Clinical Cardiology最新文献

{"title":"Atrial Fibrillation and Obstructive Sleep Apnea: Do Mortality Trends Reflect Disease Burden or Diagnostic Gaps?","authors":"Naoya Kataoka,&nbsp;Teruhiko Imamura","doi":"10.1002/clc.70200","DOIUrl":"https://doi.org/10.1002/clc.70200","url":null,"abstract":"<p>The authors demonstrated a striking and consistent rise in atrial fibrillation (AF)–related mortality involving obstructive sleep apnea (OSA), particularly among elderly, female, rural, and minority populations [<span>1</span>]. This important analysis highlights the growing public health burden of AF–OSA overlap. However, several issues merit further clarification and discussion.</p><p>The authors report a steep increase in AF-related mortality involving OSA over the past two decades [<span>1</span>]. However, as AF prevalence and mortality have also generally increased in the U.S. population [<span>2</span>], it is unclear whether the observed trend is specific to patients with comorbid OSA or merely reflects overall AF epidemiology. A comparative analysis of mortality trends in AF patients without OSA would be helpful to determine the additive risk associated with OSA.</p><p>During the study period (1999–2020), catheter ablation became increasingly adopted for rhythm control in AF [<span>3</span>]. Recent studies suggest that AF ablation is associated with improved long-term outcomes, particularly in younger male patients [<span>4</span>]. Yet, despite these advances, AF-related mortality in patients with OSA continued to rise. How do the authors interpret this apparent contradiction? Were these procedures less commonly used or less effective in the OSA subgroup?</p><p>The study identifies AF (ICD-10 I48.x) as the “underlying” cause of death and OSA (G47.33) as a “contributing” condition [<span>1</span>]. However, the clinical circumstances in which AF is recorded as the primary cause of death—distinct from its role as a comorbidity in stroke, heart failure, or sudden death—are not well defined. It would be informative to clarify how “AF-related mortality” was operationalized in this study and whether misclassification or variation in coding practices may have influenced the observed trends.</p><p>The authors correctly point out the rising burden of AF-related mortality in the presence of OSA [<span>1</span>]. Yet over the same period, mortality from stroke and heart failure—two major downstream complications of AF—has generally declined, partly due to improvements in anticoagulation and HF management [<span>5</span>]. This discrepancy raises the question of whether the increase in AF-related deaths reflects actual clinical deterioration or improved documentation of AF on death certificates.</p><p>While the use of CDC WONDER provides valuable national-level insights [<span>1</span>], the reliance on death certificate data introduces several limitations. OSA is often underdiagnosed, particularly among women, minorities, and older adults—groups in whom mortality increases were most pronounced. Additionally, data on OSA severity, AF subtype, comorbidities (e.g., heart failure, chronic kidney disease), and continuous positive airway pressure adherence were not available. These unmeasured variables may have played an important role in shaping th","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70200","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on the Observational Study on Statin Intensity Following CABG","authors":"Murat Abdulhamit Ercişli,&nbsp;Ahmet Süsenbük","doi":"10.1002/clc.70198","DOIUrl":"https://doi.org/10.1002/clc.70198","url":null,"abstract":"<p>We read with interest the article titled “Effect of Statin Intensity on Cardiovascular Outcomes and Survival Following Coronary Artery Bypass Grafting” recently published in Clinical Cardiology [<span>1</span>]. The study addresses a crucial area concerning optimal lipid management in patients undergoing Coronary Artery Bypass Grafting (CABG), particularly the impact of statin intensity on long-term cardiovascular outcomes.</p><p>While we commend the authors for conducting this relevant and timely observational study, we would like to raise several points for clarification and discussion, which might significantly impact the interpretation of the results:</p><p>First, we note considerable discrepancies in patient numbers between the comparison groups: No-statin (156 patients), low/moderate-intensity statin (1301 patients), and high-intensity statin (397 patients). Although the authors acknowledged this statistical concern due to the observational study design, such imbalanced group sizes may inherently introduce bias and confounding, limiting the reliability and generalizability of the conclusions.