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1.
Circulation ; 150(10): 806-815, 2024 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-39226381

RESUMO

Guidelines help to facilitate treatment decisions based on available evidence, and also to provide recommendations in areas of uncertainty. In this paper, we compare the recommendations for stroke workup and secondary prevention of ischemic stroke and transient ischemic attack of the American Heart Association (AHA)/American Stroke Association (ASA) with the European Stroke Organization (ESO) guidelines. The primary aim of this paper is to offer clinicians guidance by identifying areas where there is consensus and where consensus is lacking, in the absence or presence of high-level evidence. We compared AHA/ASA with the ESO guideline recommendations for 7 different topics related to diagnostic stroke workup and secondary prevention. We categorized the recommendations based on class and level of evidence to determine whether there were relevant differences in the ratings of evidence that the guidelines used for its recommendations. Finally, we summarized major topics of agreement and disagreement, while also prominent knowledge gaps were identified. In total, we found 63 ESO and 82 AHA/ASA recommendations, of which 38 were on the same subject. Most recommendations are largely similar, but not all are based on high-level evidence. For many recommendations, AHA/ASA and ESO assigned different levels of evidence. For the 10 recommendations with Level A evidence (high quality) in AHA/ASA, ESO only labeled 4 of these as high quality. There are many remaining issues with either no or insufficient evidence, and some topics that are not covered by both guidelines. Most ESO and AHA/ASA Guideline recommendations for stroke workup and secondary prevention were similar. However not all were based on high-level evidence and the appointed level of evidence often differed. Clinicians should not blindly follow all guideline recommendations; the accompanying level of evidence informs which recommendations are based on robust evidence. Topics with lower levels of evidence, or those with recommendations that disagree or are missing, may be an incentive for further clinical research.


Assuntos
Ataque Isquêmico Transitório , AVC Isquêmico , Guias de Prática Clínica como Assunto , Prevenção Secundária , Humanos , Ataque Isquêmico Transitório/prevenção & controle , Ataque Isquêmico Transitório/diagnóstico , Prevenção Secundária/métodos , Prevenção Secundária/normas , AVC Isquêmico/prevenção & controle , AVC Isquêmico/diagnóstico , Europa (Continente) , Estados Unidos , American Heart Association , Medicina Baseada em Evidências/normas , Acidente Vascular Cerebral/prevenção & controle , Acidente Vascular Cerebral/diagnóstico
2.
J Am Coll Cardiol ; 84(12): 1123-1143, 2024 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-39127953

RESUMO

This document describes performance measures for heart failure that are appropriate for public reporting or pay-for-performance programs and is meant to serve as a focused update of the "2020 ACC/AHA Clinical Performance and Quality Measures for Adults With Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures." The new performance measures are taken from the "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines" and are selected from the strongest recommendations (Class 1 or Class 3). In contrast, quality measures may not have as much evidence base and generally comprise metrics that might be useful for clinicians and health care organizations for quality improvement but are not yet appropriate for public reporting or pay-for-performance programs. New performance measures include optimal blood pressure control in patients with heart failure with preserved ejection fraction, the use of sodium-glucose cotransporter-2 inhibitors for patients with heart failure with reduced ejection fraction, and the use of guideline-directed medical therapy in hospitalized patients. New quality measures include the use of sodium-glucose cotransporter-2 inhibitors in patients with heart failure with mildly reduced and preserved ejection fraction, the optimization of guideline-directed medical therapy prior to intervention for chronic secondary severe mitral regurgitation, continuation of guideline-directed medical therapy for patients with heart failure with improved ejection fraction, identifying both known risks for cardiovascular disease and social determinants of health, patient-centered counseling regarding contraception and pregnancy risks for individuals with cardiomyopathy, and the need for a monoclonal protein screen to exclude light chain amyloidosis when interpreting a bone scintigraphy scan assessing for transthyretin cardiac amyloidosis.


