Male-female differences following concomitant coronary artery bypass grafting and aortic valve replacement surgery.

AIMS: Combined coronary artery bypass grafting (CABG) and aortic valve replacement (AVR), and female sex are associated with increased perioperative mortality in clinical risk scores. This study investigated male-female differences in short-term outcome stratified by age groups. METHODS AND RESULTS: All patients undergoing AVR and CABG between January 2001 and June 2021 at our institution were included. 1963 patients were grouped by decades into: 59 years and younger (n = 127), 60-69 (n = 471), 70-79 (n = 1070), and 80 years and older (n = 295). The primary end points of this study were 30 and 180 days mortality. Secondary end points were influence of preoperative risk factors and impact of sex on survival and postoperative major adverse events. Female patients showed higher 30 and 180 days mortality after combined CABG and AVR surgery (8.3% vs. 4.2%, P < 0.01; 15.8% vs. 9.4%, P < 0.01). Stratified by age groups, 30 and 180 days mortality remained significantly higher in septuagenarians (9.6% vs. 2.5%, P < 0.01; 16.3% vs. 7.7%, P < 0.01). Females were significantly older, had better preserved left ventricular function, and higher incidence of diabetes mellitus compared with male patients in this subgroup (P < 0.01; P = 0.01; P < 0.01). Additionally, females received significantly less internal mammary artery (IMA) conduits (P < 0.01). Female sex (OR: 3.33, 95% CI: [1.76-6.31]; 1.93, [1.22-3.06]), higher age (1.28, [1.13-1.45]; 1.16, [1.06-1.26]), diabetes mellitus (1.93, [1.03-3.60]; 1.70, [1.08-2.67]) and LVEF <30% (3.26, [1.48-7.17]; 2.23, [1.24-4.02]) were correlated with 30 and 180 days mortality, respectively. Upon multivariable testing, sex (1.77, [1.21-2.58]) and LVEF <30% (3.71, [2.39-5.76]) remained independent predictors for major adverse postoperative events. Infrequent use of IMA grafts was associated with increased 30 and 180 days mortality as well as adverse events (0.47, [0.25-0.87]; 0.46, [0.29-0.72]; 0.61, [0.42-0.88]). CONCLUSIONS: Sex disparities in baseline characteristics may delay operative intervention in female patients. The inherent risk profiles might be responsible for outcome differences in septuagenarians.

Determinants of COVID-19 vaccine fatigue.

There is growing concern that Coronavirus Disease 2019 (COVID-19) vaccine fatigue will be a major obstacle in maintaining immunity in the general population. In this study, we assessed vaccine acceptance in future scenarios in two conjoint experiments, investigating determinants such as new vaccines, communication, costs/incentives and legal rules. The experiments were embedded in an online survey (n = 6,357 participants) conducted in two European countries (Austria and Italy). Our results suggest that vaccination campaigns should be tailored to subgroups based on their vaccination status. Among the unvaccinated, campaign messages conveying community spirit had a positive effect (0.343, confidence interval (CI) 0.019-0.666), whereas offering positive incentives, such as a cash reward (0.722, CI 0.429-1.014) or voucher (0.670, CI 0.373-0.967), was pivotal to the decision-making of those vaccinated once or twice. Among the triple vaccinated, vaccination readiness increased when adapted vaccines were offered (0.279, CI 0.182-0.377), but costs (-0.795, CI -0.935 to -0.654) and medical dissensus (-0.161, CI -0.293 to -0.030) reduced their likelihood to get vaccinated. We conclude that failing to mobilize the triple vaccinated is likely to result in booster vaccination rates falling short of expectations. For long-term success, measures fostering institutional trust should be considered. These results provide guidance to those responsible for future COVID-19 vaccination campaigns.

Coronavirus vaccine hesitancy among unvaccinated Austrians: Assessing underlying motivations and the effectiveness of interventions based on a cross-sectional survey with two embedded conjoint experiments.

Background: To date, Austria is among the countries with the lowest coronavirus vaccination rates in Western Europe. It has announced the introduction of a general vaccine mandate but is experiencing an increasing societal polarization over this issue. We, therefore, aimed to provide evidence on the underlying motivations of vaccine hesitancy and evaluate what kinds of interventions - information, incentives, and rules - might increase vaccination readiness. Method: We conducted a cross-sectional survey with a sample of 1,543 unvaccinated Austrian residents in October 2021, including two embedded conjoint experiments. Findings: We screened 8,190 individuals to recruit the sample matching the Austrian micro-census. In experiment 1, easing rather than tightening of societal restrictions, a fixed monetary reward compared to a lottery and physicians' recommendations were associated with significantly higher intentions to get vaccinated. In experiment 2, standard approval by European or national authorities and simple information had a significant positive effect on vaccination propensity. Among the unvaccinated, fear of side effects, beliefs that comorbidities or the desire to have children would not allow vaccination, the assumption that the own immune system would provide sufficient protection, conspirational thinking (e.g., the refusal to participate in a 'large genetic experiment'), low trust in societal institutions, and spiritual beliefs were very common. Interpretation: While many unvaccinated showed a low propensity to become vaccinated, we identified a cluster of 195 (23% of the participants without missing values) that could potentially be reached by information and incentives, including people with heightened comorbidity rates or a desire for children. Funding: Vienna Science and Technology Fund.

Policy-Relevant Attitudes Toward COVID-19 Vaccination: Associations With Demography, Health Risk, and Social and Political Factors.

Background: Vaccination is considered to be a key public health intervention to end the COVID-19 pandemic. Yet, the success of the intervention is contingent on attitudes toward vaccination and the design of vaccination policies. Methods: We conduct cross-sectional analyses of policy-relevant attitudes toward COVID-19 vaccination using survey data of a representative sample of Austrian residents collected by the Austrian Corona Panel Project (ACPP). As outcomes, we examine the individual readiness to get vaccinated, the support for compulsory vaccinations, and the preference for making the vaccine available free of charge. The independent variables include demographics, objective and perceived health risks, and social and political factors. Results: Although there is broad public support for making the vaccine available free of charge, vaccine hesitancy and the opposition to a vaccine mandate are widespread. The protective function of the vaccine for the individual only motivates limited support for vaccinations. Opposition to COVID-19 vaccination also stems from a lack of sense of community and an ongoing politicization of the issue through conspiracy theories and party politics. Conclusion: We propose that overcoming the inherent free-rider problem of achieving sufficiently high vaccination rates poses a potential dilemma for policymakers: Given the politicized nature of the issue, they may find themselves having to choose between making vaccinations compulsory at political costs and a lingering pandemic at high costs for public health and the economy. We propose that promoting a sense of community and addressing potential practical constraints will be key in designing an effective COVID-19 vaccination policy.