Circulation-Cardiovascular Quality and Outcomes最新文献

Background: The potential J-shaped relationship whereby lower diastolic blood pressure (DBP) is associated with a higher risk of adverse cognitive outcomes has raised concerns regarding intensive systolic blood pressure (SBP) lowering. However, the current guidelines advocate a stricter SBP target of <130 mm Hg, with no clear consensus on a DBP target, especially with respect to brain health. The present study aimed to determine the relationship between treated DBP and cognitive function, as well as cerebral perfusion and structure, in adults who achieved an SBP <130 mm Hg.

Methods: This secondary analysis of SPRINT-MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension) included hypertensive participants with achieved SBP <130 mm Hg, irrespective of their original assignment to the intensive or standard treatment arm. We evaluated cognitive outcomes (probable dementia and mild cognitive impairment) and changes in cerebral blood flow, white matter lesions, and total brain volume according to achieved DBP category (<60, 60-69, 70-79, and ≥80 mm Hg) and achieved DBP as a continuous variable. Cox regression models and linear mixed models were used in analyses.

Results: In total, 4424 participants (67.4±9.1 years; 2875 [65.0%] men) were included. In the crude model, low on-treatment DBP was significantly associated with increased risks of probable dementia and mild cognitive impairment. However, after correction for all potential covariates, the statistical significance of the association was lost (all P>0.05). Treated DBP was not associated with changes in white matter lesions or total brain volume; however, there was a significant inverse relationship between achieved DBP and cerebral blood flow changes (P for trend =0.029; difference in change, -1.94 mL/100 g per minute [95% CI, -3.50 to -0.39] per 5-mm Hg increase).

Conclusions: In patients achieving an SBP <130 mm Hg, treated DBP was not associated with dementia, mild cognitive impairment, or changes in white matter lesions and total brain volume. However, there was an increased risk of impaired cerebral perfusion in patients with elevated on-treatment DBP.

Background: The COVID-19 pandemic disrupted health services, particularly affecting individuals with cardiometabolic diseases. This study compared health care use and mortality trends in adults with cardiometabolic diseases during the first pandemic year. It also examined associations between changes in outpatient visits and diagnostic tests with acute health care utilization and mortality.

Methods: Using health administrative databases, we conducted a retrospective population-based study using an open-cohort sampling on adult (≥18 years of age) Ontario residents with a prior diagnosis of angina, congestive heart failure, hypertension, or diabetes between January 2016 and March 2021. During the pandemic's first year (March 2020-March 2021), observed (per 100 000 at-risk) versus projected event rates were compared for all-cause outpatient visits, diagnostic testing, emergency department visits, hospitalizations and mortality across the 4 time periods. Auto-regressive integrated moving-average models were used to calculate projected rates from observed monthly rates from similar periods pre-COVID (January 2016-December 2019). Quasi-Poisson models examined interactions between care access and acute outcomes.

Results: In the first pandemic quarter, rates of outpatient visits, diagnostic testing, emergency department visits, and hospitalizations for adults with cardiometabolic diseases decreased. By year-end, outpatient visits exceeded projections for angina, congestive heart failure, and diabetes, while most diagnostic test rates remained below projections. Mortality was as projected, except in adults with hypertension during the first quarter (observed 54 964 versus projected, 50 134 [95% CI, 46 686-53 840]). In adults with diabetes and hypertension, fewer cardiac investigations and echocardiograms were associated with greater mortality than prepandemic (interaction P<0.01). Unlike other populations, diabetes and hypertension patients showed reduced emergency department visits, hospitalizations, and mortality during months with the highest virtual care use (P<0.02).

Conclusions: The pandemic impacted health care utilization and mortality for adults with cardiometabolic diseases. Access to diagnostic testing is critical, particularly for those with diabetes and hypertension. Virtual care may benefit frequent health care users.

Background: Effective risk communication is essential in managing cardiovascular disease, the leading cause of global mortality. Clear communication between patients and physicians supports informed decision-making, yet comprehension gaps persist. We aimed to assess the quality of risk communication during hospital admissions for cardiovascular events, from patient and physician perspectives, and identify discrepancies in risk perception and associated factors.

Methods: The HARIPA study (Heart Risk Perception and Communication Inpatient) by the Spanish Society of Cardiology was a multicenter, cross-sectional analysis conducted in 28 hospitals across Spain from October 2022 to March 2023. It included consecutive cardiology inpatients (urgent or scheduled), aged ≥18 years, who could complete structured questionnaires. Participating physicians also completed parallel questionnaires. These assessed admission diagnosis, perceptions of future cardiovascular risk, and communication about potential procedural complications. Agreement between responses was evaluated using kappa indices (weighted for ordinal variables), and multivariable logistic regression was used to examine the impact of demographic and clinical factors (odds ratios with 95% CIs).

Results: We included 943 patients (mean age, 68.2 years; 29.4% women). The most frequent reason for admission was ischemic heart disease (41.3%). Responses resulted in a substantial agreement, with a kappa index of 0.72. Concordance between patients and physicians regarding future cardiovascular risk was low (weighted kappa: 0.29), with patients often underestimating their risk. And for assessment about procedural potential complications was moderate (kappa: 0.34). Although 76.9% of patients reported feeling adequately informed about procedural risks, 69.3% of those who experienced complications (n=208) stated they had not been warned about them.

Conclusions: This study reveals significant gaps in risk communication in cardiovascular care, particularly regarding future risks and complications. As well-informed patients are more likely to adhere to preventive therapies, tailoring communication strategies to individual patient characteristics could improve understanding and align perceptions with clinical realities, enhancing health outcomes.