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Koike T, Suzuki A, Kikuchi N, Yoshimura A, Haruki K, Yoshida A, Sone M, Nakazawa M, Tsukamoto K, Imamura Y, Hattori H, Kogure T, Yamaguchi J, Shiga T. Prognostic impact of outpatient loop diuretic reduction patterns in patients with chronic heart failure. IJC HEART & VASCULATURE 2024; 55:101517. [PMID: 39386095 PMCID: PMC11462479 DOI: 10.1016/j.ijcha.2024.101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 08/24/2024] [Accepted: 09/16/2024] [Indexed: 10/12/2024]
Abstract
Background The relationship between patterns of outpatient oral loop diuretic (LD) dose reduction and prognosis in patients with heart failure (HF) remains unclear. Methods We evaluated 679 patients with HF-prescribed LDs at baseline between September 2015 and August 2019. Dose reduction was defined as a change to a lower LD dose than the previous outpatient dose. Dose intensification was defined as a change to a higher LD dose than the previous outpatient dose. Patients were classified into no-reduction (no LD dose reduction during follow-up) and reduction groups (categorized into successive-reduction [≥2 successive LD dose reductions without intervening LD dose intensification] and single-reduction [LD dose reduction without successive dose reduction] groups). The primary outcomes were all-cause death, HF hospitalization (HFH), and the composite of cardiovascular death (CVD) or HFH. Results Within a median follow-up of 53.7 (range, 2.6-99.1) months, 156 deaths were recorded: 121 (29 %), 31 (15 %), and three (4 %) patients in the no-reduction (n = 411), single-reduction (n = 195), and successive-reduction (n = 73) groups, respectively. After adjusting for cofounders, the reduction group had a lower risk of primary outcomes than the no reduction group (all-cause death: hazard ratio (HR) = 0.65, 95 % confidence interval (CI) = 0.44-0.96; CVD or HFH: HR=0.69, 95 %CI=0.52-0.93; HFH: HR=0.69, 95 % CI=0.52-0.93). The successive-reduction group had a lower risk of the composite of CVD or HFH (HR=0.26, 95 % CI: 0.10-0.67) and HFH (HR=0.34, 95 % CI=0.13-0.86) than the single-reduction group. Conclusions Outpatient LD dose reduction patterns can be indicators of good prognosis in HF patients.
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Affiliation(s)
- Toshiharu Koike
- Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Noriko Kikuchi
- Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Asami Yoshimura
- Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Kaoru Haruki
- Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Ayano Yoshida
- Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Maiko Sone
- Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Mayui Nakazawa
- Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Kei Tsukamoto
- Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Yasutaka Imamura
- Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Hidetoshi Hattori
- Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Tomohito Kogure
- Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Matsushita K, Harada K, Miyamoto T, Iida K, Yamamoto Y, Shiraishi Y, Nagatomo Y, Yoshino H, Yamamoto T, Nagao K, Takayama M. Prognostic effect of a vasopressin V 2 receptor antagonist in acute congestive heart failure patients with hypoperfusion, the wet-cold pattern. Eur J Clin Pharmacol 2024; 80:1795-1805. [PMID: 39168874 DOI: 10.1007/s00228-024-03745-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/14/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE This study investigated whether the oral vasopressin V2 receptor antagonist tolvaptan has beneficial effects on mortality in real-world congestive heart failure (CHF) patients with hypoperfusion (i.e. the wet-cold pattern), from the viewpoint of cardiorenal syndrome. METHODS Data on 5511 consecutive CHF patients were extracted from the Tokyo CCU Network data registry. Congestion and hypoperfusion were defined by Nohria-Stevenson clinical profiles at the time of hospitalization. Propensity scores for tolvaptan use were calculated for each patient and used to assemble two matched cohorts of patients receiving tolvaptan or not in the CHF with and without hypoperfusion groups. RESULTS Of the entire study cohort, 1073 patients (19%) had CHF with hypoperfusion (i.e. the wet-cold pattern). In-hospital mortality was significantly higher for CHF patients with than without hypoperfusion (log-rank, P < 0.001). The rate of tolvaptan use did not differ significantly between CHF patients with and without hypoperfusion (15% vs. 14%, respectively; P = 0.7848). In the propensity-matched CHF with hypoperfusion cohort, there was a significant association between the use of tolvaptan and a reduction in in-hospital mortality (log-rank, P = 0.0052). Conversely, in the matched CHF without hypoperfusion cohort, tolvaptan use was not associated with in-hospital mortality (log-rank, P = 0.4417). CONCLUSION There was a significant association between the use of tolvaptan and a reduction in in-hospital mortality in CHF patients with, but not without, hypoperfusion. These findings hint at possible individualized therapies for patients with CHF.
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Affiliation(s)
- Kenichi Matsushita
- Tokyo CCU Network Scientific Committee, Tokyo, Japan.
- Department of Cardiology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan.
| | | | | | - Kiyoshi Iida
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | - Yuji Nagatomo
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
| | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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Wei W, Feng B, Chen Z, Liu X, Xiao M, Hu H. Association of preoperative red blood cell width and postoperative 30-day mortality in patients undergoing non-cardiac surgery: a retrospective cohort study using propensity-score matching. Perioper Med (Lond) 2024; 13:95. [PMID: 39363316 PMCID: PMC11451129 DOI: 10.1186/s13741-024-00451-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 09/16/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND In terms of predicting surgery mortality, it is controversial whether red blood cell width works independently. In non-cardiac surgery patients older than 18 years, we intend to examine the relationship between red blood cell width and postoperative 30-day mortality. METHODS In this retrospective cohort study, 90,785 Singapore General Hospital patients were matched by propensity score between January 1, 2012 and October 31, 2016. It was determined that red blood cell width at baseline and mortality within 30 days after surgery were the independent and dependent variables. We used a non-parametric multivariate logistic regression to balance the confounders among 7807 patients with high RDW and 7807 patients with non-high RDW in the propensity score matching. We investigated the association between RDW and 30-day mortality after surgery using the doubly robust estimation method. RESULTS Cohorts matched according to propensity score, the risk of 30-day mortality after surgery increased by 114.6.0% among the high RDW group (OR = 2.146, 95% CI 1.645-2.799, P < 0.00001). In the crude model, there was a significant association between RDW and 30-day mortality after surgery (OR = 1.877, 95% CI 1.476-2.388, P < 0.00001). In the propensity-score adjusted model, the risk of 30-day mortality after surgery in the high RDW group compared to the control group was not as high as in the non-adjusted model (OR = 1.867, 95% CI 1.467-2.376, P < 0.00001). Compared to non-high RDW group, the risk of 30-day mortality after surgery increased by 117.0% and 127.7% among high RDW group in the original cohort (OR 2.170, 95% CI 1.754-2.683, P < 0.00001) and the weighted cohort (OR 2.272, 95% CI 2.009-2.580, P < 0.00001), respectively. CONCLUSIONS According to the results of this observational, propensity score-matched cohort study, uncontrolled high RDW before surgery is associated with an increased risk of death within 30 days after surgery, that is to say, patients over the age of 18 with high preoperative RDW who undergo non-cardiac surgery have a worse postoperative prognosis than those with normal RDW.
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Affiliation(s)
- Wei Wei
- Department of Burn Plastic and Cosmetic Surgery, South China Hospital, Medical School, Shenzhen University, Shenzhen, Guangdong Province, 518116, China
| | - Bishan Feng
- Department of Hematology, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong Province, 518000, China
| | - Zimiao Chen
- Department of Burn Plastic and Cosmetic Surgery, South China Hospital, Medical School, Shenzhen University, Shenzhen, Guangdong Province, 518116, China
| | - Xiaojie Liu
- Department of Burn Plastic and Cosmetic Surgery, South China Hospital, Medical School, Shenzhen University, Shenzhen, Guangdong Province, 518116, China
| | - Mengjing Xiao
- Department of Burn Plastic and Cosmetic Surgery, South China Hospital, Medical School, Shenzhen University, Shenzhen, Guangdong Province, 518116, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People's Hospital, No.3002 Sungang Road, Futian District, Shenzhen, Guangdong Province, 518000, China.
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, 518000, China.
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Amodu LI, Hakmi H, Sohail AH, Akerman M, Petrone P, Halpern DK, Sonoda T. Laparoscopic Hartmann's procedure for complicated diverticulitis is associated with lower superficial surgical site infections compared to open surgery with similar other outcomes: a NSQIP-based, propensity score matched analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02661-1. [PMID: 39356294 DOI: 10.1007/s00068-024-02661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 08/24/2024] [Indexed: 10/03/2024]
Abstract
BACKGROUND Open Hartmann's procedure has traditionally been the procedure of choice to treat complicated diverticulitis. We analyzed the ACS-NSQIP database to compare outcomes in patients who underwent emergent laparoscopic Hartmann's procedure (LHP) to those who had an open Hartmann's procedure (OHP). STUDY DESIGN Data analyzed from 2015 to 2019 using ICD-10 codes. Patients were matched on several important covariates using a propensity score matching method (PSM). Patients were matched in a 4:1 ratio of controls to cases based on the propensity score. RESULTS We identified 5026, of which 456 had LHP and 4570 had OHP. PSM analysis yielded 369 LHP and 1476 OHP patients. LHP had lower rates of superficial surgical site infection (SSSI) compared to OHP (2.44% vs. 5.89%, p = 0.007). LHP had similar post-operative outcomes compared to OHP, including 30-day mortality (5.15% vs. 2.98%, p = 0.060), organ space surgical site infection (OSSSI) (14.36% vs. 12.60%, p = 0.161), wound disruption (1.36% vs. 2.44%, p = 0.349), median LOS (8 vs. 9 days, p = 0.252), readmission within 30 days (11.92% vs. 8.67%, p = 0.176), rate of reoperation (6.0 vs. 6.5%, p = 0.897), and discharge to home (76% vs. 77%, p = 0.992). LHP had longer operative times compared to OHP (median 129 vs. 118 min, p < 0.0001). CONCLUSION The LHP is associated with lower rates of SSSI. However, it is not associated with lower rates of mortality, OSSSI, readmissions and reoperations within 30 days. Surgical times are longer in LHP. More studies are needed to determine whether LHP offers advantages in the long-term, particularly in rates of incisional hernia and colostomy closure.
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Affiliation(s)
- Leo I Amodu
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA
| | - Hazim Hakmi
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA
| | - Amir H Sohail
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA
| | - Meredith Akerman
- Biostatistics Core, Division of Health Services Research, Department of Foundations of Medicine, NYU Grossman Long Island School of Medicine, Mineola, NY, 11501, USA
| | - Patrizio Petrone
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA.
| | - David K Halpern
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA
| | - Toyooki Sonoda
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA
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Houck PD. Obesity Conundrum. Am J Cardiol 2024; 228:82-84. [PMID: 39053725 DOI: 10.1016/j.amjcard.2024.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 07/19/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Philip D Houck
- Division of Cardiology, Department of Medicine, Baylor Scott & White Health, Temple, Texas.
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Isogai T, Morita K, Okada A, Michihata N, Matsui H, Miyawaki A, Jo T, Yasunaga H. Association between complementary use of Goreisan (a Japanese herbal Kampo medicine) and heart failure readmission: A nationwide propensity score-matched study. J Cardiol 2024:S0914-5087(24)00182-5. [PMID: 39341374 DOI: 10.1016/j.jjcc.2024.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 09/02/2024] [Accepted: 09/16/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Goreisan, a Japanese herbal medicine, possesses aquaretic properties to regulate body fluid homeostasis and may therefore be effective as a complement to standard therapy in improving outcomes in patients with heart failure (HF). METHODS We retrospectively identified 431,393 patients (mean age 79.2 ± 12.6 years; male 52.3 %) who were admitted for HF for the first time and were discharged alive with standard HF medications between April 2016 and March 2022, using the Japanese Diagnosis Procedure Combination database. We divided patients into two groups according to the prescription of Goreisan at discharge: patients who received standard HF medications plus Goreisan and those who received standard medications alone. We compared the incidence of HF readmission within 1 year after discharge between the groups using propensity score matching. RESULTS Overall, Goreisan was prescribed in 1957 (0.45 %) patients at discharge. Patients who received Goreisan were older and received diuretics more frequently than those who did not. One-to-four propensity score matching created a cohort of 1957 and 7828 patients treated with and without Goreisan, respectively. No significant difference was found in the incidence of 1-year HF readmission between the groups [22.1 % vs. 21.7 %; hazard ratio (HR) = 1.02, 95 % confidence interval (CI) = 0.92-1.13]. This result was consistent with that from competing risk analysis (subdistribution HR = 1.02, 95 % CI = 0.92-1.13) and across clinically relevant subgroups except for renal disease. Goreisan use was associated with a lower incidence of HF readmission among patients with renal disease (HR = 0.77, 95 % CI = 0.60-0.97), but not among those without (HR = 1.09, 95 % CI = 0.97-1.23; p for interaction = 0.009). CONCLUSIONS This nationwide propensity score-matched analysis did not demonstrate that complementary Goreisan use at discharge was associated with a lower incidence of 1-year HF readmission in patients with HF receiving standard medications. An ongoing randomized trial is awaited to establish the effectiveness of Goreisan use in patients with HF.
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Affiliation(s)
- Toshiaki Isogai
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
| | - Kojiro Morita
- Department of Nursing Administration and Advanced Clinical Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Cancer Prevention Center, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Atsushi Miyawaki
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Liu Y, Hu H, Zheng W, Deng Z, Yang J, Zhang X, Li Z, Chen L, Chen F, Ji N, Huang G. Association between hypertension requiring medication and postoperative 30-day mortality in adult patients with tumor craniotomy: an analysis of data using propensity score matching. Front Neurol 2024; 15:1412471. [PMID: 39355090 PMCID: PMC11442953 DOI: 10.3389/fneur.2024.1412471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 09/06/2024] [Indexed: 10/03/2024] Open
Abstract
Background Reliable quantification of the association between hypertension requiring medication and postoperative 30-day mortality in adult patients who undergo craniotomy for tumor resection is limited. We aimed to explore the associations between these factors. Materials and methods This work was a retrospective cohort study that used propensity score matching (PSM) among 18,642 participants from the American College of Surgeons National Surgical Quality Improvement Program database between 2012 and 2015. Hypertension requiring medication and postoperative 30-day mortality were the independent and dependent target variables, respectively. PSM was conducted via nonparsimonious multivariate logistic regression to balance the confounders. Robust estimation methods were used to investigate the association between hypertension requiring medication and postoperative 30-day mortality. Results A total of 18,642 participants (52.6% male and 47.4% female) met our inclusion criteria; 7,116 (38.17%) participants with hypertension required medication and had a 3.74% mortality rate versus an overall mortality rate of 2.46% in the adult cohort of patients who underwent craniotomy for tumor resection. In the PSM cohort, the risk of postoperative 30-day mortality significantly increased by 39.0% among patients with hypertension who required medication (OR = 1.390, 95% confidence interval (CI): 1.071-1.804, p = 0.01324) after adjusting for the full covariates. Compared with participants without hypertension requiring medication, those with hypertension requiring medication had a 34.0% greater risk of postoperative 30-day mortality after adjusting for the propensity score (OR = 1.340, 95% CI: 1.040-1.727, p = 0.02366) and a 37.6% greater risk of postoperative 30-day mortality in the inverse probability of treatment weights (IPTW) cohort (OR = 1.376, 95% CI: 1.202, 1.576, p < 0.00001). Conclusion Among U.S. adult patients undergoing craniotomy for tumor resection, hypertension requiring medication is a notable contributor to 30-day mortality after surgery, with odds ratios ranging from 1.34 to 1.39.
