Background: Little is known about clinical characteristics, hospital course, and longitudinal outcomes of patients with cardiogenic shock (CS) related to heart failure (HF-CS) compared to acute myocardial infarction (AMI; CS related to AMI [AMI-CS]). Methods: We examined in-hospital and 1-year outcomes of 520 (219 AMI-CS, 301 HF-CS) consecutive patients with CS (January 3, 2017–December 31, 2019) in a single-center registry. Results: Mean age was 61.5±13.5 years, 71% were male, 22% were Black patients, and 63% had chronic kidney disease. The HF-CS cohort was younger (58.5 versus 65.6 years, P <0.001), had fewer cardiac arrests (15.9% versus 35.2%, P <0.001), less vasopressor utilization (61.8% versus 82.2%, P <0.001), higher pulmonary artery pulsatility index (2.14 versus 1.51, P <0.01), lower cardiac power output (0.64 versus 0.77 W, P <0.01) and higher pulmonary capillary wedge pressure (25.4 versus 22.2 mm Hg, P <0.001) than patients with AMI-CS. Patients with HF-CS received less temporary mechanical circulatory support (34.9% versus 76.3% P <0.001) and experienced lower rates of major bleeding (17.3% versus 26.0%, P= 0.02) and in-hospital mortality (23.9% versus 39.3%, P <0.001). Postdischarge, 133 AMI-CS and 229 patients with HF-CS experienced similar rates of 30-day readmission (19.5% versus 24.5%, P =0.30) and major adverse cardiac and cerebrovascular events (23.3% versus 28.8%, P =0.45). Patients with HF-CS had lower 1-year mortality (n=123, 42.6%) compared to the patients with AMI-CS (n=110, 52.9%, P =0.03). Cumulative 1-year mortality was also lower in patients with HF-CS (log-rank test, P =0.04). Conclusions: Patients with HF-CS were younger, and despite lower cardiac power output and higher pulmonary capillary wedge pressure, less likely to receive vasopressors or temporary mechanical circulatory support. Although patients with HF-CS had lower in-hospital and 1-year mortality, both cohorts experienced similarly high rates of postdischarge major adverse cardiovascular and cerebrovascular events and 30-day readmission, highlighting that both cohorts warrant careful long-term follow-up. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03378739.

Background In the past, epidemiologic research on acculturation and health has been criticized for its conceptual ambiguity and simplistic measurement approaches. This study applied a widely-used theoretical framework from cross-cultural psychology to identify acculturation strategies among South Asian immigrants in the US and to examine sociodemographic correlates of acculturation strategies. Methods Data were from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. We used latent class analysis to identify groups of individuals that were similar based on cultural attitudes and behaviors. We used latent class regression analysis to examine sociodemographic correlates of acculturation strategies. Results We found that South Asian immigrants employed three acculturation strategies, including separation (characterized by a relatively high degree of preference for South Asian culture over US culture), assimilation (characterized by a relatively high degree of preference for US culture over South Asian culture), and integration (characterized by a similar level of preference for South Asian and US cultures). Respondents with no religious affiliation, those with higher levels of income, those who lived a greater percentage of their lives in the US, and those who spoke English well or very well were less likely to use the separation strategy than the assimilation or integration strategies. Conclusions Using epidemiologic cohort data, this study illustrated a conceptual and methodological approach that addresses limitations of previous research on acculturation and health. More work is needed to understand how the acculturation strategies identified in this study affect the health of South Asian immigrants in the US.

We propose a new procedure for white noise testing of a functional time series. Our approach is based on an explicit representation of the L 2 -distance between the spectral density operator and its best (L 2 -)approximation by a spectral density operator corresponding to a white noise process. The estimation of this distance can be easily accomplished by sums of periodogram kernels, and it is shown that an appropriately standardized version of the estimator is asymptotically normal distributed under the null hypothesis (of functional white noise) and under the alternative. As a consequence, we obtain a very simple test (using the quantiles of the normal distribution) for the hypothesis of a white noise functional process. In particular, the test does not require either the estimation of a long-run variance (including a fourth order cumulant) or resampling procedures to calculate critical values. Moreover, in contrast to all other methods proposed in the literature, our approach also allows testing for 'relevant' deviations from white noise and constructing confidence intervals for a measure that measures the discrepancy of the underlying process from a functional white noise process.

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We introduce new point-wise confidence interval estimates for monotone functions observed with additive, dependent noise. Our methodology applies to both short-and long-range dependence regimes for the errors. The interval estimates are obtained via the method of inversion of certain discrepancy statistics. This approach avoids the estimation of nuisance parameters such as the derivative of the unknown function, which previous methods are forced to deal with. The resulting estimates are therefore more accurate, stable, and widely applicable in practice under minimal assumptions on the trend and error structure. The dependence of the errors especially long-range dependence leads to new phenomena, where new universal limits based on convex minorant functionals of drifted fractional Brownian motion emerge. Some extensions to uniform confidence bands are also developed.