Global Heart最新文献

Background: Heart failure (HF) continues to have an immense impact, not only on tangible outcomes such as mortality, but also on patients' health-related quality of life (QoL). The aim of this study was to assess the QoL of patients living with HF using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12).

Methods: The study considered consecutive patients of either gender, between 18 and 80 years of age, who had been diagnosed with HF with reduced ejection fraction for at least six months and who presented to the outpatient department for routine clinical follow-up. The QoL was assessed using KCCQ-12.

Results: A total of 320 patients were included in this analysis; 257 (80.3%) were male, and the mean age was 54.9 ± 12.7 years, with 25 (7.8%) patients >70 years. The median time since HF was 24 (12-60) months. The median overall QoL score was 50.5 (32-75), with 81 (25.3%) categorized as good, 83 (25.9%) as moderate, 99 (30.9%) as poor, and 57 (17.8%) as having very poor QoL. In multivariable analysis, age >70 years, presence of diabetes, and non-adherence to medication were found to be independently associated with poor QoL, with adjusted odds ratios of 2.93 [1.06-8.06], 2.76 [1.66-4.61], and 1.72 [1.07-2.77], respectively.

Conclusion: We observed good QoL in only one-fourth of the patients living with HF. Further, we observed that older age (>70 years), presence of diabetes, and non-adherence to medication were significantly associated with poorer QoL. These results underscore the need for targeted interventions to improve medication adherence and manage comorbidities, particularly diabetes, in order to enhance the QoL of HF patients.

Background: Major adverse cardiac and cerebrovascular events (MACCE) are critical clinical outcomes in patients undergoing percutaneous coronary intervention (PCI); however, evidence regarding the impact of fine particulate matter (PM2.5) on these outcomes remains limited.

Methods: This retrospective cohort study included 22,188 Thai adults who underwent PCI to investigate the association between PM2.5 exposure and the incidence of MACCE. Baseline demographic, clinical characteristics, and comorbidities, with angiographic and procedural data, were collected. Cumulative PM2.5 exposure was estimated using satellite-derived data based on patients' residential locations over a 12-month follow-up period. The primary outcome was a composite MACCE endpoint. A multilevel survival model was employed to assess the association between PM2.5 exposure and MACCE, adjusting for potential confounding variables.

Results: During the median follow-up of 11.97 months (ranging from 0.03 to 12 months), 6,382 patients (28.8%) experienced at least one MACCE. PM2.5 levels in Thailand exhibit a distinct seasonal pattern, peaking around February (Quarter 1; Q1) and reaching their lowest levels in Q3. In the final multivariable model, a 1 µg/m³ increase in PM2.5 exposure was associated with MACCE (adjusted hazard ratio (HR) 1.45 (95% CI: 1.37, 1.54)). The adjusted HR for PM2.5 comprising quarterly seasonal variations was as follows: 1.015 (95% CI: 1.005, 1.024) in Q4, 1.222 (95% CI: 1.132, 1.319) in Q1, 1.177 (95% CI: 1.096, 1.265) in Q2, and 1.500 (95% CI: 1.381, 1.629) in Q3.

Conclusion: The study's findings suggested that higher seasonal PM2.5 exposure is associated with MACCE in patients who underwent PCI. These results underscore the urgent need for public health policies that focus on reducing PM2.5 to improve health outcomes and reduce the burden of the disease.

Introduction: Unhealthy lifestyle habits, including high-calorie diets and physical inactivity, increase the risk of cardiovascular disease (CVD). Chronic conditions such as hypertension, diabetes, and kidney disease frequently precede cardiovascular events. This study aimed to characterize the sociodemographic and clinical profiles of individuals who have experienced such events and to provide updated evidence on the prevalence of cardiovascular risk factors in the Mexican adult population.

Methods: Data were obtained from adults aged ≥ 20 years with chronic diseases who participated in the 2018 National Health and Nutrition Survey. Biomarkers were measured from fasting (8 h) blood samples. The survey used a cross-sectional, probabilistic design with national representativeness. The prevalence of major cardiovascular risk factors was estimated by sex and CVD diagnosis. Logistic regression analyses yielded adjusted odds ratios, identifying significant associations between key risk factors and CVD.