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Affiliation(s)
- Yufei Liu
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Haofei Hu
- Nephrological Department, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Wenjian Zheng
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zhong Deng
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Jihu Yang
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiejun Zhang
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zongyang Li
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Lei Chen
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Fanfan Chen
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Nan Ji
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guodong Huang
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
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Budweg J, Ahmed MM, Vilaro JR, Al-Ani MA, Aranda JM, Guo Y, Li A, Patel S, Parker AM. Combination diuretic therapies in heart failure: Insights from GUIDE-IT. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 45:100436. [PMID: 39220719 PMCID: PMC11362771 DOI: 10.1016/j.ahjo.2024.100436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 07/22/2024] [Indexed: 09/04/2024]
Abstract
Introduction Diuretics are the mainstay of maintaining and restoring euvolemia in the management of heart failure. Loop diuretics are often preferred, however, combination diuretic therapy (CDT) with a thiazide diuretic is often used to overcome diuretic resistance and increase diuretic effect. We performed an analysis of the GUIDE-IT study to assess all-cause mortality and time to first hospitalizations in patients necessitating CDT. Methods Patients from the GUIDE-IT dataset were stratified by their requirement for CDT with a thiazide to achieve euvolemia. A total of 894 patients were analyzed, 733 of which were treated with loop diuretics alone vs 161 used either chlorothiazide or metolazone in addition to loop diuretics. Kaplan-Meir curves were derived with log-rank p-values to evaluate for differences between the groups. Results There was no significant difference in all-cause mortality regardless of CDT utilization status (mean survival of 612.704 days vs 603.326 days, p = 0.083). On subgroup analysis, there was no significant difference in all-cause mortality amongst those using loop diuretics compared to CDT in the BNP-guided therapy group, (mean survival time 576.385 days vs 620.585 days, p = 0.0523), nor the control group (614.1 days vs 588.9 days; p = 0.5728). Time to first hospitalization was reduced in all using CDT compared to loop diuretics alone (280.5 days vs 407.2 days, p < 0.0001). On subgroup analysis, both the BNP-guided group as well as the control group had reduced time to first hospitalization in the CDT group compared to those who did not require CDT (BNP group: 287.503 days vs 402.475 days, p ≤0.0001; control group 248.698 days vs 399.035 days, p = 0.0009). Conclusion Use of CDT is associated with earlier time to hospitalization, though no association was identified with increased all-cause mortality. Further prospective studies are likely needed to determine the true risk and benefits of combination diuretic therapy.
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Affiliation(s)
- Jeffery Budweg
- Department of Medicine, Division of Cardiology, University of Florida, Gainesville, FL, USA
| | - Mustafa M. Ahmed
- Department of Medicine, Division of Cardiology, University of Florida, Gainesville, FL, USA
| | - Juan R. Vilaro
- Department of Medicine, Division of Cardiology, University of Florida, Gainesville, FL, USA
| | - Mohammad A. Al-Ani
- Department of Medicine, Division of Cardiology, University of Florida, Gainesville, FL, USA
| | - Juan M. Aranda
- Department of Medicine, Division of Cardiology, University of Florida, Gainesville, FL, USA
| | - Yi Guo
- Department of Medicine, Division of Cardiology, Statistics, University of Florida, Gainesville, FL, USA
| | - Ang Li
- Department of Medicine, Division of Cardiology, Statistics, University of Florida, Gainesville, FL, USA
| | - Sandip Patel
- Department of Internal Medicine, Division of Cardiology, Orlando Health, Orlando, FL, USA
| | - Alex M. Parker
- Department of Medicine, Division of Cardiology, University of Florida, Gainesville, FL, USA
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Sung LC, Chiu HW, Yu SMW, Tsou LLA, Hsu YH, Wu MS, Lin CL, Tsai FJ, Chou CL. Thiazide diuretics versus loop diuretics in stage 3-5 CKD: impact on cardiorenal outcomes. Postgrad Med 2024; 136:738-748. [PMID: 39189768 DOI: 10.1080/00325481.2024.2396796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 08/22/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVES The association between diuretic use and cardiorenal outcomes remains limited in patients with stage 3-5 chronic kidney disease (CKD) and hypertension. To address this gap, we aim to investigate the long-term clinical impact of diuretic use with its pharmacological classification in Taiwanese patients with stage 3-5 CKD and hypertension who were concurrently received angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs). METHODS Using data from the National Health Insurance Research Database (January 2008 to December 2019), we focused on individuals with stage 3-5 CKD receiving ACEIs/ARBs between 2010 and 2018. We categorized the cohort into non-diuretic, loop diuretic (furosemide), thiazide diuretic, and combination diuretic groups. We used a Cox proportional hazards regression model with propensity score matching to analyze the influence of diuretics on all-cause mortality, cardiovascular (CV) death, and cardiorenal adverse outcomes. RESULTS The study included 59,719 patients, with 17,585 in the non-diuretic group and 42,134 in the diuretic group. Diuretics including furosemide use was significantly associated the risks of hospitalization for decompensated congestive heart failure (CHF), acute renal failure (ARF), end-stage renal disease (ESRD) requiring dialysis, CV mortality, and all-cause mortality (p-value <0.001). Thiazide diuretics showed no such adverse outcomes associations. The group receiving both thiazide and furosemide was more associated with all-cause mortality than the nondiuretic, thiazide, and furosemide monotherapy groups (all p-value <0.001). CONCLUSION Among stage 3-5 CKD patients on ACEIs/ARBs, loop diuretics exposure was associated with increased mortality and hospitalization for cardiorenal events, while thiazide diuretics exposure in isolation had no such associations. In the present data, we cannot evaluate the relationship between furosemide-associated adverse outcomes and worse renal function. These findings highlight the need for randomized controlled trials to assess the safety of loop diuretics in this population, urging caution in their prescription without a clear clinical indication.
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Affiliation(s)
- Li-Chin Sung
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Chiu
- Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Samuel Mon-Wei Yu
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Liam Li-An Tsou
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Biochemistry, Department of Chemistry, Hofstra University, Hempstead, NY, USA
| | - Yung-Ho Hsu
- Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan, Taiwan
| | - Mai-Szu Wu
- Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Fuu-Jen Tsai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Division of Medical Genetics, China Medical University Children's Hospital, Taichung, Taiwan
- Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan
| | - Chu-Lin Chou
- Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan, Taiwan
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10
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Fisher OM, Brown C, Esquivel J, Larsen SG, Liauw W, Alzahrani NA, Morris DL, Kepenekian V, Sourrouille I, Dumont F, Tuech JJ, Ceribelli C, Doussot B, Sgarbura O, Alhosni M, Quenet F, Glehen O, Cashin PH. Hyperthermic intraperitoneal chemotherapy in colorectal cancer. BJS Open 2024; 8:zrae017. [PMID: 38722737 PMCID: PMC11081075 DOI: 10.1093/bjsopen/zrae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND This study evaluated the efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) in colorectal cancer with peritoneal metastases (pmCRC) in a large international data set of patients. PATIENTS AND METHODS Patients with pmCRC from 39 centres who underwent cytoreductive surgery with HIPEC between 1991 and 2018 were selected and compared for the HIPEC protocols received-oxaliplatin-HIPEC versus mitomycin-HIPEC. Following analysis of crude data, propensity-score matching (PSM) and Cox-proportional hazard modelling were performed. Outcomes of interest were overall survival (OS), recurrence-free survival (RFS) and the HIPEC dose-response effects (high versus low dose, dose intensification and double drug protocols) on OS, RFS and 90-day morbidity. Furthermore, the impact of the treatment time period was assessed. RESULTS Of 2760 patients, 2093 patients were included. Median OS was 43 months (95% c.i. 41 to 46 months) with a median RFS of 12 months (95% c.i. 12 to 13 months). The oxaliplatin-HIPEC group had an OS of 47 months (95% c.i. 42 to 53 months) versus 39 months (95% c.i. 36 to 43 months) in the mitomycin-HIPEC group (P = 0.002), aHR 0.77, 95% c.i. 0.67 to 0.90, P < 0.001. The OS benefit persisted after PSM of the oxaliplatin-HIPEC group and mitomycin-HIPEC group (48 months (95% c.i. 42 to 59 months) versus 40 months (95% c.i. 37 to 44 months)), P < 0.001, aHR 0.78 (95% c.i. 0.65 to 0.94), P = 0.009. Similarly, matched RFS was significantly higher for oxaliplatin-HIPEC versus others (13 months (95% c.i. 12 to 15 months) versus 11 months (95% c.i. 10 to 12 months, P = 0.02)). High-dose mitomycin-HIPEC protocols had similar OS compared to oxaliplatin-HIPEC. HIPEC dose intensification within each protocol resulted in improved survival. Oxaliplatin + irinotecan-HIPEC resulted in the most improved OS (61 months (95% c.i. 51 to 101 months)). Ninety-day mortality in both crude and PSM analysis was worse for mitomycin-HIPEC. There was no change in treatment effect depending on the analysed time period. CONCLUSIONS Oxaliplatin-based HIPEC provided better outcomes compared to mitomycin-based HIPEC. High-dose mitomycin-HIPEC was similar to oxaliplatin-HIPEC. The 90-day mortality difference favours the oxaliplatin-HIPEC group. A trend for dose-response between low- and high-dose HIPEC was reported.
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Affiliation(s)
- Oliver M Fisher
- Department of Surgery, St George Hospital, Sydney, NSW, Australia
- St George & Sutherland Clinical School, UNSW Australia, Kogarah, NSW, Australia
- Notre Dame University School of Medicine, Sydney, NSW, Australia
| | - Chris Brown
- NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | - Jesus Esquivel
- Division of Surgical Oncology, Frederick Memorial Hospital, Frederick, Maryland, USA
| | - Stein G Larsen
- Department of Surgical Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Winston Liauw
- St George & Sutherland Clinical School, UNSW Australia, Kogarah, NSW, Australia
- Department of Medical Oncology, St George Hospital, Sydney, NSW, Australia
| | - Nayef A Alzahrani
- Department of Surgery, St George Hospital, Sydney, NSW, Australia
- Department of surgery, National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - David L Morris
- Department of Surgery, St George Hospital, Sydney, NSW, Australia
| | - Vahan Kepenekian
- Department of Digestive Surgery, Hôpital Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
- EA 3738 CICLY, Université Lyon 1, Lyon, France
| | | | - Frédéric Dumont
- Department of Oncological Surgery, Institut de Cancérologie de l’Ouest René Gauducheau, St Herblain, France
| | - Jean-Jacques Tuech
- Department of Digestive Surgery, Centre Hospitalo-Universitaire de Rouen, Rouen, France
| | - Cécilia Ceribelli
- Department of Surgery, Centre Hospitalo-Universitaire l’Archet II, Nice, France
| | - Béranger Doussot
- Department of Digestive Surgery, Centre Hospitalo-Universitaire Dijon Bourgogne, Dijon, France
| | - Olivia Sgarbura
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Institut régional du Cancer de Montpellier, Université de Montpellier, Montpellier, France
- Département de Chirurgie Oncologique, Institut régional du Cancer de Montpellier, Montpellier, France
| | - Mohammed Alhosni
- Surgical Oncology Division, Department of Surgery, Sultan Qaboos University Hospital SQUH, Muscat, Oman
| | - Francois Quenet
- Département de Chirurgie Oncologique, Institut régional du Cancer de Montpellier, Montpellier, France
| | - Olivier Glehen
- Department of Digestive Surgery, Hôpital Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
- EA 3738 CICLY, Université Lyon 1, Lyon, France
| | - Peter H Cashin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgery, Akademiska Sjukhuset, Uppsala, Sweden
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11
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Han Y, Hu H, Shao Y, Deng Z, Liu D. The link between initial cardiac rhythm and survival outcomes in in-hospital cardiac arrest using propensity score matching, adjustment, and weighting. Sci Rep 2024; 14:7621. [PMID: 38561413 PMCID: PMC10985081 DOI: 10.1038/s41598-024-58468-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/29/2024] [Indexed: 04/04/2024] Open
Abstract
The association between the initial cardiac rhythm and short-term survival in patients with in-hospital cardiac arrest (IHCA) has not been extensively studied despite the fact that it is thought to be a prognostic factor in patients with out-of-hospital cardiac arrest. This study aimed to look at the relationship between initial shockable rhythm and survival to hospital discharge in individuals with IHCA. 1516 adults with IHCA who received chest compressions lasting at least two minutes at the National Taiwan University Hospital between 2006 and 2014 made up the study population. Propensity scores were estimated using a fitted multivariate logistic regression model. Various statistical methodologies were employed to investigate the association between shockable rhythm and the probability of survival to discharge in patients experiencing IHCA, including multivariate adjustment, propensity score adjustment, propensity score matching, and logistic regression based on propensity score weighting. In the original cohort, the multivariate-adjusted odds ratio (OR) was 2.312 (95% confidence interval [CI]: 1.515-3.531, P < 0.001). In additional propensity score adjustment, the OR between shockable rhythm and the probability of survival to hospital discharge in IHCA patients was 2.282 (95% CI: 1.486, 3.504, P < 0.001). The multivariate-adjusted logistic regression model analysis revealed that patients with shockable rhythm had a 1.761-fold higher likelihood of surviving to hospital release in the propensity score-matched cohort (OR = 2.761, 95% CI: 1.084-7.028, P = 0.033). The multivariate-adjusted OR of the inverse probability for the treatment-weighted cohort was 1.901 (95% CI: 1.507-2.397, P < 0.001), and the standardized mortality ratio-weighted cohort was 2.692 (95% CI: 1.511-4.795, P < 0.001). In patients with in-hospital cardiac arrest, Initial cardiac rhythm is an independent predictor of survival to hospital discharge. Depending on various statistical methods, patients with IHCA who have a shockable rhythm have a one to two fold higher probability of survival to discharge than those who have a non-shockable rhythm. This provides a reference for optimizing resuscitation decisions for IHCA patients and facilitating clinical communication.
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Affiliation(s)
- Yong Han
- Department of Emergency, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, No.3002 Sungang Road, Futian District, Shenzhen, 518035, Guangdong Province, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China
| | - Yuankai Shao
- Department of Emergency, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, No.3002 Sungang Road, Futian District, Shenzhen, 518035, Guangdong Province, China
| | - Zhe Deng
- Department of Emergency, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, No.3002 Sungang Road, Futian District, Shenzhen, 518035, Guangdong Province, China.
| | - Dehong Liu
- Department of Emergency, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, No.3002 Sungang Road, Futian District, Shenzhen, 518035, Guangdong Province, China.
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12
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Dedman D, Williams R, Bhaskaran K, Douglas IJ. Pooling of primary care electronic health record (EHR) data on Huntington's disease (HD) and cancer: establishing comparability of two large UK databases. BMJ Open 2024; 14:e070258. [PMID: 38355188 PMCID: PMC10868307 DOI: 10.1136/bmjopen-2022-070258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVES To explore whether UK primary care databases arising from two different software systems can be feasibly combined, by comparing rates of Huntington's disease (HD, which is rare) and 14 common cancers in the two databases, as well as characteristics of people with these conditions. DESIGN Descriptive study. SETTING Primary care electronic health records from Clinical Practice Research Datalink (CPRD) GOLD and CPRD Aurum databases, with linked hospital admission and death registration data. PARTICIPANTS 4986 patients with HD and 1 294 819 with an incident cancer between 1990 and 2019. PRIMARY AND SECONDARY OUTCOME MEASURES Incidence and prevalence of HD by calendar period, age group and region, and annual age-standardised incidence of 14 common cancers in each database, and in a subset of 'overlapping' practices which contributed to both databases. Characteristics of patients with HD or incident cancer: medical history, recent prescribing, healthcare contacts and database follow-up. RESULTS Incidence and prevalence of HD were slightly higher in CPRD GOLD than CPRD Aurum, but with similar trends over time. Cancer incidence in the two databases differed between 1990 and 2000, but converged and was very similar thereafter. Participants in each database were most similar in terms of medical history (median standardised difference, MSD 0.03 (IQR 0.01-0.03)), recent prescribing (MSD 0.06 (0.03-0.10)) and demographics and general health variables (MSD 0.05 (0.01-0.09)). Larger differences were seen for healthcare contacts (MSD 0.27 (0.10-0.41)), and database follow-up (MSD 0.39 (0.19-0.56)). CONCLUSIONS Differences in cancer incidence trends between 1990 and 2000 may relate to use of a practice-level data quality filter (the 'up-to-standard' date) in CPRD GOLD only. As well as the impact of data curation methods, differences in underlying data models can make it more challenging to define exactly equivalent clinical concepts in each database. Researchers should be aware of these potential sources of variability when planning combined database studies and interpreting results.