</p><p>Second, the authors mentioned that older patients and women were less likely to receive statins or were prescribed lower-intensity statins. This finding raises concerns regarding potential selection bias or disparities in clinical practice. It would be helpful for the authors to elaborate further on possible reasons for these discrepancies and their potential influence on clinical outcomes.</p><p>Third, the study did not adequately track patient compliance or continued usage of statins over the follow-up period, which is pivotal to understanding the true impact of the medication. Given that statin adherence significantly influences clinical outcomes, this limitation might have considerably affected the study's conclusions.</p><p>Additionally, the authors defined Major Adverse Cardiovascular Events (MACE) broadly to include acute coronary syndrome (ACS), cerebrovascular accident (CVA), and cardiovascular mortality. However, the study did not consider graft occlusion rates directly, which could significantly affect revascularization rates and subsequent MACE. Including graft occlusion data might have provided additional critical insights into statin efficacy.</p><p>Lastly, the timing of lipid measurements, which were taken variably between 1 and 3 months postoperatively, could introduce measurement bias. This variability in follow-up LDL measurements might limit the robustness of the conclusions drawn about the efficacy of lipid management.</p><p>Despite these concerns, the findings strongly suggest potential long-term benefits associated with high-intensity statin therapy in reducing cardiovascular risks post-CABG, especially evident beyond 2 years. This underscores the importance of robust randomized controlled trials to conclusively establish the most effective lipid-lowering strategies in post-CABG patients.</p><p>We appreciate the authors' ","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Underrepresented Factors in Cardiovascular Mortality Trends Among Chronic Kidney Disease Patients: A Call for Comprehensive Intervention Strategies","authors":"Shaher Yar,&nbsp;Zahin Shahriar,&nbsp;Sumaiya Ahmed,&nbsp;Muhammad Shehzad Asif","doi":"10.1002/clc.70199","DOIUrl":"https://doi.org/10.1002/clc.70199","url":null,"abstract":"&lt;p&gt;I read with great interest the comprehensive retrospective analysis by Ahmad et al. examining cardiovascular mortality trends in chronic kidney disease (CKD) patients from 1999 to 2020 [&lt;span&gt;1&lt;/span&gt;]. While the authors excellently document demographic disparities and temporal patterns in cardiovascular mortality, their work highlights several critical gaps that warrant further discussion, particularly regarding the underutilization of evidence-based interventions and the impact of emerging therapeutic paradigms on cardiovascular outcomes in CKD patients.&lt;/p&gt;&lt;p&gt;The study period (1999−2020) captures a transformative era in CKD management, yet the authors do not adequately address how the introduction of novel therapies may explain certain mortality trends. The 2024 KDIGO guidelines now emphasize SGLT2 inhibitors as cornerstone therapy, showing remarkable cardiovascular benefits in CKD populations [&lt;span&gt;2&lt;/span&gt;]. Recent meta-analyses demonstrate that SGLT2 inhibitors reduce major adverse cardiovascular events by 9%−14% in CKD patients, with particularly strong effects on heart failure hospitalization and cardiovascular death [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Similarly, the emergence of non-steroidal mineralocorticoid receptor antagonists (MRAs) like finerenone has revolutionized CKD-cardiovascular care. The pooled FIDELITY analysis demonstrated a 14% reduction in cardiovascular death, myocardial infarction, stroke, and heart failure hospitalization, with a 23% reduction in CKD progression [&lt;span&gt;4&lt;/span&gt;]. These therapeutic advances, introduced toward the end of the study period, likely contributed to the stabilization of mortality rates observed by Ahmad et al.