Search

This study aimed to assess the association of a wrist-worn, device-based metric of 24-h movement with cognitive function and subjective cognitive complaints among older adults, 60 yr and older.This is a cross-sectional analysis of the 2011-2012 and 2013-2014 National Health and Nutrition Examination Survey (NHANES) cycles. A wrist-worn ActiGraph GT3X+ accelerometer captured total 24-h movement activity, analyzed as Monitor-Independent Movement Summary units (MIMS-units), and quantified into placement based on an age- and sex-standardized percentile. Cognitive tests in the domains of memory, language/verbal fluency, and executive performance were administered. Test-specific cognitive z -scores were generated. Subjective cognitive complaints included perceived difficulty remembering and confusion/memory loss.The analytical sample included 2708 U.S. older adults (69.5 ± 0.2 yr, 55% female, 20.9% non-White). Multivariable linear regressions revealed those in quartiles 3 (50th-74th percentile) and 4 (≥75th percentile) for their age and sex had higher cognitive function z -scores across all domains compared with those in quartile 1. Logistic regressions demonstrated those in quartiles 3 and 4 also had lower odds of reporting difficulty remembering (adjusted odds ratio [AOR] = 0.52, 95% confidence interval [CI] = 0.31-0.89; AOR = 0.57, 95% CI = 0.37-0.88) and confusion/memory loss (AOR = 0.49, 95% CI = 0.27-0.91; AOR = 0.49, 95% CI = 0.27-0.98), respectively, compared with those in quartile 1.In a representative sample of U.S. older adults, higher cognitive functioning occurs among those that perform total 24-h movement activity at or above the 50th percentile for their age and sex. Future studies should consider movement behaviors across a 24-h period on cognitive health outcomes in older adults. More research exploring prospective associations of MIMS-units and time-use behaviors across midlife and older adulthood that may affect cognitive functioning across diverse populations is needed.

The optimal anti-thrombotic therapy to prevent recurrent ischemic events in patients with acute coronary syndrome and coronary artery ectasia (CAE) remains unclear.To assess the efficacy and safety of antiplatelet plus anticoagulant therapy versus dual antiplatelet therapy in patients with acute coronary syndromes and coronary artery ectasia.OVER-TIME is an investigator initiated, exploratory, open label, single center, randomized clinical trial comparing dual antiplatelet therapy (acetyl-salicylic acid plus a P2Y12 inhibitor) with the combination of an antiplatelet monotherapy (a P2Y12 inhibitor) plus a low dose anticoagulant (rivaroxaban, 15mg oral dose) for the prevention of recurrent ischemic events among patients with CAE. We aim to enroll approximately 60 patients with CAE and acute coronary syndromes. After recruitment, patients are randomized to (a) standard of care (dual antiplatelet regimen) or (b) the combination of antiplatelet monotherapy and low dose anticoagulant. Patients will be followed for at least 12 months. The OVER-TIME study aims to assess the efficacy of the regimen in prevention of major cardiovascular events and its security in bleeding events in acute coronary syndromes among patients with CAE. Expected results and conclusions: OVER-TIME is the first randomized controlled trial to assess different antithrombotic strategies in patients with CAE and acute coronary syndrome, and its results will offer preliminary data for the prevention of major cardiovascular events and bleeding events in this group of patients.NCT05233124 (ClinicalTrials.gov), date of registration: February 10, 2022.

Introduction: Higher physical activity levels have been shown to preserve cognitive function and prevent cognitive impairment (CI). Whether daily steps, an easily interpretable physical activity metric, is associated with measures of brain health has not been widely studied. Hypothesis: Higher daily step count is associated with better cognitive function and lower odds of CI. Methods: Cross-sectional analysis of ARIC participants (mean age: 78 years, 41% male, 19% Black) who wore an accelerometer (ActiGraph GT3X) on the waist for ≥10 hours on ≥3 days between 2016-17. Daily steps were derived and examined continuously and by quartiles. Global and domain-specific (memory, language, executive function) factor scores were estimated from a battery of cognitive tests. Participants were classified as having CI if they had an adjudicated diagnosis of mild CI or dementia. Hypotheses were tested using linear and logistic regression models, adjusted for age, sex, race, education, and accelerometer wear time. Results: Among 454 participants, 88 (19.4%) had CI. The mean number of daily steps was 3,501 (SD=1,974). In adjusted models, a higher daily step count was associated with better global cognition and executive function factor scores (e.g., those in the 4 th daily-step quartile [≥4,499 steps] vs. 1 st [th daily-step quartile vs. 1 st had 62% [odds ratio (OR)=0.38, 95% confidence interval: 0.16 to 0.90] lower odds of CI. The OR of CI for continuous daily steps shown in the Figure. Conclusions: Higher daily steps were associated with better cognitive function and may be a helpful marker in identifying participants with CI. Prospective studies of accelerometer-measured physical activity and cognitive outcomes are needed to understand the direction of these associations.

Introduction: Steps are an easily interpretable metric that could be used in patient-clinician communication regarding the health benefits of physical activity for cardiovascular disease (CVD). However, most studies are conducted in younger populations with daily steps goals (e.g., 10,000 steps) that may be unsuitable for older adults. Hypothesis: We tested the hypothesis that more daily steps are associated with lower risk of proximal CVD events (within 3.5 years) among older adults (≥70 years). Methods: We analyzed a subsample of participants from the ARIC study visit 6 (2016-17) who wore an accelerometer (ActiGraph GT3X) on the waist ≥3 days for ≥10 hr/day. Daily steps were analyzed continuously and by quartiles. Adjudicated outcomes, through December 2019, included fatal and non-fatal CVD events (coronary heart disease, stroke, and heart failure). Multivariable adjusted Cox proportional hazard models were used to estimate the hazard ratio of CVD events across step measures, adjusted for age, sex, race, education, body mass index (BMI), and accelerometer wear time. Results: Among the 452 adults with step data (mean age = 78.4; 59% women; 20% Black), 7.5% (34/452) had a CVD event over 1,269 person-years of follow-up. Mean (SD) step count was 3447 (1796) steps/day. CVD cumulative incidence was highest among those in the least active step quartile (Q1: Conclusions: In this community-based cohort of older adults, every 500 steps (~1/4 of a mile) was associated with a 14% lower risk of a CVD event over 3.5 years of follow-up. Additional follow-up is needed to determine if higher steps prevent or delay CVD or if low steps serve as a biomarker of underlying disease.

