Sex and racial disparities in non-alcoholic fatty liver disease-related cardiovascular events: National inpatient sample analysis (2019).

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) increases cardiovascular disease (CVD) risk irrespective of other risk factors. However, large-scale cardiovascular sex and race differences are poorly understood. AIM: To investigate the relationship between NAFLD and major cardiovascular and cerebrovascular events (MACCE) in subgroups using a nationally representative United States inpatient sample. METHODS: We examined National Inpatient Sample (2019) to identify adult hospitalizations with NAFLD by age, sex, and race using ICD-10-CM codes. Clinical and demographic characteristics, comorbidities, and MACCE-related mortality, acute myocardial infarction (AMI), cardiac arrest, and stroke were compared in NAFLD cohorts by sex and race. Multivariable regression analyses were adjusted for sociodemographic characteristics, hospitalization features, and comorbidities. RESULTS: We examined 409130 hospitalizations [median 55 (IQR 43-66) years] with NFALD. NAFLD was more common in females (1.2%), Hispanics (2%), and Native Americans (1.9%) than whites. Females often reported non-elective admissions, Medicare enrolment, the median age of 55 (IQR 42-67), and poor income. Females had higher obesity and uncomplicated diabetes but lower hypertension, hyperlipidemia, and complicated diabetes than males. Hispanics had a median age of 48 (IQR 37-60), were Medicaid enrollees, and had non-elective admissions. Hispanics had greater diabetes and obesity rates than whites but lower hypertension and hyperlipidemia. MACCE, all-cause mortality, AMI, cardiac arrest, and stroke were all greater in elderly individuals (P < 0.001). MACCE, AMI, and cardiac arrest were more common in men (P < 0.001). Native Americans (aOR 1.64) and Asian Pacific Islanders (aOR 1.18) had higher all-cause death risks than whites. CONCLUSION: Increasing age and male sex link NAFLD with adverse MACCE outcomes; Native Americans and Asian Pacific Islanders face higher mortality, highlighting a need for tailored interventions and care.

Major Adverse Cardiac and Cerebrovascular Events in Geriatric Patients with Obstructive Sleep Apnea: An Inpatient Sample Analysis.

BACKGROUND: Obstructive sleep apnea (OSA) is associated with an increased risk of major cardiac and cerebrovascular events (MACCE). However, data on the burden and predictors of MACCE in geriatric patients with OSA (G-OSA) remain limited. METHODS: Using the National Inpatient Sample from 2018, we identified G-OSA admissions (age ≥ 65 years) and divided them into non-MACCE vs. MACCE (all-cause mortality, stroke, acute myocardial infarction, and cardiac arrest). We compared the demographics and comorbidities in both cohorts and extracted the odds ratio (multivariate analysis) of MACCE and associated in-hospital mortality. RESULTS: Out of 1,141,120 geriatric obstructive sleep apnea G-OSA admissions, 9.9% (113,295) had MACCE. Males, Asians, or the Pacific Islander/Native American race, and patients from the lowest income quartile revealed a higher MACCE rate. Significant clinical predictors of MACCE in elderly OSA patients on multivariable regression analysis in decreasing odds were pulmonary circulation disease (OR 1.47, 95% CI 1.31-1.66), coagulopathy (OR 1.43, 95% CI 1.35-1.50), peripheral vascular disease (OR 1.34, 95% CI 1.28-1.40), prior sudden cardiac arrest (OR 1.34, 95% CI 1.11-1.62), prior myocardial infarction (OR 1.27, 95% CI 1.22-1.33), fluid and electrolyte imbalances (OR 1.25, 95% CI 1.20-1.29), male sex (OR 1.22, 95% CI-1.18-1.26), hyperlipidemia (OR 1.20, 95% CI 1.16-1.24), low household income (OR 1.19, CI 1.13-1.26), renal failure (OR 1.15, 95% CI 1.12-1.19), diabetes (OR 1.14, 95% CI 1.10-1.17), metastatic cancer (OR 1.14, 95% CI 1.03-1.25), and prior stroke or TIA (OR 1.12, 95% CI 1.07-1.17) (All p value < 0.05). CONCLUSIONS: This study emphasizes the significant association between obstructive sleep apnea (OSA) and major cardiac and cerebrovascular events (MACCE) in the geriatric population. Among the elderly OSA patients, a substantial 9.9% were found to have MACCE, with specific demographics like males, Asian or Pacific Islander/Native American individuals, and those from the lowest income quartile being particularly vulnerable. The study sheds light on several significant clinical predictors, with pulmonary circulation disease, coagulopathy, and peripheral vascular disease topping the list. The highlighted predictors provide valuable insights for clinicians, allowing for better risk stratification and targeted interventions in this vulnerable patient cohort. Further research is essential to validate these findings and inform how tailored therapeutic approaches for geriatric OSA patients can mitigate MACCE risk. CLINICAL IMPLICATIONS: Elderly individuals with a high risk for MACCE should undergo routine OSA screening using tools like the sensitive STOP-BANG Questionnaire. Implementing CPAP treatment can enhance cardiovascular outcomes in these patients.

