Clinical Cardiology最新文献

{"title":"Prognostic Impact of Implementation of Heart Team Approach on Cardiovascular Outcomes in Patients With Complex Coronary Artery Disease","authors":"Po-Hsueh Su,&nbsp;Ya-Lin Huang,&nbsp;Po-Wei Chen,&nbsp;Hsien-Yuan Chang,&nbsp;Jun-Neng Roan,&nbsp;Ting-Hsing Chao","doi":"10.1002/clc.70141","DOIUrl":"https://doi.org/10.1002/clc.70141","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In patients with stable coronary artery disease (CAD), treatment options include medical therapy, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). The decision between PCI and CABG depends on disease severity and revascularization risk. Guidelines promote a heart team approach (HTA) with shared decision-making, yet PCI remains prevalent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We conducted a retrospective analysis of 753 patients with complex CAD (left main or multivessel disease and SYNTAX score ≥ 33) between January 2019 and April 2022. We evaluated a quality improvement program featuring a clinical decision flow map, a support system for risk score calculations, and a standard operating procedure for HTA. We compared HTA activation, revascularization strategy choices, and long-term cardiovascular outcomes (composite endpoint: death, myocardial infarction, or unplanned revascularization) between patients treated with HTA (HTA group, <i>n</i> = 448) and without HTA (non-HTA group, <i>n</i> = 304). The program significantly increased HTA activation (from 26.4% to 61.7%) and CABG selection (from 11.1% to 20.4%). The HTA group had better CABG recommendations and choices (75.5% vs. 37.2%, and 26.8% vs. 7.2%, respectively), with a lower incidence of the primary composite endpoint (18.1% vs. 42.4%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A quality improvement program enhances HTA activation and revascularization strategies, leading to improved cardiovascular outcomes in complex CAD patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70141","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896902","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":"How to Assess the Functional Impact of Atrial Fibrillation in Patients With Heart Failure","authors":"Naoya Kataoka,&nbsp;Teruhiko Imamura","doi":"10.1002/clc.70140","DOIUrl":"https://doi.org/10.1002/clc.70140","url":null,"abstract":"<p>A well-established interplay exists between atrial fibrillation (AF) and heart failure (HF). However, the specific adverse impact of AF on quality of life among HF patients remains incompletely elucidated. The authors demonstrated that the presence of AF and reduced ejection fraction was associated with a lesser degree of improvement in functional class and the physical dimension of a quality-of-life questionnaire [<span>1</span>]. Several concerns merit consideration.</p><p>In the present study, patients with HF were included regardless of their left ventricular ejection fraction (LVEF) [<span>1</span>]. Prior studies focusing on HF populations over 60 years of age have shown that quality-of-life profiles and depressive symptoms differ significantly between cohorts with preserved versus reduced LVEF [<span>2</span>]. To better delineate the target population, it may be more appropriate to restrict the LVEF range.</p><p>The study did not differentiate between paroxysmal and persistent forms of AF [<span>1</span>]. Patients with paroxysmal AF may experience a more favorable quality of life, particularly when sinus rhythm is intermittently or spontaneously restored [<span>3</span>]. Stratification by AF subtype and burden may provide deeper insight into the differential impact on patient-reported outcomes.</p><p>The definition of arrhythmia-induced cardiomyopathy warrants clarification. This condition is typically diagnosed by the observation of reverse remodeling following the resolution of the causative arrhythmia [<span>4</span>]. It may be reasonable to consider arrhythmia-induced cardiomyopathy within the broader category of idiopathic cardiomyopathies, given its distinct pathophysiological trajectory.</p><p>In the current era, catheter ablation has emerged as a standard therapeutic option for AF in patients with HF [<span>5</span>]. Notably, in the present study, great improvement in New York Heart Association functional class was achieved with pharmacological therapy alone. A discussion regarding the therapeutic approach—namely, rhythm control versus rate control—would enhance the clinical relevance of the study's findings in the context of contemporary HF management.</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143888926","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":"How to Assess Risk Factors for Lead Dislodgement in Patients Receiving Cardiac Implantable Electronic Devices-Reply-","authors":"Yasuhiro Matsuda,&nbsp;Masaharu Masuda,&nbsp;Hiroyuki Uematsu,&nbsp;Toshiaki Mano","doi":"10.1002/clc.70139","DOIUrl":"https://doi.org/10.1002/clc.70139","url":null,"abstract":"<p>The Authors' Reply:</p><p>We appreciate the comments and opinions of Dr. Kataoka and Dr. Imamura. We would like to respond to their letter.