Introduction: Neighborhood characteristics and physical activity levels may impact physical function. The present study examined the relationship between neighborhood socioeconomic status (NSES) and functional status impairment among older men and women and examined whether this relationship differed by physical activity. Hypothesis: Compared to those with high levels of NSES, participants with low NSES will have higher odds of functional impairment in late life. This association will be modified by physical activity. Methods: We constructed an aggregate measure of NSES using census-based indicators of wealth, education, and occupation and quantified distribution-based tertiles of low, middle, and high NSES among ARIC cohort participants in Visit 5 (2011-2013). We used the Rosow-Breslau scale to ascertain functional status (range 0-4; functional impairment defined as a score Results: Among 4,439 participants (mean age: 75 (SD 5) years, 22% Black, 55% female), 1,788 (40%) had functional status impairment. In analyses adjusted for sex, race, and age, the odds of functional impairment among participants with low NSES were 1.86 (95% CI: 1.60, 2.16) times the odds of functional impairment among those with high NSES. There was evidence of effect measure modification by race (p=0.06) and age (p=0.07). In White participants, the odds of functional status impairment among participants with low NSES was 1.99 (95% CI: 1.69, 2.35) times the odds of functional impairment among those with high NSES. This association was attenuated in Black participants (OR: 1.38, 95% CI: 0.96, 2.00). In participants less than 74 years, the odds of functional status impairment among participants with low NSES was 2.17 (95% CI: 1.73, 2.72) times the odds of functional impairment among those with high NSES. This association was attenuated in participants 74 years and older (OR: 1.64, 95% CI: 1.34, 1.99). There was no evidence of effect modification by physical activity (p=0.20) nor sex (p=0.65). Conclusions: Low NSES is modestly associated with functional status impairment in older adulthood. This association appeared stronger in Whites compared to Blacks, and in those younger than 74 years.

Summary Background B-lines have been associated with adverse clinical outcomes in patients with heart failure (HF) when found at hospital discharge or during outpatient visits. Whether lung ultrasound (LUS) assessed B-lines may predict in-hospital mortality in patients with acute HF is still undetermined. Aim To evaluate the association between B-lines on admission and in-hospital mortality among patients admitted with acute HF. Methods Hand-held LUS was used to examine patients with acute HF. LUS was performed in eight chest zones with a pocket ultrasound device and analyzed offline. The association between B-lines and in-hospital mortality was assessed using Cox regression models. Results We included 62 patients with median age 56 years, 69.4% men, and median left ventricle ejection fraction 25%. The sum of B-lines ranged from 0 to 53 (median 6.5). An optimal receiver operating characteristic-determined cut-off of ≥19 B-lines demonstrated a sensitivity of 57% and a specificity of 86% (area under the curve 0.788) for in-hospital mortality. The incremental prognostic value of LUS when compared with lung crackles or peripheral edema by integrated discrimination improvement was 12.96% (95% CI: 7.0–18.8, P = 0.02). Patients with ≥19 B-lines had a 4-fold higher risk of in-hospital mortality (HR 4.38; 95% CI: 1.37–13.95, P Conclusion In patients admitted with acute HF, point-of-care LUS measurements of pulmonary congestion (B-lines) are associated with in-hospital mortality.

Background Lung ultrasound (LUS) has emerged as a new tool for the evaluation of congestion in heart failure (HF); incorporation of LUS during follow-up may detect congestion earlier and prompt interventions to prevent hospitalizations. The aim of this study was to test the hypothesis that the incorporation of LUS during follow-up of patients with HF may reduce the rate of adverse events compared with usual care. Methods In this single-blinded, randomized controlled trial, patients were randomized into an LUS-guided arm or control arm. Patients were followed in 4 prespecified visits during a 6-month period. LUS was performed in every patient visit in both groups; however, LUS results were available for the treating physician only in the LUS group. The primary outcome was the composite of urgent HF visits, rehospitalization for worsening HF, and death from any cause. Results One hundred twenty-six patients were randomized to either LUS (n = 63) or control (n = 63) (age 62.5 ± 10 years, median left ventricular ejection fraction 31%). The primary end point occurred in 30 (47.6%) patients in the control group and 20 (31.7%) patients in the LUS group (P = .041). LUS-guided treatment was associated with a 45% risk reduction in the primary end point (hazard ratio 0.55, 95% CI 0.31-0.98, P = .044), mainly driven by a reduction in urgent HF visits (hazard ratio 0.28, 95% CI 0.13-0.62, P = .001). No significant differences in rehospitalizations for HF or death were found. Conclusions Incorporation of LUS into clinical follow-up of patients with HF significantly reduced the risk of urgent visits for worsening HF.

