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Implementation of an Electronic Health Records-Based Safe Contrast Limit for Preventing Contrast-Associated Acute Kidney Injury After Percutaneous Coronary Intervention. 实施基于电子健康记录的安全对比剂限制,预防经皮冠状动脉介入术后对比剂相关急性肾损伤。
IF 6.9 2区 医学 Pub Date : 2023-01-01 Epub Date: 2022-12-07 DOI: 10.1161/CIRCOUTCOMES.122.009235
Neal Yuan, Justin Zhang, Rakan Khaki, Derek Leong, Chandrashekhar Bhoopalam, Steven W Tabak, Yaron Elad, Joshua M Pevnick, Susan Cheng, Joseph E Ebinger

Background: Contrast-associated acute kidney injury (CA-AKI) after percutaneous coronary intervention is associated with increased mortality. We assessed the effectiveness of an electronic health records safe contrast limit tool in predicting CA-AKI risk and reducing contrast use and CA-AKI.

Methods: We created an alert displaying the safe contrast limit to cardiac catheterization laboratory staff prior to percutaneous coronary intervention. The alert used risk factors automatically extracted from the electronic health records. We included procedures from June 1, 2020 to October 1, 2021; the intervention went live February 10, 2021. Using difference-in-differences analysis, we evaluated changes in contrast volume and CA-AKI rates after contrast limit tool implementation compared to control hospitals. Cardiologists were surveyed prior to and 9 months after alert implementation on beliefs, practice patterns, and safe contrast estimates for example patients.

Results: At the one intervention site, there were 508 percutaneous coronary interventions before and 531 after tool deployment. At 15 control sites, there were 3550 and 3979 percutaneous coronary interventions, respectively. The contrast limit predicted CA-AKI with an accuracy of 64.1%, negative predictive value of 93.3%, and positive predictive value of 18.7%. After implementation, in high/modifiable risk patients (defined as having a calculated contrast limit <500ml) there was a small but significant -4.60 mL/month (95% CI, -8.24 to -1.00) change in average contrast use but no change in CA-AKI rates (odds ratio, 0.96 [95% CI, 0.84-1.10]). Low-risk patients had no change in contrast use (-0.50 mL/month [95% CI, -7.49 to 6.49]) or CA-AKI (odds ratio, 1.24 [95% CI, 0.79-1.93]). In assessing CA-AKI risk, clinicians heavily weighted age and diabetes but often did not consider anemia, cardiogenic shock, and heart failure.

Conclusions: Clinicians often used a simplified assessment of CA-AKI risk that did not include important risk factors, leading to risk estimations inconsistent with established models. Despite clinician skepticism, an electronic health records-based contrast limit tool more accurately predicted CA-AKI risk and was associated with a small decrease in contrast use during percutaneous coronary intervention but no change in CA-AKI rates.

背景:经皮冠状动脉介入治疗后造影剂相关急性肾损伤(CA-AKI)与死亡率增加有关。我们评估了电子健康记录安全对比剂限制工具在预测 CA-AKI 风险、减少对比剂使用和 CA-AKI 方面的有效性:我们创建了一个警报,在经皮冠状动脉介入治疗前向心导管室工作人员显示安全对比度限制。该提示使用了从电子病历中自动提取的风险因素。我们纳入了 2020 年 6 月 1 日至 2021 年 10 月 1 日的手术;干预措施于 2021 年 2 月 10 日启用。通过差异分析,我们评估了与对照医院相比,实施造影剂限制工具后造影剂用量和 CA-AKI 发生率的变化。在实施警示前和实施 9 个月后,我们对心脏病专家进行了调查,内容包括信念、实践模式以及对例患者的安全对比度估计:结果:在一家干预医院,使用工具前和使用工具后分别进行了 508 例和 531 例经皮冠状动脉介入治疗。在 15 个对照地点,分别有 3550 例和 3979 例经皮冠状动脉介入治疗。对比度极限预测 CA-AKI 的准确率为 64.1%,阴性预测值为 93.3%,阳性预测值为 18.7%。使用该方法后,在高风险/可调风险患者(定义为计算出对比度极限结论)中,临床医生经常使用简化的评估方法来预测CA-AKI:临床医生经常使用一种简化的 CA-AKI 风险评估方法,这种方法不包括重要的风险因素,导致风险评估结果与已建立的模型不一致。尽管临床医生对此持怀疑态度,但基于电子病历的造影剂限制工具能更准确地预测 CA-AKI 风险,并能使经皮冠状动脉介入治疗过程中造影剂的使用量略有下降,但 CA-AKI 发生率没有变化。
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引用次数: 0
Perioperative Considerations for Pediatric Patients With Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement From the American Heart Association. 以非心脏手术为表现的先天性心脏病患儿围手术期注意事项:来自美国心脏协会的科学声明。
IF 6.9 2区 医学 Pub Date : 2023-01-01 DOI: 10.1161/HCQ.0000000000000113
Viviane G Nasr, Larry W Markham, Mark Clay, James A DiNardo, David Faraoni, Danielle Gottlieb-Sen, Wanda C Miller-Hance, Nancy A Pike, Chloe Rotman