Results: Women exhibited a greater prevalence of obesity (38.6%), diabetes (17.4%), dyslipidemia (88.5%), and a personal history of myocardial infarction (19.5%) in comparison to men; similarly, women and individuals aged 50-59 years demonstrate the presence of more than two concurrent risk factors. The prevalence of obesity, dyslipidemia and hypertension in women was associated with an increased likelihood of a CVD diagnosis, adjusted odds ratio (aOR) = 2.6[95% CI: 1.5, 4.5].

Conclusion: The prevalence of cardiovascular events was similar between sexes; however, different risk factor profiles were identified. The pharmacological treatment alone has not been sufficient to achieve therapeutic goals.

Background: Malnutrition is common in heart failure (HF) and is associated with poor outcomes; however, longitudinal changes in the nutritional status of patients with HF are poorly investigated.

Objectives: To assess the prognostic impact of changes in Controlling Nutritional Status (CONUT) score and identify predictors of malnutrition improvement in hospitalized patients with HF.

Methods: We analyzed data on 4,016 patients from a nationwide acute HF registry in Japan (UMIN ID: UMIN000036592). We identified 812 patients with moderate or severe malnutrition at admission (CONUT score ≥5) and stratified them into an improvement (IMP, n = 168) or non-improvement (Non-IMP, n = 644) group based on in-hospital change in CONUT score. The primary outcome was all-cause mortality; the secondary outcome was a composite endpoint of all-cause mortality and HF rehospitalization.

Results: Over a median follow-up of 712 days (IQR, 392-768 days), all-cause mortality was significantly lower in the IMP group than in the Non-IMP group (11.90% vs. 30.12%; log-rank P < 0.0001). The composite endpoint was also lower in the IMP group (29.76% vs. 47.98%; log-rank P < 0.0001). After propensity score matching, the IMP group had consistently lower all-cause mortality and composite endpoints than the Non-IMP group (log-rank P = 0.0002; log-rank P = 0.041). Multivariable Cox proportional hazards model for all-cause mortality with overlap weighting demonstrated that CONUT improvement was associated with lower all-cause mortality (HR, 0.357; 95% CI, 0.205-0.624; P = 0.0003).

Conclusion: In hospitalized patients with acute HF and moderate to severe malnutrition, improvement in CONUT score during hospitalization was associated with lower post-discharge mortality and rehospitalization.

Objective: Insulin resistance (IR) is a key driver of prediabetes, type 2 diabetes, and cardiovascular disease (CVD) risk. This study evaluated the predictive performance of ten IR surrogate indexes (TyG, TyG-BMI, TyG-WC, TyG-WHtR, METS-IR, AIP, TyHGB, CTI, eGDR, CVAI) for new-onset CVD in Chinese patients with prediabetes or diabetes, aiming to identify the most effective index for cardiovascular risk stratification.

Methods: This longitudinal cohort study analyzed 3,532 middle-aged and elderly participants from the China Health and Retirement Longitudinal Study (CHARLS) baseline (Wave 1), with incident CVD events assessed at follow-up (Wave 4). Ten IR surrogate indexes were calculated at baseline. Multivariate logistic regression, adjusted for confounders, assessed associations between these indexes and CVD. Non-linear relationships were explored using restricted cubic spline analyses. Nine machine learning algorithms were employed to develop predictive models, with performance evaluated via receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis.

Results: During follow-up, 874 participants (24.7%) developed CVD. Each standard deviation increase in eGDR was associated with reduced CVD risk (OR = 0.822, 95% CI: 0.696-0.969), while CVAI was linked to increased risk (OR = 1.124, 95% CI: 1.028-1.229). Compared to the lowest quartile, the highest eGDR quartile had a 47.3% lower CVD risk (OR = 0.527, 95% CI: 0.353-0.789, P = 0.0018), and the highest CVAI quartile had a 33.1% higher risk (OR = 1.331, 95% CI: 1.038-1.709, P = 0.0243). Incorporating eGDR and CVAI into machine learning models, particularly K-Nearest Neighbors (KNN), enhanced discrimination (AUC = 0.936, 95% CI: 0.928-0.943).

Conclusion: eGDR and CVAI outperformed other IR indexes in predicting CVD in Chinese patients with prediabetes or diabetes. Their integration into KNN models significantly improved risk stratification, suggesting their utility as accessible clinical tools for early identification and intervention to reduce CVD burden.

