Extreme heat waves (HW) have intensified with climate change and represent a growing threat to cardiovascular health. Brazil, particularly the Southeast region, concentrates densely populated metropolitan areas and is highly vulnerable to the health impacts of rising temperatures. This study aimed to estimate excess mortality from cardiovascular causes associated with HW events in Southeast Brazil between 2014 and 2023. We conducted a time-series analysis using aggregated mortality data from the Brazilian Informatics Health Department and meteorological data from Brazilian National Institute of Meteorology. HW intensity was classified via the Excess Heat Factor (EHF), and excess mortality was estimated using observed-to-expected ratios. Correlation analyses between temperature and mortality from hypertension and ischemic heart disease were performed. Eleven extreme HW were identified during the study period. Mortality from cardiovascular causes coincided with HW episodes, particularly among older adults and in the largest metropolitan areas. Results indicated excess deaths during specific events, with an unusual increase observed in the winter of 2022. The correlations between mean temperature and monthly mortality were weak or negative, reinforcing the need for robust indices such as the EHF to capture health impacts of extreme heat. HW events in Southeast Brazil were associated with higher cardiovascular mortality. The findings highlight extreme heat as a relevant public health risk and reinforce the need for early warning systems, targeted mitigation strategies, and policies for urban and occupational adaptation. These results demonstrate that HW significantly aggravates cardiovascular mortality in Brazil's most populous region.

Limited studies have evaluated lung ultrasound (LUS) in ambulatory heart failure (HF). A six-zone LUS assesses B-lines, a marker of congestion. The Butterfly IQ+ probe features an automated B-line counter (ABLC), eliminating manual counting. We evaluated LUS quality by novice HF providers after training, compared expert manual counts to ABLC, and explored associations between LUS and clinical HF metrics.

Three novice providers underwent 2 h of didactics and 30 proctored exams. Image quality was independently reviewed by two LUS experts. B-lines were counted manually by experts and ABLC. We assessed associations between LUS and four clinical metrics: provider-assessed volume status, > 30% NT-proBNP increase, > 5 lb weight gain, and PAD above goal (CardioMEMS).

Seventy-five subjects were enrolled. Overall, LUS quality was excellent, with 88% good quality. Surprisingly, agreement between expert B-line counts was moderate (Gwet's AC1: 0.49, 95% CI: 0.27 to 0.71) while the accuracy of experts as compared to ABLC was modest (Expert 1 = 61.2%, Expert 2 = 40.3%). Experts correctly identified 93% of positive studies but only 19% of negative studies versus ABLC. Provider volume assessments substantially agreed with LUS (Gwet's AC1: 0.76, 95% CI: 0.61 to 0.91), but providers identified only half of positive LUS cases, suggesting utility in detecting mild volume overload. Only volume overload correlated with positive LUS. Only 25% of subjects had a CardioMEMS.

Novice providers can perform high-quality LUS after brief training. ABLC reduces B-line counting variability. LUS detects mild pulmonary congestion undetectable by clinical exam, potentially preventing worsening in HF patients.

Off-label use of antipsychotics, often at low doses, is increasing. Exploring the link between individual antipsychotic treatment patterns, including low-dose continuous use, and cardiometabolic health is crucial to prevent long-term morbidity and mortality. The current retrospective study examined the prevalence of cardiometabolic medicine use among antipsychotic-users, and its association with their past antipsychotic treatment patterns.

Using a 10% sample of the Australian national medicine dispensing claims data from 2022, we identified individuals aged 15-64 years with ≥2 antipsychotic dispensings (antipsychotic-users) and non-users. We extracted their past 5-year antipsychotic treatment patterns (dose, duration and use of multiple agents). Using Poisson regression and accounting for age and sex, we calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for cardiometabolic medicine use (anti-diabetics, antihypertensives, lipid modifiers, anti-thrombotics) among antipsychotic-users versus non-users. We applied unsupervised hierarchical clustering analysis to identify common antipsychotic-cardiometabolic co-dispensing.