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Affiliation(s)
- Daniel Dedman
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachael Williams
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Krishnan Bhaskaran
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ian J Douglas
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Shiraishi Y, Ikemura N, Urashima M, Kohno T, Nakano S, Tanaka T, Nagatomo Y, Ikoma T, Ono T, Numasawa Y, Sakamoto M, Nishikawa K, Takei M, Hakuno D, Nakamaru R, Ueda I, Kohsaka S. Rationale and protocol of the LAQUA-HF trial: a factorial randomised controlled trial evaluating the effects of neurohormonal and diuretic agents on health-status reported outcomes in heart failure patients. BMJ Open 2024; 14:e076519. [PMID: 38355194 PMCID: PMC10868297 DOI: 10.1136/bmjopen-2023-076519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION The current guidelines strongly recommend early initiation of multiple classes of cardioprotective drugs for patients with heart failure with reduced ejection fraction to improve prognosis and health status. However, evidence on the optimal sequencing of approved drugs is scarce, highlighting the importance of individualised treatment plans. Registry data indicate that only a portion of these patients can tolerate all four recommended classes, underscoring the need to establish the favoured sequence when using these drugs. Additionally, the choice between long-acting and short-acting loop diuretics in the present era remains uncertain. This is particularly relevant given the frequent use of angiotensin receptor-neprilysin inhibitor and sodium-glucose cotransporter 2 inhibitor, both of which potentiate natriuretic effects. METHODS AND ANALYSIS In a prospective, randomised, open-label, blinded endpoint method, LAQUA-HF (Long-acting vs short-acting diuretics and neurohormonal Agents on patients' QUAlity-of-life in Heart Failure patients) will be a 2×2 factorial design, with a total of 240 patients randomised to sacubitril/valsartan versus dapagliflozin and torsemide versus furosemide in a 1:1 ratio. Most enrolment sites have participated in an ongoing observational registry for consecutive patients hospitalised for heart failure involved dedicated study coordinators, and used the same framework to enrol patients. The primary endpoint is the change in patients' health status over 6 months, defined by the Kansas City Cardiomyopathy Questionnaire. Additionally, clinical benefit at 6 months defined as a hierarchical composite endpoint will be assessed by the win ratio as the secondary endpoint. ETHICS AND DISSEMINATION The medical ethics committee Keio University in Japan has approved this trial. All participants provide written informed consent prior to study entry. The results of this trial will be disseminated in one main paper and additional papers on secondary endpoints and subgroup analyses. TRIAL REGISTRATION NUMBER UMIN000045229.
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Affiliation(s)
- Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
- University of Missouri's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Mitsuyoshi Urashima
- Department of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Toshikazu Tanaka
- Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Takenori Ikoma
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Ono
- Department of Cardiology, National Hospital Organization Saitama National Hospital, Saitama, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Munehisa Sakamoto
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kei Nishikawa
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Japan
| | - Makoto Takei
- Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Daihiko Hakuno
- Department of Cardiology, Kawasaki Municipal Hospital, Kawasaki, Japan
| | - Ryo Nakamaru
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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14
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Liao LD, Zhu Y, Ngo AL, Chehab RF, Pimentel SD. Prioritizing Variables for Observational Study Design using the Joint Variable Importance Plot. AM STAT 2024; 78:318-326. [PMID: 39386318 PMCID: PMC11460722 DOI: 10.1080/00031305.2024.2303419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 10/12/2024]
Abstract
Observational studies of treatment effects require adjustment for confounding variables. However, causal inference methods typically cannot deliver perfect adjustment on all measured baseline variables, and there is often ambiguity about which variables should be prioritized. Standard prioritization methods based on treatment imbalance alone neglect variables' relationships with the outcome. We propose the joint variable importance plot to guide variable prioritization for observational studies. Since not all variables are equally relevant to the outcome, the plot adds outcome associations to quantify the potential confounding jointly with the standardized mean difference. To enhance comparisons on the plot between variables with different confounding relationships, we also derive and plot bias curves. Variable prioritization using the plot can produce recommended values for tuning parameters in many existing matching and weighting methods. We showcase the use of the joint variable importance plots in the design of a balance-constrained matched study to evaluate whether taking an antidiabetic medication, glyburide, increases the incidence of C-section delivery among pregnant individuals with gestational diabetes.
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Affiliation(s)
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA 94612
| | - Amanda L. Ngo
- Kaiser Permanente Northern California Division of Research, Oakland, CA 94612
| | - Rana F. Chehab
- Kaiser Permanente Northern California Division of Research, Oakland, CA 94612
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15
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Li M, Zheng C, Chen C, Zheng X, He Z. The Decrease in Estimated Glomerular Filtration Rate as a Risk Factor of Ventricular Tachyarrhythmias after Acute Myocardial Infarction during Hospitalization: A Retrospective Propensity Score Matching Cohort Study. Rev Cardiovasc Med 2024; 25:42. [PMID: 39077336 PMCID: PMC11263147 DOI: 10.31083/j.rcm2502042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 07/31/2024] Open
Abstract
Background To identify the decrease in estimated glomerular filtration rate (eGFR) as an independent risk factor associated with ventricular tachyarrhythmias (VTA). Methods This retrospective file review collected information from patients diagnosed with acute myocardial infarction (AMI), with and without VTA, from January 2017 to December 2019. We first applied the chi-square test to assess 12 risk factors and one outcome variable (incident rate of VTA). Next, all the 12 risk factors were further adjusted using the propensity score matching (PSM) method to simulate the dataset as a randomized controlled cohort, which can reduce the defects derived from confounding factors and the imbalance in baseline characteristics. To investigate the relationship between eGFR and VTA, univariate logistic regression analysis was applied to the cohort before and after PSM analysis. Results A total of 503 patients diagnosed as AMI were included in the study. There were eight of twelve risk factors in baseline characteristics with a p-value < 0.05, as determined by the chi-square test before PSM matching. The result of PSM analysis indicated that 86 of 91 patients with decreased eGFR were matched, and all the risk factors were not significantly different (p-value > 0.05). The incident rates of VTA in the two groups were still significantly different (p-value < 0.001) according to the Pearson chi-square test in the cohort after PSM analysis. The results of univariate (eGFR) logistic regression indicated that the odds ratio of the cohort was 6.442 (95% confidence interval = 3.770-11.05) and 3.654 (95% confidence interval = 1.764-7.993) before and after PSM analysis respectively. Conclusions The decrease in eGFR ( < 60 mL/min/1.73 m 2 ) has been demonstrated as an independent risk factor for VTA after AMI.
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Affiliation(s)
- Ming Li
- Department of Cardiology, Affiliated Hospital of Guangdong Medical University, 524001 Zhanjiang, Guangdong, China
| | - Chongzhou Zheng
- Department of Cardiology, Affiliated Hospital of Guangdong Medical University, 524001 Zhanjiang, Guangdong, China
| | - Chunmei Chen
- Department of Cardiology, Affiliated Hospital of Guangdong Medical University, 524001 Zhanjiang, Guangdong, China
| | - Xifeng Zheng
- Department of Cardiology, Affiliated Hospital of Guangdong Medical University, 524001 Zhanjiang, Guangdong, China
| | - Zhongkai He
- Department of Cardiology, Affiliated Hospital of Guangdong Medical University, 524001 Zhanjiang, Guangdong, China
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16
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Lu K, Wu YM, Shi Q, Gong YQ, Zhang T, Li C. A novel fracture liaison service using digital health: impact on mortality in hospitalized elderly osteoporotic fracture patients. Osteoporos Int 2024; 35:53-67. [PMID: 37698600 DOI: 10.1007/s00198-023-06905-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
We examined the performance of an intelligent fracture liaison service (FLS) assisted by digital health (DH) to reduce all-cause mortality (ACM) risk. According to our findings, the new FLS reduced ACM by 36%. INTRODUCTION A well-designed secondary prevention program known as FLS enhances the bone densitometry-based assessment rate as well as osteoporosis (OP) medication usage following a fracture. However, there are only a few reports on FLS incorporating DH, and it remains unclear whether this integration has influenced patient ACM, which refers to the overall death rate from any cause during the study period. METHODS This retrospective observational study was conducted on data from the Fragility Fracture Registration System database linked to the Regional Health Registration Platform of Kunshan City and the Population Death Registration System of Jiangsu Province for one tertiary-level A hospital in China. Patients aged ≥ 50 years, who experienced an OP fracture between January 1, 2017, and July 27, 2022, requiring hospitalization, were selected for analysis. We compared the outcomes of patients who received routine fragility fracture management (the no-FLS group) or FLS (the FLS group). We employed multivariable Cox regression with inverse probability weighting based on the propensity score (PS). RESULTS Of 2317 patients, 756 (32.6%) received FLS and 1561 (67.4%) did not. Using PS matching, we minimized the baseline characteristic differences between the two groups in the propensity score-matched samples, relative to the unmatched samples. Based on our analysis, the new FLS reduced ACM by 36% (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.47 to 0.87; P-value = 0.004). Moreover, FLS patients experienced further reductions in fall-related mortality, refracture rate, and total refracture-related hospital costs, and had increased dual-energy X-ray absorptiometry (DXA) testing and treatment initiation rates, relative to the no-FLS patients. CONCLUSIONS A new FLS model implementation assisted by DH can effectively reduce ACM among elderly patients with OP fractures requiring surgery. In future investigations, we recommend examining the scalability of this model.
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Affiliation(s)
- Ke Lu
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, 215300, Jiangsu, China
| | - Ya-Ming Wu
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, 215300, Jiangsu, China
| | - Qin Shi
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Orthopedic Institute of Soochow University, Suzhou, Jiangsu, China
| | - Ya-Qin Gong
- Information Department, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Ting Zhang
- Chronic Disease Department, Kunshan Center For Disease Control and Prevention, Suzhou, Jiangsu, China
| | - Chong Li
- Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, 215300, Jiangsu, China.
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17
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Kim O, Kim K, Park S, Yang H, Kim H, Ro W, Lee C. Clinical relevance of serum ionized magnesium concentration in dogs with myxomatous mitral valve disease. J Vet Intern Med 2024; 38:41-50. [PMID: 38064361 PMCID: PMC10800217 DOI: 10.1111/jvim.16963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/17/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Hypomagnesemia is associated with a poor prognosis in humans with congestive heart failure (CHF), but studies in veterinary medicine are limited. HYPOTHESIS Serum ionized magnesium concentration [iMg2+ ] would decrease as CHF progresses compared with the initial diagnostic levels and that lower [iMg2+ ] would be negatively associated with prognosis in dogs with CHF. ANIMALS A total of 181 client-owned dogs with myxomatous mitral valve disease (MMVD) were included. They were classified into the preclinical stage (NO-CHF, n = 108), stage C (n = 42), and stage D (n = 31) based on the American College of Veterinary Internal Medicine MMVD classification. METHODS This is a retrospective study from 2 referral centers. The [iMg2+ ] was compared among the NO-CHF, stage C, and stage D groups. Kaplan-Meier curves and the log-rank test were used to compare the incidence of death between groups. Multivariable Cox regression analysis was used to estimate the association of hypomagnesemia with the death. RESULTS In the stage D group, the [iMg2+ ] was lower than that in the NO-CHF (P < .0001) and stage C groups (P < .003). In the Kaplan-Meier survival analysis, the 1-year cumulative survival rate in hypomagnesemic dogs was 53% compared with 91.5% in normomagnesemic dogs (log-rank test, P < .0001). In the multivariable Cox analysis, lower concentration of [K+ ] and [iMg2+ ], along with higher Evel , were associated with negative prognoses. Specifically, hypomagnesemia was associated with an approximately 4-fold increased risk of death (hazard ratio = 4.015; 95% confidence interval, 1.537-10.488; P = .005). CONCLUSIONS AND CLINICAL IMPORTANCE Assessing the [iMg2+ ] might serve as a potential marker for estimating the severity and prognosis indirectly in dogs with MMVD. Combining [iMg2+ ] measurement with other diagnostic methods, such as echocardiography, could improve the prognostic evaluation of MMVD in dogs.
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Affiliation(s)
- Ock‐Kyu Kim
- Department of Veterinary Medicine, College of Veterinary Medicine and BK21 FOUR ProgramChonnam National UniversityGwangjuRepublic of Korea
| | - Keon Kim
- Department of Veterinary Medicine, College of Veterinary Medicine and BK21 FOUR ProgramChonnam National UniversityGwangjuRepublic of Korea
| | - Sinwook Park
- Department of Veterinary Medicine, College of Veterinary Medicine and BK21 FOUR ProgramChonnam National UniversityGwangjuRepublic of Korea
| | - Hayoung Yang
- Noah Animal Medical CenterGwangjuRepublic of Korea
| | - Hyunwoo Kim
- Noah Animal Medical CenterGwangjuRepublic of Korea
| | - Woong‐Bin Ro
- Department of Veterinary Medicine, College of Veterinary Medicine and BK21 FOUR ProgramChonnam National UniversityGwangjuRepublic of Korea
| | - Chang‐Min Lee
- Department of Veterinary Medicine, College of Veterinary Medicine and BK21 FOUR ProgramChonnam National UniversityGwangjuRepublic of Korea
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18
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Zhu J, Jin XQ, Li XY, Sun L, Peng Y. The association between oral carbohydrate intake before orthopedic surgery for osteoporotic fractures and outcomes in elderly patients. J Orthop Surg Res 2023; 18:966. [PMID: 38098008 PMCID: PMC10722799 DOI: 10.1186/s13018-023-04458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Oral carbohydrate (CHO) intake is a safe method with effective clinical results in various surgical patients before surgery. Nevertheless, due to a lack of adequate clinical data, it is not frequently utilized in older patients undergoing orthopedic surgery for osteoporotic fractures (OPFs), especially in China. The purpose of the present study was to examine the relationship between preoperative oral CHO consumption and outcomes in elderly patients undergoing surgical treatment for OPFs. METHODS This retrospective cohort study was conducted at a single Chinese institution and included a total of 879 elderly patients (median age: 71 years; range: 50-99 years) who underwent OPF surgery. Various exclusion criteria were established as follows: (a) the necessity for urgent surgical intervention; (b) the existence of hypoglycemia, hyperglycemia, or diabetes mellitus with blood glucose levels lower than 2.8 mmol/L; (c) a medical history of gastrointestinal motility disorders or delayed gastric emptying; (d) the utilization of local anesthesia; (e) a Charlson comorbidity index (CCI) score over 2; and (f) an American Society of Anesthesiologists (ASA) score exceeding 3. After propensity score (PS) matching, 264 patients from each cohort were included in the analysis. The primary outcome was the all-cause mortality rate within 60 days post-surgery, while secondary outcomes included the length of hospital stay (LOS), hospitalization costs, intraoperative and postoperative blood transfusions, and the incidence of postoperative nausea and vomiting (PONV) and aspiration. The relationship between preoperative oral CHO intake and outcomes was evaluated using multivariate regression analysis. RESULTS After PS matching, preoperative oral CHO intake was negatively associated with 60-day mortality in the fully adjusted model (odds ratio 0.35; 95% confidence interval 0.12-0.97; P-value: 0.04). Patients who received preoperative oral CHO intake also had a shorter LOS and lower hospitalization costs than those who did not receive CHO intake. However, none of the models showed a significant association between CHO intake and PONV or blood transfusion risk. Furthermore, no cases of aspiration were observed in either cohort. CONCLUSIONS Preoperative oral CHO intake may be associated with reduced mortality risk and improved outcomes in elderly patients undergoing surgical treatment for OPFs. However, it is important to acknowledge the limitations of our study, including its retrospective nature, potential unmeasured confounding variables, the small sample size, incomplete data on important variables such as duration of surgery and inflammatory markers, and the limited generalizability due to the participation of only one institution. Future research with larger sample sizes and a broader range of events is warranted to validate and enhance the validity of our findings, particularly in assessing long-term results and understanding the underlying mechanisms.
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Affiliation(s)
- Jing Zhu
- Department of Nursing, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Xue-Qin Jin
- Department of Nursing, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Xiao-Yan Li
- Department of Nursing, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Li Sun
- Department of Nursing, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Yuan Peng
- Intensive Care Unit, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, Jiangsu, China.
