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Kodur N, Tang WHW. Non-cardiac comorbidities in heart failure: an update on diagnostic and management strategies. Minerva Med 2024; 115:337-353. [PMID: 38899946 DOI: 10.23736/s0026-4806.24.09070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Managing non-cardiac comorbidities in heart failure (HF) requires a tailored approach that addresses each patient's specific conditions and needs. Regular communication and coordination among healthcare providers is crucial to providing the best possible care for these patients. Poorly controlled hypertension contributes to left ventricular remodeling and diastolic dysfunction, emphasizing the importance of optimal blood pressure control while avoiding adverse effects. Among HF patients with diabetes, SGLT2 inhibitors and mineralocorticoid receptor antagonists have shown promise in reducing HF-related morbidity and mortality. Chronic kidney disease exacerbates HF and vice versa, forming the vicious cardiorenal syndrome, so disease-modifying therapies should be maintained in HF patients with comorbid CKD, even with transient changes in kidney function. Anemia in HF patients may be multifactorial, and there is growing evidence for the benefit of intravenous iron supplementation in HF patients with iron deficiency with or without anemia. Obesity, although a risk factor for HF, paradoxically offers a better prognosis once HF is established, though developing treatment strategies may improve symptoms and cardiac performance. In HF patients with stroke and atrial fibrillation, anticoagulation therapy is recommended. Among HF patients with sleep-disordered breathing, continuous positive airway pressure may improve sleep quality. Chronic obstructive pulmonary disease often coexists with HF, and many patients can tolerate cardioselective beta-blockers. Cancer patients with comorbid HF require careful consideration of cardiotoxicity risks associated with cancer therapies. Depression is underdiagnosed in HF patients and significantly impacts prognosis. Cognitive impairment is prevalent in HF patients and impacts their self-care and overall quality of life.
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Affiliation(s)
- Nandan Kodur
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - W H Wilson Tang
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA -
- Center for Microbiome and Human Health, Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, OH, USA
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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2
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Machida K, Minamisawa M, Motoki H, Teramoto K, Okuma Y, Kanai M, Kimura K, Okano T, Ueki Y, Yoshie K, Kato T, Saigusa T, Ebisawa S, Okada A, Kuwahara K. Clinical Profile and Prognosis of Dementia in Patients With Acute Decompensated Heart Failure - From the CURE-HF Registry. Circ J 2023; 88:93-102. [PMID: 37438112 DOI: 10.1253/circj.cj-23-0129] [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: 07/14/2023]
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) has a poor prognosis and common comorbidities may be contributory. However, evidence for the association between dementia and clinical outcomes in patients with is sparse and it requires further investigation into risk reduction.Methods and Results: We assessed the clinical profiles and outcomes of 1,026 patients (mean age 77.8 years, 43.2% female) with ADHF enrolled in the CURE-HF registry to evaluate the relationship between investigator-reported dementia status and clinical outcomes (all-cause death, cardiovascular (CV) death, non-CV death, and HF hospitalization) over a median follow-up of 2.7 years. In total, dementia was present in 118 (11.5%) patients, who experienced more drug interruptions and HF admissions due to infection than those without dementia (23.8% vs. 13.1%, P<0.01; 11.0% vs. 6.0%, P<0.01, respectively). Kaplan-Meier analysis revealed that dementia patients had higher mortality rates than those without dementia (log-rank P<0.001). After multivariable adjustment for demographics and comorbidities, dementia was significantly associated with an increased risk of death (adjusted hazard ratio, 1.43; 95% confidence interval, 1.06-1.93, P=0.02) and non-CV death (adjusted hazard ratio, 1.65; 95% confidence interval, 1.04-2.62, P=0.03), but no significant associations between dementia and CV death or HF hospitalization were observed (both, P>0.1). CONCLUSIONS In ADHF patients dementia was associated with aggravating factors for HF admission and elevated risk of death, primarily non-CV death.
