Circulation-Cardiovascular Quality and Outcomes最新文献

{"title":"Resuscitation Practices at Emergency Medical Service Agencies Working in Black and Hispanic Versus White Catchment Areas in the United States.","authors":"Paul S Chan, Saket Girotra, Khadijah Breathett, Kimberly C Dukes, Jessica Sperling, Christina M Pacheco, Kevin F Kennedy, Comilla Sasson, Bryan McNally, Heather Schacht Reisinger, Marina Del Rios","doi":"10.1161/CIRCOUTCOMES.124.011799","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011799","url":null,"abstract":"<p><strong>Background: </strong>Although survival for out-of-hospital cardiac arrest (OHCA) is lower at emergency medical service (EMS) agencies serving Black/Hispanic communities, it is unknown whether this is due to practice differences.</p><p><strong>Methods: </strong>Within the Cardiac Arrest Registry to Enhance Survival (CARES) registry in the United States, we conducted a survey from 2022 to 2023 of resuscitation practices at EMS agencies with ≥10 OHCAs annually between 2015 and 2019. We examined differences in dispatch, first responder, and EMS practices between agencies with majority Black/Hispanic catchment areas (>50% residents Black or Hispanic) and majority White catchment areas using χ² tests. We estimated each agency's risk-standardized rate of survival to hospital admission for OHCA using multivariable hierarchical logistic regression and evaluated whether survival differences between the 2 agency groups were attenuated after adjusting for resuscitation practice differences.</p><p><strong>Results: </strong>Among 470 EMS agencies (181 707 OHCAs), 47 (10.0%) served a majority Black/Hispanic catchment area. At EMS agencies with Black/Hispanic catchment areas, dispatchers and police first responders were less likely to always recognize a cardiac arrest (29.8% versus 43.0%); police first responders were less likely to respond to OHCA (46.8% versus 68.9%), initiate CPR (59.6% versus 83.2%), or apply an automated external defibrillator (29.8% versus 60.0%); and EMS staff were less likely to assess CPR competency annually (46.5% versus 65.0%) and use waveform capnography (91.5% versus 99.5%), as compared with agencies with White catchment areas. EMS agencies serving majority Black/Hispanic catchment areas had 2% (95% CI, 0.9-3.1%; <i>P</i><0.001) lower risk-standardized rates of survival, as compared with agencies serving majority White catchment areas, and survival differences were partly attenuated after adjusting for practice differences between EMS groups.</p><p><strong>Conclusions: </strong>In the United States, we identified differences in dispatcher, first responder, and EMS practices for OHCA between agencies with majority Black/Hispanic and White catchment areas. These practice differences may partly account for disparities in OHCA survival between the 2 EMS agency groups.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011799"},"PeriodicalIF":6.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183354","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":"Cardiovascular Epidemiology: From Findings to Impact.","authors":"Khadijah Breathett, Emily C O'Brien, Norrina Allen","doi":"10.1161/CIRCOUTCOMES.125.012347","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012347","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012347"},"PeriodicalIF":6.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175271","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":"https://doi.org/10.1161/CIRCOUTCOMES.125.012261","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012261"},"PeriodicalIF":6.2,"publicationDate":"2025-05-29","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":"Living in Rural America Plants the Seeds for Congenital Heart Disease Challenges.","authors":"J Carter Ralphe, Petros V Anagnostopoulos","doi":"10.1161/CIRCOUTCOMES.125.012231","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.125.012231","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012231"},"PeriodicalIF":6.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175346","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":"Validation of <i>ICD-10</i> Codes to Distinguish Between Claudication and Chronic Limb-Threatening Ischemia in Patients Undergoing Peripheral Vascular Intervention Using Medicare-Matched Registry Data.","authors":"Sanuja Bose, David P Stonko, Sharon C Kiang, Daniel Roh, Jialin Mao, Andrew Cabrera, Chen Dun, Philip P Goodney, James H Black, Leigh Ann O'Banion, Jesse A Columbo, Roger T Tomihama, Caitlin W Hicks","doi":"10.1161/CIRCOUTCOMES.124.011467","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011467","url":null,"abstract":"<p><strong>Background: </strong>The accuracy of contemporary administrative claims codes to discriminate between different phenotypes of peripheral artery disease is not well defined. We aimed to validate a predefined set of <i>International Classification of Diseases, Tenth Revision</i>, codes used to distinguish between claudication and chronic limb-threatening ischemia (CLTI) and to optimize their diagnostic accuracy using a supervised machine-learning approach.