OBJECTIVES Data regarding the characteristics of patients who are morbidly and super obese, and the resources they use in nonbariatric hospital settings are limited. The aims of our study were to explore the frequency of inpatient admissions of patients who are morbid (body mass index [BMI] ≥ 40 kg/m) and super obese (BMI ≥ 50 kg/m), their specific characteristics, and to identify their utilization of hospital services and resources, 30-day readmission rates, safe patient handling equipment, and patient clinical outcomes. METHODS We conducted a retrospective chart review of adult patients hospitalized at our institution (n = 1670) who are morbidly obese or super obese. We collected and compared data regarding the characteristics of patients, the services and resources used, the use of any special handling equipment, and patient clinical outcomes. RESULTS After accounting for confounding variables, wound care and occupational therapy services were more likely to be required for the patients who are super obese (odds ratio [OR] = 1.49, P = 0.04) than for those who are morbidly obese (odds ratio [OR] = 1.36, P = 0.02). Use of safe patient handling devices was twice as likely for the super obese group (OR = 2.09, P < 0.01). There was no difference in mortality rates between the two patient groups (P = 0.81); patients who are super obese had higher odds of prolonged hospital stay by 32% (P = 0.009). CONCLUSIONS This study provides an understanding of the characteristics of patients with BMI of 40 kg/m or greater who are admitted to the hospital, the resources and services use, and their clinical outcomes. There is also a need to develop an organizational protocol to ensure safe handling using the right devices and activation of appropriate consult services.

Background Hearing loss is highly prevalent in older ages and has several health consequences. Some cardiovascular risk factors are associated with worse hearing at older ages. Still, the role of midlife leisure-time physical activity (PA) as a risk factor for hearing loss is yet to be investigated. Methods Among 3 198 participants of the Atherosclerosis Risk in Communities study, we investigated the associations of midlife and change from mid- to late-life PA (assessed via modified Baecke questionnaire) with hearing loss (audiometric battery [worse-ear pure-tone average, and speech-in-noise test]) at older ages. We used regression analyses, adjusted for demographics, medical conditions, and noise exposure, to estimate differences in hearing between those who met and did not meet PA recommendations at midlife and at late life. Results A total of 1 386 (43.3%) participants met PA recommendations at midlife. These participants, compared to those who did not meet recommendations, had lower (better) pure-tone average by 1.51 (0.46, 2.55) decibels, identified 0.37 (0.01, 0.74) more words (better score) in the speech-in-noise test, and had a lower relative risk of having hearing loss at older ages (eg, relative risk ratio for severe hearing loss vs normal hearing = 0.70 [0.52, 0.95]). Similarly, those who persistently met PA recommendations from mid- to late life had, compared with those who did not, a better hearing at older ages. Conclusions Meeting PA public health recommendations in midlife and mid- to late life was associated with better hearing at older ages and reduced risk of hearing loss. Promoting adequate levels of PA may be an essential component of hearing care.

Introduction: While multimorbidity (having ≥2 chronic conditions) is associated with inadequate higher intensity exercise, less is known about how multimorbidity relates to total movement accumulated throughout the day. We tested the hypothesis that multimorbidity is associated with lower 24-hr movement in a population-based study. Methods: We analyzed data from 2011-2014 National Health and Nutrition Examination Survey. A wrist-worn device (ActiGraph GT3X) captured movement over 24 hours in Monitor-Independent Movement Summary units (MIMS-units). Multimorbidity was quantified using 13 chronic conditions included in the CDC recommendations via self-report or clinical thresholds. We conducted multivariable linear regressions analyses to examine the association of each chronic condition and number of conditions with total daily MIMS-units. Models were adjusted for age, sex, race/ethnicity, education, and smoking, as well as the other chronic conditions in the model by condition type, per convention. Results: The sample included 7013 US adults aged 30+ (mean (± SE) age 53.2 ± 0.3 years, 53% female, 30% non-White). On average, participants had 2.4 (range 0-11) chronic conditions with 62% having ≥2. Those with ≥2 conditions had -1183.6 (95% CI: -1401.0, -966.2) lower daily MIMS-units. On a continuous scale, for each additional condition, movement was lower by -504.2 (95% CI: -580.4, -427.9) MIMS-units. Compared to those with 0 conditions, there was a dose-response reduction in movement with multimorbidity ( Figure ). Presence (vs absence) of obesity, diabetes, stroke, chronic kidney disease, cancer, depression, and memory problems were each associated with lower 24-hr movement activity. Conclusions: Multimorbidity is highly prevalent in US adults and associated with lower 24-hr movement. Intervention strategies focused on promotion of daily lifestyle movement may attenuate population-level multimorbidity burden. Future research should examine which co-occurring conditions contribute to low movement.

Introduction: Reduced physical functioning is a risk factor for many adverse outcomes for older adults, including risk of institutionalization and disability. Previous research indicates that leisure-time physical activity (LTPA) in mid-life predicts better physical function at a single timepoint in late-life, but more information is needed on the association between mid-life LTPA and trajectories of physical function in late-life. We hypothesized that higher levels of LTPA in mid-life are associated with attenuated physical function declines in late life. Methods: We studied 5,517 ARIC Study participants (Visit 5; mean age: 75.9 years; range: 67-91 years; 58% women; 21% Black participants) without Parkinson disease or prevalent stroke who completed the Short Physical Performance Battery (SPPB, a composite of gait speed, balance, and chair stands (lowest score 0, highest score 12). SPPB assessments were repeated at Visits 6 and 7 (median follow-up: 4.2 years). Engagement in LTPA was assessed using a modified Baecke Physical Activity Questionnaire in mid-life (Visit 1; mean age: 52 years; mean time between mid- and late-life exams: 23.7 years). Based on minutes/week of moderate-vigorous intensity LTPA participation, participants were classified into poor (0 min/week), intermediate (1-149), or ideal (≥150) LTPA levels, according to American Heart Association (AHA) physical activity recommendations. We also used the average total MET-mins/week and average moderate-vigorous intensity MET-min/week as continuous measures. Random-slope and random-intercept mixed models with an independent covariance structure tested the association between mid-life LTPA and SPPB score change in late-life, adjusted for age, sex, race-center, education, body mass index, smoking, diabetes, and hypertension. Results: SPPB scores declined an average of 2.19 points per 10 years (95% CI: -2.43, -1.96; p Conclusions: Higher levels of self-reported LTPA at a single time point in mid-life were associated with mitigated physical function declines in SPPB in late-life, over two decades later. Additional research may consider the role of changes in LTPA across mid- and late-life and of other types of physical activity, as well as sedentary behaviors, in further understanding the association.