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Affiliation(s)
- Keisuke Machida
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | | | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Kanako Teramoto
- Department of Biostatics, National Cerebral and Cardiovascular Center
| | - Yukari Okuma
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Masafumi Kanai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Kazuhiro Kimura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Yasushi Ueki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Tamon Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
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Doehner W, Čelutkienė J, Yilmaz MB, Coats AJS. Heart failure and the heart-brain axis. QJM 2023; 116:897-902. [PMID: 37481714 DOI: 10.1093/qjmed/hcad179] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/06/2023] [Indexed: 07/24/2023] Open
Abstract
In heart failure (HF) strong haemodynamic and neuronal signalling feedback interactions between the heart and the central nervous system (CNS) exist that are able to mutually provoke acute or chronic functional impairment. Cerebral injury secondary to HF may include acute stroke, cognitive decline and dementia and depressive disorders. Also brain stem functions are involved in the cardiac-cerebral interaction in HF as neurohormonal control and neuronal reflex circuits are known to be impaired or imbalanced in HF. In turn, impaired cerebral functions may account for direct and indirect myocardial injury and may contribute to symptomatic severity of HF, to disease progression and to increased mortality. Despite the clinical and pathophysiologic significance of the heart-CNS interaction, this relevant field of HF comorbidity is clinically under-recognized with regard to both diagnostic workup and treatment efforts. Here, principal aspects of pathophysiologic heart-CNS interactions related to HF are discussed such as stroke, effects on cognitive function, on depressive disorder and neurovegetative control and neuronal cardiovascular reflex regulation. Aspects of (limited) treatment options for cerebral functional interactions in HF are examined.
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Affiliation(s)
- Wolfram Doehner
- Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology, Deutsches Herzzentrum der Charité (Campus Virchow) and German Centre for Cardiovascular Research (DZHK)-Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jelena Čelutkienė
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Centre of Innovative Medicine, Vilnius, Lithuania
| | - Mehmet Birhan Yilmaz
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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4
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Lee YC, Lin JK, Ko D, Cheng S, Patorno E, Glynn RJ, Tsacogianis T, Kim DH. Frailty and uptake of angiotensin receptor neprilysin inhibitor for heart failure with reduced ejection fraction. J Am Geriatr Soc 2023; 71:3110-3121. [PMID: 37345734 PMCID: PMC10592538 DOI: 10.1111/jgs.18481] [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: 01/24/2023] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Frail older adults may be less likely to receive guideline-directed medical therapy (GDMT)-renin-angiotensin blockers, beta-blockers, and mineralocorticoid receptor antagonists-for heart failure with reduced ejection fraction (HFrEF). We aimed to examine the uptake of angiotensin receptor neprilysin inhibitor (ARNI) and GDMT in frail older adults with HFrEF. METHODS Using 2015-2019 Medicare data, we estimated the proportion of beneficiaries with HFrEF receiving ARNI and GDMT each year by frailty status, defined by a claims-based frailty index. Logistic regression was used to identify clinical characteristics associated with ARNI initiation. Cox proportional hazards regression was used to examine the association of GDMT use in 2015 and death or heart failure hospitalization in 2016-2019. RESULTS Among 147,506-180,386 beneficiaries with HFrEF (mean age: 77 years; 27% women; 42.6-49.1% frail) in 2015-2019, the proportion of patients receiving ARNI increased in both non-frail (0.4%-16.4%) and frail (0.3%-13.7%) patients (p for yearly-trend-by-frailty = 0.970). Among those not receiving a renin-angiotensin system blocker, patients with age ≥ 85 years (odds ratio [95% CI], 0.89 [0.80-0.99]), dementia (0.88 [0.81-0.96]), and frailty (0.87 [0.81-0.94]) were less likely to initiate ARNI. The proportion of patients receiving all 3 GDMT classes increased in non-frail patients (22.0%-27.0%) but changed minimally in frail patients (19.6%-21.8%). Regardless of frailty status, treatment with at least 1 class of GDMT was associated with lower death or heart failure hospitalization than no GDMT medications (hazard ratio [95% CI], 0.94 [0.91-0.97], 0.92 [0.89-0.94], 0.94 [0.91-0.97] for 1, 2, and 3 classes, respectively). CONCLUSIONS Our results suggest an evidence-practice gap in the use of ARNI and GDMT in Medicare beneficiaries with HFrEF, particularly those with frailty. Efforts to narrow this gap are needed to reduce the burden of HFrEF in older adults.
