#Trends in #heart #failure prevalence in post-disaster #Fukushima residents 2015–2021

 

Abstract

This study aimed to investigate the prevalence of heart failure (HF) among adults aged ≥ 40 years using health checkup and medical claim data in Fukushima from 2015 to 2021. Joinpoint regression and age-period-cohort analyses were conducted to estimate temporal trends. Age-standardized prevalence and hospital admission rates for HF were 37.0 and 7.4/1000 and 25.9 and 5.3/1000 for men and women, respectively. The prevalence was significantly higher in the coastal area and evacuation zone designated after the 2011 disaster compared to the prefecture overall. In men, the prevalence increased continuously, with an average annual percentage change (AAPC) ranging from 0.72% (evacuation zone) to 1.15% (mountainous area) (P < 0.05). In total residents, the AAPC was significant only in the mountainous areas (0.78%, P = 0.021). Age-period-cohort analysis showed a net drift of 2.50% (95% CI 1.88–3.13%) in men and 0.76% (95% CI − 0.17–1.70%) in women. Cohort rate ratios increased significantly in men born between 1925 and 1975, while in women, they decreased for those born between 1925 and 1960 but increased for those born between 1960 and 1970. The prevalence of HF varied across post-disaster areas of Fukushima. Given that pathological changes and modifiable risk factors for HF accumulate gradually, continuous monitoring among middle-aged adults is essential to enable timely prevention and targeted intervention.

Source: 

Link: https://www.nature.com/articles/s41598-026-36032-0

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#Coinfection of #SARS-CoV-2 and #Influenza: A Catastrophic Coexistence

 

Abstract 

SARS-CoV-2 is a major global public health burden associated with significant morbidity, mortality, and complications, including respiratory, cardiovascular, neurological, and digestive disorders. COVID-19 may induce venous and arterial thromboembolic complications, including deep vein thrombosis, myocardial infarction and cerebral infarction. Simultaneous myocardial and cerebral infarction, termed cardio-cerebral infarction, is exceedingly rare. There is only limited case of concurrent cardio-cerebral infarction in patients with COVID-19. Although there is no standard treatment for the condition, antiplatelet and anticoagulation agents should be used. We emphasize the catastrophic coexistence of concurrent cardio-cerebral infarction in a patient co-infected with SARS-CoV-2 and influenza A. We described a 75-year-old woman was admitted for SARS-CoV-2 and influenza A coinfection. She received anti-viral agent treatment for the virus infection. The patient presented with right side limbs weakness and declined consciousness. The magnetic resonance imaging of brain revealed acute cerebral infarction over the left corona radiata and basal ganglion. Meanwhile, acute myocardial infarction was diagnosed using electrocardiogram and elevated cardiac enzymes. Percutaneous coronary intervention and dual-antiplatelet agents were applied for the arterial thrombosis. The patient survived and recovered with mild residual hemiparesis. In addition, this is the first reported case of concurrent cardio-cerebral infarction in patients with SARS-CoV-2 and influenza A coinfection. Coinfection with SARS-CoV-2 and influenza A is associated with more complications including thromboembolic complications. Management of concurrent cardio-cerebral infarction poses challenges, as timely intervention is critical to prevent disability or death, yet aggressive anticoagulation risks hemorrhagic complications. Optimal treatment strategies remain unclear, highlighting the need for further research. This case underscores the importance of vigilance in managing thrombotic complications in patients with SARS-CoV-2 and influenza coinfection. Despite the downgrading of the COVID-19 pandemic, clinicians must remain alert to complex presentations caused by coinfections with respiratory viruses.

Source: 

Link: https://www.dovepress.com/coinfection-of-sars-cov-2-and-influenza-a-catastrophic-coexistence-peer-reviewed-fulltext-article-IDR

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Effectiveness of #nirmatrelvir/ritonavir and #molnupiravir in reducing the #risk of short-term and long-term #cardiovascular complications of #COVID19: a target trial emulation study

 

