Circulation-Cardiovascular Quality and Outcomes最新文献

{"title":"Holding Ourselves to a Higher Standard: Dynamic Prediction Modeling in Cardiac Surgery.","authors":"J Trent Magruder, Vinod H Thourani","doi":"10.1161/CIRCOUTCOMES.125.012469","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012469","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012469"},"PeriodicalIF":6.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144734894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Device-Measured Sleep Characteristics, Daily Step Count, and Cardiometabolic Health Markers: Findings From the Prospective Physical Activity, Sitting, and Sleep (ProPASS) Consortium.","authors":"Wenxin Bian, Matthew N Ahmadi, Raaj K Biswas, Joanna M Blodgett, Andrew J Atkin, Hsiu-Wen Chan, Borja Del Pozo Cruz, Kristin Suorsa, Esmée A Bakker, Richard M Pulsford, Gregore I Mielke, Peter J Johansson, Pasan Hettiarachchi, Nicholas A Koemel, Dick H J Thijssen, Sari Stenholm, Gita D Mishra, Armando Teixeira-Pinto, Vegar Rangul, Lauren B Sherar, Ulf Ekelund, Alun D Hughes, I-Min Lee, Peter A Cistulli, Andreas Holtermann, Annemarie Koster, Mark Hamer, Emmanuel Stamatakis","doi":"10.1161/CIRCOUTCOMES.124.011873","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011873","url":null,"abstract":"<p><strong>Background: </strong>Sleep and physical activity (PA) are important lifestyle-related behaviors that impact cardiometabolic health. This study investigated the joint associations of daily step count and sleep patterns (regularity and duration) with cardiometabolic biomarkers in adults.</p><p><strong>Methods: </strong>We conducted a cross-sectional study using pooled data from the Prospective PA, Sitting, and Sleep Consortium, comprising 6 cohorts across Europe and Australia with thigh-worn accelerometry data collected between 2011 and 2021. The sleep regularity index, a metric that quantifies day-to-day sleep consistency, sleep duration (h/d), and steps (per day), was derived from the accelerometer data and categorized based on tertiles and sleep duration guidelines. We used multivariate generalized linear models to examine joint associations of sleep patterns and total daily step count with individual cardiometabolic biomarkers, including body mass index, waist circumference, total cholesterol, HDL (high-density lipoprotein) cholesterol, triglycerides, HbA1c (glycated hemoglobin), and a composite cardiometabolic health score (mean of the 6 standardized biomarker <i>Z</i> scores).</p><p><strong>Results: </strong>The sample included 11 903 adults with a mean±SD age of 54.7±9.5 years, 54.9% female, a sleep regularity index of 78.7±10.4, and 10 206.4±3442.2 daily steps. Lower PA (<8475 steps/d) combined with either lower sleep regularity (sleep regularity index <75.9) or short sleep duration (<7 h/d) was associated with the least favorable composite cardiometabolic health. The corresponding <i>Z</i> scores (95% CI) were 0.34 (0.30-0.38) and 0.26 (0.22-0.31) compared with those with optimal sleep (sleep regularity index >84.5 or 7-8 h/d) and high step count (>11 553 steps/d). The combination of low sleep regularity and low daily steps was associated with higher body mass index (2.92 [2.61-3.24] kg/m²), waist circumference (8.58 [7.78-9.38] cm), total cholesterol (0.15 [0.07-0.23] mmol/L), and lower HDL levels (0.17 [0.14-0.2] mmol/L), regardless of sleep duration. The combination of short sleep and low step count had the strongest unfavorable associations for body mass index (2.31 [1.98-2.65] kg/m²) and waist circumference (7.01 [6.15-7.87] cm).</p><p><strong>Conclusions: </strong>Our findings suggest that the potential deleterious associations of irregular or insufficient sleep with cardiometabolic health outcomes may be exaggerated by lower daily PA. Investigation of the prospective joint association of sleep patterns and PA with cardiometabolic health may be warranted.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011873"},"PeriodicalIF":6.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying Patient Preferences About Features of Nonstatin Lipid-Lowering Therapies: A Discrete Choice Experiment in the United States.","authors":"Shelby D Reed, Jessie Sutphin, Juan Marcos Gonzalez, Matthew J Wallace, Judith J Stephenson, Batul Electricwala, Hayden B Bosworth, Neha Pagidipati","doi":"10.1161/CIRCOUTCOMES.124.011804","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011804","url":null,"abstract":"<p><strong>Background: </strong>Despite the growing number of nonstatin lipid-lowering treatments (NS-LLTs), data are lacking on how patients value their various features and outcomes. Study objectives were to quantify patients' preferences across levels of efficacy, treatment regimens, side effects, and out-of-pocket costs of NS-LLTs and compare approaches with framing treatment efficacy.</p><p><strong>Methods: </strong>A discrete choice experiment survey was administered to US adults aged ≥40 years with medical claims indicating statin use and atherosclerotic cardiovascular disease. Each participant was administered 12 sets of experimentally designed pairs of add-on NS-LLT profiles that varied in efficacy, administration regimen, injection-site reaction, joint pain, out-of-pocket cost, and a no-additional treatment option. Random-parameter logit models were used to estimate preference weights, and tradeoffs across attributes were reported as willingness-to-pay estimates.