Use of any cardiometabolic medicine was more prevalent among antipsychotic-users (35.8%, n = 28,345) than non-users (26%, n = 1,106,610) yielding an aPR of 1.30 (CI 1.28-1.33). aPRs for the use of anti-diabetics, lipid modifiers and antihypertensives were the highest among the younger age groups between 20 and 49 years and among women. Clustering analysis revealed increased co-dispensing of antipsychotics and anti-diabetics including sulfonylureas, statins, platelet aggregation inhibitors and beta blockers. The prevalence of cardiometabolic medicine use was associated with higher antipsychotic doses (23-54%), treatment duration (12-37%) and use of multiple agents (51%) compared with non-users. However, the prevalence of cardiometabolic medicine use for continuous (≥1 year) low-dose use of aripiprazole, asenapine, brexpiprazole, chlorpromazine, lurasidone, olanzapine, periciazine and quetiapine was also elevated (13-43%).

Use of cardiometabolic medicines is increased among people on long-term antipsychotic treatment. These results highlight the need for active monitoring for cardiometabolic adverse effects, with antipsychotic cessation where possible, or timely interventions to limit morbidity.

Constrictive pericarditis is a rare but important cause of diastolic heart failure. Its uniqueness lies in the fact that surgery (pericardiectomy) remains the mainstay of treatment. Globally, the leading causes of constrictive pericarditis include idiopathic, mediastinal irradiation, post cardiac surgery and tuberculosis.

Patients who underwent pericardiectomy at our tertiary hospital between January 2019 and December 2024 were retrospectively studied with the aim of discussing our experience with the procedure and its outcomes. Data including baseline demographics, preoperative conditions, intraoperative details, and postoperative outcomes were collected from clinical records and analysed.

Thirteen patients had total pericardiectomy during the period under review. The median age was 28 years with dyspnoea and ascites being the most common symptoms. Most patients (61.6%) presented in NYHA class III and IV and were above ASA II classification at the time of surgery. Pericardiectomy was done via median sternotomy and without cardiopulmonary bypass in all cases, with an average surgery duration of 284.5 mins. Postoperative complications included low cardiac output, acute kidney injury, coagulopathy, and prolonged pleural effusion. Median duration of intensive care unit (ICU) stay was 2days and there was 1 mortality. At twelve months follow up, more than 90% of surviving patients were in NYHA class I or II.

Pericardiectomy offers symptomatic relief to patients with constrictive pericarditis. Early identification of this disease would prevent disease progression and offer improved outcomes.

The global prevalence of hypertension has been on the increase in urban areas. Therefore, this study was aimed at establishing the prevalence and predictors of hypertension (HTN) among the adults of Bududa town council in order to inform the way forward on the prevention strategies.

A mixed methods approach with a convergent parallel design was used. The quantitative arm involved 365 randomly selected participants, while the qualitative arm included 24 hypertensive patients. Quantitative data were analyzed at univariate, bivariate, and multivariate levels (p < 0.05), and thematic analysis was applied to the qualitative data.

The prevalence of HTN was 33.97% and was associated with age ≥ 40 years (AOR 0.2; 95% CI 0.13-0.36; p=0.000), high salt intake (AOR:0.4; 95%CI:0.24-0.78; P=0.005), sedentary life style (AOR: 0.5; 95% CI: 0.30-0.89; p=0.017), inappropriate source of information about the risk factors to hypertension, knowledge on primary prevention, antihypertensive side effects, stroke and poor adherence to antihypertensive.

Hypertension remains a major public health issue in Bududa Town Council, closely linked to modifiable behaviors and limited risk awareness, including poor preventive knowledge, treatment non-adherence, and inadequate access to reliable health information.