&lt;/p&gt;&lt;p&gt;The significant racial and geographic disparities documented by the authors reflect deeper healthcare access issues that extend beyond demographic risk factors. Research demonstrates that up to 98% of people with kidney failure in low-income regions cannot access kidney replacement therapy, compared to 30% in high-income countries [&lt;span&gt;5&lt;/span&gt;]. Within the United States, these disparities manifest as differential access to nephrology care, with rural and minority populations experiencing delays in specialist referral and reduced access to evidence-based therapies [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The authors' observation that non-metropolitan areas exhibited higher age-adjusted mortality rates (8.6 vs. 8.1 per 100 000) underscores the critical role of healthcare infrastructure in cardiovascular outcomes. Studies show that less than one-third of community healthcare settings in resource-limited areas can access essential diagnostics for CKD monitoring, further contributing to delayed intervention and poor outcomes [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The study period concludes in 2020, capturing the early COVID-19 pandemic impact. Recent evidence demonstrates that COVID-19 significantly amplifies cardiovascular risk in CKD patients, with a twofold increased risk of cardiovascular death within 30 days and a 64","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 9","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70199","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144905528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to “Physician and Patient Preferences for Oral Anticoagulation Therapy Decision Making in Atrial Fibrillation: Results From a National Best–Worst Scaling Survey in Türkiye”","authors":"Pref-Af Study Group","doi":"10.1002/clc.70193","DOIUrl":"https://doi.org/10.1002/clc.70193","url":null,"abstract":"<p>K. Kılıckesmez, D. Aras, M. Degertekin, et al., “Physician and Patient Preferences for Oral Anticoagulation Therapy Decision Making in Atrial Fibrillation: Results From a National Best–Worst Scaling Survey in Türkiye,” <i>Clinical Cardiology</i> 47 (2024): e70038. https://doi.org/10.1002/clc.70038</p><p>In the published version of this article, the <b>Pref-Af Study Group</b> was missing in the author by-line. The correct author list should be:</p><p>K. Kılıckesmez, D. Aras, M. Degertekin, N. Ozer, B. Hacibedel, K. Helvacioglu, U. Koc, B. Ozdengulsun, E. Dundar Ahi, Pref-Af Study Group, and O. Ergene</p><p>Additionally, the <b>Acknowledgments</b> section has been updated as follows:</p><p>Medical writing and editorial support was provided by Ferda Kiziltas at remedium Consulting Group. The Pref-Af study group contributed to this study during the data collection and the names of the contributors as follows: Betul Balaban Kocas, Firdevs Aysenur Ekizler, Ayse Colak, Ahmet Anil Baskurt, Erdal Durmus, and Ugur Nadir Karakulak.</p><p>We apologize for this error.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 8","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70193","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality Trends Associated With Acute Myocardial Infarction and Psychoactive Substance Use in Older Adults: A US Nationwide Analysis (1999–2020)","authors":"Muhammad Hamza Shuja,&nbsp;Ramish Hannat,&nbsp;Ahmad Shahid,&nbsp;Komail Khalid Meer,&nbsp;Ayesha Mubbashir,&nbsp;Maliha Edhi,&nbsp;Irfan Ullah,&nbsp;Ahmad Alareed,&nbsp;Nitish Behary Paray,&nbsp;Raheel Ahmed,&nbsp;Bernardo Cortese,&nbsp;Michael E. Hall","doi":"10.1002/clc.70191","DOIUrl":"https://doi.org/10.1002/clc.70191","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acute myocardial infarction (AMI) remains a leading cause of mortality in the USA, particularly among individuals aged 65 and older. There is limited research about the association between psychoactive substance use and cardiovascular death due to AMI. This study aims to analyze trends in AMI-related mortality among older adults (aged ≥ 65) associated with psychoactive substance use in the USA from 1999 to 2020, with a focus on demographic and geographic variations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a descriptive analysis using death certificates from the CDC's WONDER database. Data were extracted for age, sex, race/ethnicity, urban–rural status, and geographic region. Crude mortality rates and AAMR were calculated, and temporal trends were assessed using Joinpoint regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 1999 and 2020, there were 231 359 AMI-related deaths among older adults with substance use disorders. Men (39.2) had a markedly higher mortality rate than women (15.0). Mortality rates increased across all age groups, with the most pronounced rise in those aged 85 and older (33.9). Metropolitan areas (22.3) experienced lower mortality rates than nonmetropolitan areas (37.9). The Midwest (32.3) consistently recorded the highest mortality rates, followed by the Northeast (25.0), South (24.5), and West (18.7).