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Miyazaki D, Tarasawa K, Fushimi K, Fujimori K. Risk factors of readmission and the impact of outpatient management in heart failure patients: A national study in Japan. ESC Heart Fail 2023; 10:3299-3310. [PMID: 37658614 PMCID: PMC10682852 DOI: 10.1002/ehf2.14498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 09/03/2023] Open
Abstract
AIMS Heart failure is a significant disease, and its high readmission rate is a big concern. We must identify readmission risk factors and optimize outpatient management to prevent them. This study aims to investigate the readmission risk factors, including outpatient management represented by the number of outpatient visits, and to identify the factors related to frequent outpatient visits. METHODS AND RESULTS We used the diagnosis-procedure-combination database between April 2016 and March 2022. Based on the number of outpatient visits within 60 days after discharge, we categorized patients into <1 visits/month, (1<, ≦2) visits/month, and <2 visits/month and observed the occurrence of 60 days readmission. We performed multiple logistic regression analyses to reveal the readmission risk factors and the association between the number of outpatient visits and readmission. As a subgroup analysis, we conducted the same research in the low- and high-readmission risk groups. We compared medical contents between (1<, ≦2) visits/month and <2 visits/month. We analysed 101 239 patients and identified the following factors as a risk of readmission: older age (P < 0.001), female (P = 0.009), longer length-of-hospital-stay (P < 0.001), artificial ventilator (P < 0.001), tolvaptan (P < 0.001), top 50% dosage of loop diuretics (P = 0.036), bottom 50% dosage of class III antiarrhythmic agents (P < 0.001), hypertension (P = 0.005), atrial fibrillation (P < 0.001), dilated cardiomyopathy (P < 0.001), valvular disease (P = 0.021), myocardial infarction (P < 0.001), diabetes (P < 0.001), and renal disease (P < 0.001). We revealed that the risk of readmission increases in <2 visits/month compared to (1<, ≦2) visits/month (P < 0.001), whereas the risk of readmission decreases in ≦1 visits/month compared with (1<, ≦2) visits/month (P < 0.001). In the subgroup analysis, we found the possibility that some risk factors are specific to the subgroup. We identified that the following factors were related to frequent outpatient visits: older age (P < 0.001), home medical care (P = 0.007), tolvaptan (P < 0.001), top 50% dosage of loop diuretics (P < 0.001), diabetes (P < 0.001), renal disease (P = 0.009), 0-2 weeks follow-up (P < 0.001), 2-4 weeks follow-up (P < 0.001), cardiac rehabilitation (P < 0.001), and echocardiography (P < 0.001). CONCLUSIONS This study comprehensively identified risk factors for readmission and found outpatient visit is personalized by readmission risk. There is still room to optimize outpatient management. We suggest optimizing outpatient management according to our identified characteristics.
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Affiliation(s)
- Daisuke Miyazaki
- Department of Health Administration and PolicyTohoku University Graduate School of MedicineSendaiJapan
| | - Kunio Tarasawa
- Department of Health Administration and PolicyTohoku University Graduate School of MedicineSendaiJapan
| | - Kiyohide Fushimi
- Department of Health Policy and InformaticsTokyo Medical and Dental University Graduate School of Medical and Dental SciencesTokyoJapan
| | - Kenji Fujimori
- Department of Health Administration and PolicyTohoku University Graduate School of MedicineSendaiJapan
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20
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Feng R, Zhang Z, Fan Q. Carbohydrate antigen 125 in congestive heart failure: ready for clinical application? Front Oncol 2023; 13:1161723. [PMID: 38023127 PMCID: PMC10644389 DOI: 10.3389/fonc.2023.1161723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Congestion is the permanent mechanism driving disease progression in patients with acute heart failure (AHF) and also is an important treatment target. However, distinguishing between the two different phenotypes (intravascular congestion and tissue congestion) for personalized treatment remains challenging. Historically, carbohydrate antigen 125 (CA125) has been a frequently used biomarker for the screening, diagnosis, and prognosis of ovarian cancer. Interestingly, CA125 is highly sensitive to tissue congestion and shows potential for clinical monitoring and optimal treatment of congestive heart failure (HF). Furthermore, in terms of right heart function parameters, CA125 levels are more advantageous than other biomarkers of HF. CA125 is expected to become a new biological alternative marker for congestive HF and thereby is expected be widely used in clinical practice.
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Affiliation(s)
- Rui Feng
- Department of Laboratory Medicine, Wuhan Asian Heart Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Zhenlu Zhang
- Department of Laboratory Medicine, Wuhan Asian Heart Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Qingkun Fan
- Department of Laboratory Medicine, Wuhan Asian Heart Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
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21
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Baudry G, Coutance G, Dorent R, Bauer F, Blanchart K, Boignard A, Chabanne C, Delmas C, D'Ostrevy N, Epailly E, Gariboldi V, Gaudard P, Goéminne C, Grosjean S, Guihaire J, Guillemain R, Mattei M, Nubret K, Pattier S, Vermes E, Sebbag L, Duarte K, Girerd N. Diuretic dose is a strong prognostic factor in ambulatory patients awaiting heart transplantation. ESC Heart Fail 2023; 10:2843-2852. [PMID: 37408178 PMCID: PMC10567662 DOI: 10.1002/ehf2.14467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
AIMS The prognostic value of 'high dose' loop diuretics in advanced heart failure outpatients is unclear. We aimed to assess the prognosis associated with loop diuretic dose in ambulatory patients awaiting heart transplantation (HT). METHODS AND RESULTS All ambulatory patients (n = 700, median age 55 years and 70% men) registered on the French national HT waiting list between 1 January 2013 and 31 December 2019 were included. Patients were divided into 'low dose', 'intermediate dose', and 'high dose' loop diuretics corresponding to furosemide equivalent doses of ≤40, 40-250, and >250 mg, respectively. The primary outcome was a combined criterion of waitlist death and urgent HT. N-terminal pro-B-type natriuretic peptide, creatinine levels, pulmonary capillary wedge pressure, and pulmonary pressures gradually increased with higher diuretic dose. At 12 months, the risk of waitlist death/urgent HT was 7.4%, 19.2%, and 25.6% (P = 0.001) for 'low dose', 'intermediate dose', and 'high dose' patients, respectively. When adjusting for confounders, including natriuretic peptides, hepatic, and renal function, the 'high dose' group was associated with increased waitlist mortality or urgent HT [adjusted hazard ratio (HR) 2.23, 1.33 to 3.73; P = 0.002] and a six-fold higher risk of waitlist death (adjusted HR 6.18, 2.16 to 17.72; P < 0.001) when compared with the 'low dose' group. 'Intermediate doses' were not significantly associated with these two outcomes in adjusted models (P > 0.05). CONCLUSIONS A 'high dose' of loop diuretics is strongly associated with residual congestion and is a predictor of outcome in patients awaiting HT despite adjustment for classical cardiorenal risk factors. This routine variable may be helpful for risk stratification of pre-HT patients.
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Affiliation(s)
- Guillaume Baudry
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F‐CRIN INI‐CRCT, ReicatraVandoeuvre‐lès‐Nancy54500France
| | - Guillaume Coutance
- Department of Cardiac and Thoracic SurgeryCardiology Institute, Pitié Salpêtrière Hospital, Assistance Publique‐Hôpitaux de Paris (AP‐HP). Sorbonne University Medical SchoolParisFrance
| | - Richard Dorent
- Department of Cardiac SurgeryCHU Bichat‐Claude Bernard, AP‐HP, Université Paris VIIParisFrance
| | - Fabrice Bauer
- Department of Cardiology and Cardiovascular SurgeryHospital Charles NicolleRouenFrance
| | - Katrien Blanchart
- Department of Cardiology and Cardiac SurgeryUniversity Hospital of Caen, University of CaenCaenFrance
| | - Aude Boignard
- Department of Cardiology and Cardiovascular SurgeryCHU MichallonGrenobleFrance
| | - Céline Chabanne
- Department of Thoracic and Cardiovascular SurgeryCHU Pontchaillou, Inserm U1099RennesFrance
| | - Clément Delmas
- Department of CardiologyCentre Hospitalier Universitaire de ToulouseToulouseFrance
| | - Nicolas D'Ostrevy
- Department of Cardiology and Cardiac SurgeryCHU Clermont‐FerrandClermont‐FerrandFrance
| | - Eric Epailly
- Department of Cardiology and Cardiovascular SurgeryHôpitaux Universitaires de StrasbourgStrasbourgFrance
| | - Vlad Gariboldi
- Department of Cardiac SurgeryLa Timone HospitalMarseilleFrance
| | - Philippe Gaudard
- Department of Cardiac Surgery, Anesthesiology and Critical Care MedicineArnaud de Villeneuve Hospital, CHRU MontpellierMontpellierFrance
| | - Céline Goéminne
- Department of Cardiac SurgeryCHU Lille, Institut Coeur‐PoumonsLilleFrance
| | - Sandrine Grosjean
- Department of Cardiology and Cardiac SurgeryDijon University HospitalDijonFrance
| | - Julien Guihaire
- Department of Cardiothoracic SurgeryMarie Lannelongue Hospital, University of Paris Sud, Inserm U999 (Pulmonary Hypertension: Pathophysiology and Novel Therapies [PAH])Le Plessis RobinsonFrance
| | - Romain Guillemain
- Department of Cardiology and Cardiac SurgeryEuropean Georges Pompidou HospitalParisFrance
| | - Mathieu Mattei
- Department of Cardiology and Cardiac SurgeryCHU de Nancy, Hopital de BraboisNancyFrance
| | - Karine Nubret
- Department of Thoracic and Cardiovascular SurgeryHôpital Cardiologique du Haut‐Lévêque, Université Bordeaux IIBordeauxFrance
| | - Sabine Pattier
- Department of Cardiology and Heart Transplantation UnitCHU NantesNantesFrance
| | - Emmanuelle Vermes
- Department of Cardiothoracic SurgeryTours University HospitalToursFrance
| | - Laurent Sebbag
- Department of Heart Failure and TransplantationHôpital Cardiovasculaire Louis Pradel, Hospices Civils de LyonBronFrance
| | - Kevin Duarte
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F‐CRIN INI‐CRCT, ReicatraVandoeuvre‐lès‐Nancy54500France
| | - Nicolas Girerd
- Université de Lorraine, Centre d'Investigations Cliniques Plurithématique 1433, INSERM DCAC, CHRU de Nancy, F‐CRIN INI‐CRCT, ReicatraVandoeuvre‐lès‐Nancy54500France
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22
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Sato Y, Yoshihisa A, Ide T, Tohyama T, Enzan N, Matsushima S, Tsutsui H, Takeishi Y. Regional Variation in the Clinical Practice and Prognosis in Patients With Heart Failure With Reduced Ejection Fraction in Japan - A Report From the Japanese Registry of Acute Decompensated Heart Failure (JROADHF). Circ J 2023; 87:1380-1391. [PMID: 37121703 DOI: 10.1253/circj.cj-22-0774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND The present study aimed to clarify the regional variations in clinical practice and the prognosis of patients with heart failure with reduced ejection fraction (HFrEF) in Japan using the Japanese Registry of Acute Decompensated Heart Failure (JROADHF). METHODS AND RESULTS We recruited data of hospitalized patients with HFrEF (n=4,329) from the JROADHF. The patients were divided into 6 groups based on the region of Japan where they were hospitalized: Hokkaido-Tohoku (n=504), Kanto (n=958), Chubu (n=779), Kinki (n=902), Chugoku-Shikoku (n=446), and Kyushu (n=740). We compared the patients' characteristics, including etiology of HF and prognosis after discharge. The age of the patients was lowest in the Kanto and Kinki regions. In contrast, there were no differences in the prevalence of comorbidities, levels of B-type natriuretic peptide, or left ventricular EF among the 6 groups. Post-discharge cardiospecific prognosis, specifically, the composite of cardiac death or HF hospitalization, cardiac death, and HF hospitalization, was comparable among the 6 regions. CONCLUSIONS There were no differences in cardiospecific prognosis in patients with HFrEF among the 6 regions in Japan.
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Affiliation(s)
- Yu Sato
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
- Department of Clinical Laboratory Sciences, Fukushima Medical University
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Takeshi Tohyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
- Center for Clinical and Translational Research, Kyushu University Hospital
| | - Nobuyuki Enzan
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Shouji Matsushima
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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23
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Boriani G, Imberti JF, Bonini N, Carriere C, Mei DA, Zecchin M, Piccinin F, Vitolo M, Sinagra G. Remote multiparametric monitoring and management of heart failure patients through cardiac implantable electronic devices. Eur J Intern Med 2023; 115:1-9. [PMID: 37076404 DOI: 10.1016/j.ejim.2023.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
In this review we focus on heart failure (HF) which, as known, is associated with a substantial risk of hospitalizations and adverse cardiovascular outcomes, including death. In recent years, systems to monitor cardiac function and patient parameters have been developed with the aim to detect subclinical pathophysiological changes that precede worsening HF. Several patient-specific parameters can be remotely monitored through cardiac implantable electronic devices (CIED) and can be combined in multiparametric scores predicting patients' risk of worsening HF with good sensitivity and moderate specificity. Early patient management at the time of pre-clinical alerts remotely transmitted by CIEDs to physicians might prevent hospitalizations. However, it is not clear yet which is the best diagnostic pathway for HF patients after a CIED alert, which kind of medications should be changed or escalated, and in which case in-hospital visits or in-hospital admissions are required. Finally, the specific role of healthcare professionals involved in HF patient management under remote monitoring is still matter of definition. We analyzed recent data on multiparametric monitoring of patients with HF through CIEDs. We provided practical insights on how to timely manage CIED alarms with the aim to prevent worsening HF. We also discussed the role of biomarkers and thoracic echo in this context, and potential organizational models including multidisciplinary teams for remote care of HF patients with CIEDs.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy.
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy
| | - Cosimo Carriere
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Davide A Mei
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy
| | - Massimo Zecchin
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Francesca Piccinin
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
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24
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Chatur S, Vaduganathan M, Claggett B, Vardeny O, Desai AS, Jhund PS, de Boer RA, Lam CSP, Kosiborod MN, Shah SJ, Martinez F, Inzucchi SE, Hernandez AF, Haddad T, Mitter SS, Miao ZM, Petersson M, Maria Langkilde A, McMurray JJV, Solomon SD. Dapagliflozin and diuretic utilization in heart failure with mildly reduced or preserved ejection fraction: the DELIVER trial. Eur Heart J 2023; 44:2930-2943. [PMID: 37220093 PMCID: PMC10484057 DOI: 10.1093/eurheartj/ehad283] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/20/2023] [Accepted: 05/01/2023] [Indexed: 05/25/2023] Open
Abstract
AIMS Dapagliflozin reduced the combined risk of worsening heart failure or cardiovascular death among patients with heart failure with mildly reduced or preserved ejection fraction. In this study, the safety and efficacy of dapagliflozin according to background diuretic therapy and the influence of dapagliflozin on longitudinal diuretic use were evaluated. METHODS AND RESULTS In this pre-specified analysis of the Dapagliflozin Evaluation to Improve the LIVEs of Patients With Preserved Ejection Fraction Heart Failure (DELIVER) trial, the effects of dapagliflozin vs. placebo were assessed in the following subgroups: no diuretic, non-loop diuretic, and loop diuretic furosemide equivalent doses of <40, 40, and >40 mg, respectively. Of the 6263 randomized patients, 683 (10.9%) were on no diuretic, 769 (12.3%) were on a non-loop diuretic, and 4811 (76.8%) were on a loop diuretic at baseline. Treatment benefits of dapagliflozin on the primary composite outcome were consistent by diuretic use categories (Pinteraction = 0.64) or loop diuretic dose (Pinteraction = 0.57). Serious adverse events were similar between dapagliflozin and placebo arms, irrespective of diuretic use or dosing. Dapagliflozin reduced new initiation of loop diuretics by 32% [hazard ratio (HR) 0.68; 95% confidence interval (CI): 0.55-0.84, P < 0.001] but did not influence discontinuations/disruptions (HR 0.98; 95% CI: 0.86-1.13, P = 0.83) in follow-up. First sustained loop diuretic dose increases were less frequent, and sustained dose decreases were more frequent in patients treated with dapagliflozin: net difference of -6.5% (95% CI: -9.4 to -3.6; P < 0.001). The mean dose of loop diuretic increased over time in the placebo arm, a longitudinal increase that was significantly attenuated with treatment with dapagliflozin (placebo-corrected treatment effect of -2.5 mg/year; 95% CI: -1.5, -3.7, P < 0.001). CONCLUSION In patients with heart failure with mildly reduced or preserved ejection fraction, the clinical benefits of dapagliflozin relative to placebo were consistent across a wide range of diuretic categories and doses with a similar safety profile. Treatment with dapagliflozin significantly reduced new loop diuretic requirement over time.