Introduction: Frailty, an increased vulnerability to stressors, is associated with adverse health outcomes. Cardiovascular disease (CVD) is associated with frailty, but whether circulating cardiac biomarkers of subclinical myocardial injury and strain (e.g., high-sensitivity cardiac troponin T [hs-cTnT] and natriuretic peptide [NT-proBNP]) are associated with frailty is unknown. Methods: We conducted a cross-sectional analysis of levels of hs-cTnT and NT-proBNP assessed among participants of the ARIC study at visit 5 (2011-2013, mean age: 75.5 years, 42% male, 21% Black). We used the Fried frailty phenotype that counts the presence of each component (weight loss, low physical activity, slow gait, exhaustion, and low grip strength) to classify participants as frail (≥3), pre-frail (1-2), or robust (0 components). Participants without prevalent CVD (stroke, myocardial infarction, or heart failure) were classified into hs-cTnT and NT-proBNP quartiles; those with prevalent CVD were considered in a separate group. Using adjusted multinomial logistic regression models, we tested the hypothesis that hs-cTnT and NT-proBNP are positively associated with odds of being pre-frail and frail, vs. robust. Results: Among 5,162 participants, 1,039 had prevalent CVD (20%), 2,447 (48%) were pre-frail, and 358 (7%) frail. Biomarker concentrations had graded associations with frailty and pre-frailty, vs. robust. Estimates comparing the 4 th vs. 1 st quartile, (e.g., hs-cTnT frail vs. robust OR=4.37 [95% CI: 2.69-7.09]) were similar to those observed for prevalent CVD vs. 1 st quartile (e.g., hs-cTnT frail vs. robust OR=5.11 [3.19-8.17]). All frailty components were positively associated with cardiac biomarker concentrations and CVD (Table), except exhaustion with NT-proBNP. Conclusions: Cardiac biomarker concentrations, even in the absence of CVD, may help identify people at greater risk for frailty. Future research should examine the role of changes in biomarkers from mid-life on the risk of frailty

South Asian (SA) individuals represent a large, growing population in a number of European countries. These individuals, particularly first-generation SA immigrants, are at higher risk of developing type 2 diabetes, atherogenic dyslipidaemia, and coronary heart disease than most other racial/ethnic groups living in Europe. SAs also have an increased risk of stroke compared to European-born individuals. Despite a large body of conclusive evidence, SA-specific cardiovascular health promotion and preventive interventions are currently scarce in most European countries, as well as at the European Union level. In this narrative review, we aim to increase awareness among clinicians and healthcare authorities of the public health importance of cardiovascular disease among SAs living in Europe, as well as the need for tailored interventions targeting this group - particularly, in countries where SA immigration is a recent phenomenon. To this purpose, we review key studies on the epidemiology and risk factors of cardiovascular disease in SAs living in the United Kingdom, Italy, Spain, Denmark, Norway, Sweden, and other European countries. Building on these, we discuss potential opportunities for multi-level, targeted, tailored cardiovascular prevention strategies. Because lifestyle interventions often face important cultural barriers in SAs, particularly for first-generation immigrants; we also discuss features that may help maximise the effectiveness of those interventions. Finally, we evaluate knowledge gaps, currently available risk stratification tools such as QRISK-3, and future directions in this important field.

Background Cardiovascular risk factors are associated with worse hearing, but the role of mid-life physical activity (PA) on hearing loss at older ages is yet to be investigated. Methods Among 3,198 participants of the Atherosclerosis Risk in Communities study, we investigated the association between self-reported mid-life PA (meets PA recommendations [≥150 minutes of moderate-to-vigorous PA/week] vs. not) and hearing loss (audiometric battery [pure-tone and speech-in-noise]) at older ages. We estimated differences in hearing between those who met and did not meet PA recommendations at mid-life and at late life adjusting for demographics, medical conditions, and noise exposure. Results 43.3% participants met PA recommendations at mid-life. These participants, compared to those who did not meet recommendations, had lower better hearing by 1.51 (0.46, 2.55) decibels, and 0.37 (0.01, 0.74) more words identified in the speech-in-noise test. Conclusions Meeting PA recommendations in mid-life was associated with better hearing at older ages.

Background COVID-19 has challenged the health system organization requiring a fast reorganization of diagnostic/therapeutic pathways for patients affected by time-dependent diseases such as acute coronary syndromes (ACS). Aim To describe ACS hospitalizations, management, and complication rate before and after the COVID-19 pandemic was declared. Design Ecological retrospective study. Methods: We analyzed aggregated epidemiological data of all patients > 18 years old admitted for ACS in twenty-nine hub cardiac centers from 17 Countries across 4 continents, from December 1st, 2019 to April 15th, 2020. Data from December 2018 to April 2019 were used as historical period. Results A significant overall trend for reduction in the weekly number of ACS hospitalizations was observed (20.2%; 95% confidence interval CI [1.6, 35.4] P = 0.04). The incidence rate reached a 54% reduction during the second week of April (incidence rate ratio: 0.46, 95% CI [0.36, 0.58]) and was also significant when compared to the same months in 2019 (March and April, respectively IRR: 0.56, 95%CI [0.48, 0.67]; IRR: 0.43, 95%CI [0.32, 0.58] p < 0.001). A significant increase in door-to-balloon, door-to-needle, and total ischemic time (p Conclusions Our results confirm that COVID-19 pandemic was associated with a significant decrease in ACS hospitalizations rate, an increase in total ischemic time and a higher rate of mechanical complications on a international scale.

