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Air pollution-related metabolic profiles and subsequent heart failure risk. 空气污染相关的代谢特征和随后的心力衰竭风险。
IF 4.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-21 DOI: 10.1136/heartjnl-2025-326668
Chaojun Yang, Zhixing Fan, Jing Zhang, Hui Wu, Zeng Ping, Huibo Wang, Ying Yang, Qi Li, Jian Yang

Background: Ambient air pollution is associated with heart failure (HF), but underlying biological mechanisms remain unclear. We aimed to elucidate metabolic pathways linking air pollution exposure with HF.

Methods: This prospective cohort study analysed 229 812 UK Biobank participants with nuclear magnetic resonance metabolomics data. Air pollution score was constructed by fine particulate matter, coarse particulate matter, nitrogen dioxide and nitrogen oxides. Air pollution-associated metabolic signatures were identified using elastic net regression among 251 circulating metabolites. Cox regression evaluated associations between metabolic signatures and incident HF risk. Mediation analysis quantified metabolic signatures' role in air pollution-HF relationships.

Results: During median 13.1-year follow-up, 8986 participants (3.9%) developed HF. We identified 53 metabolic metabolites reflecting air pollution exposure, comprising lipoprotein metabolism markers (22.6%), fatty acids (17.0%) and amino acids (13.2%), which were used to construct the air pollution-related metabolic signatures score. After adjustment for confounding factors, each SD increase in the metabolic signatures was associated with 8% elevated HF risk (HR 1.08, 95% CI 1.06 to 1.11). Participants in the highest quantile showed a 24% increased HF risk compared with those in the lowest quantile (HR 1.24, 95% CI 1.16 to 1.3). The metabolic signatures mediated 13.08% (95% CI 12.15% to 15.71%) of air pollution-HF associations, with lipoprotein metabolism and fatty acid signatures as primary mediators.

Conclusions: Air pollution was associated with increased HF risk, with metabolic perturbations appearing to play a mediating role. These metabolic signatures provide insights into potential mechanisms linking air pollution to cardiovascular outcomes.

背景:环境空气污染与心力衰竭(HF)有关,但潜在的生物学机制尚不清楚。我们的目的是阐明空气污染暴露与HF之间的代谢途径。方法:这项前瞻性队列研究分析了229 812名英国生物银行参与者的核磁共振代谢组学数据。以细颗粒物、粗颗粒物、二氧化氮和氮氧化物为指标构建大气污染评分。利用弹性网回归法对251种循环代谢物进行了与空气污染相关的代谢特征识别。Cox回归评估了代谢特征与心衰风险之间的关联。中介分析量化了代谢特征在空气污染- hf关系中的作用。结果:在中位13.1年的随访期间,8986名参与者(3.9%)发生心衰。我们确定了53种反映空气污染暴露的代谢代谢物,包括脂蛋白代谢标志物(22.6%)、脂肪酸(17.0%)和氨基酸(13.2%),这些代谢物用于构建与空气污染相关的代谢特征评分。校正混杂因素后,代谢特征每增加一个SD, HF风险增加8% (HR 1.08, 95% CI 1.06 ~ 1.11)。与最低分位数的参与者相比,最高分位数的参与者HF风险增加24% (HR 1.24, 95% CI 1.16至1.3)。代谢特征介导了13.08% (95% CI 12.15% ~ 15.71%)的空气污染与hf关联,其中脂蛋白代谢和脂肪酸特征是主要媒介。结论:空气污染与HF风险增加有关,代谢紊乱似乎起中介作用。这些代谢特征提供了将空气污染与心血管结果联系起来的潜在机制的见解。
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引用次数: 0
Making sense of composite endpoints: efficiency, meaning and clinical relevance in modern cardiovascular trials. 复合终点的意义:现代心血管试验的效率、意义和临床相关性。
IF 4.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-21 DOI: 10.1136/heartjnl-2025-327690
Bruno R Nascimento, Bárbara C A Marino, Marcos Antonio Marino
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引用次数: 0
Pearls and pitfalls in the diagnosis and management of mitral annular calcification. 二尖瓣环钙化诊断与治疗的要点与误区。
IF 4.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-20 DOI: 10.1136/heartjnl-2025-325937
Sebastiaan Dhont, Gitte P H van den Acker, Timothy W Churchill, Philippe B Bertrand

