A Comprehensive Approach to University Wellness Emphasizing Million Hearts® Demonstrates Improvement in Population Cardiovascular Risk

Purpose: This study evaluated changes in university faculty and staff cardiovascular population risk over a three-year period after the implementation of the Million Hearts®' initiative, which targets the ABCS for cardiac care (i.e., Appropriate aspirin therapy, Blood pressure control, Cholesterol management, and Smoking cessation), with an additional S for Stress reduction. Methods: Using a longitudinal descriptive analysis of population cardiovascular health from 2012 to 2015, the Framingham Risk criteria for over 28,000 continuously-enrolled university faculty and staff were examined in a quality improvement initiative following the implementation of the Million Hearts® national initiative. Launched in 2011 by the Centers for Disease Control and Prevention and the Center for Medicaid Services within the Department of Health and Human Services, the initiative targets modifiable risk factors to prevent one million heart attacks and strokes by 2022. Results: Faculty and staff with low-risk Framingham scores increased from 7.8 % to 14.1 % from 2012 to 2015. Conclusion: Although this study was not a randomized controlled trial, findings support a comprehensive integrated approach to population health and wellness, emphasizing the ABCS of Million Hearts® with an added S for Stress reduction, can improve cardiovascular disease risk

Differential Patterns and Outcomes of 20.6 Million Cardiovascular Emergency Department Encounters for Men and Women in the United States.

Background We describe sex-differential disease patterns and outcomes of \u3e20.6 million cardiovascular emergency department encounters in the United States. Methods and Results We analyzed primary cardiovascular encounters from the Nationwide Emergency Department Sample between 2016 and 2018. We grouped cardiovascular diagnoses into 15 disease categories. The sample included 48.7% women; median age was 67 (interquartile range, 54-78) years. Men had greater overall baseline comorbidity burden; however, women had higher rates of obesity, hypertension, and cerebrovascular disease. For women, the most common emergency department encounters were essential hypertension (16.0%), hypertensive heart or kidney disease (14.1%), and atrial fibrillation/flutter (10.2%). For men, the most common encounters were hypertensive heart or kidney disease (14.7%), essential hypertension (10.8%), and acute myocardial infarction (10.7%). Women were more likely to present with essential hypertension, hypertensive crisis, atrial fibrillation/flutter, supraventricular tachycardia, pulmonary embolism, or ischemic stroke. Men were more likely to present with acute myocardial infarction or cardiac arrest. In logistic regression models adjusted for baseline covariates, compared with men, women with intracranial hemorrhage had higher risk of hospitalization and death. Women presenting with pulmonary embolism or deep vein thrombosis were less likely to be hospitalized. Women with aortic aneurysm/dissection had higher odds of hospitalization and death. Men were more likely to die following presentations with hypertensive heart or kidney disease, atrial fibrillation/flutter, acute myocardial infarction, or cardiac arrest. Conclusions In this large nationally representative sample of cardiovascular emergency department presentations, we demonstrate significant sex differences in disease distribution, hospitalization, and death

Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, an

Outcomes of out of hospital sudden cardiac arrest in India: A review and proposed reforms

Background: Bystander cardiopulmonary resuscitation (CPR) is the cornerstone in managing out-of-hospital cardiac arrest (OHCA). However, India lacks a formal sudden cardiac arrest (SCA) registry and the infrastructure for a robust emergency medical services (EMS) response system. Also, there exists an opportunity to improve widespread health literacy and awareness regarding SCA. Other confounding variables, including religious, societal, and cultural sentiments hindering timely intervention, need to be considered for better SCA outcomes. Objectives: We highlight the current trends and practices of managing OHCA in India and lay the groundwork for improving the awareness, education, and infrastructure regarding the management of SCA. Conclusion: Effective management of OHCA in India needs collaborative grassroots reformation. Establishing a large-scale SCA registry and creating official and societal guidelines will be pivotal for transforming OHCA patient outcomes

Screening and Identification of Depression Among Patients with Coronary Heart Disease and Congestive Heart Failure

Depression occurring concurrently with cardiovascular diseases is associated with poor outcomes. Several review articles have examined the link between established indices of depression and prognosis in individuals with known coronary heart disease (CHD). These studies have demonstrated relatively consistent results and suggest an important connection between cardiovascular morbidity and mortality in patients with depressive symptoms or major depression. This article discusses the current best practices for the screening, identification, and treatment of depression in patients with CHD and coronary heart failure, as well as the financial aspects associated with care management

2022 ACC expert consensus decision pathway for integrating atherosclerotic cardiovascular disease and multimorbidity treatment: A framework for pragmatic, patient-centered care: A report of the American College of Cardiology Solution Set Oversight Committee

Atherosclerotic cardiovascular disease (ASCVD) is one of the most common chronic medical conditions worldwide. Most patients with ASCVD have other chronic conditions. Fractionated care plans, polypharmacy, side effects, drug–drug interactions, and financial toxicity can all begin to accumulate as patients acquire multimorbidity and advancing age. Clinicians caring for these patients need better guidance on how to mitigate ASCVD progression and major adverse cardiovascular events within the context of other chronic conditions, multiple guideline-directed medical therapies, changing prognoses, and patient preferences for care. Although this decision pathway is applicable to patients of all ages with ASCVD and multimorbidity, herein we advocate for the integration of evidence-based treatments into a broader value-based care framework that incorporates the American Geriatrics Society’s principles on the care of older adults with multimorbidity, the 4Ms from the Age-Friendly Health System, the 4-domain framework of care for older adults with heart failure, and social determinants of health. As patients acquire more chronic conditions, the burdens of available therapy intensify while life expectancy shortens. Accordingly, care for patients must shift from recommending all evidence-based options to an approach that prioritizes therapies with the greatest expected benefit/harm profile, while aligning with patients’ goals and preferences