Continuous advances in pediatric cardiology, surgery, and critical care have significantly improved survival rates for children and adults with congenital heart disease. Paradoxically, the resulting increase in longevity has expanded the prevalence of both repaired and unrepaired congenital heart disease and has escalated the need for diagnostic and interventional procedures. Because of this expansion in prevalence, anesthesiologists, pediatricians, and other health care professionals increasingly encounter patients with congenital heart disease or other pediatric cardiac diseases who are presenting for surgical treatment of unrelated, noncardiac disease. Patients with congenital heart disease are at high risk for mortality, complications, and reoperation after noncardiac procedures. Rigorous study of risk factors and outcomes has identified subsets of patients with minor, major, and severe congenital heart disease who may have higher-than-baseline risk when undergoing noncardiac procedures, and this has led to the development of risk prediction scores specific to this population. This scientific statement reviews contemporary data on risk from noncardiac procedures, focusing on pediatric patients with congenital heart disease and describing current knowledge on the subject. This scientific statement also addresses preoperative evaluation and testing, perioperative considerations, and postoperative care in this unique patient population and highlights relevant aspects of the pathophysiology of selected conditions that can influence perioperative care and patient management.

儿科心脏病学、外科和重症监护的不断进步显著提高了患有先天性心脏病的儿童和成人的存活率。矛盾的是,由此带来的寿命延长扩大了已修复和未修复先天性心脏病的患病率,并增加了对诊断和介入程序的需求。由于患病率的扩大,麻醉师、儿科医生和其他卫生保健专业人员越来越多地遇到先天性心脏病或其他儿科心脏病患者,他们提出不相关的非心脏疾病的手术治疗。先天性心脏病患者在非心脏手术后死亡率、并发症和再手术的风险很高。对危险因素和结果的严格研究已经确定了轻微、严重和严重先天性心脏病患者的亚群,他们在接受非心脏手术时可能具有高于基线的风险,这导致了针对这一人群的风险预测评分的发展。本科学声明回顾了非心脏手术风险的当代数据,重点关注患有先天性心脏病的儿科患者,并描述了该主题的当前知识。该科学声明还涉及了这一独特患者群体的术前评估和测试、围手术期注意事项和术后护理,并强调了可影响围手术期护理和患者管理的选定条件的病理生理学相关方面。
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引用次数: 1
Lipid-Lowering Therapy Use and Intensification Among United States Veterans Following Myocardial Infarction or Coronary Revascularization Between 2015 and 2019. 2015年至2019年美国退伍军人心肌梗死或冠状动脉血运重建后降脂治疗的使用和强化。
IF 6.9 2区 医学 Pub Date : 2022-12-01 Epub Date: 2022-10-14 DOI: 10.1161/CIRCOUTCOMES.121.008861
Alexander R Zheutlin, Catherine G Derington, Jennifer S Herrick, Robert S Rosenson, Bharat Poudel, Monika M Safford, Todd M Brown, Elizabeth A Jackson, Mark Woodward, Stephanie Reading, Kate Orroth, Jason Exter, Salim S Virani, Paul Muntner, Adam P Bress

Background: Understanding how statins, ezetimibe, and PCSK9i (proprotein convertase subtilisin/kexin type 9 serine protease inhibitors) are prescribed after a myocardial infarction (MI) or elective coronary revascularization may improve lipid-lowering therapy (LLT) intensification and reduce recurrent atherosclerotic cardiovascular disease events. We described the use and intensification of LLT among US veterans who had a MI or elective coronary revascularization between July 24, 2015, and December 9, 2019, within 12 months of hospital discharge.

Methods: LLT intensification was defined as increasing statin dose, or initiating a statin, ezetimibe, or a PCSK9i, overall and among those with an LDL-C (low-density lipoprotein cholesterol) 70 or 100 mg/dL. Poisson regression was used to determine patient characteristics associated with a greater likelihood of LLT intensification following hospitalization for MI or elective coronary revascularization.