</p><p>Immunosuppressive therapy may affect lead dislodgement by suppressing adhesion between the patient's body and not only the cardiac implantable electronic device (CIED) lead tips but also the CIED lead body. As you say, focal inflammation near the site of the CIED lead tip is suppressed regardless of immunosuppressive therapy because we used steroid-eluting leads in all patients [<span>1</span>]. However, CIED lead adhesions due to inflammation occur not only between the tips and the myocardium, but also between the lead body and the tricuspid valve or vessel wall [<span>1, 2</span>].</p><p>Regarding the incidence of lead dislodgement in patients with cardiac sarcoidosis, a previous study showed that more than half of the adverse events in implantable cardiac defibrillator implantation for cardiac sarcoidosis were lead dislodgement due to fracture [<span>3</span>]. In our study, two patients received immunosuppressive therapy for sarcoidosis, and 1 (50%) patient experienced lead dislodgement [<span>1</span>]. Additionally, cardiac sarcoidosis itself induces cardiac injury through inflammation, therefore myocardial vulnerability may also be the cause of lead dislodgement by lead tension [<span>1, 4</span>].</p><p>With respect to frailty, unfortunately, we did not have sufficient data on frailty in all patients. However, among the 323 (50%) patients for whom a clinical frailty score was retrospectively obtained [<span>5</span>], there was no significant difference in clinical frailty scores between patients with and without lead dislodgement (6 [3−7] vs. 4 [3−5] points, respectively, <i>p</i> = 0.22). In addition, there was no significant difference in clinical frailty scores between patients on regular steroids and those not taking steroids (4 [3−6] vs. 4 [3−5] points, respectively, <i>p</i> = 0.99).</p><p>As discussed in the limitations section of the manuscript, procedural strategies and implantation skills may have varied between operators in this study [<span>1</span>]. However, in terms of operator learning curves, years of operator experience were similar in patients with and without lead dislodgement (9 [6−11] vs. 9 [7−12] years, respectively, <i>p</i> = 0.66), as we have previously shown in the manuscript [<span>1</span>].</p><p>Yasuhiro Matsuda has received a scholarship from the Japanese Heart Rhythm Society, Abbott and Nihon Kohden outside the submitted work.</p><p>The protocol of this study was approved by the Kansai Rosai Hospital Institutional Review Board (Reference number: 22D104g).</p><p>Yasuhiro Matsuda has received a scholarship from the Japanese Heart Rhythm Society, Abbott and Nihon Kohden outside the submitted work.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143888927","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 Role of Esaxerenone in the Continuum of Heart Failure With Preserved Ejection Fraction: Insights From a Prospective Observational Study","authors":"Takashi Naruke,&nbsp;Miho Hashimura-Kakogawa,&nbsp;Yoichi Suzuki,&nbsp;Yuki Ikeda,&nbsp;Lisa Kitasato,&nbsp;Takeru Nabeta,&nbsp;Yuki Usami-Naruke,&nbsp;Shunsuke Ishii,&nbsp;Jun Oikawa,&nbsp;Ryo Kameda,&nbsp;Yoshiyasu Minami,&nbsp;Hidehira Fukaya,&nbsp;Masaru Yuge,&nbsp;Takeo Kawaguchi,&nbsp;Junya Ako","doi":"10.1002/clc.70137","DOIUrl":"https://doi.org/10.1002/clc.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heart failure with preserved ejection fraction (HFpEF) presents significant therapeutic challenges, particularly exacerbated by comorbidities such as hypertension and diabetes. The modulation of the Renin–Angiotensin–Aldosterone System is critical in managing HFpEF progression. Esaxerenone (ESAX), a selective mineralocorticoid receptor antagonist, may offer benefits in managing HFpEF continuum due to its unique mechanism.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Conducted at Odawara Municipal Hospital, this single-center, prospective, observational study involved hypertensive adult outpatients diagnosed with either type 2 diabetes mellitus or chronic kidney disease. Patients were categorized into HFpEF and pre-HFpEF groups based on established criteria. The study primarily assessed changes in blood pressure and cardiac function (through NT-proBNP levels and echocardiography), along with secondary outcomes including aortic stiffness and oxidative stress over a 24-week period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both HFpEF and pre-HFpEF patients exhibited significant reductions in blood pressure, with no significant differences between the patients. HFpEF patients experienced decreases in NT-proBNP levels and oxidative stress similar to those in pre-HFpEF patients. Notably, pre-HFpEF patients demonstrated more pronounced improvements in cardiac function, particularly