The period following heart failure hospitalization (HFH) is a vulnerable time with high rates of death or recurrent HFH.OBJECTIVE To evaluate clinical characteristics, outcomes, and treatment response to vericiguat according to prespecified index event subgroups and time from index HFH in the Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction (VICTORIA) trial. DESIGN, SETTING, AND PARTICIPANTSAnalysis of an international, randomized, placebo-controlled trial. All VICTORIA patients had recent (<6 months) worsening HF (ejection fraction <45%). Index event subgroups were less than 3 months after HFH (n = 3378), 3 to 6 months after HFH (n = 871), and those requiring outpatient intravenous diuretic therapy only for worsening HF (without HFH) in the previous 3 months (n = 801). Data were analyzed between May 2, 2020, and May 9, 2020.INTERVENTION Vericiguat titrated to 10 mg daily vs placebo. MAIN OUTCOMES AND MEASURESThe primary outcome was time to a composite of HFH or cardiovascular death; secondary outcomes were time to HFH, cardiovascular death, a composite of all-cause mortality or HFH, all-cause death, and total HFH. RESULTS Among 5050 patients in the VICTORIA trial, mean age was 67 years, 24% were women, 64% were White, 22% were Asian, and 5% were Black. Baseline characteristics were balanced between treatment arms within each subgroup. Over a median follow-up of 10.8 months, the primary event rates were 40.9, 29.6, and 23.4 events per 100 patient-years in the HFH at less than 3 months, HFH 3 to 6 months, and outpatient worsening subgroups, respectively. Compared with the outpatient worsening subgroup, the multivariable-adjusted relative risk of the primary outcome was higher in HFH less than 3 months (adjusted hazard ratio, 1.48; 95% CI, 1.27-1.73), with a time-dependent gradient of risk demonstrating that patients closest to their index HFH had the highest risk. Vericiguat was associated with reduced risk of the primary outcome overall and in all subgroups, without evidence of treatment heterogeneity. Similar results were evident for all-cause death and HFH. Addtionally, a continuous association between time from HFH and vericiguat treatment showed a trend toward greater benefit with longer duration since HFH. Safety events (symptomatic hypotension and syncope) were infrequent in all subgroups, with no difference between treatment arms.CONCLUSIONS AND RELEVANCE Among patients with worsening chronic HF, those in closest proximity to their index HFH had the highest risk of cardiovascular death or HFH, irrespective of age or clinical risk factors. The benefit of vericiguat did not differ significantly across the spectrum of risk in worsening HF.
RESUMENObjetivo.Conocer la asociación entre las condiciones sociales y económicas y las tasas de homicidios en jóvenes de 10 a 24 años de edad en México en 2017.Métodos.En este estudio ecológico se estudiaron las desigualdades sociales asociadas con los homicidios en la población de 10 a 24 años en 2017 en México a través de fuentes secundarias de información, correspondientes a las defunciones por homicidio por entidad federativa en México. Las desigualdades sociales en salud se estudiaron mediante la medición absoluta y relativa de las brechas de desigualdad y se estimaron razones de prevalencias de mortalidad con modelos de regresión de Poisson.Resultados.En 2017 se produjeron 8 094 homicidios en la población joven, que fueron más frecuentes en hombres (86,7%). Las brechas de desigualdad entre los estados fueron importantes. La desocupación de la población de mayores de 12 años, los hogares conformados por personas que no son familiares, la baja asistencia escolar y el ingreso por debajo de la línea de bienestar se asociaron de manera significativa con las tasas de homicidios.Conclusiones.La asociación de los determinantes sociales con los homicidios en la población estudiada es fuerte. Deben implementarse políticas y acciones intersectoriales que puedan ayudar a reducir las brechas de desigualdad y lograr mejores condiciones de vida y niveles de bienestar y salud de las personas y sus comunidades.
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