Results: Among 81 372 index events (mean age, 69.0 years, 2.3% female, mean LDL-C 89.6 mg/dL, 33.8% with LDL-C <70 mg/dL), 39.7% were not taking any LLT, and 22.0%, 37.2%, and 0.6% were taking a low-moderate intensity statin, a high-intensity statin, and ezetimibe, respectively, before MI/coronary revascularization during the study period. Within 14 days, 3 months, and 12 months posthospitalization, 33.3%, 41.9%, and 47.3%, respectively, of veterans received LLT intensification. LLT intensification was most common among veterans taking no LLT (82.5%, n=26 637) before MI/coronary revascularization. Higher baseline LDL-C, having a lipid test, and attending a cardiology visit were each associated with a greater likelihood of LLT intensification, while age 75 versus <65 years was associated with a lower likelihood of LLT intensification within 12 months posthospitalization.

Conclusions: Less than half of veterans received LLT intensification in the year after MI or coronary revascularization suggesting a missed opportunity to reduce atherosclerotic cardiovascular disease risk.

背景:了解他汀类药物、依折麦布和PCSK9i(前蛋白转化酶枯草杆菌蛋白酶/kexin 9型丝氨酸蛋白酶抑制剂)在心肌梗死(MI)或选择性冠状动脉血运重建后的处方,可以改善降脂治疗(LLT)的强化,减少复发性动脉粥样硬化性心血管疾病事件。我们描述了在2015年7月24日至2019年12月9日期间,出院后12个月内发生MI或选择性冠状动脉血运重建的美国退伍军人中LLT的使用和强化情况。方法:LLT强化被定义为增加他汀类药物剂量,或启动他汀类药物、依折麦布或PCSK9i,总体而言,以及在LDL-C(低密度脂蛋白胆固醇)≥70或100 mg/dL的人群中。泊松回归用于确定因心肌梗死住院或选择性冠状动脉血运重建后LLT增强可能性更大的患者特征。结果:81人中 372个指标事件(平均年龄,69.0岁,2.3%女性,平均LDL-C 89.6 mg/dL,33.8%LDL-C≥75)与结论:不到一半的退伍军人在MI或冠状动脉血运重建后的一年内接受了LLT强化治疗,这表明他们错过了降低动脉粥样硬化性心血管疾病风险的机会。
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引用次数: 3
Therapeutic Inertia in Lipid-Lowering Treatment Intensification: Digital Tools and Performance Management to the Rescue? 强化降脂治疗中的治疗惯性:数字工具和绩效管理来拯救?
IF 6.9 2区 医学 Pub Date : 2022-12-01 DOI: 10.1161/CIRCOUTCOMES.122.009399
Khurram Nasir, Joseph A Salami
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引用次数: 0
Sex Disparities in Failure to Rescue After Cardiac Surgery in California and New York. 加州和纽约心脏手术后抢救失败的性别差异。
IF 6.9 2区 医学 Pub Date : 2022-12-01 DOI: 10.1161/CIRCOUTCOMES.122.009050
Sundos Alabbadi, Georgina Rowe, George Gill, Ageliki Vouyouka, Joanna Chikwe, Natalia Egorova

Background: Women have a higher risk of mortality than men after cardiac surgery independent of other risk factors. The reason for this may not be limited to patient-specific variables. Failure to rescue (FTR) patients from death after a postoperative complication is a nationally endorsed quality care metric. We aimed to identify whether sex disparities exist in the quality of care after cardiac surgery using FTR rates.

Methods: A retrospective analysis of 30 973 men (70.4%) and 13 033 women (29.6%) aged over 18 years undergoing coronary artery bypass graft or valve surgery in New York (2016-2019) and California (2016-2018) who experienced at least one serious postoperative complication. The primary outcome was the FTR. Multivariable logistic regression was used to identify predictors of death after complication. Propensity matching was used to adjust for baseline differences between sexes and yielded 12 657 pairs.

Results: Female patients that experienced complications were older (mean age 67.8 versus 66.7, P<0.001), more frail (median frailty score 0.1 versus 0.07, P<0.001), and had more comorbidities (median Charlson score 2.5 versus 2.3, P<0.001) than male patients. The overall FTR rate was 5.7% (2524), men were less likely to die after a complication than women (4.8% versus 8%, P<0.001). Independent predictors of FTR included female sex (relative risk [RR]: 1.46 [CI, 1.30-1.62]), area-level poverty rate >20% (RR, 1.21 [CI, 1.01-1.59]), higher frailty (RR, 2.83 [CI, 1.35-5.93]), undergoing concomitant coronary artery bypass graft and valve surgeries (RR, 1.69 [CI, 1.49-1.9]), and higher number of postoperative complications (RR, 16.28 [CI, 14-18.89]). In the propensity-matched cohorts, the FTR rate remained significantly lower among men than women (6.0% versus 8.0%, P<0.001).

Conclusions: Women are less likely to be rescued from death following postoperative complications, independent of socioeconomic and clinical characteristics. Further research is warranted to investigate the clinical practices contributing to this disparity in quality of care following cardiac surgery.

