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Dejaco C, Ramiro S, Touma Z, Bond M, Soowamber M, Sanchez-Alvarez C, Langford CA. What is a response in randomised controlled trials in giant cell arteritis? Ann Rheum Dis 2023:ard-2022-223751. [PMID: 36801812 DOI: 10.1136/ard-2022-223751] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/09/2023] [Indexed: 02/19/2023]
Abstract
Glucocorticoids (GCs) are the gold standard for treatment of giant cell arteritis (GCA); however, there is a need for studies on GC-sparing agents, given that up to 85% of patients receiving GC only develop adverse events. Previous randomised controlled trials (RCTs) have applied different primary endpoints, limiting the comparison of treatment effects in meta-analyses and creating an undesired heterogeneity of outcomes. The harmonisation of response assessment is therefore an important unmet need in GCA research. In this viewpoint article, we discuss the challenges and opportunities with the development of new, internationally accepted response criteria. A change of disease activity is a fundamental component of response; however, it is debatable whether the ability to taper GC and/or the maintenance of a disease state for a specific time period, as applied in recent RCTs, should be part of response assessment. The role of imaging and novel laboratory biomarkers as possible objective markers of disease activity needs further investigation but might be a possibility when drugs directly or indirectly influence the levels of traditional acute-phase reactants such as erythrocyte sedimentation rate and C reactive protein. Futures response criteria might be constructed as a multidomain set, but the questions about which domains will be included and what their relative weights will be still need to be answered.
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Affiliation(s)
- Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria .,Department of Rheumatology, Brunico Hospital, Teaching Hospital of the Paracelsius Medical University, Brunico, Italy
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Zahi Touma
- Department of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Milena Bond
- Department of Rheumatology, Brunico Hospital, Teaching Hospital of the Paracelsius Medical University, Brunico, Italy
| | - Medha Soowamber
- Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Catalina Sanchez-Alvarez
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Carol A Langford
- Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA
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102
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Weber C, Hung J, Hickling S, Li I, Murray K, Briffa T. Emergent readmission and long-term mortality risk after incident atrial fibrillation hospitalisation. Heart 2023; 109:380-387. [PMID: 36384748 DOI: 10.1136/heartjnl-2022-321560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the frequency and predictors of unplanned readmissions after hospitalisation for incident atrial fibrillation (AF) and the association of readmissions with mortality over 2 years. METHODS We performed a retrospective cohort study using Western Australian morbidity and mortality data to identify all patients, aged 25-94 years, who survived incident (first-ever) hospitalisation for AF (principal diagnosis), between 2001 and 2015. Ordinal logistic models determined the covariates independently associated with unplanned readmission(s), and Cox proportional hazards models with time-varying exposures determined the hazard ratios (HR) of one or more readmissions for mortality over 2 years after incident AF. RESULTS Of 22 956 patients, 57.7% male, mean age 67.9 (SD 13.8) years, 44.0% experienced 22 053 unplanned readmissions within 2 years, 50.6% being cardiovascular-related. All-cause death occurred in 8.0% of the cohort, and the multivariable-adjusted mortality HR of 1 (vs 0) readmission was 2.9 (95% CI 2.6 to 3.3), increasing to 5.6 (95% CI 5.0 to 6.5) for 3+ readmissions. First emergent readmission for AF, stroke, heart failure or myocardial infarction was independently associated with an increased hazard for mortality. Coexistent cardiovascular and other comorbidities were independently associated with increased readmission and mortality risk, whereas AF ablation was associated with reduced risk. CONCLUSION This study highlights the large burden of unplanned all-cause and cardiovascular-specific readmissions within 2 years after being hospitalised for incident AF and their associated adverse impact on mortality. Concomitant comorbidities are independently associated with unplanned hospitalisations and mortality, which supports integrated multidisciplinary management of comorbidities, along with AF-targeted treatments, to improve long-term outcomes in patients with AF.
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Affiliation(s)
- Courtney Weber
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Joseph Hung
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Siobhan Hickling
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Ian Li
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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103
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Adami G, Tsourdi E, Rossini M, Funck-Brentano T, Chapurlat R. Patients with osteoporosis: children of a lesser god. RMD Open 2023; 9:rmdopen-2022-002973. [PMID: 36759006 PMCID: PMC9923352 DOI: 10.1136/rmdopen-2022-002973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
Osteoporosis is a common non-communicable disease with enormous societal costs. Antiosteoporosis medications have been proven efficacious in reducing the refracture rate and mortality; moreover, we have now convincing evidence about the cost-effectiveness of antiosteoporotic medications. However, albeit preventable and treatable, osteoporosis has been somehow neglected by health authorities. Drugs approval has been unnecessarily lengthy, especially when compared with other non-communicable diseases. Herein, we discuss the issue of procrastinating drug approval in osteoporosis and future implications.
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Affiliation(s)
- Giovanni Adami
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Elena Tsourdi
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III & Center for Healthy Aging, Technical University Medical Center, Dresden, Germany
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
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104
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Marques ML, Pereira da Silva N, van der Heijde D, Stal R, Baraliakos X, Braun J, Reijnierse M, Bastiaenen C, Ramiro S, van Gaalen FA. Inflammation, bone loss and 2-year bone formation at the same vertebra in axial spondyloarthritis: a multilevel MRI and low-dose CT analysis. RMD Open 2023; 9:rmdopen-2022-002836. [PMID: 36759008 PMCID: PMC9923353 DOI: 10.1136/rmdopen-2022-002836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/09/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE To investigate whether in radiographic axial spondyloarthritis (r-axSpA) inflammation is associated with lower trabecular bone density (TBD), and subsequently, if a lower TBD increases the likelihood of 2-year bone formation at the same vertebra. METHODS Whole spine (C3-L5) data from patients included in the multicentre 2-year Sensitive Imaging in Ankylosing Spondylitis cohort was used. Two readers measured baseline TBD by Hounsfield units (HU) on low-dose CT (ldCT). Baseline MRI bone marrow oedema (BME) status scores and ldCT syndesmophyte formation and/or growth change-from-baseline scores were assessed by three and two readers, respectively. Average of readers' continuous measurements or readers' agreement in binary scores generated within the same vertebra (1-present in ≥1 quadrant/0-absent in all quadrants) were used. Multilevel generalised estimating equations models were used, the unit of analysis being the vertebra. RESULTS In 50 patients with r-axSpA, TBD HU decreased from cranial to caudal vertebrae. Baseline MRI-BME was present in 300/985 (30%) and syndesmophytes in 588/910 (65%) vertebrae, both most prevalent at thoracolumbar region. Syndesmophyte formation or growth was observed in 18% of at-risk vertebrae (124/691). A significant confounder-adjusted association was found between inflammation and lower TBD (regression coefficient=-51; 95% CI-63 to -39). TBD was not associated with 2-year syndesmophyte formation or growth (adjusted OR 1.00; 95% CI 0.99 to 1.00). CONCLUSION In r-axSpA, while vertebral inflammation was associated with lower vertebral TBD, lower vertebral TBD itself did not increase the risk for new bone formation at the same vertebra. In preventing syndesmophyte progression, targeting local inflammation seems more important than targeting vertebral trabecular bone loss.
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Affiliation(s)
- Mary Lucy Marques
- Rheumatology department, Leiden University Medical Center, Leiden, Netherlands .,Rheumatology department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Nuno Pereira da Silva
- Radiology department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | | | - Rosalinde Stal
- Rheumatology department, Leiden University Medical Center, Leiden, Netherlands
| | | | - Juergen Braun
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
| | - Monique Reijnierse
- Radiology department, Leiden University Medical Center, Leiden, Netherlands
| | | | - Sofia Ramiro
- Rheumatology department, Leiden University Medical Center, Leiden, Netherlands,Rheumatology department, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Floris A van Gaalen
- Rheumatology department, Leiden University Medical Center, Leiden, Netherlands
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105
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Acevedo M, Varleta P, Casas-Cordero C, Berríos A, Navarrete C, Valentino G, Lopez R, Smith SC. Mobile-phone text messaging to promote ideal cardiovascular health in women. Open Heart 2023; 10:e002214. [PMID: 36759011 PMCID: PMC9923351 DOI: 10.1136/openhrt-2022-002214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE Ideal cardiovascular health (CVH) was developed to promote CVH as a key component of primordial prevention. Mobile short message service (SMS) is useful for improving health behaviours. We aim to test the effectiveness of SMS intervention in women to improve CVH. METHODS In a single-blinded, randomised, controlled study, 620 women, aged 35-70 years, without cardiovascular disease, were enrolled in SMS intervention versus no SMS. CVH metrics by self-report, and biochemical laboratory, anthropometric and blood pressure measurements were collected during home visits at baseline and 9 months. Women were categorised as having poor (0-2), intermediate (3-4) or ideal (5-7) CVH according to the number of ideal CVH metrics. Participants were randomised 1:1 to SMS intervention versus control. SMS was sent every 5-6 days for 9 months. The primary outcome was the difference in the proportion of women with ideal CVH between SMS and control groups at 9 months. Rates of intermediate CVH, poor CVH and each of the seven ideal CV health metrics at 9 months were key secondary endpoints. RESULTS At 9 months, there was no significant difference between groups for the primary outcome (16.3% at baseline and 13.3% at 9 months, and 10.1% and 11.1%, in SMS and control groups, respectively, adjusted RR 1.0; 95% CI 0.6 to 1.6). Similarly, there were no significant differences between groups for the key secondary endpoints. SMS had an acceptance rate of 94.9%. CONCLUSIONS Behavioural SMS intervention did not improve rates of ideal CVH in women, despite being feasible and well received. TRIAL REGISTRATION NUMBER 6377.
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Affiliation(s)
- Monica Acevedo
- Fundación SOCHICAR (Sociedad Chilena de Cardiología y Cirugía Cardiovascular), Santiago, Chile
- División de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Paola Varleta
- Fundación SOCHICAR (Sociedad Chilena de Cardiología y Cirugía Cardiovascular), Santiago, Chile
- Centro Cardiovascular, Hospital DIPRECA, Las Condes, Chile
| | - Carolina Casas-Cordero
- Instituto de Sociología, Pontificia Universidad Católica de Chile, Santiago, Chile
- Instituto de Sociología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Amalia Berríos
- Fundación SOCHICAR (Sociedad Chilena de Cardiología y Cirugía Cardiovascular), Santiago, Chile
| | - Carlos Navarrete
- Departamento de Matemáticas, Universidad de La Serena, La Serena, Chile
| | - Giovanna Valentino
- Carrera de Nutrición y Dietética, Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Rosario Lopez
- Carrera de Kinesiología, Facultad de Ciencias de la Salud, Universidad San Sebastián - Campus Bellavista, Santiago de Chile, Chile
| | - Sidney C Smith
- Cardiovascular Department, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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106
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Kamenicky P, Briot K, Brandi ML, Cohen-Solal M, Crowley RK, Keen R, Kolta S, Lachmann RH, Lecoq AL, Ralston SH, Walsh JS, Rylands AJ, Williams A, Sun W, Nixon A, Nixon M, Javaid MK. Benefit of burosumab in adults with X-linked hypophosphataemia (XLH) is maintained with long-term treatment. RMD Open 2023; 9:rmdopen-2022-002676. [PMID: 36854566 PMCID: PMC9980374 DOI: 10.1136/rmdopen-2022-002676] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/02/2023] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVES To report the impact of continued burosumab treatment on clinical laboratory tests of efficacy, patient-reported outcomes (PROs) and ambulatory function in adults with X-linked hypophosphataemia who continued from a 96-week phase 3 study into a 48-week open-label extension. METHODS Eligible participants from the phase 3 study continued on the burosumab regimen received at the end of the phase 3 study for a further 48 weeks (n=31). Some (not all) received compassionate burosumab treatment between the two studies (a period of 6-18 months). The primary efficacy outcome was fasting serum phosphate concentration; secondary outcomes were serum 1,25 dihydroxyvitamin D concentration, renal phosphate reabsorption, PROs and ambulatory function. RESULTS Improvements in fasting serum phosphate, serum 1,25 dihydroxyvitamin D and renal phosphate reabsorption at 96 weeks were maintained through the 48-week extension. Improvements were also maintained in stiffness and physical function measured using the Western Ontario and McMaster Universities Osteoarthritis Index, pain and fatigue endpoints measuring using the Brief Pain Inventory short-form and Brief Pain Inventory, respectively, and in ambulatory function (6-Minute Walk Test).A post-hoc exploratory analysis exploring outcomes in participants who discontinued burosumab treatment between the studies (n=7) and those who received at least one dose (n=23) indicated that the benefits of burosumab on clinical laboratory tests of efficacy, PROs and ambulatory function may be lost when treatment is interrupted but recover over time when treatment is reinstated. CONCLUSION Continued treatment with burosumab appears necessary for sustained clinical benefit. TRIAL REGISTRATION NUMBERS Phase 3: NCT02526160; open-label extension: NCT03920072.