Background: This review assessed the cost-effectiveness and implementation strategies of hypertension management by non-physician healthcare workers (NPHCWs) in low- and middle-income countries (LMICs).

Methods: A systematic search (inception-May 2024) included adults ≥18 years managed by NPHCWs LMICs, following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Economic evaluations were assessed using Drummond's checklist and ROBINS-I.

Results: Seven studies (2002-2022) conducted across eight countries enrolled 96-10,000 participants and included randomized, modeling, observational, and quasi-experimental designs. NPHCWs included pharmacists, community and village health workers, and nurses. Patients' mean age ranged 58-71 years, with 57-82% female. Outcomes assessed included cost per mmHg reduction ($INT 2.25 systolic, $INT 2.03 diastolic), per controlled patient ($INT 1.48), annual cost ($INT 0.22-232.31), cost per disability-adjusted life year (DALY) averted ($INT 411.39-4709.96), and per quality-adjusted life year (QALY) gained ($INT 1.04-13.30). Incremental cost-effectiveness ratio (ICERs) varied ($INT 0.41-14,373.97). Strategies included NPHCWs training and community engagement/counseling.

Conclusion: Hypertension management by NPHCWs appears cost-effective in LMICs, though more studies are needed for generalizability.

Background: Heart failure (HF) is a complex clinical condition requiring resource-intensive management and substantial health expenditure. The adverse economic impact of medical care on patients or financial burden is increasingly recognised as a significant non-clinical entity affecting HF management in low- and middle-income countries (LMIC). We explored the factors associated with Financial Burden (FB) in HF patients in India.

Methods: We recruited HF patients from 21 hospitals across India, selected to reflect regional diversity and varying stages of epidemiological transition. Trained personnel collected clinical and economic data using a validated and structured questionnaire. Expenditures were recorded in Indian rupees (INR) and converted to international dollars (INT$).

Results: We recruited 1,859 participants. Nearly one-third of participants (30.2%) were women. The mean age was 55.9 (11.3) years, and the mean duration of formal education was 11.3 (3.8) years. Health insurance coverage was reported in one-third (32.2%) of the study population. The average annual out-of-pocket (OOP) expenditure was INR 1,06,566 (INT$ 4,709.10), constituting 92.6% (95% CI: 92.5-92.7) of the total health expenditure. Compared to the previous year, a decline in monthly income was reported by 32.3% of individuals and 36.2% of households. Catastrophic health spending (CHS) and distress financing (DF) were observed in 37.7% (35.5-39.9) and 17.7% (15.9-19.4) of the households, respectively. However, CHS and DF were lower [30.8% (26.2-35.4) and 13.6% (10.2-17.0), respectively] among those with health insurance compared to the uninsured [40.3% (37.6-43.0) and 18.9% (16.7-21.1), respectively].

Conclusion: Seven out of 10 HF patients in India lack financial health protection. OOP expenditures, accounting for over 90% of total health spending, contribute significantly to economic distress in HF patients. Financial burden, affecting more than one-third of HF patients, carries profound implications for individual well-being. Addressing this financial burden, including CHS and DF, is essential for improving clinical outcomes and ensuring health equity.

Objectives: Cardiovascular diseases (CVDs) still represent a major cause of mortality, with inflammation playing a key role in their pathogenesis. Thus, elucidating the possible effects of disease-modifying antirheumatic drugs (DMARDs) on CVD risk in the general population may hold considerable clinical implications.

Methods: Genetic instruments were employed to proxy the pharmacological effects of seven DMARD classes, including sulfasalazine, cyclosporine, leflunomide, IL-6 inhibitors, TNF-alpha inhibitors, abatacept, rituximab, and JAK inhibitors. To investigate their potential causal associations with 11 CVD outcomes, a comprehensive framework incorporating two-sample Mendelian randomization (TSMR), summary-data-based MR (SMR), and colocalization analysis was developed. Lastly, several sensitivity analyses were undertaken to verify the robustness of our findings.

