Julio A. Panza

Background: Cardiac arrest remains a significant public health challenge with variable mortality trends across different demographics and regions, affecting healthcare planning and intervention strategies. We conducted this study to analyze cardiac arrest-related mortality trends from 1999 to 2023 and predict future trends up to 2035. Methods: This study analyzed data from 1999 to 2023, focusing on cardiac arrest as the primary cause of death (ICD-10: I46). Age-adjusted mortality rates (AAMRs) were standardized according to the 2000 U.S. Census. Joinpoint regression was utilized to calculate annual percentage change (APC), and an ARIMA model with Python 3.10 was used for mortality predictions. Results: A total of 365,608 cardiac arrest-related deaths were recorded in the USA from 1999 to 2023. There was a sharp decline in mortality rate until 2001 (APC: −10.35, p < 0.05), followed by a slowed decline until 2013 (APC: −2.91, p < 0.05), and then a gradual uptrend. Males exhibited a higher AAMR (5.8, 95% CI: 5.8–5.9) compared to females (4.2, 95% CI: 4.1–4.2). African Americans had the highest AAMR (8.9, 95% CI: 8.9–9), followed by Caucasians (4.8, 95% CI: 4.8–4.9) and American Indians (3.5, 95% CI: 3.3–3.7). The South region of the US had the highest AAMR, followed by the Northeast, Midwest, and West. Alabama exhibited the highest AAMR, followed by Nevada and Hawaii. Predictive analysis suggests a potential stable slow downtrend in mortality rates by 2035 (AAMR: 4.28, 95% CI: −1.8–10.4). Conclusions: The observed trends and future predictions underscore the importance of targeted public health interventions and healthcare planning to address cardiac arrest mortality.

Background: Ischemic heart disease (IHD) remains the leading cause of mortality globally, contributing significantly to rising healthcare costs. This study aims to analyze trends in IHD-related mortality from 1999 to 2020 using data from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Methods: Mortality data from 1999 to 2020 were extracted from the CDC WONDER database, with IHD identified as the primary cause of death (International Classification of Diseases, 10th Revision Codes: I20–I25). Age-adjusted mortality rates (AAMRs) were calculated and analyzed. Trends were assessed using Joinpoint Regression Analysis to determine the annual percentage change (APC). Additionally, predictive modeling was performed using an autoregressive integrated moving average model implemented in Python and Generative Pre-trained Transformer 4. Results: The study observed a decline in AAMR over the 22-year period, totaling 9 105 056 deaths. The APC revealed a significant decline in mortality rates until 2011 [APC: −4.99, P < 0.05, 95% confidence interval (CI): −5.3 to −4.7], followed by a slower decline through 2020 (APC: −2.35, P < 0.05, 95% CI: −2.8 to −1.6). Both males (AAMR: 161.4, 95% CI: 161.3–161.6) and females (AAMR: 93.1, 95% CI: 93.0–93.2) experienced a continuous decline in APC until 2018, after which trends began to reverse. African Americans had the highest AAMR (144.1, 95% CI: 143.8–144.3), followed by Whites (125.3, 95% CI: 125.3–125.4), American Indians (106.1, 95% CI: 105.0–107.2), Hispanics (92.9, 95% CI: 92.7–93.2), and Asians (67.1, 95% CI: 66.8–67.4). Geographically, the Mid-Atlantic region exhibited the highest AAMR, followed by the East South-Central region. Among states, Oklahoma had the highest AAMR, followed by New York. Non-metropolitan areas had the highest mortality rates, whereas large-fringe metropolitan areas exhibited the lowest. Predictive analysis suggests a potential plateau or slight increase in mortality rates by 2035 (AAMR: 104.5, 95% CI: 50.05–159.64). Conclusions: The observed slowing in the decline of IHD mortality rates and the potential for future increases underscore the need for sustained public health interventions and vigilant surveillance to mitigate the burden of IHD.

Purpose of Review We aim to reevaluate how the assessment of myocardial viability can guide optimal treatment strategies for patients with ischemic cardiomyopathy (ICM) based on a more contemporary understanding of the mechanism of benefit of revascularization. Recent Findings The assessment of viability in left ventricular (LV) segments with diminished contraction has been proposed as key to predict the benefit of revascularization and, therefore, as a requisite for the selection of patients to undergo this form of treatment. However, data from prospective trials have diverged from earlier retrospective studies. Summary Traditional binary viability assessment may oversimplify ICM’s complexity and the nuances of revascularization benefits. A conceptual shift from the traditional paradigm centered on the assessment of viability as a dichotomous variable to a more comprehensive approach encompassing a thorough understanding of ICM’s complex pathophysiology and the salutary effect of revascularization in the prevention of myocardial infarction and ventricular arrhythmias is required.

Hypertrophic cardiomyopathy is a genetic disease that frequently presents at a young age. Pregnancy represents a state of high physiological stress to the cardiovascular system. Thus, pregnant women with hypertrophic cardiomyopathy face the potential for higher morbidity and, therefore, their management may become a significant challenge when complications develop. Physiologic changes that occur during pregnancy, that is, decreased vascular resistance, increased blood volume, and increased heart rate can lead to worsening heart failure in women with hypertrophic cardiomyopathy. In addition, pregnant women with hypertrophic cardiomyopathy are at higher risk for arrhythmias. The hemodynamic effects of atrial fibrillation and ventricular tachycardia are significant and can be dangerous for the mother and the fetus. In addition, they can lead to heart failure exacerbation. Atrial fibrillation is of particular interest in this population subgroup. Pregnancy is a hypercoagulable state and atrial fibrillation is an arrhythmia associated with significant thromboembolic complications. Patients with hypertrophic cardiomyopathy that develop atrial fibrillation are especially at a higher risk of thrombosis. Anticoagulation is recommended regardless of CHA2DS2-VASc score. Anticoagulation during pregnancy is challenging not only because of the teratogenic effects of some drugs and the lack of evidence for some others, but also the differences in the plasma concentration of many anticoagulants. Overall, the potential for high morbidity in pregnant women with hypertrophic cardiomyopathy is not negligible. Major cardiac events such as arrhythmias and heart failure are common. However, early recognition and treatment of these complications can lead to full-term pregnancy and successful delivery.