Pub Date : 2026-07-01Epub Date: 2026-01-08DOI: 10.1016/j.hrtlng.2025.102715
Valentina Scheggi , Pier Luigi Stefàno
Background
Despite advancements in diagnostic and therapeutic strategies, infective endocarditis (IE) remains associated with high morbidity and mortality rates. Recent studies have highlighted significant sex-related differences in the clinical presentation, management, and outcomes of IE, reporting conflicting results.
Objectives
identifying the sex-related differences of patients with IE in clinical presentation and predictors of all-cause mortality.
Methods
We conducted a retrospective study at a high-volume surgical centre, examining 687 new cases of non-device-related IE admitted between January 2013 and November 2023. Data were collected from anonymized electronic hospital records, including demographic, clinical, echocardiographic, and microbiologic characteristics. Statistical analyses were performed to identify sex-related differences in clinical presentation and predictors of all-cause mortality.
Results
Female patients represented 34% of the cohort and were significantly older than males (69.6 vs. 63.9 years, p < 0.001). Females had higher prevalence of diabetes (24.8% vs. 18.1%, p = 0.039) and hypertension (65.8% vs. 57%, p = 0.025). Mitral valve IE was more common in females (46.6% vs. 36%, p = 0.023), while males had higher incidence of spondylodiscitis (10.2% vs. 3.4%, p = 0.002). Overall mortality was higher in females, but sex was not an independent predictor of mortality at multivariable analysis.
Conclusion
Our study highlights important sex-based differences in IE, emphasizing the need for sex-specific approaches to diagnosis, treatment, and management. Recognizing and addressing these differences can improve outcomes for both male and female patients with IE.
{"title":"Sex-related differences in infective endocarditis. A retrospective study in a high-volume surgical centre","authors":"Valentina Scheggi , Pier Luigi Stefàno","doi":"10.1016/j.hrtlng.2025.102715","DOIUrl":"10.1016/j.hrtlng.2025.102715","url":null,"abstract":"<div><h3>Background</h3><div>Despite advancements in diagnostic and therapeutic strategies, infective endocarditis (IE) remains associated with high morbidity and mortality rates. Recent studies have highlighted significant sex-related differences in the clinical presentation, management, and outcomes of IE, reporting conflicting results.</div></div><div><h3>Objectives</h3><div>identifying the sex-related differences of patients with IE in clinical presentation and predictors of all-cause mortality.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study at a high-volume surgical centre, examining 687 new cases of non-device-related IE admitted between January 2013 and November 2023. Data were collected from anonymized electronic hospital records, including demographic, clinical, echocardiographic, and microbiologic characteristics. Statistical analyses were performed to identify sex-related differences in clinical presentation and predictors of all-cause mortality.</div></div><div><h3>Results</h3><div>Female patients represented 34% of the cohort and were significantly older than males (69.6 vs. 63.9 years, <em>p</em> < 0.001). Females had higher prevalence of diabetes (24.8% vs. 18.1%, <em>p</em> = 0.039) and hypertension (65.8% vs. 57%, <em>p</em> = 0.025). Mitral valve IE was more common in females (46.6% vs. 36%, <em>p</em> = 0.023), while males had higher incidence of spondylodiscitis (10.2% vs. 3.4%, <em>p</em> = 0.002). Overall mortality was higher in females, but sex was not an independent predictor of mortality at multivariable analysis.</div></div><div><h3>Conclusion</h3><div>Our study highlights important sex-based differences in IE, emphasizing the need for sex-specific approaches to diagnosis, treatment, and management. Recognizing and addressing these differences can improve outcomes for both male and female patients with IE.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"78 ","pages":"Article 102715"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-07-01Epub Date: 2026-02-08DOI: 10.1016/j.hrtlng.2026.102735
Serdar Özdemir, İbrahim Altunok, Merve Osoydan Satıcı M.D., Hilal Sümeyye Körelçiner MD
Background
Early risk stratification in sepsis is essential for guiding timely clinical decisions in the emergency department (ED). While several prognostic scores exist, many rely on laboratory parameters that may not be immediately available at triage.
Objective
To evaluate the prognostic performance of the S-S.M.A.R.T score for predicting 30-day mortality in patients with Sepsis-3–defined sepsis and to assess whether incorporating comorbidity and biomarker data enhances predictive accuracy.
Methods
This prospective observational study included adult patients (≥18 years) presenting to a ED with sepsis defined by Sepsis-3 criteria. Demographic, clinical, and laboratory data were collected at ED presentation. The S-S.M.A.R.T score, SOFA score, and a novel SSMART-MC model (S-S.M.A.R.T plus malignancy and CRP) were calculated. Logistic regression identified independent predictors of 30-day mortality. Prognostic performance was assessed using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and overall accuracy.
Results
Among 180 patients, 104 (57.8%) died within 30 days. Median S-S.M.A.R.T and SOFA scores were higher in non-survivors (3 vs. 2 and 9 vs. 6; p < .001). S-S.M.A.R.T predicted 30-day mortality with an AUC of 0.718, similar to SOFA (AUC 0.735; p = .701). Incorporating malignancy and CRP, the SSMART-MC model achieved an AUC of 0.867, with 87.3% sensitivity, 72.0% specificity, and 80.8% overall accuracy.
Conclusions
In this Sepsis-3 cohort, the S-S.M.A.R.T score showed performance comparable to qSOFA for predicting 30-day mortality. The incorporation of malignancy and CRP appeared to improve prognostic accuracy. However, given the limited sample size and lack of external validation, the SSMART-MC model should be considered a promising tool that requires confirmation in larger, multicenter studies before routine clinical use.
