Peripartum cardiomyopathy (PPCM) outcomes have been previously linked to demographic and social factors. The social vulnerability index (SVI) is a measure of social vulnerability in the United States. We explored PPCM disparities and the impact of SVI on PPCM mortality.
Introduction: Dilated cardiomyopathy (DCM) is associated with a significant mortality risk, with untreated cases showing a five-year survival rate of just 50%. However, there is a scarcity of data on how DCM-related mortality rates have changed over time. Goals: How have temporal trends and demographic disparities in DCM mortality evolved in the United States over time? Methods: Mortality/demographic data (i.e. sex, race, ethnicity, and area of residence) in adults in the US spanning from 1999-2020 were sourced from the CDC-WONDER database, using ICD-10 code I42.0. Age-adjusted mortality rates (AAMR) per 1,000,000 population were standardized to the 2000 US population. Temporal trends in mortality were assessed using log-linear regression, with results expressed as the average annual percentage change (AAPC). Results: A total of 168,702 DCM deaths were recorded between 1999-2020. DCM-related AAMR declined from 34.00 [95% CI, 33.31-34.69] in 1999 to 17.17 [16.74-17.59] in 2020, with AAPC -3.47%, p<0.001. Higher mortality was observed in males (AAMR 33.94 [33.74-34.15]) than females (AAMR 14.68 [14.56-14.80]), in non-Hispanic populations (AAMR 24.06 [23.94-24.18]) compared to their Hispanic counterparts (AAMR 16.68 [16.35-17.01]), and in rural regions (AAMR 23.31 [23.03-23.59]) compared to urban regions (AAMR 23.31 [23.19-23.44]). Black populations (AAMR 41.89 [41.42-42.36]) and residents of the Midwestern US region (AAMR 26.14 [25.89-26.39]) experienced the highest mortality rates. Conclusions: DCM-related mortality halved between 1999 and 2020. However, the burden of mortality disproportionately affected males and Black populations. Further research is essential to uncover the underlying factors contributing to these disparities.
Background: Percutaneous coronary intervention (PCI) is a cornerstone in the management of acute coronary syndrome (ACS) patients. Despite technological advancements, the occurrence of no-reflow phenomenon remains a significant concern among ACS patients. Atrial fibrillation (AF) is a common arrhythmia associated with cardiovascular events. We conducted a meta-analysis to investigate the potential influence of AF on the development of no-reflow in ACS patients following PCI. Methods: Relative risk (RR) with a 95% confidence interval (95%CI) served as the summary measure in our meta-analysis using the random-effects model to estimate the summary effect. The primary outcome is to investigate the potential influence of AF on the development of no-reflow in ACS patients following PCI. We assigned I2 > 50% as an indicator of statistical heterogeneity. P value <0.05 was considered significant. Data analysis was conducted using SPSS v.25. A comprehensive literature search was performed identifying relevant studies published up to January 2024 from October 2001 from PubMed, Google Scholar, Scopus databases. Studies reporting the baseline AF and no-reflow in ACS patients post-PCI were included. Case reports, duplicate studies, reviews and metaanalysis were excluded. Data screening and analysis were conducted independently by two reviewers. Results: The meta-analysis included 10 studies comprising a total of 11079 ACS patients who underwent PCI. No reflow developed in 2442 of these patients. In total, 653 patients had baseline AF and 10426 patients had not AF. No-reflow developed in 243 of the patients with baseline AF. Also, no-reflow developed in 2199 of the patients with non-AF. Our findings revealed a statistically significant association between AF and increased incidence of no-reflow in ACS patients following PCI (RR: 1.5 Cl %95) (p < 0.05). There was moderate statistical heterogeneity across the studies that evaluated no-reflow outcomes (I2= 61%) Conclusion: In this meta-analysis, we provide evidence suggesting that the presence of AF may have a deleterious effect on the development of no-reflow phenomenon in ACS patients following PCI. AF may have deleterious effects on the coronary microvasculature. Further research is warranted to elucidate the underlying mechanisms and to determine the clinical implications of these observations.