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study reveals notable temporal trends in AMI mortality among older adults with psychoactive substance use, highlighting significant demographic and regional disparities. These findings underscore the need for targeted interventions to address this growing public health issue.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 8","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70191","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Sodium-Glucose Co-Transporter-2 Inhibitors Improve Sleep Quality, Anxiety, and Quality of Life in Patients With Heart Failure?","authors":"Ilke Erbay,&nbsp;Naile Eris Gudul,&nbsp;Ahmet Furkan Suner,&nbsp;Pelin Aladag,&nbsp;Umit Karacar,&nbsp;Ahmet Avci","doi":"10.1002/clc.70190","DOIUrl":"https://doi.org/10.1002/clc.70190","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sodium-glucose co-transporter-2 (SGLT2) inhibitors improve cardiovascular outcomes in heart failure (HF), but their effect on sleep quality (SQ) and patient-centered outcomes remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aims to evaluate the impact of SGLT2 inhibitor use on SQ, anxiety, and quality of life in patients with HF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This longitudinal observational study included 95 HF patients grouped by SGLT2 inhibitor use. A total of 79 patients (SGLT2 inhibitor group: 33; non-SGLT2 inhibitor group: 46) completed a 6-month follow-up. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), anxiety with the Beck Anxiety Inventory (BAI), and quality of life with the Short Form-36 (SF-36). Subgroup analyses were conducted based on left ventricular ejection fraction (LVEF), and logistic regression was used to identify predictors of PSQI improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, PSQI scores were slightly better in the SGLT2 inhibitor group (<i>p</i> = 0.036), while BAI and SF-36 scores were similar. At follow-up, the SGLT2 inhibitor group showed significant improvements in PSQI (<i>p</i> &lt; 0.001) and BAI (<i>p</i> = 0.002), whereas no significant changes were observed in the non-SGLT2 inhibitor group for either PSQI (<i>p</i> = 0.698) or BAI (<i>p</i> = 0.373). PSQI improvement was observed in SGLT2 users regardless of LVEF. In multivariate analysis, SGLT2 inhibitor use was an independent predictor of PSQI improvement (adjusted OR: 4.255; <i>p</i> = 0.010).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SGLT2 inhibitor use was associated with improved SQ and reduced anxiety in patients with HF, suggesting symptom-related benefits beyond cardiovascular effects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 8","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144773999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Presence of Native Valvular Disease in Patients With Atrial Fibrillation Using the EHRA (Evaluated Heartvalves, Rheumatic, or Artificial) Classification","authors":"Antonio Escolar Conesa,&nbsp;María Asunción Esteve-Pastor,&nbsp;Vanessa Roldán,&nbsp;Eva Soler Espejo,&nbsp;José Miguel Rivera-Caravaca,&nbsp;Pablo Gil Pérez,&nbsp;Eduardo González Lozano,&nbsp;José María Arribas Leal,&nbsp;Sergio Cánovas López,&nbsp;Daniel Saura Espín,&nbsp;María José Oliva Sandoval,&nbsp;Eduardo Pinar Bermúdez,&nbsp;Juan García De Lara,&nbsp;Gregory Y. H. Lip,&nbsp;Francisco Marín","doi":"10.1002/clc.70172","DOIUrl":"https://doi.org/10.1002/clc.70172","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) in association with native valvular heart disease (VHD) is very common and both entities perpetuate each other due to volume and pressure overload. In 2017, the new EHRA classification (Evaluated Heartvalves, Rheumatic or Artificial) was proposed: EHRA 1 (mechanical prostheses or moderate/severe mitral stenosis), EHRA 2 (native valvular involvement or biological prosthesis) and EHRA 3 (without valve disease). The objective was to analyze the clinical characteristics as well as adverse events in the follow-up