BACKGROUND:Left bundle branch block (LBBB) and right ventricular pacing (RVP) are associated with abnormal myocardial mechanics and cardiomyopathy. Consequently, chronic LBBB may increase the risk of heart failure and mortality in patients undergoing RVP. METHODS:Using the TriNetX Analytics Network database, we identified patients who underwent pacemaker implantation between January 1, 2014 and January 1, 2024. Exclusion criteria included a history of heart failure, previous cardiac devices, cardiac resynchronization therapy (CRT) during the index hospitalization, or a left ventricular ejection fraction (LVEF) of less than 50%. The primary outcome incident systolic heart failure and all-cause mortality occurring from the index hospitalization through November 2024. RESULTS:Among 70,526 patients undergoing RVP implantation, 3916 (5.6%) had chronic LBBB prior to the procedure, with a median age of 75 ± 15 years. Over a median follow-up of 2.5 years, 5356 (7.6%) developed incident systolic heart failure, and 9714 (13.7%) experienced all-cause mortality. After propensity score matching, chronic LBBB was associated with a higher risk of systolic heart failure (HR: 1.39; 95% CI: 1.20-1.62) but not all-cause mortality (HR: 0.93; 95% CI: 0.83-1.06). Patients with chronic LBBB who developed systolic heart failure were more likely to present with moderately depressed LVEF and require CRT upgrades during follow-up compared to those without chronic LBBB. CONCLUSION:Chronic LBBB was associated with a higher risk of systolic heart failure, worse left ventricular function, and greater likelihood of CRT upgrade among patients undergoing RVP.

Aim: Coronary heart disease (CHD) increases the risk of adverse outcomes from invasive pneumococcal disease. Methods: Using the 2020 and 2021 data from the national health interview survey, we identified adults with CHD. Chi-square analysis and logistic regression were used to examine factors that influence vaccination status. Results: There were 2675 participants aged 41 and above with CHD. Participants were predominantly white people (82.5%) and males (60.1%). The odds of receiving the pneumococcal vaccine increased with stepwise increase in comorbidities from 1 to 2 and from 2 to 3. Among individuals with ≥2 comorbidities, black people were less likely to be vaccinated compared with white people. Conclusion: Pneumococcal vaccine uptake among adults with CHD is determined by cumulative comorbidities and ethnicity.

BACKGROUND The use of Mechanical Circulatory Support (including Left ventricular assist devices) in patients with advanced Heart failure as a bridge-to-transplant or as a destination therapy has been linked to clinically significant 1- and 2- year survival rates. This study examines the trends of racial differences in the use of mechanical circulatory support devices (MCS) as well as some in-hospital outcomes. METHODS We identified all patients with Mechanical Circulatory Support (including Left ventricular assist devices) using ICD 10 codes from the national inpatient sample of the Health Care Utilization Project database, years 2016 - 2020. We classified our population into subgroups based on RACE (white, blacks, Hispanics and Asians). Using the chi-square test, we compared the differences in baseline characteristics amongst the racial subgroups and further used multivariate logistic regression to identify outcomes. RESULTS We observed about 95,430 patients with MCS. 73.2% were Whites, 14.3% Blacks, 9.4% Hispanics and 3.1% Asians and of these, Blacks were noted to have a younger mean age of 57 years. The population was composed highly of males than females across all races. AKI (64.1%), anemia (64.9%), obesity (21.33%) and OSA (13.0%), were all reported to be more common in Blacks than in other racial groups. Whites had greater rates of hypertension (14.9%) and nicotine use (25.8%) while Asians had higher rates of dyslipidemia (54.4%). Hispanics had higher rates of Diabetes (14.4%). Our black population had higher rates of cardiogenic shock (aOR: 0.88; 0.78 - 0.99, p=0.033), significantly longer mean length of stay (24.7 days vs 14.5 days, p<0.001) and higher hospital costs incurred ($750,083 vs $517,196, p<0.001) when compared to other racial groups. The most important independent predictor for the utilization of MCS was cardiogenic shock (aOR: 30.67; CI: 28.8 - 32.67, p<0.001); Asians (3.52%), Hispanics (2.58%) and blacks (2.20%) had higher rates than whites (2.13%). Between 2017 and 2020, Whites had the highest rates of Mechanical Circulatory support usage, with 0.78 per 1000 patients in 2020. Asians had the second highest usage rate with 0.69 per 1000 patients in 2020, while Blacks and Hispanics had lower but similar and stable rates during this period. CONCLUSION Despite having higher rates of cardiogenic shock (which is the independent predictor of MCS utilization) Blacks, Hispanics and Asians had lesser rates of MCS utilization. The findings from out study suggests that racial disparities persist in the use and outcomes of MCS, and efforts should be made to address these disparities and improve the care of patients with advanced heart failure across all racial groups.

