Archives of Cardiovascular Diseases最新文献

Background: Few epidemiological data are available for venous thromboembolism (VTE) at French national and subnational levels.

Aims: To quantify VTE events in France in 2022 and describe the features of hospital management and outcomes.

Methods: Adults hospitalized for a VTE as the primary reason for hospitalization or treatment in a medical unit in 2022 were identified from medical administrative data. Data were stratified as pulmonary embolism (PE) and deep vein thrombosis (DVT), and by French department and various sociodemographic indicators. VTE prevalence at 1 January 2023 was defined as the number of people alive at that date with a history of hospitalization for VTE or a chronic long-term disease status due to VTE (2012-2022).

Results: VTE cases reached 896,846 adults on 1 January 2023. VTE was the primary diagnosis for a hospital stay or medical unit in 62,055 patients hospitalized in 2022. The age-standardized rate of hospitalized patients was 23.0% higher for men versus women. There were considerable variations between departments of residence, while Martinique had the highest age-standardized rate. The prevalence of triggering factors was high, with almost 30% having cancer and 20% a recent long hospitalization. One-year mortality was approximately 20% for both PE and DVT, despite rehospitalization rates <5%.

Conclusion: The high prevalence of cancer among patients hospitalized due to VTE partly explains the high 1-year mortality. As VTE is partially avoidable, the prevention of VTE needs to be improved in France and whether thromboprophylaxis guidance is being followed should regularly be assessed.

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: Demographic changes and improvements in the diagnosis and treatment of valvular heart diseases (VHDs) have led to changes in its epidemiological profile.

Aims: To describe the epidemiology of VHD in France in 2022.

Methods: Adults hospitalized due to VHD in 2022 were identified from the French National Health Data System and categorized by type of VHD on the basis of hospital diagnoses and interventions. Incidence and prevalence rates were calculated using national French demographic data.

Results: In 2022, 51,894 adults (60.1% men) were hospitalized for VHD (97.0/100,000 inhabitants). The most frequently observed hospitalized VHDs were AS (61.6%) and MR (23.2%). The mean age at hospitalization was 74.0years, and this was higher for AS than MR (77.3 vs 71.2years). Infectious endocarditis was managed during the index hospitalization in 13.3% of patients. During the index hospitalization and the following 6months, 75.0% of patients underwent valve repair or replacement. Among hospitalized patients with AS, 56.9% had transcatheter aortic valve implantation and 24.9% had surgical aortic valve replacement. Among patients hospitalized for MR, 27.1% underwent surgical mitral valve repair, 12.7% transcatheter mitral valve repair and 19.1% mitral valve replacement. The all-cause death rate 1year after hospitalization for VHD was 13.7%. Overall, in France, on 1 January 2023, 1.90% of the adult population had VHD (2.08% of men and 1.72% of women). Overall, 363,574 had aortic stenosis (AS) and 409,570 had mitral regurgitation (MR).

Conclusion: VHDs are a major burden in France, particularly degenerative valve diseases of the left heart in older adults.

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.

Background: Elevated concentrations of low-density lipoprotein cholesterol (LDL-C) are highly prevalent and are associated with the development of cardiovascular diseases.

Aim: To estimate the proportion of cardiovascular disease cases attributable to high concentrations of LDL-C (population attributable fraction [PAF]) in France in 2017, based on the most recent individual data on LDL-C, and the attributable burden on hospitalizations and death.

Methods: We estimated the PAF of high LDL-C concentrations for ischaemic heart disease (IHD), ischaemic stroke and aortic valve stenosis (AVS). Distributions of LDL-C concentrations were obtained from the most recent French health examination representative survey (ESTEBAN). The relative risks of each disease per 1-mmol/L increase in blood LDL-C were obtained either from the most appropriate meta-analyses or from Mendelian randomization.

Results: The PAF of high LDL-C concentrations varied between 44.2% (95% CI 24.6%-60.5%) for IHD-related death and 49.4% (95% CI 35.6-60.8%) for IHD-related years-of-life lost (YLL), 22.5% (95% CI 0.0-43.3%) and 25.5% (95% CI 11.6-36.8%) for ischaemic stroke indicators, and 29.0% (95% CI 8.6-45.4%) and 29.3% (95% CI 8.4-45.6%) for AVS indicators. Overall, 230,000 hospitalizations, 1,303,000 prevalent cases and 23,000 deaths were estimated to be attributable to high LDL-C concentrations, with most cases related to IHD. PAFs were similar across sex and cardiovascular diseases, whereas PAF strongly varied with age for IHD and ischaemic stroke, with PAF reaching 80.6% (95% CI 55.3-92.7%) and 60.9% (95% CI 33.8-80.8%), respectively, in the group aged 35-44 years.