{"title":"S-S.M.A.R.T score for mortality prediction in sepsis: Comparative analysis with qSOFA and a novel SSMART-MC model","authors":"Serdar Özdemir, İbrahim Altunok, Merve Osoydan Satıcı M.D., Hilal Sümeyye Körelçiner MD","doi":"10.1016/j.hrtlng.2026.102735","DOIUrl":"10.1016/j.hrtlng.2026.102735","url":null,"abstract":"<div><h3>Background</h3><div>Early risk stratification in sepsis is essential for guiding timely clinical decisions in the emergency department (ED). While several prognostic scores exist, many rely on laboratory parameters that may not be immediately available at triage.</div></div><div><h3>Objective</h3><div>To evaluate the prognostic performance of the S-S.M.A.R.T score for predicting 30-day mortality in patients with Sepsis-3–defined sepsis and to assess whether incorporating comorbidity and biomarker data enhances predictive accuracy.</div></div><div><h3>Methods</h3><div>This prospective observational study included adult patients (≥18 years) presenting to a ED with sepsis defined by Sepsis-3 criteria. Demographic, clinical, and laboratory data were collected at ED presentation. The S-S.M.A.R.T score, SOFA score, and a novel SSMART-MC model (S-S.M.A.R.T plus malignancy and CRP) were calculated. Logistic regression identified independent predictors of 30-day mortality. Prognostic performance was assessed using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and overall accuracy.</div></div><div><h3>Results</h3><div>Among 180 patients, 104 (57.8%) died within 30 days. Median S-S.M.A.R.T and SOFA scores were higher in non-survivors (3 vs. 2 and 9 vs. 6; <em>p</em> < .001). S-S.M.A.R.T predicted 30-day mortality with an AUC of 0.718, similar to SOFA (AUC 0.735; <em>p</em> = .701). Incorporating malignancy and CRP, the SSMART-MC model achieved an AUC of 0.867, with 87.3% sensitivity, 72.0% specificity, and 80.8% overall accuracy.</div></div><div><h3>Conclusions</h3><div>In this Sepsis-3 cohort, the S-S.M.A.R.T score showed performance comparable to qSOFA for predicting 30-day mortality. The incorporation of malignancy and CRP appeared to improve prognostic accuracy. However, given the limited sample size and lack of external validation, the SSMART-MC model should be considered a promising tool that requires confirmation in larger, multicenter studies before routine clinical use.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"78 ","pages":"Article 102735"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-07-01Epub Date: 2026-02-13DOI: 10.1016/j.hrtlng.2026.102742
Tuğçe Yılmaz, Serdar Özdemir
Background
Norepinephrine is widely used as a first-line vasopressor in acute hypotension and septic shock. Its acute effects on electrocardiographic (ECG) parameters, particularly the frontal QRS-T angle, remain unclear.
Objectives
To evaluate the short-term impact of therapeutic-dose norepinephrine infusion on ECG parameters, with a focus on the frontal QRS-T angle, in the emergency department.
Methods
This prospective observational study included 135 adult patients clinically indicated for norepinephrine in the emergency department of a tertiary training and research hospital. ECG recordings were obtained at baseline and at the first and second hours after norepinephrine initiation. Parameters assessed included heart rate, P-wave duration, PR interval, QRS duration, QT, QTcB, P axis, QRS axis, T axis, and frontal QRS-T angle. Temporal changes were analyzed using the Friedman test.
Results
The median age of the patients was 77 (68–84) years, and 52% were male. When ECG parameters were compared over time, no statistically significant change was detected in any parameter, including heart rate, P-wave duration, PR interval, QRS duration, QT, QTcB, and frontal QRS-T angle (p > 0.05 for all). The frontal QRS-T angle was recorded as 91° (31–159) at baseline, 86° (28.5–152) at the first hour, and 76° (30–150) at the second hour (p = 0.273). Similarly, no significant change in ECG parameters was observed in the sepsis subgroup.
Conclusion
Short-term therapeutic-dose norepinephrine infusion in the emergency department did not significantly affect ECG parameters, including the frontal QRS-T angle. These findings suggest that norepinephrine does not acutely alter ventricular repolarization heterogeneity.
{"title":"Acute effects of norepinephrine infusion on electrocardiographic parameters: A prospective study focusing on the frontal QRS-T angle","authors":"Tuğçe Yılmaz, Serdar Özdemir","doi":"10.1016/j.hrtlng.2026.102742","DOIUrl":"10.1016/j.hrtlng.2026.102742","url":null,"abstract":"<div><h3>Background</h3><div>Norepinephrine is widely used as a first-line vasopressor in acute hypotension and septic shock. Its acute effects on electrocardiographic (ECG) parameters, particularly the frontal QRS-T angle, remain unclear.</div></div><div><h3>Objectives</h3><div>To evaluate the short-term impact of therapeutic-dose norepinephrine infusion on ECG parameters, with a focus on the frontal QRS-T angle, in the emergency department.</div></div><div><h3>Methods</h3><div>This prospective observational study included 135 adult patients clinically indicated for norepinephrine in the emergency department of a tertiary training and research hospital. ECG recordings were obtained at baseline and at the first and second hours after norepinephrine initiation. Parameters assessed included heart rate, P-wave duration, PR interval, QRS duration, QT, QTcB, P axis, QRS axis, T axis, and frontal QRS-T angle. Temporal changes were analyzed using the Friedman test.</div></div><div><h3>Results</h3><div>The median age of the patients was 77 (68–84) years, and 52% were male. When ECG parameters were compared over time, no statistically significant change was detected in any parameter, including heart rate, P-wave duration, PR interval, QRS duration, QT, QTcB, and frontal QRS-T angle (<em>p</em> > 0.05 for all). The frontal QRS-T angle was recorded as 91° (31–159) at baseline, 86° (28.5–152) at the first hour, and 76° (30–150) at the second hour (<em>p</em> = 0.273). Similarly, no significant change in ECG parameters was observed in the sepsis subgroup.</div></div><div><h3>Conclusion</h3><div>Short-term therapeutic-dose norepinephrine infusion in the emergency department did not significantly affect ECG parameters, including the frontal QRS-T angle. These findings suggest that norepinephrine does not acutely alter ventricular repolarization heterogeneity.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"78 ","pages":"Article 102742"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-07-01Epub Date: 2026-01-24DOI: 10.1016/j.hrtlng.2026.102725
Zhihui Lu MD , Chen Zhang MD , Jun Wan MD , Yao Xiao MD , Lei Zhao MD , Guanyu Lu MD , Hongbo Zhang MD , Lanling Wang MD , Yuhan Yi MD , Lili Wang MD , Xiaohai Ma MD
Background
Balloon pulmonary angioplasty (BPA) is an effective therapeutic alternative for patients with chronic thromboembolic pulmonary hypertension (CTEPH), which improved pulmonary arterial compliance (CPA) and pulmonary vascular resistance (PVR).
