The role of lifestyle physical activity (PA) trajectories in the mortality risk of patients with coronary heart disease (CHD) remains unclear. The purpose of this study was to determine the association of longitudinal PA trajectories with all-cause and cardiovascular disease (CVD) mortality in patients with CHD. Longitudinal cohorts reporting the association of PA trajectories with mortality in patients with CHD were identified in April 2021 by searching 5 databases without language restrictions. Published HRs and 95% CIs were pooled using random effects models and bias assessed by Egger regression. A total of 9 prospective cohorts included 33,576 patients. The mean age was 62.5 years. The maximum follow-up was 15.7 years. All of the studies assessed PA through validated questionnaires, and mortality was well documented. Changes in PA defined 4 nominal PA trajectories. Compared with always-inactive patients, the risk of all-cause mortality was 50% lower in those who remained active (HR: 0.50; 95% CI: 0.39-0.63); 45% lower in those who were inactive but became active (HR: 0.55; 95% CI: 0.44-0.7); and 20% lower in those who were active but became inactive (HR: 0.80; 95% CI: 0.64-0.99). Similar results were observed for CVD mortality, except for the category of decreased activity (HR: 0.91; 95% CI: 0.67-1.24). The overall risk of bias was low. No evidence of publication bias was found. Multiple sensitivity analyses provided consistent results. This study illustrates how patients with CHD may benefit by preserving or adopting an active lifestyle. The observation that the benefits of past activity can be weakened or lost if PA is not maintained may be confounded by disease progression.

Aims: Underrepresentation of migrants, women, and older adults in cardiovascular disease (CVD) trials may contribute to disparate care and survival. Among patients who underwent percutaneous coronary intervention (PCI), we aimed to investigate the associations of (i) underrepresented groups with major adverse cardiac events (MACE), CVD mortality, and non-CVD mortality, (ii) underrepresented groups with cardiac rehabilitation (CR) uptake, and (iii) CR uptake with outcomes. Methods and results: We included 15 211 consecutive patients from the CARDIOBASE Bern PCI registry (2009–18). In multi-state models comparing transition probabilities of events, sex was not associated with increased risk of any event. For each year increase in age, the increased risk of non-CVD and CVD mortality was 8% [95% confidence interval (CI) 6–9%]. Being migrant was associated with a lower risk of non-CVD mortality [hazard ratio (HR) (95% CI) 0.49 (0.27–0.90)] but not with CVD mortality. In logistic regression analysis, CR uptake was lower among women [odds ratio (95% CI) = 0.72 (0.57–0.86)] and older adults [0.32 (0.27–0.38)], but not among migrants. In cox regression, CR was independently associated with lower all-cause [HR (95% CI) = 0.12 (0.03–0.37)] and CVD mortality [0.1 (0.02–0.7)], but not with MACE [1.08 (0.8–1.4)]. Conclusion: Among underrepresented groups undergoing PCI, age, but not migration status nor sex, contributed to disparities in mortality. Migrant status did not result in lower attendance of CR. Considering the protective associations of CR on CVD mortality independent of age, sex, and migration status, the lower uptake in women and older adults is noteworthy.

Objetivo Este estudio tiene como primer objetivo: realizar predicciones del curso de la infección en el horizonte temporal desde marzo 18 a abril 18 del 2020, según diferentes medidas de aislamiento aplicadas. Las predicciones incluyen, población total contagiada, mortalidad y necesidad de recursos hospitalarios. Segundo objetivo: modelar la mortalidad y la necesidad de recursos hospitalarios, estratificando por edad el escenario de contagio del 70% de la población. Métodos Para el primer objetivo, nos basamos en el número de casos confirmados en el país hasta marzo 18, 2020 (n=93). Como suposiciones para el modelo, incluimos un índice de contagio R0=2,5 y el índice de casos reales por cada caso confirmado. Para la proporción de pacientes que necesitarían cuidados intensivos u otros cuidados intrahospitalarios, nos basamos en datos aportados por el Imperial College of London. Para el segundo objetivo usamos como tasa de mortalidad por edad, datos aportados por el Instituto Superiore di Sanità en Italia. Resultados Basándonos en los 93 casos reportados al 18 de marzo, si no se aplicase ninguna medida de mitigación, para el 18 de abril el país tendría un total de 613 037 casos. Medidas de mitigación que reduzcan el R0 en un 10%, generan una reducción del 50% del número de casos. Sin embargo, a pesar de reducirse los casos a la mitad, todavía habría un déficit en el número de camas requeridas y sólo uno de cada dos pacientes tendría acceso a dicho recurso. Conclusión En nuestro modelo encontramos que las medidas de mitigación que han sido implementadas hasta la fecha por el gobierno colombiano, se fundamentan en evidencia suficiente para pensar que es posible reducir significativamente el número de casos contagiados y con esto, el número de pacientes que requerirán manejo hospitalario.