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Affiliation(s)
- Yu-Chien Lee
- Harvard T.H. Chan School of Public Health, Boston, MA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Department of Family Medicine, Chang Gung Memorial Hospital, Linko Branch, Taiwan
| | - Joshua K. Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Darae Ko
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, MA
| | - Susan Cheng
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Robert J. Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Theodore Tsacogianis
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
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5
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Young S, Smith M, Shafique S, Piamjariyakul U. You're Not Who You Used to Be: A Case Report of a Family Living with Heart Failure and Vascular Dementia. Home Healthc Now 2023; 41:140-148. [PMID: 37144929 PMCID: PMC11168254 DOI: 10.1097/nhh.0000000000001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Heart failure and vascular dementia have similar underlying pathologies, so it is not uncommon for one condition to exist in the presence of the other. In-home management of each condition is challenging for patients and their family caregivers, but when both conditions are present, those challenges are amplified. The purpose of this case report is to describe one family's experience managing heart failure and vascular dementia at home. A mixed method of semistructured interviews and short surveys was used to examine the health status and well-being of the patient and family caregiver. Data were derived from individual interviews and standardized measures. Survey results revealed the patient had worsening dementia, poor heart failure-related quality of life, poor spiritual well-being, depression, and diminished self-care. The caregiver reported poor physical and mental health. Interview data revealed frustration dealing with worsening symptoms, inadequate information about disease progression, and fear of an unknown future. Additionally, the patient suggested strategies to deal with challenges. Families managing heart failure and vascular dementia need easy-to-understand education from healthcare providers, on-going assessments, and early referrals to support services including those provided by social workers and chaplains.
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6
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Wu Y, Chen L, Zhong F, Zhou K, Lu C, Cheng X, Wang S. Cognitive impairment in patients with heart failure: molecular mechanism and therapy. Heart Fail Rev 2023:10.1007/s10741-022-10289-9. [PMID: 36593370 DOI: 10.1007/s10741-022-10289-9] [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] [Accepted: 11/28/2022] [Indexed: 01/04/2023]
Abstract
Heart failure (HF) is associated with multiple organ dysfunction and many comorbidities. Its incidence is high among the elderly and is a major health burden worldwide. Cognitive impairment (CI) is highly prevalent in older patients with HF, which is an abnormality in one or more of the items of cognition, attention, memory, language, psychomotor function, and visual spatial acuity. Studies have shown that the incidence of CI in HF patients is between 13 and 54%, and patients with both conditions have poor self-care ability and prognosis, as well as increased mortality rates. However, the mechanisms of CI development in HF patients are still unclear. In this review, we describe the epidemiology and risk factors as well as measures of improving CI in HF patients. We update the latest pathophysiological mechanisms related to the neurocognitive changes in HF patients, expounding on the mechanisms associated with the development of CI in HF patients.
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Affiliation(s)
- Yanan Wu
- Department of Anesthesiology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Liwen Chen
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
- Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Feng Zhong
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Kaiyi Zhou
- Department of Anesthesiology, School of Medicine, South China University of Technology, Guangzhou, 510006, China
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Chao Lu
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Xiao Cheng
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Sheng Wang
- Department of Anesthesiology, School of Medicine, South China University of Technology, Guangzhou, 510006, China.
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
- Department of Anesthesiology, Guangdong Province, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China.
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7
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Khodneva Y, Ringel JB, Rajan M, Goyal P, Jackson EA, Sterling MR, Cherrington A, Oparil S, Durant R, Safford MM, Levitan EB. Depressive symptoms, cognitive impairment, and all-cause mortality among REGARDS participants with heart failure. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac064. [PMID: 36330357 PMCID: PMC9617474 DOI: 10.1093/ehjopen/oeac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/06/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
Abstract
Aims To ascertain whether depressive symptoms and cognitive impairment (CI) are associated with mortality among patients with heart failure (HF), adjusting for sociodemographic, comorbidities, and biomarkers. Methods and results We utilized Medicare-linked data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a biracial prospective ongoing cohort of 30 239 US community-dwelling adults, recruited in 2003-07. HF diagnosis was ascertained in claims analysis. Depressive symptoms were defined as a score ≥4 on the four-item Center for Epidemiological Studies-Depression scale. Cognitive impairment was defined as a score of ≤4 on the six-item screener that assessed three-item recall and orientation to year, month, and day of the week. Sequentially adjusted Cox proportional hazard models were used to estimate the risk of death. We analyzed 1059 REGARDS participants (mean age 73, 48%-African American) with HF; of those 146 (14%) reported depressive symptoms, 136 (13%) had CI and 31 (3%) had both. Over the median follow-up of 6.8 years (interquartile range, 3.4-10.3), 785 (74%) died. In the socio-demographics-adjusted model, CI was significantly associated with increased mortality, hazard ratio 1.24 (95% confidence interval 1.01-1.52), compared with persons with neither depressive symptoms nor CI, but this association was attenuated after further adjustment. Neither depressive symptoms alone nor their comorbidity with CI was associated with mortality. Risk factors of all-cause mortality included: low income, comorbidities, smoking, physical inactivity, and severity of HF. Conclusion Depressive symptoms, CI, or their comorbidity was not associated with mortality in HF in this study. Treatment of HF in elderly needs to be tailored to cognitive status and includes focus on medical comorbidities.
