The Association between Frailty and All-Cause Mortality in Community-Dwelling Older Individuals: An Umbrella Review

Frailty is associated with multiple adverse health outcomes, including mortality. Several methods have been used to characterize frailty, each based on different frailty scales. These include scales based on phenotype, multidomain, and deficit accumulations. Several systematic reviews have examined the association between frailty and mortality; however, it is unclear whether these different frailty scales similarly predict mortality. This umbrella review aims to examine the association between frailty assessed by different frailty scales and all-cause mortality among community-dwelling older adults. A protocol was registered at PROSPERO, and it was conducted following the PRISMA statement. MEDLINE, Embase, PubMed, Cochrane Database of Systematic Reviews, Joanna Briggs Institute (JBI) EBP database, and Web of Science database was searched. Methodological quality was assessed using the JBI critical appraisal checklist and online AMSTAR-2 critical appraisal checklist. For eligible studies, essential information was extracted and synthesized qualitatively. Five systematic reviews were included, with a total of 434,115 participants. Three systematic reviews focused on single frailty scales; one evaluated Fried's physical frailty phenotype and its modifications; another focused on the deficit accumulation frailty index. The third evaluated the FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale. The two other systematic reviews determined the association between frailty and mortality using different frailty scales. All of the systematic reviews found that frailty was significantly associated with all-cause mortality. This umbrella review demonstrates that frailty is a significant predictor of all-cause mortality, irrespective of the specific frailty scale.

Accelerated Epigenetic Aging in Peripheral Blood does not Predict Dementia Risk

BACKGROUND

There is strong evidence that epigenetic age acceleration is associated with increased risk of later-life diseases and all-cause mortality. However, there is currently limited evidence that suggests accelerated epigenetic age is associated with dementia risk.

OBJECTIVE

This study aims to clarify whether epigenetic biomarkers of accelerated aging can predict dementia risk, which is an important consideration as aging is the greatest risk factor for the disease.

METHODS

DNA methylation was measured in peripheral blood samples provided by 160 participants from the ASPirin in Reducing Events in the Elderly study, including 73 pre-symptomatic dementia cases and 87 controls matched for age, sex, and smoking and education status. Epigenetic age was calculated using Horvath, Hannum, GrimAge and PhenoAge DNA methylation clocks, and age acceleration (the disparity between chronological age and epigenetic age) was determined.

RESULTS

There was no difference in age acceleration between dementia cases and controls. In males, only Hannum's intrinsic epigenetic age acceleration was increased in pre-symptomatic dementia cases compared to controls (Δ +1.8 years, p = 0.03).

CONCLUSION

These findings provide no strong evidence that accelerated epigenetic aging measured in peripheral blood can predict dementia risk.

Femoral condylar fractures in four continental giant breed rabbits

Four male neutered continental giant rabbits aged between 10 and 30 months were presented with femoral condylar fractures, which developed without an observed traumatic injury. Stabilisation of the condylar fracture was achieved with screw fixation in all cases, which was supplemented with additional fixation in three cases. Complications consequent to the surgical intervention occurred in two cases: a femoral fracture and loss of fixation. Three rabbits were reported to have recovered normal limb function, and the rabbit that developed a femoral fracture as a consequence of its surgical intervention was treated with amputation.

Impact of a National Lockdown on Cycling Injuries

Introduction The Sars-CoV-2 pandemic led to a national lockdown in Ireland from March 12th to June 7th, 2020. The present study aimed to assess the change in the pattern of cycling attendances to an Irish ED during a pandemic. Methods This is a retrospective before-and-after study carried out at a university hospital ED. We compared cycling attendances during Lockdown (LD) (13th March-7th June 2020) with Pre-Lockdown (PLD) (January 1st-March 12th, 2020). Furthermore, we also compared lockdown to an historical control period during the equivalent dates in 2019 (i.e. March 13th-June 7th, 2019) Results There were 151 cycling attendances during LD, 122 in PLD and 164 during the control period. The number of cyclists presenting during "rush hour traffic" in the LD period was 30 (19.9%) versus 42 (34.4%) during PLD (p<0.05) and 51 (31.1%) during the control period (p<0.05). During LD, 8 (5.3%) collisions involved a motor vehicle compared to 26 (21.3%) in PLD (p<0.05) and 43 (26.2%) during the control period (p<0.05). Conclusion Lockdown did not result in increased cycling attendances to this ED. The patients who did sustain a cycling-related injury during lockdown were less likely to have collided with a motor vehicle compared to the control period. The reduction in motor vehicle collisions could be attributed to less traffic congestion and highlights the potential benefits of road-user segregation.

