European Society of Cardiology: Cardiovascular Disease Statistics 2019

Aims The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. Methods and results In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5–23.1%] vs. 15.7% (IQR 14.5–21.1%)}, diabetes [7.7% (IQR 7.1–10.1%) vs. 5.6% (IQR 4.8–7.0%)], and among males smoking [43.8% (IQR 37.4–48.0%) vs. 26.0% (IQR 20.9–31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0–10.8) vs. 16.7% (IQR 13.9–19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655–8115)] compared with high-income [2235 (IQR 1896–3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. Conclusion A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest

Cardiac transplantation and donation in Icelandic patients - indications and outcome

INNGANGUR Upplýsingar skortir um fjölda, ábendingar og árangur hjartaígræðsluaðgerða á Íslendingum en einnig fjölda þeirra hjartna sem gefin hafa verið héðan til líffæraígræðslu erlendis. EFNIVIÐUR OG AÐFERÐIR Afturskyggn rannsókn á öllum sem gengust undir hjartaígræðslu frá fyrstu aðgerðinni 1988 til 1. mars 2019. Klínískar upplýsingar fengust frá ígræðslugöngudeild Landspítala og rafrænni sjúkraskrá, en upplýsingar um hjartagjafir á Íslandi úr líffæragjafaskrá gjörgæsludeildar Landspítala. Reiknað var út aldursstaðlað nýgengi aðgerðarinnar og lifun reiknuð með aðferð Kaplan-Meier. Meðaleftirfylgd var 10,3 ár. NIÐURSTÖÐUR Alls gengust 24 Íslendingar (19 karlar) undir hjartaígræðslu á tímabilinu, þar af einn undir endurígræðslu, þrír fengu hjarta- og lungnaígræði samtímis og tveir aðrir fengu hjarta- og nýraígræði samtímis. Miðgildi aldurs var 38 ár (bil 4 - 65 ár) og voru 20 aðgerðanna framkvæmdar í Gautaborg, þrjár í London og tvær í Kaupmannahöfn. Algengustu ábendingar voru ofþenslu- hjartavöðvakvilli (n=10), meðfæddir hjartagallar (n=4) og hjartavöðvabólga eftir vírussýkingu (n=3). Fimm sjúklingar fengu tímabundið hjálparhjarta sem brú að ígræðslu. Eins árs og 5 ára lifun eftir hjartaígræðslu var 91% og 86% en meðallifun 24 ár. Nýgengi hjartaígræðslu reyndist 2,7 á milljón íbúa/ári, og jókst í 4,6 ígræðslur/milljón íbúa á ári eftir 2008 (p=0,01). Á sama tímabili voru gefin 42 hjörtu frá Íslandi til ígræðslu, það fyrsta 2002, og fjölgaði þeim úr 0,8 hjörtum/ári á fyrri hluta tímabilsins í 3,0 á síðari hluta tímabilsins. ÁLYKTANIR Lifun Íslendinga eftir hjartaígræðslu er ágæt og sambærileg við það sem best gerist í nágrannalöndunum. Hjartagjöfum hefur fjölgað á síðustu tveimur áratugum og Íslendingar gefa nú næstum tvöfalt fleiri hjörtu en þeir þiggja. INTRODUCTION: Information on the number, indications and outcome of cardiac transplantations in Icelandic patients is scarce, as is information on the number of hearts donated from Iceland for cardiac transplantation. MATERIAL AND METHODS: A retrospective study on patients receiving heart transplantation from the first procedure in 1988 until March 2019. Clinical information was gathered from Landspitali Transplantation Clinic, patient charts, and information on donated hearts from the Icelandic Donation Registry. Age-standardized incidence of the procedure was calculated, and overall survival (Kaplan-Meier) estimated. Mean follow-up was 10.3 years. RESULTS: Altogether 24 patients (19 males, median age 38 years, range: 4-65 years) underwent cardiac transplantation; that included one re-transplantation, three simultaneous heart- and lung transplants and two heart- and kidney transplants. The transplantations were performed in Gothenburg (n=20), London (n=3) and Copenhagen (n=2). Most common indications were dilated cardiomyopathy (n=10), congenital heart disease (n=4), and viral myocarditis (n=3). Five patients were bridged left ventricular-assist device preoperatively. Overall survival at 1 and 5 years was 91% and 86%, respectively; median survival being 24 years. The incidence of cardiac transplantation was 2.7 heart-TX pmp/year but increased to 4.6 heart-TX pmp/year after 2008 (p=0.01). During the same period 42 hearts were donated from Iceland for transplantation abroad, the first in 2002 and increasing from 0.8 to 3.0 hearts/year during the first and second half of the study-period, respectively. CONCLUSION: Survival of Icelandic cardiac transplant recipients is good and comparable to larger transplant centers overseas. Number of hearts donated from Iceland have increased and currently Iceland donates twice as many hearts at it receives.Peer reviewe