Cerebral infarction is one of the leading causes of death in adults, impairing patients' quality of life and imposing a heavy burden on families. With current therapeutic approaches, functional recovery after cerebral infarction remains suboptimal. Mesenchymal stem cells (MSCs), due to their broad availability, low immunogenicity, and multipotent differentiation potential, have promise in the treatment of ischemic cerebral infarction. The present study aimed to evaluate the efficacy and safety of mesenchymal stem cells in the treatment of cerebral infarction. VIP Information, China National Knowledge Infrastructure, Wanfang Data, PubMed, Cochrane Library and Web of Science were systematically searched up to October 2024 using the search terms 'mesenchymal stem cells', 'cerebral infarction', and 'randomized controlled trials', which yielded 19 randomized controlled trials for meta-analysis. The efficacy of mesenchymal stem cells in the treatment of cerebral infarction was better than that of conventional treatment, and mesenchymal stem cell therapy decreased the neurological deficit score (National Institutes of Health Stroke Scale) and improved the motor function score (Fugl-Meyer Assessment) and functional independence score (Functional Independence Measure, FIM). Mesenchymal stem cells have a high safety profile in the treatment of patients with cerebral infarction. Most of the adverse effects reported were fever and headache, which resolved spontaneously or following treatment. Umbilical cord mesenchymal stem cells were more effective than bone marrow mesenchymal stem cells. There was no significant difference between transplantation methods. This may be due to the small number of included studies.

Comparisons of preload unloading techniques for left ventricle overdistension during venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support are scarce. We compared outcomes in patients with left ventricular distension treated with cannulated percutaneous atrioseptostomy combined with ECMO-specified as selective biatrial extracorporeal membrane oxygenation (SBA-ECMO)-versus those treated with Impella CP/5.0 in combination with ECMO (ECPELLA).

Consecutive adult patients who received VA-ECMO and underwent additional left ventricle unloading between January 2014 and March 2023 were studied. The primary endpoint was the number of ventilation-free days. The secondary endpoints were serious bleeding, blood product consumption, thrombotic complications, and 28-day mortality.

We included 57 patients, 27 of whom received SBA-ECMO and 30 of whom received ECPELLA. The median number of ventilation-free days was 10 days (0-23) with SBA-ECMO and 5 days (0-23) with the ECPELLA (p = 0.61). According to the multivariable analyses, SBA-ECMO was associated with a lower risk of serious bleeding (HR 0.31 [95% CI 0.12-0.80]) and less blood product consumption (RR 0.57 [95% CI 0.36-0.90]) than ECPELLA. Thrombotic complications and 28-day mortality were similar between the groups before and after multivariable analyses.

In patients with left ventricle congestion during VA-ECMO support, left ventricle unloading with SBA-ECMO was associated with reduced serious bleeding and transfusions compared with ECPELLA, despite a similar number of ventilation-free days, thrombotic complications, and mortality.

ClinicalTrials.gov identifiers: NCT03431467 and NCT05577195.

Cardiometabolic multimorbidity (CMM), defined as the coexistence of two or more cardiometabolic diseases, is increasingly prevalent in older adults. Traditional Chinese medicine (TCM) constitution may influence individual susceptibility and provide complementary approaches for prevention and management. This study aimed to examine the potential association between TCM constitution and CMM to offer novel insights into individualized risk stratification and potential preventive approaches for older adults.

A national cross-sectional study of 24,812 Chinese adults aged ≥60 years was conducted. CMM was defined as having at least two cardiometabolic conditions, including diabetes, stroke, and heart disease. TCM constitutions were assessed using the Chinese Medicine Constitution Questionnaire for the Elderly Edition (CCMQ-EE) and categorized as balanced or eight unbalanced types. The association between TCM constitutions and CMM was analyzed using multivariate logistic regression. To assess the robustness of these associations, inverse probability of treatment weighting (IPTW) based on propensity scores was applied. Stratified analyses assessed subgroup heterogeneity, while tetrachoric correlation and association rule analyses identified constitution co-occurrence patterns.

Qi-deficiency constitution (QDC) [OR 1.57, 95% CI 1.21-2.04], Yang-deficiency constitution (YaDC) [OR 1.63, 95% CI 1.35-1.96], Yin-deficiency constitution (YiDC) [OR 1.62, 95% CI 1.33-1.96], and Phlegm-dampness constitution (PDC) [OR 1.40, 95% CI 1.17-1.68] were independently associated with CMM. Associations remained robust after IPTW based on propensity scores. Subgroup analyses showed a stronger association between YaDC and CMM among obese individuals, while the association between YiDC and CMM was more pronounced in participants with central obesity and without hypertension (P for interaction = 0.049). Common mixed constitution patterns in CMM included YiDC with Dampness-heat constitution (DHC), YiDC with Blood stasis constitution (BSC), and PDC with DHC.