Objective
To investigate whether the CPA is a predictor of exercise tolerance after BPA.
Methods
The correlations between changes in each parameter and changes in six-minute walking distance (6MWD) were evaluated by Pearson’s test. The determinants of functional capacity that was defined as 6MWD ≥440 m were assessed with a logistic regression model. Multiple linear regression analysis was used to identify the independent variables related to △6MWD.
Results
We enrolled 70 patients (female/male: 40/30, mean age: 64 years) who underwent a total of 271 BPA sessions which significantly increased CPA [1.0 (0.7, 1.3) vs. 2.1 (1.7, 2.5) mL/mmHg], and decreased PVR [6.7 (3.6, 9.7) vs. 3.0 (2.1, 4.3) wood units]. The correlation coefficient between improvement in 6MWD and changes in CPA was r = 0.328 (P = 0.006). At univariate analysis, duration of pulmonary hypertension symptoms and pulmonary arterial compliance were found to be associated with good exercise tolerance. Multivariate analysis demonstrated that CPA (95 %CI: 1.23 to 3.75, P = 0.026) was an independent predictor of exercise tolerance after BPA. The multiple linear regression analysis demonstrated that △CPA (β= 0.292, P = 0.019) was an independent predictor of △6MWD.
Conclusion
BPA significantly improved CPA in inoperable patients with CTEPH and the resistance-compliance relationship maintained inversely associated. After successful BPA, baseline CPA is an important determinant of exercise tolerance.
背景：球囊肺血管成形术（BPA）是慢性血栓栓塞性肺动脉高压（CTEPH）患者的有效治疗选择，可改善肺动脉顺应性（CPA）和肺血管阻力（PVR）。目的探讨CPA是否可作为双酚a术后运动耐量的预测指标。方法采用Pearson检验评价各参数变化与6分钟步行距离（6MWD）的相关性。功能容量的决定因素定义为6MWD≥440 m，通过逻辑回归模型进行评估。采用多元线性回归分析确定与△6MWD相关的自变量。结果我们招募了70名患者（女/男：40/30，平均年龄：64岁），他们共接受了271次BPA治疗，显著增加了CPA [1.0 (0.7, 1.3) vs. 2.1 (1.7, 2.5) mL/mmHg]，降低了PVR [6.7 (3.6, 9.7) vs. 3.0（2.1, 4.3）木单位]。6MWD改善与CPA变化的相关系数r = 0.328 （P = 0.006）。单因素分析发现，肺动脉高压症状持续时间和肺动脉顺应性与良好的运动耐量有关。多变量分析表明，CPA （95% CI: 1.23 ~ 3.75, P = 0.026）是BPA后运动耐量的独立预测因子。多元线性回归分析表明，△CPA （β= 0.292, P = 0.019）是△6MWD的独立预测因子。结论双酚a可显著改善不能手术的CTEPH患者的CPA，且阻力-依从性呈负相关。BPA成功后，基线CPA是运动耐量的重要决定因素。
{"title":"Exercise tolerance in patients with chronic thromboembolic pulmonary hypertension after balloon pulmonary angioplasty","authors":"Zhihui Lu MD , Chen Zhang MD , Jun Wan MD , Yao Xiao MD , Lei Zhao MD , Guanyu Lu MD , Hongbo Zhang MD , Lanling Wang MD , Yuhan Yi MD , Lili Wang MD , Xiaohai Ma MD","doi":"10.1016/j.hrtlng.2026.102725","DOIUrl":"10.1016/j.hrtlng.2026.102725","url":null,"abstract":"<div><h3>Background</h3><div>Balloon pulmonary angioplasty (BPA) is an effective therapeutic alternative for patients with chronic thromboembolic pulmonary hypertension (CTEPH), which improved pulmonary arterial compliance (C<sub>PA</sub>) and pulmonary vascular resistance (PVR).</div></div><div><h3>Objective</h3><div>To investigate whether the C<sub>PA</sub> is a predictor of exercise tolerance after BPA.</div></div><div><h3>Methods</h3><div>The correlations between changes in each parameter and changes in six-minute walking distance (6MWD) were evaluated by Pearson’s test. The determinants of functional capacity that was defined as 6MWD ≥440 m were assessed with a logistic regression model. Multiple linear regression analysis was used to identify the independent variables related to △6MWD.</div></div><div><h3>Results</h3><div>We enrolled 70 patients (female/male: 40/30, mean age: 64 years) who underwent a total of 271 BPA sessions which significantly increased C<sub>PA</sub> [1.0 (0.7, 1.3) vs. 2.1 (1.7, 2.5) mL/mmHg], and decreased PVR [6.7 (3.6, 9.7) vs. 3.0 (2.1, 4.3) wood units]. The correlation coefficient between improvement in 6MWD and changes in C<sub>PA</sub> was r = 0.328 (<em>P</em> = 0.006). At univariate analysis, duration of pulmonary hypertension symptoms and pulmonary arterial compliance were found to be associated with good exercise tolerance. Multivariate analysis demonstrated that C<sub>PA</sub> (95 %CI: 1.23 to 3.75, <em>P</em> = 0.026) was an independent predictor of exercise tolerance after BPA. The multiple linear regression analysis demonstrated that △C<sub>PA</sub> (β= 0.292, <em>P</em> = 0.019) was an independent predictor of △6MWD.</div></div><div><h3>Conclusion</h3><div>BPA significantly improved C<sub>PA</sub> in inoperable patients with CTEPH and the resistance-compliance relationship maintained inversely associated. After successful BPA, baseline C<sub>PA</sub> is an important determinant of exercise tolerance.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"78 ","pages":"Article 102725"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-07-01Epub Date: 2026-01-08DOI: 10.1016/j.hrtlng.2025.102701
Adnan Bhat , Anchit Chauhan , Maulinkumar Patel , Mariam Shahabi , Umar Iqbal , Mohammed Elzeneini , Waseem Nabi , Muzamil Khan , Nouman Aziz , Cesar A. Trillo , Jorge E. Lascano
Background
As survival improves for people with cystic fibrosis (PwCF) in the era of CFTR modulators, cardiovascular (CV) diseases are emerging as clinically important comorbidities. Beyond age-related risks, mechanistic pathways such as systemic inflammation, chronic hypoxia, CF-related diabetes, and CFTR-related endothelial dysfunction may contribute to CV injury. However, national-level data on CV outcomes in PwCF remain limited.