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Affiliation(s)
- Peter Kamenicky
- Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, Paris, France
| | - Karine Briot
- Service de Rhumatologie, Hôpital Cochin, Paris, France
| | | | - Martine Cohen-Solal
- INSERM U1132 BIOSCAR, Service de Rhumatologie, Hôpital Lariboisiere, Université de Paris, Paris, France
| | - Rachel K Crowley
- Rare Disease Clinical Trial Network, University College Dublin School of Medicine, Dublin, Ireland.,Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
| | - Richard Keen
- Metabolic Bone Disease Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Sami Kolta
- INSERM U1153, Service de Rhumatologie, Hôpital Cochin, Paris, France
| | - Robin H Lachmann
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Anne-Lise Lecoq
- Physiologie et Physiopathologie Endocriniennes, Assistance Publique - Hôpitaux de Paris, Paris, France.,Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital Bicêtre, Paris, France
| | - Stuart H Ralston
- Medical Research Council Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Jennifer S Walsh
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Angela J Rylands
- Health Economics and Outcomes Research Department, Kyowa Kirin International PLC, Marlow, UK
| | - Angela Williams
- Health Economics and Outcomes Research Department, Kyowa Kirin International PLC, Marlow, UK
| | - Wei Sun
- Biostatistics Department, Kyowa Kirin Pharmaceutical Development, Inc, Princeton, New Jersey, USA
| | | | | | - Muhammad K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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107
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Affiliation(s)
- Rahul H Rathod
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA .,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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108
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Affiliation(s)
- Jonathan D Davis
- Cardiology, University of California San Francisco, San Francisco, California, USA
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109
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Bruce IN, Buie J, Bloch L, Bae SC, Costenbader K, Levy RA, Werth VP, Marion A, Sangodkar S, Manzi S. Lupus spectrum ambiguity has long-term negative implications for patients. Lupus Sci Med 2023; 10:e000856. [PMID: 37534513 PMCID: PMC9835935 DOI: 10.1136/lupus-2022-000856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023]
Abstract
Lupus is a complex disease that is often difficult to diagnose. Risks of diagnostic delays include non-specific signs and symptoms that mimic other diseases and a lack of diagnostic criteria and referral pathways for non-specialists. To address these issues, we convened a series of virtual meetings with members of our Addressing Lupus Pillars for Health Advancement clinical care team. Meeting participants included lupus physicians, treatment developers from biotechnology, patient advocacy group representatives from the Lupus Foundation of America and advocacy/government consultants. Causes and consequences of ambiguity in diagnosis and diagnostic delays were evaluated through historical, experiential and evidence-based accounts (survey data, literature reviews and patient testimonials). Discussions highlighted the need for a clearer understanding of the definition of lupus, the natural history of the disease and the need for advancements in biotechnology to support an accurate and timely diagnosis with the potential development of a lupus spectrum.
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Affiliation(s)
- Ian N Bruce
- Rheumatology, The University of Manchester, Manchester, UK
| | - Joy Buie
- Research, Lupus Foundation of America, Washington, District of Columbia, USA
| | - Lauren Bloch
- Health Policy and Regulatory Affairs, Faegre Drinker Biddle and Reath, Washington, District of Columbia, USA
| | - Sang-Cheol Bae
- Rheumatology, Hanyang University Seoul Hospital, Seoul, Korea (the Republic of)
| | - Karen Costenbader
- Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Roger A Levy
- Global Medical Expert Immunology and Specialty Medicine, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Victoria P Werth
- Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ashley Marion
- Research, Lupus Foundation of America, Washington, District of Columbia, USA
| | - Sanjyot Sangodkar
- Strategy and Consulting, Faegre Drinker Consulting, Washington, District of Columbia, USA
| | - Susan Manzi
- Lupus Center of Excellence, Autoimmunity Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Choi YJ, Kim HK, Hwang IC, Park CS, Rhee TM, Lee HJ, Park JB, Yoon YE, Lee SP, Cho GY, Kim YJ. Prognosis of patients with hypertrophic cardiomyopathy and low-normal left ventricular ejection fraction. Heart 2022; 109:771-778. [PMID: 36581445 DOI: 10.1136/heartjnl-2022-321853] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To investigate whether low-normal left ventricular ejection fraction (LVEF) is associated with adverse outcomes in hypertrophic cardiomyopathy (HCM) and evaluate the incremental value of predictive power of LVEF in the conventional HCM sudden cardiac death (SCD)-risk model. METHODS This retrospective study included 1858 patients with HCM from two tertiary hospitals between 2008 and 2019. We classified LVEF into three categories: preserved (≥60%), low normal (50%-60%) and reduced (<50%); there were 1399, 415, and 44 patients with preserved, low-normal, and reduced LVEF, respectively. The primary outcome was a composite of SCD, ventricular tachycardia/fibrillation and appropriate implantable cardioverter-defibrillator shocks. Secondary outcomes were hospitalisation for heart failure (HHF), cardiovascular death and all-cause death. RESULTS During the median follow-up of 4.09 years, the primary outcomes occurred in 1.9%. HHF, cardiovascular death, and all-cause death occurred in 3.3%, 1.9%, and 5.3%, respectively. Reduced LVEF was an independent predictor of SCD/equivalent events (adjusted HR (aHR) 5.214, 95% CI 1.574 to 17.274, p=0.007), adding predictive value to the HCM risk-SCD model (net reclassification improvement 0.625). Compared with patients with HCM with preserved LVEF, those with low-normal and reduced LVEF had a higher risk of HHF (LVEF 50%-60%, aHR 2.457, 95% CI 1.423 to 4.241, p=0.001; LVEF <50%, aHR 7.937, 95% CI 3.315 to 19.002, p<0.001) and cardiovascular death (LVEF 50%-60%, aHR 2.641, 95% CI 1.314 to 5.309, p=0.006; LVEF <50%, aHR 5.405, 95% CI 1.530 to 19.092, p=0.009), whereas there was no significant association with all-cause death. CONCLUSIONS Low-normal LVEF was an independent predictor of HHF and cardiovascular death in patients with HCM.
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Affiliation(s)
- You-Jung Choi
- Internal Medicine, Korea University Guro Hospital, Seoul, Korea (the Republic of).,Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of) .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - In-Chang Hwang
- Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of) .,Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Chan Soon Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Tae-Min Rhee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Yeonyee Elizabeth Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Goo-Yeong Cho
- Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Yong-Jin Kim
- Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of).,Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (the Republic of).,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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111
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Vilalta V, Cediel G, Mohammadi S, López H, Kalavrouziotis D, Resta H, Dumont E, Voisine P, Philippon F, Escabia C, Borrellas A, Alperi A, Fernandez-Nofrerias E, Carrillo X, Panagides V, Bayes-Genis A, Rodés-Cabau J. New-onset persistent left bundle branch block following sutureless aortic valve replacement. Heart 2022; 109:143-150. [PMID: 35842233 DOI: 10.1136/heartjnl-2022-321191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate the incidence, predictive factors and prognostic value of new-onset persistent left bundle branch block (NOP-LBBB) in patients undergoing sutureless surgical aortic valve replacement (SU-SAVR). METHODS A total of 329 consecutive patients without baseline conduction disturbances or previous permanent pacemaker implantation (PPI) who underwent SU-SAVR with the Perceval valve (LivaNova Group, Saluggia, Italy) in two centres from 2013 to 2019 were included. Patients were on continuous ECG monitoring during hospitalisation and 12-lead ECG was performed after the procedure and at hospital discharge. NOP-LBBB was defined as a new postprocedural LBBB that persisted at hospital discharge. Baseline, procedural and follow-up clinical and echocardiography data were collected in a dedicated database. RESULTS New-onset LBBB was observed in 115 (34.9%) patients, and in 76 (23.1%) persisted at hospital discharge. There were no differences in baseline and procedural characteristics between patients with (n=76) and without (n=253) NOP-LBBB. After a median follow-up of 3.3 years (2.3-4.4 years), patients with NOP-LBBB had a higher incidence of PPI (14.5% vs 6.3%, p=0.016), but exhibited similar rates of all-cause mortality (19.4% vs 19.2%, p=0.428), cardiac mortality (8.1% vs 9.4%, p=0.805) and heart failure readmission (21.0% vs 23.2%, p=0.648), compared with the no/transient LBBB group. NOP-LBBB was associated with a decrease in left ventricular ejection fraction (LVEF) at 1-year follow-up (delta: -5.7 vs +0.2, p<0.001). CONCLUSIONS NOP-LBBB occurred in approximately a quarter of patients without prior conduction disturbances who underwent SU-SAVR and was associated with a threefold increased risk of PPI along with a negative impact on LVEF at follow-up.