Androgen deprivation therapy is the cornerstone of systemic management for prostate cancer but is associated with multiple adverse effects that must be considered during treatment. These effects occur because of the profound hypogonadism that is induced from lack of testosterone or due to the medications used in the treatment or in combination with androgen receptor signaling inhibitors. This article critically reviews the associations between androgen deprivation therapy, androgen receptor signaling inhibitors, and cardiovascular complications such as prolonged QT interval, atrial fibrillation, heart failure, atherosclerosis, coronary heart disease, venous thromboembolism, and peripheral arterial occlusive disease. These unfavorable outcomes reinforce the need for regular cardiovascular screening of patients undergoing androgen deprivation for the management of prostate cancer.

Introduction: Cardiac arrest (CA) has been linked with worse outcomes in patients with chronic medical conditions such as chronic obstructive pulmonary disease, chronic kidney disease, diabetes mellitus, hypertension, and coronary artery disease. Autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) have been linked to increased risk of cardiovascular diseases, but their effect on the outcome of CA is not well studied. Aim: This study aimed to evaluate the effect of SLE and RA on the outcomes of admitted CA patients. Methodology: We identified all adult CA hospitalizations in the US between 2016 and 2020 using the National Inpatient Sample database and categorized them based on RA and SLE diagnoses. We applied logistic regression analysis to study the effects of SLE or RA diagnosis on CA outcomes, with a p-value threshold of 0.01. Results: A total of 1,099,235 adults were admitted with CA between 2016 to 2020. There were 5745 and 16920 patients with SLE and RA diagnoses among CA hospitalizations, respectively. Among CA patients, the mean age was 54.4 vs. 70.5 years among SLE and RA groups. CA patients with SLE diagnosis had 18% higher odds of in-hospital mortality (OR: 1.18 [1.04-1.34]; p=0.008), similar to those with RA diagnosis (OR:1.16 [1.08-1.24]; p<0.001) when compared to those without SLE or RA. Unlike RA, the SLE effect persisted (AOR:1.44 [1.26-1.64]; p< 0.001) after adjusting for sociodemographic factors (such as age and sex) and other co-morbidities (for RA, AOR: 1.09 [1.01-1.18]; p=0.023). Further analysis to determine if this reported mortality effect of SLE on CA patients is explainable by a general SLE mortality revealed that the interaction of SLE and CA is associated with higher mortality in the broader adult patient population, independent of CA or SLE alone (OR:1.52 [1.34-1.71]; P<0.001). This synergistic effect persisted after controlling for comorbidities and sociodemographic factors (AOR: 1.9 [1.66-2.27]; p< 0.001). RA or SLE diagnosis were not associated with acute heart failure, cardiogenic shock, and acute kidney injury outcomes in CA patients. Conclusion: Our findings suggest an adverse clinical interaction between SLE and CA that is independent of CA or SLE alone, and also independent of other comorbidities and sociodemographic factors. More research is needed to further explore the potential mechanisms involved.

Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting between 3 and 6 million people in the United States. It is associated with a reduced quality of life and increased risk of stroke, cognitive decline, heart failure and death. Black patients have a lower prevalence of AF than White patients but are more likely to suffer worse outcomes with the disease. It is important that stakeholders understand the disproportionate burden of disease and management gaps that exists among Black patients living with AF. Appropriate treatments, including aggressive risk factor control, early referral to cardiovascular specialists and improving healthcare access may bridge some of the gaps in management and improve outcomes.

Background: Racial and socioeconomic disparities in healthcare access are well-documented. Minority and rural populations face barriers and often have limited access to healthcare services and facilities. Digital health solutions can help bridge these gaps. Previous studies examining digital health usage patterns have reported mixed findings, with some showing lower adoption among minority/underserved groups and others finding no significant differences compared to the general population. Hypothesis: Minority and rural patients would participate in the digital health intervention at similar rates as non-minority, affluent patients when provided with equal access to cardiologist and device training. Aims: To analyze the variance in usage of digital health products between underserved and general patient populations. Methods: The 5,000-patient clinic serves a population of underserved minority and affluent non-minority patients. All patients were offered cellular-enabled blood pressure cuffs and weight scales that transmitted data automatically to a physician portal as part of routine care. Patients consented to have their data used for research and were instructed to use these devices > 4 times per week for six months, with periodic reminders from clinic staff. Patient participation was tracked, and digital records were analyzed. Results: Demographic information of enrolled patients (n=18) is reported (Figure 1). There was an overall 90% retention rate throughout the six-month study period, including 90% retention from African American patients, 87.5% from indigent patients, and 100% from both rural and inner-city residents. Conclusion: With a modest sample size, this data suggested that minority and rural populations may participate in digital health and remote patient monitoring interventions at the same rate as the general population of patients. This study supports the growing potential of digital health to improve healthcare access for minority and rural communities.