in the E/e' ratio and global longitudinal strain, compared to HFpEF patients. Additionally, 30% of pre-HFpEF patients had improved to stage A, suggesting potential for early intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ESAX appears to be effective in managing the heart failure continuum, particularly benefiting pre-HFpEF patients. Its impacts suggest the potential benefits of early intervention in decelerating disease progression and potentially preventing the new onset of HFpEF, highlighting the importance of targeted therapies at early stages of heart failure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866032","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":"Impact of Socioeconomic Disparities on Care and Outcomes of Cancer Patients Presenting With STEMI Between 2005 and 2019; a Nationwide British Study","authors":"Mohamed Dafaalla,&nbsp;Nicholas Weight,&nbsp;Muhammad Rashid,&nbsp;James Nolan,&nbsp;Mamas A. Mamas","doi":"10.1002/clc.70135","DOIUrl":"https://doi.org/10.1002/clc.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>While current evidence suggests that the clinical outcomes of STEMI are worse among patients with cancer, it is unknown what role the patient's socioeconomic status plays.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A nationally linked cohort of STEMI patients (January 2005 to March 2019) was obtained from the MINAP and UK national Hospital Episode Statistics (HES APC) registries. Socioeconomic status was measured using Index of Multiple Deprivation (IMD) score divided into 5 quintiles (quintile 1: most affluent, quintile 5: most deprived). The impact of socioeconomic status on clinical outcomes was assessed using Cox-proportional-hazard and competing risk models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 8459 STEMI admissions with cancer were identified between 01/01/2005 and 30/03/2019 with 1577 patients (18%) from the most deprived quintile. Patients from the most deprived quintile were more frequently female (quintile 5; 29% vs. quintile 1; 24%) and from ethnic minorities (quintile 5; 8% vs. quintile 1; 2%). They were less likely to receive PCI between 2005 and 2009. By 2018 PCI use was higher in quintile 5 (quintile 5; 84% vs. quintile 1;81%). The odds of death at1year was not higher in the most deprived patients. The risk of death was significantly higher at 5 years post-discharge (HR 1.27, 95% CI 1.10−1.47).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The socioeconomic status impact on outcomes of STEMI patients with cancer can be minimized by delivering equitable inpatient care, particularly PCI. While patients from the most deprived areas have similar odds of survival in the short-term, they have lower probability of survival in the long-term.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143865794","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 and Disparities in Acute Myocardial Infarction-Related Mortality Among U.S. Adults With Hypertension, 2000–2023","authors":"Maryam Sajid,&nbsp;Dua Ali,&nbsp;Shaheer Qureshi,&nbsp;Reja Ahmad,&nbsp;Asim Sajjad,&nbsp;Saad Ahmed Waqas,&nbsp;Raheel Ahmed,&nbsp;Peter Collins","doi":"10.1002/clc.70129","DOIUrl":"https://doi.org/10.1002/clc.70129","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypertension is a major public health concern and a key risk factor for acute myocardial infarction (AMI), significantly contributing to cardiovascular mortality. Despite advancements in management and treatment, trends in associated mortality remain underexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study examines U.S. national trends in hypertension- and AMI-associated mortality from 2000 to 2023, focusing on demographics and regions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Age-adjusted mortality rates (AAMRs) per 100,000 for adults aged ≥ 25 with hypertension and AMI were extracted from the CDC WONDER database. Annual percent changes (APCs) and average APCs (AAPCs) with 95% confidence intervals (CIs) were calculated, stratified by year, sex, race/ethnicity, age, urbanization, and Census region.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 2000 to 2023, 933,024 hypertension- and AMI-related deaths were recorded. Overall, AAMR declined from 19.84 per 100,000 in 2000 to 16.26 in 2023 (AAPC: −0.93%, 95% CI: −1.18% to −0.76%). However, a sharp rise in mortality occurred between 2018 and 2021, coinciding with the COVID-19 pandemic. Stratified analyses revealed persistently higher mortality rates among menmen, non-Hispanic BlackBlack individuals, and residents of the Southern and rural U.S. regions. Younger adults showed an increasing AAMR trend, indicating a growing burden of hypertension and AMI-associated disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While long-term mortality trends show a decline, recent years have seen a rise, particularly among high-risk groups. Targeted public health interventions addressing hypertension management, cardiovascular risk reduction, and healthcare disparities are essential to mitigate the ongoing burden of hypertension and AMI mortality in the U.S.