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Affiliation(s)
- Victoria Vilalta
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Germán Cediel
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Siamak Mohammadi
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Helena López
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Dimitri Kalavrouziotis
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Helena Resta
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Eric Dumont
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Pierre Voisine
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - François Philippon
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Claudia Escabia
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Andrea Borrellas
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Alberto Alperi
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | | | - Xavier Carrillo
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Vassili Panagides
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Antoni Bayes-Genis
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Rodés-Cabau
- Department of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
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112
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Sprow G, Dan J, Feng R, Werth VP. Comparing dermatologic patient-reported outcome measures in cutaneous lupus erythematosus. Lupus Sci Med 2022; 9:9/1/e000827. [PMID: 36521938 PMCID: PMC9756276 DOI: 10.1136/lupus-2022-000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Grant Sprow
- Dermatology, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA,Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joshua Dan
- Dermatology, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA,Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rui Feng
- Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria P Werth
- Dermatology, Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA,Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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113
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Holder CR, Schenker ML, Baker JL, Giordano NA. Defense and Veterans Pain Rating Scale scores associated with longer PROMIS measures. Reg Anesth Pain Med 2022:rapm-2022-104010. [PMID: 36517201 DOI: 10.1136/rapm-2022-104010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Affiliation(s)
| | - Mara L Schenker
- Grady Memorial Hospital, Atlanta, Georgia, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - J'Lynn L Baker
- Mercer University School of Medicine, Macon, Georgia, USA
| | - Nicholas A Giordano
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, USA
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114
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Moriyama S, Hieda M, Kisanuki M, Kawano S, Yokoyama T, Fukata M, Kusaba H, Maruyama T, Baba E, Akashi K, Fukuda H. Effect of renin-angiotensin system inhibitors in patients with cancer treated with anti-VEGF therapy. Open Heart 2022; 9:openhrt-2022-002135. [PMID: 36600585 PMCID: PMC9743396 DOI: 10.1136/openhrt-2022-002135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/08/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cancer treatment with vascular endothelial growth factor signalling pathway (VSP) inhibitors frequently causes hypertension. Although previous reports suggested that the antihypertensive drug renin-angiotensin system inhibitor (RASI) may have a positive synergistic effect with VSP inhibitors, the actual impact on clinical outcomes is unknown. OBJECTIVES The study aims to clarify whether RASIs exhibit clinical benefits for patients with cancer with hypertension. METHOD From the Longevity Improvement and Fair Evidence Study database, comprising Japanese claims data between 2016 and 2020, we reviewed 2380 patients treated with VSP inhibitors who received antihypertensive treatment during cancer therapy. The patients were classified into two groups: with-RASI (n=883) and without-RASI (n=1497). In addition, 1803 of these patients treated for hypertension with RASI-only (n=707) or calcium channel blocker-only (n=1096) were also reviewed. The time-to-treatment failure (TTF), the interval from initiation of chemotherapy to its discontinuation, was applied as the primary endpoint. RESULTS The median TTFs were 167 (60-382) days in the with-RASI group and 161 (63-377) days in the without-RASI group (p=0.587). All models, including Cox proportional hazard models and multiple propensity score models, did not reveal the superiority of with-RASI treatment. In the propensity score matching model, the HR for treatment with-RASI compared with that for without-RASI was 0.96 (95% CI 0.86 to 1.06, p=0.386). In addition, the TTFs of RASI-only were not superior to calcium channel blocker-only (p=0.584). CONCLUSIONS RASIs for hypertension do not benefit clinical outcomes during cancer therapy with VSP inhibitors. In addition, RASIs and calcium channel blockers have comparable clinical efficacy as first-line antihypertensive.
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Affiliation(s)
- Shohei Moriyama
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Michinari Hieda
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Megumi Kisanuki
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Shotaro Kawano
- Division of Immunology and Rheumatology, Hamanomachi Hospital, Fukuoka, Japan
| | - Taku Yokoyama
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Mitsuhiro Fukata
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Hitoshi Kusaba
- Division of Oncology, Hamanomachi Hospital, Fukuoka, Japan
| | - Toru Maruyama
- Campus Life Health Center, Kyushu University, Fukuoka, Japan
| | - Eishi Baba
- Department of Oncology and Social Medicine, Kyushu University, Fukuoka, Japan
| | - Koichi Akashi
- Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University, Fukuoka, Japan
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Zanetti A, Zambon A, Scirè CA, Bortoluzzi A. Impact of rheumatoid arthritis and methotrexate on pregnancy outcomes: retrospective cohort study of the Italian Society for Rheumatology. RMD Open 2022; 8:rmdopen-2022-002412. [PMID: 36597979 DOI: 10.1136/rmdopen-2022-002412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/02/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To evaluate the impact of rheumatoid arthritis (RA) and methotrexate (MTX) on the probability of becoming pregnant, pregnancy losses, elective termination of pregnancy (TOP) and congenital malformations. METHODS A retrospective cohort study on administrative healthcare databases was conducted. Three patients' cohorts were enrolled among childbearing-age women. The first cohort included patients with RA starting MTX between July 2004 and December 2011. The second cohort included patients with RA without MTX treatment randomly selected from the same population (ratio 1:1). Finally, a cohort of subjects without RA was identified (ratio 1:4). Multivariate logistic regression models were implemented, ORs and 95% CI were reported. RESULTS The two matched RA cohorts included 3564 patients with MTX and without MTX. The cohort without RA included 14 256 subjects. In the three cohorts, the proportion of women achieving pregnancy during follow-up was 6.3%, 9.1% and 11.9%, respectively. Congenital malformations were very rare in all cohorts. RA women treated with MTX at any time before conception showed significantly higher risks of pregnancy losses than non-RA women (OR (95% CI) 2.22 (1.40 to 3.45)). We observed a significant positive relationship between the exposure to MTX in the 3 months window before conception and increased risk of elective TOP (OR (95% CI) 4.77 (1.08 to 19.40)). CONCLUSION MTX-treated patients appeared to be the cohort with the highest risk of pregnancy losses. The positive association with elective TOP and exposure to MTX in the three months window before conception in patients with RA reinforces the need for adequate preconception counselling to avoid unplanned pregnancies.
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Affiliation(s)
- Anna Zanetti
- Epidemiology Unit, Italian Society of Rheumatology, Milano, Italy.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,IRCCS Istituto Auxologico Italiano, Biostatistics Unit, Milan, Italy
| | - Carlo Alberto Scirè
- Epidemiology Unit, Italian Society of Rheumatology, Milano, Italy .,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alessandra Bortoluzzi
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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116
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Wouters P, Schoots T, Niemeijer V, Spee RF, Kemps H. Does recovery from submaximal exercise predict response to cardiac resynchronisation therapy? Open Heart 2022; 9:openhrt-2022-002047. [PMID: 36376007 PMCID: PMC9664270 DOI: 10.1136/openhrt-2022-002047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Exercise parameters are not routinely incorporated in decision making for cardiac resynchronisation therapy (CRT). Submaximal exercise parameters better reflect daily functional capacity of heart failure patients than parameters measured at maximal exertion, and may therefore better predict response to CRT. We compared various exercise parameters, and sought to establish which best predict CRT response. Methods In 31 patients with chronic heart failure (61% male; age 68±7 years), submaximal and maximal cycling testing was performed before and 3 months after CRT. Submaximal oxygen onset (τVO2 onset) and recovery kinetics (τVO2 recovery), peak oxygen uptake (VO2 peak) and oxygen uptake efficiency slope (OUES) where measured. Response was defined as ≥15% relative reduction in end-systolic volume. Results After controlling for age, New York Heart Association and VO2 peak, fast submaximal VO2 kinetics were significantly associated with response to CRT, measured either during onset or recovery of submaximal exercise (area under the curve, AUC=0.719 for both; p<0.05). By contrast, VO2 peak (AUC=0.632; p=0.199) and OUES (AUC=0.577; p=0.469) were not associated with response. Among patients with fast onset and recovery kinetics, below 60 s, a significantly higher percentage of responders was observed (91% and 92% vs 43% and 40%, respectively). Conclusions Impaired VO2 kinetics may serve as an objective marker of submaximal exercise capacity that is age-independently associated with non-response following CRT, whereas maximal exercise parameters are not. Assessment of VO2 kinetics is feasible and easy to perform, but larger studies should confirm their clinical utility.
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Affiliation(s)
- Philippe Wouters
- Department of Cardiology, Máxima Medisch Centrum, Eindhoven, The Netherlands .,Department of Cardiology, University Medical Centre, Utrecht, The Netherlands
| | - Thijs Schoots
- Department of Cardiology, Máxima Medisch Centrum, Eindhoven, The Netherlands.,Technical University of Eindhoven, Eindhoven, The Netherlands
| | - Victor Niemeijer
- Department of Sports Medicine, Elkerliek Hospital, Helmond, The Netherlands
| | - Ruud F Spee
- Department of Cardiology, Máxima Medisch Centrum, Eindhoven, The Netherlands
| | - Hareld Kemps
- Department of Cardiology, Máxima Medisch Centrum, Eindhoven, The Netherlands.,Technical University of Eindhoven, Eindhoven, The Netherlands
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Montag LJ, Horneff G, Hoff P, Klein A, Kallinich T, Foeldvari I, Seipelt E, Tatsis S, Peer Aries MD, Niewerth M, Klotsche J, Minden K. Medication burden in young adults with juvenile idiopathic arthritis: data from a multicentre observational study. RMD Open 2022; 8:rmdopen-2022-002520. [PMID: 36283758 PMCID: PMC9608545 DOI: 10.1136/rmdopen-2022-002520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the medication and disease burden of young adults with juvenile idiopathic arthritis (JIA). METHODS Young adults with JIA prospectively followed in the Juvenile Arthritis Methotrexate/Biologics long-term Observation reported on their health status and medication use. All medications taken (disease-modifying antirheumatic drugs (DMARDs)/prescription/over-the-counter drugs, but excluding most local therapies) classified according to the Anatomical Therapeutic Chemical Classification System were included in this analysis. Medication use at last follow-up was evaluated by sex, JIA category and time from symptom onset to the first biological DMARD (bDMARD) start. RESULTS A total of 1306 young adults (68% female) with JIA and a mean disease duration of 13.6±6 years were included in the study. Patients reported using on average 2.4±2.1 medicines and 1.5±1.7 non-DMARD medicines, respectively, at the last follow-up. Almost a quarter of the patients reported polypharmacy. The higher the number of medications used was, the higher the disease activity, pain and fatigue, and the lower the quality of life of patients. Medication usage differed significantly between sexes and JIA categories, being highest in patients with rheumatoid factor-positive polyarthritis and systemic JIA. The number of medications used was significantly associated with the time from symptom onset to bDMARD start. Patients taking opioids or antidepressants had a particularly high disease burden and had received bDMARDs an average of 2 years later than patients not taking these medications. CONCLUSION Medication use in adults with JIA varies depending on sex, JIA category, and the time between symptom onset and initiation of treatment with bDMARD.
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Affiliation(s)
- Laura J Montag
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Programme area Epidemiology and Health Services Research, Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Berlin, Germany
| | - Gerd Horneff
- Department of Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany,Department of Paediatric and Adolescent Medicine, University Hospital Cologne, Cologne, Germany
| | - Paula Hoff
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Department of Rheumatology, MVZ Endokrinologikum Berlin, Berlin, Germany
| | - Ariane Klein
- Department of Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
| | - Tilmann Kallinich
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Programme area Pathophysiology of Rheumatic Inflammation, Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Berlin, Germany
| | - Ivan Foeldvari
- Klinikum Eilbek, Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg, Germany
| | - Eva Seipelt
- Immanuel Krankenhaus Berlin-Buch, Berlin, Germany
| | | | | | - Martina Niewerth
- Programme area Epidemiology and Health Services Research, Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Berlin, Germany
| | - Jens Klotsche
- Programme area Epidemiology and Health Services Research, Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Berlin, Germany
| | - Kirsten Minden
- Programme area Epidemiology and Health Services Research, Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Berlin, Germany,Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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118
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Holler, MPH E, Ortiz, MD D, Mohanty, MD, MS S, Meagher, MD, MPH AD, Boustani, MD, MPH M, Zarzaur, MD, MPH BL, Simons, MD CJ. Violent injury prevention does not equal to violent crime prevention: an analysis of violence intervention program efficacy using propensity score methods. Trauma Surg Acute Care Open 2022; 7:e000905. [PMID: 36267559 PMCID: PMC9577934 DOI: 10.1136/tsaco-2022-000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022] Open
Abstract
Objective The purpose of this study was to determine if exposure to Prescription for Hope (RxH), a hospital-based violence intervention program (HVIP), is associated with reduced violent reinjury and new convictions for violent crime in the 2-year period after index hospitalization for a violent injury. Methods This was a retrospective cohort study analyzing patients from two level I trauma centers in Indianapolis, Indiana. RxH participants (n=260) enrolled between January 1, 2015 and December 31, 2018 and who had trauma registry data were included. RxH eligibility criteria: admitted for a violent injury (excluding sexual violence), at least 15 years of age, live in Marion County, Indiana, and stay in the hospital for at least 24 hours. RxH exclusion criteria: heavy active substance use, acute psychosis, dementia, severe traumatic brain injury, intentional self-harm, and incarceration. All patients admitted to IU Health Methodist Hospital, a nearby level I trauma center, for an assault, stabbing, or gunshot wound during the same period and met the RxH eligibility criteria were included as a comparison group (n=732). Doubly adjusted logistic regression with inverse probability of treatment weighting was used to estimate the average treatment effect of RxH participation on violent reinjury and new convictions for violent crime. Results Data from 992 patients were analyzed. RxH was significantly associated with reduced odds of violent reinjury (OR=0.35, 95% CI 0.20 to 0.59) and increased odds of conviction for a violent crime (OR=2.43, 95% CI 1.64 to 3.61). Conclusion RxH was associated with decreased odds of violent reinjury but increased odds of new conviction for a violent crime. Our results highlight the importance of robust, routine evaluation of HVIP efficacy and recommend inclusion of other outcomes in addition to violent reinjury when evaluating program success. High-quality randomized controlled trials are needed to further investigate the impact of HVIPs on a variety of outcomes. Level of evidence IV: retrospective study with more than one negative criterion ((1) limited control of confounding and (2) heterogeneous populations).