Mitral annular calcification (MAC) is a progressive, degenerative process increasingly recognised for its clinical impact. Beyond being an incidental finding, MAC contributes to mitral valve dysfunction, arrhythmias, systemic embolisation and elevated cardiovascular risk. In developed countries, it has now overtaken rheumatic disease as the leading cause of mitral stenosis.The pathophysiology of MAC involves chronic mechanical stress, pro-inflammatory activation and osteogenic differentiation of valvular cells. Progression is accelerated by age, chronic kidney disease and metabolic derangements. Diagnosing MAC-related valve dysfunction is challenging, as traditional echocardiographic measures often prove unreliable. Multimodality imaging-including 3D echocardiography and cardiac CT-is essential for assessing anatomy, function and procedural feasibility. Importantly, symptoms often reflect combined valvular (eg, aortic stenosis) and myocardial disease (eg, heart failure with preserved ejection fraction (HFpEF) phenocopy), necessitating careful haemodynamic evaluation to avoid futile interventions.Management should prioritise medical therapy for symptom control and comorbid HFpEF, reserving interventions for selected patients. Surgical and transcatheter approaches carry high risk and should be undertaken only in specialised centres. Future advances may include tailored devices and therapies targeting calcification pathways.

二尖瓣环钙化(MAC)是一种进行性退行性过程,其临床影响日益得到认可。除了偶然发现外,MAC还会导致二尖瓣功能障碍、心律失常、全身栓塞和心血管风险升高。在发达国家,它已经超过风湿病成为二尖瓣狭窄的主要原因。MAC的病理生理机制包括慢性机械应力、促炎激活和瓣膜细胞的成骨分化。年龄、慢性肾病和代谢紊乱会加速病情的发展。诊断mac相关的瓣膜功能障碍是具有挑战性的,因为传统的超声心动图测量通常被证明是不可靠的。多模态成像——包括三维超声心动图和心脏ct——对于评估解剖、功能和手术可行性至关重要。重要的是,症状通常反映瓣膜(如主动脉狭窄)和心肌疾病(如保留射血分数(HFpEF)表型的心力衰竭)的合并,需要仔细的血流动力学评估,以避免无效的干预。管理应优先考虑对症状控制和合并症HFpEF进行药物治疗,对选定的患者保留干预措施。外科手术和经导管入路风险较高,应仅在专门中心进行。未来的进展可能包括针对钙化途径的定制设备和治疗。
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引用次数: 0
Effects of exercise training in left ventricular assist device patients: a systematic review with an individual participant data meta-analysis. 运动训练对左心室辅助装置患者的影响:一项包含个体参与者数据荟萃分析的系统综述。
IF 4.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-20 DOI: 10.1136/heartjnl-2025-326962
Tim Kambič, Anna Feuerstein, Tim Friede, Kate Hayes, Dennis J Kerrigan, Ioannis D Laoutaris, Phuc Thien Tran, Mitja Lainscak, Frank Edelmann

Background: Safety and efficacy of supervised exercise training (ET) remain unclear in left ventricular assist device (LVAD) patients. A systematic review with an individual participant data (IPD) meta-analysis was performed to determine: (1) safety, (2) the effects of ET on peak oxygen consumption (peakVO2), 6 min walk distance (6MWT) and quality of life (QoL) and (3) the effects of ET on different subgroups of patients with LVAD (age, sex, body mass index (BMI), time post LVAD implantation, baseline exercise performance).

Methods: IPD were retrieved from all published randomised, controlled trials that compared the efficacy of ET versus standard care in LVAD patients. One-stage and two-stage (sensitivity analysis) meta-analyses were used to determine the effects of ET overall and for subgroup and ET effects interactions.

Results: Four trials that included 119 LVAD patients (89.1 % males; age: mean (SD), 53 (14) years; BMI: 28 (5) kg/m2; ejection fraction: 19 (6)%) were analysed. ET was safe and improved peakVO2 (mean difference (95% CI) +1.43 (0.39 to 2.45) mL/kg/min, p=0.004), 6MWT distance (+48 (95% CI 24 to 73) m, p<0.001), QoL (+0.66 (95% CI 0.26 to 1.05) standardised units, p<0.001) more than standard care. Males, older patients, 1 year post LVAD implantation and those with lower baseline BMI and (sub)maximal exercise performance had larger benefit of ET.

Conclusions: ET is safe and improves (sub)maximal exercise performance and QoL in LVAD patients, and should be considered in management of LVAD.