Abstract Aims Transthyretin amyloid cardiomyopathy (ATTR-CM) is characterized by the accumulation of transthyretin (TTR) protein in the myocardium. The aim of this scoping review is to provide a descriptive summary of the clinical trials and observational studies that evaluated the clinical efficacy and safety of various agents used in ATTR-CM, with a goal of identifying the contemporary gaps in literature and to reveal future research opportunities. Methods and results The search was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search using several databases for observational and clinical trials investigating the treatment modalities for ATTR-CM was undertaken. We extracted data including study characteristics, primary endpoints, and adverse events from each study. A total of 19 studies were included in our scoping review. Out of which, 8 were clinical trials and 11 were observational analyses. The drugs evaluated included tafamadis, acoramidis, revusiran, doxycycline and tauroursodeoxycholic acid and doxycycline, diflusinil, inotersan, eplontersen, and patisiran. Tafamidis has shown to be efficacious in the management of ATTR-CM, particularly when initiated at earlier stages. RNA interference and antisense oligonucleotide drugs have shown promising impacts on quality of life. Additionally, this review identified gaps in the literature, particularly among long-term outcomes, comparative effectiveness, and the translation of research into economic contexts. Conclusion Multiple pharmacological options are potential disease-modifying therapies for ATTR-CM. However, many gaps exist in the understanding of these various drug therapies, warranting further research. The future directions for management of ATTR-CM are promising in regard to improving prognostic implications.
Background: Recent studies have suggested performing coronary artery bypass grafting (CABG) within 24 hours of acute myocardial infarction increases mortality risk. However, the ideal timing after the first day remains unclear. This study aims to suggest an optimal timing of CABG in NSTEMI patients using the large National Inpatient Sample (NIS) database over a 5-year period. Methods: This retrospective cohort study analyzed survey-weighted NIS data over 2017-2021, including adult-age admissions with NSTEMI as the principal diagnosis who underwent CABG without prior transfer from another hospital. Patients were categorized into eight groups based on days from admission to CABG (0, 1, 2, 3, 4, 5, 6, and ≥7 days). Baseline characteristics were compared across groups. Multivariate regression analysis adjusted for multiple confounders to assess the association between Time-to-CABG and in-hospital mortality and stroke prevalence. Results: Table 1 presents the baseline characteristics across the eight groups, encompassing 142,200 included admissions (mean age 65.24 years; 26.78% female). In-Hospital Mortality: The adjusted odds ratios (OR) were less than one for groups 1 through 7 compared to group 0, indicating that immediate CABG (day 0) is associated with higher mortality risk. While the reduced odds in the day 1 group were not statistically significant, substantial and statistically significant reductions in mortality were observed between days 2 and 5 (OR: 0.624 - 0.609; p<0.05). After day 5, the OR for mortality trended up, reaching 0.667 (p<0.05) on day 6 and 0.692 (p<0.05) for surgeries performed on day 7 or later. Stroke Prevalence: The adjusted ORs for stroke prevalence were significantly lower for groups 1 through 7 compared to the CABG within 24-hour group (all p-values <0.05). The lowest ORs were observed between days 2 and 4 (OR: 0.654 and 0.542, p<0.05, respectively). After day 4, the ORs increased, reaching 0.672 (p<0.05) for surgeries performed on day 5 and 0.609 (p<0.05) on day 7 and beyond. Conclusion: The mortality risk in NSTEMI patients remained higher if CABG was performed in the first 48 hours of admission (end of day 1) compared to later. This risk also increased if CABG was done after day 5. Combined with the possible risk of stroke being increased from day 5, we suggest the optimal time-to-CABG is between admission day 2 and day 4 in NSTEMI patients. Future prospective studies are warranted to confirm these findings and guide clinical practice.
US-Mexico (US-MX) border regions are impacted by socioeconomic disadvantages. Alcohol use disorder remains widely prevalent in US-MX border regions, which may increase the risk of alcoholic liver disease (ALD).
Over the past several decades, the overweight and obesity epidemic in the USA has resulted in a significant health and economic burden. Understanding current trends and future trajectories at both national and state levels is crucial for assessing the success of existing interventions and informing future health policy changes. We estimated the prevalence of overweight and obesity from 1990 to 2021 with forecasts to 2050 for children and adolescents (aged 5-24 years) and adults (aged ≥25 years) at the national level. Additionally, we derived state-specific estimates and projections for older adolescents (aged 15-24 years) and adults for all 50 states and Washington, DC.
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