Abstract

While treatment with nirmatrelvir/ritonavir or molnupiravir is effective in lowering the rate of severe COVID-19, the effectiveness of these antivirals in reducing the risk of cardiovascular outcomes, especially among the hospitalized population, remains largely unknown. In this study, we assessed the real-world effectiveness of nirmatrelvir/ritonavir and molnupiravir on short- and long-term cardiovascular complications of COVID-19 using a target trial emulation design. Two target trials of COVID-19 antivirals were emulated by using a territory-wide, population-based, retrospective cohort of hospitalized patients in Hong Kong. Nine cardiovascular outcomes were evaluated in both short-term (day 0–21) and long-term (day 22–365) post-SARS-CoV-2 infection. Compared with the control group, the use of nirmatrelvir/ritonavir was associated with a significantly lower one-year risk of cardiovascular mortality, composite cardiovascular complications, major adverse cardiac events, cerebrovascular disorders, dysrhythmia, ischemic heart disease, and other cardiac disorders following infection. Molnupiravir use was associated with a short-term risk reduction in cardiovascular complications, but only a marginal risk reduction in long-term cardiovascular mortality among other complications. This study demonstrated the effectiveness of nirmatrelvir/ritonavir in reducing the risks of short- and long-term cardiovascular complications following a SARS-CoV-2 infection among the hospitalized population. Our findings suggested health-related benefits of prescribing nirmatrelvir/ritonavir over molnupiravir against severe cardiovascular post-acute sequelae of COVID-19 in the long term.

Source: 

Link: https://www.nature.com/articles/s41467-025-67776-4

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#Influenza #vaccination to improve #outcomes for #patients with acute heart failure (PANDA II): a multiregional, seasonal, hospital-based, cluster-randomised, controlled trial in #China

 

Summary

Background

Influenza vaccination is widely recommended to prevent death and serious illness in vulnerable people, including those with heart failure. However, the randomised evidence to support this practice is limited and few people are vaccinated in many parts of the world. We aimed to determine whether influenza vaccination can improve the outcome of patients after an episode of acute heart failure requiring admission to hospital in China.

Methods

We undertook a pragmatic, multiregional, parallel-group, cluster (hospital)-randomised, controlled, superiority trial over three winter seasons in China. Participating hospitals were located in the counties of 12 provinces with the capability of establishing a point-of-care service to provide free influenza vaccination to a sufficient number of patients before their discharge, if allocated to the intervention group. No such service was used in hospitals allocated to usual care (control) but patients were informed of fee-for-service influenza vaccination being available at local community medical centres, as per usual standard of care. Hospitals were randomised (1:1) in each year, stratified by province and up to three times (ie, new randomisation for each season), to include eligible adult (aged ≥18 years) patients with moderate to severe heart failure (New York Heart Association class III or IV) and no contraindication to influenza vaccination. Patient enrolment was conducted over three consecutive winter seasons, from October in each year to March of the following year, between 2021 and 2024. All patients received usual standard of care and were followed up at 1, 3, 6, and 12 months after their hospital discharge by trained study personnel using a standardised protocol. The primary outcome was a composite of all-cause mortality or any hospital readmission over 12 months, excluding events that occurred within 30 days after hospital discharge at all sites and in the summer season only for sites in northern China. The effect of the intervention was assessed at an individual level in the modified intention-to-treat population (all randomly assigned patients with available information until the time of last follow-up, excluding censored events) with a two-level hierarchical logistic regression model that included study period (year) as a fixed effect, and hospital and hospital-period as random effects, with the censored events excluded. The trial is registered at the Chinese Clinical Trial Registry (ChiCTR2100053264).

Findings

Of 252 hospitals assessed for eligibility, 196 hospitals agreed to join and were randomised in three batches at the beginning of each winter season from October, 2021, but 32 hospitals subsequently withdrew before any patients were included. Overall, 7771 participants were enrolled at 164 hospitals in each winter season between Dec 3, 2021, and Feb 14, 2024, with 3570 assigned to the influenza vaccination group and 4201 to the usual care (control) group. The primary outcome occurred in 1378 (41·2%) of 3342 patients in the vaccination group and in 1843 (47·0%) of 3919 patients in the usual care group (odds ratio 0·83 [95% CI 0·72–0·97]; p=0·019). The result was consistent in the sensitivity analysis. The number of participants with a serious adverse event was significantly lower in the vaccination group (1809 [52·5%] of 3444) than the usual care group (2426 [59·0%] of 4110; odds ratio 0·82 [0·70–0·96]; p=0·013).

Interpretation

Influenza vaccination during a hospital admission in patients with acute heart failure can improve their survival and reduce likelihood of readmission to hospital over the subsequent 12 months. The integration of influenza vaccination into inpatient care could offer a widely applicable strategy for an underserved high-risk patient group, that is relevant to resource-limited and possibly resource-rich settings.

Funding

Sanofi and the Chinese Society of Cardiology.

Source: The Lancet, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01485-0/abstract?rss=yes

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