Toward a New Strategic Public Health Science for Policy, Practice, Impact, and Health Equity

The COVID-19 pandemic and its social and health impact have underscored the need for a new strategic science agenda for public health. To optimize public health impact, high-quality strategic science addresses scientific gaps that inform policy and guide practice. At least 6 scientific gaps emerge from the US experience with COVID-19: health equity science, data science and modernization, communication science, policy analysis and translation, scientific collaboration, and climate science. Addressing these areas within a strategic public health science agenda will accelerate achievement of public health goals. Public health leadership and scientists have an unprecedented opportunity to use strategic science to guide a new era of improved and equitable public health.

411 EFFICACY OF CDSS IN IMPROVING ANTI-RESORPTIVE BONE PROTECTIVE THERAPY AMONGST ORTHOGERIATRIC INPATIENTS: A COMPARISON STUDY

Background

Hip fractures have a mortality rate of 20% in the year following the fracture. Therefore, patients presenting with hip fractures should be assessed and prescribed anti-resorptive bone protective therapy (ABPT) to reduce the risk of further fractures. In our institution, this decision is undertaken by a specialist only. Purpose: The objective of this study is to compare the proportion of patients commenced on ABPT by surgical interns following the introduction of a Clinical Decision Support System (CDSS) in January 2020 to support appropriate ABPT prescribing amongst non-specialists.

Methods

The study compares the orthogeriatric patient cohort before and after CDSS introduction within the same time period (Jan 1st to June 30th) in 2019 and 2020. Data were extracted from the Irish Hip Fracture Database and statistically analyzed using SPSS. The Mann–Whitney two-tailed test was employed to calculate statistical significance.

Results

In 2019, 31% (55/178) of patients admitted during the study period (n = 178) did not receive orthogeriatric specialist input and only 27% (15/55) of these had ABPT prescribed during their admission. In 2020, 17% (32/185) of patients admitted during the study period (n = 185) did not receive specialist input; however, 44% (14/32) of these were commenced on ABPT. Overall, more patients were prescribed ABPT in 2020 (78%;146/185), as compared to 55% (98/178) in 2019 (z-score 6.57069; p-value &lt;0.01). The number of patients awaiting specialist outpatient appointments before being prescribed ABPT also dropped from 40% (71/178) in 2019 to 13% (24/185) in 2020 (p-value &lt;0.01).

Conclusion

This study highlighted the significance of a CDSS to improve inpatient ABPT prescribing by non-specialists and to reduce outpatient specialist appointments. This could have a major impact on the long-term reduction of mortality rates amongst orthogeriatric patients and the reduction of future healthcare costs.

Strain echocardiography to describe left ventricular function pre- and postexercise in elite basketball athletes: A feasibility study

BACKGROUND

Elite athletes show structural cardiac changes as an adaptation to exercise. Studies examining strain in athletes have largely analyzed images at rest only. There is little data available regarding the change in strain with exercise. Our objectives were: to investigate the feasibility of strain analysis in athletes at peak exercise, to determine the normal range of left ventricular (LV) global longitudinal strain (GLS) within this population postexercise, to describe how LV GLS changes with exercise, and to determine whether any clinical characteristics correlate with the change in GLS that occurs with exercise.

METHODS

We conducted a cross-sectional study on elite athletes who participated in the 2016-2018 National Basketball Association Draft Combines. Echocardiograms were obtained at rest and after completing a treadmill stress test to maximal exertion or completion of Bruce protocol. Primary outcomes included GLS obtained at rest and peak exercise. Secondary outcome was the change in GLS between rest and exercise. Univariate relationships between various clinical characteristics and our secondary outcome were analyzed.

RESULTS

Our final cohort (n = 111) was all male and 92/111 (82.9%) were African American. Mean GLS magnitude increased in response to exercise (-17.6 ± 1.8 vs -19.2 ± 2.6, P < .0001). Lower resting heart rates (r = .22, P = .02) and lower heart rates at peak exercise (r = .21, P = .03) correlated with the increase in LV GLS from exercise.

CONCLUSIONS

Strain imaging is technically feasible to obtain among elite basketball athletes at peak exercise. Normative strain response to exercise from this study may help identify abnormal responses to exercise in athletes.

