bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heatwaves and cardiovascular emergencies in our city, in Italy: pre-Covid-19, Covid-19 and post-Covid-19 characteristics and associated risk during heat days
Authors: Nawaro J , Gianquintieri L , Pagliosa A , Sechi G M , Caiani E G 
Published: November 2023

Abstract

Background
Recent research reports both direct and indirect impact of the coronavirus disease 2019 (COVID-19) on cardiovascular (CV) health. Existing case-studies mostly focus on the immediate effects, leaving the long-term consequences of the pandemic in this field as yet unrecognised.

Purpose
The aim of this study was to analyse the changes in CV emergencies’ characteristics during COVID-19 (C, 2020-21) and post-COVID-19 (post-C, 2022) periods in reference to pre-COVID-19 (pre-C, 2017-19) and to provide the associated relative risk (RR) during heat days (i.e., with apparent temperature &gt; 95th percentile of the annual distribution) compared to non-heat days.

Methods
Ambulance dispatches for CV problems in our city, Italy during May-September in pre-C, C, and post-C were considered. Their characteristics, i.e., mean daily quantity, patients’ age and gender distribution and emergency severity (i.e., fatal, requiring transportation to a hospital, non severe) distribution were compared using Student’s t-test and Fisher’s exact test. For each period, the RR of CV emergencies during heat days in reference to non-heat days was calculated, dividing the number of emergencies in heat days by their number in randomly selected subset of non-heat days, accounting for vacation period.

Results
In total, 64,881 CV emergencies were reported. In both C and post-C, compared to pre-C, a significant reduction of around 3% in events in women, and of almost 5% in events that required transportation to a hospital, was observed (Table 1). In pre-C, the average daily number of emergencies was 72.8, reduced to 66.5 in C, and back to the pre-pandemic level (72.7) in post-C. Also, the age of patients in post-C was reduced. Interestingly, stratifying by the severity of the emergencies, significant increase in the age for fatal emergencies in both C and post-C was found, together with an age decrease for events resulting in hospital admission. The RR of having a CV emergency in heat days was similar in pre-C, C, and post-C periods (1.11 (95% CI: [1.06; 1.15]), 0.98 ([0.94; 1.03]), and 1.07 ([1.01; 1.14], respectively), with the RR being the highest for fatal emergencies, lower for non severe ones and the lowest for those requiring transportation to a hospital (Figure 1).

Conclusions
The risk of having a CV emergency is higher in heat days than in non-heat days, in particular for fatal emergencies. The COVID-19 pandemic had a significant impact on CV emergencies, including a temporary decrease in demand for the emergency medical service, also in extreme weather, and a long-term decrease in the mean age of the patients and in the fraction of emergencies requiring transportation to a hospital. Monitoring the trends in upcoming years will be crucial to fully comprehend the impact of the pandemic on CV emergency service demand, as well as of heatwaves.Table 1Figure 1
Association of prehospital tracheal intubation with outcomes comparing to supraglottic airway device during out-of-hospital cardiac arrest by drowning: nationwide cohort study in Japan
Authors: Yoshimura S , Kiguchi T , Ikeda N , Takegawa M , Nakamori N , Miyamae N , Sumida Y , Kitamura T , Iwami T 
Published: November 2023

Abstract

Background/Introduction
Drowning is the third leading cause of unintentional injury death, which causes more than 500,000 deaths annually worldwide. Several studies have examined the impact of tracheal intubation for outcomes in out-of-hospital cardiac arrest (OHCA) patients, however few studies examined it in OHCA patients by drowning.

Purpose
To compare survival outcomes among adults OHCA patients by drowning between tracheal intubation and supraglottic airway device.

Methods
This study compared the outcome of OHCA patients by drowning according to the airway management using Japanese nationwide, population-based registry (All-Japan Utstein Registry). From 2014 to 2020, consecutive adult OHCA patients were included. Patients who received tracheal intubation during cardiopulmonary resuscitation (CPR) were matched with patients treated with supraglottic airway device on the basis propensity scores in a 1:1 ratio, with a 0.2 caliper width. Propensity score was calculated by logistic regression model using following variables; year, prefectural preference of ETI use, age, sex, witnessed status, those who witnessed (By family, citizen, EMS, others), AED use, bystander-initiated CPR, prehospital involvement of physician, defibrillation by EMS, administration of adrenaline, time from call to CPR, first rhythm documented by EMS. The outcome measures were return of spontaneous circulation, survival at one month, and favorable neurological outcome defined as cerebral performance status 1 or 2.

