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Background: Cardiac rehabilitation (CR) can improve cardiovascular health. We identified whether CR participation was associated with fewer subsequent inpatient hospitalizations and emergency department visits and less Medicare and out-of-pocket expenditures, and whether outcomes varied by amount of participation., Methods: This retrospective study used Medicare fee-for-service claims data, including beneficiaries with a CR-qualifying event in 2016. Participants attended ≥2 sessions of CR within 365 days of the event. Propensity score matching was used to identify CR-eligible nonparticipants. Difference-in-differences analyses were used to compare differences in outcomes before (2014-2015) and after (2018-2019; 2-year CR period=2016-2017) the CR period between participants and nonparticipants., Results: We identified 57 668 CR-eligible beneficiaries after matching, with equal numbers of participants and nonparticipants. Nearly 65% of beneficiaries had a percutaneous coronary intervention, 33.5% had an acute myocardial infarction, 17.5% had a coronary artery bypass graft, and 16.8% had a heart valve repair/replacement. Compared with nonparticipants, participants had 47.6 fewer subsequent annual inpatient hospitalizations per 1000 beneficiaries (95% CI, -58.8 to -36.3) and $1005 lower subsequent annual Medicare expenditures per beneficiary (95% CI, -$1352 to -$659). Compared with no participation, medium participation (12-23 sessions), high participation (24-35 sessions), and CR completion (≥36 sessions) were associated with fewer inpatient hospitalizations and lower Medicare expenditures per year., Conclusions: CR was associated with fewer subsequent annual inpatient hospitalizations and lower subsequent annual Medicare expenditures. A higher amount of participation was associated with a further reduction in hospitalizations and expenditures. These findings can inform programs and policies that encourage CR participation.

Background: Modernization of public health data systems is a national priority. Improved chronic disease surveillance can provide more timely, accurate, and local measures to inform public health policy and intervention. Although electronic health record (EHR) data have great potential for surveillance, population coverage is non-random, which may result in biased estimates. Statistical approaches are needed to adjust estimates to represent the underlying population and validate the results against independent estimates., Methods: MENDS, the Multi-State-EHR-Based Network for Disease Surveillance, uses EHR data to calculate chronic disease and risk factor prevalence metrics. In this study, we applied post-stratification weighting to MENDS data from nearly 800,000 adults from Louisiana to estimate the prevalence of hypertension and hypertension control at the state and parish (county-equivalent) levels during February 2023. We then compared weighted MENDS hypertension prevalence estimates with measures derived from traditional public health surveillance., Results: Weighted MENDS hypertension prevalence estimates were approximately 10% lower than crude MENDS estimates, and approximately 13% higher than hypertension awareness estimates from the 2021 Behavioral Risk Factor Surveillance System, with similar geographic and demographic patterns. Weighted MENDS hypertension prevalence estimates indicated that 43.0% of Louisiana adult residents had hypertension (versus 47.7% crude prevalence). Prevalence was higher than the overall state estimate among men (47.3% weighted; 55.9% crude), Black patients (50.2% weighted; 55.7% crude), those receiving Medicare (70.6% weighted; 76.2% crude), and individuals living in rural areas (46.1% weighted; 49.8% crude). Hypertension prevalence increased with age and with more clinical visits during the previous 2 years. Hypertension prevalence was highest in the southeastern parishes near New Orleans and Baton Rouge. Demographic and geographic patterns in prevalence of hypertension control were like hypertension prevalence., Conclusions: Post-stratification weighting of MENDS data brought EHR-based data estimates closer to survey-based estimates of hypertension and can improve representativeness of chronic disease indicators. These estimates can provide public health organizations with timely, accurate, and local information. Further, EHR-based systems can produce unique measures, such as the prevalence of hypertension control, which can provide a more nuanced understanding of community needs and help public health agencies evaluate the effectiveness of community interventions., Competing Interests: Declarations. Ethics approval and consent to participate: The need for ethics approval was deemed unnecessary according to national regulations. The CDC provided a written determination that MENDS operates within the public health authority pursuant to the Health Insurance Portability and Accountability Act (HIPAA). The legislation that outlines the exclusions for public health surveillance activities from HIPAA can be found in 45 CFR §164.512(b). As a public health surveillance project, MENDS does not require institutional review board approval. Consent for publication: Not applicable—The manuscript does not contain data from any individual person. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: Age-adjusted mortality rates (AAMR) for cardiovascular diseases (CVD) increased in 2020 and 2021, and provisional data indicated an increase in 2022, resulting in substantial excess CVD deaths during the COVID-19 pandemic. Updated estimates using final data for 2022 are needed., Methods: The National Vital Statistics System's final Multiple Cause of Death files were analyzed in 2024 to calculate AAMR from 2010 to 2022 and excess deaths from 2020 to 2022 for U.S. adults aged ≥35 years, with CVD as the underlying cause of death., Results: The CVD AAMR among adults aged ≥35 years in 2022 was 434.6 deaths per 100,000 (95% CI=433.8, 435.5), which was lower than in 2021 (451.8 deaths per 100,000; 95% CI=450.9, 452.7). The most recent year with a similarly high CVD AAMR as in 2022 was 2012 (434.7 deaths per 100,000 population, 95% CI=433.8, 435.7). The CVD AAMR for 2022 calculated using provisional data overestimated the AAMR calculated using final data by 4.6% (95% CI=4.3%, 4.9%) or 19.9 (95% CI=18.6, 21.2) deaths per 100,000 population. From 2020 to 2022, an estimated 190,661 (95% CI=158,139, 223,325) excess CVD deaths occurred., Conclusions: In 2022, the CVD AAMR among adults aged ≥35 years did not increase, but rather declined from a peak in 2021, signaling improvements in adverse mortality trends that began in 2020, amid the COVID-19 pandemic. However, the 2022 CVD AAMR remains higher than observed before the COVID-19 pandemic, indicating an ongoing need for CVD prevention, detection, and management., (Published by Elsevier Inc.)

The Western Himalayan mountains, with several riverine systems, are considered one of the most fragile environments in the world. Among them is Beas, a primary river that provides essential ecosystem benefits to thousands of indigenous people in North India. One of the major pollutants, microplastics (MPs), are ubiquitous contaminants, yet their occurrence in the Beas and ecological risk factors remain largely unexplored. Due to extensive tourism and urban-related burdens, the usage and release of enormous amounts of plastics and MPs into the Beas are apparent. Here, we investigated the extent of MPs pollution and subsequent environmental risks in water and sediments from Beas along a stretch of 300 km. Our results showed that MPs were abundant and widely distributed, with the abundance range (mean ± SE) being 46-222 (112.27 ± 12.43) items/L in water and 36-896 (319.47 ± 49.25) items/kg in sediment samples. We found significant differences in MPs' abundance in water but not sediments among the five sampling sites. There was a significant positive correlation between population size and the abundance of MPs, with the highest abundance in populated Kullu and the lowest loads at the remote Dhundi Glacier. Fibers and film were common morphotypes; most items measured <1 mm. Of the eleven polymers identified, the majority were polyethylene. The pollution load index ranged up to 4.99 (low-risk category); however, the polymer hazard index exceeded 1000 (highest-risk category), and the potential ecological risk index was 13,761 (extreme-risk category) at selected sites. This study fills a crucial knowledge gap and raises concerns about the possible impact on human health, as many riparian residents depend on Beas as their primary source of potable water. Our findings may assist governmental agencies in formulating comprehensive eco-friendly policies and advancing environmentally sustainable strategies in vulnerable locales adjoining the Beas waterway., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)