Assuntos
American Heart Association , Cardiologia , Insuficiência Cardíaca , Humanos , Insuficiência Cardíaca/terapia , Estados Unidos , Cardiologia/normas , Adulto
3.
Front Endocrinol (Lausanne) ; 15: 1376463, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39086898

RESUMO

Background and aims: The American Heart Association (AHA) recently introduced the Life's Essential 8 (LE8) to improve cardiovascular health (CVH). However, the association between LE8 and the risk of prediabetes or diabetes is not yet fully understood. Consequently, this study aims to assess the association between CVH, as evaluated by LE8, and the risk of prediabetes and diabetes. Methods and Results: This cross-sectional study encompassed 7,739 participants aged ≥20 years from the 2007-2018 National Health and Nutrition Examination Surveys (NHANES). The CVH of participants was evaluated using the LE8, combining four health behaviors and three health factors. Glucose metabolic status categories included normal glucose metabolism, prediabetes including isolated impaired fasting glucose, isolated impaired glucose tolerance, both IFG and IGT, and diabetes. The associations between CVH and prediabetes and diabetes were analyzed using logistic regression, linear regression, restricted cubic splines, and subgroup analyses. Among 7,739 participants, 1,949 had iIFG, 1,165 were diagnosed with iIGT, 799 were IFG+IGT, and 537 were diagnosed with diabetes. After multivariable adjustments, CVH scores were inversely associated with prediabetes and diabetes, with the most robust inverse association observed between IFG+IGT and CVH across all prediabetes subgroups. Of all CVH components not directly in the causal pathway, body mass index (BMI) had the most robust associations with prediabetes and diabetes. Subgroup analyses indicated that the negative correlation between CVH and prediabetes was stronger among those with university or higher education. Conclusion: CVH, as defined by LE8, showed a significant negative association with prediabetes and diabetes.


Assuntos
American Heart Association , Inquéritos Nutricionais , Estado Pré-Diabético , Humanos , Estado Pré-Diabético/epidemiologia , Estudos Transversais , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Estados Unidos/epidemiologia , Diabetes Mellitus/epidemiologia , Idoso , Doenças Cardiovasculares/epidemiologia , Fatores de Risco , Glicemia/metabolismo , Glicemia/análise
5.
Circulation ; 150(11): e228-e254, 2024 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-39129620

RESUMO

Aortopathy encompasses a spectrum of conditions predisposing to dilation, aneurysm, dissection, or rupture of the aorta and other blood vessels. Aortopathy is diagnosed commonly in children, from infancy through adolescence, primarily affecting the thoracic aorta, with variable involvement of the peripheral vasculature. Pathogeneses include connective tissue disorders, smooth muscle contraction disorders, and congenital heart disease, including bicuspid aortic valve, among others. The American Heart Association has published guidelines for diagnosis and management of thoracic aortic disease. However, these guidelines are predominantly focused on adults and cannot be applied adeptly to growing children with emerging features, growth and developmental changes, including puberty, and different risk profiles compared with adults. Management to reduce risk of progressive aortic dilation and dissection or rupture in children is complex and involves genetic testing, cardiovascular imaging, medical therapy, lifestyle modifications, and surgical guidance that differ in many ways from adult management. Pediatric practice varies widely, likely because aortopathy is pathogenically heterogeneous, including genetic and nongenetic conditions, and there is limited published evidence to guide care in children. To optimize care and reduce variation in management, experts in pediatric aortopathy convened to generate this scientific statement regarding the cardiovascular care of children with aortopathy. Available evidence and expert consensus were combined to create this scientific statement. The most common causes of pediatric aortopathy are reviewed. This document provides a general framework for cardiovascular management of aortopathy in children, while allowing for modification based on the personal and familial characteristics of each child and family.


Assuntos
American Heart Association , Doenças da Aorta , Humanos , Criança , Estados Unidos , Doenças da Aorta/terapia , Doenças da Aorta/diagnóstico , Adolescente , Gerenciamento Clínico , Lactente , Pré-Escolar
6.
Arq Bras Cardiol ; 121(7): e20230785, 2024 Jul.
Artigo em Português, Inglês | MEDLINE | ID: mdl-39194062

