diagnosis. This relationship was identified for both critical and noncritical CHDs.

背景:先天性心脏缺陷(CHD)的产前诊断与CHD手术年龄之间的关系尚不清楚,尽管手术年龄与长期结果之间存在已知关系。本研究的目的是确定CHD的产前诊断与手术年龄之间的相关性,以及这些相关性在危重和非危重CHD中是否不同。2015年至2021年间,芝加哥卢里儿童医院以产前诊断为暴露变量。所有数据均来自鲁里儿童医院当地维护的胸科外科医生学会先天性心脏外科数据库。我们使用多变量固定效应回归模型来估计危重(手术≤60天)和非危重(手术>60天)CHD患者的产前诊断与手术年龄的相关性,手术时的中位年龄为119天(四分位间距为11-309天)。在控制了人口统计学、合并症和手术复杂性后,产前诊断为危重型CHD的患者的平均手术年龄明显低于产后诊断为危重症CHD的人群(早7.1天,PP=0.037],室间隔缺损早6.0个月,PP=0.010]),与产前CHD诊断显著相关。对于临界和非临界CHD,都确定了这种关系。
{"title":"Association Between Prenatal Diagnosis and Age at Surgery for Noncritical and Critical Congenital Heart Defects.","authors":"Joyce L Woo, Christina Laternser, Brett R Anderson, William A Grobman, Michael C Monge, Matthew M Davis","doi":"10.1161/CIRCOUTCOMES.122.009638","DOIUrl":"10.1161/CIRCOUTCOMES.122.009638","url":null,"abstract":"<p><strong>Background: </strong>The relationship between the prenatal diagnosis of congenital heart defects (CHDs) and age at CHD surgery is poorly understood, despite the known relationships between age at surgery and long-term outcomes. The objective of this study was to determine the associations between prenatal diagnosis of CHD and age at surgery, and whether these associations differ for critical and noncritical CHDs.</p><p><strong>Methods: </strong>This is a cohort analysis of patients aged 0 to 9 years who received their initial cardiac surgery at Ann & Robert H. Lurie Children's Hospital of Chicago between 2015 and 2021 with prenatal diagnosis as the exposure variable. All data were obtained from the locally maintained Society of Thoracic Surgeons Congenital Heart Surgery Database at Lurie Children's Hospital. We used multivariable fixed effects regression models to estimate the strength of the association of prenatal diagnosis with age at surgery among patients with critical (surgery ≤60 days) and noncritical (surgery >60 days) CHDs.</p><p><strong>Results: </strong>Of 1131 individuals who met inclusion criteria, 532 (47%) had a prenatal diagnosis, 428 (38%) had critical CHDs, 533 (47%) were female, and the median age at surgery was 119 days (interquartile range, 11-309 days). After controlling for demographics, comorbidities, and surgical complexity, the mean age at surgery was significantly younger in those with prenatally versus postnatally diagnosed critical CHD (7.1 days sooner, <i>P</i><0.001) and noncritical CHDs (atrial septal defects [12.4 months sooner, <i>P</i>=0.037], ventricular septal defects [6.0 months sooner, <i>P</i><0.003], and noncritical coarctation of the aorta [1.8 months sooner, <i>P</i>=0.010]).</p><p><strong>Conclusions: </strong>Younger age at CHD surgery, which is associated with postsurgical neurodevelopmental and physical outcomes, is significantly associated with prenatal CHD diagnosis. This relationship was identified for both critical and noncritical CHDs.</p>","PeriodicalId":10301,"journal":{"name":"Circulation. Cardiovascular Quality and Outcomes","volume":" ","pages":"e009638"},"PeriodicalIF":6.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10524984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Circulation. Cardiovascular Quality and Outcomes
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