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The contemporary health care resource utilization after an acute myocardial infarction (MI) is not well-known. All patients admitted because of MI between January 2015 and December 2021 across 28 hospitals in the Baylor Scott & White Health system were studied. Patient characteristics and outcomes, including all-cause and cardiovascular (CV) rehospitalizations, emergency department (ED) visits, and outpatient visits were evaluated. Of 6,804 patients admitted because of MI, 6,556 were discharged alive. The median age was 69 years, 60% were men, and 77% had non-ST-elevation MI; 17% (1,090) had multivessel disease. The number of patients with first all-cause readmissions within 30 days, 3 months, and 12 months of discharge were 844 (13%), 1,372 (21%), and 2,306 (35%), respectively, with a higher readmission rate in patients with non-ST-elevation MI, previous heart failure (HF), new-onset HF, and left ventricular ejection fraction ≤40%. ED visits at 12 months for any cause were 2,401 (37%), of which 1,321 (55%) were for any CV cause, with a higher incidence in patients with previous HF. Of the 6,556 patients, 4,102 (63%) had at least 1 primary care visit in the past year, 5,009 (76%) had CV specialty visits, and 3,860 (59%) had non-CV visits, with a similar distribution across subgroups. Patients hospitalized with an MI had a high risk of subsequent hospital readmissions and ED and outpatient visits, especially those with a previous HF diagnosis and those discharged with an MI and HF diagnosis., Competing Interests: Declaration of competing interest Dr. Butler reports financial support was provided by Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance. Dr. Afzal reports a relationship with AstraZeneca that includes: speaking and lecture fees. Dr. Alhamdow reports a relationship with Boehringer Ingelheim GmbH that includes: employment. Dr. Hartgers-Gubbels reports a relationship with Boehringer Ingelheim GmbH that includes: employment. Dr. Martinez-Traba reports a relationship with Boehringer Ingelheim GmbH that includes: employment. Dr. Butler reports a relationship with Abbott that includes: consulting or advisory. Dr. Butler reports a relationship with American Regent Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Amgen Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Applied Therapeutics Inc that includes: consulting or advisory. Dr. Butler reports a relationship with AskBio that includes: consulting or advisory. Dr. Butler reports a relationship with Astellas that includes: consulting or advisory. Dr. Butler reports a relationship with AstraZeneca that includes: consulting or advisory and speaking and lecture fees. Dr. Butler reports a relationship with Bayer that includes: consulting or advisory. Dr. Butler reports a relationship with Boehringer Ingelheim that includes: consulting or advisory and speaking and lecture fees. Dr. Butler reports a relationship with Boston Scientific Corporation that includes: consulting or advisory. Dr. Butler reports a relationship with Bristol Myers Squibb Co that includes: consulting or advisory. Dr. Butler reports a relationship with Cardiac Dimensions Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Cardiocell that includes: consulting or advisory. Dr. Butler reports a relationship with Cardior that includes: consulting or advisory. Dr. Butler reports a relationship with Cardiorem that includes: consulting or advisory. Dr. Butler reports a relationship with CSL Behring that includes: consulting or advisory. Dr. Butler reports a relationship with CVRx Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Cytokinetics Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Edwards Lifesciences Corporation that includes: consulting or advisory. Dr. Butler reports a relationship with Daxor that includes: consulting or advisory. Dr. Butler reports a relationship with Element Science that includes: consulting or advisory. Dr. Butler reports a relationship with Faraday that includes: consulting or advisory. Dr. Butler reports a relationship with Foundry that includes: consulting or advisory. Dr. Butler reports a relationship with G3P that includes: consulting or advisory. Dr. Butler reports a relationship with Innolife that includes: consulting or advisory. Dr. Butler reports a relationship with Impulse Dynamics that includes: consulting or advisory and speaking and lecture fees. Dr. Butler reports a relationship with Imbria that includes: consulting or advisory. Dr. Butler reports a relationship with Inventiva that includes: consulting or advisory. Dr. Butler reports a relationship with Ionis that includes: consulting or advisory. Dr. Butler reports a relationship with Lexicon that includes: consulting or advisory. Dr. Butler reports a