Comparative Assessment of Modified Self-Reported Periodontal Risk Assessment Model and Periodontal Risk Assessment Model among the Adult Population.

Introduction: A high burden of periodontal diseases is seen in the adult population. Hence, it is important to monitor the risk and progression of periodontal diseases. Instead of using complex clinical periodontal risk assessment models, self-reported measures would be favorable for obtaining data in order to conduct research and surveillance of population over time on the progression of periodontitis. Our aim was to compare two tools for periodontal risk assessment, the originally described periodontal risk assessment (PRA) model given by Lang and Tonetti and the modified self-reported periodontal risk assessment model, in patients, depending upon can be changed to after. Materials and Methods: All the participants completed a questionnaire used for modified self-reported periodontal risk assessment model. Periodontal status of the participants was recorded using the periodontal risk assessment (PRA) model given by Lang and Tonetti. Results: Among 50 patients examined 28, 14, and eight were in low-, moderate-, high-risk groups, respectively, identified by self-reported periodontal risk assessment, whereas 34, 10, and six were in low-, moderate-, high-risk groups, respectively, when identified by the PRA model given by Lang and Tonetti. Receiver operating characteristic curve (ROC curve) showed an area under the curve (AUC) of 0.835, and it represents good predictability of self-reported periodontal risk assessment model. Conclusion: This is feasible method with self-reported measures; it is easier, of low cost, and requires less equipment for obtaining data for research and surveillance of the periodontal status of a population.

Demographic and Regional Trends of Heart Failure-Related Mortality in Young Adults in the US, 1999-2019.

Importance: There are limited data on mortality trends in young adults with heart failure (HF). Objective: To study the trends in HF-related mortality among young adults. Design, Setting, and Participants: This retrospective cohort analysis used mortality data of young adults aged 15 to 44 years with HF listed as a contributing or underlying cause of death in the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from January 1999 to December 2019. Analysis took place in October 2021. Exposures: Age 15 to 44 years with HF listed as a contributing or underlying cause of death. Main Outcomes and Measures: HF-related age-adjusted mortality rates (AAMR) per 100 000 US population stratified by sex, race and ethnicity, and geographic areas. Results: Between 1999 and 2019, a total of 61 729 HF-related deaths occurred in young adults. Of these, 38 629 (62.0%) were men and 23 460 (38.0%) were women, and 22 156 (35.9%) were Black, 6648 (10.8%) were Hispanic, and 30 145 (48.8%) were White. The overall AAMR per 100 000 persons for HF in young adults increased from 2.36 in 1999 to 3.16 in 2019. HF mortality increased in young men and women, with men having higher AAMRs throughout the study period. AAMR increased for all race and ethnicity groups, with Black adults having the highest AAMRs (6.41 in 1999 and 8.58 in 2019). AAMR for Hispanic adults and White adults increased from 1.62 to 2.04 and 1.83 to 2.45 over the same time period, respectively. Across most demographic and regional subgroups, HF-related mortality stayed stable or decreased between 1999 and 2012, followed by an increase between 2012 and 2019. There were significant regional differences in the burden of HF-related mortality, with states in the upper 90th percentile of HF-related mortality (Oklahoma, South Carolina, Louisiana, Arkansas, Alabama, and Mississippi) having a significantly higher mortality burden compared with those in the bottom tenth percentile. Conclusions and Relevance: Following an initial period of stability, HF-related mortality in young adults increased from 2012 to 2019 in the United States. Black adults have a 3-fold higher AAMR compared with White adults, with significant geographic variation. Targeted health policy measures are needed to address the rising burden of HF in young adults, with a focus on prevention, early diagnosis, and reduction in disparities.

Utilization of Implantable Cardioverter-Defibrillators in Patients With Heart Transplant (from National Inpatient Sample Database).

Heart transplant (HT) recipients represent a unique and vulnerable population in whom medium and long-term outcomes are significantly affected by the risk of arrhythmias and sudden cardiac death. The use of implantable cardioverter-defibrillators (ICDs) in this population remains debated. A retrospective analysis of the National Inpatient Sample data between 2009 and 2018 was conducted. Hospitalization data on patients who underwent HT, or who had a preexisting HT, and who received a new ICD were included (excluding the preexisting ICD). Outcomes assessed included inpatient mortality, length of stay, and inflation-adjusted costs. We explored temporal trends in ICD placement and mean length of stay, and predictors of ICD placement. Between 2009 and 2018, 22,673 hospitalizations were recorded for HT, during which patients either received a concurrent new ICD placement (n = 70 [0.31%]) or no new ICD placement (n = 22,603 [99.7%]). During the same period, 146,555 admissions were recorded in patients with a history of HT. ICD placement in patients with a preexisting HT was associated with significantly higher inflation-adjusted costs ($55,680.7 vs $17,219.2; p <0.001). Predictors of ICD placement in preexisting patients with HT included cardiac arrest during hospitalization (odds ratio [OR]:14.3 [3.5 to 58.6]), drug abuse (OR:6.0 [1.3 to 27.1]), and previous PCI (OR:6.0 [2.1 to 17.3]). In conclusion, ICD placement in patients with HT history was associated with significantly higher inflation-adjusted costs. In patients with HT history, factors predicting ICD placement included cardiac arrest at hospitalization, previous PCI, and drug abuse.

Trends in HF Hospitalizations Among Young Adults in the United States From 2004 to 2018.

OBJECTIVES: The aim of this study was to assess trends in heart failure (HF) hospitalizations among young adults. BACKGROUND: Data are limited regarding clinical characteristics and outcomes of young adults hospitalized for HF. METHODS: The National Inpatient Sample database was analyzed to identify adults aged 18 to 45 years who were hospitalized for HF between 2004 and 2018. RESULTS: In total, 767,180 weighted hospitalizations for HF in young adults were identified, equivalent to 4.32 (95% CI: 4.31-4.33) per 10,000 person-years. Overall HF hospitalizations per 10,000 U.S. population of young adults decreased from 2.43 in 2004 to 1.82 in 2012, followed by an increase to 2.51 in 2018. Black adults (50.1%) had a significantly higher proportion of HF hospitalizations compared with White (31.9%) and Hispanic adults (12.2%) throughout the study period. Nearly half of patients (45.8%) lived in zip codes in the lowest quartile of national household income. Overall, in-hospital mortality was 1.3%, which decreased over time; this trend was consistent by sex and race. The overall mean LOS (5.2 days) remained stable over time, while the mean inflation-adjusted cost increased from $12,449 in 2004 to $16,786 in 2018, with significant overall differences by race and sex. CONCLUSIONS: This longitudinal examination of U.S. clinical practice revealed that HF hospitalizations among young adults have increased since 2013. Approximately half of these patients are Black and reside in zip codes in the lowest quartile of national household income. Temporal trends showed decreased in-hospital mortality, stable adjusted lengths of stay, and increased inflation-adjusted costs, with significant racial differences in hospitalization rates.