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Affiliation(s)
- Emma Holler, MPH
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, Indiana, USA
| | - Damaris Ortiz, MD
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA,Eskenazi Health, Eskenazi Health Hospital, Indianapolis, Indiana, USA
| | - Sanjay Mohanty, MD, MS
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA,Methodist Hospital, Indiana University Health, Indianapolis, Indiana, USA
| | - Ashley D Meagher, MD, MPH
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA,Methodist Hospital, Indiana University Health, Indianapolis, Indiana, USA
| | | | - Ben L Zarzaur, MD, MPH
- Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Clark J Simons, MD
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA,Eskenazi Health, Eskenazi Health Hospital, Indianapolis, Indiana, USA
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Truchetet ME, Drumez E, Barnetche T, Martin C, Devaux M, Goulenok T, Maria A, Schmidt J, Abdallah NA, Melki I, Hachulla E, Richez C. Outcome of COVID-19 in patients with rheumatic and inflammatory diseases treated with mycophenolic acid: data from the French RMD COVID-19 cohort. RMD Open 2022; 8:rmdopen-2022-002476. [PMID: 36113962 PMCID: PMC9485642 DOI: 10.1136/rmdopen-2022-002476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/05/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with inflammatory rheumatic and musculoskeletal diseases (iRMD) receiving mycophenolic acid (MPA) may have a less favourable outcome from COVID-19 infection. Our aim was to investigate whether MPA treatment is associated with severe infection and/or death. METHODS IRMD patients with and without MPA treatment with highly suspected/confirmed COVID-19 were included in this observational multicentre study. The primary outcome was death rate from COVID-19 with secondary objectives to determine the severity of infection and length of hospital stay. Outcome comparisons were made using regression models with and without adjustment on prespecified confounding factors. ORs, sub-HR (sHR) and 95% CIs were calculated using patients not treated with MPA as a reference group. RESULTS Of the 1977 patients, 1928 were not treated with MPA (393 were MPA eligible), and 49 patients were treated with MPA. MPA-treated patients had more severe disease, longer hospital stays and higher death rate from COVID-19 than non-MPA patients (OR 8.02 (95% CI 3.35 to 19.20), p<0.001; sHR 0.57 (95% CI 0.33 to 0.98), p=0.040; OR 11.58 (95% CI 4.10 to 32.69), p<0.001). In adjusted analyses, however, no outcome was independently associated with MPA treatment. Death rate, severity and length of hospital stay of MPA-treated patients were not significantly different from those of not treated but MPA-eligible patients. CONCLUSION MPA therapy is not associated with a more severe COVID-19 infection. However, due to increased vulnerability of developing a severe form of COVID-19, careful consideration should be taken with iRMD patients likely to be treated with MPA. TRIAL REGISTRATION NUMBER NCT04353609.
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Affiliation(s)
- Marie-Elise Truchetet
- Rheumatology Department, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, Aquitaine, France
| | - Elodie Drumez
- Department of Biostatistics, CHU Lille, Lille, Hauts-de-France, France
| | - Thomas Barnetche
- Rheumatology Department, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, Aquitaine, France
| | - Claire Martin
- Department of Biostatistics, CHU Lille, Lille, Hauts-de-France, France
| | - Mathilde Devaux
- Department of Internal Medicine, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Saint-Germain-en-Laye, Île-de-France, France
| | - Tiphaine Goulenok
- Department of Internal Medicine, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Alexandre Maria
- Department of Internal Medicine, Saint-Eloi Hospital Department of Internal Medicine, Montpellier, Languedoc-Roussillon, France
| | - Jean Schmidt
- Department of Internal Medicine and RECIF, Amiens University Hospital, Amiens, France,Université de Picardie Jules Verne, Amiens, Hauts-de-France, France
| | - Nassim Ait Abdallah
- Unité de Médecine Interne (UF 04): CRMR MATHEC, Maladies auto-immunes et thérapie cellulaire; Centre de Référence des Maladies auto-immunes systémiques Rares d’Ile-de-France MATHEC, AP-HP, Hôpital St-Louis, Paris, France,IRSL, Recherche clinique appliquée à l'hématologie, EA3518 (Equipe 3 MATHEC-EUROCORD), Université de Paris, Paris, Île-de-France, France
| | - Isabelle Melki
- Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Paris, France,Department of General Paediatrics, Infectious Diseases and Internal Medicine, Hopital Universitaire Robert Debre, Paris, Île-de-France, France
| | - Eric Hachulla
- Department of Internal Medicine and Clinical immunology, Referral Centre for Rare Systemic Auto-immune Diseases North and North-West of France, Lille University School of Medicine, Lille, France
| | - Christophe Richez
- Rheumatology Department, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, Aquitaine, France
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Silverio A, Parodi G, Scudiero F, Bossone E, Di Maio M, Vriz O, Bellino M, Zito C, Provenza G, Radano I, Baldi C, D'Andrea A, Novo G, Mauro C, Rigo F, Innelli P, Salerno-Uriarte J, Cameli M, Vecchione C, Antonini Canterin F, Galasso G, Citro R. Beta-blockers are associated with better long-term survival in patients with Takotsubo syndrome. Heart 2022; 108:1369-1376. [PMID: 35361673 DOI: 10.1136/heartjnl-2021-320543] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/07/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The advantage of beta-blockers has been postulated in patients with Takotsubo syndrome (TTS) given the pathophysiological role of catecholamines. We hypothesised that beta-blocker treatment after discharge may improve the long-term clinical outcome in this patient population. METHODS This was an observational, multicentre study including consecutive patients with TTS diagnosis prospectively enrolled in the Takotsubo Italian Network (TIN) register from January 2007 to December 2018. TTS was diagnosed according to the TIN, Heart Failure Association and InterTAK Diagnostic Criteria. The primary study outcome was the occurrence of all-cause death at the longest available follow-up; secondary outcomes were TTS recurrence, cardiac and non-cardiac death. RESULTS The study population included 825 patients (median age: 72.0 (63.0-78.0) years; 91.9 % female): 488 (59.2%) were discharged on beta-blockers and 337 (40.8%) without beta-blockers. The median follow-up was 24.0 months. The adjusted Cox regression analysis showed a significantly lower risk for all-cause death (adjusted HR: 0.563; 95% CI: 0.356 to 0.889) and non-cardiac death (adjusted HR: 0.525; 95% CI: 0.309 to 0.893) in patients receiving versus those not receiving beta-blockers, but no significant differences in terms of TTS recurrence (adjusted HR: 0.607; 95% CI: 0.311 to 1.187) and cardiac death (adjusted HR: 0.699; 95% CI: 0.284 to 1.722). The positive survival effect of beta-blockers was higher in patients with hypertension than in those without (pinteraction=0.014), and in patients who developed cardiogenic shock during the acute phase than in those who did not (pinteraction=0.047). CONCLUSIONS In this real-world register population, beta-blockers were associated with a significantly higher long-term survival, particularly in patients with hypertension and in those who developed cardiogenic shock during the acute phase.
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Affiliation(s)
- Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
| | - Guido Parodi
- Department of Cardiology, ASL4 Liguria, Lavagna, Italy
| | - Fernando Scudiero
- Cardiology Department, Azienda Ospedaliera Bolognini Seriate, Seriate, Italy
| | - Eduardo Bossone
- Department of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
| | - Olga Vriz
- Cardiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine - Cardiology, University of Messina, Messina, Italy
| | - Gennaro Provenza
- Cardiovascular Department, Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Ilaria Radano
- Cardiovascular Department, Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Cesare Baldi
- Cardiovascular Department, Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | | | - Giuseppina Novo
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza (PROMISE), Università degli Studi di Palermo, Palermo, Italy
| | - Ciro Mauro
- Department of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Fausto Rigo
- Department of Cardiology, Ospedale dell'Angelo Mestre-Venice, Mestre, Italy
| | - Pasquale Innelli
- Department of Cardiovascular Imaging, San Carlo Hospital, Potenza, Italy
| | | | - Matteo Cameli
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy
| | - Francesco Antonini Canterin
- Department of Cardiology, High Specialization Rehabilitation Hospital Motta di Livenza, Motta di Livenza, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
| | - Rodolfo Citro
- Cardiovascular Department, Azienda Ospedaliera Universitaria 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli, Italy
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Drenkard C, Theis KA, Daugherty TT, Helmick CG, Dunlop-Thomas C, Bao G, Aspey L, Lewis TT, Lim SS. Depression, stigma and social isolation: the psychosocial trifecta of primary chronic cutaneous lupus erythematosus, a cross-sectional and path analysis. Lupus Sci Med 2022; 9:9/1/e000697. [PMID: 35953237 PMCID: PMC9379542 DOI: 10.1136/lupus-2022-000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
Abstract
Objective Depression is common in individuals with chronic cutaneous lupus erythematosus (CCLE). However, how CCLE may impact patients’ psychological well-being is poorly understood, particularly among disproportionally affected populations. We examined the relationships between depression and psychosocial factors in a cohort of predominantly Black patients with primary CCLE (CCLE without systemic manifestations). Methods Cross-sectional assessment of individuals with dermatologist-validated diagnosis of primary CCLE. NIH-PROMIS short-forms were used to measure depression, disease-related stigma, social isolation and emotional support. Linear regression analyses (ɑ=0.05) were used to test an a priori conceptual model of the relationship between stigma and depression and the effect of social isolation and emotional support on that association. Results Among 121 participants (87.6% women; 85.1% Black), 37 (30.6%) reported moderate to severe depression. Distributions of examined variables divided equally among those which did (eg, work status, stigma (more), social isolation (more), emotional support (less)) and did not (eg, age, sex, race, marital status) significantly differ by depression. Stigma was significantly associated with depression (b=0.77; 95% CI0.65 to 0.90), whereas social isolation was associated with both stigma (b=0.85; 95% CI 0.72 to 0.97) and depression (b=0.70; 95% CI0.58 to 0.92). After controlling for confounders, stigma remained associated with depression (b=0.44; 95% CI0.23 to 0.66) but lost significance (b=0.12; 95% CI −0.14 to 0.39) when social isolation (b=0.40; 95% CI 0.19 to 0.62) was added to the model. Social isolation explained 72% of the total effect of stigma on depression. Emotional support was inversely associated with depression in the univariate analysis; however, no buffer effect was found when it was added to the multivariate model. Conclusion Our findings emphasise the psychosocial challenges faced by individuals living with primary CCLE. The path analysis suggests that stigmatisation and social isolation might lead to depressive symptoms. Early clinical identification of social isolation and public education demystifying CCLE could help reduce depression in patients with CCLE.