POS1162 PREDICTORS OF HOSPITALISATION IN PATIENTS WITH RHEUMATIC DISEASE AND COVID-19 IN IRELAND: DATA FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE PHYSICIAN-REPORTED REGISTRY

Background:

There is limited data regarding the risk of hospitalisation in patients with rheumatic disease and COVID-19 in Ireland.

Objectives:

We used the COVID-19 Global Rheumatology Alliance (GRA) registry data to study outcomes and their predictors.

Methods:

We examined data on patients and their disease-related characteristics entered into the COVID-19 GRA provider registry from Ireland (24th March 2020 to 31st August 2020). Multivariable logistic regression was used to assess the association of demographic and clinical characteristics with hospitalisation.

Results:

Of 105 patients, 47 (45.6%) were hospitalised and 10 (9.5%) died. Multivariable logistic regression analysis showed age (OR=1.06, 95%CI 1.01 to 1.10), number of comorbidities (OR=1.93, 95%CI 1.11 to 3.35), and glucocorticoid use (OR=15.01, 95%CI 1.77 to 127.16) were significantly associated with hospitalisation. A diagnosis of inflammatory arthritis was associated with a lower odds of hospitalisation (OR=0.09, 95%CI 0.02 to 0.32).

All significant variable modelMost parsimonious modelUnadjusted OR (95% CI)Adjusted OR (95%CI)*Adjusted p-value*Adjusted OR (95%CI)&Adjusted p-value&Female0.45 (0.20-1.02)0.33 (0.05-2.23)0.34 (0.09-1.36)0.128Age (years)1.08 (1.05-1.11)1.04 (0.97-1.10)0.2241.06 (1.01-1.10)0.010Inflammatory arthritis0.11 (0.05-0.28)0.14 (0.02-0.95)0.0440.09 (0.02-0.32)<0.001Connective Tissue Disease and Other1.56 (0.62 - 3.92)No comorbidities0.11 (0.04-0.30)0.76 (0.09-6.58)0.802Most common comorbiditiesCOPD / asthma4.77 (1.23-18.54)3.09 (0.16-60.07)0.456CVD3.40 (1.31-8.85)0.11 (0.01-1.88)0.129Hypertension3.71 (1.52-9.08)0.56 (0.04-7.94)0.668Obesity0.58 (0.10-3.30)Number of comorbidities (Median, IQR)3.01 (1.92-4.72)2.99 (0.59-15.02)0.1841.93 (1.11-3.35)0.020Never Smokerref.0.889Ever Smoker3.17 (1.18-8.89)1.19 (0.10-13.68)Medication prior to COVID-19 diagnosisGlucocorticoids9.26 (1.95-43.89)18.14 (1.13-290.81)0.04115.01 (1.77-127.16)0.013csDMARD monotherapy0.42 (0.17-1.00)b/tsDMARD (monotherapy or in combination with csDMARD)0.24 (0.10-0.58)1.36 (0.19-9.72)0.557

Conclusion:

Increasing age, comorbidity burden, and glucocorticoid use were associated with hospitalisation, while a diagnosis of inflammatory arthritis was associated with lower odds of hospitalization.

Disclosure of Interests:

Richard Conway Speakers bureau: Janssen, Roche, Sanofi, Abbvie, Elena Nikiphorou Speakers bureau: AbbVie, Eli-Lilly, Gilead, Celltrion, Pfizer, Sanofi, Christiana Demetriou: None declared, Candice Low: None declared, Kelly Leamy: None declared, John Ryan: None declared, Ronan Kavanagh: None declared, Alexander Fraser: None declared, John Carey: None declared, Paul O’Connell: None declared, Rachael Flood: None declared, Ronan Mullan: None declared, David Kane: None declared, Philip Robinson Speakers bureau: UCB, Roche, Pfizer, Gilead, Janssen, Novartis, Eli Lilly, Abbvie, Grant/research support from: Abbvie, UCB, Novartis, Janssen, Pfizer, Jean Liew Grant/research support from: Pfizer, Rebecca Grainger Speakers bureau: Pfizer, Cornerstones, Janssen, Novartis, Abbvie, Geraldine McCarthy: None declared.

