Daily Cardiology Research Analysis

BACKGROUND: Obesity is prevalent among patients with heart failure with preserved ejection fraction (HFpEF). OBJECTIVES: This study aims to evaluate whether anthropometrics including body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) are associated with kidney outcomes in patients with HFpEF. METHODS: In this participant-level pooled analysis of DELIVER, PARAGON-HF, TOPCAT Americas, and I-PRESERVE, we evaluated the impact of adiposity-related anthropometrics on risk of kidney outcomes (sustained eGFR reduction of ≥50%, end-stage kidney disease, or kidney-related death). BMI was collected in all trials and WC was collected in PARAGON-HF and TOPCAT. Multivariable Cox models stratified by trial and treatment were used. RESULTS: Overall, 16,919 participants were included in the analysis (71.9 ± 8.7 years of age; 50.7% women). Of these, 18% were normal/underweight, 35% had overweight, and 47% had obesity as assessed by BMI. WC data was available in 6,177 (105 cm; Q1-Q3: 95-116 cm), and 95% had an elevated WHtR (≥0.5). During follow-up (2.3 years; Q1-Q3: 0.6-2.9 years), 339 kidney outcome events accrued. In multivariable models, higher BMI was not associated with incident kidney events (HR: 0.99; 95% CI: 0.96-1.02; P = 0.45, per 1 kg/m CONCLUSIONS: In this participant-level pooled analysis of 4 large-scale HFpEF outcome trials, obesity and excess abdominal adiposity were highly prevalent. WC and WHtR were associated with an increased risk of kidney outcomes, while BMI was not. (Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213) (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711) (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]; NCT00094302) (Irbesartan in Heart Failure With Preserved Systolic Function [I-PRESERVE]; NCT00095238).

IMPORTANCE: Racial disparities in the management of peripheral arterial disease (PAD) are well established. Analysis of the temporal trends and geographic variation in racial differences in the use of revascularization and major amputation may identify areas for targeted intervention. OBJECTIVE: To investigate differences in the treatment of PAD between Black and White patients over time and by US state. DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined data for Medicare fee-for-service beneficiaries with a PAD diagnosis between 2018 and 2022. Data were analyzed from November 14, 2023, to February 13, 2025. EXPOSURES: Black and White race. MAIN OUTCOMES AND MEASURES: The proportions of Black and White patients with PAD undergoing revascularization and major amputation were compared over time and by state. Data were adjusted for age, sex, hypertension, diabetes, tobacco use, chronic kidney disease, and county-level Social Vulnerability Index (SVI). RESULTS: The total sample size was 2 376 300 beneficiaries (1 224 537 men [51.5%]). Black patients (219 338 [9.2%]) were slightly younger than White patients (2 156 962 [90.8%]; mean [SD] age, 75.8 [7.9] years vs 76.9 [7.8] years; P < .001) and had a higher prevalence of comorbidities. A higher proportion of Black patients (8.9%) than White patients (7.6%) underwent revascularization (odds ratio, 1.19 [95% CI, 1.18-1.21]; P < .001), and a higher proportion of Black patients (2.8%) than White patients (1.0%) underwent major amputation (odds ratio, 2.91 [95% CI, 2.83-2.99]; P < .001). Higher proportions of Black patients than White patients underwent revascularization and major amputation in the majority of states, although with marked variation in these proportional differences across states. The proportions of Black and White patients who underwent revascularization decreased over time (from 8.0% to 7.4% for Black patients and from 6.8% to 6.2% for White patients). The proportion of Black patients who underwent major amputation decreased (from 2.9% to 2.5%; P < .001), but there was no change among White patients (from 0.7% to 0.7%; P = .53). Revascularization correlated weakly (ρ = 0.10), and amputation correlated moderately with SVI (ρ = 0.46). CONCLUSIONS AND RELEVANCE: These findings suggest that higher proportions of Black patients than White patients undergo invasive procedures for PAD, with considerable variation across states. Although the proportional difference in major amputations has narrowed over time, the persistent proportional excess of major amputations among Black patients requires further study to investigate whether this difference reflects remediable disparities in care.

IMPORTANCE: Percutaneous coronary intervention (PCI) is the criterion standard for acute ST-elevation myocardial infarction (STEMI). Achieving target first medical contact (FMC)-to-device time is a quality metric in STEMI care. OBJECTIVES: To describe site-level variability in achieving target FMC-to-device time (≤90 minutes for primary presentations to PCI-capable hospitals and ≤120 minutes for transfers), compare treatment times according to hospital performance, location, and primary PCI volume, and assess whether these aspects are associated with clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cross-sectional study from the American Heart Association Get With the Guidelines-Coronary Artery Disease registry from 2020 to 2022. Patients were recruited from a multicenter quality-improvement registry across 503 US hospitals. Patients with STEMI or STEMI equivalent who underwent primary PCI were included in this analysis. EXPOSURES: FMC-to-device time. MAIN OUTCOMES AND MEASURES: Hospital performance was determined by the proportion of patients meeting target FMC-to-device time at each site. Treatment times and outcomes were compared by hospital performance, location, and primary PCI volume. RESULTS: A total of 73 826 patients were analyzed (median [IQR] age, 62 [54-71] years; 53 474 male [72.4%]). Of 60 109 patients who presented directly to PCI-capable hospitals (primary presentations), 35 783 (59.5%) achieved an FMC-to-device time of 90 minutes or less, whereas 6900 (50.3%) of 13 717 transfers had an FMC-to-device time of 120 minutes or less. There was substantial institutional variability in achieving target FMC-to-device time for both primary presentations (median [IQR], 60.8% [51.2%-68.8%]) and transfers (median [IQR], 50.0% [32.5%-66.9%]). High-performing centers met all target treatment times more frequently. Low-performing sites experienced prolonged emergency department stays, catheterization laboratory arrival-to-PCI times, and transfer delays, varying by mode of presentation. Compared with urban centers, presentation to rural hospitals did not affect the odds of meeting target FMC-to-device time for primary presentations (adjusted odds ratio [aOR], 1.20; 95% CI, 0.96-1.50) or transfers (aOR, 0.86; 95% CI, 0.50-1.47). Failure to achieve target FMC-to-device time was associated with increased in-hospital mortality risk for primary presentations (aOR, 2.21; 95% CI, 2.02-2.42) and transfers (aOR, 2.44; 95% CI, 1.90-3.12). Low hospital performance was associated with increased mortality risk compared with high performance in primary presentations (aOR, 1.16; 95% CI, 1.00-1.34). Outcomes were similar between rural vs urban and low vs high primary PCI volume centers. CONCLUSIONS AND RELEVANCE: In this large cross-sectional study of patients with STEMI, there was substantial hospital-level variability in achieving target treatment times. Patients in whom target FMC-to-device time was not met and those presenting to low-performing hospitals had worse outcomes.