Myocarditis is a potentially fatal medical condition with varied etiologies. Peripartum cardiomyopathy (PPCM) refers to systolic dysfunction occurring toward the end of pregnancy or in the months following delivery; it is a diagnosis of exclusion. We present a patient with chest pain, bipedal edema, markedly elevated troponins, electrocardiogram (EKG) findings that were concerning for myocardial infarction, and a significantly reduced left ventricular ejection fraction (LVEF) on the echocardiogram. The patient's presentation in the postpartum period closely resembled peripartum cardiomyopathy and presented a peculiar diagnostic challenge to our team. The right diagnosis was possible with cardiac magnetic resonance imaging, which revealed late gadolinium enhancement. Additionally, the patient had positive Coxsackie B5 and Epstein Bar virus serologies. While the clinical course of the disease is often benign, it could rapidly deteriorate, so early recognition and diagnosis are important to ensure patients receive adequate therapeutic support.

Background Recent literature has not studied current hospitalization trends among patients with alcohol-induced cardiomyopathy (AC) and end-stage heart failure (ACend). We sought to analyze the recent trends in this population. Hypothesis Studying recent hospitalization trends and outcomes among the ACend population will facilitate understanding the current disease trends. Methods We retrospectively analyzed the Nationwide Inpatient Sample (NIS) from 2016 through 2020. We used the International Classification of Disease-10th edition-Clinical Modification (ICD-10) codes for AC (I426) and end-stage heart failure to identify our population of interest. Results Of the 34955252 hospitalizations during the study period, 21182 (0.06%) had a diagnosis of AC. The AC group had 33.4% of the population with end-stage heart failure (ACend). The trend in AC hospitalization slightly increased during the 2020 pandemic, 0.04% in 2019 vs. 0.05% in 2020 (p<0.001). Males had a higher prevalence of ACed (87.6%). However, there was no statistical difference in the hospitalization rate trend by gender; females increased from 16% in 2016 to 21.6% in 2020, while males increased from 14.4% in 2016 to 21.9% (p=0.26). The mean age and LOS increased during the study period, from 56.6 years (SD=11.8) in 2016 to 56.8 (SD=12.5) and 7.2 days (SD=7.5) in 2016 to 7.5 days (SD=8.8) in 2020. However, there were no trend differences in hospitalization rates among races (Caucasians, Blacks, Hispanics, Asians, and Native Americans) (p=0.1). The in-hospital mortality rose from 3.9% in 2016 to 4.7% in 2020 (p<0.02). Approximately 34% of the ACend had concomitant atrial fibrillation (AFIB), and 5.8% had a history of myocardial infarction (MI). Conclusion A high proportion of the patients hospitalized for AC had end-stage heart failure, with the middle-aged population being the most affected. There was a steady rise in the in-hospital mortality rate among the subgroup with end-stage HF. However, there was no difference in the trend of hospitalization rates between sex or race. Continued alcohol consumption and the high prevalence of AFIB may antagonize efforts at heart failure management. More studies are warranted in this area.