</p><p><strong>Results: </strong>A total of 1193 participants completed the survey (36% female; 90% White; mean age, 68.2±9.7 years). Across treatment features assessed, out-of-pocket cost ranging from $0 to $200 per month was the most important factor. All else being equal, a daily oral dosing regimen was the most preferred regimen. Among injectable regimens, participants preferred dosing every 6 months versus every 2 weeks (<i>P</i><0.001) or every month (<i>P</i><0.001). Efficacy presented as 25% to 60% reductions in LDL-C (low-density lipoprotein-cholesterol) levels was valued greater than equivalent reductions in 5-year cardiovascular risks. Among those reporting annual household incomes <$150 000 (93.5%), the average maximum willingness to pay for an add-on NS-LLT as a daily, oral medication without side effects ranged from $131 to $175 per month with efficacy framed as a 25% reduction in LDL-C levels versus $89 to $124 with efficacy framed as corresponding reductions in 5-year cardiovascular risk.</p><p><strong>Conclusions: </strong>Among treatment features assessed, out-of-pocket costs were the primary factor driving choices. Those opting for an add-on NS-LLT were willing to trade off additional efficacy for less frequent injections or a daily oral medication.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011804"},"PeriodicalIF":6.2,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Neurodevelopmental and Mental Health Diagnoses in Congenital Heart Disease: A Danish Population-Based Cohort Study.","authors":"Kimberley G Miles, Dana B Gal, Dóra Körmendiné Farkas, Kristina Laugesen, Henrik Toft Sørensen, Nadine A Kasparian, Nicolas L Madsen","doi":"10.1161/CIRCOUTCOMES.125.011944","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.011944","url":null,"abstract":"<p><strong>Background: </strong>Over 35% of Danish children with congenital heart disease (CHD) are diagnosed with or treated for a neurodevelopmental or mental health condition. We examined child clinical, parent socioeconomic, and family health factors associated with 4 common diagnostic groups in children with CHD: developmental disorders, intellectual disability, attention-deficit/hyperactivity disorder, and anxiety and mood disorders.</p><p><strong>Methods: </strong>This population-based cohort study identified children aged <18 years with CHD from 1996 to 2017 by linking individual-level data across Danish health and social registries, excluding children with a neurodevelopmental or mental health diagnosis, by <i>International Classification of Diseases, Tenth Revision</i> codes, before the index date (ie, CHD diagnosis). Using age as a time scale, we computed cumulative incidence by the age of 18 years, incidence rates, and crude and adjusted hazard ratios for each diagnostic group. Hazard ratios were adjusted for child sex and year of CHD diagnosis. In addition, cumulative days in hospital were adjusted for CHD complexity.</p><p><strong>Results: </strong>In 16 473 children with CHD (male, 50.9%; median age at index date, 0.1 [interquartile range, 0.0-1.3] years), the cumulative incidence by the age of 18 years was 7.5% (95% CI, 7.0%-8.1%), 5.0% (95% CI, 4.6%-5.5%), 5.8% (95% CI, 5.3%-6.3%), and 10.3% (95% CI, 9.6%-11.1%) for these 4 diagnostic groups, respectively. Cumulative days in hospital within the first year after CHD diagnosis were the strongest clinical predictor of neurodevelopmental and mental health diagnoses, followed by sex, the presence of a genetic syndrome, and small for gestational age birthweight. Multiple socioeconomic metrics, including maternal or paternal age <25 years, low education (9-10 years), unemployment, and maternal marital status (eg, single or divorced), were predictors, particularly for attention-deficit/hyperactivity disorder and intellectual disability. Maternal and paternal mental health diagnoses were predictors of all 4 diagnostic groups.</p><p><strong>Conclusions: </strong>We identified clinical, socioeconomic, and parent mental health factors associated with neurodevelopmental and mental health diagnoses in children with CHD. These data may inform early identification of these conditions and guide prevention and resource allocation.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011944"},"PeriodicalIF":6.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Sociodemographic Disparities in Ischemic Heart Disease Mortality According to Sex, 1980 to 2021.","authors":"Ahmed Sayed, Erin D Michos, Ann Marie Navar, Salim S Virani, LaPrincess C Brewer, JoAnn E Manson","doi":"10.1161/CIRCOUTCOMES.124.011648","DOIUrl":"10.1161/CIRCOUTCOMES.124.011648","url":null,"abstract":"<p><strong>Background: </strong>Mortality due to ischemic heart disease (IHD) has declined in countries with high socioeconomic development. Whether these declines extend to other settings, and whether socioeconomic development influences IHD mortality among men and women differently, is unknown.</p><p><strong>Methods: </strong>We obtained annual data on sex-specific IHD mortality rates for countries/territories in the GBD study (Global Burden of Disease) from 1980 to 2021. The sociodemographic index (SI), a measure of socioeconomic development, was retrieved for each country/territory. Age-adjusted IHD mortality rates were modeled as a smooth function of sex, year, and SI.