QDC, YaDC, YiDC, and PDC were independently associated with CMM, suggesting that they may represent potential risk factors for its development. Incorporating constitution assessment into routine health evaluations could facilitate the early identification of high-risk subgroups and support the implementation of targeted, constitution-based prevention and management strategies, thereby contributing to reducing the prevalence and burden of CMM in older adults.

Coronary heart disease (CHD) is increasingly affecting younger adults, but many face difficulties returning to work, exacerbating financial burdens. Although vocational rehabilitation may improve employment outcomes, evidence for Chinese CHD patients remains scarce. Therefore, the goal of this study is to improve the employment status of middle-aged and young patients with CHD by implementing vocational rehabilitation measures based on society ecosystems theory.

The vocational rehabilitation program was developed in a multi-stage process. First, a preliminary draft was formulated based on a literature review, expert panels, and semi-structured interviews. Subsequently, this draft was refined and validated through a two-round Delphi expert consensus process. Following this, a pilot study was conducted to assess its feasibility. Finally, we evaluated the finalized program in a single-center randomized controlled trial, where 158 participants were equally randomized to receive either the 3-month intervention (n = 79) or usual care (n = 79). Return-to-work rates were the primary outcome indicator, with anxiety, quality of life, and return-to-work self-efficacy as secondary outcome indicators.

Following the 3-month intervention, the vocational rehabilitation intervention significantly improved return-to-work rates compared to the control group (87.1% vs. 61.6%; χ ² = 12.114, p < 0.001). In addition, return-to-work self-efficacy, quality of life, and anxiety improved in the intervention group after the intervention, and the difference was statistically significant compared to the control group (all p < 0.05). After adjusting for demographic characteristics and clinically relevant factors, the logistic regression model results robustly demonstrated that patients in the intervention group had 5.204 times the odds of successfully returning to work compared to those in the control group [95% CI (2.060, 13.148), p < 0.001].

Our findings indicate that ecosystem theory-based vocational rehabilitation can effectively enhance employment outcomes in young and middle-aged patients with CHD. Healthcare professionals should consider multidimensional factors when developing return-to-work interventions, with future efforts incorporating workplace-related considerations.

A few recent studies have associated ultrafine particulate matter (UFP) with metabolic disorders, contributing to cardiovascular disease, however, evidence is inconsistent. This study aims to investigate the causal relationship between long-term ultrafine particles (UFP) and noise exposures on cardiovascular disease and whether short-term healthy lifestyle interventions can reduce the risks of metabolic disorders.

The research starts from an observational cross-sectional study which involves 1,000 randomly selected 45-64-year-old Kaunas city (Lithuania) men and women. Then a three-arm randomized healthy lifestyle trial of 180 participants is conducted to study the effects of short-term lifestyle interventions, such as promoting physical activity in green spaces and Mediterranean diet. The pollution exposure patterns and the resulting health impacts are estimated on the spatial distribution and participants home addresses. The randomized trial health endpoints will be physicians assessed before intervention on Day 1 and on Day 8 (after intervention) using 7-days monitoring sensors data, clinical survey data, clinical biomarkers of metabolic disorders, and novel cardiometabolic biomarkers. Mathematical models and advanced analytical chemistry techniques will be used to estimate the associations and the effects of the interventions.

This clinical trial with an interdisciplinary approach can provide new insights by evaluating the combined impact of UFP and noise on the indicators of metabolic syndrome and the effects of short-term lifestyle interventions, such as promoting physical activity in green spaces and healthy diets. It can strengthen the evidence base for pollution-disease associations and provide practical recommendations for reducing the burden of metabolic disorders and cardiovascular diseases.

https://www.clinicaltrials.gov/study/NCT07111208, NCT07111208.