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Affiliation(s)
- Yulia Khodneva
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Joanna Bryan Ringel
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Mangala Rajan
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Parag Goyal
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
- Division of Cardiology, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Elizabeth A Jackson
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Madeline R Sterling
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Andrea Cherrington
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Suzanne Oparil
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Raegan Durant
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, MT509H 1717 11th Avenue South, Birmingham, AL 35294-4410, USA
| | - Monika M Safford
- Division of Internal Medicine, Weill Cornell University, 530 East 70st Street, New York, NY 10021, USA
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, Al 35294, USA
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Loosen SH, Roderburg C, Curth O, Gaensbacher J, Joerdens M, Luedde T, Konrad M, Kostev K, Luedde M. The spectrum of comorbidities at the initial diagnosis of heart failure a case control study. Sci Rep 2022; 12:2670. [PMID: 35177698 PMCID: PMC8854549 DOI: 10.1038/s41598-022-06618-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/07/2022] [Indexed: 02/07/2023] Open
Abstract
The prognosis of heart failure (HF) patients is determined to a decisive extent by comorbidities. The present study investigates the association between a broad spectrum of diseases and the occurrence of HF in a large collective of outpatients. This retrospective case control study assessed the prevalence of 37 cardiac and extracardiac diseases in patients with an initial diagnosis of heart failure (ICD-10: I50) in 1,274 general practices in Germany between January 2005 and December 2019. The study is based on the Disease Analyzer database (IQVIA), which contains drug prescriptions, diagnoses, and basic medical and demographic data. Patients with and without heart failure were matched by sex, age, and index year. Hazard regression models were conducted to evaluate the association between different disease entities and heart failure. The present study included 162,246 patients with heart failure and 162,246 patients without heart failure. Mean age [SD] was 73.7 [12.1] years; 52.6% were women. Out of 37 predefined diagnoses, 36 were more prevalent in HF patients. The highest prevalence was primary hypertension (63.4% in HF patients vs. 53.3% in controls, p < 0.001) followed by lipid metabolism disorders (34.6% in HF patients vs. 29.1% in HF patients p < 0.001) and diabetes mellitus type II (32.2% in HF patients vs. 25.2% in controls, p < 0.001). In the regression analysis, 19 diseases were significantly associated with heart failure. Non-cardiovascular diagnoses strongly associated with HF were obesity (HR = 1.46), chronic bronchitis and COPD (HR = 1.41), gout (HR: 1.41), and chronic kidney disease (HR = 1.27). In the present study, we identified a variety of cardiac and extracardiac diseases associated with heart failure. Our data underscore the immense importance of comorbidities, even as early as at the stage of initial diagnosis of heart failure.