Objectives
We hypothesized that primary cardiac admissions in PwCF are increasing over time and associated with worse in-hospital outcomes compared to non-cardiac admissions.
Methods
We retrospectively analyzed adult (≥18 years) PwCF hospitalizations in the U.S. National Inpatient Sample (2016–2022). Primary cardiac admissions were defined by a principal diagnosis of atrial fibrillation (AF), heart failure (HF), or myocardial infarction (MI) using ICD-10 codes. Outcomes included in-hospital mortality, length of stay (LOS), charges, and discharge disposition. Temporal trends in cardiac admissions were modeled using negative binomial regression with an offset for total CF hospitalizations; Joinpoint regression was performed as a complementary method. Descriptive statistics and multivariable regression models adjusted for age, sex, and race were used. A p-value <0.05 was considered statistically significant.
Results
Among 121,290 PwCF hospitalizations, 520 (0.43%) were for cardiac causes. PwCF with cardiac admissions were older (median 62 vs. 29 years, p < 0.001) and had more traditional CV comorbidities. Cardiac admission rates increased by 16.4% per year from 2016 to 2022 (IRR 1.16 [1.04–1.29], p = 0.009) in negative binomial regression. Joinpoint regression detected no significant inflection points and estimated a non-significant APC of 16.4% per year (95% CI 10.9–57.4, p = 0.214). Unadjusted mortality was higher for cardiac vs. non-cardiac admissions (OR 3.70, 95% CI 1.61–8.53, p = 0.002), but not significant after adjustment (OR 1.36, 95% CI 0.55–3.34, p = 0.468).
Conclusion
Our findings indicated higher in-hospital mortality among PwCF admitted for cardiac causes, and more discharge to nursing facilities among PwCF admitted for cardiac causes. There is a need for greater CV screening, and geriatric care in PwCF.
在CFTR调节剂时代，随着囊性纤维化（PwCF）患者生存率的提高，心血管（CV）疾病正在成为临床重要的合并症。除了年龄相关的风险外，系统性炎症、慢性缺氧、cf相关糖尿病和cftr相关内皮功能障碍等机制途径也可能导致CV损伤。然而，关于PwCF的CV结果的国家级数据仍然有限。目的：我们假设PwCF的原发性心脏住院随着时间的推移而增加，并且与非心脏住院相比，住院结果更差。方法回顾性分析2016-2022年美国全国住院患者样本中成人（≥18岁）PwCF住院情况。根据ICD-10编码，以心房颤动（AF）、心力衰竭（HF）或心肌梗死（MI）为主要诊断来定义原发性心脏入院。结果包括住院死亡率、住院时间（LOS）、收费和出院处理。心脏住院的时间趋势采用负二项回归模型，并对CF总住院率进行偏移；结合点回归作为补充方法。使用描述性统计和多变量回归模型调整年龄、性别和种族。p值<；0.05被认为具有统计学意义。结果121290例PwCF患者中，520例（0.43%）因心脏原因住院。心脏入院的PwCF患者年龄较大（中位62岁vs. 29岁，p < 0.001），并且有更多传统的心血管合并症。在负二项回归中，2016 - 2022年心脏住院率每年增加16.4% （IRR 1.16 [1.04-1.29], p = 0.009）。联合点回归未检测到显著拐点，估计无显著APC为每年16.4% （95% CI 10.9-57.4, p = 0.214）。未经调整的心脏病死亡率高于非心脏病死亡率（OR 3.70, 95% CI 1.61-8.53, p = 0.002），但调整后的死亡率不显著（OR 1.36, 95% CI 0.55-3.34, p = 0.468）。结论因心脏原因住院的PwCF患者住院死亡率较高，因心脏原因住院的PwCF患者出院率较高。有必要加强心血管筛查和老年护理的PwCF。
{"title":"Cardiovascular disease-associated admissions in patients with Cystic Fibrosis: A 7-Year U.S. National Inpatient Sample Analysis","authors":"Adnan Bhat , Anchit Chauhan , Maulinkumar Patel , Mariam Shahabi , Umar Iqbal , Mohammed Elzeneini , Waseem Nabi , Muzamil Khan , Nouman Aziz , Cesar A. Trillo , Jorge E. Lascano","doi":"10.1016/j.hrtlng.2025.102701","DOIUrl":"10.1016/j.hrtlng.2025.102701","url":null,"abstract":"<div><h3>Background</h3><div>As survival improves for people with cystic fibrosis (PwCF) in the era of CFTR modulators, cardiovascular (CV) diseases are emerging as clinically important comorbidities. Beyond age-related risks, mechanistic pathways such as systemic inflammation, chronic hypoxia, CF-related diabetes, and CFTR-related endothelial dysfunction may contribute to CV injury. However, national-level data on CV outcomes in PwCF remain limited.</div></div><div><h3>Objectives</h3><div>We hypothesized that primary cardiac admissions in PwCF are increasing over time and associated with worse in-hospital outcomes compared to non-cardiac admissions.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed adult (≥18 years) PwCF hospitalizations in the U.S. National Inpatient Sample (2016–2022). Primary cardiac admissions were defined by a principal diagnosis of atrial fibrillation (AF), heart failure (HF), or myocardial infarction (MI) using ICD-10 codes. Outcomes included in-hospital mortality, length of stay (LOS), charges, and discharge disposition. Temporal trends in cardiac admissions were modeled using negative binomial regression with an offset for total CF hospitalizations; Joinpoint regression was performed as a complementary method. Descriptive statistics and multivariable regression models adjusted for age, sex, and race were used. A p-value <0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Among 121,290 PwCF hospitalizations, 520 (0.43%) were for cardiac causes. PwCF with cardiac admissions were older (median 62 vs. 29 years, <em>p</em> < 0.001) and had more traditional CV comorbidities. Cardiac admission rates increased by 16.4% per year from 2016 to 2022 (IRR 1.16 [1.04–1.29], <em>p</em> = 0.009) in negative binomial regression. Joinpoint regression detected no significant inflection points and estimated a non-significant APC of 16.4% per year (95% CI 10.9–57.4, <em>p</em> = 0.214). Unadjusted mortality was higher for cardiac vs. non-cardiac admissions (OR 3.70, 95% CI 1.61–8.53, <em>p</em> = 0.002), but not significant after adjustment (OR 1.36, 95% CI 0.55–3.34, <em>p</em> = 0.468).</div></div><div><h3>Conclusion</h3><div>Our findings indicated higher in-hospital mortality among PwCF admitted for cardiac causes, and more discharge to nursing facilities among PwCF admitted for cardiac causes. There is a need for greater CV screening, and geriatric care in PwCF.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"78 ","pages":"Article 102701"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-07-01Epub Date: 2026-02-09DOI: 10.1016/j.hrtlng.2026.102728