Outcome of coronary artery bypass grafting in women in Iceland

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesInngangur Markmið þessarar rannsóknar var að bera saman árangur kransæðahjáveituaðgerða hjá konum og körlum á Íslandi með áherslu á snemm- og síðkomna fylgikvilla, 30 daga dánartíðni og langtímalifun. Efniviður og aðferðir Afturskyggn rannsókn á öllum sjúklingum sem gengust undir kransæðahjáveituaðgerð á Íslandi á árunum 2001-2013. Upplýsingar fengust úr sjúkraskrám og Dánarmeinaskrá Embættis landlæknis. Fylgikvillum var skipt í snemm- og síðkomna fylgikvilla og heildarlifun reiknuð með aðferð Kaplan-Meier. Fjölþátta aðhvarfsgreining var notuð til að meta forspárþætti dauða innan 30 daga og Cox aðhvarfsgreining til að meta forspárþætti verri langtímalifunar. Meðaleftirfylgd var 6,8 ár. Niðurstöður Af 1755 sjúklingum voru 318 konur (18%). Meðalaldur þeirra var fjórum árum hærri en karla (69 ár á móti 65 árum, p<0,001), þær höfðu oftar sögu um háþrýsting (72% á móti 64%, p=0,009) og EuroSCOREst þeirra var hærra (6,1 á móti 4,3, p<0,001). Hlutfall annarra áhættuþátta eins og sykursýki var hins vegar sambærilegt, líkt og útbreiðsla kransæðasjúkdóms. Alls létust 12 konur (4%) og 30 karlar (2%) innan 30 daga frá aðgerð en munurinn var ekki marktækur (p=0,08). Tíðni snemmkominna fylgikvilla, bæði minniháttar (53% á móti 48% p=0,07) og alvarlegra (13% á móti 11%, p=0,2), var sambærileg. Fimm árum frá aðgerð var lifun kvenna 87% borin saman við 90% hjá körlum (p=0,09). Þá var tíðni síðkominna fylgikvilla sambærileg hjá konum og körlum 5 árum frá aðgerð (21% á móti 19%, p=0,3). Kvenkyn reyndist hvorki sjálfstæður forspárþáttur 30 daga dánartíðni (OR 0,99; 95%-ÖB: 0,97-1,01) né verri lifunar (HR 1,08; 95%-ÖB: 0,82-1,42). Ályktun Mun færri konur en karlar gangast undir kransæðahjáveituaðgerð á Íslandi og eru þær fjórum árum eldri þegar kemur að aðgerð. Árangur kransæðahjáveitu er góður hjá konum líkt og körlum, en 5 árum eftir aðgerð eru 87% kvenna á lífi.Introduction The aim of this study was to evaluate the outcome of coronary artery bypass grafting (CABG) in women compared to men, with focus on short-term and long-term complications, 30 day mortality and survival. Materials and methods This was a retrospective study on all CABG patients operated in Iceland between 2001 and 2013. Clinical information was gathered from hospital charts and survival data was obtained from the National Statistics in Iceland. Overall survival was estimated with the Kaplan- Meier method. Logistic and Cox regression analysis were used to identify predictors of operative mortality and long-term survival. Mean follow-up was 6.8 years. Results Of 1755 patients 318 were women (18%). Women were on average four years older than men at the time of operation (69 vs. 65 yrs, p<0.001). Female patients had a higher incidence of hypertension (72 vs. 64%, p=0.009) and their EuroSCOREst was higher (6.1 vs. 4.3, p<0.001). The prevalence of diabetes, dyslipidemia and the extent of coronary artery disease was comparable between groups. The rate of short-term complications, both minor (53% vs. 48%, p=0.07) and major (27% vs. 32%, p=0.2), was similar and operative mortality for women was not statistically different from males (4% vs. 2%, p=0.08). Female gender was neither found to be a predictor of 30-day mortality (OR 0.99; 95%-CI: 0.98-1.01) nor survival (HR 1,08; 95%-ÖB: 0,82-1,42). Conclusions The number of women that undergo CABG is low and they are four years older than men when operated on. As is the case with men, outcome following CABG in Iceland is very good for women, their overall five-year survival being 87%.Vísindasjóður Landspítala, Rannsóknarsjóður Háskóla Íslands, Minningarsjóður Helgu Guðmundsdóttur og Sigurliða Kristjánssonar og GoRed samtökin á Íslandi