Prospero registration number: CRD42023480119.

背景:监督运动训练(ET)对左心室辅助装置(LVAD)患者的安全性和有效性尚不清楚。采用个体参与者数据(IPD)荟萃分析进行系统回顾,以确定:(1)安全性;(2)ET对峰值耗氧量(peakVO2)、6分钟步行距离(6MWT)和生活质量(QoL)的影响;(3)ET对不同亚组LVAD患者(年龄、性别、体重指数(BMI)、LVAD植入后时间、基线运动表现)的影响。方法:从所有已发表的随机对照试验中检索IPD,这些试验比较了ET与标准治疗对LVAD患者的疗效。采用一阶段和两阶段(敏感性分析)荟萃分析来确定ET的总体影响以及亚组和ET效应的相互作用。结果:4项试验纳入119例LVAD患者(89.1%为男性),年龄:平均(SD) 53(14)岁;BMI: 28 (5) kg/m2;射血分数:19(6)%。ET是安全的,可改善峰值vo2(平均差值(95% CI) +1.43 (0.39 ~ 2.45) mL/kg/min, p=0.004), 6MWT距离(+48 (95% CI 24 ~ 73) m, p。结论:ET是安全的,可改善LVAD患者的(次)最大运动表现和生活质量,在LVAD的治疗中应予以考虑。普洛斯彼罗注册号:CRD42023480119。
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引用次数: 0
Myocarditis and look-alikes: when the diagnosis matters. 心肌炎和心肌炎:当诊断很重要时。
IF 4.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-20 DOI: 10.1136/heartjnl-2025-326381
Michele Marchetta, Brittany N Weber, Alessio Gasperetti, Marco Giuseppe Del Buono, Michele Golino, Matteo Palazzini, Antonio Abbate

Myocarditis is an inflammatory disease of the heart muscle that can be triggered by various causes, including viruses, autoimmune response, molecular mimicry and exposure to immune-stimulating drugs or vaccines. Most cases of myocarditis heal, and cardiac dysfunction, if present, recovers; however, selected forms may require targeted therapy to improve outcomes. We herein review five conditions presenting with or mimicking myocarditis that require targeted diagnostic approaches, including endomyocardial biopsy, and/or targeted treatments. Giant cell myocarditis is an intense and unresolving inflammation of the heart, characterised by rapid progression, significant arrhythmias, heart failure and shock, that is unlikely to resolve without immunosuppression therapy. Myocarditis related to immune checkpoint inhibitors is a rare but potentially fatal adverse effect of the use of cancer immunotherapy with checkpoint inhibitors, requiring immunosuppressive therapy. Eosinophilic myocarditis can be triggered by allergy, hypersensitivity reactions, infections or can be idiopathic and is characterised by eosinophilic infiltrates in the heart and other organs, associated with thrombosis and necessitating targeted therapy. Myocarditis is a frequent cardiovascular manifestation of systemic immune-mediated inflammatory diseases such as systemic lupus erythematosus, and injury is caused by an autoimmune response in the myocardium and cytokine-mediated damage, requiring targeted therapy. Genetic pathogenic mutations in desmoplakin and other desmosomal genes can present with 'hot phases' mimicking myocarditis associated with an increased risk of arrhythmias, heart failure, and sudden cardiac death.

心肌炎是一种心肌炎症性疾病,可由多种原因引发,包括病毒、自身免疫反应、分子模仿和暴露于免疫刺激药物或疫苗。大多数心肌炎可痊愈,心功能障碍如有,可恢复;然而,选择的形式可能需要有针对性的治疗来改善结果。我们在此回顾五种表现为或模拟心肌炎的情况,需要有针对性的诊断方法,包括心肌炎内膜活检和/或靶向治疗。巨细胞性心肌炎是一种强烈且无法治愈的心脏炎症,其特征是进展迅速,明显的心律失常,心力衰竭和休克,不经免疫抑制治疗不太可能消退。与免疫检查点抑制剂相关的心肌炎是使用检查点抑制剂的癌症免疫治疗的罕见但潜在致命的不良反应,需要免疫抑制治疗。嗜酸性心肌炎可由过敏、超敏反应、感染引发,也可是特发性的,其特征是嗜酸性心肌炎浸润到心脏和其他器官,与血栓形成有关,需要靶向治疗。心肌炎是系统性红斑狼疮等全身性免疫介导炎症性疾病的常见心血管表现,损伤是由心肌自身免疫反应和细胞因子介导的损伤引起的,需要靶向治疗。桥粒蛋白和其他桥粒体基因的遗传致病性突变可出现类似心肌炎的“热期”,与心律失常、心力衰竭和心源性猝死的风险增加有关。
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引用次数: 0
Transcatheter aortic valve degeneration: a combined clinical and translational perspective. 经导管主动脉瓣退行性变:临床和翻译的综合观点。
IF 4.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-19 DOI: 10.1136/heartjnl-2025-326405
Joshua Yoon, Quentin Liabot, Colin Jamieson, Brooke MacLeod, David Meier, Stephanie L Sellers