Gabriel Torres-Ruiz M.D, Jordi Sans-Roselló M.D, PhD, Eduard Bosch-Peligero M.D, Paola Rojas-Flores M.D, Jordi Cahís-Vela M.D, Meritxell Lloreda-Surribas M.D, Mario Sutil-Vega M.D, Marcelo Rizzo M.D, Nuria Mallofré-Vila M.D, Josep Guindo-Soldevila M.D, Victor García-Hernando M.D, Gala Caixal-Vila M.D, PhD, Pablo Del Castillo-Vázquez M.D, Pablo Carrión-Montaner M.D, Daniel Valcárcel-Paz M.D, PhD, Antoni Martínez-Rubio M.D, FESC, FACC
Background
Pretreatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) is controversial.
Objectives
Evaluate the safety and efficacy of pretreatment in a center without daily access to the catheter laboratory (CL).
Methods
This prospective observational single-center study (June 2021-June 2024) included patients with suspected NSTE-ACS undergoing coronary angiography (CAG). Clinical, biochemical and CL data were registered. Patients were monitored during their hospital stay for bleedings events (BE), ischemic events (IE) and misdiagnosis.
Results
443 consecutive patients with suspected NSTE-ACS were included. Median age was 70.0 years (IQR 60.0-77.0) and 71.8 % were male. 84.0 % were under pretreatment. IE, BE and cardiovascular death were of 5.0 %, 4.1 % and 1.8 %, respectively. IE were more frequent in the non-pretreatment group (10.3 % vs 4.1 %; p = 0.030), whereas there was no significant difference in BE (1.4 % vs 4.6 %; p = 0.216). Myocardial infarction (MI) before CAG and type 4b MI rate were lower in the pretreatment group (1.6 % vs 8.5 %; p < 0.001 and 0.3 % vs 2.8 %; p = 0.016, respectively). After adjusting for covariates, pretreatment was associated with a lower incidence of IE (OR 0.35 95 % CI 0.135-0.928; p = 0.035) whereas it was not associated with BE (OR 3.68 95 % CI 0.427-31.651; p = 0.236). A lower estimated glomerular filtration rate and active malignancy were associated with BE, while chronic ischemic heart disease was associated with IE.
Conclusions
Pretreatment was associated with a lower incidence of IE in NSTE-ACS patients with lower rates of MI before CAG and type 4b MI, without a significant increase in BE.
背景：非st段抬高急性冠脉综合征（NSTE-ACS）患者的预处理存在争议。目的：评价在不需要每天进入导管实验室（CL）的中心进行预处理的安全性和有效性。方法：这项前瞻性观察性单中心研究（2021年6月- 2024年6月）纳入了接受冠状动脉造影（CAG）的疑似NSTE-ACS患者。记录临床、生化和CL数据。患者住院期间监测出血事件（BE）、缺血事件（IE）和误诊。结果：共纳入443例疑似NSTE-ACS患者。中位年龄为70.0岁（IQR为60.0 ~ 77.0），71.8%为男性。预处理率为84.0%。IE、BE和心血管死亡率分别为5.0%、4.1%和1.8%。IE在非预处理组更常见（10.3% vs 4.1%, p = 0.030），而BE无显著差异（1.4% vs 4.6%, p = 0.216）。CAG前心肌梗死（MI）和4b型心肌梗死发生率均低于预处理组（分别为1.6% vs 8.5%, p < 0.001和0.3% vs 2.8%, p = 0.016）。调整协变量后，预处理与较低的IE发生率相关（OR 0.35 95% CI 0.135-0.928; p = 0.035），而与BE无关（OR 3.68 95% CI 0.427-31.651; p = 0.236）。较低的肾小球滤过率和活动性恶性肿瘤与BE相关，而慢性缺血性心脏病与IE相关。结论：预处理与CAG前心肌梗死和4b型心肌梗死发生率较低的NSTE-ACS患者的IE发生率较低相关，未显著增加BE。
{"title":"Antiplatelet pretreatment effects in patients with non-ST-segment elevation acute coronary syndromes in a center without daily 24 hours access to the catheter laboratory","authors":"Gabriel Torres-Ruiz M.D, Jordi Sans-Roselló M.D, PhD, Eduard Bosch-Peligero M.D, Paola Rojas-Flores M.D, Jordi Cahís-Vela M.D, Meritxell Lloreda-Surribas M.D, Mario Sutil-Vega M.D, Marcelo Rizzo M.D, Nuria Mallofré-Vila M.D, Josep Guindo-Soldevila M.D, Victor García-Hernando M.D, Gala Caixal-Vila M.D, PhD, Pablo Del Castillo-Vázquez M.D, Pablo Carrión-Montaner M.D, Daniel Valcárcel-Paz M.D, PhD, Antoni Martínez-Rubio M.D, FESC, FACC","doi":"10.1016/j.hrtlng.2026.102728","DOIUrl":"10.1016/j.hrtlng.2026.102728","url":null,"abstract":"<div><h3>Background</h3><div>Pretreatment in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) is controversial.</div></div><div><h3>Objectives</h3><div>Evaluate the safety and efficacy of pretreatment in a center without daily access to the catheter laboratory (CL).</div></div><div><h3>Methods</h3><div>This prospective observational single-center study (June 2021-June 2024) included patients with suspected NSTE-ACS undergoing coronary angiography (CAG). Clinical, biochemical and CL data were registered. Patients were monitored during their hospital stay for bleedings events (BE), ischemic events (IE) and misdiagnosis.</div></div><div><h3>Results</h3><div>443 consecutive patients with suspected NSTE-ACS were included. Median age was 70.0 years (IQR 60.0-77.0) and 71.8 % were male. 84.0 % were under pretreatment. IE, BE and cardiovascular death were of 5.0 %, 4.1 % and 1.8 %, respectively. IE were more frequent in the non-pretreatment group (10.3 % vs 4.1 %; <em>p</em> = 0.030), whereas there was no significant difference in BE (1.4 % vs 4.6 %; <em>p</em> = 0.216). Myocardial infarction (MI) before CAG and type 4b MI rate were lower in the pretreatment group (1.6 % vs 8.5 %; <em>p</em> < 0.001 and 0.3 % vs 2.8 %; <em>p</em> = 0.016, respectively). After adjusting for covariates, pretreatment was associated with a lower incidence of IE (OR 0.35 95 % CI 0.135-0.928; <em>p</em> = 0.035) whereas it was not associated with BE (OR 3.68 95 % CI 0.427-31.651; <em>p</em> = 0.236). A lower estimated glomerular filtration rate and active malignancy were associated with BE, while chronic ischemic heart disease was associated with IE.</div></div><div><h3>Conclusions</h3><div>Pretreatment was associated with a lower incidence of IE in NSTE-ACS patients with lower rates of MI before CAG and type 4b MI, without a significant increase in BE.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"78 ","pages":"Article 102728"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146159270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-07-01Epub Date: 2026-02-05DOI: 10.1016/j.hrtlng.2026.102733
