Circulation-Cardiovascular Quality and Outcomes最新文献

{"title":"Equitable Stroke Care for a Growing Population: The Need for Cultural Sensitivity.","authors":"Patricia R Rodriguez-Lozano, Cristiane C Singulane","doi":"10.1161/CIRCOUTCOMES.124.011737","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011737","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011737"},"PeriodicalIF":6.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014819","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":"Medicare Coverage and Patient Out-of-Pocket Costs for Mavacamten.","authors":"Kannu Bansal, Christopher V Chien, Ahmad Masri, Ralph J Riello, Tariq Ahmad, Nihar R Desai, Sourbha S Dani","doi":"10.1161/CIRCOUTCOMES.124.011331","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011331","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011331"},"PeriodicalIF":6.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014823","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":"Examining Healthy Lifestyles as a Mediator of the Association Between Socially Determined Vulnerabilities and Incident Heart Failure.","authors":"Nickpreet Singh, Chanel Jonas, Laura C Pinheiro, Jennifer D Lau, Jinhong Cui, Leann Long, Samprit Banerjee, Raegan W Durant, Madeline R Sterling, James M Shikany, Monika M Safford, Emily B Levitan, Parag Goyal","doi":"10.1161/CIRCOUTCOMES.124.011107","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011107","url":null,"abstract":"<p><strong>Background: </strong>Increased burden of socially determined vulnerabilities (SDV), which include nonmedical conditions that contribute to patient health, is associated with incident heart failure (HF). Mediators of this association have not been examined. We aimed to determine if a healthy lifestyle mediates the association between SDV and HF.</p><p><strong>Methods: </strong>We included adults aged 45 to 64 years old across the United States from the REGARDS cohort study (Reasons for Geographic and Racial Differences in Stroke) without evidence of HF at baseline. The primary exposure was a count of SDV based on the Healthy People 2030 framework. The primary outcome was incident HF. We assessed the role of a healthy behavior score (HBS range, 0-8) and its components (adherence to a Mediterranean diet, physical activity, lack of sedentary lifestyle, and smoking abstinence) as potential mediators of the association between SDV and incident HF.</p><p><strong>Results: </strong>We included 13 on 525 participants. The median HBS was 4, with 16% with low HBS (0-2), 55% with moderate HBS (3-5), and 29% with high HBS (6-8). Increasing burden of SDV was associated with a stepwise increase in incident HF (adjusted hazard ratio, 1.84 [95% CI, 1.32-2.52] for 1 SDV, 2.59 [95% CI, 1.87-3.60] for 2 SDV, and 4.20 [95% CI, 3.08-5.73] for ≥3 SDV). There was no statistically significant mediation of HBS for the association of SDV count of 1 and incident HF. HBS score mediated 10.6% of the association between SDV count of 2 and incident HF and 11.1% of the association for those with ≥3 SDV. This increased to 10.8% and 18.3%, respectively, in the complete case analysis. Regarding individual components of HBS as mediators, only avoidance of a sedentary lifestyle was statistically significant (8.6% mediation) for the association of SDV count of 2 and incident HF.</p><p><strong>Conclusions: </strong>A healthy lifestyle plays a small role in mediating the association between high SDV count and incident HF.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011107"},"PeriodicalIF":6.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014821","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":"Associations of Social, Behavioral, and Clinical Factors With Sex Differences in Stroke Recurrence and Poststroke Mortality.","authors":"Chen Chen, Mathew J Reeves, Kevin He, Lewis B Morgenstern, Lynda D Lisabeth","doi":"10.1161/CIRCOUTCOMES.124.011082","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011082","url":null,"abstract":"<p><strong>Background: </strong>Few population-based studies have assessed sex differences in stroke recurrence. In addition, contributors to sex differences in recurrence and poststroke mortality, including social factors, are unclear. We investigated sex differences in these outcomes and the contribution of social, clinical, and behavioral factors to the sex differences.</p><p><strong>Methods: </strong>First-ever ischemic stroke cases identified from 2008 to 2019 from the population-based Brain Attack Surveillance in Corpus Christi Project in Texas were included and followed for recurrence and all-cause mortality through 2020. Sex differences in outcomes with and without adjustment for potential confounding factors, including social, behavioral, and clinical factors, were examined using Cox proportional hazard models. Factors that changed the log hazard ratio (HR) for sex by at least 10% after adjustment were identified as confounders/contributors. Final models were adjusted for all identified confounders.</p><p><strong>Results: </strong>Of 2326 participants (mean age, 68 years; 48% women; 57% Mexican American), over median follow-ups of 5.4 years for recurrence and 3.7 years for mortality, 274 recurrences and 965 deaths occurred. No significant sex differences in recurrence were noted in unadjusted (HR, 0.89 [95% CI, 0.70-1.13]), age-adjusted (HR, 0.92 [95% CI, 0.72-1.18]), or fully adjusted models (HR, 0.88 [95% CI, 0.67-1.16]). Although women had a higher crude mortality rate than men (HR, 1.22 [95% CI, 1.08-1.38]), this sex difference disappeared after age adjustment (HR, 0.91 [95% CI, 0.80-1.03]). Other factors contributing to the sex difference included education, marital status, prestroke depression, health behaviors, initial stroke severity, prestroke disability, comorbidities, atrial fibrillation, and coronary artery disease. After simultaneously adjusting for all identified confounders, women had lower poststroke mortality (HR, 0.79 [95% CI, 0.68-0.91]).