Al‐Kindi, Sadeer

Abstract Introduction Cardiovascular disease (CVD) is the leading cause of death among patients with kidney failure on dialysis. Social determinants of health may worsen this risk but are seldom incorporated into prognostic models. ICD-10 Z-codes provide standardized documentation of social determinants of health, yet their prognostic value in dialysis populations remains uncertain. This study examined whether Z-coded social determinants of health are associated with adverse cardiovascular outcomes and mortality among patients receiving dialysis for kidney failure. Methods A retrospective cohort study was conducted using the TriNetX Research Network (2010–2024), encompassing de-identified data from 103 institutions. Adults with kidney failure on chronic dialysis were stratified by the presence of ICD-10 Z-codes (Z55–Z65). Propensity score matching (1:1) balanced demographics, comorbidities, medications, and laboratory values. Primary outcomes were all-cause mortality and hospitalization; secondary outcomes included acute heart failure, myocardial infarction, stroke, cardiac arrest, bradyarrhythmias, and ventricular tachycardia. Results After matching, mean age was 62 years, and 42.4% were female in the Z-code cohort versus 41.2% in controls. Over one year, mortality occurred in 12.5% versus 10.9% (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.15–1.29) and all-cause hospitalizations in 57.3% versus 53.1% (HR, 1.22; 95% CI, 1.19–1.26). Cardiovascular complications were consistently higher in Z-coded patients, including heart failure (24.3% vs 20.5%; HR, 1.29), myocardial infarction (8.0% vs 7.1%; HR, 1.19), stroke (6.6% vs 6.2%; HR, 1.13), cardiac arrest (3.8% vs 3.1%; HR, 1.29), and bradyarrhythmias (6.9% vs 5.5%; HR, 1.33). Discussion Among patients with kidney failure, documented Z-coded social risk factors were associated with greater mortality and cardiovascular morbidity. Incorporating social determinants of health documentation into nephrology care may improve risk stratification and inform targeted interventions.

Background Although micro‐ and nanoplastics are an emerging risk factor for the development of cardiovascular diseases, the association of marine microplastic levels (MMLs) with the burden of cardiometabolic diseases at a population level remains unexplored. We investigated the relationship between the mean microplastic concentration in ocean water within 200 nautical miles of the US coastline and the prevalence of type 2 diabetes, coronary artery disease, and stroke in nearby counties. Methods Microplastic concentration data within 200 nautical miles of the US coastline were geospatially analyzed to calculate mean MMLs. The coastal counties were stratified into 4 categories based on MMLs in the adjacent ocean water body: low, medium, high, or very high. The Behavioral Risk Factor Surveillance System 2019 to 2020 survey data were used to identify the prevalence of type 2 diabetes, coronary artery disease, and stroke in these counties. Univariate and population‐weighted multivariate quasi‐Poisson regression, adjusted for county‐level confounding variables, was used to evaluate the unadjusted and adjusted associations between disease prevalence and MMLs. Results The mean age of the population was 43±6 years. After adjusting for age, sex, physician access, and socioenvironmental vulnerabilities at the county level, counties with very high MMLs exhibited an 18%, 7%, and 9% higher adjusted prevalence of type 2 diabetes, coronary artery disease, and stroke, respectively, compared with those with low levels. Conclusion Marine microplastic levels were significantly associated with the prevalence of cardiometabolic diseases in coastal counties. Comprehensive studies at an individual level are needed to further investigate the health impacts of microplastic pollution.