</p><p><strong>Results: </strong>From 1980 to 2021, IHD mortality rates did not decrease in low SI settings for men or women. In contrast, mortality rates relative to 1980 declined by >25% in average SI settings (age-adjusted mortality per 100 000, 153-107 for women and 218-161 for men) and >50% in high SI settings (age-adjusted mortality per 100 000, 162-69 for women and 258-114 for men). Comparing the 20th versus 80th percentile of SI in 2021 (corresponding to lower versus higher socioeconomic development), mortality rates were 81% higher for men and 111% higher for women living in socioeconomically deprived settings (<i>P</i> for difference by sex: 0.01), although absolute differences were larger in men. The association of low SI with higher IHD mortality was especially pronounced for mortality attributable to environmental/occupational risk factors (eg, particulate matter air pollution, lead exposure, and extremes of temperature), with mortality rates being 174% higher among women and 199% higher among men.</p><p><strong>Conclusions: </strong>Across the past 4 decades, low socioeconomic development was associated with no improvement in IHD mortality rates for men or women, in contrast to the large reductions observed in settings with high socioeconomic development. In contemporary settings, socioeconomic deprivation is associated with larger relative excess mortality in women and larger absolute excess mortality in men.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011648"},"PeriodicalIF":6.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intelligence, Meet Clinic.","authors":"David P Kao","doi":"10.1161/CIRCOUTCOMES.125.012370","DOIUrl":"10.1161/CIRCOUTCOMES.125.012370","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012370"},"PeriodicalIF":6.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Nudging People Toward Better Health Worth the Cost?","authors":"Paul A Heidenreich","doi":"10.1161/CIRCOUTCOMES.125.012339","DOIUrl":"10.1161/CIRCOUTCOMES.125.012339","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012339"},"PeriodicalIF":6.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building a Sustainable Cardiac Surgery Program in Sub-Saharan Africa: The Case of Angola.","authors":"Valdano Manuel, Jeffrey P Jacobs, Frank Edwin","doi":"10.1161/CIRCOUTCOMES.125.012261","DOIUrl":"10.1161/CIRCOUTCOMES.125.012261","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012261"},"PeriodicalIF":6.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying a Heterogeneous Effect of Atrial Fibrillation Screening in Older Adults: A Secondary Analysis of the VITAL-AF Trial.","authors":"Sachin J Shah, Jay M Iyer, Leila Agha, Yuchiao Chang, Jeffrey M Ashburner, Steven J Atlas, David D McManus, Patrick T Ellinor, Steven A Lubitz, Daniel E Singer","doi":"10.1161/CIRCOUTCOMES.124.011482","DOIUrl":"10.1161/CIRCOUTCOMES.124.011482","url":null,"abstract":"<p><strong>Background: </strong>One-time atrial fibrillation (AF) screening trials in older adults have produced mixed results. In a secondary analysis of the VITAL-AF trial, we aimed to identify a subset of people in whom such screening is effective, using effect-based and risk-based approaches.</p><p><strong>Methods: </strong>The VITAL-AF trial was a cluster-randomized trial of 1-time, 30-second single-lead ECG screening during primary care visits. It enrolled adults aged ≥65 years in 16 Massachusetts General Hospital primary care practices (2018-2019). In this secondary analysis, we tested 2 approaches to identify subgroups where screening is effective. First, we developed an effect-based model using T-learner, a causal inference approach that estimates screening effects by separately training 2 predictive models-one for screening and one for usual care-and then compares their predictions for each individual. Second, we used a validated AF risk model (Cohorts for Heart and Aging Research in Genomic Epidemiology AF) to test for heterogeneous screening effectiveness. We assessed AF screening effectiveness by quartile of predicted effect and predicted AF risk and determined their correlation.</p><p><strong>Results: </strong>The study included 29 656 participants (mean±SD age 74±7 years, 59% women). In the highest quartile of predicted screening effect, AF diagnosis rates were higher in the screening versus the usual care group (4.00 versus 2.88 per 100 person-years, rate difference 1.12 [95% CI, 0.11-2.13] per 100 person-years). In the highest quartile of predicted AF risk, AF diagnosis rates were also higher in the screening versus the usual care group (5.55 versus 4.23 per 100 person-years, rate difference 1.32 [95% CI, 0.14-2.50] per 100 person-years). Predicted screening effect and predicted AF risk were weakly correlated (Spearman correlation coefficient, 0.23).</p><p><strong>Conclusions: </strong>One-time screening was associated with increased AF diagnoses in the top quartile of both predicted screening effect and predicted AF risk. Because predicted effect and risk were only weakly correlated, future AF screening efforts should include both high-effect and high-risk individuals.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011482"},"PeriodicalIF":6.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the Gap: Improving Awareness of ANOCA for Patients and Providers.","authors":"Samit M Shah","doi":"10.1161/CIRCOUTCOMES.125.012372","DOIUrl":"10.1161/CIRCOUTCOMES.125.012372","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012372"},"PeriodicalIF":6.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}