RESUMO

BACKGROUND: Cardiovascular disease (CVD) is a series of diseases affecting the heart or blood vessels. OBJECTIVES: To assess the relationship between blood pressure (BP) levels defined by the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline and CVD/atherosclerotic cardiovascular disease (ASCVD) risk for middle-aged and elderly people in China. METHODS: A total of 6,644 middle-aged and elderly people from the China Health and Retirement Longitudinal Study (CHARLS) were finally included. According to the 2017 ACC/AHA guideline, all subjects were divided into four groups: normal BP, elevated BP, stage 1 hypertension, and stage 2 hypertension. The outcome of this study was considered as the risk of CVD and ASCVD. Univariate and multivariate COX regression models were adopted to examine the relationship of the 2017 ACC/AHA BP classification with the risk of CVD. Univariate and multivariate logistic regression models were used to investigate the association between BP levels and ASCVD risk. Subgroup analyses based on age, gender, and use of antihypertensive drugs were performed. P<0.05 was accepted as statistically significant. RESULTS: After adjusting all covariates, compared to middle-aged and elderly patients with normal BP, we found that patients with stage 1/2 hypertension were associated with a higher risk of CVD, separately. Simultaneously, we also observed a positive association between individuals with elevated BP, stage 1 hypertension, stage 2 hypertension, and higher ASCVD risk in the fully adjusted model. The result of subgroup analyses implied that the relationship between stage 1/2 hypertension and CVD/ high ASCVD was robust in different ages and genders, and participants without using antihypertensive drugs. CONCLUSION: BP classification under the 2017 ACC/AHA BP guidelines may apply to the Chinese population.


Assuntos
Pressão Sanguínea , Doenças Cardiovasculares , Hipertensão , Guias de Prática Clínica como Assunto , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , China/epidemiologia , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Pressão Sanguínea/fisiologia , American Heart Association , Medição de Risco , Fatores de Risco , Fatores Etários , Estudos Longitudinais , Anti-Hipertensivos/uso terapêutico , Estados Unidos , Fatores de Risco de Doenças Cardíacas , Fatores Sexuais
7.
J Am Heart Assoc ; 13(15): e033990, 2024 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-39077816

RESUMO

BACKGROUND: This study investigated the association of American Heart Association's cardiovascular health guidelines Life's Essential 8 (LE8) and Life's Simple 7 (LS7) with carotid artery outcomes among young adults. METHODS AND RESULTS: This cross-sectional study included 240 young adults (age 24.2±1.6 years) who underwent a carotid ultrasound between 2018 and 2022. LE8 score was calculated from 4 health factors (body mass index, non-high-density lipoprotein cholesterol, fasting glucose, and blood pressure), and 4 health behaviors (dietary intake, physical activity, tobacco use, and sleep). LS7 was calculated from 7 metrics (all LE8 metrics, except for sleep) with a simpler algorithm. Higher LE8 and LS7 scores both indicate better health and better adherence to American Heart Association guidelines. Carotid artery outcomes included carotid artery intima-media thickness, arterial stiffness (eg, distensibility), and echogenicity determined by grayscale median of the intima media complex. Results of linear regression analyses, adjusting for age, sex, ethnicity, and parents' highest degree, indicated that a 1-SD increase in LE8 score was associated with 12.14 µm lower carotid artery intima-media thickness (95% CI, -20.93 to 3.35), 1.17 (10-6×m2/N) greater distensibility (95% CI, 0.09-2.24), suggesting less arterial stiffness, and 2.66 µm greater grayscale median of the intima media complex (95% CI, 0.58-4.75), suggesting less lipid deposition. Analyses using LS7 score demonstrated comparable findings. Health factor metrics demonstrated stronger association with carotid artery outcomes, as compared with behavior metrics. CONCLUSIONS: Greater adherence to the American Heart Association's cardiovascular health guidelines is associated with lower risk for subclinical atherosclerosis in young adults. LE8 and LS7 demonstrated comparable associations with carotid artery outcomes.


Assuntos
American Heart Association , Espessura Intima-Media Carotídea , Humanos , Masculino , Feminino , Estudos Transversais , Adulto Jovem , Estados Unidos/epidemiologia , Adulto , Rigidez Vascular/fisiologia , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças Assintomáticas , Comportamentos Relacionados com a Saúde , Aterosclerose/epidemiologia , Aterosclerose/diagnóstico , Medição de Risco , Fatores de Risco , Nível de Saúde , Artérias Carótidas/diagnóstico por imagem
10.
Circulation ; 150(8): e183-e196, 2024 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-38984417

RESUMO

The rapid technological advancements in cardiac implantable electronic devices such as pacemakers, implantable cardioverter defibrillators, and loop recorders, coupled with a rise in the number of patients with these devices, necessitate an updated clinical framework for periprocedural management. The introduction of leadless pacemakers, subcutaneous and extravascular defibrillators, and novel device communication protocols underscores the imperative for clinical updates. This scientific statement provides an inclusive framework for the periprocedural management of patients with these devices, encompassing the planning phase, procedure, and subsequent care coordinated with the primary device managing clinic. Expert contributions from anesthesiologists, cardiac electrophysiologists, and cardiac nurses are consolidated to appraise current evidence, offer patient and health system management strategies, and highlight key areas for future research. The statement, pertinent to a wide range of health care professionals, underscores the importance of quality care pathways for patient safety, optimal device function, and minimization of hemodynamic disturbances or arrhythmias during procedures. Our primary objective is to deliver quality care to the expanding patient cohort with cardiac implanted electronic devices, offering direction in the era of evolving technologies and laying a foundation for sustained education and practice enhancement.