of AF patients under oral anticoagulation classified according EHRA classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A multicenter retrospective observational descriptive study was designed and collected clinical, analytical, echocardiographic characteristics as well as adverse events in the follow-up of patients with AF who start oral anticoagulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>1.399 patients were included (mean age 75.3 ± 9.9 years; 659 (47.1%) male), of whom, 63% were classified as EHRA 2. After a median follow-up of 910 (IQR 730−1018) days, native EHRA 2 patients had higher event rates/patient-year as well as a higher total rate of adverse events such as cardiovascular mortality (5.5% vs. 1.1% event/patient-year; 8.7% vs. 1.1% <i>p</i> &lt; 0.001) and major adverse cardiovascular events (MACE) (8.9% vs. 3.4% event/patient-year; 14.2% vs. 3.1% <i>p</i> &lt; 0.001), compared with EHRA 3 patients. Multivariate logistic regression analysis showed that native EHRA 2 group was independently associated with all major adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In anticoagulated AF patients, those with native valve involvement (EHRA 2) have a worse prognosis than patients without valve involvement (EHRA 3). The presence of native valvular disease is shown as an independent risk factor for all-cause mortality, major bleeding, cardiovascular mortality, ACS, heart failure, and MACE.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 8","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70172","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Cardiovascular Mortality in Patients With Chronic Kidney Disease From 1999 to 2020: A Retrospective Study in the United States","authors":"Eeman Ahmad,&nbsp;Shoaib Ahmad,&nbsp;Azka Naeem,&nbsp;Shahzaib Ahmed,&nbsp;Maryam Shehzad,&nbsp;Umar Akram,&nbsp;Hamza Ashraf,&nbsp;Obaid Ur Rehman,&nbsp;Irfan Ullah,&nbsp;Raheel Ahmed,&nbsp;Chadi Alraies,&nbsp;Gregg C. Fonarow","doi":"10.1002/clc.70174","DOIUrl":"https://doi.org/10.1002/clc.70174","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic kidney disease (CKD) may be associated with fatal cardiovascular diseases (CVDs). We aim to identify CVD-related mortality trends in patients with CKD in the US, examining the variation by sex, race, and region, and compare them to CVD-related mortality trends in general.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The CDC-WONDER database was used to obtain age-adjusted mortality rates (AAMRs) per 100,000 population. Annual percent change (APC) and average APC (AAPC) in these rates were calculated using Joinpoint regression and comparisons were done using pairwise comparison.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1999 to 2020, a total of 605,384 CVD-related deaths were observed in patients with CKD. The AAMR was almost double in males (11.0) than females (6.3). NH (Non-Hispanic) Blacks or African Americans displayed the highest overall AAMR while NH Asians or Pacific Islanders displayed the lowest. AAMRs also varied substantially by region (Midwest: 8.8; West: 8.6; South: 8.0; Northeast: 7.3). States with the highest AAMR was the District of Columbia. Nonmetropolitan regions exhibited a slightly higher AAMR (8.6) than metropolitan regions (8.1). The AAPC for CVD-related deaths in patients with CKD differed significantly from that of the general population for the entire cohort, across both sexes, as well as among NH Whites, NH Black or African Americans, and Hispanics or Latinos. Regional differences were also observed in the Midwest, Northeast, and West.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Significant differences in CVD-related deaths in patients with CKD were observed. These high-risk groups should be the point of focus for targeted interventions to reduce CVD-related mortality in CKD patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 8","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70174","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Effectiveness of a Stent-Less Strategy With Drug Coated Balloon in Coronary Artery Disease: 3-Year Follow-Up of a Prospective All-Comers Observational Study","authors":"Ludovic Meunier,&nbsp;Simon Eccleshall,&nbsp;Ronan Bakdi,&nbsp;Matthieu Godin,&nbsp;Géraud Souteyrand,&nbsp;Benoît Mottin,&nbsp;Yann Valy,&nbsp;Christian Benoit,&nbsp;Vincent Lordet,&nbsp;Virginie Laurençon,&nbsp;Antoine Milhem,&nbsp;Matthias Waliszewski,&nbsp;Caroline