BACKGROUND Ventricular arrhythmias (VAs) are a common cause of death in patients with acute myocardial infarction (AMI). Studies have shown sex differences in the incidence, presentation, and outcomes of AMI. However, less is known about sex differences in patients with AMI who develop VAs. OBJECTIVES The authors assessed sex differences in incidence and in-hospital outcomes of patients with AMI and VAs. METHODS Using the National Inpatient Sample 2016 to 2020, we conducted a retrospective analysis of patients admitted for AMI with a secondary diagnosis of VAs. Multivariable logistic regression was performed to estimate the sex-specific differences in the rates and in-hospital outcomes of VAs post-AMI. RESULTS We identified 1,543,140 patients admitted with AMI. Of these, (11.3%) 174,565 patients had VAs after AMI. The odds of VAs after AMI were higher among men (12.6% vs 8.8% adjusted odds ratio [AOR]: 1.72; CI: 1.67-1.78; P < 0.001). Women had significantly higher odds of in-hospital mortality (AOR: 1.32; CI: 1.21-1.42; P < 0.001), cardiogenic shock (AOR: 1.08; CI: 1.01-1.15; P < 0.022), and cardiac arrest (AOR: 1.11; CI: 1.03-1.18; P < 0.002). Women were less likely to receive an implantable cardioverter-defibrillator (ICD) (AOR: 0.57; CI: 0.47-0.68; P < 0.001) or undergo catheter ablation (AOR: 0.51; CI: 0.27-0.98; P < 0.001) during the index admission. CONCLUSIONS We found important sex differences in the incidence and outcomes of VAs among patients with AMI. Women had lower odds of VAs but worse hospital outcomes overall. In addition, women were less likely to receive ICD. Further studies to address these sex disparities are needed. (JACC Adv 2024;3:101042) (c) 2024 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction: Preeclampsia occurs in about 5-8% of pregnancies and is a leading cause of maternal morbidity and mortality. We aimed to study the inpatient population with preeclampsia. Hypothesis: The disparity gap remains apparent in maternal health, and minority populations would have poorer outcomes Methods: We conducted a retrospective analysis using the 2016 to 2020 Nationwide Inpatient Sample (NIS) database. Using ICD-10 codes, we identified all hospitalizations with a primary diagnosis of preeclampsia. We adjusted for confounders and used a multivariate logistic regression model to estimate the odds ratio (adjusted odds ratios (aOR)) of our outcomes of interest. Results: There were 126,255 primary preeclampsia hospitalizations (PRE) during the study period, of which 2.2% (2,736) had eclampsia (ECL). There was an increase in the number of PRE hospitalizations from 24459 (24.5 per 1000 deliveries) in 2016 to 28448 (28.4 per 1000 pregnancies) in 2020 (p <0.0001). Contrary to PRE admissions, there was a considerable decrease in hospitalizations or diagnoses for ECL from 958 (1 per 1000 deliveries) in 2016 to 417 (0.4 per 1000 deliveries) in 2020 (p<0.0001). The mean age was 29 years (SD=6.3), and the mean length of hospitalization was 4 days (SD=3.6). Compared to their Caucasian counterparts, the risk of eclampsia was higher in the minority populations, with aOR of 2.4 (CI 2.1-2.6, p<0.0001) in the Black, 1.3 (CI 1.1-1.4, p<0.0001) in the Hispanic, 1.01 (CI 0.8-1.3, p=0.7) in the Asian, and 1.7 (CI 1.1-2.4, p<0.0001) in the Native-American populations. Furthermore, the PRE group had a higher likelihood of postpartum acute kidney injury, 9.6 (CI 7.8-11.6, p<0.0001), and postpartum cardiomyopathy 3.3 (2.9-3.9, p<0.0001). Conclusions: Our five-year inpatient analysis revealed that while preeclampsia hospitalizations increased, eclampsia decreased. It also highlighted a higher likelihood of eclampsia in Black, Hispanic, and Native-American women and a subsequent increased risk for postpartum cardiomyopathy and acute kidney injury. Tailoring individualized maternal cardiovascular care based on risk stratification is crucial in these populations.

Introduction: Endovascular revascularization is becoming the mainstay management of peripheral vascular disease (PVD). Our study seeks to find out the impact of racial disparity on the outcome of this procedure. Methods: We queried the National Inpatient Sample (NIS) database from 2016 to 2019. The NIS is the largest all-payer inpatient healthcare database in the United States. The NIS was searched for hospitalization of adult patients with PVD who had endovascular revascularization, using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Following Propensity score matching, we assessed for a primary outcome of inpatient mortality. The secondary results were acute kidney injury (AKI), amputation, cardiac arrest, cardiogenic shock, total hospital charge (THC), and length of stay (LOS). Results: About 395,510 patients with PVD had endovascular revascularization; 322,015 patients who had the procedure were either White (n=254,840, 79.1%) or Black (n=67,175, 20.9%). White patients had a mean age of 69.2±0.1 years compared to 64.9±0.1 years in Black patients (males: 61.1% versus 53.4%; females: 38.9% versus 46.6%). Compared to White patients, Blacks had significantly lower in-hospital mortality (2.2% versus 2.6%; p=0.005) and cardiogenic shock (0.9% vs 1.2%; p=0.004); however, they had significantly higher AKI (21.6% vs 19.0% p-value 0.015), amputations (7.6% vs 4.4% p-value <0.001), and LOS (10.1 vs 7.5; p-value <0.001) compared to Whites. Conclusions: This study showed that compared to Whites, Black patients were more predisposed to amputations, AKI, and higher LOS despite having a lower mortality rate after endovascular revascularization.