Results
Of the 11, 703 eligible patients, 4467 (38.2%) and 7236 (61.8%) received tracheal intubation and supraglottic airway device during CPR, respectively. After propensity score matching, 3566 patients in each cohort were matched. The return of spontaneous circulation was higher in those with tracheal intubation compared with those with supraglottic airway device: 207/3566 (5.8%) versus 167/3566 (4.7%) (odds ratio 1.25, 95% confidence interval[CI] 1.02 to 1.55). There was no difference between the groups in one-month survival and favorable neurological outcome: 32/3566 (0.90%) versus 34/3566 (0.95%) (odds ratio 0.94, 95% CI 0.58 to 1.53), and 9/3566 (0.25%) versus 8/3566 (0.22%) (odds ratio 1.13, 95% CI 0.43 to 2.92), respectively.

Conclusions
In the propensity score matched study for adult OHCA by drowning, tracheal intubation was associated with the return of spontaneous circulation, whereas it was not associated with survival and favorable neurological outcome at one month compared to those with supraglottic airway device. Further studies such as to investigate the heterogeneity of the effect of intubation during the resuscitation might be mandated for the improvement of the outcome among the OHCA patients by drowning.Out-of-hospital cardiac arrest outcomes
Association of air quality improvement and frailty progression: A national study across China
Authors: Liu M Q , Hu X M , Ou Y Q 
Published: November 2023

Abstract

Introduction
More and more evidence shows that air pollution has an adverse effect on frailty. However, it’s little known about the effect of air pollution on frailty progression.

Purpose
With a strict clean air action implemented in China, we aimed to investigate whether improvements in air quality can alleviate the frailty progression.

Methods
This study involved 12891 participants with geocoded environmental data from the national wide China Health and Retirement Longitudinal Study (CHARLS) between wave 1 (2011) to wave 3 (2015). Average exposure to air pollutants (PM1, PM2.5, PM10, NO2, and O3) were estimated by satellite-based spatiotemporal approaches and matched with the residence. Air pollution improvements was defined as absolute changes of air pollutants (Δambient air pollutants = ambient air pollutants in 2011 – ambient air pollutants in 2015). Frailty progression was calculated by frailty index (FI) change (ΔFI=FI 2015-FI 2011) which was based on 53 items of the questionnaire covering physical limitations, psychological symptoms, comorbidities, history of trauma and cognitive impairment from wave 1 to wave 3. Multivariate logistic regression models were used to analyze the associations of air pollution improvements and the frailty progression, and restricted cube splines were used to exam possible nonlinear relationships between them.

Results
Compared to the lowest (Q1) quartile of PM1 exposure reduction, the highest (Q4) reduction was associated with the lowest risk for frailty progression after fully adjusting for confounders [aOR (95% CI)=0.75（0.68∼0.84）]. Similar protective effects of frailty progression were observed with the improvement of the air quality in PM2.5, PM10, and NO2 index, with aORs ranging 0.72-0.79 (Q4 vs Q1 of level reduction), while the reduction in O3 level appeared to be less related to changes in frailty progression [aOR=0.94（0.85∼1.04）]. The restricted cubic spline showed a dose response for the protective effect of improving of air quality and frailty progression.

Conclusions
The air quality improvement in PM1, PM2.5, PM10, and NO2, could alleviate the progression of frailty, while a reduction in O3 may not. This study is the first to examine the association between air pollution and the progression of frailty, sheading lights into the prevention of frailty in a national wide population.Odds ratios (95% CI) for main outcomeThe restricted cubic spline
Trends in cardiovascular care in Japan from 2010 to 2019 in relation to population density
Authors: Miyamoto Y , Kanaoka K , Nakai M , Sumita Y , Iwanaga Y 
Published: November 2023

Abstract

Background
As Japan faces a declining birthrate and an ageing population, it is also necessary to transfer the population from urban areas to rural areas to prevent depopulation in rural areas. On the other hand, it is necessary to verify whether cardiovascular medical care systems are equalized regardless of population density.

Purpose
The aim of this study is to describe the evolution of healthcare in Japan by population density.