Ana Paula Coelho Figueira Freire , Mark R Elkins , Marceli Rocha Leite , Ryan Galindo , Italo Ribeiro Lemes , Hailey McNeill , Bo Warner , Jacob Crumb , Nathan Herde , Heloisa Rocha Reverte Siqueira Ribeiro , Karen Roemer , Francis Lopes Pacagnelli , Rafael Z Pinto
Background
‘Usual care’ is a term that can refer to a variety of control conditions in randomized controlled trials (RCTs). The lack of standardization of usual care groups can lead to problems for clinical decision-making.
Objectives
1) Systematically describe the types and characterizations of “usual care” interventions in COPD RCTs. 2) Determine how well RCTs report usual care interventions and the extent to which COPD guideline-recommended treatment components are a part of usual care interventions.
Methods
Systematic review design. Two investigators screened studies and independently extracted data. We extracted type of usual care described, quality of reporting, and classification of usual care components as validated (i.e., aligned with guidelines) or unvalidated comparators.
Results
We included 233 studies. The most frequently described usual care intervention included patient education (n = 72, 31%) and continued care with the general practitioner (n = 67, 29%). Only 7% of the studies provided a complete description of the usual care intervention. Almost half of usual care interventions (49%) were deemed unvalidated. Higher PEDro scores were associated with greater odds of the intervention being validated (Exp(B) = 1.32; 95% CI: 1.04 to 1.66).
Conclusion
There is significant variability and frequent lack of reporting in the characterization of ‘usual care’ comparators in RCTs involving patients with COPD. Usual care is often poorly described, inconsistently delivered, and commonly not aligned with clinical guidelines. Higher quality trials had better odds of providing valid usual care.
{"title":"How usual is usual care in Chronic Obstructive Pulmonary Disease trials? A systematic review on quality of reporting and validity of comparator interventions","authors":"Ana Paula Coelho Figueira Freire , Mark R Elkins , Marceli Rocha Leite , Ryan Galindo , Italo Ribeiro Lemes , Hailey McNeill , Bo Warner , Jacob Crumb , Nathan Herde , Heloisa Rocha Reverte Siqueira Ribeiro , Karen Roemer , Francis Lopes Pacagnelli , Rafael Z Pinto","doi":"10.1016/j.hrtlng.2026.102733","DOIUrl":"10.1016/j.hrtlng.2026.102733","url":null,"abstract":"<div><h3>Background</h3><div>‘Usual care’ is a term that can refer to a variety of control conditions in randomized controlled trials (RCTs). The lack of standardization of usual care groups can lead to problems for clinical decision-making.</div></div><div><h3>Objectives</h3><div>1) Systematically describe the types and characterizations of “usual care” interventions in COPD RCTs. 2) Determine how well RCTs report usual care interventions and the extent to which COPD guideline-recommended treatment components are a part of usual care interventions.</div></div><div><h3>Methods</h3><div>Systematic review design. Two investigators screened studies and independently extracted data. We extracted type of usual care described, quality of reporting, and classification of usual care components as validated (i.e., aligned with guidelines) or unvalidated comparators.</div></div><div><h3>Results</h3><div>We included 233 studies. The most frequently described usual care intervention included patient education (n = 72, 31%) and continued care with the general practitioner (n = 67, 29%). Only 7% of the studies provided a complete description of the usual care intervention. Almost half of usual care interventions (49%) were deemed unvalidated. Higher PEDro scores were associated with greater odds of the intervention being validated (Exp(B) = 1.32; 95% CI: 1.04 to 1.66).</div></div><div><h3>Conclusion</h3><div>There is significant variability and frequent lack of reporting in the characterization of ‘usual care’ comparators in RCTs involving patients with COPD. Usual care is often poorly described, inconsistently delivered, and commonly not aligned with clinical guidelines. Higher quality trials had better odds of providing valid usual care.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"78 ","pages":"Article 102733"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The increase in patients with heart failure is a global issue, and various symptoms of heart failure, such as fatigue and shortness of breath, are associated with a decline in quality of life and high readmission rates. Many patients experience difficulties in managing heart failure at home. Readiness before discharge, including physical, psychological status, knowledge and ability to care, and expected support, is important.
