Archives of Cardiovascular Diseases最新文献

Cardiovascular diseases (CVDs) and strokes are the leading cause of death worldwide. To estimate the number and incidence of cardiovascular hospitalizations and deaths in adults and children and strokes and acute coronary syndromes (ACS) among pregnant women in France. Using National Health Data, we identified all hospitalizations for CVD in 2022 and cardiovascular deaths in 2021. We also identified all women in the general health insurance scheme who gave birth in France during 2010-2018 after 22 weeks' gestation and all strokes and ACS that occurred during pregnancy and postpartum. In adults in 2022, there were 1,229,003 hospitalizations for CVD among 925,936 adults (59.2% men) for a standardized rate of 1614 per 100,000. This was twice as high in men versus women and increased with age and social deprivation. In 2021, 138,137 adults died of CVD (47.4% men), i.e. 216 per 100,000 adults. Among children born during the first 6 months of 2022, a congenital heart defect (CHD) was identified in 3876 (1068 cases per 100,000 live births). In 2021, 193 children died of a CHD (1.4 per 100,000) and 100 of another CVD (0.7 per 100,000). In the women accounting for the 6.3 million deliveries during 2010-2018, 1261 strokes and 225 ACS were identified during pregnancy and the postpartum period, i.e. respective incidence rates of 24.0 and 4.3 per 100,000 person-years. The burden of CVD calls for large-scale action to improve the prevention, screening and management of CVD in these different populations.

Background: Peripheral arterial diseases (PADs) account for much of the morbidity and hospitalizations experienced by patients with cardiovascular disease. Epidemiological data on these diseases are lacking in France.

Aims: To describe the epidemiology of aortic diseases (aneurysm and dissection) and PADs in France in 2022.

Methods: This study was carried out using the National Health Data System. Patients hospitalized with these diseases in 2022 and patients who died from these diseases in 2021 were selected. The prevalence of aortic diseases and PADs among people alive on 1 January 2023 was estimated from previous hospitalizations and registered long-term disease. Mortality and secondary treatment were examined in the year following hospitalization.

Results: In 2022, there were 68,702 patients hospitalized in France for a lower extremity artery disease (LEAD), 9083 for abdominal aortic aneurysm and 9027 for dissection or aneurysm of a medium-sized artery (standardized rates: 112.6, 15.0 and 15.5 per 100,000, respectively). The standardized prevalences of these diseases were 1.23%, 0.17% and 0.22% of adults, respectively. Regional and social disparities in the age-standardized rates of hospitalized patients were observed. One-year mortality ranged from approximately 11% for patients hospitalized for thoracic aortic aneurysm or medium-sized artery dissection/aneurysm to 27.0% for aortic dissection. The proportions of patients hospitalized due to LEAD who were being treated with antiplatelet or lipid-lowering drugs 1 year after the index hospitalization were 86.6% and 75.9%, respectively.

Conclusion: The burden of aortic diseases and PADs is considerable in France and mortality remains high for ruptured aortic aneurysm and aortic dissection.

Background: On the one hand, climate change affects health and healthcare systems worldwide. On the other hand, the healthcare system contributes to environmental pollution. These environmental issues concern rhythmology, particularly because of the use of complex, often plastic, single-use devices.

Aims: To assess current practices, as well as the training received by rhythmologists and their willingness to implement the necessary changes.

Methods: A four-part questionnaire with 15 questions was designed, and was distributed online to rhythmologists, via the French Society of Cardiology.

Results: Eighty-seven responses were received from 42 French departments. Most rhythmologists (98.9%) had never attended courses on climate change and its impact on human health during their medical studies; they thought it would be relevant to offer courses on these issues as part of initial medical training (59.5% of answers), continuing medical education (62.3% of answers) and training in interventional rhythmology (55.9% of answers). The participants had already been able to implement actions in their healthcare establishments, in the following categories: transport; food; waste management; scientific studies; and political work. One hundred percent of rhythmologists were willing to change some of their interventional practices if the changes did not alter the risk for the patient or diminish the clinical benefit. However, there were numerous obstacles to overcome: "I don't know where to start"; "I'm not helped by my healthcare institution"; "regulatory constraints are too important"; "I don't have the time" and "I don't know what's relevant".

Conclusions: These responses reinforce the importance of supporting these doctors so that their interventional practices can evolve. This evolution in interventional practices, based on scientific studies, and within a legislative and regulatory framework adapted to environmental issues, will enable the development of a more sustainable rhythmology practice.

Background: The prevalence and short-term cardiovascular consequences of recent cannabis use in patients admitted to an intensive cardiac care unit for acute coronary syndrome is not well established.

Aims: To assess the prevalence of recent cannabis use detected by prospective systematic screening, and its prognostic value in predicting the occurrence of in-hospital major adverse events in consecutive patients with acute coronary syndrome.

Methods: From 07 to 22 April 2021, all consecutive patients admitted to an intensive cardiac care unit in 39 centres throughout France were studied prospectively. Systematic recreational drug screening was performed on admission by urine assay in all patients. The primary outcome was the prevalence of recent cannabis use. The secondary outcome was in-hospital major adverse events, defined by death, resuscitated cardiac arrest and cardiogenic shock requiring medical or mechanical haemodynamic support.

Results: A total of 772 patients were hospitalized for acute coronary syndrome (mean age 64±13years; 74% male). Among those, 86 patients (11.1%) had a positive urine test for cannabis. Patients with cannabis detected were younger (53±12 vs. 65±12years, respectively; P<0.001) and were more frequently male (88% vs. 72%, respectively; P=0.001). After a median hospitalization duration of 2days, 33 (4.3%) in-hospital major adverse events occurred. The detection of cannabis was associated with a higher rate of in-hospital major adverse events after adjustment for prior co-morbidities (odds ratio 3.28; P=0.015) and after adjustment for known predictors of severity (odds ratio 3.68; P=0.009).

Conclusions: The prevalence of recent cannabis use in patients hospitalized for acute coronary syndrome was 11.1%. The detection of recent cannabis use was independently associated with a higher occurrence of in-hospital major adverse events.