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143856725","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":"Short-Term, Mid-Term, and Long-Term Outcomes of Transcatheter Aortic Valve Replacement With Balloon-Expandable Versus Self-Expanding Valves: A Meta-Analysis of Randomized Controlled Trials","authors":"Kiarash Tavakoli,&nbsp;Negin Sadat Hosseini Mohammadi,&nbsp;Pegah Bahiraie,&nbsp;Sahar Saeidi,&nbsp;Farhad Shaker,&nbsp;Arman Soltani Moghadam,&nbsp;Sara Montazeri Namin,&nbsp;Habib Rahban,&nbsp;Shubhadarshini Pawar,&nbsp;Masih Tajdini,&nbsp;Hamidreza Soleimani,&nbsp;Yaser Jenab,&nbsp;Yousif Ahmad,&nbsp;Fady Hany Iskander,&nbsp;Mohamad Alkhouli,&nbsp;Raj Makkar,&nbsp;Aakriti Gupta,&nbsp;Kaveh Hosseini","doi":"10.1002/clc.70134","DOIUrl":"https://doi.org/10.1002/clc.70134","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Comparisons of outcomes after transcatheter aortic valve replacement with balloon-expandable (BEV) versus self-expanding (SEV) valves are limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>This study aimed to compare clinical and hemodynamic outcomes of BEV and SEV at short-term (30 days), midterm (1 year), and long-term (&gt; 1 year) endpoints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, Embase, Scopus, and Cochrane Library databases were searched until July 2024 for randomized controlled trials. Random-effect model (DerSimonian–Laird method) was used to pool the risk ratios (RR), mean differences, and 95% confidence intervals (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 10 studies comprising 4325 patients (2295 BEV, 2030 SEV) were included. In short-term, cardiovascular (RR: 0.56, 95% CI: 0.36–0.87) and all-cause mortality (RR: 0.54, 95% CI: 0.35–0.81) were lower in the BEV group. Risk of moderate to severe paravalvular leak (PVL) was lower among BEV patients in short-term (RR: 0.28, 95% CI: 0.17–0.49) and long-term (RR: 0.28, 95% CI: 0.1–0.79). A limited number of studies showed a greater risk of clinical valve thrombosis on BEV in midterm and long-term. The need for permanent pacemaker implantation was lower in BEV at both short-term (RR: 0.56, 95% CI: 0.37–0.87), and midterm (RR: 0.78, 95% CI: 0.64–0.94). The SEV group had a larger effective orifice area with lower mean transvalvular pressure gradient at all endpoints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>BEV is associated with reduced risk of clinical outcomes in short-term; however, most differences diminish in longer evaluations, except for moderate to severe PVL, which remains elevated for SEV. SEVs had better hemodynamic results and lower risk of clinical valve thrombosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70134","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849147","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":"Rising Mortality Related to Diabetes Mellitus and Hypertension: Trends and Disparities in the United States (1999−2023)","authors":"Shahnawaz Hashmi,&nbsp;Iqra Safdar,&nbsp;Muhammad Hazqeel Kazmi,&nbsp;Eeshal Zulfiqar,&nbsp;Maryam Shahzad,&nbsp;Sonia Hurjkaliani,&nbsp;Mennatalla Ayyad,&nbsp;Nimra Zuberi,&nbsp;Toqeer Ahmed,&nbsp;Gauri Balan Sujay,&nbsp;Hamid Talal,&nbsp;Syeda Hazqah Kazmi,&nbsp;Muhammad Farooq Khan,&nbsp;Gabriel Imbianozor,&nbsp;Mushood Ahmed,&nbsp;Raheel Ahmed","doi":"10.1002/clc.70132","DOIUrl":"https://doi.org/10.1002/clc.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Individuals with diabetes mellitus (DM) are at an increased risk of vascular stiffness and atherosclerosis, which can predispose them to hypertension (HTN). Our study aims to analyze long-term mortality trends related to DM and HTN in the United States (US) and to identify vulnerable populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The CDC WONDER database was used to extract mortality data among adults (≥ 25 years of age) in the US who had concomitant DM and HTN. Age-adjusted mortality rates (AAMRs) were estimated and mortality trends were assessed using annual percentage change (APCs) with JoinPoint.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2 769 118 deaths were attributed to DM and HTN in the US from 1999 to 2023. The AAMRs increased from 14.9 in 1999 to 66.8 in 2023 reflecting a 4.5-fold increase in mortality. A peak in mortality was observed during the COVID-19 pandemic with AAMR reaching 77.9 in with an APC of 15.7. Men had consistently higher AAMR compared to women (84.5 vs. 52.6 in 2023). Among racial/ethnic groups, non-Hispanic (NH) Black or African American individuals had the highest average AAMR, followed by Hispanic or Latino individuals, NH Other populations, and lastly the NH White individuals. The south had the highest AAMR among census regions and rural areas had higher mortality rates compared to urban areas (85.5 vs. 71.7).