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Aim: We studied the association between neighbourhood material deprivation, a metric estimating inability to attain basic material needs, with outcomes and processes of care among incident heart failure patients in a universal healthcare system. Methods and results: In a population‐based retrospective study (2007–2019), we examined the association of material deprivation with 1‐year all‐cause mortality, cause‐specific hospitalization, and 90‐day processes of care. Using cause‐specific hazards regression, we quantified the relative rate of events after multiple covariate adjustment, stratifying by age ≤65 or ≥66 years. Among 395 763 patients (median age 76 [interquartile range 66–84] years, 47% women), there was significant interaction between age and deprivation quintile for mortality/hospitalization outcomes (p ≤ 0.001). Younger residents (age ≤65 years) of the most versus least deprived neighbourhoods had higher hazards of all‐cause death (hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.10–1.29]) and cardiovascular hospitalization (HR 1.29 [95% CI 1.19–1.39]). Older individuals (≥66 years) in the most deprived neighbourhoods had significantly higher hazard of death (HR 1.11 [95% CI 1.08–1.14]) and cardiovascular hospitalization (HR 1.13 [95% CI 1.09–1.18]) compared to the least deprived. The magnitude of the association between deprivation and outcomes was amplified in the younger compared to the older age group. More deprived individuals in both age groups had a lower hazard of cardiology visits and advanced cardiac imaging (all p < 0.001), while the most deprived of younger ages were less likely to undergo implantable cardioverter‐defibrillator/cardiac resynchronization therapy‐pacemaker implantation (p = 0.023), compared to the least deprived. Conclusion: Patients with newly‐diagnosed heart failure residing in the most deprived neighbourhoods had worse outcomes and reduced access to care than those less deprived. [ABSTRACT FROM AUTHOR]

Background: Catheter ablation (CA) for ventricular arrhythmias (VAs) is increasingly utilized in recent years. We aimed to investigate the nationwide trends in utilization and procedural complications of CA for VAs in patients with mechanical valve (MV) prosthesis. Methods: We drew data from the US National Inpatient Sample database to identify cases of VA ablations, including premature ventricular contraction and ventricular tachycardia, in patients with MVs, between 2003 and 2015. Sociodemographic and clinical data were collected and the incidence of catheter ablation complications, mortality, and length of stay were analyzed. We compared the outcomes to a propensity‐matched cohort of patients without prior valve surgery. Results: The study population included a weighted total of 647 CA cases in patients with prior MVs. The annual number of ablations almost doubled, from 34 ablations on average during the "early years" (2003–2008) to 64 on average during the "late years" (2009–2015) of the study (p =.001). Length of stay at the hospital did not differ significantly between patients with MVs and 649 matched patients without prior MVs (5.4 ± 0.4, 4.7 ± 0.3 days, respectively, p =.12). The data revealed a trend toward a higher incidence of complications (12.6% vs. 7.5% respectively, p =.14) and mortality (3.7% vs. 0.7%, respectively, p =.087) among patients with MVs compared to the matched control group, not reaching statistical significance. Conclusion: The data show increased utilization of VA ablations in patients with MVs and a trend toward a higher incidence of in‐hospital mortality and complications compared to the propensity‐matched control group without MVs. [ABSTRACT FROM AUTHOR]

Background: The rapid growth in cardiac imaging utilization has led to the development of appropriate use criteria (AUC) in an effort to control costs. Recently, cardiac MRI has developed into a valuable modality in the evaluation of cardiac disease. However, there are no studies examining the appropriate use of cardiac MRI in clinical practice. Purpose: To determine the appropriate utilization of cardiac MRI in a large quaternary care institution and to compare percentages of appropriate utilization pre‐ and postpublication of the AUC document. We hypothesized that percentages of appropriate cardiac MRI utilization will be similar to those of other comparable cardiac imaging modalities and that there would be a significant change in appropriate use pre‐ and post‐AUC publication. Study Type: Retrospective cohort study. Population: In all, 2032 consecutive patients undergoing cardiac MRI for the assessment of heart failure between 2012–2016. Field Strength: 1.5T. Assessment: Data were collected and an appropriateness category was assigned for each cardiac MRI. Statistical Tests: Rates of major cardiac risk factors were compared between those undergoing cardiac MRIs pre‐ and post‐AUC using the chi‐square and the Mann–Whitney tests for categorical and continuous variables, respectively. Appropriateness classification was compared pre‐ and post‐AUC publication using the chi‐square test. Results: There were no significant differences in the prevalence of major cardiovascular risk factors before and after publication of the AUC. 95.5% of all cardiac MRIs were appropriate based on the AUC. Further, there was a significant difference when comparing the appropriateness classification before and after publication of the AUC (P = 0.0003), potentially associated with annual cost savings of ∼$14.8 million. Data Conclusion: We report a very high percentage of appropriate use of cardiac MRI and a significant increase in the proportion of tests classified as appropriate after AUC publication. Level of Evidence: 3 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;49:e132–e138. [ABSTRACT FROM AUTHOR]