背景:独立于其他危险因素的心脏手术后,女性的死亡率高于男性。造成这种情况的原因可能不限于患者特定的变量。术后并发症后患者死亡抢救失败(FTR)是国家认可的质量护理指标。我们的目的是通过FTR率来确定心脏手术后护理质量是否存在性别差异。方法:回顾性分析纽约(2016-2019年)和加州(2016-2018年)接受冠状动脉搭桥或瓣膜手术的年龄在18岁以上的30 973名男性(70.4%)和13 033名女性(29.6%),这些患者至少经历了一次严重的术后并发症。主要结果是FTR。多变量逻辑回归用于确定并发症后死亡的预测因素。倾向匹配用于调整两性之间的基线差异,并产生了12 657对。结果:出现并发症的女性患者年龄较大(平均年龄67.8比66.7,PPPP20% (RR, 1.21 [CI, 1.01-1.59]),体弱多病(RR, 2.83 [CI, 1.35-5.93]),同时行冠状动脉搭桥术和瓣膜手术(RR, 1.69 [CI, 1.49-1.9]),术后并发症较多(RR, 16.28 [CI, 14-18.89])。在倾向匹配的队列中,男性的FTR率仍然明显低于女性(6.0%对8.0%)。结论:女性在术后并发症后获救的可能性较小,独立于社会经济和临床特征。进一步的研究需要调查导致心脏手术后护理质量差异的临床实践。
{"title":"Sex Disparities in Failure to Rescue After Cardiac Surgery in California and New York.","authors":"Sundos Alabbadi,&nbsp;Georgina Rowe,&nbsp;George Gill,&nbsp;Ageliki Vouyouka,&nbsp;Joanna Chikwe,&nbsp;Natalia Egorova","doi":"10.1161/CIRCOUTCOMES.122.009050","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.122.009050","url":null,"abstract":"<p><strong>Background: </strong>Women have a higher risk of mortality than men after cardiac surgery independent of other risk factors. The reason for this may not be limited to patient-specific variables. Failure to rescue (FTR) patients from death after a postoperative complication is a nationally endorsed quality care metric. We aimed to identify whether sex disparities exist in the quality of care after cardiac surgery using FTR rates.</p><p><strong>Methods: </strong>A retrospective analysis of 30 973 men (70.4%) and 13 033 women (29.6%) aged over 18 years undergoing coronary artery bypass graft or valve surgery in New York (2016-2019) and California (2016-2018) who experienced at least one serious postoperative complication. The primary outcome was the FTR. Multivariable logistic regression was used to identify predictors of death after complication. Propensity matching was used to adjust for baseline differences between sexes and yielded 12 657 pairs.</p><p><strong>Results: </strong>Female patients that experienced complications were older (mean age 67.8 versus 66.7, <i>P</i><0.001), more frail (median frailty score 0.1 versus 0.07, <i>P</i><0.001), and had more comorbidities (median Charlson score 2.5 versus 2.3, <i>P</i><0.001) than male patients. The overall FTR rate was 5.7% (2524), men were less likely to die after a complication than women (4.8% versus 8%, <i>P</i><0.001). Independent predictors of FTR included female sex (relative risk [RR]: 1.46 [CI, 1.30-1.62]), area-level poverty rate >20% (RR, 1.21 [CI, 1.01-1.59]), higher frailty (RR, 2.83 [CI, 1.35-5.93]), undergoing concomitant coronary artery bypass graft and valve surgeries (RR, 1.69 [CI, 1.49-1.9]), and higher number of postoperative complications (RR, 16.28 [CI, 14-18.89]). In the propensity-matched cohorts, the FTR rate remained significantly lower among men than women (6.0% versus 8.0%, <i>P</i><0.001).</p><p><strong>Conclusions: </strong>Women are less likely to be rescued from death following postoperative complications, independent of socioeconomic and clinical characteristics. Further research is warranted to investigate the clinical practices contributing to this disparity in quality of care following cardiac surgery.</p>","PeriodicalId":10301,"journal":{"name":"Circulation. Cardiovascular Quality and Outcomes","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10572100","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: 1
Examination of Sexual Identity Differences in the Prevalence of Hypertension and Antihypertensive Medication Use Among US Adults: Findings From the Behavioral Risk Factor Surveillance System. 美国成年人高血压患病率和使用抗高血压药物的性别认同差异研究:来自行为风险因素监测系统的研究结果。
IF 6.9 2区 医学 Pub Date : 2022-12-01 Epub Date: 2022-12-20 DOI: 10.1161/CIRCOUTCOMES.122.008999
Yashika Sharma, Anisha Bhargava, Danny Doan, Billy A Caceres

Background: Recent evidence suggests that sexual minority (eg, gay/lesbian, bisexual) adults might be at increased risk of hypertension compared with heterosexual adults. However, disparities by sexual identity in antihypertensive medication use among adults with hypertension have not been comprehensively examined.