Importance Hearing impairment, a common treatable condition, may contribute to poorer physical function with aging. Objective To assess whether hearing impairment is associated with poorer physical function, reduced walking endurance, and faster decline in physical function. Design, Setting, and Participants In this cohort study, cross-sectional and longitudinal analyses were performed using data from the 2011 to 2019 period of the Atherosclerosis Risk in Communities study, a population-based study of community-dwelling adults at 4 sites in the US. Exposures Hearing thresholds (per 10 dB) assessed with pure tone audiometry and categorized as normal hearing or mild, moderate, or severe hearing impairment. Main Outcomes and Measures Physical function was assessed using the short physical performance battery (SPPB), with composite scores ranging from 0 to 12. A composite score of 6 or less and a score for each component (balance, gait speed, and chair stands) of 2 or less indicated poor performance. Walking endurance was assessed using a 2-minute fast-paced walk test. Tobit regression models adjusted for sociodemographic factors and medical history were used to calculate the mean differences in SPPB composite scores; logistic regression models, to estimate the odds ratios (ORs) of low SPPB composite and component scores; and linear mixed-effects models, to estimate the mean rate of change in SPPB composite scores over time. Results Of the 2956 participants (mean [SD] age, 79 [4.6] years) who attended study visit 6 between 2016 and 2017, 1722 (58.3%) were women, and 2356 (79.7%) were White. As determined by pure tone audiometry, 973 (33%) participants had normal hearing, 1170 (40%) had mild hearing impairment, 692 (23%) had moderate hearing impairment, and 121 (4%) had severe hearing impairment. In the Tobit regression model, severe hearing impairment was associated with a lower mean SPPB score (β, –0.82; 95% CI, –0.34 to –1.30) compared with normal hearing. In fully adjusted logistic regression models, hearing impairment was associated with higher odds of low physical performance scores (severe impairment vs normal hearing: OR for composite physical performance, 2.51 [95% CI, 1.47-4.27]; OR for balance, 2.58 [95% CI, 1.62-4.12]; OR for gait speed, 2.11 [95% CI, 1.03-4.33]). Over time (2 to 3 visits; maximum, 8.9 years), participants with hearing impairment had faster declines in SPPB compared with those with normal hearing (moderate hearing impairment × time interaction, –0.34 [–0.52 to –0.16]). In adjusted models for walking endurance, participants with moderate or severe hearing impairment walked a mean distance of –2.81 m (95% CI, –5.45 to –0.17 m) and –5.31 m (95% CI, –10.20 to –0.36 m) than those with normal hearing, respectively, during the 2-minute walk test. Conclusions and Relevance In this cohort study, hearing impairment was associated with poorer performance, faster decline in physical function, and reduced walking endurance. The results of the longitudinal analysis suggest that hearing impairment may be associated with poorer physical function with aging. Whether management of hearing impairment could delay decline in physical function requires further investigation.

Objective: The objective of the study was to describe the myocardial infarction treatment network and compare in-hospital mortality in patients undergoing either primary angioplasty or pharmacoinvasive strategy in Mexico City and a broad metropolitan area. Methods: Cohort study including patients with ST-elevation myocardial infarction. We recorded demographic and clinical data, laboratory tests and in-hospital mortality in patients that underwent primary angioplasty and pharmacoinvasive strategy. Kaplan–Meier analysis was used to assess mortality and Cox-regression assessed mortality risk factors. Results: Three hundred forty patients from a network of 60 hospitals and 9 states were analyzed. Of the total population, 166 were treated with pharmacoinvasive strategy and 174 with primary angioplasty. Door to thrombolytic time was 54 min and door to wire crossing time was 72.5 min; no differences in total ischemia time were demonstrated. No differences for in-hospital mortality (6.3% vs. 5.4%, p = 0.49) were found when comparing pharmacoinvasive and primary angioplasty groups. The main predictors for in-hospital mortality were: glucose > 180 mg/dl (HR 3.73), total ischemia time > 420 min (HR 3.18), heart rate > 90 bpm (HR 5.46), Killip and Kimball > II (HR 11.03), and left ventricle ejection fraction < 40% (HR 3.21). Conclusions: This myocardial infarction network covers a large area and constitutes one of the biggest in the world. There were no differences regarding in-hospital mortality between pharmacoinvasive strategy and primary angioplasty. Pharmacoinvasive strategy is an effective and safe option for prompt reperfusion in Mexico.

Background Although hearing impairment (HI) is linked to poorer physical functioning, the longitudinal associations between HI and higher-level functional measures are unclear. Method Data are from the Baltimore Longitudinal Study of Aging (2012–2019). Using pure-tone audiometry, we categorized hearing into normal, mild, and moderate or greater HI. Physical function was assessed with the expanded Short Physical Performance Battery (eSPPB) and walking endurance with time to walk 400 m. Multivariable and mixed-effects linear models tested the hypotheses that participants with HI, at baseline, have poorer physical performance and walking endurance, and faster decline over time (up to 6 measurements). In a subset (n = 526), we further adjusted for vestibular function. Among participants with HI, we evaluated the differences in eSPPB scores and walking endurance between hearing aid users and nonusers. Results Of 831 participants, 26% had mild, and 17% moderate or greater HI. After adjustment for demographics and medical history, moderate or greater impairment versus normal hearing was associated with poorer function (0.17 [95% CI: 0.09, 0.26] lower eSPPB score, and 13.3 [95% CI: 3.31, 23.4] seconds slower 400-m walk time) and faster decline in these parameters over 6 years. Adjustment for vestibular function did not attenuate these associations. Hearing aid users walked 400 m 24 seconds faster than nonusers (p = .001). Conclusion Moderate or greater HI is associated with poorer initial and greater decline in higher-level physical performance. The observation that hearing aid users had better walking endurance suggests that screening for and treatment of HI may delay or slow progression of hearing-related functional decline.