Assuntos
American Heart Association , Desfibriladores Implantáveis , Marca-Passo Artificial , Assistência Perioperatória , Humanos , Desfibriladores Implantáveis/normas , Estados Unidos , Assistência Perioperatória/normas , Assistência Perioperatória/métodos , Equipe de Assistência ao Paciente , Arritmias Cardíacas/terapia
11.
J Can Dent Assoc ; 90: 3, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-39052444

RESUMO

Infective endocarditis (IE) remains one of the most serious diseases with a high morbidity and mortality rate. Although the condition is more common in the medical field in a hospital setting, dentists must have a thorough understanding of the overall pathogenesis, epidemiology, risk factors and signs and symptoms that may be present in their patient population. In 2021, the American Heart Association (AHA) updated its guidelines on IE, emphasizing the specific criteria that put a patient at risk of acquiring IE, specific dental procedures that can increase the risk of IE by inducing bacteremia and an antibiotic prophylaxis regimen to act as a preventive measure if needed. This literature review gives the dental practitioner a general overview of the AHA guidelines as well as information on prevention in their at-risk patients and the need to emphasize a well-structured, consistent daily oral hygiene routine.


Assuntos
Endocardite , Guias de Prática Clínica como Assunto , Humanos , Endocardite/epidemiologia , Endocardite/prevenção & controle , Endocardite/etiologia , Fatores de Risco , Antibioticoprofilaxia , American Heart Association , Estados Unidos/epidemiologia , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/prevenção & controle , Endocardite Bacteriana/etiologia
12.
JAMA Netw Open ; 7(7): e2421547, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38995647

RESUMO

This cross-sectional study assesses the generalizability of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions (ACC/AHA/SCAI) guideline by examining the representation of older adults in studies cited in the guideline.


Assuntos
Doença da Artéria Coronariana , Revascularização Miocárdica , Guias de Prática Clínica como Assunto , Humanos , Idoso , Masculino , Feminino , Estados Unidos , Doença da Artéria Coronariana/cirurgia , Revascularização Miocárdica/normas , Revascularização Miocárdica/estatística & dados numéricos , Revascularização Miocárdica/métodos , American Heart Association , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais
13.
Circ Cardiovasc Qual Outcomes ; 17(8): e000131, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38946532

RESUMO

Cardiovascular disease exacts a heavy toll on health and quality of life and is the leading cause of death among people ≥65 years of age. Although medical, surgical, and device therapies can certainly prolong a life span, disease progression from chronic to advanced to end stage is temporally unpredictable, uncertain, and marked by worsening symptoms that result in recurrent hospitalizations and excessive health care use. Compared with other serious illnesses, medication management that incorporates a palliative approach is underused among individuals with cardiovascular disease. This scientific statement describes palliative pharmacotherapy inclusive of cardiovascular drugs and essential palliative medicines that work synergistically to control symptoms and enhance quality of life. We also summarize and clarify available evidence on the utility of guideline-directed and evidence-based medical therapies in individuals with end-stage heart failure, pulmonary arterial hypertension, coronary heart disease, and other cardiomyopathies while providing clinical considerations for de-escalating or deprescribing. Shared decision-making and goal-oriented care are emphasized and considered quintessential to the iterative process of patient-centered medication management across the spectrum of cardiovascular disease.


Assuntos
American Heart Association , Fármacos Cardiovasculares , Doenças Cardiovasculares , Cuidados Paliativos , Qualidade de Vida , Humanos , Fármacos Cardiovasculares/uso terapêutico , Fármacos Cardiovasculares/efeitos adversos , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/diagnóstico , Estados Unidos , Resultado do Tratamento , Consenso , Tomada de Decisão Compartilhada , Tomada de Decisão Clínica
14.
BMC Pregnancy Childbirth ; 24(1): 451, 2024 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-38951766

RESUMO

BACKGROUND: Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes. METHODS: We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120-129 and dBP < 80), stage 1 hypertension (sBP 130-139 or dBP 80-89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group. RESULTS: From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes. CONCLUSION: The ACC/AHA criteria (≥ 130/80) identified additional cases of hypertension but had limited predictive accuracy for stillbirths and preterm births, highlighting the ongoing need for improved criteria in managing pregnancy-related hypertension.