Objectives
To determine the level of and factors associated with readiness for hospital discharge among inpatients with heart failure
Methods
A cross-sectional study design was used. We included adult patients admitted to a tertiary referral hospital in Tokyo, Japan, for heart failure treatment. The Readiness for Hospital Discharge Scale-Japanese version was used to measure the patients’ readiness before hospital discharge. Hierarchical multiple regression analysis was used to assess the impact of independent variables such as patient and clinical characteristics on the Readiness for Hospital Discharge Scale.
Results
The readiness score for one of the subscales, ‘expected support’, was below 7 in the pre-discharge readiness scale. Younger age, living with someone, higher ‘self-care maintenance’ scores, and absence of history of hospitalisation for heart failure were associated with good pre-discharge readiness in patients with heart failure.
Conclusion
This study revealed that hospitalised patients with heart failure generally had low readiness before discharge and identified its relevant factors. The results can be used to identify at-risk patients at an early stage for additional and continuous support.
{"title":"Pre-discharge readiness of hospitalised patients with heart failure and associated factors: A cross-sectional study","authors":"Mina Nozawa , Soichiro Hotta , Miki Arahata , Kaoru Kizawa , Tetsuo Sasano , Makoto Tanaka","doi":"10.1016/j.hrtlng.2025.102722","DOIUrl":"10.1016/j.hrtlng.2025.102722","url":null,"abstract":"<div><h3>Background</h3><div>The increase in patients with heart failure is a global issue, and various symptoms of heart failure, such as fatigue and shortness of breath, are associated with a decline in quality of life and high readmission rates. Many patients experience difficulties in managing heart failure at home. Readiness before discharge, including physical, psychological status, knowledge and ability to care, and expected support, is important.</div></div><div><h3>Objectives</h3><div>To determine the level of and factors associated with readiness for hospital discharge among inpatients with heart failure</div></div><div><h3>Methods</h3><div>A cross-sectional study design was used. We included adult patients admitted to a tertiary referral hospital in Tokyo, Japan, for heart failure treatment. The Readiness for Hospital Discharge Scale-Japanese version was used to measure the patients’ readiness before hospital discharge. Hierarchical multiple regression analysis was used to assess the impact of independent variables such as patient and clinical characteristics on the Readiness for Hospital Discharge Scale.</div></div><div><h3>Results</h3><div>The readiness score for one of the subscales, ‘expected support’, was below 7 in the pre-discharge readiness scale. Younger age, living with someone, higher ‘self-care maintenance’ scores, and absence of history of hospitalisation for heart failure were associated with good pre-discharge readiness in patients with heart failure.</div></div><div><h3>Conclusion</h3><div>This study revealed that hospitalised patients with heart failure generally had low readiness before discharge and identified its relevant factors. The results can be used to identify at-risk patients at an early stage for additional and continuous support.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"78 ","pages":"Article 102722"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-07-01Epub Date: 2026-01-12DOI: 10.1016/j.hrtlng.2025.102702
Robert Wells , Leah Boulos , Megan Gray , Sarah E. Keeping , Emily Jane Devereaux , Tatjana Brauer-Chapin , Ash Hariharan , Gabriella Fera , Kelly DeCoste , Madison Hickey , Catie Johnson , Donna Rubenstein , Gregory M. Hirsch , Ryan Gainer , Janet A. Curran
Background
Although cardiac rehabilitation is widely acknowledged as the gold standard for improved outcomes in cardiac procedures, it remains underutilized. Digital education tools have the potential to improve access and adherence to cardiac rehabilitation.
Objectives
The primary objective of this review is to determine the impact of digital education interventions for patients undergoing cardiac procedures on patient-level and health system-level outcomes.
Methods
Conceptualized by a patient partner, a mixed methods systematic review was conducted using JBI methodology. MEDLINE, Embase, CINAHL, and Scopus were searched. Studies were included if they reported on a digital education intervention for adult patients preparing for or recovering from cardiac procedures, and if they reported primary outcomes related to healthcare utilization, learning/knowledge, and/or patient-level health. Interventions were mapped onto the WHO taxonomy of Digital Health Interventions for Persons.
Results
41 studies were included, and most reported a positive effect across several outcome categories: knowledge; behavior, attitude, and self-efficacy; physiological; healthcare utilization; mental health; quality of life; physical function and activity; and other. Considerable variation in outcomes, measurement instruments, and intervention characteristics hindered meta-analysis and made it challenging to draw broad conclusions.
Conclusion
Overall, interventions included in this review resulted in a positive effect on a wide range of outcomes. However, most studies did not report the use of an educational theory or underlying framework, leading to wide variability in intervention design and implementation. Future developers should consider using an educational framework to design and evaluate digital interventions. Additionally, engaging patients and knowledge users as co-designers could increase relevance, acceptability, and uptake.