Methods
This descriptive study used data obtained from the Japanese Registry of All Cardiac and Vascular Diseases database from 2010 to 2019. The nationwide 10-year trend in cardiovascular medical care systems was described in total and according to quartiles of hospitals based on population density.

Results
The number of patients admitted to cardiovascular facilities and the number of cardiologists showed a 1.26-fold and 1.18-fold increase from 2010 to 2019, respectively (P for trend &lt;0.01 for both). The very high population density category had a lower number of hospitals and cardiology beds per population, whereas the very low population density category had a lower number of cardiologists per population. A greater increase in the number of patients was observed in the higher population density category (P for interaction&lt;0.01). The difference in the number of hospitalized patients per cardiologist decreased among the population density categories.

Conclusion
Based on population density, the highest increase in the number of patients and cardiologists per hospital was observed in the higher population density category; however, the difference in the number of patients per cardiologist decreased among the categories.
Figure legend
Hospital-level trends in cardiovascular medical care systems according to population density. (A, B, and C) The number of patients to cardiologists according to population density. (D)
Understanding of seasonal influenza immunisation and its cardiovascular benefits among cardiology patients
Authors: Monagle S R , Spear E , Thakur U , Pol D , Tan S , Bellamy K , Hickman J , Jackson B , Chan J , Nicholls S J , Nelson A J 
Published: November 2023

Abstract

Background
Seasonal influenza immunisation reduces the risk of cardiovascular events. Patients with established cardiovascular disease (CVD) derive a greater benefit than those without yet up to 50% globally do not take up the immunisation.

Purpose
To describe the understanding and perceptions of seasonal influenza immuni2ation among patients CVD.

Methods
A cross sectional, voluntary and anonymous survey was administered to cardiology inpatients and outpatients attending a large health system in Australia during the 2022 influenza season, May 1st 2022 to August 31st 2022. Demographics, educational and employment status and prior immunisation behaviours were collected. Questions on perceptions and beliefs around seasonal influenza immunisation and influenza-related illness were presented with 5-point Likert scale (strongly disagree through to strongly agree).

Results
A total of 181 surveys were completed; median age was 64 (50.5% &lt;65 years), 65.0% (115/177) of the population were inpatients, 82.2% (143/174) had completed high school or more; 35.0% (63/180) were female and 24.2% (43/178) spoke a language other than English at home. Over one third of respondents did not receive the seasonal influenza immunisation in the prior year (63/181, 34.5%). Only half (97/179, 54.2%) of patients agreed that their heart condition placed them at higher risk of complications and serious illness if they contracted influenza. While 73.3% (132/180) agreed that immunisation would help prevent risk of serious illness, only 26.8% (48/179) agreed that it would help to prevent myocardial infarction. Nearly a quarter of patients (24.0%, 43/179) were concerned about side effects while 1 in 10 (12.8%, 23/179) patients raised cost as a barrier despite being free-of-charge to all patients with CVD in Australia. If asked to receive the seasonal influenza immunisation, 86% (154/179) patients would agree if their cardiologist recommended it.

Conclusions
Despite guideline recommendations, most cardiology patients are uninformed of the cardiovascular benefits of seasonal influenza immunisation with many unaware they are at higher risk of influenza-related, preventable illness. The vast majority of patients would accept the immunisation if recommended by their cardiologist highlighting their important role in improving uptake among this high-risk group.
Level of evidence supporting the chinese cardiovascular disease clinical practice guidelines and its evolution in the past two decades
Authors: Li C , Wang C S , Hao J , Zheng Y T , Yang J , Tang Y D 
Published: November 2023

Abstract

Background
Clinical practice is guided by guidelines in the era of evidence-based medicine to improve healthcare. The consistency between the strength of recommendations and the underlying quality of evidence in clinical guidelines and its evolution dynamically reflects the status of medical practice in important aspects. This study aimed to evaluate the levels of evidence (LOEs) supporting different classes of recommendations (CORs) in Chinese cardiovascular disease (CVD) guidelines between 2003 and 2021 and changes over time.

Method
Clinical guideline documents on cardiovascular topics issued by leading professional organizations were retrieved in the Databases of SinoMed and Wanfang Med Online from inception to June 2021. All guidelines were screened through abstract and full-text reading and included if satisfying the pre-specified criteria. 79 Chinese guideline documents on 12 sub-topics including a total of 5195 recommendations and the designated CORs/LOEs, were abstracted. The number of recommendations of Class I, Class II, Class III, LOE A, LOE B and LOE C were identified for each guideline document. The proportion of CORs, LOEs and COR-LOE combinations in guidelines and the changes among those with ≥2 versions.