Assuntos
Hipertensão Induzida pela Gravidez , Guias de Prática Clínica como Assunto , Nascimento Prematuro , Natimorto , Humanos , Feminino , Gravidez , Nascimento Prematuro/epidemiologia , Natimorto/epidemiologia , Adulto , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/epidemiologia , Estados Unidos/epidemiologia , Paquistão/epidemiologia , Estudos de Coortes , American Heart Association , Bangladesh/epidemiologia , Tanzânia/epidemiologia , Adulto Jovem , Pressão Sanguínea , Recém-Nascido , Ásia Meridional
15.
BMC Public Health ; 24(1): 1637, 2024 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-38898446

RESUMO

BACKGROUND: People with chronic kidney disease (CKD) are more likely to die prematurely, and this increased risk of death is primarily attributable to deaths from cardiovascular disease (CVD). We aim to investigate the relationship between Life's Essential 8 (LE8), a newly proposed cardiovascular health (CVH) measurement system, and all-cause mortality of CKD patients among US adults. METHODS: A total of 3,169 CKD patients aged 20 and older from the National Health and Nutritional Examination Survey in 2009-2016 were involved in this study. Participants were divided into low (0-49), moderate (50-79) and high (80-100) CVH groups according to LE8 score (range 0-100). The mortality was ascertained from the National Death Index. Cox proportional hazards regression and restricted cubic spline were used to investigate the relationship. RESULTS: Among the 3,169 CKD patients, the median age was 66.0 (25.0) years and 1,671 (52.7%) were female, and the median follow-up time was 6.00 years. The median LE8 score of the study cohort was 57.5 (19.4). CKD patients with low CVH, health behavior (HB) and health factors (HF) scores presented with higher all-cause mortality (both log-rank P-values < 0.001). After adjusted for multiple confounders, patients in higher CVH group had a lower risk of all-cause mortality, with a HR (95%CI) of 0.32 (0.19-0.55). Similar results were observed in high HB group [HR 0.36 (0.25-0.50)]. The restricted cubic spline showed a significant inverse relationship between LE8, HB and HF scores with CKD all-cause mortality, while the protective effect seemed weaker for HF score. Above results remained robust in the sensitivity analysis. Stronger inverse associations were revealed in middle-aged patients and patients with higher education levels. CONCLUSIONS: LE8 and its subscales scores were inversely associated with all-cause mortality in patients with CKD. Promoting CVH in CKD patients is a potential way to improve their long-term survival rate.


Assuntos
Inquéritos Nutricionais , Insuficiência Renal Crônica , Humanos , Feminino , Masculino , Insuficiência Renal Crônica/mortalidade , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Idoso , Adulto , Estudos de Coortes , American Heart Association , Causas de Morte , Doenças Cardiovasculares/mortalidade , Fatores de Risco
16.
Ann Intern Med ; 177(6): JC71, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38830213

RESUMO

SOURCE CITATION: Khan SS, Matsushita K, Sang Y, et al; Chronic Kidney Disease Prognosis Consortium and the American Heart Association Cardiovascular-Kidney-Metabolic Science Advisory Group. Development and validation of the American Heart Association's PREVENT equations. Circulation. 2024;149:430-449. 37947085.


Assuntos
Doenças Cardiovasculares , Humanos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Pessoa de Meia-Idade , Medição de Risco , Idoso , Adulto , Masculino , Feminino , Estados Unidos/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Taxa de Filtração Glomerular , American Heart Association
17.
Am Heart J ; 275: 151-162, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38862074