</p><p><strong>Conclusions: </strong>Sex differences in stroke recurrence were not apparent. Women had a higher unadjusted poststroke mortality rate but lower adjusted mortality than men. Social and psychosocial factors, alongside clinical factors, primarily explained the sex disparity in poststroke mortality.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011082"},"PeriodicalIF":6.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014815","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":"Development of an Innovative Decision-Aid to Better Align Patients' Implantable Cardioverter Defibrillator Shock Status With Goals of Care.","authors":"Christine L Chen, Sarah Godfrey, Kelley Newcomer, Kristin Alvarez, Brenden Garrett, Jingwen Zhang, Nakul Patel, Christopher Viamontes, Nainesh Shah, Nimesh S Patel, Megan M Kelly, Melanie S Sulistio","doi":"10.1161/CIRCOUTCOMES.124.011544","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011544","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011544"},"PeriodicalIF":6.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014817","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":"Determinants of Racial and Ethnic Differences in Maternal Cardiovascular Health in Early Pregnancy.","authors":"Natalie A Cameron, Xiaoning Huang, Lucia C Petito, Hongyan Ning, Nilay S Shah, Lynn M Yee, Amanda M Perak, David M Haas, Brian M Mercer, Samuel Parry, George R Saade, Robert M Silver, Hyagriv N Simhan, Uma M Reddy, Jasmina Varagic, Ernesto Licon, Philip Greenland, Donald M Lloyd-Jones, Kiarri N Kershaw, William A Grobman, Sadiya S Khan","doi":"10.1161/CIRCOUTCOMES.124.011217","DOIUrl":"10.1161/CIRCOUTCOMES.124.011217","url":null,"abstract":"<p><strong>Background: </strong>Suboptimal cardiovascular health (CVH) in pregnancy is associated with adverse maternal and offspring outcomes. To guide public health efforts to reduce disparities in maternal CVH, we determined the contribution of individual- and neighborhood-level factors to racial and ethnic differences in early pregnancy CVH.</p><p><strong>Methods: </strong>We included nulliparous individuals with singleton pregnancies who self-identified as Hispanic, non-Hispanic Black (NHB), or non-Hispanic White (NHW) and participated in the nuMoM2b cohort study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be). First-trimester CVH was quantified using 6 routinely assessed factors in pregnancy included in the American Heart Association Life's Essential 8 score (0-100 points), in which higher scores indicate better CVH. Oaxaca-Blinder decomposition evaluated the extent to which racial and ethnic differences in CVH were explained by differences in individual- and neighborhood-level factors (age, socioeconomic characteristics, psychosocial factors, nativity, perceived racial discrimination, and area deprivation index).</p><p><strong>Results: </strong>Among 9104 participants, the mean age was 26.8 years, 18.7% identified as Hispanic, 15.6% identified as NHB, and 65.8% identified as NHW. Mean (SD) CVH scores were 76.7 (14.1), 69.8 (15.1), and 79.9 (14.3) in the Hispanic, NHB, and NHW groups, respectively (<i>P</i><0.01). The individual- and neighborhood-level factors evaluated explained all differences in CVH between Hispanic and NHW groups and 82% of differences between NHW and NHB groups. Racial and ethnic differences in educational attainment explained the greatest proportion of differences in CVH. If mean years of education among the Hispanic (14.0 [2.5]) and NHB (13.4 [2.4]) groups were the same as the NHW (15.8 [2.4]) group, mean CVH scores would be higher by 2.98 points (95% CI, 2.59-3.37) in the Hispanic and 4.28 points (95% CI, 3.77-4.80) in NHB groups.</p><p><strong>Conclusions: </strong>Racial and ethnic differences in early pregnancy CVH were largely explained by differences in individual- and neighborhood-level factors.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011217"},"PeriodicalIF":6.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979596","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":"Predicting Mortality in Patients Hospitalized With Acute Myocardial Infarction: From the National Cardiovascular Data Registry.","authors":"Kamil F Faridi, Yongfei Wang, Karl E Minges, Nathaniel R Smilowitz, Robert L McNamara, Michael C Kontos, Tracy Y Wang, Annie C Connors, Julie M Clary, Anwar D Osborne, Lucy Pereira, Jeptha P Curtis, Kristina Blankinship, Jarrott Mayfield, J Dawn Abbott","doi":"10.1161/CIRCOUTCOMES.124.011259","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011259","url":null,"abstract":"<p><strong>Background: </strong>In-hospital mortality risk prediction is an important tool for benchmarking quality and patient prognostication. Given changes in patient characteristics and treatments over time, a contemporary risk model for patients with acute myocardial infarction (MI) is needed.</p><p><strong>Methods: </strong>Data from 313 825 acute MI hospitalizations between January 2019 and December 2020 for adults aged ≥18 years at 784 sites in the National Cardiovascular Data Registry Chest Pain-MI Registry were used to develop a risk-standardized model to predict in-hospital mortality. The sample was randomly divided into 70% development (n=220 014) and 30% validation (n=93 811) samples, and 23 separate registry-based patient characteristics at presentation were considered for model inclusion using stepwise logistic regression with 1000 bootstrapped samples. A simplified risk score was also developed for individual risk stratification.