As transcatheter aortic valve implantation (TAVI) is increasingly used in younger and lower-risk patients, long-term valve durability has become a growing concern. Bioprosthetic valve degeneration (BVD) is multifactorial, encompassing calcific and non-calcific structural deterioration, non-structural deterioration, valve thrombosis and procedural or device-related factors. This review aims to provide a look across the spectrum of understanding BVD, presenting insights from fundamental and translational science through to the clinic to give a comprehensive overview of the mechanisms underlying BVD in TAVI valves. This review highlights the pivotal role of multimodality imaging in detection, classification and monitoring of degeneration and discusses the emerging pharmacological and engineering innovations aimed at preventing degeneration. Finally, reintervention strategies, including redo-TAV and surgical explantation, are explored with an emphasis on CT-based planning and bench-testing insights that have enhanced our understanding of BVD and inform ongoing procedural refinement. These perspectives support a proactive and tailored approach to managing transcatheter aortic valve degeneration across the patient's lifetime.

随着经导管主动脉瓣植入术(TAVI)越来越多地用于年轻和低风险患者,瓣膜的长期耐用性越来越受到关注。生物假体瓣膜退行性变(BVD)是多因素的,包括钙化和非钙化结构恶化、非结构恶化、瓣膜血栓形成以及手术或器械相关因素。这篇综述旨在提供对BVD的理解,从基础科学和转化科学到临床的见解,对TAVI瓣膜中BVD的机制进行全面概述。这篇综述强调了多模态成像在变性的检测、分类和监测中的关键作用,并讨论了旨在预防变性的新兴药理和工程创新。最后,探讨了再干预策略,包括redo-TAV和手术移植,重点是基于ct的计划和台架测试的见解,这些见解增强了我们对BVD的理解,并为正在进行的程序改进提供了信息。这些观点支持在患者的一生中积极主动和量身定制的方法来管理经导管主动脉瓣变性。
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引用次数: 0
Innovations in cardiac device therapy in the era of advanced rhythm management: implantable defibrillators and conduction system pacing. 先进心律管理时代心脏装置治疗的创新:植入式除颤器和传导系统起搏。
IF 4.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-19 DOI: 10.1136/heartjnl-2025-325834
Margarida Pujol-Lopez, Roderick Tung, Lluis Mont

Cardiac device therapy has significantly evolved since the introduction of the first implantable pacemaker and the subsequent development of the implantable cardioverter-defibrillator (ICD). ICDs are highly effective; however, their main weakness lies in lead-related complications. To avoid the need for venous access and the complications associated with transvenous leads, a fully subcutaneous ICD (S-ICD) system was developed. Despite these advancements, the S-ICD system is limited by its inability to provide bradycardia pacing and antitachycardia pacing. This limitation prompted the development of a modular cardiac rhythm management system, integrating a new leadless pacemaker with an S-ICD that uses unidirectional communication to command the pacemaker to deliver antitachycardia pacing.Conduction system pacing, including His bundle pacing and left bundle branch area pacing (LBBAP), has emerged as a physiological alternative to biventricular resynchronisation therapy and conventional pacing, pending results of large clinical trials. LBBAP offers superior electrical parameters and long-term performance compared with His bundle pacing. The capability to provide defibrillation via the same lead used for LBBAP represents an unresolved challenge that is currently under ongoing research.This state-of-the-art review presents the latest developments and innovations in cardiac device therapy, offering a comprehensive overview of current technologies that increasingly enable therapy to be tailored to individual patient needs.