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Affiliation(s)
- Cristina Drenkard
- Department of Medicine/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA .,Department of Epidemiology, Emory University School of Public Health, Atlanta, Georgia, USA
| | - Kristina A Theis
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Timothy T Daugherty
- Department of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Charles G Helmick
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Charmayne Dunlop-Thomas
- Department of Medicine/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gaobin Bao
- Department of Medicine/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laura Aspey
- Department Medicine/Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tené T Lewis
- Department of Epidemiology, Emory University School of Public Health, Atlanta, Georgia, USA
| | - S Sam Lim
- Department of Medicine/Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
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Bouget V, Duquesne J, Hassler S, Cournède PH, Fautrel B, Guillemin F, Pallardy M, Broët P, Mariette X, Bitoun S. Machine learning predicts response to TNF inhibitors in rheumatoid arthritis: results on the ESPOIR and ABIRISK cohorts. RMD Open 2022; 8:rmdopen-2022-002442. [PMID: 35999028 PMCID: PMC9403109 DOI: 10.1136/rmdopen-2022-002442] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/05/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives Around 30% of patients with rheumatoid arthritis (RA) do not respond to tumour necrosis factor inhibitors (TNFi). We aimed to predict patient response to TNFi using machine learning on simple clinical and biological data. Methods We used data from the RA ESPOIR cohort to train our models. The endpoints were the EULAR response and the change in Disease Activity Score (DAS28). We compared the performances of multiple models (linear regression, random forest, XGBoost and CatBoost) on the training set and cross-validated them using the area under the receiver operating characteristic curve (AUROC) or the mean squared error. The best model was then evaluated on a replication cohort (ABIRISK). Results We included 161 patients from ESPOIR and 118 patients from ABIRISK. The key selected features were DAS28, lymphocytes, ALT (aspartate aminotransferase), neutrophils, age, weight, and smoking status. When predicting EULAR response, CatBoost achieved the best performances of the four tested models. It reached an AUROC of 0.72 (0.68–0.73) on the train set (ESPOIR). Better results were obtained on the train set when etanercept and monoclonal antibodies were analysed separately. On the test set (ABIRISK), these models respectively achieved on AUROC of 0.70 (0.57–0.82) and 0.71 (0.55–0.86). Two decision thresholds were tested. The first prioritised a high confidence in identifying responders and yielded a confidence up to 90% for predicting response. The second prioritised a high confidence in identifying inadequate responders and yielded a confidence up to 70% for predicting non-response. The change in DAS28 was predicted with an average error of 1.1 DAS28 points. Conclusion The machine learning models developed allowed predicting patient response to TNFi exclusively using data available in clinical routine.
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Affiliation(s)
| | | | - Signe Hassler
- Sorbonne Université, INSERM UMR 959, Immunology-Immunopathology-Immunotherapy (i3), Assistance Publique Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Paris, France.,CESP, INSERM UMR 1018, Paris-Saclay University, France, Villejuif, France
| | - Paul-Henry Cournède
- CentraleSupélec Laboratory of Mathematics and Informatics for Systems Complexity, Gif-sur-Yvette, France
| | - Bruno Fautrel
- Rheumatology Departement, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié Salpêtrière, Paris, France.,Institut Pierre Louis d'épidémiologie et santé publique, Inserm UMRS 1136, équipe PEPITES (Pharmaco-épidémiologie et Évaluation des Soins), Paris, France
| | | | - Marc Pallardy
- INSERM UMR 996, Faculty of Pharmacy, Paris-Saclay University, Châtenay-Malabry, France.,ABIRISK (Anti-Biopharmaceutical Immunization: prediction and analysis of clinical relevance to minimize the RISK consortium), Innovative Medicines Initiative, Brussels, Belgium
| | - Philippe Broët
- Sorbonne Université, INSERM UMR 959, Immunology-Immunopathology-Immunotherapy (i3), Assistance Publique Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Paris, France.,CESP, INSERM UMR 1018, Paris-Saclay University, France, Villejuif, France
| | - Xavier Mariette
- Rheumatology departement, Université Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, INSERM UMR 1184, FHU CARE, Le Kremlin Bicêtre, France
| | - Samuel Bitoun
- Rheumatology departement, Université Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, INSERM UMR 1184, FHU CARE, Le Kremlin Bicêtre, France
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Williams-Hall R, Berry P, Williamson N, Barclay M, Roberts A, Gater A, Tolley C, Bradley H, Ward A, Hsia E, Zuraw Q, DeLong P, Touma Z, Strand V. Generation of evidence supporting the content validity of SF-36, FACIT-F, and LupusQoL, and novel patient-reported symptom items for use in patients with systemic lupus erythematosus (SLE) and SLE with lupus nephritis (LN). Lupus Sci Med 2022; 9:e000712. [PMID: 36007978 PMCID: PMC9422858 DOI: 10.1136/lupus-2022-000712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE SLE and lupus nephritis (LN) have significant impacts on the health-related quality of life of patients living with the condition, which are important to capture from the patient's perspective using patient-reported outcomes (PROs). The objectives of this study were to evaluate the content validity of PROs commonly used in SLE and LN (36-Item Short Form Health Survey (SF-36), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and Lupus Quality of Life (LupusQoL), as well as novel PRO symptom severity items measuring skin rash, joint pain, joint stiffness and swelling of the legs and/or feet, in both populations. METHODS Qualitative, semi-structured, cognitive interviews were conducted with 48 participants (SLE=28, LN=20). Understanding and relevance of symptom and impact PRO concepts from existing PROs were assessed, alongside novel PRO symptom severity items with different recall periods (24 hours vs 7 days) and response scales (Numerical Rating Scale (NRS) vs Verbal Rating Scale). Interviews were conducted in multiple rounds to allow for modifications to the novel PRO items. Analysis of verbatim interview transcripts was performed. RESULTS Symptom and impact concepts assessed by the SF-36, FACIT-F, and LupusQoL were well understood by both participants with SLE and LN (≥90.0%), with most considered relevant by over half of the participants asked (≥51.9%). All participants asked (100%) understood the novel PRO symptom severity items, and the majority (≥90.0%) considered the symptoms relevant. Minor modifications to the novel PRO items were made between rounds to improve clarity based on participant feedback. The selected 7-day recall period and NRS in the final iteration of the PRO items were understood and relevant. No differences in interview findings between the SLE and LN samples were identified. CONCLUSIONS Findings provide evidence of content validity for concepts assessed by the SF-36, FACIT-F, LupusQoL and the novel PRO symptom severity items, supporting use of these PROs to comprehensively assess disease impact in future SLE and LN clinical trials.
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Affiliation(s)
| | - Pamela Berry
- Patient Reported Outcomes, Janssen Global Services LLC, Titusville, Florida, USA
| | | | | | - Anna Roberts
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
| | - Adam Gater
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
| | - Chloe Tolley
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
| | - Helena Bradley
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
| | - Amy Ward
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
| | - Elizabeth Hsia
- Immunology Clinical Development, Janssen Research & Development LLC, Spring House, Pennsylvania, USA
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Qing Zuraw
- Immunology Clinical Development, Janssen Research & Development LLC, Spring House, Pennsylvania, USA
| | - Patricia DeLong
- Patient Reported Outcomes, Janssen Global Services LLC, Titusville, Florida, USA
| | - Zahi Touma
- Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, California, USA
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Magni-Manzoni S, Muratore V, Vojinović J, Pires Marafon D, D'Agostino MA, Naredo E. Procedures for the content, conduct and format of EULAR/PReS paediatric musculoskeletal ultrasound courses. RMD Open 2022; 8:rmdopen-2022-002455. [PMID: 35798512 PMCID: PMC9263933 DOI: 10.1136/rmdopen-2022-002455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Despite the worldwide increasing request of education on paediatric musculoskeletal ultrasound (PedMSUS), content, conduct and format of PedMSUS courses have never been internationally agreed. Objectives To produce educational procedures for the conduct, content and format of EULAR/PReS PedMSUS courses. Methods After a systemic literature review and expert opinion collection, a panel of items for the development of procedures on PedMSUS courses was identified. Agreement on the items was assessed through Delphi surveys among a taskforce of 24 members, which included 18 experts in PedMSUS (8 rheumatologists, 1 radiologist, 9 paediatric rheumatologists), 1 methodologist and rheumatologist expert in MSUS, 2 patient research partners, 1 health professional in rheumatology and 2 EMEUNET/EMERGE members, from 8 different European countries. Each item was assessed through a 5-point Likert scale (0, full disagreement; 5, full agreement); agreement was reached for >75% of answers rating 4–5. All items with agreement were included in the preliminary core set of educational procedures, which underwent external assessment by a broader Consensus group (Faculty and Tutors of previous EULAR PedMSUS courses and PReS Imaging Working Party members), through Delphi survey. Results Two Delphi surveys produced the preliminary core set of procedures for basic, intermediate, advanced and teach-the-teachers (TTT) PedMSUS courses. A Delphi survey within the Consensus group produced agreement on the proposed procedures. Conclusions Shared EULAR/PReS procedures for the conduct, content and format of basic, intermediate, advanced and TTT PedMSUS courses were identified on international basis.
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Affiliation(s)
| | | | - Jelena Vojinović
- Faculty of Medicine, University of Niš, Niš, Serbia.,Department of Pediatric Rheumatology and Immunology, Nis, Nis, Serbia, Clinical Centre Niš, Niš, Serbia
| | | | - Maria Antonietta D'Agostino
- Rheumatology Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,INSERM, Paris, France
| | - Esperanza Naredo
- Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain
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125
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Essa H, Walker L, Mohee K, Oguguo C, Douglas H, Kahn M, Rao A, Bellieu J, Hadcroft J, Hartshorne-Evans N, Bliss J, Akpan A, Wong C, Cuthbertson DJ, Sankaranarayanan R. Multispecialty multidisciplinary input into comorbidities along with treatment optimisation in heart failure reduces hospitalisation and clinic attendance. Open Heart 2022; 9:openhrt-2022-001979. [PMID: 35858706 PMCID: PMC9305818 DOI: 10.1136/openhrt-2022-001979] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
Aims Heart failure (HF) is associated with comorbidities which independently influence treatment response and outcomes. This retrospective observational study (January 2020–June 2021) analysed the impact of monthly HF multispecialty multidisciplinary team (MDT) meetings to address management of HF comorbidities and thereby on provision, cost of care and HF outcomes. Methods Patients acted as their own controls, with outcomes compared for equal periods (for each patient) pre (HF MDT) versus post-MDT (multispecialty) meeting. The multispecialty MDT comprised HF cardiologists (primary, secondary, tertiary care), HF nurses, nephrologist, endocrinologist, palliative care, chest physician, pharmacist, clinical pharmacologist and geriatrician. Outcome measures were (1) all-cause hospitalisations, (2) outpatient clinic attendances and (3) cost. Results 334 patients (mean age 72.5±11 years) were discussed virtually through MDT meetings and follow-up duration was 13.9±4 months. Mean age-adjusted Charlson Comorbidity Index was 7.6±2.1 and Rockwood Frailty Score 5.5±1.6. Multispecialty interventions included optimising diabetes therapy (haemoglobin A1c-HbA1c pre-MDT 68±11 mmol/mol vs post-MDT 61±9 mmol/mol; p<0.001), deprescribing to reduce anticholinergic burden (pre-MDT 1.85±0.4 vs 1.5±0.3 post-MDT; p<0.001), initiation of renin–angiotensin aldosterone system inhibitors in HF with reduced ejection fraction (HFrEF) with advanced chronic kidney disease (9% pre vs 71% post-MDT; p<0.001). Other interventions included potassium binders, treatment of anaemia, falls assessment, management of chest conditions, day-case ascitic, pleural drains and palliative support. Total cost of funding monthly multispecialty meetings was £32 400 and resultant 64 clinic appointments cost £9600. The post-MDT study period was associated with reduction in 481 clinic appointments (cost saving £72150) and reduced all-cause hospitalisations (pre-MDT 1.1±0.4 vs 0.6±0.1 post-MDT; p<0.001), reduction of 1586 hospital bed-days and cost savings of £634 400. Total cost saving to the healthcare system was £664 550. Conclusion HF multispecialty virtual MDT model provides integrated, holistic care across all healthcare tiers for management of HF and associated comorbidities. This approach is associated with reduced clinic attendances and all-cause hospitalisations, leading to significant cost savings.