Allix-Béguec","doi":"10.1002/clc.70189","DOIUrl":"https://doi.org/10.1002/clc.70189","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Drug-eluting stent (DES) angioplasty is the gold standard treatment for coronary lesions. Drug-coated balloon (DCB) is an option for in-stent restenosis, and has also shown promise for small-calibre coronary artery disease. We evaluated the 3-year effectiveness of a decision algorithm for percutaneous coronary intervention (PCI) that favoured a stent-less strategy (SLS) in primary angioplasty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All patients who underwent angioplasty during 1 year were included in a prospective observational study. Patients eligible for SLS first underwent scoring balloon followed by DCB angioplasty or DES in case of mandatory bailout. Patients not eligible for SLS were unstable patients who underwent conventional drug-eluting stenting. The metal index, stent burden, was calculated by stent length divided by the total lesion length. A 36-month follow-up recorded target lesion revascularization (TLR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients eligible for SLS represented 85% (<i>n</i> = 840) of patients who underwent PCI. TLR was required in 2.6% and 6% of patients in the DCB-only and bailout-DES groups, respectively. Median metal index was 0.25 (IQR: 0.5) in patients with TLR. There was a difference between TLR–free survival distributions in the DCB-only and bailout-DES groups (<i>p</i> = 0.016).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The SLS based on a combination of scoring balloon and DCB was effective at 3 years with a low rate of TLR. This rate was higher in patients with stent burden.</p>\u0000 \u0000 <p><b>Trial Registration:</b> This study was registered with clinicaltrials. gov (NCT03893396, first posted on March 28, 2019).</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 8","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70189","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144751303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Age on 1-Year Readmissions in Atrial Fibrillation Patients: Trends and Insights From a Conflict-Stricken Country","authors":"Ibrahim Antoun,&nbsp;Alkassem Alkhayer,&nbsp;Aref Jalal Eldin,&nbsp;Alamer Alkhayer,&nbsp;Riyaz Somani,&nbsp;G. André Ng,&nbsp;Mustafa Zakkar","doi":"10.1002/clc.70186","DOIUrl":"https://doi.org/10.1002/clc.70186","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Atrial fibrillation (AF) is a leading cause of cardiovascular morbidity and hospitalization worldwide. However, limited data exist on AF readmissions in low-resource and conflict-affected settings. This study investigates the impact of age on 1-year readmission rates among AF patients in a Syrian tertiary hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational cohort study was conducted at a tertiary Syrian center between June/2021–November/2023. Patients admitted with primary AF were included, while those with secondary AF or missing demographic data were excluded. Patients were stratified into three age groups: 18–50 years (Group 1), 51–70 years (Group 2), and &gt; 70 years (Group 3). The primary outcome was all-cause and cardiovascular-related 1-year readmissions, with secondary outcomes including readmission frequencies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 657 AF patients were included, with a median age of 60 320 (52%) were males. One-year readmission occurred in 64% of patients, with AF being the most common cause (75%). Group 1 had the highest smoking rates (70%). Group 3 had the highest rates of ischemic heart disease (47%), congestive cardiac failure (CCF) (35%), chronic kidney disease (15%, <i>p</i> &lt; 0.001) and chronic liver disease (20). Older age was significantly associated with increased readmissions (87% in Group 3 vs. 62% in Group 2 and 49% in Group 1, <i>p</i> &lt; 0.001). Frequent readmissions were more prevalent in Group 3 (≥ 3 admissions: 46%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Older AF patients in a conflict-affected setting experience significantly higher readmission rates. Addressing healthcare resource limitations and optimizing AF management strategies are crucial to improving outcomes in resource-limited settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 7","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144705692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}