ABSTRACTBackgroundMicroplastics are emerging as environmental pollutants with potential neurotoxic effects, yet their association with neurological disabilities remains largely unexplored.MethodsIn this cross‐sectional study comprising 218 coastal counties in the United States, we compared the self‐reported prevalence of cognitive disability, mobility disability, self‐care disability, and independent living disability in counties with very high and low marine microplastic levels (MMLs). Unadjusted and adjusted prevalence ratios (PRs) were computed using population‐weighted quasi‐Poisson regression across three different models to examine the relationship between disability prevalence and MMLs.ResultsCounties exposed to very high marine microplastic levels had a higher mean prevalence of self‐reported cognitive disability (15.2% vs. 13.9%), mobility disability (14.1% vs. 12.3%), self‐care disability (4.2% vs. 3.6%), and independent living disability (8.5% vs. 7.7%) compared to those exposed to low levels (p < 0.001). Regression analyses revealed significantly elevated adjusted prevalence ratios (PRs) for cognitive (PR: 1.09 [95% CI: 1.06–1.12], p < 0.001), mobility (PR: 1.06 [1.03–1.10], p < 0.001), self‐care (PR: 1.16 [1.11–1.20], p < 0.001), and independent living disability (PR: 1.08 [1.05–1.12], p < 0.001) in counties with very high microplastic exposure compared to those with low exposure.ConclusionsThis study highlights a significant association between marine microplastic pollution and the self‐reported prevalence of cognitive, mobility, self‐care, and independent living disabilities at the county level. While merely associative, these findings emphasize the urgent need for further investigation into the individual‐level health impacts of microplastic exposure and underscore the importance of environmental interventions to mitigate potential risks.

Introduction: Metabolic pharmacotherapies [Glucagon-like peptide-1 receptor agonists (GLP1RA) and sodium-glucose cotransporter type 2 inhibitors (SGLT2i)] have shown benefit in patients with heart failure and preserved ejection fraction (HFpEF). It remains unclear whether the two classes would have additive effects. Methods: We performed a retrospective study using a de-identified federated database with 89 contributing health care organizations (HCO), including over 126 million patients (TriNetX Research Network, Cambridge, MA; date of data access: May 23, 2024). TriNetX regularly aggregates clinical data directly from participating HCOs, and performs extensive data quality and accuracy assessment. While TriNetX obfuscates institutional information relating to participating HCOs, a typical HCO includes a large academic health center with inpatient, outpatient, and specialty care services. We identified all patients with a diagnosis of Heart failure with preserved ejection fraction (HFpEF, ICD-10: I50.3), and SGLT2i usage. We then categorized this patient population into two cohorts, including patients with concomitant GLP1RA use, and patients without GLP1RA use. For both cohorts, we collected data on patient demographics, and the outcomes of all-cause mortality, and all-cause hospitalization, occurring up to 10-years after the index diagnosis. We evaluated differences in outcome risk using hazards ratios and 95% confidence intervals. Results: Prior to propensity score matching, we identified 114,329 patients, with 7931 patients receiving SGLT2i +GLP1RA vs 106398 receiving SGLT2i-alone. Majority (55.7%) identified as white and 24.4% as African Americans and >90% of the patients had a diagnosis of type 2 diabetes mellitus. After propensity matching, the rate of all-cause hospitalization within the combination group was lower than SGLT2i group (29.6% vs 32.4%, HR 0.76 [0.73- 0.79], P<0.001). All-cause mortality for the combination group was 6.8% versus 10.6% within the SGLT2i-alone group (HR 0.52 [0.47-0.56], P<0.001)). Conclusion: In this propensity-matched cohort, patients with HFpEF receiving GLP1RA and SGLT2i had lower rates of hospitalizations and all-cause mortality compared with those receiving SGLT2i alone. Large randomized controlled trials are warranted to corroborate these findings.

Abstract Enduring shortages of infectious disease physicians across the United States continue despite efforts to mitigate the problem. The recent fellowship match results underscore the difficulty in rectifying that shortage. Our report sheds light on the current geographic distribution of US infectious disease physicians and highlights the challenges faced by rural communities.