Objectives: To quantitatively summarize changes in cognitive performance in individuals with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Design: Metaanalysis. Participants: Individuals undergoing TAVI (N = 1,065 (48.5% male) from 18 studies, average age ≥80). Measurements: The MEDLINE, EMBASE, and Cochrane Central databases were searched for original peer‐reviewed reports assessing cognitive performance using standardized cognitive tests before and after TAVI. Data were extracted for cognitive scores before TAVI; perioperatively (within 7 days after TAVI); 1, 3, and 6 months after TAVI, and 12 to 34 months after TAVI (over the long term). Standardized mean differences (SMDs) were generated using random‐effects models for changes in cognition at each time point. Metaregression analyses were conducted to assess the association between population and procedural characteristics and cognitive outcomes. Risk of bias was assessed. Results: There were no significant changes from baseline in perioperative cognitive performance (SMD = 0.05, 95% confidence interval (CI) = −0.08–0.18; z = 0.75, P = .46), although overall cognitive performance had improved significantly 1 month after TAVI (SMD = −0.33, 95% CI = −0.50 to −0.16; z = 3.83, P < .001). There were no differences in cognitive performance 3 and 6 months after TAVI or over the long term. Cognitive outcomes were not associated with any covariates in regression analyses. Conclusion: Cognitive performance is preserved after TAVI, suggesting TAVI is not detrimental to cognition. [ABSTRACT FROM AUTHOR]

Key Clinical Message Retrograde dissection re-entry can cause pericardial trauma of sufficient degree to lead to the development of an auto-immune postpericardial injury syndrome. Clinical suspicion for this condition should be high in the event of fever, symptoms, pericardial/pleural effusion, and pleuritic chest pain following chronic total occlusion ( CTO) Post cardiac injury syndromes ( PCI). [ABSTRACT FROM AUTHOR]

Aims In healthy men, brachial artery adenosine infusion elicits a reflex increase in total body norepinephrine (NE) spillover (TBS) that is blunted by oral angiotensin AT1 receptor blockade. Our objectives were to determine whether a similar reflex is active in treated heart failure (HF) patients and attenuated by ARB. Methods and results In this double-blind study, 12 patients with an ejection fraction ≤40% were randomized to 2 weeks of oral candesartan up-titrated to 32 mg/day or placebo. Forearm blood flow was measured bilaterally by venous occlusion plethysmography. Total body NE spillover was determined following infusion of tritiated NE. After saline was infused into the non-dominant brachial artery to establish baseline values, adenosine and nitroprusside (as vasodilator control) were administered in random order. Both caused dose-dependent increases in ipsilateral but not contralateral blood flow. Nitroprusside had no TBS effect, whereas adenosine reduced TBS from 3967 (SD 2362) to 3293 pmol/min (SD 2093) (P = 0.03). This decrease was not augmented in candesartan-treated subjects [−1096 (SD 726) vs. −253 pmol/min (SD 1094); placebo vs. candesartan; P = 0.22]. Conclusions In contrast to healthy men, in treated HF patients, locally infused adenosine does not elicit a reflex sympatho-excitatory response mediated by angiotensin AT1-modulated neurotransmission. [ABSTRACT FROM PUBLISHER]

Background: When transcatheter aortic valve replacement (TAVR) was first approved by the Food and Drug Administration in October 2011, it was an innovative treatment with limited accessibility. However, over the past few years, TAVR has become standard of care in patients with aortic stenosis. The effect of socioeconomic status (SES) on this transition of use of TAVR is unknown., Method: Using the New York state department Statewide Planning and Research Cooperative System database, we compared baseline patient characteristics and facilities in low-income areas and high-income areas. Trends in residential SES of patients undergoing TAVR were examined over time and assessed with a Poisson regression and Cochran Armitage trend tests., Result: From October 2011 and 2012 to December 2016, we found that the numbers of TAVR procedures performed among patients from both low (187-1150 in 2016, P < .001) and high (227-1160, P < .001) income areas increased over time. The proportion of TAVR procedures performed in patients from low-income areas increased over time, while those in high-income areas decreased (from 45.2% in 2011 and 2012 to 49.8% in 2016 for low-income and from 54.8%-50.2% for high-income, P = .009)., Conclusion: In the case of TAVR in New York State, when the innovative treatment was introduced in the clinical practice, there were initial SES-based disparities in access to the procedure. However, these disparities resolved over time, probably due to the broader diffusion of the technique., (© 2019 Wiley Periodicals, Inc.)

Background: Depression is strongly linked to increased morbidity and mortality in patients with chronic stable angina; however, its associated healthcare costs have been less well studied. Our objective was to identify the characteristics of chronic stable patients found to have depression and to determine the impact of an occurrence of depression on healthcare costs within 1 year of a diagnosis of stable angina., Methods and Results: In this population-based study conducted in Ontario, Canada, we identified patients diagnosed with stable angina based on angiogram between October 1, 2008, and September 30, 2013. Depression was ascertained by physician billing codes and hospital admission diagnostic codes contained within administrative databases. The primary outcome was cumulative mean 1-year healthcare costs following index angiogram. Generalized linear models were developed with a logarithmic link and γ distribution to determine predictors of cost. Our cohort included 22 917 patients with chronic stable angina. Patients with depression had significantly higher mean 1-year healthcare costs ($32 072±$41 963) than patients without depression ($23 021±$25 741). After adjustment for baseline comorbidities, depression was found to be a significant independent predictor of cost, with a cost ratio of 1.33 (95% confidence interval, 1.29-1.37). Higher costs in depressed patients were seen in all healthcare sectors, including acute and ambulatory care., Conclusions: Depression is an important driver of healthcare costs in patients following a diagnosis of chronic stable angina. Further research is needed to understand whether improvements in the approach to diagnosis and treatment of depression will translate to reduced expenditures in this population., (© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)