自第一台植入式心脏起搏器和随后的植入式心律转复除颤器(ICD)问世以来,心脏装置治疗已经发生了重大变化。icd非常有效;然而,它们的主要缺点在于与铅有关的并发症。为了避免需要静脉通道和与经静脉导联相关的并发症,我们开发了一种完全皮下ICD (S-ICD)系统。尽管有这些进步,S-ICD系统仍受其无法提供心动过缓起搏和抗心动过速起搏的限制。这一限制促使模块化心律管理系统的开发,将新型无铅起搏器与S-ICD集成在一起,使用单向通信命令起搏器进行抗心动过速起搏。传导系统起搏,包括His束起搏和左束分支起搏(LBBAP),已经成为双心室再同步治疗和传统起搏的生理替代方案,有待大型临床试验的结果。与His束起搏相比,LBBAP具有优越的电参数和长期性能。通过与LBBAP相同的导联提供除颤的能力是目前正在进行的研究中尚未解决的挑战。这篇最先进的综述介绍了心脏装置治疗的最新发展和创新,提供了当前技术的全面概述,这些技术越来越多地使治疗能够适应个体患者的需求。
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引用次数: 0
Fluid restriction in patients with heart failure: a systematic review. 心力衰竭患者的液体限制:一项系统综述
IF 4.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-13 DOI: 10.1136/heartjnl-2025-326784
Job J Herrmann, Rachna van Berlo, Hans-Peter Brunner-La Rocca, Sandra Sanders-Van Wijk, D H Frank Gommans, Roland R J van Kimmenade

Background: Fluid restriction is a commonly prescribed non-pharmacological intervention in the management of heart failure (HF). However, data on its efficacy and safety are scarce. Recent randomised clinical trial (RCT) data prompt reassessment of the available evidence.

Methods: CINAHL, EMBASE, PubMed and the Cochrane Library were searched up to 1 May 2025. RCTs were included if adults with HF were randomised to fluid restriction in comparison to a liberal or unrestricted intake, less strict restriction or usual care. Outcomes of interest were mortality, HF hospitalisation, quality of life (QoL), thirst distress, New York Heart Association (NYHA) class and N-terminal pro-Brain Natriuretic Peptide (CRD42022292319). No meta-analysis was performed due to high heterogeneity of the included trials.

Results: In total, four RCTs were included, comprising 682 randomised inpatient, recently discharged and stable outpatient patients (ranging from 46 to 504 patients per trial). Only one study had a low risk of bias. None of the four trials found a significant difference in mortality or HF hospitalisations. For QoL, the results are contradictory, but overall, there is no clear benefit for fluid restriction, but it resulted in more thirst distress. No significant differences in NYHA class or (NT-pro)BNP were observed.

Conclusion: Studies on fluid restriction in patients with HF are scarce, and most of the available studies are at high risk of bias. Although power is lacking, there is no evidence indicating that fluid restriction affects mortality or HF hospitalisations, but there is a signal of harm in terms of thirst distress. Taken together, the current evidence does not support the routine use of fluid restriction in patients with HF.

背景:限制液体是治疗心力衰竭(HF)的常用非药物干预措施。然而,关于其有效性和安全性的数据很少。最近的随机临床试验(RCT)数据提示对现有证据的重新评估。方法:检索截至2025年5月1日的CINAHL、EMBASE、PubMed和Cochrane Library。如果成年HF患者被随机分配到液体限制组,与自由或无限制摄入组、较不严格的限制组或常规护理组相比,则纳入rct。研究结果包括死亡率、心衰住院率、生活质量(QoL)、口渴窘迫、纽约心脏协会(NYHA)分级和n端前脑利钠肽(CRD42022292319)。由于纳入试验的异质性较高,未进行meta分析。结果:共纳入4项随机对照试验,包括682例随机住院患者、近期出院患者和稳定门诊患者(每项试验46 - 504例患者)。只有一项研究的偏倚风险较低。四项试验均未发现死亡率或心衰住院率有显著差异。对于生活质量,结果是矛盾的,但总的来说,限制液体没有明显的好处,但它会导致更多的口渴痛苦。NYHA类和(NT-pro)BNP未见显著差异。结论:关于心衰患者限制饮水的研究很少,而且现有的研究大多存在高偏倚风险。虽然缺乏动力,但没有证据表明限制液体会影响死亡率或心力衰竭住院治疗,但在口渴窘迫方面有危害的迹象。综上所述,目前的证据并不支持在心衰患者中常规使用液体限制。
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引用次数: 0
Heart failure and fluid restriction: time to let go? 心力衰竭和液体限制:是时候放手了?
IF 4.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-13 DOI: 10.1136/heartjnl-2025-327288
Ryosuke Sato, Constanze Schmidt, Stephan von Haehling
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引用次数: 0
Agreement of ethnicity reporting among patients with cancer with acute coronary syndrome: a national multiregistry analysis. 癌症合并急性冠脉综合征患者种族报告的一致性:一项全国多登记分析。
IF 4.4 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-01-13 DOI: 10.1136/heartjnl-2025-326988
Mohamed O Mohamed, Mamas A Mamas, Charlotte Manisty, Evangelos Kontopantelis, Fizzah A Choudry, Arjun K Ghosh, Clive Weston, Michael Peake, Avirup Guha, Andrew Wragg, Muhiddin Ozkor, Mark A de Belder, John Deanfield, David Adlam, Amitava Banerjee