Although physical activity (PA) is an important determinant of exercise capacity, the association between these constructs is modest. The authors investigated the associations of self-reported and objectively measured PA with maximal and submaximal tests of exercise capacity. Participants aged ≥40 years (N = 413; 49.6% female) completed a PA questionnaire, wore a uniaxial accelerometer (5.2 ± 1.1 days), and performed maximal (cardiopulmonary exercise test [CPET]) and submaximal (long-distance corridor walk) tests with indirect calorimetry (oxygen consumption, ). Linear regression models were fitted to assess the variation in exercise capacity explained (partial eta squared, η2) by PA variables. Accelerometer-measured vigorous (η2 = 22% female; η2 = 16% male) and total PA (η2 = 17% female; η2 = 13% male) explained the most variance in CPET (p 2 values were lower for long-distance corridor walk (η2 ≤ 11%). Age contributed more to CPET than any PA variable in males (η2 = 32%), but not in females (η2 = 19%). Vigorous and total PA play important roles in CPET in mid to late life.

The consequences of the coronavirus disease (COVID)-19 pandemic go beyond the number of cases and deaths attributed to severe acute respiratory syndrome (SARS)-coronavirus-2 infection. The overwhelmed health care systems and the strict social containment measures have had an impact on the threshold at which patients seek medical care for diseases other than COVID-19, including cardiovascular conditions.

Currently, South Asia accounts for a quarter of the world population, yet it already claims ≈60% of the global burden of heart disease. Besides the epidemics of type 2 diabetes mellitus and coronary heart disease already faced by South Asian countries, recent studies suggest that South Asians may also be at an increased risk of heart failure (HF), and that it presents at earlier ages than in most other racial/ethnic groups. Although a frequently underrecognized threat, an eventual HF epidemic in the densely populated South Asian nations could have dramatic health, social and economic consequences, and urgent interventions are needed to flatten the curve of HF in South Asia. In this review, we discuss recent studies portraying these trends, and describe the mechanisms that may explain an increased risk of premature HF in South Asians compared with other groups, with a special focus on highly relevant features in South Asian populations including premature coronary heart disease, early type 2 diabetes mellitus, ubiquitous abdominal obesity, exposure to the world’s highest levels of air pollution, highly prevalent pretransition forms of HF such as rheumatic heart disease, and underdevelopment of healthcare systems. Other rising lifestyle-related risk factors such as use of tobacco products, hypertension, and general obesity are also discussed. We evaluate the prognosis of HF in South Asian countries and the implications of an anticipated HF epidemic. Finally, we discuss proposed interventions aimed at curbing these adverse trends, management approaches that can improve the prognosis of prevalent HF in South Asian countries, and research gaps in this important field.

The right coronary artery involvement occurs in 1-2% of aortic dissection and may cause atrioventricular (AV) block due to obstruction of blood supply to the AV node. A 59-year-old man with a history of hypertension presented to the emergency department with chest pain and complete AV block. After the diagnostic approach, aortic dissection Stanford A was diagnosed. Aortic dissection must be suspected in hypertensive patients who present with AV block and chest pain.

The objective of PHASE-MX registry is to validate the efficacy and safety of the pharmacoinvasive strategy in comparison with percutaneous coronary intervention (PCI) in patients with acute myocardial infarction with ST segment elevation (STEMI) in a metropolitan region of Mexico. The primary outcome will consist of the composite of cardiovascular death, re-infarction, stroke and cardiogenic shock.The PHASE-MX registry will include a prospective cohort of patients with STEMI who received reperfusion treatment (mechanical of pharmacological) in the first 12 h after the onset of symptoms. The registry is designed to compare the efficacy and safety of primary PCI and pharmacoinvasive strategy. The simple size was calculated in 344 patients divided into two groups, with an estimated loss rate of 10%. Patients included in the PHASE-MX cohort will be followed for up to one year.In Mexico, only 5 out of 10 patients with STEMI have access to reperfusion therapy. Pharmacoinvasive strategy is takes advantage of the accessibility of fibrinolysis and the effectiveness of PCI. The present research protocol aims to provide information that serves as a link between information derived from controlled clinical trials and records derived from real world experience.El objetivo del registro PHASE-MX es validar la eficacia y seguridad de la estrategia farmacoinvasiva en comparación con la angioplastia coronaria transluminal percutánea primaria (ACTPp) en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) en una región metropolitana de México. El desenlace primario es el compuesto de muerte cardiovascular, reinfarto, accidente vascular cerebral y choque cardiogénico.El registro PHASE-MX es una cohorte prospectiva de pacientes con IAMCEST que recibieron tratamiento de reperfusión (mecánico o farmacológico) en las primeras 12 horas desde el inicio de los síntomas, atendidos en el Instituto Nacional de Cardiología Ignacio Chávez. El análisis estadístico se basa en la no inferioridad de la estrategia farmacoinvasiva en comparación con la ACTPp. Se calcula un tamaño de muestra de 344 pacientes divididos en dos grupos (angioplastia primaria y estrategia farmacoinvasiva), considerada una tasa de pérdidas de 10%. Los pacientes incluidos en la cohorte PHASE-MX se seguirán durante un año.En México, sólo 5 de cada 10 pacientes con IAMCEST tienen acceso al tratamiento de reperfusión. La estrategia farmacoinvasiva aprovecha la accesibilidad de la fibrinólisis y la efectividad de la ACTPp, por lo que podría resultar el método de elección en el tratamiento del IAMCEST en la mayoría de los casos. El presente protocolo de investigación pretende aportar información que sirva como enlace entre la información derivada de los estudios clínicos controlados y los registros derivados de la experiencia del mundo real.

