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Additional file 1: Supplemental Table 1. HPI Domains and Indicators. This table summarizes the domains and indicators presented in the HPI. The weights of the domains are presented, and the component indicators are classified according to their related SDoH domains. Supplemental Table 2. SVI Domains and Indicators. This table summarizes the domains and indicators presented in the SVI. The weights of the domains are presented, and the component indicators are classified according to their related SDoH domains. Supplemental Table 3. CES Domains, Subdomains, and Indicators. This table summarizes the domains, subdomains, and indicators presented in the CES. The weights of the domains are presented, and the component indicators are classified according to their related SDoH domains. Supplemental Table 4. Health Outcomes. This table presents the source documentation and description of the nine adult and the single child health outcomes analyzed. Supplemental Table 5. Associations Between Population Weighted HPI and Simple Average HPI with Health Outcomes and Behaviors. R2 values for the population weighted HPI and the simple average HPI are presented. The population weighted HPI explained a similar level of variability in the health outcomes of interest compared to the simple average of the HPI. Supplemental Fig. 1. Comparison of Census Tract, City, and County Level Aggregation. In Panel A, each point on the scatterplot represents a census tract within the ten counties investigated in this analysis. The x-axis represents the percent Latino within each of the Southern California census tracts. The y-axis represents the HPI Score Percentile, with 0 representing the census tract with the least healthy community conditions and 100 representing the community with the healthiest community conditions. In Panel B, each point on the scatterplot represents a city within the ten counties investigated. The x-axis represents the percent Latino within each of the Southern California cities. The y-axis represents the HPI Score Percentile, with 0 representing the city with the least healthy community conditions and 100 representing the community with the healthiest community conditions. In Panel C, each point on the scatterplot represents a county within the ten counties investigated. The x-axis represents the percent Latino within each of the Southern California counties. The y-axis represents the HPI Score Percentile, with 0 representing the county with the least healthy community conditions and 100 representing the community with the healthiest community conditions. Supplemental Fig. 2. A Similar Negative Association is Observed in the SVI Score and Percent Latino. Each point on this scatterplot represents a city in Southern California considered in the analysis. Cities are grouped into counties, the colors of which are depicted on the righthand legend of the graph. The x-axis is percent Latino for each of the Southern California cities considered in this analysis. The y-axis represents the SVI Score percentile, with 0 representing the community with the healthiest SVI score and 100 representing the community with the least healthy SVI score. Relative to the HPI, the SVI score is interpreted in the opposite direction, with 0 representing communities with lowest vulnerability. Supplemental Fig. 3. A Similar Negative Association is Observed in the CES Score and Percent Latino. Each point on this scatterplot represents a city in Southern California considered in the analysis. Cities are grouped into counties, the colors of which are depicted on the righthand legend of the graph. The x-axis is percent Latino for each of the Southern California cities considered in this analysis. The y-axis represents the CES Score percentile, with 0 representing the community with the healthiest CES score and 100 representing the community with the least healthy CES score. Relative to the HPI, the CES score is interpreted in the opposite direction, with 0 representing communities with the lowest vulnerability and lowest exposure to pollution burden. Supplemental Fig. 4. SVI Demonstrates that Latinos Live in Less Healthy Community Conditions with Higher Prevalence of Disease. Each point on the scatterplot represents a city within the ten counties investigated in this analysis. The x-axis shows the percentile SVI score, and a higher percentile score indicates a less healthy community. The y-axis shows the percentile score of the prevalence of each health outcome relative to each other (i.e., a percentile score of 100 translates to the city with the highest prevalence of adult obesity or diabetes. Each point (i.e., city) on the scatterplot is colored based on the percent Latino in each city. A red shading indicates a higher percent Latino compared to a purple shading. Panel A shows the relationship between adults with diabetes and SVI score. Panel B shows the relationship between adults with obesity and SVI score. The directionality of the SVI score is opposite to the directionality of the HPI score, where a higher score indicates a greater level of community vulnerability. Supplemental Fig. 5. CES Demonstrates that Latinos Live in Less Healthy Community Conditions with Higher Prevalence of Disease. Each point on the scatterplot represents a city within the ten counties investigated in this analysis. The x-axis shows the percentile CES score, and a higher percentile score indicates a less healthy community. The y-axis shows the percentile score of the prevalence of each health outcome relative to each other (i.e., a percentile score of 100 translates to the city with the highest prevalence of adult obesity or diabetes). Each point (i.e., city) on the scatterplot is colored based on the percent Latino in each city. A red shading indicates a higher percent Latino compared to a purple shading. Panel A shows the relationship between adults with diabetes and CES score. Panel B shows the relationship between adults with obesity and CES score. Note that the CES score has the opposite directionality as the HPI score. A higher CES score indicates greater vulnerability and greater exposure to pollution burden. Supplemental Fig. 6. Young Latinos Live in Less Healthy Community Conditions and Face a Greater Burden of Obesity. Each point on the scatterplot represents a city within the ten counties investigated in this analysis. The x-axis shows the percentile SVI and CES score, and a higher percentile score indicates a less healthy community. The y-axis shows the percentile score of the prevalence of childhood obesity relative to each other (i.e., a percentile score of 100 translates to the city with the highest prevalence of childhood obesity). Each point (i.e., city) on the scatterplot is colored based on the percent Latino in each city. A red shading indicates a higher percent Latino compared to a purple shading. Panel A shows the relationship between children with obesity and SVI score. Panel B shows the relationship between children with obesity and CES score. Note that the SVI and CES scores have an opposite directionality compared to the HPI score. A higher SVI or CES score indicates greater vulnerability or greater exposure to pollution burden.