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Affiliation(s)
- Sven H. Loosen
- grid.14778.3d0000 0000 8922 7789Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Christoph Roderburg
- grid.14778.3d0000 0000 8922 7789Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Ole Curth
- Internal Medicine I, Central Hospital Bremerhaven, Bremerhaven, Germany
| | - Julia Gaensbacher
- grid.412468.d0000 0004 0646 2097Internal Medicine III, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Markus Joerdens
- grid.14778.3d0000 0000 8922 7789Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Tom Luedde
- grid.14778.3d0000 0000 8922 7789Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Marcel Konrad
- grid.448793.50000 0004 0382 2632Health & Social, FOM University of Applied Sciences for Economics and Management, Frankfurt am Main, Germany
| | | | - Mark Luedde
- KGP Bremerhaven, Postbrookstr. 105, 27574 Bremerhaven, Germany ,grid.9764.c0000 0001 2153 9986Christian-Albrechts University of Kiel, Kiel, Germany
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9
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Osundolire S, Naqvi S, Nunes AP, Lapane KL. Heart failure among US nursing home residents with diabetes mellitus. Int J Cardiol 2022; 349:138-143. [PMID: 34826498 PMCID: PMC8766946 DOI: 10.1016/j.ijcard.2021.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/07/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus is associated with an increased risk of developing heart failure. However, few recent studies have examined the characteristics of older adults living in US nursing homes with heart failure and diabetes mellitus. This study is important for clinical practice and public health action plans for heart failure. OBJECTIVE To estimate the prevalence of, and factors associated with, heart failure in long-stay nursing home residents with diabetes mellitus. METHODS We conducted a cross-sectional study using the US 2016 Minimum Data Set data consisting of all residents with diabetes aged ≥65 years in Medicare/Medicaid certified nursing homes (n = 297,570). Diabetes mellitus and heart failure were operationalized using the resident's transfer notes at admission and the progress notes during admission through physical examination findings and current treatment orders. RESULTS Among all residents with diabetes, 26.4% had heart failure. Increasing age of residents, and comorbidities including coronary artery disease (aOR: 1.34; 95% CI: 1.31-1.37), end stage renal disease (aOR: 1.30; 95% CI: 1.26-1.35), and chronic obstructive pulmonary disease (aOR: 1.60; 95% CI: 1.57-1.63) were associated with a higher odds of heart failure. CONCLUSIONS This is one of the first U.S studies to examine the prevalence and factors associated with heart failure in nursing home residents with diabetes mellitus. It highlights a clinically complex population with multiple comorbid conditions. Future research is needed to understand the pharmacological management of these residents and the extent to which appropriate management can improve quality of life for a medically vulnerable population.
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Affiliation(s)
- Seun Osundolire
- Department of Population & Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA.
| | - Syed Naqvi
- Department of Population & Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA
| | - Anthony P Nunes
- Department of Population & Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA
| | - Kate L Lapane
- Department of Population & Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA
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Cognitive decline and risk of dementia in individuals with heart failure: A systematic review and meta-analysis. J Card Fail 2021; 28:1337-1348. [PMID: 34971812 DOI: 10.1016/j.cardfail.2021.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022]
Abstract
AIM To determine the association between heart failure (HF) and cognitive change and dementia. METHODS AND RESULTS Systematic search of three electronic databases was performed and 29 eligible studies involving approximately 3 million participants were identified. Twelve studies examined dementia and 20 cognitive change, but only a subset of studies could be included in the meta-analysis. These findings indicated that HF was not significantly associated with dementia (n=8, hazard ratio [HR] 1.18, 95% confidence interval [CI] [0.93, 1.50]), but increased the risk of cognitive impairment (n=3, HR 1.80, 95%CI [1.14,2.86]) . Additionally, HF was associated with poorer mean cognitive performance in global cognition (Hedges' g -0.73, 95%CI [-1.12, -0.35]), memory (Hedges' g -0.57, 95%CI [-0.72, -0.42]), executive function (Hedges' g -0.58, 95%CI [-0.72, -0.43]), attention/speed (Hedges' g -0.50, 95%CI [-0.63, -0.37]) and language (Hedges' g -0.61, 95%CI [-1.05, -0.17]). CONCLUSION Patients with HF perform worse on all cognitive tests, and have an increased risk of cognitive impairment. These findings highlight the need for clinicians to consider cognition as part of routine care for patients with HF.