Background: Starr-Edwards prosthetic valves were used for valve replacement, but due to their high thrombogenic risk, they were withdrawn from market. Nevertheless, there are some cases of Starr-Edwards prosthetic valve carriers that have shown long-term survival reaching up to 50 years. The objective of this study was to determine survival in 12 patients with mechanical Starr-Edwards prosthetic valve and risk factors for predicting valve dysfunction. Methods: Cross-sectional study of patients who had valve replacement with a Starr-Edwards prosthetic valve in a single center from 1968 to 1990. Socio-demographic data, valvular dysfunction variables and mortality were recorded. Logistic regression models to determine valvular dysfunction were constructed. Survival was analyzed with Cox regression and Kaplan-Meier survival curves. Results: A total of 12 patients were analyzed. The median age was 59 years (48.5 - 64). Eleven patients had normal right and left ventricular function. The most common cause of valve replacement was rheumatic valve disease (75%) and it was more frequently in mitral position (50%). Valvular dysfunction was detected in 3 patients (25%). Atrial fibrillation had the highest association with valvular dysfunction (P = 0.005). Stroke was seen in 25% of the population and the overall mortality was 33.3%. Conclusions: The survival of patients with Starr-Edwards prosthetic valve was 66.66% in the 50-year follow-up. Atrial fibrillation had the highest association with prosthetic valvular dysfunction.

BACKGROUND AND AIMS: Peripheral artery disease (PAD) is associated with poor mobility and fatigue, but the relationship between preclinical ankle-brachial index (ABI) and early markers of fatigue and functional decline has not been defined. METHODS: 570 adults, 50 and older, from the Baltimore Longitudinal Study of Aging (N = 570), with normal values of ABI (1–1.29), were classified into ABI tertiles. Perceived fatigability was assessed after a 5-min, treadmill walk (1.5 mph) using the Borg rating of perceived exertion (RPE, range 6–20). Functional evaluation included the Health, Aging and Body Composition Physical Performance Battery (HABC PPB), time to complete a 400-m corridor walk (LDCW), and VO(2) peak (ml/kg/min). High RPE and poor walking endurance (PWE) were defined as RPE≥10 and taking >5 min for the LDCW, respectively. Differences between tertiles in fatigability and functional measures were tested adjusting for demographics, behavioral characteristics, self-reported fatigue, and medical history. RESULTS: Mean LDCW time and RPE were greater for participants in the lowest tertile compared to those in the highest; mean VO(2) peak and HABC PPB scores were lower, suggesting hierarchical associations between fatigue, functional performance, and ABI (p < 0.05 for all). Odds of PWE were greater for those in the lowest ABI tertile compared to the highest; odds of reporting high RPE were greater for those in the middle tertile. CONCLUSIONS: Lower ABI is associated with poorer physical function and increased fatigability, suggesting that early changes in ABI may infer greater risk of functional decline, even among those who may not progress to PAD.

The longitudinal associations between hearing impairment and higher-level functional measures and the potential confounding role of vestibular function have not been assessed. We investigated these associations in 831 participants of the Baltimore Longitudinal Study of Aging (2012–2019). Hearing was measured using pure-tone audiometry and categorized using WHO standards. Physical function was assessed with the Health Aging and Body Composition Physical Performance Battery (HABCPPB, higher=better) and walking endurance with time to walk 400 meters. Multivariable regression models tested the hypotheses that participants with hearing impairment have poorer physical outomes. In a subset, we further adjusted for vestibular function. Hearing impairment was associated with decrements in higher-level physical performance and walking endurance, and faster decline over time, regardless of vestibular function. Among participants with any hearing impairment, hearing aid users were faster in the 400-m walk. Early screening for higher-level functional loss among older adults with hearing loss is warranted.

Heart failure is a global public health problem, with more than 37 million patients living with heart failure around the world. Heart failure with preserved ejection fraction is an increasingly common category (approximately 60% of the cases) and shows remarkable differences in diagnosis and treatment when compared with heart failure with reduced ejection fraction. The current review covers epidemiology, risk factors, pathophysiologic mechanisms, clinical and paraclinical characteristics and diagnostic criteria of heart failure with preserved ejection fraction and concludes with a plea for original research in our country.

Background Cardiovascular disease ( CVD ) and fatigue commonly co‐occur in older adults, yet the subjective nature of fatigue and its situational dependence leave the true magnitude of this association undefined. Methods and Results Six‐hundred and twenty‐five participants with no history of CVD (aged 68.1+12.0 years), from the Baltimore Longitudinal Study of Aging who underwent ≥2 clinic visits between 2007 and 2015 were classified according to sex‐specific predicted 10‐year CVD risk scores using the Framingham CVD risk score (Framingham) and the Pooled Cohort Equation at baseline. Perceived fatigability was assessed using the Borg rating of perceived exertion scale after a 5‐minute treadmill walk (0.67 m/s, 0% grade). Linear models were used to assess the association between baseline CVD risk and perceived fatigability an average of 4.5 years later, adjusted for demographics, behaviors, and medical history. In final models, a 5% higher baseline Pooled Cohort Equation score was associated with greater perceived fatigability at follow‐up (β=0.13 rating of perceived exertion, P =0.008). Stratified analyses suggested this association was stronger among those aged ≤70 years and those with obesity. Of the individual CVD risk score components, older age was most strongly associated with perceived fatigability (β=0.48, P P =0.002), and treated hypertension (β=0.11, P =0.003). There was no association with the Framingham risk score. Conclusions Perceived fatigability was higher among participants with greater CVD risk measured using the Pooled Cohort Equation risk score. The strong associations with hypertension and obesity suggest prevention and promotion of cardiovascular health may also lower perceived fatigability, particularly among those aged ≤70 years or living with obesity.

