Nickpreet Singh

Background: Outcomes are poor for older adults following a hospitalization for heart failure (HF). Neighborhood‐level socially determined vulnerabilities could contribute to this, but this is not well studied. We aimed to determine associations between neighborhood‐level socially determined vulnerabilities (density of clinical treatment facilities, physical activity facilities, and unhealthy food sources) and outcomes following HF hospitalization. Methods: We included 366 Medicare beneficiaries in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) cohort study aged ≥65 years and living in urban areas, who were discharged to home following HF hospitalization between 2003 and 2017. The main exposures were low versus high density (based on median) of clinical treatment facilities, physical activity facilities, and unhealthy food sources within 1 km of each participants' home. The primary outcomes were 90‐day and 6‐month composite of all‐cause mortality or readmission. Results: Living in an area with high density of unhealthy food sources was associated with a 6‐month composite of all‐cause mortality and hospitalization (adjusted hazard ratio [aHR], 1.47 [95% CI, 1.09–1.98]). This was largely driven by readmission (aHR, 1.52 [95% CI, 1.12–2.07]). There were no associations between density of clinical treatment or physical activity facilities with outcomes at either time point. Conclusions: Higher density of unhealthy food sources in a participant's neighborhood environment is associated with worse outcomes after HF hospitalization among older adults living in urban environments. Neighborhood‐level interventions, such as those that can mitigate exposure to unhealthy foods, may be important to improve posthospitalization outcomes in people living with HF.

BACKGROUND: Cardiac conduction disturbances remain the most frequent complication of transcatheter aortic valve replacement (TAVR), but the clinical implications of new left bundle branch block (LBBB) after TAVR remain controversial. Here, we aim to assess the impact of new LBBB after TAVR on patient outcomes in a large, real-world registry. METHODS: The study population consisted of patients in the TVT registry (Society of Thoracic Surgery and American College of Cardiology Transcatheter Valve Therapy Registry) who underwent TAVR for aortic stenosis between 2016 and 2022 and were discharged alive from the index hospitalization. Key exclusion criteria included preexisting conduction defects and a permanent pacemaker before TAVR or during the index hospitalization. Clinical outcomes were compared between patients with and without new LBBB using Cox proportional hazards models adjusted for baseline demographic, clinical, and echocardiographic variables. RESULTS: Among 202 533 TAVR recipients, 32 933 (16.3%) developed new LBBB after TAVR. Over the study period, there was a significant decrease in the incidence of new LBBB from 19.9% in the first quarter of 2016 to 14.4% in the third quarter of 2022. Patients with new LBBB after TAVR, compared with those without LBBB, had significantly greater 1-year all-cause mortality (adjusted hazard ratio, 1.19 [95% CI, 1.13–1.25]; P P P P P <0.001). CONCLUSIONS: New LBBB after TAVR is associated with worse 1-year outcomes, including death, rehospitalization, and permanent pacemaker, as well as worse health status and lower left ventricular ejection fraction. These findings suggest that continued efforts to limit the development of conduction disturbance after TAVR are warranted.

BACKGROUND: Increased burden of socially determined vulnerabilities (SDV), which include nonmedical conditions that contribute to patient health, is associated with incident heart failure (HF). Mediators of this association have not been examined. We aimed to determine if a healthy lifestyle mediates the association between SDV and HF. METHODS: We included adults aged 45 to 64 years old across the United States from the REGARDS cohort study (Reasons for Geographic and Racial Differences in Stroke) without evidence of HF at baseline. The primary exposure was a count of SDV based on the Healthy People 2030 framework. The primary outcome was incident HF. We assessed the role of a healthy behavior score (HBS range, 0–8) and its components (adherence to a Mediterranean diet, physical activity, lack of sedentary lifestyle, and smoking abstinence) as potential mediators of the association between SDV and incident HF. RESULTS: We included 13 on 525 participants. The median HBS was 4, with 16% with low HBS (0–2), 55% with moderate HBS (3–5), and 29% with high HBS (6–8). Increasing burden of SDV was associated with a stepwise increase in incident HF (adjusted hazard ratio, 1.84 [95% CI, 1.32–2.52] for 1 SDV, 2.59 [95% CI, 1.87–3.60] for 2 SDV, and 4.20 [95% CI, 3.08–5.73] for ≥3 SDV). There was no statistically significant mediation of HBS for the association of SDV count of 1 and incident HF. HBS score mediated 10.6% of the association between SDV count of 2 and incident HF and 11.1% of the association for those with ≥3 SDV. This increased to 10.8% and 18.3%, respectively, in the complete case analysis. Regarding individual components of HBS as mediators, only avoidance of a sedentary lifestyle was statistically significant (8.6% mediation) for the association of SDV count of 2 and incident HF. CONCLUSIONS: A healthy lifestyle plays a small role in mediating the association between high SDV count and incident HF.