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11
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Egídio de Sousa I, Pedroso A, Chambino B, Roldão M, Pinto F, Guerreiro R, Araújo I, Henriques C, Fonseca C. Palliative Care in Heart Failure: Challenging Prognostication. Cureus 2021; 13:e18301. [PMID: 34722076 PMCID: PMC8548045 DOI: 10.7759/cureus.18301] [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] [Accepted: 09/26/2021] [Indexed: 12/13/2022] Open
Abstract
Heart failure (HF) is a chronic progressive disease with high morbimortality and poor quality of life (QoL). Palliative care significantly improves clinical outcomes but few patients receive it, in part due to challenging decisions about prognosis. This retrospective study, included all patients consecutively discharged from an Acute Heart Failure Unit over a period of one year, aiming to assess the accuracy of the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score in predicting mortality. Additionally, predictors of death at one and three years were explored using a multivariate regression model. The MAGGIC score was useful in predicting mortality, without significant difference between mortality observed at three-years follow-up compared with a mortality given by the score (p=0.115). Selected variables were statistically compared showing that poor functional status, high New York Heart Association (NYHA) at discharge, psychopharmacs use, and high creatininemia were associated with higher mortality (p<0.05). The multivariate regression model identified three predictors of one-year mortality: psychopharmacs baseline use (OR=4.110; p=0.014), angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (ACEI/ARB) medication at discharge (OR=0.297; p=0.033), and higher admission's creatinine (OR=2.473; p=0.028). For three-year mortality outcome, two variables were strong independent predictors: psychopharmacs (OR=3.330; p=0.022) and medication with ACEI/ARB at discharge (OR=0.285; p=0.018). Models' adjustment was assessed through the receiver operating characteristic (ROC) curve. The best model was the one-year mortality (area under the curve, AUC 81%), corresponding to a good discrimination power. Despite prognostication, when setting goals of care an individualised patient-centred approach is imperative, based on the patient's objectives and needs. Risk factors related to poorer outcomes should be considered, in particular, higher NYHA at discharge which also represents symptom burden. Hospitalisation is an opportunity to optimize global care for heart failure patients including palliative care.
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Affiliation(s)
| | - Ana Pedroso
- Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, PRT
| | - Beatriz Chambino
- Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, PRT
| | - Marta Roldão
- Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, PRT
| | - Fausto Pinto
- Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, PRT
| | - Renato Guerreiro
- Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, PRT
| | - Inês Araújo
- Heart Failure Clinic, Department of Internal Medicine, Hospital São Francisco Xavier, Lisbon, PRT
| | - Célia Henriques
- Heart Failure Clinic, Department of Internal Medicine, Hospital São Francisco Xavier, Lisbon, PRT
| | - Candida Fonseca
- Heart Failure Clinic, Department of Internal Medicine, Hospital São Francisco Xavier, Lisbon, PRT
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Roderburg C, Loosen SH, Jördens MS, Konrad M, Luedde T, Kostev K, Luedde M. Heart failure and dementia: a comparative analysis with different types of cancer. EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab003. [PMID: 35919092 PMCID: PMC9242070 DOI: 10.1093/ehjopen/oeab003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/18/2021] [Accepted: 06/07/2021] [Indexed: 12/16/2022]
Abstract
Aims The prognosis and quality of life of patients with heart failure (HF) is determined by comorbidities, with dementia/cognitive decline believed to have a significant impact in this regard. This study compares the incidence of dementia in patients with HF with that in patients with common cancers in a large collective of outpatients. Methods and results This retrospective cohort study assessed the incidence of dementia/cognitive decline [International Classification of Diseases, 10th revision (ICD-10): I50] in a cohort of patients ≥65 years diagnosed with HF (ICD-10: I50), breast cancer (ICD-10: C50), prostate cancer (ICD-10: C61), or digestive organ cancer (ICD-10: C15-C26) in 1274 German general practices between January 2000 and December 2018. Multivariable Cox regression models were used to study the association between HF and dementia compared to each of three cancer cohorts. We included 72 259 patients with HF, 10 310 patients with breast cancer, 12 477 patients with prostate cancer, and 12 136 patients with digestive organ cancer. A total of 27.8% of patients with HF were diagnosed with dementia during the 10-year observation period compared to 16.2% of patients with breast cancer, 18.6% of patients with digestive organ cancer, and 16.1% of patients with prostate cancer. Patients with HF were significantly more likely to develop dementia within 10 years after diagnosis than patients with breast cancer [hazard ratio (HR): 1.36 (95% confidence interval 1.28–1.45, P < 0.001], prostate cancer [HR 1.38 (1.130–1.47), P < 0.001], or gastrointestinal tumours [HR 1.31 (1.24–1.39), P < 0.001]. Conclusions Our study demonstrates the significance of dementia in patients with HF, in whom the condition is much more prevalent than in patients with cancer.