Methods: We analyzed data from the Behavioral Risk Factor Surveillance System (2015-2019), to examine sexual identity differences in the prevalence of hypertension and antihypertensive medication use among adults. We ran sex-stratified logistic regression models to estimate the odds ratios of diagnosis of hypertension and antihypertensive medication use among sexual minority (ie, gay/lesbian, bisexual, and other) and heterosexual adults (reference group).

Results: The sample included 420 340 participants with a mean age of 49.7 (±17.0) years, of which 66.7% were Non-Hispanic White. Compared with heterosexual participants of the same sex, bisexual women (adjusted odds ratio, 1.19 [95% CI, 1.03-1.37]) and gay men (adjusted odds ratio, 1.18 [95% CI, 1.03-1.35]) were more likely to report having been diagnosed with hypertension. Among women with diagnosed hypertension, bisexual women had lower odds of current antihypertensive medication use (adjusted odds ratio, 0.71 [95% CI, 0.56-0.90]). Among men with diagnosed hypertension, gay men were more likely than heterosexual men to report current antihypertensive medication use (adjusted odds ratio, 1.39 [95% CI, 1.10-1.78]). Compared with heterosexual participants of the same sex, there were no differences in hypertension or antihypertensive medication use among lesbian women, bisexual men, and participants who reported their sexual identity as other.

Conclusions: Clinical and public health interventions are needed to reduce the risk of hypertension among bisexual women and gay men. Bisexual women were at higher risk of untreated hypertension, which may be attributed to lower health care utilization due to fear of discrimination from health care providers and socioeconomic disadvantage. Future research is needed to better understand factors that may contribute to untreated hypertension among bisexual women with hypertension.

背景:最近的证据表明,与异性恋成人相比,性少数群体(如同性恋、双性恋)成人患高血压的风险可能会增加。然而,尚未对高血压成人患者在使用降压药方面因性别身份而产生的差异进行全面研究:我们分析了行为危险因素监测系统(2015-2019 年)的数据,以研究成人高血压患病率和降压药使用率的性别认同差异。我们运行了性别分层逻辑回归模型,以估算性少数群体(即男同性恋/女同性恋、双性恋和其他)和异性恋成人(参照组)诊断高血压和使用降压药的几率比:样本包括 420 340 名参与者,平均年龄为 49.7 (±17.0) 岁,其中 66.7% 为非西班牙裔白人。与同性异性恋参与者相比,双性恋女性(调整后的几率比为 1.19 [95% CI, 1.03-1.37])和男同性恋者(调整后的几率比为 1.18 [95% CI, 1.03-1.35])更有可能被诊断出患有高血压。在确诊患有高血压的女性中,双性恋女性目前使用降压药的几率较低(调整后的几率比为 0.71 [95% CI, 0.56-0.90])。在确诊为高血压的男性患者中,同性恋男性比异性恋男性更有可能报告目前正在服用降压药(调整后的几率比为 1.39 [95% CI, 1.10-1.78])。与同性异性恋参与者相比,女同性恋者、双性恋男性以及报告其性身份为其他的参与者在高血压或服用降压药方面没有差异:结论:需要采取临床和公共卫生干预措施来降低双性恋女性和男同性恋者罹患高血压的风险。双性恋女性未接受治疗的高血压风险较高,这可能是由于她们害怕受到医疗服务提供者的歧视以及处于社会经济劣势,从而降低了对医疗服务的利用率。今后需要开展研究,以更好地了解可能导致患有高血压的双性恋女性高血压得不到治疗的因素。
{"title":"Examination of Sexual Identity Differences in the Prevalence of Hypertension and Antihypertensive Medication Use Among US Adults: Findings From the Behavioral Risk Factor Surveillance System.","authors":"Yashika Sharma, Anisha Bhargava, Danny Doan, Billy A Caceres","doi":"10.1161/CIRCOUTCOMES.122.008999","DOIUrl":"10.1161/CIRCOUTCOMES.122.008999","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests that sexual minority (eg, gay/lesbian, bisexual) adults might be at increased risk of hypertension compared with heterosexual adults. However, disparities by sexual identity in antihypertensive medication use among adults with hypertension have not been comprehensively examined.</p><p><strong>Methods: </strong>We analyzed data from the Behavioral Risk Factor Surveillance System (2015-2019), to examine sexual identity differences in the prevalence of hypertension and antihypertensive medication use among adults. We ran sex-stratified logistic regression models to estimate the odds ratios of diagnosis of hypertension and antihypertensive medication use among sexual minority (ie, gay/lesbian, bisexual, and other) and heterosexual adults (reference group).</p><p><strong>Results: </strong>The sample included 420 340 participants with a mean age of 49.7 (±17.0) years, of which 66.7% were Non-Hispanic White. Compared with heterosexual participants of the same sex, bisexual women (adjusted odds ratio, 1.19 [95% CI, 1.03-1.37]) and gay men (adjusted odds ratio, 1.18 [95% CI, 1.03-1.35]) were more likely to report having been diagnosed with hypertension. Among women with diagnosed hypertension, bisexual women had lower odds of current antihypertensive medication use (adjusted odds ratio, 0.71 [95% CI, 0.56-0.90]). Among men with diagnosed hypertension, gay men were more likely than heterosexual men to report current antihypertensive medication use (adjusted odds ratio, 1.39 [95% CI, 1.10-1.78]). Compared with heterosexual participants of the same sex, there were no differences in hypertension or antihypertensive medication use among lesbian women, bisexual men, and participants who reported their sexual identity as other.</p><p><strong>Conclusions: </strong>Clinical and public health interventions are needed to reduce the risk of hypertension among bisexual women and gay men. Bisexual women were at higher risk of untreated hypertension, which may be attributed to lower health care utilization due to fear of discrimination from health care providers and socioeconomic disadvantage. Future research is needed to better understand factors that may contribute to untreated hypertension among bisexual women with hypertension.</p>","PeriodicalId":10301,"journal":{"name":"Circulation. Cardiovascular Quality and Outcomes","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9782752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9325451","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: 1
Comparative Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin Among Adults With Cancer and Atrial Fibrillation. 成人癌症合并心房颤动患者直接口服抗凝剂与华法林的有效性和安全性比较。
IF 6.9 2区 医学 Pub Date : 2022-12-01 DOI: 10.1161/CIRCOUTCOMES.122.008951
Hemalkumar B Mehta, Huijun An, Shirin Ardeshirrouhanifard, Mukaila A Raji, G Caleb Alexander, Jodi B Segal