</p><p><strong>Methods: </strong>We included all patients who underwent a peripheral vascular intervention for claudication or CLTI in the US Medicare-matched VQI-VISION (Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network) registry database between January 2016 and December 2019. Gold standard claudication and CLTI diagnoses were determined using VQI (Vascular Quality Initiative) registry data. These diagnoses were compared with a predetermined set of <i>International Classification of Diseases, Tenth Revision</i>, codes in the Medicare-matched data set. We used traditional logistic regression modeling and 6 machine-learning models to distinguish claudication from CLTI. We evaluated the sensitivity, specificity, total agreement, and area under the curve for all models, implementing grid search cross-validation to boost machine-learning model performance.</p><p><strong>Results: </strong>Of 54 180 patients who underwent a peripheral vascular intervention (mean age, 71.9±10.0 years; 41.0% female; 74.2 non-Hispanic White), 20 769 (38.3%) had claudication and 33 411 (61.7%) had CLTI per gold standard registry definitions. The predefined set of <i>International Classification of Diseases, Tenth Revision</i>, codes had high sensitivity (80.9%), specificity (81.9%), and total agreement (81.3%) for distinguishing claudication versus CLTI. Traditional logistic regression improved sensitivity to 96.2%, but with a substantial drop in specificity (41.8%) and an area under the curve of 0.785. Of the machine-learning models, gradient boosting classifier performed the best (area under the curve, 0.892), improving sensitivity to 88.6% and total agreement to 84.2% with minimal drop in specificity (77.1%).</p><p><strong>Conclusions: </strong><i>International Classification of Diseases, Tenth Revision</i>, codes can be used to discriminate between claudication and CLTI in claims data. Our defined set of claims codes can be used by investigators to accurately distinguish between these 2 peripheral artery disease phenotypes.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011467"},"PeriodicalIF":6.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175375","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":"Sedentary Behavior and Cardiac Events and Mortality After Hospitalization for Acute Coronary Syndrome Symptoms: A Prospective Study.","authors":"Keith M Diaz, Benjamin D Boudreaux, Chang Xu, Gabriel J Sanchez, Margaret E Murdock, Gaspar J Cruz, Ammie Jurado, Alvis Gonzalez, Melinda J Chang, Allie Scott, Sung A J Lee, Emily K Romero, Alexandra M Sullivan, Andrea T Duran, Joseph E Schwartz, Ian M Kronish, Donald Edmondson","doi":"10.1161/CIRCOUTCOMES.124.011644","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011644","url":null,"abstract":"<p><strong>Background: </strong>Patients hospitalized with symptoms of acute coronary syndrome remain at high risk for adverse events postdischarge, highlighting a need for modifiable therapeutic targets. The role of sedentary behavior in this risk and the potential benefits of replacing sedentary time with other activities remain unclear. This study examined the association between sedentary behavior and 1-year cardiac events/mortality among patients evaluated for acute coronary syndrome and estimated risk reductions from substituting alternative activities for sedentary time.</p><p><strong>Methods: </strong>Patients presenting to the emergency department of a New York City hospital with acute coronary syndrome symptoms were enrolled from 2016 to 2020. Sedentary behavior, light-intensity physical activity, moderate-to-vigorous physical activity, and sleep were measured via a wrist-mounted accelerometer worn for 30 days postdischarge. Cardiac events and all-cause mortality were ascertained 1 year postdischarge via participant contact, electronic health records, and the Social Security Death Index. Participants were categorized into tertiles of sedentary time, with tertile 1 representing the lowest sedentary time and tertile 3 the highest. Cox proportional hazards regression models were used to evaluate associations.</p><p><strong>Results: </strong>Of 609 participants (mean age, 62 years; 52% male, 58% Hispanic), 8.2% experienced a cardiac event or died within 1 year. Mean sedentary time was 13.6 h/d (SD, 1.8). Sedentary time was associated with increased risk of cardiac events/mortality (tertile 2: hazard ratio [HR], 0.95 [95% CI, 0.37-2.40]; tertile 3: HR, 2.58 [95% CI, 1.11-6.03]; <i>P</i>_trend=0.011). In isotemporal substitution analyses, replacing 30 minutes of sedentary time (referent) with sleep (HR, 0.86 [95% CI, 0.78-0.95]), light-intensity physical activity (HR, 0.49 [95% CI, 0.32-0.75]), or moderate-to-vigorous physical activity (HR, 0.39 [95% CI, 0.16-0.96]) was associated with lower cardiac event/mortality risk.</p><p><strong>Conclusions: </strong>Sedentary behavior was associated with increased risk of 1-year cardiac events/mortality among patients evaluated for acute coronary syndrome. Replacing sedentary behavior with sleep, light-intensity physical activity, or moderate-to-vigorous physical activity was associated with lower risk. These findings highlight reducing sedentary behavior as a potential strategy to improve posthospitalization outcomes.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011644"},"PeriodicalIF":6.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095144","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":"https://doi.org/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":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Rurality With Mortality After Congenital Heart Surgery.","authors":"Yanxu Yang, Yijian Huang, Jessica Knight, Matthew E Oster, Lazaros Kochilas","doi":"10.1161/CIRCOUTCOMES.124.011708","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011708","url":null,"abstract":"<p><strong>Background: </strong>Disparities between metro and nonmetro areas exist in health outcomes. The effect of residing areas on mortality for patients with congenital heart disease remains unclear. We evaluated the relationship of residing areas with survival outcomes after congenital heart surgery (CHS).