Results
A total of 79 guidelines were included in the analysis. When examining the status of current guidelines, among the 3325 recommendations derived from 59 documents during 2011-2021, 735 recommendations (22.1%) were classified as LOE A, 1280 (38.5%) as LOE B, and 1310 (39.4%) as LOE C. 596 recommendations (17.9%) were characterized as Class I-LOE A, accounting for the majority of LOE A recommendations but only one-third of Class I recommendations. Evidence levels varied greatly across different sub-topics and individual guidelines. There are 9 guidelines on 5 sub-topics having ≥2 versions. When analyzing the changes over time, although an increase was observed in the total number of recommendations, the proportion of recommendations designated as Class I-LOE A did not significantly improve (19.1% [current] vs 19.0%[prior], p=0.97).

Conclusions
In current Chinese CVD guidelines, the high level of evidence lacks and its alignment with strong recommendations is deficient. Although it shows moderate improvements in certain major topics (e.g., Coronary artery disease, Interventional therapy, Surgery) in the past two decades, the overall proportion of Class I-LOE A recommendations remains small, suggesting that conduction, and particularly translation, of high-quality studies like RCTs addressing CVDs-related questions are still essential and demanded, especially for areas with less attention.Abstract Picture 1
Venous thromboembolism in users of hormonal contraception and non-steroidal anti-inflammatory drugs: a nationwide cohort study
Authors: Meaidi A , Mascolo A M , Sessa M S , Toft-Petersen A P T P , Skals R S , Gerds T A G , Skovlund C W S , Morch L M , Rossi F R , Capuano A C , Lidegaard O L , Torp-Pedersen C T P 
Published: November 2023

Abstract

Objective
To study the influence of concomitant use of hormonal contraception and non-steroidal anti-inflammatory drugs (NSAIDs) on the risk of venous thromboembolism.
Design: Nationwide cohort study.
Setting: Denmark through national registries.
Participants: All 15-49-year-old women living in Denmark between the years 1996-2017 with no medical history of any venous or arterial thrombotic event, cancer, thrombophilia, hysterectomy, bilateral oophorectomy, sterilisation, or infertility treatment.
Main outcome measure: A first-time discharge diagnosis of lower-limb deep venous thrombosis or pulmonary embolism.

Results
Among 2.0 million women followed for 21.0 million person-years, 8710 venous thromboembolic events occurred. Compared to non-use of NSAIDs, use of NSAIDs was associated with an adjusted incidence rate ratio of venous thromboembolism of 8.1 (95% confidence interval (CI) 6.9 to 9.6) in women not using hormonal contraception, 12.1 (10.6 to 13.9) in women using high-risk hormonal contraception, 8.7 (6.5 to 11.6) in users of medium-risk hormonal contraception, and 5.1 (2.9 to 9.1) with low/no-risk hormonal contraception.
Compared to non-use of NSAIDs, the number of extra venous thromboembolic events per 100,000 one-week NSAID treatments was 4 in women not using hormonal contraception, 18 in women using high-risk hormonal contraception, 9 in users of medium-risk hormonal contraception, and 2 in women using low/no-risk hormonal contraception.

Conclusions
NSAID use was positively associated with the development of venous thromboembolism. The association was stronger in women concomitantly using high-risk hormonal contraceptives and weaker in women using low/no-risk hormonal contraception. Women requiring both hormonal contraception and regular use of NSAIDs should be advised accordingly.
The impact of chronic kidney disease on healthcare utilization and costs associated with pacemaker infection
Authors: Wright D J , Trucco M E , Marti M A , Margetta J , Wolff C , El-Chami M F 
Published: November 2023

Abstract

Background
Patients with CKD are at increased risk of bleeding and device-related infections due to their chronic illness. CKD complicates treatment which could lead to an increase in duration of hospitalizations and higher costs.

Purpose
The goal of this study is to compare hospitalizations and the total costs associated with permanent pacemaker (PPM) infection in patients with and without CKD.