Results: In the primary TSMR results, sulfasalazine targeting PLA2G1B was linked to reduced risks of heart failure (OR: 0.86, 95% CI: 0.80-0.94), total cholesterol (OR: 0.89, 95% CI: 0.83-0.95), high-density lipoprotein cholesterol (OR: 0.88, 95% CI: 0.82-0.94), and aortic stenosis (OR: 0.72, 95% CI: 0.62-0.84). Sulfasalazine targeting RELB exhibited similar protective associations, whereas RELA exhibited the opposite associations. Moreover, IL-6R was robustly associated with increased risks of atrial fibrillation (OR: 1.29, 95% CI: 1.16-1.44), coronary artery disease (OR: 1.38, 95% CI: 1.23-1.56), myocardial infarction (OR: 1.27, 95% CI: 1.11-1.44), ischemic stroke (OR: 1.34, 95% CI: 1.22-1.48), and aortic stenosis (OR: 1.75, 95% CI: 1.46-2.09). Genetically higher IL-6R expression was associated with increased CVD risk, suggesting that IL-6 inhibition may confer cardiovascular benefit. SMR analysis further validated the associations of RELA, CD80, and IL-6R with one or more cardiovascular phenotypes. Finally, colocalization analyses for IL-6R and RELB provided strong evidence supporting their involvement in multiple CVDs.

Conclusion: Overall, this study presents evidence supporting a causal association between DMARDs and several CVDs. Nevertheless, further clinical investigations are necessary to validate our findings.

Background: Central obesity, as indicated by waist circumference (WC), is a major risk factor for coronary artery disease (CAD). However, the independent causal role of WC in CAD remains underexplored, particularly after adjusting for metabolic comorbidities such as hypertension and diabetes.

Objectives: This study aims to evaluate the causal relationship between WC and CAD using a two-pronged approach: propensity score-matched observational analysis and Mendelian randomization (MR) analysis.

Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2023 were used for cross-sectional analysis, while genetic instrumental variables associated with WC were sourced from genome-wide association studies (GWAS). We performed inverse variance weighted (IVW) MR analysis and sensitivity tests including MR-Egger and leave-one-out analysis.

Results: Propensity score matching showed that WC was significantly higher in the CAD group compared to controls (p < 0.001). MR analysis confirmed a causal relationship between increased WC and CAD risk, with an estimated causal effect size of 0.02884 (95% CI: 0.016, 0.041; p = 0.00000883). Sensitivity analyses validated the robustness of these findings.

Conclusion: Our results provide strong genetic and observational evidence linking increased WC with a higher risk of CAD. These findings highlight the need for targeted interventions to reduce central obesity and prevent CAD, especially in populations prone to metabolic disorders.

Background and aim: Acute myocardial infarction (AMI) remains a major global health problem, being the leading cause of both morbidity and mortality. We aim to present the temporal trends, demographic, clinical characteristics and risk factors of AMI in Kosovo.

Methodology: We conducted a retrospective, single-center observational study at the Clinic of Cardiology, University Clinical Center of Kosovo, having analyzed all patients admitted with AMI between January 2014 and December 2024. STEMI and NSTEMI cases were diagnosed according to ESC criteria. Patient's risk factors, biomarkers, PCI, and outcome data were extracted from hospital clinical records. Latent class analysis identified patient subgroups based on risk profiles. Temporal trends and projections of AMI incidence (per 100,000 population) were analyzed using polynomial and Joinpoint regression models. Statistical comparisons employed Chi-squared, t-tests, or Mann-Whitney U tests.

Results: Over the course of 11 years, 13,099 AMI patients (mean age 63.8 years; 29% female) were admitted; 55% had STEMI and 45% NSTEMI. Annual Age-standardized incidence increased from 23.5 to 86.4 per 100,000 (2014-2021) then fell to 71.3 in 2024. Hypertension (66%), smoking (47%), diabetes (34%) and dyslipidemia were highly prevalent. Latent class analysis identified four distinct patient clusters with varying combinations of smoking, diabetes, hypertension and family history of cardiovascular disease (CVD) (p < 0.001). STEMI patients were younger, more often male and smokers, while NSTEMI patients were older with higher rates of diabetes, hypertension and prior LBBB. In-hospital mortality was 9.15%, higher for STEMI (~12%) than NSTEMI (~6%), and declined markedly over time (19.3% in 2014 vs 7-10% in 2022, p < 0.001).

Conclusions: In a developing country, Kosovo, STEMI was more frequent than NSTEMI, affecting younger male patients. The leading risk factors included arterial hypertension, smoking, diabetes mellitus, and a family history of CVD. The decline in acute MI related mortality over recent years, can be explained by the increasing use of myocardial reperfusion procedures. Furthermore, the rates of acute MI related complications are not different from neighboring countries.