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study shows a 4.5-fold increase in DM and HTN-related mortality in the United States from 1999 to 2023. Demographic and geographical disparities were evident with men, NH Blacks or African Americans, and rural areas at the highest risk reflecting the need for improved healthcare.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70132","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143835950","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":"How to Assess Risk Factors for Lead Dislodgement in Patients Receiving Cardiac Implantable Electronic Devices","authors":"Naoya Kataoka,&nbsp;Teruhiko Imamura","doi":"10.1002/clc.70131","DOIUrl":"https://doi.org/10.1002/clc.70131","url":null,"abstract":"<p>Based on the hypothesis that focal inflammation following cardiac implantable electronic device (CIED) implantation is pivotal in the development of adhesions between the lead and surrounding tissues, Matsuda et al. demonstrated a higher incidence of lead dislodgement in patients undergoing immunosuppressive therapy [<span>1</span>]. Several concerns have been raised regarding this finding.</p><p>The causality between immunosuppressive therapy and lead dislodgement remains questionable. The tip of a CIED lead typically elutes steroids to prevent an increase in the pacing threshold immediately postimplantation, thereby mitigating acute device-related inflammation. Consequently, focal inflammation is suppressed regardless of systemic immunosuppressant administration. Furthermore, many patients with cardiac sarcoidosis, who often require CIEDs and receive steroid therapy, do not exhibit a notably high incidence of lead dislodgement.</p><p>Alternative factors, such as frailty, might be implicated in lead dislodgement rather than steroid administration. Previous literature has identified frailty as an independent risk factor for lead dislodgement, potentially due to psychomotor agitation, inappropriate limb and chest movements, traumatic events, and progressive weight loss [<span>2</span>]. Long-term steroid therapy is generally associated with the progression of frailty [<span>3</span>]. Did the authors evaluate the severity of frailty in individuals receiving steroid therapy?</p><p>In a representative case of lead dislodgement presented in the authors' study, the lead appears to be pulled upwards, indicating insufficient pre-deflection at the time of implantation [<span>1</span>]. Variations in operator learning curves may have influenced clinical outcomes, including the incidence of lead dislodgement.</p><p>The authors have nothing to report.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826902","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 Prevalence and Characteristics of Infective Endocarditis in Liver Transplant Recipients: Insights From National Inpatient Sample Database","authors":"Ajit Brar,&nbsp;Ayushi Garg,&nbsp;Isha Kohli,&nbsp;Soumiya Ravi,&nbsp;Carol Singh,&nbsp;Aalam Sohal,&nbsp;M Luay Alkotob","doi":"10.1002/clc.70130","DOIUrl":"https://doi.org/10.1002/clc.70130","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Liver transplant (LT) recipients are immunocompromised and thus predisposed to various bacterial and fungal infections, including infective endocarditis (IE). The current paper aims to determine the prevalence, characteristics, and outcomes of IE in LT recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The National Inpatient Sample (NIS) data from 2016 to 2020 was used to identify LT recipients. Patients were separated into two groups based on the presence of IE. Information was collected on patient demographics, hospital characteristics, infections, comorbidities, and outcomes. Multivariate logistic regression was performed to assess the impact of IE on outcomes after adjusting for confounding factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 170 650 patients who underwent LT were identified using NIS data from 2016 to 2020, of which 0.003% had IE. IE group had higher odds of in-hospital mortality [aOR 2.2 (95% CI 1.07–4.78)], Shock [aOR 2.7 (95% CI 1.61–4.65)], ICU admission [aOR 2.40 (95% CI 1.4–4.2)], longer Length of Stay [adj. Coeff- 3.4 days (95% CI −0.89–5.9, <i>p</i> &lt; 0.008)], and higher hospitalization charges (adj. coeff-$65271.52, 95% CI $14 825–$115 718) than LT without IE group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Staphylococcus was present in 18.6% of IE in LT, followed by enterococcus (12.8%) and gram-negative bacteria (9.8%). Concomitant IE was associated with increased in-hospital death, ICU stay, and shock. The IE group was also associated with increased LOS and total charges compared to the LT without IE. Although the prevalence of IE is low in LT recipients, its presence portends worse outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826903","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}