American heart journal plus : cardiology research and practice最新文献

Background

Current knowledge about non-acute myocardial infarction-associated cardiogenic shock (nAMI-CS) by ethnicity is limited. This study compares clinical features and outcomes of nAMI-CS in Hispanic versus non-Hispanic patients in the U.S.

Methods

Hospitalizations with nAMI-CS from 2018 to 2020 were identified using the National Inpatient Sample (NIS) database. Patients were classified by ethnicity (Hispanic vs. non-Hispanic). Statistical analysis, including Chi-square and t-tests, was conducted using STATA version 18.

Results

Out of 8607 nAMI-CS hospitalizations, 832 (9.6 %) were Hispanic. Hispanic patients were younger (62.3 ± 15.2 vs. 66.2 ± 15.3 years) and had higher incidences of smoking (2.4 % vs. 2.1 %), coronary artery disease (45.4 % vs. 44.1 %), myocardial infarction (2.9 % vs. 1.9 %), heart failure (10.1 % vs. 9.2 %), and diabetes mellitus (18.9 % vs. 18.1 %). They had lower incidences of hypertension (32.9 % vs. 34.3 %), valve disease (1.9 % vs. 2.1 %), and cerebrovascular disease (6.5 % vs. 8.5 %, all p < 0.005). Hispanic patients had slightly higher in-hospital mortality rates (18.6 % vs. 17 %, p < 0.001), with an adjusted odds ratio (aOR) of 1.20 (95 % CI: 1.01–1.50, p = 0.01). Their hospital stays were longer (17.7 ± 1.87 vs. 13.2 ± 0.31 days, p = 0.03) and costlier ($409,280 ± 591,582 vs. $291,298 ± 461,920, p = 0.03).

Conclusion

Hispanic nAMI-CS patients are younger, have more co-morbid conditions, longer hospital stays, higher costs, and higher in-hospital mortality rates than non-Hispanic patients. Further research is needed to understand the mechanisms behind these disparities.

Congestive heart failure (CHF) and opioid use disorder (OUD) commonly coexist and are major contributors to high healthcare utilization in the United States. Medication assisted treatment (MAT; e.g., buprenorphine and methadone) reduces opioid-related mortality by about 50 %; yet little is known about how OUD treatment impacts CHF outcomes in patients with both CHF and OUD. We examined the impact of MAT (buprenorphine, methadone, and naltrexone) on CHF outcomes in patients diagnosed with OUD and CHF, and which MAT (buprenorphine or methadone) medication is associated with the fewest CHF outcomes. A retrospective cohort study of patients 18 years or older diagnosed with both CHF and OUD was conducted using Optum's de-identified Clinformatics® Data Mart Database. Multivariate logistic regression modeling was used to compared patients who were prescribed MAT to those who were not. The primary outcomes were CHF hospitalizations and CHF emergency department visits. No significant differences in the primary outcomes between the MAT and non-MAT cohorts were observed. In conclusion, the lack of association of MAT with negative CHF outcomes suggest that life-saving MAT can be safely used for OUD treatment in the CHF setting.

The role of incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP1RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, in the management of type 2 diabetes mellitus (T2DM) and obesity has been increasingly recognized, along with significant cardiovascular (CV) benefits. Despite the clinical efficacy of incretin-based therapies, high costs, suboptimal access, limited insurance coverage, and therapeutic inertia present substantial barriers to widespread adoption. Overcoming these obstacles is essential for the equitable initiation, access, and utilization of incretin-based therapies. Clinicians must make targeted efforts to ensure health equity in the use of these and other advanced therapies.

Background

Nicorandil and verapamil can improve coronary blood flow and coronary microcirculation during percutaneous coronary intervention. However, the effects of intracoronary (IC) administration of nicorandil and verapamil on hemodynamics remain unclear.

Aims

To clarify the safety and effects of IC administration of nicorandil and verapamil on blood pressure (BP) and heart rate (HR) to provide evidence-based basis for clinical intervention.