The treatment of left main (LM) coronary artery disease (CAD) requires complex decision-making. Recent clinical practice guidelines provide clinicians with guidance; however, decisions regarding treatment for individual patients can still be difficult. The American College of Cardiology's Cardiac Surgery Team and Interventional Council joined together to develop a practical approach to the treatment of LM CAD, taking into account randomized clinical trial, meta-analyses, and clinical practice guidelines. The various presentations of LM CAD based on anatomy and physiology are presented. Recognizing the complexity of LM CAD, which rarely presents isolated and is often in combination with multivessel disease, a treatment algorithm with medical therapy alone or in conjunction with percutaneous coronary intervention or coronary artery bypass grafting is proposed. A heart team approach is recommended that accounts for clinical, procedural, operator, and institutional factors, and features shared decision-making that meets the needs and preferences of each patient and their specific clinical situation.

ImportanceAlthough durable left ventricular assist device (LVAD) therapy has emerged as an important treatment option for patients with advanced heart failure refractory to pharmacological support, outcomes, including survival, beyond 2 years remain poorly characterized.ObjectiveTo report the composite end point of survival to transplant, recovery, or LVAD support free of debilitating stroke (Modified Rankin Scale score >3) or reoperation to replace the pump 5 years after the implant in participants who received the fully magnetically levitated centrifugal-flow HeartMate 3 or axial-flow HeartMate II LVAD in the MOMENTUM 3 randomized trial and were still receiving LVAD therapy at the 2-year follow-up.Design, Setting, and ParticipantsThis observational study was a 5-year follow-up of the MOMENTUM 3 trial, conducted in 69 US centers, that demonstrated superiority of the centrifugal-flow LVAD to the axial-flow pump with respect to survival to transplant, recovery, or LVAD support free of debilitating stroke or reoperation to replace the pump at 2 years. A total of 295 patients were enrolled between June 2019 to April 2021 in the extended-phase study, with 5-year follow-up completed in September 2021.ExposuresOf 1020 patients in the investigational device exemption per-protocol population, 536 were still receiving LVAD support at 2 years, of whom 289 received the centrifugal-flow pump and 247 received the axial-flow pump.Main Outcomes and MeasuresThere were 10 end points evaluated at 5 years in the per-protocol population, including a composite of survival to transplant, recovery, or LVAD support free of debilitating stroke or reoperation to replace the pump between the centrifugal-flow and axial-flow pump groups and overall survival between the 2 groups.ResultsA total of 477 patients (295 enrolled and 182 provided limited data) of 536 patients still receiving LVAD support at 2 years contributed to the extended-phase analysis (median age, 62 y; 86 [18%] women). The 5-year Kaplan-Meier estimate of survival to transplant, recovery, or LVAD support free of debilitating stroke or reoperation to replace the pump in the centrifugal-flow vs axial-flow group was 54.0% vs 29.7% (hazard ratio, 0.55 [95% CI, 0.45-0.67]; P P = .003). Serious adverse events of stroke, bleeding, and pump thrombosis were less frequent in the centrifugal-flow pump group.Conclusions and RelevanceIn this observational follow-up study of patients from the MOMENTUM 3 randomized trial, per-protocol analyses found that receipt of a fully magnetically levitated centrifugal-flow LVAD vs axial-flow LVAD was associated with a better composite outcome and higher likelihood of overall survival at 5 years. These findings support the use of the fully magnetically levitated LVAD.Trial RegistrationClinicalTrials.gov Identifier: NCT02224755 and NCT03982979

BACKGROUND: Patients requiring biventricular assist device (BiVAD) for mechanical circulatory support (MCS) have substantially worse outcomes than patients requiring left VAD (LVAD) support only. Patient-specific risk factors have yet to be consistently identified in a large, multicenter registry, which may underlie the poorer outcomes for BiVAD patients. The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) is a registry of U.S. Food and Drug Administration-approved durable MCS devices used for bridge-to-transplantation, destination therapy, or recovery. The purposes of this study were to 1) identify the underlying pre-implant characteristics of the population requiring BiVAD support that contribute to reduced survival, and 2) identify differences in postoperative outcomes with respect to adverse events compared with patients supported with LVAD alone. METHODS: From June 2006 to September 2009, 1,646 patients were entered into the INTERMACS database in which adverse events and outcomes were recorded for primary implants with LVAD or BiVAD. Competing outcomes methodology was used to estimate the time-related probability of death, transplant, or recovery. Overall survival for all groups was analyzed with Kaplan-Meier methods and Cox proportional regression analysis. RESULTS: The distribution of primary device implants included 1,440 LVADs and 206 BiVADs. BiVAD patients presented with a lower INTERMACS profile 93% in INTERMACS 1 or 2, compared with 73% for LVAD patients (p < 0.001). Survival at 6 months was 86% for LVADs and 56% for BiVADs (p < .0001). Adverse event rates, expressed as episodes/100 patient-months for the BiVAD group compared with LVAD, were significantly higher for infection (33.2 vs 14.3), bleeding (71.6 vs 15.5), neurologic events (7.9 vs 2.6), and for device failure (4.9 vs 2.0). CONCLUSIONS: Patients requiring BiVAD support at the time of durable MCS implant are more critically ill at the time of MCS implant. BiVAD patients experience worse survival than patients supported with LVAD alone and higher rates of serious adverse events. Characteristics of the population present at the time of BiVAD implant likely influence post-implant MCS outcomes.