Archives of Cardiovascular Diseases最新文献

Background: Heart failure (HF) prevalence may increase because of population ageing and has become a major public health issue in European countries.

Aim: To update the epidemiology of HF in France in 2022.

Methods: Adults hospitalized for HF in 2022 were identified in the National Health Data System (SNDS) and followed up for 1year. The first stay of the year was taken as the index hospitalization. The prevalence of HF was estimated by combining hospitalization data and patients with 100% coverage for a long-term disease associated with HF. Patients and their hospital stays were described on the basis of the sociodemographic and medical information in the SNDS.

Results: In 2022, 181,178 adults were hospitalized for HF in France, which equates to a crude rate of 339.3 per 100,000 inhabitants, and 1,376,692 prevalent cases of HF were recorded, which is an estimated prevalence of 2.6% in the adult population. For people living in the most socioeconomically deprived municipalities, the rate of hospitalization was 1.6 times higher than for those living in the least deprived municipalities. The departments of Haut-de-France and Réunion Island, and some departments in Normandy and the Grand-Est had much higher rates than others. The fatality rate was 10.2% in hospital, and 34.0% at 1year. Only 20.1% of patients were admitted to a rehabilitation unit within 6months, and 47.9% of patients alive at 1year were being treated with a combination of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers and beta-blockers.

Conclusions: The large number of people hospitalized for HF, and the fact that rates vary across the different French departments, means that more ambitious general cardiovascular prevention measures are needed, and that healthcare provision needs significant adaptation. Short-term patient outcomes could be improved by following recommendations more closely and taking into account patients' social circumstances.

Background: Heart rhythm and conduction disorders cover a variety of pathologies, ranging from the benign to the immediately life threatening.

Aims: To describe the epidemiology of patients hospitalized for arrhythmias in France, and to estimate the prevalence and mortality associated with these disorders, divided into three separate groups: atrial fibrillation and flutter; conduction disorders; and ventricular tachycardia/cardiac arrest.

Methods: We looked in the National Health Data System and selected patients who had been hospitalized at least once in 2022 for these diseases and patients who died as a result of these diseases in 2021. The prevalence of these disorders among people alive on 1st January 2023 was estimated by combining previous hospitalizations and people in receipt of 100% coverage for a registered long-term disease.

Results: At 1st January 2023, the prevalence of patients who had been hospitalized with major rhythm and conduction disorders was 2,740,141: 2,027,900 with atrial fibrillation/flutter; 999,692 with conduction disorders; and 214,989 with ventricular tachycardia/cardiac arrest. In 2022, respectively 90,502, 48,268 and 16,930 were hospitalized for these conditions, which equate to rates of 169.5, 68.3, and 31.7 per 100,000 inhabitants, respectively. Several departments in the Hauts-de-France and Grand-Est regions had rates>20% above the national rate. The rate of ventricular tachycardia/cardiac arrest was 40% higher among residents of the most deprived municipalities than among residents of the least deprived municipalities. Mortality at the end of hospitalization reached 44% for patients hospitalized for ventricular tachycardia/cardiac arrest.

Conclusions: Arrhythmias and conduction disorders affect a significant proportion of the population, leading to a large number of hospitalizations and procedures, particularly ablation techniques and pacemaker/defibrillator implantation. Given the extent of regional disparities and the impact of the socioeconomic status of the municipality of residence, targeted prevention and screening strategies should be implemented.

Background: Arrhythmic risk stratification is a major challenge in Brugada syndrome. Studies have evaluated risk stratification based on manually measured electrocardiogram (ECG) parameters at baseline and/or after drug challenge.

Aim: To assess the predictive value of multiple ECG parameters measured automatically from digitized paper ECGs.

Methods: During a prospective, multicentre cohort study that included patients with Brugada syndrome with type 1 ECG (spontaneously or drug-induced), paper ECGs were digitized and analysed. Major events were sudden cardiac death, aborted cardiac arrest and appropriate implantable cardioverter-defibrillator (ICD) therapy in the ventricular fibrillation (VF) zone. The predictive value of clinical and ECG parameters was assessed using univariable and multivariable Cox models.

Results: ECGs from 301 patients (74% male, mean age 43.1±13.3years, mean follow-up 7.1±5.6years) were analysed. Major events occurred in 6% of patients before diagnosis and 8% during follow-up. Two baseline ECG parameters were independently associated with major events: QRS prolongation in lead V1>113ms (hazard ratio [HR] 3.49, 95% confidence interval [CI] 1.72-7.09; P<0.001) and S duration on DI>33.5ms (HR 3.56, 95% CI 1.52-8.31; P<0.01). In drug-induced patients, changes in the Tpeak-Tend interval on V2 were associated with major events (HR 4.69, 95% CI 1.21-18.17; P=0.014).

Conclusion: Paper ECG datasets could be used for automatic quantitative ECG measurements. We confirmed the association of previously described parameters with events and identified useful new parameters. Multi-parametric ECG quantification may be used to assess risk in patients with Brugada syndrome.

Cardiovascular disease is the leading cause of death worldwide, and the second leading cause in France. Among the modifiable cardiovascular risk factors, metabolic diseases (hypertension, low-density lipoprotein hypercholesterolaemia, diabetes and obesity) play a major role, contributing to the development and progression of atherosclerosis. This review summarizes the latest epidemiological data available at a national level. In 2015, the prevalence among adults aged 18-74years was 17.2% for obesity, 7.4% for diabetes, 30.6% for hypertension, 23.3% for low-density lipoprotein hypercholesterolaemia and 1.5% for stage 3-5 chronic kidney disease. Awareness of these diseases among affected individuals was very poor, ranging from 23% for diabetes to 45% for hypertension. While the prevalence of obesity and hypertension remained stable between 2006 and 2015, the prevalence of diabetes increased significantly. Prevention of these risk factors, particularly through nutrition, as well as awareness and management of them, must be intensified to reduce the burden of cardiovascular diseases in France. Whereas the prevalence of metabolic factors remains higher in men, particular attention should also be paid to risk factors specific to women, such as gynaecological diseases (endometriosis, polycystic ovary syndrome) and pregnancy disorders (hypertensive disorders in pregnancy, gestational diabetes), which contribute significantly to cardiovascular risk.