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

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.

Background

Cardiogenic shock (CS) is the leading cause of mortality in acute myocardial infarction (AMI) patients, especially in those with vascular disease. This study aimed to assess the association between extent of polyvascular disease and the in hospital management and outcome of patients with AMI-induced CS.

Method

Using the National Inpatient Sample from 2016 to 2019, adult patients with AMI and CS with known vascular disease were identified and stratified by number of diseased vascular beds and into STEMI and NSTEMI subgroups. The study assessed in-hospital major adverse cardiovascular and cerebrovascular events (MACCE), mortality, acute CVA and major bleeding, as well as invasive management by number of diseased vascular beds.

Results

Out of 136,245 patients, 57.9 % attributed to STEMI and 42.1 % to NSTEMI. The study revealed that the likelihood of percutaneous coronary intervention (PCI) [(aOR for 2 beds 0.94, CI 0.91–0.96, p-value < 0.001; 3 beds 1.0, CI 0.94–1.06, p-value 0.96)] and coronary artery bypass grafting (CABG) [(aOR for 2 beds 0.66, CI 0.64–0.69, p-value < 0.001; 3 beds 0.76, CI 0.71–0.81, p-value < 0.001)] decreased as the number of diseased vascular sites increased. The study also highlighted a direct dose-response relationship between the number of diseased vascular beds and major adverse outcomes, including MACCE, mortality and acute CVA, underscoring the prognostic significance of polyvascular disease in this patient population.

Conclusion

The study demonstrated that polyvascular disease significantly worsens AMI-induced CS outcomes. The findings highlight the importance of early identification and aggressive management of polyvascular disease in these patients. Further research is needed to develop targeted treatment strategies for this high-risk population.

Background

Takotsubo cardiomyopathy (TTC) has a preponderance for females, particularly postmenopausal. However, recent data from multicenter registries identified a worse prognosis in male patients, particularly with cardiogenic shock. We aim to investigate gender disparities in outcomes of TTC-associated cardiogenic shock (TTC-CS).

Methods

The National Readmission Database (2016–2020) was utilized to identify TTC-CS hospitalizations. Cohorts were stratified by gender. A Propensity Score Matching (PSM) model, which utilized complete Mahalanobis Distance Matching within the Propensity Score Caliper following multivariate regression, successfully matched males and females. Pearson's χ² test was applied to the propensity-matched cohorts to compare outcomes.

Results

Among 12,803 TTC-CS hospitalizations, the majority (74.1 %) were females (N: 9490), and 25.9 % were males (N: 3313). On propensity-matched cohorts (2609), males were found to have higher in-hospital mortality (31 % vs. 26 %, p < 0.001), higher incidence of sudden cardiac arrest (14 % vs. 10.8 %, p < 0.001), endotracheal intubation (52.1 % vs. 48.8 %, p: 0.001), acute liver injury (18 % vs. 15.9 %, p: 0.004), acute stroke (7.2 % vs. 5.8 %, p: 0.004), cardiac arrhythmias (55.1 % vs. 49.3 %, p < 0.001) and acute kidney injury (63.1 % vs. 49 %, p < 0.001); while female patients were found to have higher utilization of mechanical circulatory support (MCS) modalities (16.1 % vs 13.2 %, p < 0.001).

Males had a higher adjusted cost of hospitalization ($54,537 vs. $42,805, p < 0.001) with a higher median length of hospital stay (10 vs. 9 days, p < 0.001). The two groups had no significant difference in 30, 90, and 180-day readmission rates (p > 0.05). From 2016 to 2020; mortality has not changed significantly for TTC-CS, while the use of percutaneous coronary angiogram (PCA) and MCS has down-trended (p-trend < 0.05).

Conclusion

For TTC-CS hospitalization, males have higher in-hospital mortality and complication rates, along with higher LOS and cost of hospitalization. Despite advances in the management of CS, there was no significant difference in mortality from 2016 to 2020.

Insights in age- and sex-specific coronary atherosclerotic plaque characteristics may contribute to a better understanding of coronary artery disease and, ultimately, to its prevention and treatment. In 307 women and 406 men aged 20 to 90 years undergoing intravascular ultrasound imaging, sex-based differences in coronary atherosclerotic plaque characteristics were mainly present in younger patients, while these differences were less pronounced at advanced age.

Hypertension is one of the leading risk factors for cardiovascular disease. The ACC/AHA/Multisociety hypertension guideline covered all aspects of the recommendations for optimal blood pressure diagnosis and management to improve cardiovascular outcomes. Despite this, there remains a growing prevalence of hypertension within the United States, largely in non-Hispanic Black women at earlier stages of their life course. This highlights the evident racial disparities, but offers a targeted opportunity for improved outcomes. With hypertension increasingly seen in the antenatal and immediate postpartum period, and obstetrics societies weighing in on the need to alter pharmacotherapy initiation goals, national initiatives have purposefully targeted pregnant and postpartum women in an effort to improve outcomes. This same energy must also re-focus health care efforts across the entire health continuum. Public health and system strategies are in place to do so, with the strongest enforcing initiatives as early as childhood with a greater focus on primordial prevention.

Contemporary studies of rheumatic heart disease (RHD) within American Indian communities are lacking, despite recent work indicating high rates of group A streptococcus, the precursor to RHD. Utilizing retrospective chart review of the Indian Health Service, we sought to characterize the burden of acute rheumatic fever and RHD within an American Indian tribe in Eastern Arizona. Our study found that, in line with other high-income countries, RHD in the US continues to disproportionately impact native peoples, with rates 10 times that of the general population.