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Affiliation(s)
- Hani Essa
- Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Lauren Walker
- Pharmacology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Clinical Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Kevin Mohee
- Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Chukwuemeka Oguguo
- Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Homeyra Douglas
- Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Matthew Kahn
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.,Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Archana Rao
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.,Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Julie Bellieu
- Palliative Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Justine Hadcroft
- Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Nick Hartshorne-Evans
- CEO and Founder, The Pumping Marvellous Foundation (Patient-Led Heart Failure Charity), Preston, UK
| | - Janet Bliss
- Chair, NHS Liverpool Clinical Commissioning Group, Liverpool, UK.,GP Senior Partner, Grey Road Surgery, Liverpool, UK
| | - Asangaedem Akpan
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.,Institute of Health, University of Cumbria, Cumbria, UK.,Geriatrics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
| | - Christopher Wong
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.,Nephrology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,School of Health and Sport Sciences, Liverpool Hope University, Liverpool, UK
| | - Daniel J Cuthbertson
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.,Faculty of Health and Life Science, University of Liverpool, Liverpool, UK.,Diabetes and Endocrinology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rajiv Sankaranarayanan
- Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK .,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.,NIHR Research Scholar, NIHR CRN North West Coast, National Institute for Health and Care Research (NIHR), Liverpool, UK
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126
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Cohen OC, Sathyanath A, Petrie A, Ravichandran S, Law S, Manwani R, Foard D, Sachchithanantham S, Mahmood S, Martinez-Naharro A, Fontana M, Whelan CJ, Hawkins PN, Lachmann HJ, Gillmore JD, Wechalekar AD. Prognostic importance of the 6 min walk test in light chain (AL) amyloidosis. Heart 2022; 108:1616-1622. [PMID: 35764371 DOI: 10.1136/heartjnl-2021-320703] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/14/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES In AL amyloidosis, organ response assessment is based on surrogates (eg, cardiac biomarkers). An objective functional test, such as the 6 min walk test (6MWT), capturing overall clinical improvement, is required. We aimed to evaluate the prognostic impact of the 6MWT at baseline and change following chemotherapy. METHODS This study evaluated the outcomes of patients who enrolled in a prospective observational study at the UK National Amyloidosis Centre (2012-2017). Patients underwent comprehensive assessments inclusive of blood testing, echocardiogram and 6MWT at baseline and annually thereafter. RESULTS In total, 799 patients were included within the study. Median baseline 6 min walk distance (6MWD) was 362 m (IQR: 231 m). 6MWD progressively decreased with worsening cardiac disease stage (458 m, 404 m, 331 m and 168 m for cardiac Mayo stages I, II, IIIa and IIIb, respectively (p<0.0001)). In patients with a baseline 6MWT of ≥350 m, the median overall survival was not reached (vs 30.0 (95% CI 23.2 to 36.8) months if <350 m and 5.0 (95% CI 2.8 to 7.2) months if unable to attempt 6MWT (p<0.0001). Following chemotherapy, only patients in a complete haematological response improved their 6MWD by 12 months (p=0.001). Improvement in 6MWD prolonged survival in patients with cardiac amyloidosis (p=0.005). CONCLUSION The 6MWT is prognostic in AL amyloidosis. A baseline distance of ≥350 m independently predicts better survival. These data suggest that 6MWT has utility in AL amyloidosis for baseline prognosis and assessing response.
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Affiliation(s)
- Oliver C Cohen
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Ananth Sathyanath
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Aviva Petrie
- Eastman Dental Institute, University College London, London, UK
| | - Sriram Ravichandran
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Steven Law
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Richa Manwani
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Darren Foard
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | | | - Shameem Mahmood
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Marianna Fontana
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Carol J Whelan
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Helen J Lachmann
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Julian D Gillmore
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK
| | - Ashutosh D Wechalekar
- National Amyloidosis Centre, University College London (Royal Free Campus), London, UK .,Department of Haematology, University College London Hospitals, London, UK
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Jourde-Chiche N, Costedoat-Chalumeau N, Baumstarck K, Loundou A, Bouillet L, Burtey S, Caudwell V, Chiche L, Couzi L, Daniel L, Deligny C, Dussol B, Faguer S, Gobert P, Gondran G, Huart A, Hummel A, Kalbacher E, Karras A, Lambert M, Le Guern V, Lebourg L, Loubière S, Maillard-Lefebvre H, Maurier F, Pha M, Queyrel V, Remy P, Sarrot-Reynauld F, Verhelst D, Hachulla E, Amoura Z, Daugas E. Weaning of maintenance immunosuppressive therapy in lupus nephritis (WIN-Lupus): results of a multicentre randomised controlled trial. Ann Rheum Dis 2022; 81:1420-1427. [PMID: 35725295 PMCID: PMC9484365 DOI: 10.1136/annrheumdis-2022-222435] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/07/2022] [Indexed: 11/05/2022]
Abstract
Objectives Lupus nephritis (LN) is a frequent complication of systemic lupus erythematosus (SLE). Severe (proliferative) forms of LN are treated with induction immunosuppressive therapy (IST), followed by maintenance IST, to target remission and avoid relapses. The optimal duration of maintenance IST is unknown. The WIN-Lupus trial tested whether IST discontinuation after 2‒3 years was non-inferior to IST continuation for two more years in proliferative LN. Methods WIN-Lupus was an investigator-initiated multicentre randomised controlled trial. Patients receiving maintenance IST with azathioprine or mycophenolate mofetil for 2–3 years, and hydroxychloroquine, were randomised (1:1) into two groups: (1) IST continuation and (2) IST discontinuation. The primary endpoint was the relapse rate of proliferative LN at 24 months. Main secondary endpoints were the rate of severe SLE flares, survival without renal relapse or severe flare, adverse events. Results Between 2011 and 2016, 96 patients (out of 200 planned) were randomised in WIN-Lupus: IST continuation group (n=48), IST discontinuation group (n=48). Relapse of proliferative LN occurred in 5/40 (12.5%) patients with IST continuation and in 12/44 (27.3%) patients with IST discontinuation (difference 14.8% (95% CI −1.9 to 31.5)). Non-inferiority was not demonstrated for relapse rate; time to relapse did not differ between the groups. Severe SLE flares (renal or extrarenal) were less frequent in patients with IST continuation (5/40 vs 14/44 patients; p=0.035). Adverse events did not differ between the groups. Conclusions Non-inferiority of maintenance IST discontinuation after 2‒3 years was not demonstrated for renal relapse. IST discontinuation was associated with a higher risk of severe SLE flares. Trial registration number NCT01284725.
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Affiliation(s)
- Noemie Jourde-Chiche
- Nephrology, AP-HM, Marseille, France .,C2VN, INSERM, INRAE, Aix-Marseille Universite, Marseille, France
| | - Nathalie Costedoat-Chalumeau
- entre de recherche épidémiologie et biostatistiques de Sorbonne Paris Cité, Universite de Paris, Paris, France.,Centre de référence maladies rares, Hôpital Cochin, AP-HP, Paris, France
| | - Karine Baumstarck
- Laboratoire de Santé Publique, CERESS, Aix-Marseille Universite, Marseille, France
| | - Anderson Loundou
- Laboratoire de Santé Publique, CERESS, Aix-Marseille Universite, Marseille, France
| | - Laurence Bouillet
- Internal Medicine, Centre Hospitalier Universitaire Grenoble, Michallon Hospital, Grenoble, France
| | - Stéphane Burtey
- C2VN, INSERM, INRAE, Aix-Marseille Universite, Marseille, France.,Nephrology, AP-HM, Marseille, France
| | | | | | - Lionel Couzi
- Nephrology, CHU Bordeaux GH Pellegrin, Bordeaux, France
| | - Laurent Daniel
- C2VN, INSERM, INRAE, Aix-Marseille Universite, Marseille, France.,Laboratoire d'Anatomie Pathologique, AP-HM, Marseille, France
| | | | - Bertrand Dussol
- Nephrology, AP-HM, Marseille, France.,Centre d'Investigation Clinique, AP-HM, Marseille, France
| | - Stanislas Faguer
- Nephrology and Organ Transplantation, CHU Toulouse, Toulouse, France
| | | | | | - Antoine Huart
- Nephrology and Organ Transplantation, CHU Toulouse, Toulouse, France
| | - Aurélie Hummel
- Nephrology, Necker-Enfants Malades Hospitals, Paris, France
| | | | - Adexandre Karras
- Nephrology, Hopital Europeen Georges Pompidou, Paris, France.,Universite Paris Descartes, Paris, France
| | | | | | | | - Sandrine Loubière
- Support Unit for Clinical Research and Health Economics, AP-HM, Marseille, France
| | | | | | - Micheline Pha
- Médecine Interne 2, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | | | | | | | | | - Eric Hachulla
- Internal Medicine, Lille University School of Medicine, Lille, France
| | - Zahir Amoura
- Centre de reference maladies auto-immunes et systemiques, Internal Medicine, AP-HP, Paris, France
| | - Eric Daugas
- Nephrology, AP-HP, Paris, France.,INSERM U1149, Universite de Paris, Paris, France
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128
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Anderson EW, Mackay M, Franchin G, Aranow C. Determination of the minimal clinically important difference (MCID) of the physician global assessment (PGA) in SLE. Ann Rheum Dis 2022; 81:annrheumdis-2022-222350. [PMID: 35680388 DOI: 10.1136/annrheumdis-2022-222350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/29/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Erik W Anderson
- The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Meggan Mackay
- The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Giovanni Franchin
- The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Cynthia Aranow
- The Feinstein Institute for Medical Research, Manhasset, New York, USA
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129
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Marques ML, Pereira da Silva N, van der Heijde D, Reijnierse M, Baraliakos X, Braun J, van Gaalen FA, Ramiro S. Low-dose CT hounsfield units: a reliable methodology for assessing vertebral bone density in radiographic axial spondyloarthritis. RMD Open 2022; 8:rmdopen-2021-002149. [PMID: 35732346 PMCID: PMC9226987 DOI: 10.1136/rmdopen-2021-002149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Studying vertebral bone loss in radiographic axial spondyloarthritis (r-axSpA) has been challenging due to ectopic bone formation. We cross-sectionally analysed low-dose CT (ldCT) trabecular bone density Hounsfield units (HU) measurements and calculated inter-reader reliability at the vertebral level in patients with r-axSpA. Methods LdCT scans of 50 patients with r-axSpA from the sensitive imaging in ankylosing spondylitis study, a multicentre 2-year prospective cohort were included. Trabecular bone HU taken from a region of interest at the centre of each vertebra (C3-L5) were independently assessed by two trained readers. HU mean (SD), and range were provided at the vertebral level, for each reader and centre separately. Inter-reader reliability and agreement were assessed using intraclass correlation coefficients (ICC; single measurements, absolute agreement, two-way mixed effects models); smallest detectable difference and Bland-Altman plots. Results Overall, 1100 vertebrae were assessed by each reader. HU values decreased from cranial to caudal vertebrae. For readers 1 and 2 respectively, the highest mean (SD) HU value was obtained at C3 (354(106) and 355(108)), and the lowest at L3 (153(65) and 150 (65)). Inter-reader reliability was excellent (ICC(2,1):0.89 to 1.00). SDD varied from 4 to 8. For most vertebrae, reader 1 scored somewhat higher than reader 2 (mean difference of scores ranging from −0.6 to 2.9 HU). Bland-Altman plots showed homoscedasticity. Conclusion LdCT measurement of HU is a feasible method to assess vertebral bone density in r-axSpA with excellent inter-reader reliability from C3 to L5. These results warrant further validation and longitudinal assessment of reliability.