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Affiliation(s)
- Safia Chatur
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Orly Vardeny
- Minneapolis VA Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis, MN, USA
| | - Akshay S Desai
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Carolyn S P Lam
- National Heart Centre Singapore & Duke-National University of Singapore, Singapore, Singapore
| | - Mikhail N Kosiborod
- Saint Luke’s Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Tariq Haddad
- Department of Cardiology, Virginia Heart, Falls Church, VA, USA
| | | | - Zi Michael Miao
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Magnus Petersson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Yang Y, Zhang X, Fan Y, Zhang J, Chen B, Sun X, Zhao X. Correlation analysis of hysterectomy and ovarian preservation with depression. Sci Rep 2023; 13:9744. [PMID: 37328539 PMCID: PMC10275915 DOI: 10.1038/s41598-023-36838-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 06/11/2023] [Indexed: 06/18/2023] Open
Abstract
The relationship between hysterectomy and ovarian preservation and depression is controversial. This study aimed to determine the association of hysterectomy and ovarian preservation with depression using National Health and Nutrition Examination Survey. To assess the association between hysterectomy with or without ovariectomy and depression, we used 3 methods. Method 1: propensity score model (PSM) was established. Method 2 was logistics regression analysis of hysterectomy and depression before and after PSM. Method 3 was a logistics regression analysis of the relationship between hysterectomy and different depressive symptoms. At the same time, in order to evaluate the association between hysterectomy with or without oophorectomy and depression, we explored the effect of four different surgical procedures on depression using logistic regression equations. We enrolled 12,097 women, of whom 2763 underwent hysterectomy, 34.455% were positive for depression. After weighting, 33.825% of the total sample had a PHQ ≥ 5. Finally, a total of 2778 women were successfully matched by propensity score, and 35.537% of them were positive for depression. The OR for PHQ ≥ 5 was 1.236 after crude adjustment of covariates and 1.234 after exact adjustment. This suggests that Hysterectomy is strongly associated with positive depression. Positive depression (PHQ ≥ 5) was associated with little interest, feeling down and trouble concentrating. It was not associated with trouble sleeping, feeling tired, poor appetite, feeling bad, slow moving or speaking, and suicidal thoughts. Oophorectomy-alone is not associated with depression. Hysterectomy-alone is a risk factor for depression, but Hysterectomy combined with Oophorectomy has a stronger correlation with depression than Hysterectomy-alone. Women who have had a Hysterectomy are at higher risk of depression than women who have not had a Hysterectomy, and this risk may be exacerbated if the uterus and ovaries are removed. When clinically appropriate, surgeons should try to preserve the patient's ovaries.
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Affiliation(s)
- Yunhong Yang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangqi Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yinuo Fan
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiahao Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bingchun Chen
- Taihe Town Health Center, Baiyun District, Guangzhou, China
| | - Xiaofeng Sun
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Xiaofeng Zhao
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Han Y, Zuo Y, Luo Z, Ju M, Hua J, He B, Wu Y, Zhang J. Positive sputum culture of Candida spp . as a risk factor for 30-day mortality in patients with hospital-acquired pneumonia: A propensity-score matched retrospective clinical study. CHINESE MEDICAL JOURNAL PULMONARY AND CRITICAL CARE MEDICINE 2023; 1:113-118. [PMID: 39170823 PMCID: PMC11332850 DOI: 10.1016/j.pccm.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Indexed: 08/23/2024]
Abstract
Background Candida species (Candida spp.) are commonly isolated microorganisms from lower respiratory tract (LRT) specimens of patients with hospital-acquired pneumonia (HAP); however, the clinical significance remains controversial. This study aimed to investigate the correlation between Candida spp. in the LRT and the clinical features and prognosis of HAP. Methods This retrospective analysis included eligible patients with HAP from the database of a prospective study carried out between 2018 and 2019 in nine Chinese hospitals. Data on demographics, clinical characteristics, and prognosis were collected and analyzed. Propensity score matching (PSM) was used to balance the baseline characteristics. Results A total of 187 HAP patients were enrolled. After PSM of severity score, 27 cases with positive sputum culture of Candida spp. were compared with the control group at a ratio of 1:1. The Candida-positive group had more bacterial isolates in blood culture than the Candida-negative group (39.1% [9/23] vs. 7.7% [2/26],χ 2 = 6.928, effect size [ES] = 0.38, 95% CI: 0.12-0.61, P = 0.008). The proportion of patients with chronic lung diseases was significantly higher in the Candida-positive group (55.6% [15/27] vs. 22.2% [6/27],χ 2 = 6.312, ES = 0.34, 95% CI: 0.07-0.59, P = 0.012). The 30-day prognosis of HAP was significantly different between the two groups (80.8% [21/26] vs. 38.5% [10/26],χ 2 = 9.665, ES = 0.43, 95% CI: 0.19-0.66, P = 0.002). Univariable logistic regression analysis showed that LRT Candida spp. colonization was a risk factor for 30-day mortality of HAP (OR = 6.720, 95% CI: 1.915-23.577, P = 0.003). Conclusions Candida spp. in the LRT was associated with 30-day mortality of HAP. Patients with chronic underlying lung diseases tend to have Candida spp. colonization.
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Affiliation(s)
- Yaopin Han
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yihui Zuo
- Department of Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Minjie Ju
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jianlan Hua
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Binfeng He
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yixing Wu
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Liu H, Dai A, Zhou Z, Xu X, Gao K, Li Q, Xu S, Feng Y, Chen C, Ge C, Lu Y, Zou J, Wang S. An optimization for postpartum depression risk assessment and preventive intervention strategy based machine learning approaches. J Affect Disord 2023; 328:163-174. [PMID: 36758872 DOI: 10.1016/j.jad.2023.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Postpartum depression (PPD) is one of the most common psychiatric disorders for women after delivery. The establishment of an effective PPD prediction model helps to distinguish high-risk groups, and verifying whether such high-risk groups can benefit from drug intervention is very important for clinical guidance. METHODS We collected data of parturients that underwent a cesarean delivery. The Control group was divided into a training cohort and a testing cohort. Six different ML models were constructed and we compared their prediction performance in the testing cohort. For model interpretation, we introduced SHapley Additive exPlanations (SHAP). Then, training cohort, ketamine group and dexmedetomidine (DEX) group were classified as high or low risk for PPD by the model. A 1:1 propensity score matching (PSM) was performed to compare the incidence of PPD between two groups in different risk cohorts. RESULTS Extreme gradient enhancement (XGB) had the best recognition effect, with an area under the receiver operating characteristic curve (AUROC) of 0.789 (95 % CI 0.742-0.836) in the training cohort and 0.744 (95 % CI 0.655-0.823) in the testing cohort, respectively. A threshold of 21.5 % PPD risk probability was determined. After PSM, the results showed that the incidence of PPD in the two intervention groups was significantly different from the control group in the high-risk cohort (P < 0.001) but not in the low-risk cohort (P > 0.001). CONCLUSION Our study demonstrated that the XGB algorithm provided a more accurate in prediction of PPD risk, and it was beneficial to receive early intervention for the high-risk groups distinguished by the model.
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Affiliation(s)
- Hao Liu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 211198, China; Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Anran Dai
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 211198, China; Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Zhou Zhou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Xiaowen Xu
- Office of Clinical Trials, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Kai Gao
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Qiuwen Li
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Shouyu Xu
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Yunfei Feng
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Chen Chen
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing 210006, China
| | - Chun Ge
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing 210006, China
| | - Yuanjun Lu
- Research and Development Department, Hangzhou Million Happy Deer Co. Ltd, Hangzhou 310012, China
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing 210006, China.
| | - Saiying Wang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, China.
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Zheng R, Jin X, Liao W, Lin L. Association between the volume of fluid resuscitation and mortality modified by disease severity in patients with sepsis in ICU: a retrospective cohort study. BMJ Open 2023; 13:e066056. [PMID: 37041062 PMCID: PMC10106076 DOI: 10.1136/bmjopen-2022-066056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE The important effect modifiers of high disease severity on the relationship between the different volumes of early fluid resuscitation and prognosis in septic patients are unknown. Thus, this study was designed to assess whether the efficacy of different volumes in the early fluid resuscitation treatment of sepsis is affected by disease severity. DESIGN Retrospective cohort study. SETTING Adult intensive care unit (ICU) patients with sepsis from 2001 to 2012 in the MIMIC-III database. INTERVENTIONS The intravenous fluid volume within 6 hours after the sepsis diagnosis serves as the primary exposure. The patients were divided into the standard (≥ 30 mL/kg) and restrict (<30 mL/kg) groups. Disease severity was defined by the sequential organ failure assessment (SOFA) score at ICU admission. Propensity score matching analysis was performed to ensure the robustness of our results. PRIMARY AND SECONDARY OUTCOME MEASURES The primary endpoint of this study was 28-day mortality. Days without needing mechanical ventilation or vasopressor administration within 28-day of ICU admission serving as the secondary endpoint. RESULTS In total, 5154 consecutive individuals were identified in data analysis, 776 patients had a primary end-point event, 386 (49.68%) in the restrict group and 387 (49.81%) in the standard group. Compared with the restrict group, the standard group had higher 28-day mortality (adjusted HR, 1.32; 95% CI 1.03 to 1.70; p=0.03) in the subgroup with a sequential organ failure assessment (SOFA) score ≥10. By contrast, the risk of mortality reduction was modest in the subgroup with an SOFA score <10 (adjusted HR, 0.85; 95% CI 0.70 to 1.03; p=0.10). The effect of the interaction between the SOFA score and fluid resuscitation strategies on the 28-day mortality was significant (p=0.0035). CONCLUSIONS High disease severity modifies the relationship between the volume of fluid resuscitation and mortality in patients with sepsis in the ICU; future studies investigating this interaction are warranted.
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Affiliation(s)
- Rui Zheng
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Xinhao Jin
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Weichao Liao
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Ling Lin
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
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Predictors of Poor Very Early Diuretic Response and Effectiveness of Early Tolvaptan in Symptomatic Acute Heart Failure. Am J Cardiovasc Drugs 2023; 23:185-196. [PMID: 36739357 DOI: 10.1007/s40256-023-00571-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Diuretic response (DR) in patients with symptomatic acute decompensated heart failure (ADHF) has an impact on prognosis. This study aimed to identify predictive factors influencing acute 6 h poor DR and to assess DR after early administration of tolvaptan (TLV). METHODS This multicenter retrospective study included 1670 patients who were admitted for ADHF and received intravenous furosemide within 1 h of presentation in clinical scenario 1 or 2 defined based on initial systolic blood pressure ≥100 mmHg with severe symptoms (New York Heart Association class III or IV (n = 830). The score for the poor DR factors in the very acute phase was calculated in patients treated with furosemide-only diuretics (n = 439). The DR to TLV administration was also assessed in patients who received an additional dose of TLV within 6 h (n = 391). RESULTS The time since discharge from the hospital for a previous heart failure < 3 months (odds ratio [OR] 2.78, 95% confidence interval [CI] 1.34-5.83; p = 0.006), loop diuretics at admission (OR 3.05, 95% CI 1.74-5.36; p < 0.0001), and estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73 m2 (OR 2.99, 95% CI 1.58-5.74; p = 0.0007) were independent determinants of poor DR. The frequency of poor DR according to the risk stratification group was low risk (no risk factor), 18.9%; middle risk (one risk factor), 33.1%; and high risk (two to three risk factors), 58.0% (p < 0.0001). All risk groups demonstrated a significantly lower incidence of poor DR with early TLV administration: 10.7% in the early TLV group versus 18.9% in the loop diuretics group (p = 0.09) of the low-risk group; 18.4% versus 33.1% (p = 0.01) in the middle-risk group, and 20.2% versus 58.0% (p < 0.0001) in the high-risk group. CONCLUSION Early administration of TLV in patients with predicted poor DR contributed to a significant diuretic effect and suppression of worsening renal function.
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Miyazaki D, Tarasawa K, Fushimi K, Fujimori K. Risk Factors with 30-Day Readmission and the Impact of Length of Hospital Stay on It in Patients with Heart Failure: A Retrospective Observational Study Using a Japanese National Database. TOHOKU J EXP MED 2023; 259:151-162. [PMID: 36543246 DOI: 10.1620/tjem.2022.j114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Heart failure is a major disease, and its 30-day readmission (readmission within 30-day after discharge) negatively impacts patients and society. Thus, we need to stratify the risk and prevent readmission. We aimed to investigate risk factors associated with 30-day readmission and examine the impact of length of hospital stay (LOS) on 30-day readmission. Using the Diagnosis-Procedure-Combination database from April 2018 to March 2021, we conducted multiple logistic regression to investigate risk factors with 30-day readmission. Also, we conducted subgroup analysis in the short LOS group. To examine the association between LOS and 30-day readmission, we performed propensity score matching between the short and middle LOS groups. As a result, we categorized 10,283 patients and 169,842 patients into the readmission group and the no-readmission group. We identified the following factors as the risk of readmission: short LOS, female, smoking, older age, lower body mass index, lower barthel index, artificial ventilator, beta-blockers, thiazides, tolvaptan, loop diuretics, carperitides, class Ⅲ antiarrhythmic agents, myocardial infarction, diabetes, renal disease, atrial fibrillation, dilated cardiomyopathy, and discharge to home. As a subgroup analysis in the short LOS group, we revealed that the short LOS group risk factors differed from overall. After propensity score matching in the short LOS group and middle LOS group, 37,199 pairs were matched, and we revealed that shorter LOS increases the risk of readmission. These results demonstrated that shortened LOS increases 30-day readmission, and risk factors are unique to each LOS. We suggest stratifying the readmission risk and being careful with early discharge.
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Affiliation(s)
- Daisuke Miyazaki
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine
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Yang D, Lan J, Cen J, Han Y, Hu H. Association Between Hypertension and New-Onset Non-Alcoholic Fatty Liver Disease in Chinese Non-Obese People: A Longitudinal Cohort Study. Diabetes Metab Syndr Obes 2023; 16:345-363. [PMID: 36788988 PMCID: PMC9922508 DOI: 10.2147/dmso.s396011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/18/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Quantification of the relationship between hypertension and non-alcoholic fatty liver disease (NAFLD) risk is limited and controversial. This study aimed to investigate the relationship between hypertension and NAFLD in non-obese Chinese and to use different methods to demonstrate that hypertension is an independent risk factor for NAFLD. METHODS On 16,153 nonobese individuals, a retrospective cohort study was conducted in China to examine the impact of hypertension on incident NAFLD. We compared five methods: multivariable Cox proportional-hazards regression, propensity score-matched (PSM) analysis, propensity score adjustment method (considering the propensity score as a covariate in a multivariable Cox proportional-hazard regression), and two propensity score-based weighted methods-The first one estimated the hypertension effect in the overall study population-inverse probability of treatment weights (IPTW), the other in the hypertensive population-standardized mortality ratio (SMR) weights. We also used a genetic matching (GenMatch) algorithm to match the participants for sensitive analysis. RESULTS Between 2010 and 2014, 16,153 participants met our inclusion criteria, including 2427 (15.03%) with hypertension. A total of 2321 (14.37%) participants developed NAFLD during the median follow-up of 2.98 years. The crude hazard ratio (HR) between hypertension and incident NAFLD was 2.05 (95% confidence interval (CI): 1.87, 2.25). The adjusted HR depended on the different methods, ranging from 1.09 (95% CI: 0.77, 1.23) for the PSM method to 2.24 (95% CI: 2.05, 2.44) for the SMR weighted analysis. Hypertensive participants with high propensity scores had a higher risk of developing NAFLD in the future. Excluding participants with propensity scores <8% yielded comparable hazard ratios with a narrower range, from 1.04 to 1.80. After adjusting for the confounding variables, the relationship also existed in the GenMatch cohort as a sensitivity analysis (HR=1.06, 95% CI 1.01-1.13). CONCLUSION Hypertension is a significant cause of NAFLD in Chinese adults in non-obese Chinese adults, with the hazard ratio ranging from 1.09 to 2.24.