Background: While clinical guidelines recommend direct-acting oral anticoagulants (DOAC) over warfarin to treat isolated nonvalvular atrial fibrillation, guidelines are silent regarding nonvalvular atrial fibrillation treatment among individuals with cancer, reflecting the paucity of evidence in this setting. We quantified relative risk of ischemic stroke or systemic embolism and major bleeding (primary outcomes), and all-cause and cardiovascular death (secondary outcomes) among older individuals with cancer and nonvalvular atrial fibrillation comparing DOACs and warfarin.

Methods: This retrospective cohort study used Surveillance, Epidemiology, and End Results cancer registry and linked US Medicare data from 2010 through 2016, and included individuals diagnosed with cancer and nonvalvular atrial fibrillation who newly initiated DOAC or warfarin. We used inverse probability of treatment weighting to control confounding. We used competing risk regression for primary outcomes and cardiovascular death, and Cox proportional hazard regression for all-cause death.

Results: Among 7675 individuals included in the cohort, 4244 (55.3%) received DOACs and 3431 (44.7%) warfarin. In the inverse probability of treatment weighting analysis, there was no statistically significant difference among DOAC and warfarin users in the risk of ischemic stroke or systemic embolism (1.24 versus 1.19 events per 100 person-years, adjusted hazard ratio 1.41 [95% CI, 0.92-2.14]), major bleeding (3.08 versus 4.49 events per 100 person-years, adjusted hazard ratio 0.90 [95% CI, 0.70-1.17]), and cardiovascular death (1.88 versus 3.14 per 100 person-years, adjusted hazard ratio 0.82 [95% CI, 0.59-0.1.13]). DOAC users had significantly lower risk of all-cause death (7.09 versus 13.3 per 100 person-years, adjusted hazard ratio 0.81 [95% CI, 0.69-0.94]) compared to warfarin users.

Conclusions: Older adults with cancer and atrial fibrillation exposed to DOACs had similar risks of stroke and systemic embolism and major bleeding as those exposed to warfarin. Relative to warfarin, DOAC use was associated with a similar risk of cardiovascular death and a lower risk of all-cause death.