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Affiliation(s)
- Mary Lucy Marques
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands .,Department of Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Nuno Pereira da Silva
- Department of Radiology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Juergen Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Bochum, Germany
| | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
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130
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Madrigal J, Richardson S, Hadaya J, Verma A, Tran Z, Sanaiha Y, Benharash P. Perioperative outcomes and readmissions following cardiac operations in kidney transplant recipients. Heart 2022; 108:heartjnl-2022-321030. [PMID: 35589379 DOI: 10.1136/heartjnl-2022-321030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/02/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Although kidney transplant (KTx) recipients are at significant risk for cardiovascular disease, outcomes following cardiac operations have been examined in limited series. The present study thus aimed to assess the impact of KTx on in-hospital perioperative outcomes and readmissions in a nationally representative cohort. METHODS All adults undergoing elective coronary artery bypass grafting, valve repair/replacement or a combination thereof were identified from the 2010-2018 Nationwide Readmissions Database. Patients were stratified by history of KTx. Transplant-capable centres were defined as hospitals performing at least one KTx annually. To perform risk-adjustment in assessing outcomes, multivariable regression models were developed. RESULTS Of an estimated 1 407 351 patients included for analysis, 0.2% (n=2849) were KTx recipients. Compared with the general cardiac surgical population, patients with prior KTx experienced higher adjusted odds of in-hospital mortality (adjusted OR (AOR) 2.44, 95% CI 1.72 to 3.47, p<0.001) and perioperative complication (AOR 1.67, 95% CI 1.44 to 1.94, p<0.001). Additionally, KTx was independently associated with greater readmission rates within 30 days (AOR 1.96, 95% CI 1.65 to 2.34, p<0.001) with kidney injury contributing significantly to the burden of rehospitalisation (4.6 vs 1.8%, p=0.005). In a subpopulation comprised of only KTx recipients, treatment at a transplant-capable centre reduced odds of kidney injury with non-transplant hospitals as reference (AOR 0.65, 95% CI 0.43 to 0.98, p=0.037). CONCLUSIONS Kidney transplant recipients undergoing cardiac operations encounter significant risks compared with the general surgical population. Referral to transplant-capable centres should be explored to improve outcomes and to preserve allograft function in this population.
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Affiliation(s)
- Josef Madrigal
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Shannon Richardson
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Zachary Tran
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
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Affiliation(s)
- Paula Guedes Ramallo
- Adult Congenital Heart Disease Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Dos-Subirà
- Adult Congenital Heart Disease Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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132
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Al-Omary MS, Majeed T, Al-Khalil H, Sugito S, Clapham M, Ngo DTM, Attia JR, Boyle AJ, Sverdlov AL. Patient characteristics, short-term and long-term outcomes after incident heart failure admissions in a regional Australian setting. Open Heart 2022; 9:e001897. [PMID: 35641098 PMCID: PMC9157343 DOI: 10.1136/openhrt-2021-001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/11/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS This study aims to (1) define the characteristics of patients with a first admission for heart failure (HF), stratified by type (reduced (HFrEF) vs preserved (HFpEF) ejection fraction) in a regional Australian setting; (2) compare the outcomes in terms of mortality and rehospitalisation and (3) assess adherence to the treatment guidelines. METHODS We identified all index hospitalisations with HF to John Hunter Hospital and Tamworth Rural Referral Hospital in the Hunter New England Local Health District over a 12 months. We used the recent Australian HF guidelines to classify HFrEF and HFpEF and assess adherence to guideline-directed therapy. The primary outcome of the study was to compare short-term (1 year) and long-term all-cause mortality and the composite of all-cause hospitalisation or all-cause mortality of patients with HFrEF and HFpEF. RESULTS There were 664 patients who had an index HF admission to John Hunter and Tamworth hospitals in 2014. The median age was 80 years, 47% were female and 22 (3%) were Aboriginal. In terms of HF type, 29% had HFrEF, 37% had HFpEF, while the remainder (34%) did not have an echocardiogram within 1 year of admission and could not be classified. The median follow-up was 3.3 years. HFrEF patients were predominantly male (64%) and in 48% the aetiology was ischaemic heart disease. The 1-year all-cause mortality was 23% in HFpEF subgroup and 29% in HFrEF subgroup (p=0.15). Five-year mortality was 61% in HFpEF and HFrEF patients. Of the HFrEF patients, only 61% were on renin-angiotensin-aldosterone blockers, 74% were on β-blockers and 39% were on aldosterone antagonist. CONCLUSION HF patients are elderly and about evenly split between HFrEF and HFpEF. In this regional cohort, both HF types are associated with similar 1-year and 5-year mortality following incident HF hospitalisation. Echocardiography and guideline-directed therapies were underused.
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Affiliation(s)
- Mohammed S Al-Omary
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
| | - Tazeen Majeed
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Hafssa Al-Khalil
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Stuart Sugito
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Mathew Clapham
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Doan T M Ngo
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - John R Attia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Andrew J Boyle
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Aaron L Sverdlov
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Lucasson F, Kiltz U, Kalyoncu U, Leung YY, Palominos P, Cañete JD, Scrivo R, Balanescu A, Dernis E, Meisalu S, Ryussen-Witrand A, Soubrier M, Aydin SZ, Eder L, Gaydukova I, Lubrano E, Richette P, Husni E, Coates LC, de Wit M, Smolen JS, Orbai AM, Gossec L. Disparities in healthcare in psoriatic arthritis: an analysis of 439 patients from 13 countries. RMD Open 2022; 8:e002031. [PMID: 35523519 PMCID: PMC9083399 DOI: 10.1136/rmdopen-2021-002031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/14/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Patient care can vary substantially by country. The objective was to explore differences in psoriatic arthritis (PsA) across countries for disease activity, impact and treatments. METHODS A cross-sectional analysis of 13 countries from the Remission/Flare in PsA study (NCT03119805) of consecutive adult patients with definite PsA was performed. Countries were classified into tertiles by gross domestic product (GDP)/capita. Disease activity (Disease Activity in PsA, DAPSA and Minimal Disease Activity, MDA) and their components, disease impact (patient-reported outcomes) and biological disease-modifying antirheumatic drugs (bDMARDs) were analysed per country and compared between the three tertiles of GDP/capita by parametric and non-parametric tests. We also explored the percentage of patients with significant disease activity (DAPSA >14) and no ongoing bDMARD prescription. RESULTS In 439 patients (50.6% male, mean age 52.3 years, mean disease duration 10.1 years), disease activity and disease impact were higher in the lowest GDP/capita countries. DAPSA remission and MDA were attained in the lowest tertile in 7.0% and 18.4% patients, vs 29.1% and 49.5% in the middle tertile and 16.8% and 41.3% in the high tertile, respectively (all p<0.001). bDMARDs use was similar in the tertiles (overall mean 61%). The overall rate of patients with DAPSA >14 and no bDMARDs was 18.5%, and was higher in lower GDP/capita countries (p=0.004). CONCLUSION PsA patients from countries with the lowest GDP/capita, despite similar use of bDMARDs, were more likely to have high disease activity and worse disease impact. There is a need for more equity in healthcare.
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Affiliation(s)
- Florian Lucasson
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Uta Kiltz
- Herne and Ruhr-Universität, Rheumazentrum Ruhrgebiet, Bochum, Germany
| | - Umut Kalyoncu
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ying Ying Leung
- Duke-NUS Medical School, Singapore General Hospital, Singapore
| | - Penélope Palominos
- Rheumatology Department, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Juan D Cañete
- Servicio de Reumatología, Hospital Clínic and IDIBAPS, Barcelona, Spain
| | - Rossana Scrivo
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza Università di Roma, Roma, Italy
| | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, "Sf. Maria" Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Adeline Ryussen-Witrand
- Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, Paul Sabatier University, Toulouse University Hospital, Toulouse, France
| | | | - Sibel Zehra Aydin
- The Ottawa Hospital Research Institute, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Lihi Eder
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Inna Gaydukova
- North-western State Medical University, St.Petersburg, Russian Federation
| | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Pascal Richette
- Service de Rhumatologie, Hopital Lariboisiere Centre Viggo Petersen, Paris, France
- Inserm UMR1132 Bioscar, Universite Paris Diderot UFR de Medecine, Paris, France
| | - Elaine Husni
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Maarten de Wit
- Patient Research Partner, EULAR, Zaltbommel, The Netherlands
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Wien, Austria
| | - Ana-Maria Orbai
- Division of Rheumatology, Psoriatic Arthritis Program, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
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Demmen J, Hartshorne-Evans N, Semino E, Sankaranarayanan R. Language matters: representations of 'heart failure' in English discourse-a large-scale linguistic study. Open Heart 2022; 9:openhrt-2022-001988. [PMID: 35760521 PMCID: PMC9157359 DOI: 10.1136/openhrt-2022-001988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/12/2022] [Indexed: 11/03/2022] Open
Abstract
AIMS Heart failure (HF) has a lower public profile compared with other serious health conditions, notably cancer. This discourse analysis study investigates the extent to which HF is discussed in general contemporary English, UK parliamentary debates and the ways in which HF is framed in discussions, when compared with two other serious health conditions, cancer and dementia. METHODS The Oxford English Corpus (OEC) of 21st century English-language texts (2 billion words) and the UK Hansard Reports of parliamentary debates from 1945 to early 2021 were used to investigate the relative frequencies, contexts and use of the terms 'heart failure', 'cancer' and 'dementia'. RESULTS In the OEC, the term 'heart failure' occurs 4.26 times per million words (pmw), 'dementia' occurs 3.68 times pmw and 'cancer' occurs 81.96 times pmw. Cancer is talked about 19 times more often than HF and 22 times more often than dementia. These are disproportionately high in relation to actual incidence: annual cancer incidence is 1.8 times that of the other conditions; annual cancer mortality is two times that caused by coronary heart disease (including HF) or dementia.'Heart failure' is used much less than 'cancer' in UK parliamentary debates (House of Commons and House of Lords) between 1945 and early 2021, and less than 'dementia' from 1990 onwards. Moreover, HF is even mentioned much less than pot-holes in UK roads and pavements. In 2018, for example, 'pot-hole/s' were mentioned over 10 times pmw, 37 times more often than 'heart failure', mentioned 0.28 times pmw. Discussions of HF are comparatively technical and formulaic, lacking survivor narratives that occur in discussions of cancer. CONCLUSIONS HF is underdiscussed in contemporary English compared with cancer and dementia and underdiscussed in UK parliamentary debates, even compared with the less-obviously life-threatening topic of pot-holes in roads and pavements.