Introduction: There is limited data on how psychosocial risk factors (PSRFs) affect the outcomes of patients undergoing atrial fibrillation (AF) ablation. Hypothesis: We hypothesized that the presence of PSRFs affects the outcomes of AF ablation and tested this hypothesis using a nationally representative sample of the US population. Methods: The National Readmissions Database (NRD) was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing AF ablation. Patients were divided into two cohorts based on the presence or absence of ≥1 PSRF. PSRFs were divided into 5 domains including limited cognitive understanding, substance use, psychiatric disease, low socioeconomic status, and uninsured status. A multivariable logistic regression model was utilized to adjust for confounders. Results: Our cohort included 50,623 AF ablation procedures, of which 21,363 (42.2%) had ≥ 1 PSRF. On multivariable analysis, the presence of ≥ 1 PSRF was associated with higher odds of cardiovascular complications (adjusted odds ratio [aOR] 1.11; 95% confidence interval [CI]: 1.02-1.22; p=0.02), peripheral vascular complications (aOR:1.18; 95% CI: 1.01-1.38; p=0.04), pulmonary complications (aOR:1.16; 95% CI: 1.05-1.29; p<0.01) and neurological complications (aOR:1.42; 95% CI: 1.12-1.78; p<0.01), along with higher odds of 30-day all-cause readmissions (aOR:1.30; 95% CI: 1.19-1.43; p<0.01) and atrial fibrillation/flutter related readmissions (aOR:1.27; 95% CI: 1.08-1.50; p<0.01), 90-day all-cause readmissions (aOR:1.30; 95% CI: 1.20-1.40; p<0.01) and atrial fibrillation/flutter related readmissions (aOR:1.22; 95% CI: 1.06-1.41; p<0.01), and 180-day all-cause readmissions (aOR:1.35; 95% CI: 1.24-1.45; p<0.01) (Figure 1). Conclusion: In conclusion, our data suggest an association between PSRFs and worse in-hospital outcomes along with increased all-cause and arrhythmia-related readmissions in patients undergoing AF ablation.

Background Although cardiovascular mortality (CVM) rates in the United States have been declining overall, our study evaluated whether this holds true for areas with increased social deprivation. Methods and Results We used county‐level cross‐sectional age‐adjusted CVM rates (aa‐CVM) (2000–2019) linked to the Centers for Disease Control and Prevention Social Vulnerability Index (SVI–2010). We grouped counties as per SVI (Groups I 0–0.2, II 0.21–0.4, III 0.41–0.6, IV 0.61–0.8, and V 0.81–1) and calculated the relative change in the aa‐CVM between 2000 to 2003 and 2016 to 2019. We used adjusted linear regression analyses to explore the association between a higher SVI and temporal aa‐CVM improvement; we studied this temporal change in aa‐CVM across subgroups of race, sex, and location. The median aa‐CVM rate (per 100 000) was 272.6 (interquartile range [IQR]: 237.5–311.7). The aa‐CVM was higher in men (315.6 [IQR: 273.4–363.9]) than women (221.3 [IQR: 189.6–256.7]), and in Black residents (347.2 [IQR: 301.1–391.1]; P <0.001) than White residents (258.9 [IQR: 226–299.1]; P <0.001). The aa‐CVM for SVI I (233.6 [IQR: 214.8–257.0]) was significantly lower than that of group V (323.6 [IQR: 277.2–359.2]; P <0.001). The relative reduction in CVM was significantly higher for SVI group I (32.2% [IQR: 24.2–38.4]) than group V (27.2% [IQR: 19–34.1]) counties. After multivariable adjustment, a higher SVI index was associated with lower relative improvement in the age‐adjusted CVM (model coefficient −3.11 [95% CI, −5.66 to −1.22]; P <0.001). Conclusions Socially deprived counties in the United States had higher aa‐CVM rates, and the improvement in aa‐CVM over the past 20 years was lower in these counties.

AbstractThe association of psychosocial risk factors with cardiovascular disease is well‐established, and there is a growing recognition of their influence on atrial fibrillation (AF) . A recent National Heart, Lung, and Blood Institute workshop called for transforming AF research to integrate social determinants of health. There is limited data examining the impact of psychosocial risk factors (PSRFs) on outcomes in patients with an established diagnosis of AF. Catheter ablation for AF has been shown to improve arrhythmia burden and quality of life compared with medical treatment alone. It is unknown how PSRFs affect clinical outcomes in patients undergoing AF ablation. It is important to understand this relationship, especially given the increasing adoption of catheter ablation in clinical practice.