{"title":"Wide variability in studies reporting on digital education interventions for patients undergoing cardiac procedures: A patient-commissioned mixed methods systematic review","authors":"Robert Wells , Leah Boulos , Megan Gray , Sarah E. Keeping , Emily Jane Devereaux , Tatjana Brauer-Chapin , Ash Hariharan , Gabriella Fera , Kelly DeCoste , Madison Hickey , Catie Johnson , Donna Rubenstein , Gregory M. Hirsch , Ryan Gainer , Janet A. Curran","doi":"10.1016/j.hrtlng.2025.102702","DOIUrl":"10.1016/j.hrtlng.2025.102702","url":null,"abstract":"<div><h3>Background</h3><div>Although cardiac rehabilitation is widely acknowledged as the gold standard for improved outcomes in cardiac procedures, it remains underutilized. Digital education tools have the potential to improve access and adherence to cardiac rehabilitation.</div></div><div><h3>Objectives</h3><div>The primary objective of this review is to determine the impact of digital education interventions for patients undergoing cardiac procedures on patient-level and health system-level outcomes.</div></div><div><h3>Methods</h3><div>Conceptualized by a patient partner, a mixed methods systematic review was conducted using JBI methodology. MEDLINE, Embase, CINAHL, and Scopus were searched. Studies were included if they reported on a digital education intervention for adult patients preparing for or recovering from cardiac procedures, and if they reported primary outcomes related to healthcare utilization, learning/knowledge, and/or patient-level health. Interventions were mapped onto the WHO taxonomy of Digital Health Interventions for Persons.</div></div><div><h3>Results</h3><div>41 studies were included, and most reported a positive effect across several outcome categories: knowledge; behavior, attitude, and self-efficacy; physiological; healthcare utilization; mental health; quality of life; physical function and activity; and other. Considerable variation in outcomes, measurement instruments, and intervention characteristics hindered meta-analysis and made it challenging to draw broad conclusions.</div></div><div><h3>Conclusion</h3><div>Overall, interventions included in this review resulted in a positive effect on a wide range of outcomes. However, most studies did not report the use of an educational theory or underlying framework, leading to wide variability in intervention design and implementation. Future developers should consider using an educational framework to design and evaluate digital interventions. Additionally, engaging patients and knowledge users as co-designers could increase relevance, acceptability, and uptake.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"78 ","pages":"Article 102702"},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-05-01Epub Date: 2025-12-24DOI: 10.1016/j.hrtlng.2025.102690
Lin Zhu , Yanqing Gong , Zijie An , Liumei Mo , Jian Rong , Zhenhao Liu
Background
Global aging and lifestyle shifts raise cardiovascular disease burden, but the specific contribution of non-rheumatic calcific aortic valve disease (nrCAVD) to heart failure (HF) in older adults is incompletely defined.
Objectives
To quantify global trends, drivers, inequalities, and future projections of HF attributable to nrCAVD among persons aged ≥60 and to assess causality.
Methods
Using GBD 2021 estimates (1990–2021) for prevalence, Years Lived with Disability(YLDs), and age-standardized rates across 204 countries, we applied decomposition analysis, Social Inequality Index (SII), and Bayesian age-period-cohort forecasting to 2040. Two-sample Mendelian randomization (FinnGen GWAS) evaluated causality.
Results
In 2021 an estimated 1.38 million persons aged ≥60 had HF due to nrCAVD with 123,907 YLDs—cases rose 123 % since 1990 though age-standardized prevalence fell ∼16.7 %. Male burden was ∼1.5 × female. High-SDI regions had the highest rates but burdens are rising in middle/low-SDI areas. Decomposition attributed increases to population growth (+100.9 %) and aging (+20.0 %), partially offset by epidemiological improvement (−20.9 %). Cross-country inequality declined. Forecasts project ∼79 % increases in cases and YLDs by 2040. Mendelian randomization supported a causal effect of nrCAVD on HF.
Conclusions
These findings demonstrate that heart failure due to non-rheumatic calcific aortic valve disease represents a growing global health burden in aging populations, particularly in lower-SDI settings. Targeted preventive measures, early screening, and equitable access to effective interventions are urgently needed to mitigate this trend.
{"title":"Non-rheumatic calcific aortic valve disease as a global driver of heart failure: Burden and three-decade trends","authors":"Lin Zhu , Yanqing Gong , Zijie An , Liumei Mo , Jian Rong , Zhenhao Liu","doi":"10.1016/j.hrtlng.2025.102690","DOIUrl":"10.1016/j.hrtlng.2025.102690","url":null,"abstract":"<div><h3>Background</h3><div>Global aging and lifestyle shifts raise cardiovascular disease burden, but the specific contribution of non-rheumatic calcific aortic valve disease (nrCAVD) to heart failure (HF) in older adults is incompletely defined.</div></div><div><h3>Objectives</h3><div>To quantify global trends, drivers, inequalities, and future projections of HF attributable to nrCAVD among persons aged ≥60 and to assess causality.</div></div><div><h3>Methods</h3><div>Using GBD 2021 estimates (1990–2021) for prevalence, Years Lived with Disability(YLDs), and age-standardized rates across 204 countries, we applied decomposition analysis, Social Inequality Index (SII), and Bayesian age-period-cohort forecasting to 2040. Two-sample Mendelian randomization (FinnGen GWAS) evaluated causality.</div></div><div><h3>Results</h3><div>In 2021 an estimated 1.38 million persons aged ≥60 had HF due to nrCAVD with 123,907 YLDs—cases rose 123 % since 1990 though age-standardized prevalence fell ∼16.7 %. Male burden was ∼1.5 × female. High-SDI regions had the highest rates but burdens are rising in middle/low-SDI areas. Decomposition attributed increases to population growth (+100.9 %) and aging (+20.0 %), partially offset by epidemiological improvement (−20.9 %). Cross-country inequality declined. Forecasts project ∼79 % increases in cases and YLDs by 2040. Mendelian randomization supported a causal effect of nrCAVD on HF.</div></div><div><h3>Conclusions</h3><div>These findings demonstrate that heart failure due to non-rheumatic calcific aortic valve disease represents a growing global health burden in aging populations, particularly in lower-SDI settings. Targeted preventive measures, early screening, and equitable access to effective interventions are urgently needed to mitigate this trend.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"77 ","pages":"Article 102690"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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