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Affiliation(s)
- Dezhi Yang
- Department of Cardiology Second Ward, Hechi People’s Hospital, Hechi, People’s Republic of China
| | - Jing Lan
- Department of Gastroenterology, Hechi People’s Hospital, Hechi, People’s Republic of China
| | - Ji Cen
- Department of Nephrology, Hechi People’s Hospital, Hechi, People’s Republic of China
| | - Yong Han
- Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, People’s Republic of China
- Department of Emergency, The First Affiliated Hospital of Shenzhen University, Shenzhen, People’s Republic of China
- Shenzhen University Health Science Center, Shenzhen University, Shenzhen, People’s Republic of China
- Correspondence: Yong Han, Department of Emergency, Shenzhen Second People’s Hospital, No. 3002 Sungang Road, Futian District, Shenzhen, Guangdong Province, People’s Republic of China, Tel +86-755-83366388, Email
| | - Haofei Hu
- Shenzhen University Health Science Center, Shenzhen University, Shenzhen, People’s Republic of China
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, People’s Republic of China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, People’s Republic of China
- Haofei Hu, Department of Nephrology, Shenzhen Second People’s Hospital, No. 3002 Sungang Road, Futian District, Shenzhen, Guangdong Province, People’s Republic of China, Tel +86-755-83366388, Email
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Potter GE, Bonnett T, Rubenstein K, Lindholm DA, Rapaka RR, Doernberg SB, Lye DC, Mularski RA, Hynes NA, Kline S, Paules CI, Wolfe CR, Frank MG, Rouphael NG, Deye GA, Sweeney DA, Colombo RE, Davey RT, Mehta AK, Whitaker JA, Castro JG, Amin AN, Colombo CJ, Levine CB, Jain MK, Maves RC, Marconi VC, Grossberg R, Hozayen S, Burgess TH, Atmar RL, Ganesan A, Gomez CA, Benson CA, Lopez de Castilla D, Ahuja N, George SL, Nayak SU, Cohen SH, Lalani T, Short WR, Erdmann N, Tomashek KM, Tebas P. Temporal Improvements in COVID-19 Outcomes for Hospitalized Adults: A Post Hoc Observational Study of Remdesivir Group Participants in the Adaptive COVID-19 Treatment Trial. Ann Intern Med 2022; 175:1716-1727. [PMID: 36442063 PMCID: PMC9709721 DOI: 10.7326/m22-2116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The COVID-19 standard of care (SOC) evolved rapidly during 2020 and 2021, but its cumulative effect over time is unclear. OBJECTIVE To evaluate whether recovery and mortality improved as SOC evolved, using data from ACTT (Adaptive COVID-19 Treatment Trial). DESIGN ACTT is a series of phase 3, randomized, double-blind, placebo-controlled trials that evaluated COVID-19 therapeutics from February 2020 through May 2021. ACTT-1 compared remdesivir plus SOC to placebo plus SOC, and in ACTT-2 and ACTT-3, remdesivir plus SOC was the control group. This post hoc analysis compared recovery and mortality between these comparable sequential cohorts of patients who received remdesivir plus SOC, adjusting for baseline characteristics with propensity score weighting. The analysis was repeated for participants in ACTT-3 and ACTT-4 who received remdesivir plus dexamethasone plus SOC. Trends in SOC that could explain outcome improvements were analyzed. (ClinicalTrials.gov: NCT04280705 [ACTT-1], NCT04401579 [ACTT-2], NCT04492475 [ACTT-3], and NCT04640168 [ACTT-4]). SETTING 94 hospitals in 10 countries (86% U.S. participants). PARTICIPANTS Adults hospitalized with COVID-19. INTERVENTION SOC. MEASUREMENTS 28-day mortality and recovery. RESULTS Although outcomes were better in ACTT-2 than in ACTT-1, adjusted hazard ratios (HRs) were close to 1 (HR for recovery, 1.04 [95% CI, 0.92 to 1.17]; HR for mortality, 0.90 [CI, 0.56 to 1.40]). Comparable patients were less likely to be intubated in ACTT-2 than in ACTT-1 (odds ratio, 0.75 [CI, 0.53 to 0.97]), and hydroxychloroquine use decreased. Outcomes improved from ACTT-2 to ACTT-3 (HR for recovery, 1.43 [CI, 1.24 to 1.64]; HR for mortality, 0.45 [CI, 0.21 to 0.97]). Potential explanatory factors (SOC trends, case surges, and variant trends) were similar between ACTT-2 and ACTT-3, except for increased dexamethasone use (11% to 77%). Outcomes were similar in ACTT-3 and ACTT-4. Antibiotic use decreased gradually across all stages. LIMITATION Unmeasured confounding. CONCLUSION Changes in patient composition explained improved outcomes from ACTT-1 to ACTT-2 but not from ACTT-2 to ACTT-3, suggesting improved SOC. These results support excluding nonconcurrent controls from analysis of platform trials in rapidly changing therapeutic areas. PRIMARY FUNDING SOURCE National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Gail E Potter
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland (G.E.P.)
| | - Tyler Bonnett
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland (T.B., K.R.)
| | - Kevin Rubenstein
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland (T.B., K.R.)
| | - David A Lindholm
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, and Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas (D.A.L.)
| | - Rekha R Rapaka
- University of Maryland Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland (R.R.R.)
| | - Sarah B Doernberg
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco, California (S.B.D.)
| | - David C Lye
- National Centre for Infectious Diseases, Tan Tock Seng Hospital, Yong Loo Lin School of Medicine, and Lee Kong Chian School of Medicine, Singapore (D.C.L.)
| | - Richard A Mularski
- Department of Pulmonary and Critical Care Medicine, Northwest Permanente PC, and Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (R.A.M.)
| | - Noreen A Hynes
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (N.A.H.)
| | - Susan Kline
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota Medical School, Minneapolis, Minnesota (S.K.)
| | - Catharine I Paules
- Division of Infectious Diseases, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania (C.I.P.)
| | - Cameron R Wolfe
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina (C.R.W.)
| | - Maria G Frank
- Department of Medicine, Denver Health Hospital Authority, Denver, Colorado, and University of Colorado School of Medicine, Aurora, Colorado (M.G.F.)
| | - Nadine G Rouphael
- Hope Clinic, Emory Vaccine Center, Infectious Diseases Division, Atlanta, Georgia (N.G.R.)
| | - Gregory A Deye
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland (G.A.D., S.U.N., K.M.T.)
| | - Daniel A Sweeney
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, California (D.A.S.)
| | - Rhonda E Colombo
- Madigan Army Medical Center, Tacoma, Washington, Infectious Diseases Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, and The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland (R.E.C.)
| | - Richard T Davey
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland (R.T.D.)
| | - Aneesh K Mehta
- Division of Infectious Diseases, Emory University School of Medicine, and National Emerging Special Pathogens Training and Education Center, Atlanta, Georgia (A.K.M.)
| | - Jennifer A Whitaker
- Departments of Molecular Virology and Microbiology and Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas (J.A.W.)
| | - Jose G Castro
- Division of Infectious Diseases, University of Miami, Miami, Florida (J.G.C.)
| | - Alpesh N Amin
- Department of Medicine, University of California, Irvine, Irvine, California (A.N.A.)
| | - Christopher J Colombo
- Madigan Army Medical Center, Tacoma, Washington, and Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland (C.J.C.)
| | - Corri B Levine
- Department of Internal Medicine, Division of Infectious Disease, University of Texas Medical Branch, Galveston, Texas (C.B.L.)
| | - Mamta K Jain
- Department of Internal Medicine, Division of Infectious Disease and Geographic Medicine, UT Southwestern Medical Center, and Parkland Health & Hospital System, Dallas, Texas (M.K.J.)
| | - Ryan C Maves
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, and Infectious Diseases Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland (R.C.M.)
| | - Vincent C Marconi
- Emory University School of Medicine, Rollins School of Public Health, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia (V.C.M.)
| | - Robert Grossberg
- Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York (R.G.)
| | - Sameh Hozayen
- Department of Medicine, Division of Hospital Medicine, University of Minnesota, Minneapolis, Minnesota (S.H.)
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland (T.H.B.)
| | - Robert L Atmar
- Department of Medicine, Baylor College of Medicine, Houston, Texas (R.L.A.)
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., and Walter Reed National Military Medical Center, Bethesda, Maryland (A.G.)
| | - Carlos A Gomez
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska (C.A.G.)
| | - Constance A Benson
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California (C.A.B.)
| | - Diego Lopez de Castilla
- Division of Infectious Diseases, Evergreen Health Medical Center, Kirkland, Washington (D.L.)
| | - Neera Ahuja
- Department of Internal Medicine, Stanford University Medical Center, Palo Alto, California (N.A.)
| | - Sarah L George
- Saint Louis University and St. Louis VA Medical Center, Saint Louis, Missouri (S.L.G.)
| | - Seema U Nayak
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland (G.A.D., S.U.N., K.M.T.)
| | - Stuart H Cohen
- Division of Infectious Diseases, University of California, Davis, Sacramento, California (S.H.C.)
| | - Tahaniyat Lalani
- Naval Medical Center Portsmouth, Portsmouth, Virginia, Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, and The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland (T.L.)
| | - William R Short
- Department of Medicine, Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania (W.R.S.)
| | - Nathaniel Erdmann
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (N.E.)
| | - Kay M Tomashek
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland (G.A.D., S.U.N., K.M.T.)
| | - Pablo Tebas
- Division of Infectious Diseases/Clinical Trials Unit, University of Pennsylvania, Philadelphia, Pennsylvania (P.T.)
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Mortality in Elderly Patients Taking Furosemide: Prospective Cohorts Study. Int J Hypertens 2022; 2022:4708259. [PMID: 36345286 PMCID: PMC9637038 DOI: 10.1155/2022/4708259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/02/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Low blood pressure (BP) has been proposed as a risk factor of death in elderly patients. However, this association could be partially accounted for by the deleterious effects of BP-lowering drugs. We analyzed whether these drugs are associated to an increased risk of death in elderly patients taking multiple potential confounders into account. Design This is a prospective cohort study. Setting and Participants. Probabilistic sample of 772 community-dwelling patients aged >65 years living in Spain, who were appointed for an initial clinical visit and followed up through telephone calls 4, 6, 9, 12, and 60 months afterwards. Methods At baseline visit, BP was measured using standardized methods, and BP medications and risk factors of death in elderly patients (BMI, oxygen saturation, toxic habits, comorbidity, muscular strength, and functional and cognitive capacity) were collected. During the follow-up, the vital status of patients and the date of death were ascertained. Results During a median 5-year follow-up, 226 all-cause deaths occurred among the 686 participants included in the analysis. In a Cox regression model that included all the BP drug classes, diuretics and nitrites were significantly associated with mortality (p < 0.005). Within diuretics, furosemide was found to be responsible for the association of the group. In multivariable Cox regression models adjusted for BP and the rest of the mortality risk factors, furosemide remained as the only BP drug that was independently associated with mortality (hazard ratio 2.34; p < 0.01). Conclusions Furosemide was prospectively associated with increased mortality in older people. If confirmed, this drug should be taken into account by prescribers and considered a confounder in BP studies.
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Yano M, Nishino M, Ukita K, Kawamura A, Nakamura H, Matsuhiro Y, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Egami Y, Tanouchi J, Yamada T, Yasumura Y, Tamaki S, Hayashi T, Nakagawa A, Nakagawa Y, Sotomi Y, Nakatani D, Hikoso S, Sakata Y. Clinical impact of blood urea nitrogen, regardless of renal function, in heart failure with preserved ejection fraction. Int J Cardiol 2022; 363:94-101. [PMID: 35777488 DOI: 10.1016/j.ijcard.2022.06.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/06/2022] [Accepted: 06/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Blood urea nitrogen (BUN) reflects decreased glomerular filtration rate (GFR). The effect of BUN on clinical outcomes, excluding the impact of GFR, in heart failure with preserved ejection fraction (HFpEF) patients remains unknown. METHODS We enrolled HFpEF (left ventricular ejection fraction ≥50%) patients hospitalized due to acute decompensated heart failure (HF) from PURSUIT-HFpEF registry which was prospective, multicenter and observational study. For excluding the effect of renal function on BUN value, propensity score-matching was performed using the variables which were associated with GFR. The incidence of composite of all-cause death and HF readmission among the patients stratified by BUN and the association between BUN and echocardiographic parameters in HFpEF patients were evaluated. RESULTS We finally analyzed 1029 patients. In the present study, BUN cut-off value was defined as 24.4 mg/dL, which was the median value in overall population. The high and low BUN groups consisted of 193 patients after 1:1 propensity score-matching, respectively. The median follow-up duration was 401 days and the composite endpoint occurred in 129 patients (33.4%). Kaplan-Meier analysis showed the high BUN group had a significantly greater risk of the composite endpoint than the low group in the propensity score-matched pairs (p = 0.032). BUN value significantly correlated with left atrial volume index by multiple regression analysis using echocardiographic parameters (standardized beta-coefficient = 0.139, p = 0.043). CONCLUSION BUN was a useful marker for the composite of all-cause death and HF readmission, regardless of the baseline renal function and correlated with left atrial function in HFpEF patients. CLINICAL TRIAL REGISTRATION UMIN000021831 <https://uplaod.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000024414>; PURSUIT-HFpEF.
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Affiliation(s)
- Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan.
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Hitoshi Nakamura
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Yutaka Matsuhiro
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Yasuharu Matsunaga-Lee
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka 591-8025, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, 3-1-56 Mandaihigashi, Sumiyoshi-ku, Osaka 558-8558, Japan
| | - Yoshio Yasumura
- Division of Cardiology, Amagasaki Chuo Hospital, 1-12-1 Shioe, Amagasaki, Hyogo 661-0076, Japan
| | - Shunsuke Tamaki
- Department of Cardiology, Rinku General Medical Center, 2-23 Ourai-kita, Rinku, Izumisano, Osaka 598-8577, Japan
| | - Takaharu Hayashi
- Cardiovascular Division, Osaka Police Hospital, 10-31 Kitayamacho, Tennoji-ku, Osaka 543-0035, Japan
| | - Akito Nakagawa
- Division of Cardiology, Amagasaki Chuo Hospital, 1-12-1 Shioe, Amagasaki, Hyogo 661-0076, Japan; Department of Medical Informatics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
| | - Yusuke Nakagawa
- Division of Cardiology, Kawanishi City Hospital, 1-21-5 Higashiueno, Kawanishi 666-0195, Japan
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
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Simoneau G, Pellegrini F, Debray TPA, Rouette J, Muñoz J, Platt RW, Petkau J, Bohn J, Shen C, de Moor C, Karim ME. Recommendations for the use of propensity score methods in multiple sclerosis research. Mult Scler 2022; 28:1467-1480. [PMID: 35387508 PMCID: PMC9260471 DOI: 10.1177/13524585221085733] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/03/2022] [Accepted: 02/17/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND With many disease-modifying therapies currently approved for the management of multiple sclerosis, there is a growing need to evaluate the comparative effectiveness and safety of those therapies from real-world data sources. Propensity score methods have recently gained popularity in multiple sclerosis research to generate real-world evidence. Recent evidence suggests, however, that the conduct and reporting of propensity score analyses are often suboptimal in multiple sclerosis studies. OBJECTIVES To provide practical guidance to clinicians and researchers on the use of propensity score methods within the context of multiple sclerosis research. METHODS We summarize recommendations on the use of propensity score matching and weighting based on the current methodological literature, and provide examples of good practice. RESULTS Step-by-step recommendations are presented, starting with covariate selection and propensity score estimation, followed by guidance on the assessment of covariate balance and implementation of propensity score matching and weighting. Finally, we focus on treatment effect estimation and sensitivity analyses. CONCLUSION This comprehensive set of recommendations highlights key elements that require careful attention when using propensity score methods.