Background: Ethnic inequalities exist in the management of patients with cancer with acute coronary syndrome (ACS). Given their under-representation in trials, ethnic minority patients are often studied using large registries, but the quality of ethnicity coding in these datasets remains unclear.

Methods: Agreement of ethnicity coding and outcomes for patients with cancer with ACS (2000-2018) was examined across four national datasets: National Cancer Registration and Analysis Service (NCRAS), Myocardial Ischaemia National Audit Project (MINAP), British Cardiovascular Intervention Society database (BCIS) and Hospital Episode Statistics (HES). Three linkages were performed: NCRAS-MINAP, NCRAS-MINAP-BCIS, NCRAS-MINAP-HES, with four groups based on ethnicity agreement: Concordant, Discordant, Missing (1 and ≥2 datasets). Multivariable logistic regression and Cox's Proportional Hazards models assessed 1-year and long-term (≤5 years) cardiac and cancer-related death for each agreement group.

Results: Among three linkages, just over half of the ethnicities were concordant (range: 52.4%-53.8%). Discordance was relatively low (range 1.2%-5.5%) while missingness ranged between 28.6% and 43.4% in 1 dataset and 1.6%-12.6% in ≥2 datasets. Ethnicity correlation between individual datasets was poor, lowest between NCRAS and BCIS (r=0.318). We observed higher 1-year and long-term cardiac and cancer deaths in several of the Missing (1 and ≥2 datasets) groups across the three linkages, compared with the Concordant group.

Conclusion: Across four national datasets for patients with cancer with ACS, nearly half of patients had missing ethnicity in at least one dataset, which was associated with higher cardiac or cancer mortality. Inconsistency in ethnicity coding represents a missed opportunity to examine health inequalities in this high-risk and understudied population.

背景:在癌症合并急性冠脉综合征(ACS)患者的管理中存在种族不平等。考虑到他们在试验中的代表性不足,少数民族患者通常使用大型注册库进行研究,但这些数据集中的种族编码质量仍不清楚。方法:通过四个国家数据集(国家癌症登记和分析服务中心(NCRAS)、心肌缺血国家审计项目(MINAP)、英国心血管干预协会数据库(BCIS)和医院事件统计(HES))检查癌症ACS患者(2000-2018)的种族编码和结局的一致性。进行了三个关联:NCRAS-MINAP, NCRAS-MINAP- bcis, NCRAS-MINAP- hes,根据种族一致性分为四组:Concordant, disdant, Missing(1和≥2个数据集)。多变量logistic回归和Cox比例风险模型评估了每个协议组1年和长期(≤5年)心脏和癌症相关死亡。结果:在三个联系中,超过一半的种族是一致的(范围:52.4% ~ 53.8%)。不一致性相对较低(范围为1.2%-5.5%),而缺失度在1个数据集的28.6% - 43.4%之间,在≥2个数据集的1.6%-12.6%之间。各个数据集之间的种族相关性较差,NCRAS和BCIS之间的相关性最低(r=0.318)。我们观察到,与协和组相比,在三个关联中,缺失组(1个和≥2个数据集)中的几个组的1年和长期心脏和癌症死亡率更高。结论:在癌症合并ACS患者的四个国家数据集中,近一半的患者在至少一个数据集中缺少种族,这与较高的心脏或癌症死亡率相关。种族编码的不一致意味着错过了在这一高风险和研究不足的人群中检查健康不平等的机会。
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引用次数: 0
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