Conclusion: The high estimated PAF of elevated LDL-C concentrations for IHD, ischaemic stroke and AVS support the urgent need to reduce the prevalence of hypercholesterolaemia in this French population.

Cardiovascular diseases (CVDs) have a multifactorial origin. Among the risk factors, so-called behavioural risk factors play a major role in the onset of these diseases: smoking, unhealthy diet, lack of physical activity and sedentary lifestyle, alcohol, sleep disorders, depression and illicit drug use are among the main behavioural risk factors for CVD and are considered to be modifiable and accessible to prevention. The prevalence of these cardiovascular risk factors remains high among the French population. Nearly one in three adults are smokers, 71.7% do not meet the recommendation to eat five fruits and vegetables per day, and 4 out of 5 adults consume more than 6g of salt per day. Further, 38.7% of adults do not meet the recommendations for physical activity, 40.8% have a high level of sedentary, 49.4% report sleep problems in the last 8 days, and 12.5% have had a major depressive episode in the last 12 months. Despite some positive trends, such as an increase in the level of physical activity among men and the decline in smoking prevalence, the epidemiological situation regarding these risk factors remains a cause for concern in France. While the gap between risk factors in men and women is narrowing, this is often due to a worsening of the situation among women, who are increasingly adopting unfavourable behaviours and tending to reach the higher levels of risk factors traditionally observed among men. The epidemiological situation demonstrates the urgent need to strengthen policies to prevent these risk factors.

Background: It has been nearly 10years since the first national stroke plan in France.

Aims: To examine the epidemiology of strokes, how they are managed and patient outcomes.

Methods: Adults hospitalized for stroke in 2022 were identified in the national database. Stroke prevalence at 1 January 2023 was defined as the number of people alive at that date with a history of hospitalization for stroke or a chronic long-term disease status due to stroke (2012-2022). Patients were monitored up for up to 1year after hospitalization for a stroke.

Results: In 2022, 122,422 adults were hospitalized due to stroke, and there were an estimated 1,086,795 cases. Important geographical and socioeconomic disparities were observed. Admission to a stroke intensive care unit was found in 46.8% of patients, with significant variations by department of residence, age and gender. Only 7.2% of ischaemic strokes resulted in mechanical thrombectomy. Among survivors at 6months, admission to a rehabilitation unit was found for 34.3% for patients with ischaemic strokes and 41.7% of those with haemorrhagic strokes, while 28.8% and 18.8%, respectively, had a consultation with a neurologist, and 19.5% and 10.9% were seen by a cardiologist within 6months. Mortality rates after 1year were 20.8% and 37.9% among patients hospitalized due to ischaemic and haemorrhagic strokes, respectively.

Conclusion: The considerable numbers and rates of stroke - and disparities by age, sex and area - highlight the need for more effective stroke prevention, regular information campaigns on the symptoms of stroke and improved availability and accessibility of stroke units.

Background: Cardiovascular disease is the leading cause of death worldwide. Ischaemic heart disease (IHD), including acute coronary syndromes (ACS) with or without ST-segment elevation and chronic coronary syndromes, is one of the main causes.

Aim: To describe the epidemiology of IHD in France in 2022.

Methods: Adults hospitalized due to IHD in 2022 were identified in the French National Health Data System. The characteristics, hospital management and one-year outcomes of patients were described. The IHD prevalence among people alive on 01.01.23 was estimated by combining previous hospitalizations and people in receipt of 100% coverage for a registered long-term disease. IHD-related mortality was estimated from death certificates.

Results: In 2022, 242,227 adults were hospitalized for IHD in France (452/100,000 person-years); 2.98 million prevalent cases of IHD (5.6% of the adult population) and 31,391 IHD-related deaths (4.8% of all deaths) were recorded. The average age at hospitalization for IHD was 69.3years and 29.0% of patients were women. Exposure to cardiovascular risk factors was high. The average length of hospitalization was 4.9 days, 55.9% had undergone a percutaneous coronary intervention and 4.5% a coronary artery bypass graft. The in-hospital death rate was 3.6%. Six months after the index hospitalization, 22.0% of patients had been admitted to a rehabilitation service (42.9% for STE-ACS). In the year following the index hospitalization, 84.5% of patients had received antiplatelet drugs, 82.6% a statin, 68.8% a beta-blocker and 67.7% a renin-angiotensin-aldosterone system treatment. One year after index hospitalization, the rate of rehospitalization for IHD was 29.9% and the rate of all-cause death was 9.3%.

Conclusions: The burden of IHD remains high in France. These results suggest that primary prevention of IHD should be maintained and improved, as well as secondary prevention, to improve the prognosis and quality of life of the 3 million patients with coronary disease.