Methods
This retrospective analysis used Medicare Fee for service (FFS) claims to identify patients implanted with a transvenous PPM from June 2016-December 2020. Device infections, hospitalizations and costs were identified in a 12-month follow-up period post-device implant. Costs include all inpatient and outpatient hospital costs. Patients with CKD and infections were identified based on ICD-10 diagnostic codes. A generalized linear model was utilized to calculate non-infection and infection costs by CKD status. The simple differences between these cohorts represent the total infection cost with CKD and total infection cost without CKD highlighting the incremental cost of infected patients with CKD.

Results
A total of 439,679 Medicare FFS patients had PPM insertion from June 2016-December 2020, of which 13% had CKD and 1.2% had a device infection within 12-months post-implant. Infected patients with CKD incurred two admissions on average (p-value = &lt;0.001), versus 1.4 (p-value = &lt;0.001) for an infected patient without CKD. The total days in hospital for infected patients with CKD were 32 days (p-value = &lt;0.001) versus 22 days (p-value=&lt;0.001) for infected patients without CKD (Figure 1). The average cost of an infection in the US for a CKD patient was $176,483 (p-value = &lt;0.001) versus $65,792 (p-value =&lt;0.001) for a patient without CKD. The incremental costs of an infection in CKD as compared to no CKD was $110,691 (p-value of interaction = 0.0160).

Conclusion
In our analysis PPM-related infection in patients with CKD were characterized by more health care utilizations and higher costs compared to patients without CKD.Figure 1
Bystander defibrillation increases 30-day survival even with short emergency medical service response time
Authors: Hindborg M , Yonis H , Gnesin F , Soerensen K K , Torp-Pedersen C 
Published: November 2023

Abstract

Background
Rates of bystander initiated defibrillation are increasing in many areas of the world (1-4), but the effect of defibrillation at different time points after recognition of out-of-hospital cardiac arrest (OHCA) remains largely unknown.

Purpose
To assess the effect on 30-day survival of bystander defibrillation at different intervals of emergency medical service (EMS) response time.

Methods
We included OHCAs from 2016 through 2020 from the Danish Cardiac Arrest Registry. Cases were included if they were ≥18 years of age, bystander witnessed, received bystander cardiopulmonary resuscitation (CPR), had EMS response time of 25 minutes or less and only the first OHCA for each subject was considered. We excluded cases witnessed by EMS or if they had missing values of OHCA-related variables.
Crude survival proportions were calculated for each minute of EMS response time.
Relative risks (RR) and corresponding 95 % confidence intervals (95 % CI) of the outcome (30-day survival) for eight different intervals of EMS response time were estimated using a causal inference framework utilizing Targeted Maximum Likelihood Estimation (TMLE) with ensemble Super Learning, adjusting for age, sex, place of arrest (public/private), initial cardiac rhythm (shockable/not shockable), and comorbidities (prior acute myocardial infarction, ischemic heart disease, heart failure, chronic obstructive pulmonary disease, stroke, cancer).

Results
We included 7,471 cases of bystander witnessed OHCA receiving CPR before EMS arrival. Of these, 14.7 % (1,098/7,471) received bystander defibrillation before arrival of EMS. Overall, 44.5 % (489/1,098) survived to 30 days when bystander defibrillation was performed versus 18.8 % (1,200/6,373) when no bystander defibrillation was performed. When examining the crude survival proportion for each minute of EMS response time, we found that 30-day survival was consistently higher in the group receiving bystander defibrillation for the first 20 minutes after which the survival was approximately the same for the two groups (Figure 1). When adjusting for confounders, we found statistically significantly increased relative risks of 30-day survival for patients receiving bystander defibrillation, compared to patients not bystander defibrillated, for all intervals of EMS response time, except for response times of 0-2 min., where the increase did not reach statistical significance (0-2 min: RR; 1.34 [95 % CI: 0.88-2.05], 2-4 min: RR; 1.37 [95 % CI: 1.10-1.70], 4-6 min: RR; 1.55 [95 % CI: 1.33-1.80], 6-8 min: RR; 2.23 [95 % CI: 1.86-2.67], 8-10 min: RR; 1.99 [95 % CI: 1.55-2.55], 10-12 min: RR; 1.89 [95 % CI: 1.34-2.68], 12-15 min: RR; 1.86 [95 CI: 1.22-2.84], &gt;15 min: RR; 1.98 [95 % CI: 1.16-3.38]) (Figure 2).

Conclusion
For all intervals of EMS response time, bystander defibrillation increased 30-day survival of OHCA. The effect was significant for EMS response times as short as 2-4 minutes.