背景:虽然临床指南推荐直接作用口服抗凝剂(DOAC)而不是华法林治疗孤立性非瓣膜性房颤,但指南对癌症患者的非瓣膜性房颤治疗保持沉默,这反映了在这种情况下证据的缺乏。我们量化了老年癌症和非瓣膜性心房颤动患者的缺血性卒中或全系统栓塞和大出血(主要结局)以及全因和心血管死亡(次要结局)的相对风险,比较DOACs和华法林。方法:这项回顾性队列研究使用2010年至2016年的监测、流行病学和最终结果癌症登记和相关的美国医疗保险数据,包括新开始DOAC或华法林的诊断为癌症和非瓣膜性心房颤动的个体。我们使用处理加权的逆概率来控制混淆。我们对主要结局和心血管死亡使用竞争风险回归,对全因死亡使用Cox比例风险回归。结果:在纳入队列的7675人中,4244人(55.3%)接受了doac治疗,3431人(44.7%)接受了华法林治疗。在治疗加权逆概率分析中,DOAC和华法林使用者在缺血性卒中或全系统栓塞(1.24 vs 1.19事件/ 100人-年,校正风险比1.41 [95% CI, 0.92-2.14])、大出血(3.08 vs 4.49事件/ 100人-年,校正风险比0.90 [95% CI, 0.70-1.17])和心血管死亡(1.88 vs 3.14 / 100人-年,校正风险比0.82 [95% CI,0.59 0.1.13])。与华法林服用者相比,DOAC服用者的全因死亡风险显著降低(7.09 vs 13.3 / 100人-年,校正风险比0.81 [95% CI, 0.69-0.94])。结论:老年癌症和房颤患者暴露于DOACs与暴露于华法林的患者卒中、全身性栓塞和大出血的风险相似。与华法林相比,DOAC的使用与心血管死亡风险相似,全因死亡风险较低。
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引用次数: 3
Early Stage and Established Hypertension in Sub-Saharan Africa: Results From Population Health Surveys in 17 Countries, 2010-2017. 撒哈拉以南非洲的早期高血压和高血压:2010-2017年17个国家人口健康调查结果
IF 6.9 2区 医学 Pub Date : 2022-12-01 Epub Date: 2022-10-13 DOI: 10.1161/CIRCOUTCOMES.122.009046
Saate S Shakil, Dike Ojji, Chris T Longenecker, Gregory A Roth

Background: Multiple studies have reported a high burden of hypertension in sub-Saharan Africa, but none have examined early stage hypertension. We examined contemporary prevalence of diagnosed, treated, and controlled stage I (130-139/80-89 mm Hg) and II (140/90 mm Hg) hypertension in the general population of sub-Saharan Africa.

Methods: We analyzed World Health Organization STEPwise Approach to Noncommunicable Disease Risk Factor Surveillance surveys from 17 sub-Saharan Africa countries including 85 371 respondents representing 85 million individuals from 2010 to 2017. We extracted demographic variables, blood pressure, self-reported hypertension diagnosis/awareness, and treatment status to estimate prevalence of stage I and II hypertension and treatment by country. We examined diagnosis and treatment trends by national sociodemographic index, a marker of development.

Results: Stage I hypertension prevalence (regardless of diagnosis/treatment) was >25% in 13 of 17 countries, highest in Sudan (35.3% [95% CI, 33.7%-37.0%]), and lowest in Eritrea (20.2% [18.8%-21.6%]). Combined stages I and II hypertension prevalence was >50% in 13 countries; <20% were diagnosed in every country. Treatment among those diagnosed ranged from 26% to 63%, and control (<140/90 mm Hg) from 4% to 17%. In 8 of 9 countries reporting on behavioral interventions (eg, salt reduction, weight loss, exercise, and smoking cessation), <60% of diagnosed individuals received counseling. Rates of diagnosis, but not treatment, were positively associated with sociodemographic index (P=0.008), although there was substantial variation between countries even at similar levels of development.

Conclusions: Hypertension is common in sub-Saharan Africa but rates of diagnosis, treatment, and control markedly low. There is a large population with early stage hypertension that may benefit from behavioral counseling to prevent progression. Our analyses suggest that success in population hypertension care may be achieved independently of socioeconomic development, highlighting a need for policymakers to identify best practices in those countries that outperform similar or more developed countries.