Methods

The study cohort included 70 patients with coronary artery stenosis recruited from Zhejiang Provincial Hospital of Traditional Chinese Medicine. The patients were randomly assigned to the intervention group (IC administration of 2 mg/2 ml of nicorandil and 200 μg/2 ml of verapamil) or the control group (IC administration of 2 ml of saline). BP and HR were compared before medication, after medication, and when stabilized.

Results

IC administration of verapamil at 200 μg significantly reduced systolic BP as compared to the control group (113.72 ± 3.40 vs. 123.63 ± 3.33 mmHg, respectively, p < 0.05) for a short period of time, and returned to baseline within 2 min, but had no effect on diastolic BP and HR. IC administration injection of nicorandil at 2 mg had no effect on BP or HR. There were no instances of major cardiovascular events.

Conclusion

IC administration of nicorandil at 2 mg is safe as an adjunctive medication during interventional angiography. Verapamil can also be used as an IC adjuvant, although BP and HR must be monitored for patients with low basal BP, especially systolic BP.

Background/aims

Myocarditis is an inflammatory disease with diverse clinical presentations. It is known that low-risk patients have a good prognosis compared to high-risk patients. There are few data regarding the prognosis of intermediate-risk patients. This study aimed to analyze the long-term outcomes of patients with acute myocarditis with different risk profiles at presentation, focusing on the intermediate risk one.

Methods

A retrospective multicenter study was conducted, enrolling patients who met the diagnostic criteria for clinically suspected myocarditis with acute presentation. Patients were stratified into high, intermediate and low risk, according to the classification proposed by Sinagra and his team. Cardiovascular adverse events (AEs) were assessed after a median follow-up of 19 months. Echocardiographic and cardiac magnetic resonance (CMR) parameters predictive of adverse events have been reported.

Results

We enrolled 127 patients (mean age 30 ± 13 years; 103 men, 24 women). High-risk patients had a higher frequency of adverse events (80 %) compared to other groups (16 %–16 %, p < 0.0001). An association was observed between the number of segments with late gadolinium enhancement (LGE) at baseline CMR and the occurrence of adverse events (p < 0.0037). The sum of segments with LGE was statistically correlated with lower left ventricular GLS (p < 0.009). The number of segments with LGE that most accurately identified the occurrence of adverse events was 2.5 [AUC 0.5; p = 0.24].

Conclusions

Our study confirms the higher incidence of AE in the high group; the prognosis of patients at intermediate risk is not very different from those at low risk. It can be hypothesized that the extent of LGE at baseline is the main predictor of adverse events in patients at intermediate risk.

Study objective

Design and setting

Participants

Main outcomes

Results

Conclusions

Study objective

To describe the age, sex and racial disparities in mortality rates for heart disease (HD) and heart failure (HF) in the United States (US) between 2000 and 2020.

Design

This was an ecological study with trend analysis of mortality rates.

Setting

United States.

Participants

Adults aged 18 years and above.

Main outcomes measures

Mortality rates per 100,000 for HD and HF.

Results

There was a significant decrease in the age-standardized mortality rate for HD over the past two decades (from 343.5 per 100,000 cases to 215.1 per 100,000 cases, p < 0.001). HD mortality rates were significantly higher in males (p < 0.001), non-Hispanic blacks (p < 0.001) and in adults aged 65+ (p < 0.001) and 75+ (p < 0.001). There was no significant change in the age-standardized mortality rate for HF (from 26.9 per 100,000 cases to 25.7 per 100,000 cases (p = 0.706)) due to a reversal in the trend beyond 2011. Though the HF mortality rates were significantly lower in males (p = 0.001), and not significantly different in non-Hispanic blacks and non-Hispanic whites, there were shifts in trends beyond 2016, with higher rates in males and in non-Hispanic blacks compared to non-Hispanic whites.

Conclusions

In summary, this study underscores significant reductions in heart disease mortality rates over the past two decades, alongside persistent disparities among different demographic groups. It also highlights emerging trends in heart failure mortality rates in particular population subgroups in recent years, necessitating further exploration to inform targeted interventions and policies.