Role of t-tubule remodeling on mechanisms of abnormal calcium release during heart failure development in canine ventricle

The goal of this work was to investigate the role of t-tubule (TT) remodeling in abnormal Ca2+ cycling in ventricular myocytes of failing dog hearts. Heart failure (HF) was induced using rapid right ventricular pacing. Extensive changes in echocardiographic parameters, including left and right ventricular dilation and systolic dysfunction, diastolic dysfunction, elevated left ventricular filling pressures, and abnormal cardiac mechanics, indicated that severe HF developed. TT loss was extensive when measured as the density of total cell volume, derived from three-dimensional confocal image analysis, and significantly increased the distances in the cell interior to closest cell membrane. Changes in Ca2+ transients indicated increases in heterogeneity of Ca2+ release along the cell length. When critical properties of Ca2+ release variability were plotted as a function of TT organization, there was a complex, nonlinear relationship between impaired calcium release and decreasing TT organization below a certain threshold of TT organization leading to increased sensitivity in Ca2+ release below a TT density threshold of 1.5%. The loss of TTs was also associated with a greater incidence of triggered Ca2+ waves during rapid pacing. Finally, virtually all of these observations were replicated by acute detubulation by formamide treatment, indicating an important role of TT remodeling in impaired Ca2+ cycling. We conclude that TT remodeling itself is a major contributor to abnormal Ca2+ cycling in HF, reducing myocardial performance. The loss of TTs is also responsible for a greater incidence of triggered Ca2+ waves that may play a role in ventricular arrhythmias arising in HF.NEW & NOTEWORTHY Three-dimensional analysis of t-tubule density showed t-tubule disruption throughout the whole myocyte in failing dog ventricle. A double-linear relationship between Ca2+ release and t-tubule density displays a steeper slope at t-tubule densities below a threshold value (∼1.5%) above which there is little effect on Ca2+ release (T-tubule reserve). T-tubule loss increases incidence of triggered Ca2+ waves. Chemically induced t-tubule disruption suggests that t-tubule loss alone is a critical component of abnormal Ca2+ cycling in heart failure.

Solvent-free manufacture of methacrylate polymers from biomass pyrolysis products

Biomass pyrolysis liquid is functionalised into a potential replacement for petrochemical derived methacrylates used in resins, adhesives and binders.

Cosmic-ray antinuclei as messengers of new physics: status and outlook for the new decade

The precise measurement of cosmic-ray antinuclei serves as an important means for identifying the nature of dark matter and other new astrophysical phenomena, and could be used with other cosmic-ray species to understand cosmic-ray production and propagation in the Galaxy. For instance, low-energy antideuterons would provide a "smoking gun" signature of dark matter annihilation or decay, essentially free of astrophysical background. Studies in recent years have emphasized that models for cosmic-ray antideuterons must be considered together with the abundant cosmic antiprotons and any potential observation of antihelium. Therefore, a second dedicated Antideuteron Workshop was organized at UCLA in March 2019, bringing together a community of theorists and experimentalists to review the status of current observations of cosmic-ray antinuclei, the theoretical work towards understanding these signatures, and the potential of upcoming measurements to illuminate ongoing controversies. This review aims to synthesize this recent work and present implications for the upcoming decade of antinuclei observations and searches. This includes discussion of a possible dark matter signature in the AMS-02 antiproton spectrum, the most recent limits from BESS Polar-II on the cosmic antideuteron flux, and reports of candidate antihelium events by AMS-02; recent collider and cosmic-ray measurements relevant for antinuclei production models; the state of cosmic-ray transport models in light of AMS-02 and Voyager data; and the prospects for upcoming experiments, such as GAPS. This provides a roadmap for progress on cosmic antinuclei signatures of dark matter in the coming years.

Presentation, treatment and outcome of long-bone fractures in pet rabbits (Oryctolagus cuniculus)

OBJECTIVES

To describe the incidence, aetiology, characteristics, assessment, management and outcome of long-bone fractures in rabbits presenting to a single institution.

MATERIALS AND METHODS

Medical records of pet rabbits diagnosed with long-bone fractures over a 12-year period were analysed. Patient signalment, fracture aetiology, fracture location, fracture description, time from fracture occurrence to veterinary presentation, fixation method, postoperative complications, clinical outcome and follow-up were recorded.