背景:多项研究报道了撒哈拉以南非洲地区高血压的高负担,但没有一项研究涉及早期高血压。我们研究了撒哈拉以南非洲普通人群中诊断、治疗和控制的I期(130-139/80-89毫米汞柱)和II期(≥140/90毫米汞柱)高血压的当代患病率。方法:我们分析了来自17个撒哈拉以南非洲国家的世界卫生组织逐步方法非传染性疾病风险因素监测调查,包括2010年至2017年的85 371名受访者,代表8500万人。我们提取了人口统计学变量、血压、自我报告的高血压诊断/意识和治疗状况,以估计各国I期和II期高血压的患病率和治疗情况。我们通过国家社会人口指数(发展的标志)检查了诊断和治疗趋势。结果:在17个国家中,有13个国家的I期高血压患病率(无论诊断/治疗)>25%,苏丹最高(35.3% [95% CI, 33.7%-37.0%]),厄立特里亚最低(20.2%[18.8%-21.6%])。13个国家I期和II期合并高血压患病率>50%;P=0.008),尽管在发展水平相似的国家之间存在很大差异。结论:高血压在撒哈拉以南非洲很常见,但诊断、治疗和控制率明显较低。有大量的早期高血压患者可以从行为咨询中获益,以防止病情恶化。我们的分析表明,人群高血压护理的成功可以独立于社会经济发展而实现,这突出了决策者需要在那些表现优于类似或更发达国家的国家中确定最佳做法。
{"title":"Early Stage and Established Hypertension in Sub-Saharan Africa: Results From Population Health Surveys in 17 Countries, 2010-2017.","authors":"Saate S Shakil, Dike Ojji, Chris T Longenecker, Gregory A Roth","doi":"10.1161/CIRCOUTCOMES.122.009046","DOIUrl":"10.1161/CIRCOUTCOMES.122.009046","url":null,"abstract":"<p><strong>Background: </strong>Multiple studies have reported a high burden of hypertension in sub-Saharan Africa, but none have examined early stage hypertension. We examined contemporary prevalence of diagnosed, treated, and controlled stage I (130-139/80-89 mm Hg) and II (<i>≥</i>140/90 mm Hg) hypertension in the general population of sub-Saharan Africa.</p><p><strong>Methods: </strong>We analyzed World Health Organization STEPwise Approach to Noncommunicable Disease Risk Factor Surveillance surveys from 17 sub-Saharan Africa countries including 85 371 respondents representing 85 million individuals from 2010 to 2017. We extracted demographic variables, blood pressure, self-reported hypertension diagnosis/awareness, and treatment status to estimate prevalence of stage I and II hypertension and treatment by country. We examined diagnosis and treatment trends by national sociodemographic index, a marker of development.</p><p><strong>Results: </strong>Stage I hypertension prevalence (regardless of diagnosis/treatment) was >25% in 13 of 17 countries, highest in Sudan (35.3% [95% CI, 33.7%-37.0%]), and lowest in Eritrea (20.2% [18.8%-21.6%]). Combined stages I and II hypertension prevalence was >50% in 13 countries; <20% were diagnosed in every country. Treatment among those diagnosed ranged from 26% to 63%, and control (<140/90 mm Hg) from 4% to 17%. In 8 of 9 countries reporting on behavioral interventions (eg, salt reduction, weight loss, exercise, and smoking cessation), <60% of diagnosed individuals received counseling. Rates of diagnosis, but not treatment, were positively associated with sociodemographic index (<i>P</i>=0.008), although there was substantial variation between countries even at similar levels of development.</p><p><strong>Conclusions: </strong>Hypertension is common in sub-Saharan Africa but rates of diagnosis, treatment, and control markedly low. There is a large population with early stage hypertension that may benefit from behavioral counseling to prevent progression. Our analyses suggest that success in population hypertension care may be achieved independently of socioeconomic development, highlighting a need for policymakers to identify best practices in those countries that outperform similar or more developed countries.</p>","PeriodicalId":10301,"journal":{"name":"Circulation. Cardiovascular Quality and Outcomes","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9771997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10522224","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: 3
Racial Disparities in Specific Maternal Cardiovascular Outcomes. 特定产妇心血管结局的种族差异。
IF 6.9 2区 医学 Pub Date : 2022-12-01 DOI: 10.1161/CIRCOUTCOMES.122.009529
Zainab Mahmoud, Karen E Joynt Maddox, Elena Deych, Kathryn J Lindley
{"title":"Racial Disparities in Specific Maternal Cardiovascular Outcomes.","authors":"Zainab Mahmoud,&nbsp;Karen E Joynt Maddox,&nbsp;Elena Deych,&nbsp;Kathryn J Lindley","doi":"10.1161/CIRCOUTCOMES.122.009529","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.122.009529","url":null,"abstract":"","PeriodicalId":10301,"journal":{"name":"Circulation. Cardiovascular Quality and Outcomes","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10516490","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: 1
Addressing the Unique Social and Structural Drivers of Hypertension Among Sexual Minority Adults in the United States. 解决美国性少数成年人高血压的独特社会和结构驱动因素。
IF 6.9 2区 医学 Pub Date : 2022-12-01 DOI: 10.1161/CIRCOUTCOMES.122.009650
Humberto López Castillo, Omar Martínez
{"title":"Addressing the Unique Social and Structural Drivers of Hypertension Among Sexual Minority Adults in the United States.","authors":"Humberto López Castillo,&nbsp;Omar Martínez","doi":"10.1161/CIRCOUTCOMES.122.009650","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.122.009650","url":null,"abstract":"","PeriodicalId":10301,"journal":{"name":"Circulation. Cardiovascular Quality and Outcomes","volume":null,"pages":null},"PeriodicalIF":6.9,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10510108","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
期刊
Circulation. Cardiovascular Quality and Outcomes
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