relationship with Eli Lilly and Company that includes: consulting or advisory and speaking and lecture fees. Dr. Butler reports a relationship with LivaNova that includes: consulting or advisory. Dr. Butler reports a relationship with Janssen that includes: consulting or advisory. Dr. Butler reports a relationship with Medtronics that includes: consulting or advisory. Dr. Butler reports a relationship with Merck & Co Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Occlutech that includes: consulting or advisory. Dr. Butler reports a relationship with Owkin Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Novartis that includes: consulting or advisory and speaking and lecture fees. Dr. Butler reports a relationship with Novo Nordisk Inc that includes: consulting or advisory. Dr. Butler reports a relationship with Pfizer that includes: consulting or advisory. Dr. Butler reports a relationship with Pharmacosmos that includes: consulting or advisory. Dr. Butler reports a relationship with PharmaIN that includes: consulting or advisory. Dr. Butler reports a relationship with Prolaio that includes: consulting or advisory. Dr. Butler reports a relationship with Regeneron that includes: consulting or advisory. Dr. Butler reports a relationship with Renibus Therapeutics, Inc. that includes: consulting or advisory. Dr. Butler reports a relationship with Roche that includes: consulting or advisory. Dr. Butler reports a relationship with Salamandra that includes: consulting or advisory. Dr. Butler reports a relationship with Sanofi that includes: consulting or advisory. Dr. Butler reports a relationship with SC Pharma that includes: consulting or advisory. Dr. Butler reports a relationship with Secretome that includes: consulting or advisory. Dr. Butler reports a relationship with Sequana that includes: consulting or advisory. Dr. Butler reports a relationship with SQ Innovation that includes: consulting or advisory. Dr. Butler reports a relationship with Tenex that includes: consulting or advisory. Dr. Butler reports a relationship with Tricog that includes: consulting or advisory. Dr. Butler reports a relationship with Ultromics that includes: consulting or advisory. Dr. Butler reports a relationship with Vifor that includes: consulting or advisory. Dr. Butler reports a relationship with ZOLL that includes: consulting or advisory. Dr. Gottlieb reports a relationship with Alnylam Pharmaceuticals Inc that includes: consulting or advisory, funding grants, and speaking and lecture fees. Dr. Gottlieb reports a relationship with AstraZeneca that includes: consulting or advisory and funding grants. Dr. Gottlieb reports a relationship with Eli Lilly and Company that includes: consulting or advisory and funding grants. Dr. Gottlieb reports a relationship with Pfizer that includes: funding grants and speaking and lecture fees. Dr. Gottlieb reports a relationship with Johnson & Johnson that includes: funding grants. Dr. Priest reports a relationship with AstraZeneca that includes: funding grants. Dr. Priest reports a relationship with Owkin Inc that includes: funding grants. The remaining authors have no competing interests to declare., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Rheumatoid arthritis (RA) is a systemic autoimmune disease with important cardiovascular (CV) implications. CV disease represents over half of RA patient deaths and causes significant morbidity. CV manifestations in RA can be complex, raising concerns for adequate patient management and provider-dependent roles., Methods: This is a retrospective study of patients diagnosed with RA and coronary artery disease (CAD). Patients were identified and filtered via EPIC Database search engine. Parameters were set from January 1, 2014, to December 31, 2020. Inclusion criteria consisted of patients who met diagnostic criteria for both RA and CAD. A total of 399 patients met criteria., Results: Of the 399 identified patients, 272 were female (68.2%) and 127 were male (31.8%) with a median age of 73 (range 26-98). The population was further divided into two groups: those with established cardiology care versus those without. Patients without cardiology follow-up experienced significantly more hospitalizations (RR 1.63 95% CI 1.12, 2.38), higher rates of adverse events including myocardial infarction (MI) (RR 4.82 95% CI 1.94, 11.98), heart failure (HF) (OR 15.81 95% CI 3.54, 70.52), and stroke (RR 2.55 95% CI 1.29, 5.03). Patients not followed by cardiology also had numerical increases in CV death (4 deaths compared to none in those with cardiology follow) and all-cause mortality (HR 1.03 95% CI 0.63, 1.67)., Conclusion: Patients with regular cardiology follow-up demonstrated fewer cardiac-related adverse events. This suggests that co-management may have a role in adverse cardiac