Hearing loss is highly prevalent among older adults and has deleterious effects on health. However, its association with physical functioning is not well defined. We investigated the cross-sectional association between hearing and physical function in 3,339 community-dwelling participants (mean age: 79 years, 59% women) of the Atherosclerosis Risk in Communities Study (ARIC). Hearing was measured by pure-tone average ([dB]) of 4 frequencies [0.5,1,2,4 kHz] and physical function was measured using the short physical performance battery (SPPB), which consisted of 3 performance-based tests (balance, gait speed, and chair stands) each scored ranging from 0-4, resulting in a total possible score of 0-12 (higher scores indicating better physical function). We estimated the association between hearing and physical function using continuous scores for each component of the battery, and the overall SPPB score categorized into high [10-12], intermediate [7-9], and low [≤6]) using ordinal logistic regression models. The SPPB scores were reversed for an easier interpretation of the odds ratios (OR). The category with better physical functions was the reference group for each model. After adjustment for demographics and comorbidities, poorer hearing (+10 dB in PTA) was associated with worse physical functioning: OR for lower balance score=1.17, 95% CI [1.08, 1.26]; OR for lower gait speed score=1.15, 95%CI [1.06, 1.25]; OR for lower chair stand score=1.07, 95% CI [1.04, 1.11]; and OR for lower overall SPPB category=1.15, 95%CI [1.07, 1.24]. Hearing loss is associated with poorer physical functioning, highlighting the potentially negative impact of hearing loss on mobility at older ages.

Introduction: Efforts to prevent CVD and its associated health outcomes are paramount to preserving health and functional status in a rapidly aging population. Fatigue is a common side-effect of CVD, but is difficult to measure due to its subjectivity and situational dependence. Fatigability anchors fatigue perception to a standardized walking task, and has been associated with poor functional outcomes with aging. Given the modifiable properties of most CVD risk factors, efforts to prevent the onset and progression of fatigability with aging may benefit from evaluation of -and interventions to treat- components of cardiovascular risk. Hypothesis: Older adults with greater CVD risk have higher fatigability, which is primarily contributed by hypertension. Methods: From 2007-2015, 623 participants of the Baltimore Longitudinal Study of Aging (BLSA) underwent ≥ 2 perceived fatigability and health history assessments. The mean follow-up time is 4.5 years. At baseline, the sex-specific predicted 10-year CVD risk scores were calculated using the Framingham CVD risk score (Framingham) and the Pooled Cohort Equation (ASCVD). At the most recent visit, perceived fatigability was assessed immediately following a slow-paced 5-minute treadmill walk (1.5 mph; 0.67 m/s; 0% grade) using the Borg rating of perceived exertion (RPE; range 6-20). Linear model was used to conduct a cross-sectional analysis. Results: At baseline, participants ranged in age from 32-95 years (mean 68.1±12.0, 56.8% women, 27.6% black), with average CVD risk scores of 17.5±10.5 (Framingham) and 16.8±12.8 (ASCVD), and average fatigability RPE of 8.7±2.4. In crude continuous models, a 5% increase in CVD risk score corresponded to a 0.43 higher RPE (Framingham (p Conclusions: Perceived fatigability was higher among participants with greater 10-year CVD risk as measured using the Framingham and the ASCVD risk scores. The strong associations with hypertension and obesity suggest interventions to reduce CVD risk may also lower fatigability, particularly among those aged ≤70 years or living with obesity.

OBJECTIVE This study aimed to compare and contrast the associations between measures of adiposity and fat distribution and perceived fatigability among well-functioning individuals in mid- to late life. METHODS In 1,054 adults (70.4 ± 12.4 years, 52% female), adiposity was measured as BMI, percent fat (dual-energy x-ray absorptiometry), waist and hip circumferences, and waist to height ratio. In a subset of 383 participants, visceral fat was measured. Perceived fatigability was evaluated after a 5-minute treadmill walk (1.5 mph) using the Borg rating of perceived exertion (range, 6-20). Associations between adiposity measures and perceived fatigability were assessed using regression models adjusting for age, sex, race, smoking, and comorbidities. RESULTS All adiposity measures, except subcutaneous fat, were positively associated with perceived fatigability after adjustment (P

Background Using objectively collected physical activity (PA) data from the Baltimore Longitudinal Study of Aging, the authors tested whether patterns of daily activity and sedentary time differed by cancer survivorship in older adults. Methods In total, 659 participants (mean age ± standard deviation, 71 ± 10 years; 51% women) who had self-reported information on cancer history were instructed to wear an accelerometer for 7 consecutive days. Accelerometer data were summarized into: 1) PA volume and 2) activity fragmentation (interrupted activity), expressed as both continuous and as dichotomized (low and high) variables. Participants were categorized into 4 groups by cross-classification of dichotomous PA volume and fragmentation. Multiple regression models were used to estimate differences in PA patterns by cancer history. Results Cancer survivors averaged 0.12 fewer log-transformed activity counts per day (standard error, 0.05; P = .02) than individuals who reported no history of cancer after adjusting for demographics, behavioral factors, and comorbidities. Although fragmentation did not differ by cancer survivorship in the continuous model (P = .13), cancer survivorship was associated with 77% greater odds (odds ratio, 1.77; 95% confidence interval, 1.11-2.82) of having high (vs low) fragmentation and 94% greater odds (odds ratio, 1.94; 95% confidence interval, 1.13-3.33) of having combined low PA/high fragmentation (vs high PA/low fragmentation) relative to those with no cancer history. Conclusions The current findings suggest that cancer survivors engage in lower total daily PA and that they perform this activity in a more fragmented manner compared with adults without a history of cancer. These results may reflect the onset and progression of a low-activity phenotype that is more vulnerable to heightened levels of fatigue and functional decline with aging.

Physical activity (PA) and its associated health benefits are widely recognized but how working and volunteering contribute to PA level and change with aging is unclear. This study evaluates this association in 694 adults (mean age 70 years) Accelerometry data were collected and processed into minutes spent in inactivity, light, and moderate intensity PA. Working, volunteering, and caregiving were self-reported. 291 participants were reassessed 1–4 years later (mean 2.5 years). Differences in time spent in each PA intensity and their rate of change were modeled using linear regressions adjusted for demographics, BMI, and comorbidities. Engaging in any work or volunteering was associated with higher daily light PA and lower inactive minutes, than no engagement (p =0.009, p= 0.01, respectively). No longitudinal differences were observed (p>0.05 for all). Working and/or volunteering are positively associated with higher levels of light PA and lower inactive time, and may provide health benefits with aging.