RESULTS

Twenty-eight pet rabbits that sustained 30 fractures were included in the study [femoral (n=12), tibial (n=6), metacarpal/metatarsal/phalangeal (n=5), radial and ulnar (n=4) and tarsal (n=3)]. Twenty-one (75%) of the rabbits were less than 2 years of age, including seven (25%) under 6 months of age. Twenty-five fractures had no identifiable cause and five were traumatic. Only one fracture was open. Surgical stabilisation was performed in 22 fractures, four were non-surgically managed, two had the affected limb amputated, one underwent digital amputation and one was euthanased. Postoperative complications occurred in nine fractures [major (n=6), minor (n=3)]. The frequency of complications or attainment of a functional recovery was not notably different between the different methods of fixation. Overall, 24 rabbits recovered, two were euthanased and four underwent limb amputation.

CLINICAL SIGNIFICANCE

Fractures in rabbits typically occur in young animals and they usually lack an obvious aetiology. The majority of the rabbits treated achieved a functional recovery, although the postoperative complication rate was high in fractures treated surgically (41%).

A Temporal Comparative Study of Women’s Rugby Injuries Presenting to an Emergency Department

Aim We aimed to examine the change in injury patterns, diagnostics and treatments provided to female rugby players in an emergency department between two separate seasons ten years apart. Methods A search was carried out on attendances from 01/07/2007 to 30/06/2008 and from 01/07/2017 to 30/06/2018. The records of females presenting following rugby injuries were studied to establish demographics, investigations used, injury suffered and definitive care. Results There was a 242.9% increase in attendances with women’s rugby injuries. There were increases in high impact injuries: dislocations (0% vs 2.8%), wounds (4.8% vs 6.3%) and concussions (2.4% vs 10.4%). Ct scans are utilised more (2.4% vs 6.9%). Follow up has changed with increased specialist opinion with team physicians (0% vs 7.7%), hand clinics (4.8% vs 9.0%) and concussion clinics (0.0% vs 6.9%). Discussion Women’s rugby injury presentations are increasing. We have seen a rise in significant injuries. Patients now require first level diagnostics and specialist follow up care.

1197The development and validation of a novel transcatheter microwave renal denervation system

Background

Clinical studies of transcatheter radiofrequency renal denervation for treating hypertension have been hampered by the lack of consistent denervation efficacy. Microwave energy is well suited to renal denervation due to its capacity to spare vascular structures due to cooling from adjacent blood flow while enabling deep perivascular heating.

Purpose

We aimed to: 1) develop a transcatheter microwave system capable of safely delivering deep and circumferential perivascular renal nerve ablation, and 2) demonstrate the feasibility, short-term efficacy and safety of transcatheter microwave renal denervation.

Method

A novel 7F transcatheter microwave denervation system was designed, built, and iteratively prototyped in vitro and in 15 sheep. A histological grading system for microwave induced renal arterial and renal nerve injury was devised. The microwave denervation system was validated in an additional 9 sheep, which underwent unilateral renal denervation. Up to 2 microwave ablations were delivered to each artery with maximum power at 100–110W for 480s. Sheep were euthanised at 2–3 weeks post procedure. Gross microscopic histological examination as well as renal tissue norepinephrine content was analysed.

Results

Catheter deployment and ablation was successful in all 19 targeted vessel segments and ablation produced substantial circumferential perivascular injury; median ablation lesion area >395 (IQR 251–437) mm2, depth 17.1 (IQR 15.8–18.4) mm, length 16 (IQR 12–20) mm, without collateral visceral injury. Limiting power to 100W minimised arterial injury, while maintaining a deep circumferential perivascular ablation. At microwave ablation sites, a total of 292 nerve fascicles were identified, median distance from the renal artery of 4.2mm (IQR 2.1–8.8mm), of which 249 (85%) had sustained thermal injury with 128/249 (51%) showing grade 3–4 (moderate to severe) injury. Microwave denervation reduced median functional sympathetic nerve surface area at the renal hilum on anti-tyrosine hydroxylase staining by 100% (IQR 87%-100%), p=0.0039, and median renal cortical norepinephrine content by 83% (IQR 76%–92%), p=0.0078, compared to the paired control kidney.

Conclusion

Transcatheter microwave ablation can produce deep circumferential perivascular ablations over a long segment of the renal artery without significant arterial or collateral visceral injury to provide effective renal denervation. Clinical translation may enable more consistent and complete transcatheter renal denervation and antihypertensive efficacy.

Acknowledgement/Funding

University of Sydney; Western Sydney Local health District; National Health and Medical Research Council of Australia; National Heart Foundation (Au)