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Affiliation(s)
| | | | | | - Julie Rouette
- Department of Epidemiology, Biostatistics and
Occupational Health, McGill University, Montreal, QC, Canada/Centre for
Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital,
Montreal, QC, Canada
| | - Johanna Muñoz
- University Medical Center Utrecht, Utretch, The
Netherlands
| | - Robert W. Platt
- Department of Pediatrics, McGill University,
Montreal, QC, Canada/Department of Epidemiology, Biostatistics and
Occupational Health, McGill University, Montreal, QC, Canada/Centre for
Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital,
Montreal, QC, Canada
| | - John Petkau
- Department of Statistics, The University of
British Columbia, Vancouver, BC, Canada
| | | | | | | | - Mohammad Ehsanul Karim
- School of Population and Public Health, The
University of British Columbia, Vancouver, BC, Canada/Centre for Health
Evaluation and Outcome Sciences, The University of British Columbia,
Vancouver, BC, Canada
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36
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Kawai T, Nakatani D, Watanabe T, Yamada T, Morita T, Sakata Y, Hikoso S, Mizuno H, Suna S, Kitamura T, Okada K, Dohi T, Sotomi Y, Sunaga A, Kida H, Oeun B, Sato T, Sato H, Hori M, Komuro I, Fukunami M, Sakata Y. Loop Diuretic Use is Associated With Adverse Clinical Outcomes in Acute Myocardial Infarction Patients With Low Volume Status: Loop diuretics in AMI patient. Curr Probl Cardiol 2022; 47:101326. [PMID: 35870545 DOI: 10.1016/j.cpcardiol.2022.101326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/17/2022] [Accepted: 07/17/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little information is available on the difference in the prognostic impact of loop diuretics in patients with acute myocardial infarction (AMI) based on plasma volume status. METHODS A total of 3,364 survivors of AMI who were registered in the large database of the Osaka Acute Coronary Insufficiency Study (OACIS) were studied. Plasma volume status was assessed by the estimated plasma volume status (ePVS) that was calculated based on a weight- and hematocrit-based formula at discharge. The endpoint was a composite endpoint of all-cause death and rehospitalization due to heart failure for 5 years. RESULTS During a median follow-up period of 1.9 years, 90 and 223 patients had events in the groups with low ePVS (<median value of 4.07%) and high ePVS (≥4.07%), respectively. Multivariable Cox regression analysis showed that loop diuretics use was independently associated with an increased risk of the composite endpoint in the low ePVS group (hazard ratio [HR], 2.572; 95% confidence interval [CI], 1.386-4.771; p=0.002), but not in the high ePVS group (HR, 1.028; 95% CI, 0.698-1.512; p=0.890). These results were unchanged even in the propensity-score matched cohorts. There was no heterogeneity in the increased risk of the primary endpoints between various patient characteristics and loop diuretic use in the matched cohorts. CONCLUSION Prescription of loop diuretics at discharge was associated with increased risk of poor long-term prognosis in patients with AMI without PV expansion, but not with PV expansion. Therefore, careful observation is needed when loop diuretics are prescribed for AMI patients without PV expansion.
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Affiliation(s)
- Tsutomu Kawai
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Tetsuya Watanabe
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Takashi Morita
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroya Mizuno
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shinichiro Suna
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoharu Dohi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akihiro Sunaga
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirota Kida
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Bolrathanak Oeun
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Taiki Sato
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroshi Sato
- School of Human Welfare Studies, Kwansei Gakuin University, Nishinomiya, Japan
| | - Masatsugu Hori
- Osaka Prefectural Hospital Organization Osaka International Cancer Institute, Osaka, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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Imaeda S, Shiraishi Y, Kohsaka S, Niimi N, Goda A, Nagatomo Y, Takei M, Saji M, Nakano S, Kohno T, Fukuda K, Yoshikawa T. Use of short-acting vs. long-acting loop diuretics after heart failure hospitalization. ESC Heart Fail 2022; 9:2967-2977. [PMID: 35730147 DOI: 10.1002/ehf2.14030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/05/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS Furosemide, a short-acting loop diuretic (SD), is the dominant agent prescribed for heart failure (HF) in clinical practice. However, accumulating data suggests that long-acting loop diuretics (LD), such as torsemide or azosemide, might have more favourable pharmacological profiles. This study aimed to investigate the relationship between the type of loop diuretics and long-term outcomes among patients hospitalized for acute HF enrolled in a contemporary multicentre registry. METHODS AND RESULTS Within the West Tokyo Heart Failure Registry from 2006 to 2017, a total of 2680 patients (60.1% men with a median age of 77 years) were analysed. The patients were characterized by the type of diuretics used at the time of discharge; 2073 (77.4%) used SD, and 607 (22.6%) used LD. The primary endpoint was composite of all-cause death or HF re-admission after discharge, and the secondary endpoints were all-cause death and HF re-admission, respectively. During the median follow-up period of 2.1 years, 639 patients died [n = 519 (25.0%) in the SD group; n = 120 (19.8%) in the LD group], and 868 patients were readmitted for HF [n = 697 (33.6%) in the SD group; n = 171 (28.2%) in the LD group]. After multivariable adjustment, the LD group had lower risk for the composite outcome [hazard ratio (HR), 0.80; 95% confidence interval (CI), 0.66-0.96; P = 0.017], including all-cause death (HR; 0.73; 95% CI; 0.54-0.99; P = 0.044) and HF re-admission (HR, 0.81; 95% CI, 0.66-0.99; P = 0.038), than the SD group. Propensity score matching yielded estimates that were consistent with those of the multivariable analyses, with sub-group analyses demonstrating that use of LD was associated with favourable outcomes predominantly in younger patients with reduced ejection fraction. CONCLUSIONS LD was associated with lower risk of long-term outcomes in patients with HF and a recent episode of acute decompensation.
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Affiliation(s)
- Shohei Imaeda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Nozomi Niimi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University Fuculty of Medicine, Tokyo, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Makoto Takei
- Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Fuculty of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Han Y, Hu H, Liu Y, Li Q, Huang Z, Wang Z, Liu D, Wei L. The Association Between Congestive Heart Failure and One-Year Mortality After Surgery in Singaporean Adults: A Secondary Retrospective Cohort Study Using Propensity-Score Matching, Propensity Adjustment, and Propensity-Based Weighting. Front Cardiovasc Med 2022; 9:858068. [PMID: 35783819 PMCID: PMC9247191 DOI: 10.3389/fcvm.2022.858068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although congestive heart failure (CHF) is considered a risk factor for postoperative mortality, reliable quantification of the relationship between CHF and postoperative mortality risk is limited. We aimed to investigate the association between CHF and 1-year mortality after surgery in a large cohort of the Singaporean population. Methods In this retrospective cohort study, the study population included 69,032 adult patients who underwent surgery at Singapore General Hospital between 1 January 2012 and 31 October 2016. The target independent and dependent variables were CHF and 1-year mortality after surgery, respectively. Propensity score was estimated using a non-parsimonious multivariable logistic regression model. Multivariable adjustment, propensity score matching, propensity score adjustment, and propensity score-based weighting Cox proportional-hazards regression were performed to investigate the association between CHF and 1-year mortality after surgery. Results The multivariate-adjusted hazard ratio (HR) in the original cohort was 1.39 (95% confidence interval (CI): 1.20–1.61, P < 0.001). In additional propensity score adjustment, the HR between CHF and 1-year mortality after surgery was 1.34 (95% CI: 1.15–1.56, P < 0.001). In the propensity score-matched cohort, the multivariate-adjusted Cox proportional hazard regression model analysis showed participants with CHF had a 54% increased risk of 1-year mortality after surgery (HR 1.54, 95% CI: 1.19–1.98, P < 0.001). The multivariate-adjusted HR of the inverse probability of treatment-weighted and standardised mortality ratio-weighted cohorts was 1.34 (95% CI: 1.10–1.62, P = 0.004) and 1.24 (95% CI: 1.17–1.32, P < 0.001), respectively. Conclusion CHF is an independent risk factor for 1-year mortality after surgery in patients undergoing surgery. Depending on the statistical method, patients with CHF had a 24–54% increased risk of 1-year all-cause mortality after surgery. This provides a reference for optimising clinical decision-making, improving preoperative consultation, and promoting clinical communication.
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Affiliation(s)
- Yong Han
- Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Yufei Liu
- Department of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Qiming Li
- Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Zhiqiang Huang
- Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Zhibin Wang
- Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Dehong Liu
- Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, China
- *Correspondence: Dehong Liu,
| | - Longning Wei
- Department of Emergency, Hechi People’s Hospital, Hechi, China
- Longning Wei,
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Lei X, Qingqing L, Weijie Y, Li P, Huang C, Kexun Y, Zihua C. Effect of surgical treatment for anorectal melanoma: a propensity score-matched analysis of the Surveillance, Epidemiology, and End Results programme data. BMJ Open 2022; 12:e053339. [PMID: 35450893 PMCID: PMC9024256 DOI: 10.1136/bmjopen-2021-053339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Anorectal melanoma (AM) is a rare but aggressive tumour with limited information in the existing literature. This study aimed to assess the effect of surgical treatment for AM and predict the prognosis of affected patients. DESIGN A retrospective cohort study. SETTING Data of patients diagnosed with AM between 1975 and 2016 in the USA were collected from the Surveillance, Epidemiology, and End Results (SEER) database. PARTICIPANTS This study enrolled a total of 795 patients with AM from the SEER database and the validation cohort comprised 40 patients with AM enrolled from Chinese institutes. PRIMARY AND SECONDARY OUTCOME MEASURES Overall survival (OS) and AM-specific survival (AM-SS). RESULTS A total of 795 patients with AM diagnosed between 1975 and 2016 were enrolled in this study. Data over the past four decades showed a trend of increase in incidence rate. A nomogram based on a multivariate Cox regression model was generated to predict AM-SS. The C-index of the nomogram was 0.74 (95% CI 0.71 to 0.77) on internal verification. In the validation cohort, the C-index of the nomogram was 0.72 (95% CI 0.68 to 0.76). The results of propensity score matching (PSM) analysis showed that patients who underwent surgical treatment achieved significant survival (OS: log-rank=17.41, p<0.001; AM-SS: log-rank=14.55, p<0.001). Patients who underwent surgery were stratified into local and extended surgery subgroups. AM-SS and OS were also compared after PSM, but the results were not significantly different between the two surgery subgroups (all p>0.05). CONCLUSIONS The nomogram based on the analysis of SEER data showed good performance in predicting OS and AM-SS. Patients with AM can benefit from surgery; however, extensive surgery and appendectomy may not improve AM-SS or OS.
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Affiliation(s)
- Xiao Lei
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Luo Qingqing
- Department of Oncology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, People's Republic of China, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Yuan Weijie
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Peng Li
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Changhao Huang
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Yu Kexun
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Chen Zihua
- Department of Gastrointestinal Surgery, Xiangya Hospital of Central South University, Changsha, China
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Andrade L, Ortega-Legaspi JM, Awh K, Fuller S, Patel B, Tobin L, Wald J, Kim YY. Diuretic use in the adult Fontan. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Busgang SA, Waller LA, Colicino E, D’Agostino R, Hertz-Picciotto I, Gennings C. Selecting External Controls for Internal Cases Using Stratification Score Matching Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2549. [PMID: 35270242 PMCID: PMC8909853 DOI: 10.3390/ijerph19052549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022]
Abstract
Rare-disease registries can be useful for studying the associations between environmental exposures and disease severity, but often require the addition of a healthy comparison control group. Defining a surrogate control group, matched and balanced on potentially confounding variables, would allow for the comparison of exposure distributions with cases from a registry. In the present study, we assess whether controls selected externally, using stratification score (SS) matching, can serve as effective proxies for internal controls. In addition, we use methyl paraben (MEPB) to compare the estimated associations between an externally matched sample and case-control frequencies in a cohort with internally matched controls. We started with 225 eligible cases of autism spectrum disorder (ASD) from Childhood Autism Risks from Genetics and the Environment (CHARGE), 241 internal controls from CHARGE, and 265 external controls from the National Health and Nutrition Examination Survey (NHANES) cycles 2005-2016. We calculated the SSs using demographic covariates and matched 1:1 using a caliper method without a replacement. The distribution of the covariates and the mean squared error of the paired differences (MSEpaired) in the SSs between the internal and external group were similar (MSEpaired = 0.007 and 0.011, respectively). The association between MEPB and ASD compared to the controls was similar between the externally matched SS pairs and the original frequency matched cohort. Controls selected externally, via SS matching, can provide a comparable bias reduction to that provided by the internal controls, and therefore may be a useful strategy in situations when the internal controls are not available.
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Affiliation(s)
- Stefanie A. Busgang
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (E.C.); (C.G.)
| | - Lance A. Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30329, USA;
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (E.C.); (C.G.)
| | - Ralph D’Agostino
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27101, USA;
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences, University of California, Davis, CA 95616, USA;
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (E.C.); (C.G.)
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Albani S, Mesin L, Roatta S, De Luca A, Giannoni A, Stolfo D, Biava L, Bonino C, Contu L, Pelloni E, Attena E, Russo V, Antonini-Canterin F, Pugliese NR, Gallone G, De Ferrari GM, Sinagra G, Scacciatella P. Inferior Vena Cava Edge Tracking Echocardiography: A Promising Tool with Applications in Multiple Clinical Settings. Diagnostics (Basel) 2022; 12:427. [PMID: 35204518 PMCID: PMC8871248 DOI: 10.3390/diagnostics12020427] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/29/2022] [Indexed: 01/25/2023] Open
Abstract
Ultrasound (US)-based measurements of the inferior vena cava (IVC) diameter are widely used to estimate right atrial pressure (RAP) in a variety of clinical settings. However, the correlation with invasively measured RAP along with the reproducibility of US-based IVC measurements is modest at best. In the present manuscript, we discuss the limitations of the current technique to estimate RAP through IVC US assessment and present a new promising tool developed by our research group, the automated IVC edge-to-edge tracking system, which has the potential to improve RAP assessment by transforming the current categorical classification (low, normal, high RAP) in a continuous and precise RAP estimation technique. Finally, we critically evaluate all the clinical settings in which this new tool could improve current practice.
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Affiliation(s)
- Stefano Albani
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
| | - Luca Mesin
- Mathematical Biology & Physiology, Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy;
| | - Silvestro Roatta
- Integrative Physiology Lab, Department of Neuroscience, University of Turin, 10125 Turin, Italy;
| | - Antonio De Luca
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
| | - Alberto Giannoni
- Scuola Superiore Sant’Anna, 56127 Pisa, Italy;
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy
| | - Davide Stolfo
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
| | - Lorenza Biava
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Caterina Bonino
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Laura Contu
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Elisa Pelloni
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Emilio Attena
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli-Monaldi Hospital—A.O.R.N. Dei Colli, 80131 Naples, Italy; (E.A.); (V.R.)
| | - Vincenzo Russo
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli-Monaldi Hospital—A.O.R.N. Dei Colli, 80131 Naples, Italy; (E.A.); (V.R.)
| | | | | | - Guglielmo Gallone
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, 10124 Turin, Italy; (G.G.); (G.M.D.F.)
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, 10124 Turin, Italy; (G.G.); (G.M.D.F.)
| | - Gianfranco Sinagra
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
| | - Paolo Scacciatella
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
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Yang ST, Yang SQ, Duan KM, Tang YZ, Ping AQ, Bai ZH, Gao K, Shen Y, Chen MH, Yu RL, Wang SY. The development and application of a prediction model for postpartum depression: optimizing risk assessment and prevention in the clinic. J Affect Disord 2022; 296:434-442. [PMID: 34606808 DOI: 10.1016/j.jad.2021.09.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/10/2021] [Accepted: 09/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Preventive intervention can significantly reduce the human and economic costs of postpartum depression (PPD) compared with treatment post-diagnosis. However, identifying women with a high PPD risk and making a judgement as to the benefits of preventive intervention is a major challenge. METHODS This is a retrospective study of parturients that underwent a cesarean delivery. Control group was used as development cohort and validation cohort to construct the risk prediction model of PPD and determine a risk threshold. Ketamine group and development cohort were used to verify the risk classification of parturients by evaluating whether the incidence of PPD decreased significantly after ketamine treatment in high-risk for PPD population. RESULTS The AUC for the development cohort and validation cohort of the PPD prediction model were 0.751 (95%CI:0.700-0.802) and 0.748 (95%CI:0.680-0.816), respectively. A threshold of 19% PPD risk probability was determined, with a specificity and sensitivity in the validation cohort are 0.766 and 0.604, respectively. After matching the high-risk group and the low-risk group by propensity score, the results demonstrated that PPD incidence significantly reduced in the high-risk group following ketamine, versus non-ketamine, intervention (p < 0.01). In contrast, intervention in the low-risk group showed no significant difference in PPD outcomes (p > 0.01). LIMITATION Randomized trials are needed to further verify the feasibility of the model and the thresholds proposed. CONCLUSION This prediction model developed in this study shows utility in predicting PPD risk. Ketamine intervention significantly lowers PPD incidence in parturients with a risk classification threshold greater than 19%.