</p><p><strong>Methods: </strong>This is a retrospective cohort study of patients enrolled in the Pediatric Cardiac Care Consortium who had a history of CHS. Outcomes were tracked by the National Death Index through 2022. Logistic regression and Cox proportional hazards models were fitted to examine the associations between residence at CHS with in-hospital mortality and long-term survival after adjustment for covariates.</p><p><strong>Results: </strong>Among 28 504 eligible patients (47.0% female) with a history of CHS, 19 772 (69.4%) patients resided in metro areas. Patients with congenital heart disease living in nonmetro areas at CHS had a lower (86.5%) 30-year survival rate following discharge from initial CHS versus patients living in metro areas (88.4%). After adjustment for sex, birth era, congenital heart disease severity, and presence of chromosomal abnormality, residing in nonmetro areas was associated with an increased risk of long-term mortality (adjusted hazard ratio, 1.12 [95% CI, 1.03-1.21]). Further adjustment for the neighborhood socioeconomic status attenuated the observed reduction in risk of death between nonmetro and metro areas. Patients with mild congenital heart disease who resided in nonmetro and not adjacent to metro areas were independently associated with an increased risk of long-term death (adjusted hazard ratio, 1.34 [95% CI, 1.00-1.77]), after adjustment for covariates and neighborhood socioeconomic status.</p><p><strong>Conclusions: </strong>Residence in nonmetro areas at CHS is associated with an increased risk of death both in the immediate postoperative period in-hospital and on the long-term up to 30 years after CHS discharge, but this association is explained by differential neighborhood socioeconomic status at the time of CHS. These findings provide opportunities for targeted interventions to reduce disparities and improve outcomes for all patients after CHS.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011708"},"PeriodicalIF":6.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036190","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":"Understanding Contemporary Atrial Fibrillation Trends in the United States: The Importance of Different Perspectives.","authors":"T Jared Bunch, Mintu P Turakhia","doi":"10.1161/CIRCOUTCOMES.125.012082","DOIUrl":"10.1161/CIRCOUTCOMES.125.012082","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012082"},"PeriodicalIF":6.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781863","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":"Comparing Cardiovascular Mortality Estimates From Global Burden of Disease and From the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research.","authors":"Abdul Mannan Khan Minhas, Sadeer Al-Kindi, Harriette G C Van Spall, Dmitry Abramov","doi":"10.1161/CIRCOUTCOMES.124.011459","DOIUrl":"10.1161/CIRCOUTCOMES.124.011459","url":null,"abstract":"<p><strong>Background: </strong>Several sources of data, including the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) and the Global Burden of Disease (GBD) data set, report causes of mortality in the United States. While CDC WONDER contains data based on death certificate codes, the GBD mortality data undergo additional processing, such as cause-of-death reassignment before reporting. Potential differences in reported mortality from cardiovascular disease in the United States between these 2 data sources have not been characterized.</p><p><strong>Methods: </strong>US nationwide cardiovascular cause-of-death data for each year between 2000 and 2019 were obtained from the GBD and the Multiple Cause-of-Death files using CDC WONDER in this longitudinal study. In addition to mortality from cardiovascular disease, mortality from key components of cardiovascular disease, including ischemic heart disease, stroke, and atrial fibrillation/flutter, was determined from each data set. Absolute and crude mortality rates per 100 000 are reported for each data set. Percent differences in cardiovascular mortality from GBD and CDC WONDER and percent changes in cardiovascular mortality across years were calculated.</p><p><strong>Results: </strong>In 2019, GBD reported 957 455 (95% uncertainty interval, 855 065-1 013 175) cardiovascular deaths, while CDC WONDER reported 859 290 cardiovascular deaths in the United States. Between 2000 and 2019, the reported crude mortality rates from cardiovascular causes in GBD decreased from 327 (297-341) to 292 (261-309), a reduction of 10.7%, and decreased in CDC WONDER from 335 (334-335) to 267 (266-267), a reduction of 20.3%. In 2019, the reported mortality rates for components of cardiovascular disease were higher in GBD compared with CDC WONDER for ischemic heart disease (percent difference, 54.5%), stroke (percent difference, 26.1%), and atrial fibrillation/flutter (percent difference, 25.0%).</p><p><strong>Conclusions: </strong>There are prominent differences in reported cardiovascular mortality between GBD and CDC WONDER data.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011459"},"PeriodicalIF":6.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781810","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}