event risk reduction and should therefore be an early consideration. Key Points • Rheumatoid arthritis patients demonstrate higher rates of coronary disease compared to the general population. Traditional cardiac risk factors may not be entirely responsible for this phenomenon • Hospitalization rates and adverse event occurrence are significantly higher in patients with single-provider care (rheumatology only) compared to dual provider care (rheumatology and cardiology) • Cardiology co-management should be an early consideration in the management of RA patients • Early screening, risk stratification of coronary disease, and utilization of appropriate treatment algorithms are important to decrease morbidity and mortality., (© 2022. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

Background: Optimal medical therapy after myocardial infarction with nonobstructive coronary arteries (MINOCA; <50% stenosis) is uncertain. We evaluated variability in discharge prescription of angiotensin-converting enzyme inhibitors / angiotensin receptor blockers (ACEI/ARB) and beta-blockers (BB) to MINOCA patients between hospitals to assess physician equipoise about secondary prevention., Methods: Patients with MINOCA between 2007-2014 were identified in the NCDR Chest Pain-MI Registry. Those with prior revascularization or missing demographic, angiographic, or medication data were excluded. Analysis was limited to high-volume hospitals with ≥20 MINOCA total discharges. Discharge prescriptions for ACEI/ARB and BB after MINOCA were analyzed for each hospital. Clinical data on left ventricular ejection fraction (LVEF), glomerular filtration rate (GFR), and diabetes mellitus status were extracted to identify other indications for ACEI/ARB or BB., Results: Clinical data were available for 17,849 MINOCA patients, of whom 8,752 (49%) had LVEF <40%, GFR ≤60 mL/min, and/or diabetes. 5,913 patients without one of these indications for ACEI/ARB or BB were discharged from 156 high-volume hospitals. At discharge, ACEI/ARB was prescribed to between 16.0% and 88.8% of MINOCA patients (median 45.6%, IQR 38.0%-56.5%) and BB to between 28.0% and 97.5% (median 74.1%, IQR 64.7%-80.0%)., Conclusion: There is marked variability between hospitals in the proportions of patients receiving ACEI/ARB and BB after hospitalization for MINOCA, suggesting clinical equipoise about the routine use of these agents. Randomized clinical trials are necessary to establish the benefit of ACEI/ARB and BB to improve outcomes after MINOCA., Competing Interests: Dr. Reynolds has received in kind support for an unrelated research study in MINOCA from Abbott Vascular and from Siemens, and for an unrelated research study in takotsubo syndrome from BioTelemetry Inc. Dr. Smilowitz serves on an advisory board for Abbott Vascular and as a consultant for Medyria. Industry had no role in the funding, study design, data collection and analysis, decision to publish, or preparation of this manuscript.

Background Women with non-obstructive coronary artery disease have increased cardiovascular morbidity. The role of risk factors in this population has yet to be established. We aimed to study the predictive effect of triglycerides and the triglyceride/high-density lipoprotein ratio on major adverse cardiovascular events (MACE) in patients with non-obstructive coronary artery disease, and to explore the role of lipid lowering therapy in modifying this risk. Methods and Results This is a prospective cohort study enrolling patients with anginal symptoms referred to the cardiac catheterization laboratory for suspected ischemia, who were subsequently diagnosed with non-obstructive coronary artery disease, defined as no stenosis >20% on angiography. All patients had baseline laboratory testing and were followed for 7.8±4.3 years for the development of major adverse cardiovascular events. We performed Cox proportional hazard testing to determine the effect of triglycerides on risk of major adverse cardiovascular events among men and women by baseline statin use. A total of 462 patients were included. Median age was 53 (Q1, Q3: 45, 62) years. In a Cox proportional hazard model stratified by statin use adjusting for confounders, among those not on baseline statins, triglycerides were independently predictive of major adverse cardiovascular events in women (per 50 mg/dL risk ratio: hazard ratio 1.25 [95% CI : 1.06, 1.47]; P=0.01). This was not true among men. The interaction between triglycerides and sex, and triglycerides and statin was statistically significant. Conclusions Triglyceride levels may play a key role in predicting cardiovascular-specific risk in women, and statin use may be protective. Further investigation is necessary to better delineate the role of statin use in preventing cardiovascular risk.