Objetivo Modelar el curso de la pandemia COVID-19 en Chile y proyectar la demanda de recursos hospitalarios y letalidad en escenarios simulados: primero, recurriendo a distintas medidas de mitigación para contener la propagación en un mes —desde el 14 de abril hasta el 14 de mayo del 2020— y, segundo, en el supuesto contagio del 70% de la población, se ún edad, sin límite de tiempo.Métodos Utilizamos como base el número de contagios confirmados con SARS-CoV-2 en Chile hasta el 14 de abril del 2020 (8 273 casos, 94 muertes). Para los distintos escenarios, asumimos un número reproductivo básico que va desde R0=2,5 hasta R0=1,5. La proyección de la demanda hospitalaria y letalidad por edad se fundamentaron en reportes italianos y británicos.Resultados Estimamos que para el 14 de mayo del 2020 habría en Chile 2 019 775 contagiados y 15 068 fallecidos en ausencia de medidas de mitigación (R0=2,5). Al implementar medidas que reduzcan R0 a 1,5 (detección temprana y aislamiento de casos, cuarentena y distanciamiento social de mayores de 70 años), el número de contagios y letalidad disminuirían a 94 235 y 703 respectivamente. Sin embargo, la demanda hospitalaria aún sobrepasaría la capacidad de respuesta. La población de mayor riesgo la componen los mayores de 60 años.Conclusión Encontramos evidencia a favor de las medidas de mitigación implementadas por el Gobierno chileno. Sin embargo, medidas más estrictas son necesarias para no colapsar el sistema sanitario, que cuenta con menos recursos hospitalarios que los proyectados. Es esencial aumentar la capacidad hospitalaria en términos de equipamiento y entrenamiento del personal de salud.

Background: Chronic inflammation and immunity play an important role in the pathophysiology and progression of bronchiectasis. However, the role of sputum immunoglobulins (Igs) and their association with disease progression is still unknown. Research question: What is the relationship between airway immunoglobulins and disease progression in bronchiectasis? Study design and methods: Patients from the prospective European Bronchiectasis Registry (EMBARC-BRIDGE; NCT03791086 ) were included. We defined three severity groups (mild, moderate, and severe) according to the Bronchiectasis Severity Index, which ranges from 0 to 26. The levels of sputum IgG, IgM, and IgA were quantified in sputum supernatants using commercial ELISA kits (R&D Systems), and correlations of local Igs with severity were estimated using Spearmańs coefficients. p - trend values were obtained to evaluate the trend of the correlation across the spectrum of severity. Results: 227 patients were analyzed (49% were female, and 64% were older than 65 years). IgA accounted for 90% of the total sputum Igs in the mild risk group, 89% in the moderate risk group, and 86% in the severe risk group (p - trend value=0.007). IgG accounted for 6% of the total sputum Igs in the mild risk group, 9% in the moderate risk group, and 11% in the severe risk group (p-trend value=0.008). IgA/IgG ratio varied between 23 (IQR 11–53) in the mild risk group, 21 (IQR 8–40) in the moderate risk group and 14 (IQR7–27) in the severe risk group (p-trend value=0.02). We found moderate positive correlations between IgG levels and severity among patients with COPD (rho: 0.41, pairwise comparison p-value=0.04) and post-infective as the underlying etiology (rho: 0.40, pairwise comparison p-value=0.05). Interpretation: In this bronchiectasis cohort, we have provided evidence of imbalanced immunoglobulin isotypes in severe bronchiectasis. This could indicate less functional antimicrobial defenses, contributing to persistent airway inflammation and airway remodeling in disease progression.