RESUMO

BACKGROUND: Cardiovascular health literacy (CVHL) and social determinants of health (SDoH) play interconnected and critical roles in shaping cardiovascular health (CVH) outcomes. However, awareness of CVH risk has declined markedly, from 65% of women being aware that cardiovascular disease (CVD) is the leading cause of death for women in 2009 to just 44% being aware in 2019. The American Heart Association Research Goes Red (RGR) initiative seeks to develop an open-source, longitudinal, dynamic registry that will help women to be aware of and participate in research studies, and to learn about CVD prevention. We proposed to leverage this platform, particularly among Black and Hispanic women of reproductive age, to address CVHL gaps and advance health equity. METHODS: The primary objective of the study is to evaluate the cross-sectional association of CVHL, SDoH using a polysocial score, and CVH in women of reproductive age at increased risk of developing hypertension (HTN). To achieve this we will use a cross-sectional study design, that engages women already enrolled in the RGR registry (registry-enrolled). To enhance the racial and ethnic/social economic diversity of the cohort, we will additionally enroll 300 women from the Baltimore and Washington D.C. community into the Social Determinants of the Risk of Hypertension in Women of Reproductive Age (SAFE HEART) Study. Community-enrolled and registry-enrolled women will undergo baseline social phenotyping including detailed SDoH questionnaire, CVH metrics assessment, and CVHL assessment. The secondary objective is to assess whether a 4-month active health education intervention will result in a change in CVHL in the 300 community-enrolled women. DISCUSSION: The SAFE HEART study examines the association between CVHL, SDoH, and CVH, with a focus on racial and ethnic minority groups and socioeconomically disadvantaged women of reproductive age, and the ability to improve these parameters by an educational intervention. These findings will inform the future development of community-engaged strategies that address CVHL and SDoH among women of reproductive age.


Assuntos
American Heart Association , Hipertensão , Determinantes Sociais da Saúde , Humanos , Feminino , Estados Unidos/epidemiologia , Hipertensão/epidemiologia , Hipertensão/etnologia , Adulto , Estudos Transversais , Sistema de Registros , Letramento em Saúde , Fatores de Risco , Hispânico ou Latino/estatística & dados numéricos , Pessoa de Meia-Idade , Adulto Jovem
18.
J Am Heart Assoc ; 13(13): e033879, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38934865

RESUMO

BACKGROUND: Most pretest probability (PTP) tools for obstructive coronary artery disease (CAD) were Western -developed. The most appropriate PTP models and the contribution of coronary artery calcium score (CACS) in Asian populations remain unknown. In a mixed Asian cohort, we compare 5 PTP models: local assessment of the heart (LAH), CAD Consortium (CAD2), risk factor-weighted clinical likelihood, the American Heart Association/American College of Cardiology and the European Society of Cardiology PTP and 3 extended versions of these models that incorporated CACS: LAH(CACS), CAD2(CACS), and the CACS-clinical likelihood. METHODS AND RESULTS: The study cohort included 771 patients referred for stable chest pain. Obstructive CAD prevalence was 27.5%. Calibration, area under the receiver-operating characteristic curves (AUC) and net reclassification index were evaluated. LAH clinical had the best calibration (χ2 5.8; P=0.12). For CACS models, LAH(CACS) showed least deviation between observed and expected cases (χ2 37.5; P<0.001). There was no difference in AUCs between the LAH clinical (AUC, 0.73 [95% CI, 0.69-0.77]), CAD2 clinical (AUC, 0.72 [95% CI, 0.68-0.76]), risk factor-weighted clinical likelihood (AUC, 0.73 [95% CI: 0.69-0.76) and European Society of Cardiology PTP (AUC, 0.71 [95% CI, 0.67-0.75]). CACS improved discrimination and reclassification of the LAH(CACS) (AUC, 0.88; net reclassification index, 0.46), CAD2(CACS) (AUC, 0.87; net reclassification index, 0.29) and CACS-CL (AUC, 0.87; net reclassification index, 0.25). CONCLUSIONS: In a mixed Asian cohort, Asian-derived LAH models had similar discriminatory performance but better calibration and risk categorization for clinically relevant PTP cutoffs. Incorporating CACS improved discrimination and reclassification. These results support the use of population-matched, CACS-inclusive PTP tools for the prediction of obstructive CAD.