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Affiliation(s)
- Jane Demmen
- Department of Linguistics and English Language, Lancaster University, Lancaster, UK
| | | | - Elena Semino
- Department of Linguistics and English Language, Lancaster University, Lancaster, UK
| | - Rajiv Sankaranarayanan
- Department of Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- National Institute for Health Research, London, UK
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135
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Weeding E, Fava A, Magder L, Goldman D, Petri M. One-third of patients with lupus nephritis classified as complete responders continue to accrue progressive renal damage despite resolution of proteinuria. Lupus Sci Med 2022; 9:e000684. [PMID: 35512816 PMCID: PMC9047706 DOI: 10.1136/lupus-2022-000684] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/29/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Treatment response in lupus nephritis (LN) is defined based on proteinuria, yet protocol kidney biopsy studies have shown that patients with lupus can have active nephritis in the absence of proteinuria. Using estimated glomerular filtration rate (eGFR) trajectories, we characterised early chronic kidney disease in LN and examined whether certain patients continue to accrue renal damage despite proteinuric response. METHODS We conducted a single-centre study of patients diagnosed with their first episode of biopsy-proven class III, IV, and/or V LN (n=37). For each patient, eGFR trajectory was graphed over 5 years following renal biopsy. Participants were divided into those with progressive eGFR loss (eGFR slope <-5 mL/min/1.73 m2/year) versus those with stable eGFR. Participant demographics, renal biopsy features and response status at 1 year (urine protein to creatinine ratio <500 mg/g) were compared between eGFR trajectory groups. RESULTS Overall, 30% (n=11) of participants accrued progressive eGFR loss despite standard of care therapy over the first 5 years following renal biopsy. There were no significant differences in baseline renal biopsy features, medication regimens or comorbidities between eGFR trajectory groups. Resolution of proteinuria at 1 year did not differentiate between groups: 6 of 18 (33%) of complete responders continued to accrue renal damage compared with 5 of 17 (29%) of non-responders. Response status could not be assigned for two participants in the stable eGFR group due to missing clinical information at 1 year. CONCLUSIONS We identified an understudied category of patients with LN who accrue progressive renal damage despite apparent response to standard of care therapy. Better definitions and biomarkers of response are needed to improve renal outcomes and trial design.
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Affiliation(s)
- Emma Weeding
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea Fava
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laurence Magder
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Daniel Goldman
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Ugarte-Gil MF, Gamboa-Cardenas RV, Reátegui-Sokolova C, Pimentel-Quiroz VR, Medina M, Elera-Fitzcarrald C, Zevallos F, Pastor-Asurza CA, Zazzetti F, Karyekar CS, Alarcón GS, Perich-Campos RA. Severe flares are associated with a poorer health-related quality of life (HRQoL) in patients with SLE: data from the Almenara Lupus Cohort. Lupus Sci Med 2022; 9:9/1/e000641. [PMID: 35351811 PMCID: PMC8966564 DOI: 10.1136/lupus-2021-000641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/17/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Flares in patients with SLE, regardless of their severity, have been associated with damage accrual. However, their impact on health-related quality of life (HRQoL) has not been fully evaluated. In fact, disease activity is only minimally associated with HRQoL. OBJECTIVE To determine the association between flares and HRQoL. METHODS Patients from the Almenara Lupus Cohort were included. Visits occurring between December 2015 and February 2020 were evaluated. Flares were defined as an increase on the SLE Disease Activity Index 2000 (SLEDAI-2K) of at least 4 points; severe flares were those with a final SLEDAI-2K ≥12 and mild-moderate flares all the others. HRQoL was measured using the LupusQoL. Univariable and multivariable generalised estimating regression equations were performed, adjusting for possible confounders. Confounders were determined at one visit, whereas the outcome was determined on the subsequent visit; flares were determined based on the variation of the SLEDAI-2K between these visits. RESULTS Two hundred and seventy-seven patients were included; 256 (92.4%) were female, mean age at diagnosis was 36.0 (SD: 13.3) years and mean disease duration at baseline was 9.1 (SD: 7.1) years. Patients had mean of 4.8 (SD: 1.9) visits and a mean follow-up of 2.7 (1.1) years. Out of 1098 visits, 115 (10.5%) flares were defined, 17 were severe and 98 mild-moderate. After adjustment for possible confounders, only severe flares were associated with a poorer HRQoL in planning, pain, emotional health and fatigue. CONCLUSIONS Severe flares, but not mild-moderate, flares are associated with poorer HRQoL.
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Affiliation(s)
- Manuel Francisco Ugarte-Gil
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Cientifica del Sur, Lima, Peru
| | - Rocio Violeta Gamboa-Cardenas
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Cientifica del Sur, Lima, Peru
| | - Cristina Reátegui-Sokolova
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Unidad de Investigación Para La Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Victor Román Pimentel-Quiroz
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Cientifica del Sur, Lima, Peru
| | - Mariela Medina
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Claudia Elera-Fitzcarrald
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Cientifica del Sur, Lima, Peru
| | - Francisco Zevallos
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Cesar Augusto Pastor-Asurza
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | | | - Graciela S Alarcón
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Risto Alfredo Perich-Campos
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
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Shahin W, Kennedy GA, Stupans I. The association between social support and medication adherence in patients with hypertension: A systematic review. Pharm Pract (Granada) 2021; 19:2300. [PMID: 34221197 PMCID: PMC8234709 DOI: 10.18549/pharmpract.2021.2.2300] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/06/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Medication adherence is a primary determinant of treatment success in
hypertensive patients. One of the challenges for healthcare providers that
has received little attention is the impact of patients’ social
supports on medication adherence. Objective: This review evaluates the impact of patients’ social supports on
medication adherence in hypertensive patients. Methods: A systematic review methodology was used. Pubmed, CINAHL, Embase, and
PsycINFO databases were searched systematically for relevant articles. The
outcome measure in the studies was medication adherence in hypertension. Results: From 1155 articles, 238 were retained for further assessment, and finally, 14
met the inclusion criteria. Statistically significant positive associations
between medication adherence and social support were found in nine studies
(p<0.05). Conclusions: This review evaluated the impact of social support on medication adherence
and highlighted gaps in the literature regarding the impact of social
support on adherence. Family members or peer support may promote better
adherence in some patient groups. This review suggests that healthcare
providers may need to consider whether patients have appropriate social
supports in place which will assist them adhering to and benefiting from
treatment recommendations.
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Affiliation(s)
- Wejdan Shahin
- School of Health & Biomedical Sciences, RMIT University. Bundoora, VIC (Australia).
| | - Gerard A Kennedy
- School of Health & Biomedical Sciences, RMIT University. Bundoora, VIC (Australia).
| | - Ieva Stupans
- School of Health & Biomedical Sciences, RMIT University. Bundoora, VIC (Australia).
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Yusuf MYA, Kirubakaran R, Albadwi AMM, Saad AE, Mjahed AHS, Saleh SH. Levels and Determinants of Health Literacy in Bahrain's Community Context. Oman Med J 2020; 35:e195. [PMID: 33204521 PMCID: PMC7642644 DOI: 10.5001/omj.2020.88] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 04/14/2020] [Indexed: 11/03/2022] Open
Abstract
Objectives We sought to assess health literacy (HL) and its associated factors in the Bahraini community using a validated HL scale and address its deficient domains to inform policy. Methods We carried out a conveniently sampled, cross-sectional survey using the All Aspects of Health Literacy Scale in the Bahraini community. The scale has three key aspects: basic or functional HL (FUN-4 items), which corresponds to basic reading and writing skills, and knowledge of health conditions and health systems; communicative or interactive HL (COM-3 items) on communicative and social skills to extract information from different forms of communication; and critical HL (CR-4 items), the advanced cognitive and social skills to critically analyze information and exert greater control over life events and situations relating to individual and community level wellbeing goals. We examined the association between sociodemographic and health information for the survey tool items using the chi-square test. The relationship between total scale score and subscale scores of the three domains of the survey tool to sociodemographic and health information was investigated using the t-test and ANOVA. Results Of the 836 participants (mean age = 26.6 years), single (64.0%) and university students (76.6%) were predominant; 15.6% reported long-term sickness and visited the general physician often. The highest mean item scores were for empowerment (1.8) and lowest for functional HL (0.1). The significant domain-specific responses to the survey tool items were 12 for critical HL, 10 for functional HL, six for communicative HL, and five for empowerment. Participants aged < 30 years old, female, married, pursuing/completed Master's program, employed, and whose self-rating of health was excellent had higher total HL scores. Conclusions Older, less educated respondents with a poor self-rating of health had low HL scores. We recommend further studies to address the relative importance of functional, interactive, and critical HL in the community to promote health outcomes.
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Affiliation(s)
| | - Mohamed Yaqoob Ali Yusuf
- Nursing Program, WHO Collaborating Centre for Nursing Development, College of Health Sciences, University of Bahrain, Salmanya Medical Complex, Salmanya, Bahrain
| | - Richard Kirubakaran
- South Asian Cochrane Centre and Network, Christian Medical College and Hospital, Vellore, India
| | - Abdulaziz Mohamed Muqbel Albadwi
- Nursing Program, WHO Collaborating Centre for Nursing Development, College of Health Sciences, University of Bahrain, Salmanya Medical Complex, Salmanya, Bahrain
| | - Ahmed Ebrahim Saad
- Nursing Program, WHO Collaborating Centre for Nursing Development, College of Health Sciences, University of Bahrain, Salmanya Medical Complex, Salmanya, Bahrain
| | - Ahmed Hussain S Mjahed
- Nursing Program, WHO Collaborating Centre for Nursing Development, College of Health Sciences, University of Bahrain, Salmanya Medical Complex, Salmanya, Bahrain
| | - Saleh Hamad Saleh
- Nursing Program, WHO Collaborating Centre for Nursing Development, College of Health Sciences, University of Bahrain, Salmanya Medical Complex, Salmanya, Bahrain
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Al-Ghafri TS, Al-Harthi SM, Al-Farsi Y, Craigie AM, Bannerman E, Anderson AS. Perceived Changes in General Well-being: Findings from the 'MOVEdiabetes' Physical Activity Randomized Control Trial. Oman Med J 2020; 35:e149. [PMID: 32728484 PMCID: PMC7370892 DOI: 10.5001/omj.2020.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/03/2019] [Indexed: 12/16/2022] Open
Abstract
Objectives Studies have consistently reported the health benefits of physical activity (PA) in diabetes care. Our study aimed to explore perceptions of general well-being in participants of the ‘MOVEdiabetes’ intervention aimed at increasing PA in adults with type 2 diabetes in Oman. Methods ‘MOVEdiabetes’ is a cluster-randomized study where participants in the intervention group (IG) received PA consultations, pedometers, and WhatsApp messages versus the usual care in the control group (CG). At baseline and 12 months, perceptions on well-being were assessed using an English translated to Arabic 13-item questionnaire. Between groups differences in responses were compared using chi-squared tests. Spearman correlation analysis was utilized to explore associations between changes in responses and self-reported PA levels (metabolic equivalent of task.min/week). Results Of the 232 participants in the ‘MOVEdiabetes’ study, 75.0% completed the study. Overall, findings indicate a positive effect of the intervention on perceived general health, sleep, mental health, pain, and responses to quality of life. For the IG and CG, significant associations were shown between changes in self-reported PA and general health (r = 0.70 and 0.36, p < 0.001), feeling calm/peaceful (r = 0.86 and 0.93, p < 0.001), energetic (r = 0.86 and 0.82, p < 0.001), and depressed (r = -0.35 and -0.30, p < 0.001). However, the Cronbach’s alpha value was 0.50, indicating insufficient internal consistency of the assessment tool. Conclusions The intervention has a positive effect on many parameters of well-being. Further studies are needed to identify robust tools to measure associations between well-being and PA in culturally bounded Arabic speaking countries.
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Affiliation(s)
- Thamra S Al-Ghafri
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Saud M Al-Harthi
- Directorate General of Health Services, Ministry of Health, Muscat, Oman
| | - Yahya Al-Farsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Angela M Craigie
- Centre for Public Health Nutrition Research, University of Dundee, Scotland, UK
| | - Elaine Bannerman
- Global Academy of Agriculture and Food Security, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Scotland, UK
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, University of Dundee, Scotland, UK
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