Predicting Risk of Cardiac Arrest in Young Asian Americans: Insights from an Artificial Neural Network Analysis of the Nationwide Cohort.

We used the Artificial Neural Network (ANN) model to identify predictors of Sudden Cardiac Arrest (SCA) in a national cohort of young Asian patients in the United States. The National Inpatient Sample (2019) was used to identify young Asians (18-44-year-old) who were hospitalized with SCA. The neural network's predicted criteria for SCA were selected. After eliminating missing data, young Asians (n = 65,413) were randomly divided into training (n = 45,094) and testing (n = 19347) groups. Training data (70%) was used to calibrate ANN while testing data (30%) was utilized to assess the algorithm's accuracy. To determine ANN's performance in predicting SCA, we compared the frequency of incorrect prediction between training and testing data and measured the area under the Receiver Operating Curve (AUC). The 2019 young Asian cohort had 327,065 admissions (median age 32 years; 84.2% female), with SCA accounting for 0.21%. The exact rate of error in predictions vs. tests was shown by training data (0.2% vs 0.2%). In descending order, the normalized importance of predictors to accurately predict SCA in young adults included prior history of cardiac arrest, sex, age, diabetes, anxiety disorders, prior coronary artery bypass grafting, hypertension, congenital heart disease, income, peripheral vascular disease, and cancer. The AUC was 0.821, indicating an excellent ANN model for SCA prediction. Our ANN models performed excellently in revealing the order of important predictors of SCA in young Asian American patients. These findings could have a considerable impact on clinical practice to develop risk prediction models to improve the survival outcome in high-risk patients.

Recurrent/Subsequent Stroke and Associated Outcomes in Geriatric Patients with OSA and Prior Stroke Events: A Retrospective Study Using the 2019 National Inpatient Sample.

Background: Obstructive sleep apnea (OSA) increases the risk of stroke and cardiovascular diseases. However, its impact on geriatric patients with a prior history of stroke/transient ischemic attack (TIA) has not been adequately studied. Methods: We utilized the 2019 National Inpatient Sample in the US to identify geriatric patients with OSA (G-OSA) who had a prior history of stroke/TIA. We then compared subsequent stroke (SS) rates among sex and race subgroups. We also compared the demographics and comorbidities of SS+ and SS- groups and utilized logistic regression models to assess outcomes. Results: Out of 133,545 G-OSA patients admitted with a prior history of stroke/TIA, 4.9% (6520) had SS. Males had a higher prevalence of SS, while Asian-Pacific Islanders and Native Americans had the highest prevalence of SS, followed by Whites, Blacks, and Hispanics. The SS+ group had higher all-cause in-hospital mortality rates, with Hispanics showing the highest rate compared to Whites and Blacks (10.6% vs. 4.9% vs. 4.4%, p < 0.001), respectively. Adjusted analysis for covariates showed that complicated and uncomplicated hypertension (aOR 2.17 [95% CI 1.78-2.64]; 3.18 [95% CI 2.58-3.92]), diabetes with chronic complications (aOR 1.28 [95% CI 1.08-1.51]), hyperlipidemia (aOR 1.24 [95% CI 1.08-1.43]), and thyroid disorders (aOR 1.69 [95% CI 1.14-2.49]) were independent predictors of SS. The SS+ group had fewer routine discharges and higher healthcare costs. Conclusions: Our study shows that about 5% of G-OSA patients with a prior history of stroke/TIA are at risk of hospitalization due to SS, which is associated with higher mortality and healthcare utilization. Complicated and uncomplicated hypertension, diabetes with chronic complications, hyperlipidemia, thyroid disorders, and admission to rural hospitals predict subsequent stroke.

Epidemiology of out-of-Hospital Cardiac Arrests, knowledge of cardiovascular disease and risk factors in a regional setting in India: The Warangal Area out-of-hospital Cardiac Arrest Registry (WACAR).

OBJECTIVE: Out-of-Hospital Cardiac Arrest (OHCA) is a global public health problem. There is inadequate data on OHCA in India. The Warangal Area out-of-hospital Cardiac Arrest Registry (WACAR) was planned to understand OHCA in a regional setting in India. METHODS: WACAR is a prospective one-year observational cohort study of OHCA in the Warangal area, Telangana, India. The study included 814 subjects of OHCA of presumed cardiac etiology brought to the Mahatma Gandhi Memorial Hospital during January 1, 2018, and December 31, 2018. The data collected included; standard Utstein variables with additional data on clinical characteristics (modified Utstein template). RESULTS: The majority of OHCA subjects were male with a median age of 60 years, and mostly occurring in residential locations within 1 h of onset of symptoms. Individuals with knowledge of CVD risk factors were more likely to report symptoms before OHCA. Data on resuscitation characteristics were inadequate. CONCLUSIONS: The WACAR study provides baseline data regarding OHCA in a regional setting in India. The study demonstrated barriers involving data collection, patient knowledge of CVD risk factors and disease, and access to healthcare, which; impacted the data registry.