</p><p><strong>Results: </strong>The mean age of the study cohort was 65.3 (SD 13.1) years, and 33.6% were women. The overall in-hospital mortality rate was 5.0% (n=15 822 deaths). The final model included 14 variables, with out-of-hospital cardiac arrest, cardiogenic shock, and ST-segment elevation MI as the strongest independent predictors of mortality. The model also included age, comorbidities (dyslipidemia, diabetes, prior percutaneous coronary intervention, cerebrovascular disease, and peripheral artery disease), heart failure on admission, heart rate, systolic blood pressure, glomerular filtration rate, and hemoglobin. The model demonstrated excellent discrimination (C-statistic, 0.868 [95% CI 0.865-0.871]) and good calibration, with similar performance across subgroups based on MI type, periods before and during the COVID-19 pandemic, and hospital volume. The simplified risk score included values from 0 to 25, with mortality risk ranging from 0.3% with a score of 0 to 1 up to 49.4% with a score >11.</p><p><strong>Conclusions: </strong>This contemporary risk model accurately predicts in-hospital mortality for patients with acute MI and can be used for risk standardization across hospitals and at the bedside for patient prognostication.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011259"},"PeriodicalIF":6.2,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972980","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":"Patient-Reported Outcomes in Heart Failure Clinical Trials: Trends, Utilization, and Implications.","authors":"Xichong Liu, Roy H Lan, Alexander T Sandhu","doi":"10.1161/CIRCOUTCOMES.124.011423","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011423","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011423"},"PeriodicalIF":6.2,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972979","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":"How to Put Survival After Cardiothoracic Interventions in the General Population Context: A Case-Based Practical Guideline to Calculate Cumulative Matched-General-Population Survival.","authors":"Xu Wang, Maximiliaan L Notenboom, Kevin M Veen, Pepijn Grashuis, Eleni-Rosalina Andrinopoulou, Jonathan R G Etnel, Ad J J C Bogers, Mostafa M Mokhles, Johanna J M Takkenberg","doi":"10.1161/CIRCOUTCOMES.123.009993","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.123.009993","url":null,"abstract":"<p><strong>Background: </strong>Observed patient survival after cardiothoracic interventions should ideally be placed in the context of matched-general-population survival. This study outlines several methodologies of matching general population mortality to the study sample, subsequently calculating cumulative matched-general-population survival, highlighting their respective advantages, disadvantages, and limitations.</p><p><strong>Methods: </strong>A multicenter data set containing survival data after the Ross procedure was used for methodological illustration. General population mortality was extracted from country-specific life tables in the Human Mortality Database. The matched-general-population mortality, also known as background mortality, was obtained by matching general population mortality to the study sample using different matching strategies, iteratively considering median/individual age and median/individual calendar year, besides country and sex. The corresponding cumulative matched-general-population survival was calculated subsequently. Sensitivity analyses were performed to assess the impact of varying patient ages on survival estimates by adding and subtracting 15 years from individual patients. A web-based Shiny Application (App) was developed to easily calculate cumulative matched-general-population survival.</p><p><strong>Results: </strong>In total, 1431 hospital survivors from the Ross procedure from 5 countries (25.7% female; median age, 48.5 [interquartile range, 42.7-54.0] years) were included. Fifteen-year survival was 88.3% (95% CI, 85.3-90.6). Cumulative matched-general-population 15-year survival varied from 87.7% to 89.8% using the 3 methods of different complexities. For 15-year-older patients, the cumulative matched-general-population 15-year survival was 67.4%, 59.8%, and 63.2%, respectively, using the simplest to the most comprehensive matching methods; for 15-year-younger patients, it was 96.9%, 96.1%, and 96.7%, respectively.</p><p><strong>Conclusions: </strong>Different methodologies to match general population mortality to observed patient mortality yield variable estimates of cumulative matched-general-population survival, especially in older patients. The cumulative matched-general-population survival should ideally be calculated by considering country, sex, individual patient age, and calendar year (both updated annually). This method can be easily implemented using the web-based Shiny App enclosed in this article.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e009993"},"PeriodicalIF":6.2,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972978","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":"Food Insecurity and Poor Health: Unraveling the Mechanisms, Informing Better Solutions.","authors":"Dariush Mozaffarian","doi":"10.1161/CIRCOUTCOMES.124.011743","DOIUrl":"https://doi.org/10.1161/CIRCOUTCOMES.124.011743","url":null,"abstract":"","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e011743"},"PeriodicalIF":6.2,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957129","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}