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Affiliation(s)
- Shu-Ting Yang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Si-Qi Yang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Kai-Ming Duan
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Yong-Zhong Tang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China; Hunan Key Laboratory of Brain Homeostasis, China
| | - An-Qi Ping
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Zhi-Hong Bai
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Kai Gao
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Yang Shen
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Ming-Hua Chen
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Ri-Li Yu
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China
| | - Sai-Ying Wang
- Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha 410013, P. R. China.
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Duan Z, Song P, Yang C, Deng L, Jiang Y, Deng F, Jiang X, Chen Y, Yang G, Ma Y, Deng W. The impact of hyperglycaemic crisis episodes on long-term outcomes for inpatients presenting with acute organ injury: A prospective, multicentre follow-up study. Front Endocrinol (Lausanne) 2022; 13:1057089. [PMID: 36545333 PMCID: PMC9760800 DOI: 10.3389/fendo.2022.1057089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/16/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND The long-term clinical outcome of poor prognosis in patients with diabetic hyperglycaemic crisis episodes (HCE) remains unknown, which may be related to acute organ injury (AOI) and its continuous damage after hospital discharge. This study aimed to observe the clinical differences and relevant risk factors in HCE with or without AOI. METHODS A total of 339 inpatients were divided into an AOI group (n=69) and a non-AOI group (n=270), and their differences and risk factors were explored. The differences in clinical outcomes and prediction models for evaluating the long-term adverse events after hospital discharge were established. RESULTS The mortality among cases complicated by AOI was significantly higher than that among patients without AOI [8 (11.59%) vs. 11 (4.07%), Q = 0.034] during hospitalization. After a 2-year follow-up, the mortality was also significantly higher in patients with concomitant AOI than in patients without AOI after hospital discharge during follow-up [13 (21.31%) vs. 15 (5.8%), Q < 0.001]. The long-term adverse events in patients with concomitant AOI were significantly higher than those in patients without AOI during follow-up [15 (24.59%) vs. 31 (11.97%), Q = 0.015]. Furthermore, Blood β-hydroxybutyric acid (P = 0.003), Cystatin C (P <0.001), serum potassium levels (P = 0.001) were significantly associated with long-term adverse events after hospital discharge. CONCLUSIONS The long-term prognosis of HCE patients complicated with AOI was significantly worse than that of HCE patients without AOI. The laboratory indicators were closely correlated with AOI, and future studies should explore the improvement of clinical outcome in response to timely interventions.
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Affiliation(s)
- Zixiao Duan
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
- Department of Endocrinology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peiyang Song
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Cheng Yang
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Liling Deng
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Youzhao Jiang
- Department of Endocrinology, Banan People’s Hospital of Chongqing, Chongqing, China
| | - Fang Deng
- Department of Endocrinology, Chongqing Southwest Hospital, Chongqing, China
| | - Xiaoyan Jiang
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Yan Chen
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Gangyi Yang
- Department of Endocrinology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Ma
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Wuquan Deng
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
- *Correspondence: Wuquan Deng,
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Nakao Y, Kawakami H, Saito M, Inoue K, Ikeda S, Yamaguchi O. Cost-Effectiveness of long-term tolvaptan administration for chronic heart failure treatment in Japan. J Cardiol 2021; 79:408-416. [PMID: 34799217 DOI: 10.1016/j.jjcc.2021.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/24/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tolvaptan (TLV) is effective for acute heart failure (HF) with congestion, but its long-term administration in patients with chronic HF (CHF) remains controversial. Moreover, the cost-effectiveness of TLV for CHF treatment has not yet been investigated. Thus, we sought to validate the cost-effectiveness of TLV for CHF treatment in Japan. METHODS A Markov model was developed to compare total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) between long-term TLV strategy and the standard strategy using furosemide for CHF. The target population included 75-year-old patients with CHF. The effectiveness of the TLV strategy for CHF treatment was determined based on a systematic review and meta-analysis. We used a 10-year horizon, with sensitivity analyses for significant variables and a scenario analysis for patients with CHF receiving high-dose furosemide (≥60 mg per day). RESULTS In the base case analysis, the total cost of the long-term TLV strategy was higher than that of the standard strategy (\3,243,779 vs. \1,179,964). The total QALYs of the long-term TLV strategy were lower than those of the standard strategy (4.52 vs 4.59). Thus, a standard TLV prescription for CHF treatment has no clinical or economic benefit. In the scenario analysis (i.e. in patients with CHF receiving high-dose furosemide), the long-term TLV strategy was more effective (total QALYs, 5.10 vs. 4.41) but more expensive (total costs, \3,540,558 vs. \1,272,208) than the standard strategy. The ICER of the TLV strategy against the standard strategy (¥3,289,579/QALY) was below the willingness-to-pay of \5,000,000, which suggests that the long-term TLV strategy is cost-effective relative to the standard strategy in patients with CHF receiving high-dose furosemide. CONCLUSIONS Long-term TLV administration did not provide a clear benefit for all patients with CHF. However, this treatment strategy may be a cost-effective therapeutic option for patients who require high-dose furosemide.
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Affiliation(s)
- Yasuhisa Nakao
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Hiroshi Kawakami
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan.
| | - Makoto Saito
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Nephrology and Hypertension, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
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Temporal trends in tolvaptan use after revision of national heart failure guidelines in Japan. Sci Rep 2021; 11:19360. [PMID: 34588492 PMCID: PMC8481277 DOI: 10.1038/s41598-021-98173-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/19/2021] [Indexed: 11/08/2022] Open
Abstract
Within no definite diuretic protocol for acute heart failure (AHF) patients and its variation in regional clinical guidelines, the latest national guidelines in Japan commends use of tolvaptan in diuretic-resistant patients. This study aimed to examine trends in tolvaptan usage and associated outcomes of AHF patients requiring hospitalization. Between April, 2018 and October, 2019, 1343 consecutive AHF patients (median 78 [69-85] year-old) were enrolled in a prospective, multicenter registry in Japan. Trends over time in tolvaptan usage, along with the severity of heart failure status based on the Get With The Guideline-Heart Failure [GWTG-HF] risk score, and in-hospital outcomes were investigated. During the study period, tolvaptan usage has increased from 13.0 to 28.7% over time (p for trend = 0.07), and 49.4% started tolvaptan within 3 days after admission. The GWTG-HF risk score in the tolvaptan group has significantly decreased over time, while that in the non-tolvaptan group has unchanged. There were no differences in the in-hospital mortality rate between the patients with and without tolvaptan (6.7% vs. 5.8%). After revision of the Japanese clinical practice guidelines for AHF in March 2018, tolvaptan usage for AHF patients has steadily increased. However, in-hospital outcomes including mortality do not seem to be affected.
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Winkelman RD, Kavanagh MD, Tanenbaum JE, Pelle DW, Benzel EC, Mroz TE, Steinmetz MP. The change in postoperative opioid prescribing after lumbar decompression surgery following state-level opioid prescribing reform. J Neurosurg Spine 2021; 35:275-283. [PMID: 34243163 DOI: 10.3171/2020.11.spine201046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/02/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE On August 31, 2017, the state of Ohio implemented legislation limiting the dosage and duration of opioid prescriptions. Despite the widespread adoption of such restrictions, few studies have investigated the effects of these reforms on opioid prescribing and patient outcomes. In the present study, the authors aimed to evaluate the effect of recent state-level reform on opioid prescribing, patient-reported outcomes (PROs), and postoperative emergency department (ED) visits and hospital readmissions after elective lumbar decompression surgery. METHODS This study was a retrospective cohort study of patients who underwent elective lumbar laminectomy for degenerative disease at one of 5 hospitals within a single health system in the years prior to and after the implementation of the statewide reform (September 1, 2016-August 31, 2018). Patients were classified according to the timing of their surgery relative to implementation of the prescribing reform: before reform (September 1, 2016-August 31, 2017) or after reform (September 1, 2017- August 31, 2018). The outcomes of interest included total outpatient opioids prescribed in the 90 days following discharge from surgery as measured in morphine-equivalent doses (MEDs), total number of opioid refill prescriptions written, patient-reported pain at the first postoperative outpatient visit as measured by the Numeric Pain Rating Scale, improvement in patient-reported health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System-Global Health (PROMIS-GH) questionnaire, and ED visits or hospital readmissions within 90 days of surgery. RESULTS A total of 1031 patients met the inclusion criteria for the study, with 469 and 562 in the before- and after-reform groups, respectively. After-reform patients received 26% (95% CI 19%-32%) fewer MEDs in the 90 days following discharge compared with the before-reform patients. No significant differences were observed in the overall number of opioid prescriptions written, PROs, or postoperative ED or hospital readmissions within 90 days in the year after the implementation of the prescribing reform. CONCLUSIONS Patients undergoing surgery in the year after the implementation of a state-level opioid prescribing reform received significantly fewer MEDs while reporting no change in the total number of opioid prescriptions, PROs, or postoperative ED visits or hospital readmissions. These results demonstrate that state-level reforms placing reasonable limits on opioid prescriptions written for acute pain may decrease patient opioid exposure without negatively impacting patient outcomes after lumbar decompression surgery.
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Affiliation(s)
- Robert D Winkelman
- 1Center for Spine Health, Neurological Institute, and
- 2Case Western Reserve University School of Medicine; and
- Departments of3Neurosurgery and
| | - Michael D Kavanagh
- 1Center for Spine Health, Neurological Institute, and
- 2Case Western Reserve University School of Medicine; and
| | - Joseph E Tanenbaum
- 1Center for Spine Health, Neurological Institute, and
- 2Case Western Reserve University School of Medicine; and
- 4Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Dominic W Pelle
- 1Center for Spine Health, Neurological Institute, and
- 5Orthopaedic Surgery, Cleveland Clinic
| | - Edward C Benzel
- 1Center for Spine Health, Neurological Institute, and
- Departments of3Neurosurgery and
| | - Thomas E Mroz
- 1Center for Spine Health, Neurological Institute, and
- 5Orthopaedic Surgery, Cleveland Clinic
| | - Michael P Steinmetz
- 1Center for Spine Health, Neurological Institute, and
- Departments of3Neurosurgery and
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Faselis C, Safren L, Allman RM, Lam PH, Brar V, Morgan CJ, Ahmed AA, Deedwania P, Alagiakrishnan K, Sheikh FH, Fonarow GC, Ahmed A. Income disparity and incident cardiovascular disease in older Americans. Prog Cardiovasc Dis 2021; 71:92-99. [PMID: 34320387 DOI: 10.1016/j.pcad.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the association between income and cardiovascular disease (CVD) in community-dwelling older adults. METHODS Of the 5795 Medicare-eligible community-dwelling older Americans aged 65-100 years in the Cardiovascular Health Study (CHS), 4518 (78%) were free of baseline CVD, defined as heart failure, acute myocardial infarction, stroke, or peripheral arterial disease. Of them, 1846 (41%) had lower income, defined as a total annual household income <$16,000. Using propensity scores for lower income, estimated for each of the 4518 participants, we assembled a matched cohort of 1078 pairs balanced on 42 baseline characteristics. Outcomes included centrally adjudicated incident CVD and mortality. RESULTS Matched participants (n = 2156) had a mean age of 73 years, 63% were women, and 13% African American. During an overall follow-up of 23 years, incident CVD, all-cause mortality and the combined endpoint of incident CVD or mortality occurred in 1094 (51%), 1726 (80%) and 1867 (87%) individuals, respectively. Compared with the higher income group, hazard ratio (HR) for time to the first occurrence of incident CVD in the lower income group was 1.16 with a 95% confidence interval of 1.03 to 1.31. A lower income was also associated with a significantly higher risk of all-cause mortality (HR, 1.19; 95% CI, 1.08-1.30), and consequently a higher risk of the combined endpoint of incident CVD or death (HR, 1.20; 95% CI, 1.09-1.31). CONCLUSION Among community-dwelling older Americans free of baseline CVD, an annual household income <$16,000 is independently associated with significantly higher risks of new-onset CVD and death.
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Affiliation(s)
- Charles Faselis
- Veterans Affairs Medical Center, Washington, DC, United States of America; George Washington University, Washington, DC, United States of America; Uniformed Services University, Washington, DC, United States of America; University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Lowell Safren
- Veterans Affairs Medical Center, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America; MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Richard M Allman
- George Washington University, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America
| | - Phillip H Lam
- Veterans Affairs Medical Center, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America; MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Vijaywant Brar
- Veterans Affairs Medical Center, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America
| | - Charity J Morgan
- George Washington University, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America
| | - Amiya A Ahmed
- University of Maryland, Baltimore, MD, United States of America
| | - Prakash Deedwania
- Veterans Affairs Medical Center, Washington, DC, United States of America; University of California, San Francisco, CA, United States of America
| | | | - Farooq H Sheikh
- Georgetown University, Washington, DC, United States of America; MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Gregg C Fonarow
- University of California, Los Angeles, CA, United States of America
| | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC, United States of America; George Washington University, Washington, DC, United States of America; Georgetown University, Washington, DC, United States of America.
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Sawicki KT, Ben-Sahra I, McNally EM. SGLT2 Inhibition on Cardiac Mitochondrial Function: Searching for a Sweet Spot. J Am Heart Assoc 2021; 10:e021949. [PMID: 34169746 PMCID: PMC8403270 DOI: 10.1161/jaha.121.021949] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Konrad Teodor Sawicki
- Division of Cardiology Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Issam Ben-Sahra
- Department of Biochemistry and Molecular Genetics Northwestern University Feinberg School of Medicine Chicago IL
| | - Elizabeth M McNally
- Division of Cardiology Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Department of Biochemistry and Molecular Genetics Northwestern University Feinberg School of Medicine Chicago IL.,Center for Genetic Medicine Northwestern University Feinberg School of Medicine Chicago IL
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Sjöland H, Silverdal J, Bollano E, Pivodic A, Dahlström U, Fu M. Temporal trends in outcome and patient characteristics in dilated cardiomyopathy, data from the Swedish Heart Failure Registry 2003-2015. BMC Cardiovasc Disord 2021; 21:307. [PMID: 34144681 PMCID: PMC8212489 DOI: 10.1186/s12872-021-02124-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022] Open
Abstract
Background Temporal trends in clinical composition and outcome in dilated cardiomyopathy (DCM) are largely unknown, despite considerable advances in heart failure management. We set out to study clinical characteristics and prognosis over time in DCM in Sweden during 2003–2015. Methods DCM patients (n = 7873) from the Swedish Heart Failure Registry were divided into three calendar periods of inclusion, 2003–2007 (Period 1, n = 2029), 2008–2011 (Period 2, n = 3363), 2012–2015 (Period 3, n = 2481). The primary outcome was the composite of all-cause death, transplantation and hospitalization during 1 year after inclusion into the registry. Results Over the three calendar periods patients were older (p = 0.022), the proportion of females increased (mean 22.5%, 26.4%, 27.6%, p = 0.0001), left ventricular ejection fraction was higher (p = 0.0014), and symptoms by New York Heart Association less severe (p < 0.0001). Device (implantable cardioverter defibrillator and/or cardiac resynchronization) therapy increased by 30% over time (mean 11.6%, 12.3%, 15.1%, p < 0.0001). The event rates for mortality, and hospitalization were consistently decreasing over calendar periods (p < 0.0001 for all), whereas transplantation rate was stable. More advanced physical symptoms correlated with an increased risk of a composite outcome over time (p = 0.0043). Conclusions From 2003 until 2015, we observed declining mortality and hospitalizations in DCM, paralleled by a continuous change in both demographic profile and therapy in the DCM population in Sweden, towards a less affected phenotype. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02124-0.
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Affiliation(s)
- Helen Sjöland
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, University of Gothenburg, Smörslottsgatan 1, 416 85, Gothenburg, Sweden.
| | - Jonas Silverdal
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, University of Gothenburg, Smörslottsgatan 1, 416 85, Gothenburg, Sweden
| | - Entela Bollano
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, University of Gothenburg, Smörslottsgatan 1, 416 85, Gothenburg, Sweden
| | - Aldina Pivodic
- Statistiska Konsultgruppen, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, University of Gothenburg, Smörslottsgatan 1, 416 85, Gothenburg, Sweden
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