Assuntos
Doença da Artéria Coronariana , Guias de Prática Clínica como Assunto , Calcificação Vascular , Humanos , Masculino , Feminino , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/diagnóstico por imagem , Pessoa de Meia-Idade , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/epidemiologia , Calcificação Vascular/diagnóstico , Medição de Risco/métodos , Estados Unidos/epidemiologia , Idoso , American Heart Association , Valor Preditivo dos Testes , Povo Asiático , Fatores de Risco , Angiografia Coronária , Curva ROC , Angiografia por Tomografia Computadorizada , Cardiologia/normas , Prevalência
19.
Radiol Cardiothorac Imaging ; 6(3): e230271, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38842455

RESUMO

Purpose To provide a comprehensive head-to-head comparison and temporal analysis of cardiac MRI indications between the European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines to identify areas of consensus and divergence. Materials and Methods A systematic review and meta-analysis was conducted. ESC and ACC/AHA guidelines published until May 2023 were systematically screened for recommendations related to cardiac MRI. The class of recommendation (COR) and level of evidence (LOE) for cardiac MRI recommendations were compared between the two guidelines and between newer versus older versions of each guideline using χ2 or Fisher exact tests. Results ESC guidelines included 109 recommendations regarding cardiac MRI, and ACC/AHA guidelines included 90 recommendations. The proportion of COR I and LOE B was higher in ACC/AHA versus ESC guidelines (60% [54 of 90] vs 46.8% [51 of 109]; P = .06 and 53% [48 of 90] vs 35.8% [39 of 109], respectively; P = .01). The increase in the number of cardiac MRI recommendations over time was significantly higher in ESC guidelines (from 63 to 109 for ESC vs from 65 to 90 for ACC/AHA; P = .03). The main areas of consensus were found in heart failure and hypertrophic cardiomyopathy, while the main divergences were in valvular heart disease, arrhythmias, and aortic disease. Conclusion ESC guidelines included more recommendations related to cardiac MRI use, whereas the ACC/AHA recommendations had higher COR and LOE. The number of cardiac MRI recommendations increased significantly over time in both guidelines, indicating the increasing role of cardiac MRI evaluation and management of cardiovascular disease. Keywords: Cardiovascular Magnetic Resonance, Guideline, European Society of Cardiology, ESC, American College of Cardiology/American Heart Association, ACC/AHA Supplemental material is available for this article. © RSNA, 2024.


Assuntos
American Heart Association , Imageamento por Ressonância Magnética , Guias de Prática Clínica como Assunto , Humanos , Guias de Prática Clínica como Assunto/normas , Imageamento por Ressonância Magnética/normas , Imageamento por Ressonância Magnética/métodos , Estados Unidos , Europa (Continente) , Cardiologia/normas , Cardiologia/tendências , Cardiopatias/diagnóstico por imagem , Sociedades Médicas
20.
Circ Cardiovasc Qual Outcomes ; 17(7): e010637, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38887950

RESUMO

BACKGROUND: Cardiogenic shock is a morbid complication of heart disease that claims the lives of more than 1 in 3 patients presenting with this syndrome. Supporting a unique collaboration across clinical specialties, federal regulators, payors, and industry, the American Heart Association volunteers and staff have launched a quality improvement registry to better understand the clinical manifestations of shock phenotypes, and to benchmark the management patterns, and outcomes of patients presenting with cardiogenic shock to hospitals across the United States. METHODS: Participating hospitals will enroll consecutive hospitalized patients with cardiogenic shock, regardless of etiology or severity. Data are collected through individual reviews of medical records of sequential adult patients with cardiogenic shock. The electronic case record form was collaboratively designed with a core minimum data structure and aligned with Shock Academic Research Consortium definitions. This registry will allow participating health systems to evaluate patient-level data including diagnostic approaches, therapeutics, use of advanced monitoring and circulatory support, processes of care, complications, and in-hospital survival. Participating sites can leverage these data for onsite monitoring of outcomes and benchmarking versus other institutions. The registry was concomitantly designed to provide a high-quality longitudinal research infrastructure for pragmatic randomized trials as well as translational, clinical, and implementation research. An aggregate deidentified data set will be made available to the research community on the American Heart Association's Precision Medicine Platform. On March 31, 2022, the American Heart Association Cardiogenic Shock Registry received its first clinical records. At the time of this submission, 100 centers are participating. CONCLUSIONS: The American Heart Association Cardiogenic Shock Registry will serve as a resource using consistent data structure and definitions for the medical and research community to accelerate scientific advancement through shared learning and research resulting in improved quality of care and outcomes of shock patients.


Assuntos
American Heart Association , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Sistema de Registros , Choque Cardiogênico , Humanos , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/terapia , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/etiologia , Estados Unidos , Resultado do Tratamento , Benchmarking , Projetos de Pesquisa , Fatores de Tempo , Registros Eletrônicos de Saúde , Desenvolvimento de Programas , Mortalidade Hospitalar
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