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Affiliation(s)
- Christoph Roderburg
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf , Moorenstraße 5, Düsseldorf 40225, Germany
| | - Sven H Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf , Moorenstraße 5, Düsseldorf 40225, Germany
| | - Markus S Jördens
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf , Moorenstraße 5, Düsseldorf 40225, Germany
| | - Marcel Konrad
- Health and Social, FOM University of Applied Sciences for Economics and Management Frankfurt , Franklinstr. 52, 60486 Frankfurt a.M., Germany
| | - Tom Luedde
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf , Moorenstraße 5, Düsseldorf 40225, Germany
| | - Karel Kostev
- Epidemiology, IQVIA Germany , Unterschweinstiege 2-14, 60549 Frankfurt a. M., Germany
| | - Mark Luedde
- Christian-Albrechts-University of Kiel , Christian-Albrechts-Platz 4, 24118 Kiel, Germany
- KGP Bremerhaven , Postbrookstr. 105, Bremerhaven 27574, Germany
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13
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Mental involvement in heart failure. Rev Port Cardiol 2021; 40:557-559. [PMID: 34392897 DOI: 10.1016/j.repce.2021.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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14
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Wu H, Le Couteur DG, Hilmer SN. Mortality trends of stroke and dementia: Changing landscapes and new challenges. J Am Geriatr Soc 2021; 69:2888-2898. [PMID: 34133024 DOI: 10.1111/jgs.17322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/28/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND/IMPORTANCE Stroke and dementia are important causes of death in the United States and may be interrelated as competing risks for mortality. No previous studies have simultaneously compared age- and sex-specific mortality trends between stroke and subtypes of dementia at a population level. Insights gained from this study can help identify high-risk populations and inform healthcare service requirements for managing stroke and dementia in the United States. OBJECTIVES To examine nationwide trends in mortality from stroke and subtypes of dementia in the United States by age group and sex. DESIGN Population-based cross-sectional study. SETTING U.S. mortality data from 2007 to 2016. PARTICIPANTS All U.S. residents whose primary cause of death was stroke, Alzheimer's disease, vascular dementia, or Lewy body dementia. MEASUREMENTS Age-adjusted mortality, mortality trends among men and women were analyzed separately using joinpoint regression. RESULTS From 2007 to 2016, age-adjusted stroke mortality fell by 21.6%. Age-adjusted mortality (per 1,000,000) for Alzheimer's disease, vascular dementia, and Lewy body dementia increased by 1.2-fold, 2-fold, and 3-fold, respectively. Annual age-adjusted stroke mortality decreased by an average rate of 2.67% per year, while annual age-adjusted mortality for Alzheimer's disease, vascular dementia, and Lewy body dementia increased by an average rate of 2.06%, 4.90%, and 12.13% per year, respectively. Mortality from stroke and dementia increased with age. Greater reductions in stroke mortality and greater increases in dementia mortality were seen in women than men; and in older than younger (<65 years) people. CONCLUSIONS There has been a striking rising trend in dementia mortality coincident with a reduction in stroke mortality in the United States. There are persistent age and sex disparities in stroke and dementia mortality trends. Our findings support the pathophysiological relationship between stroke and dementia, and have important implications for future research, healthcare planning, and provision.
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Affiliation(s)
- Harry Wu
- Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Laboratory of Ageing and Pharmacology, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - David G Le Couteur
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Ageing and Alzheimer's Institute (AAAI), Centre for Education and Research on Ageing (CERA) and ANZAC Research Institute, Concord Hospital, Concord, New South Wales, Australia.,Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah N Hilmer
- Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Laboratory of Ageing and Pharmacology, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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15
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Mental involvement in heart failure. Rev Port Cardiol 2021. [PMID: 34083100 DOI: 10.1016/j.repc.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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16
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Sun D, Wang Q, Kang J, Zhou J, Qian R, Wang W, Wang H, Zhang Q. Correlation between Serum Platelet Count and Cognitive Function in Patients with Atrial Fibrillation: A Cross-Sectional Study. Cardiol Res Pract 2021; 2021:9039610. [PMID: 33824766 PMCID: PMC8007372 DOI: 10.1155/2021/9039610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 01/18/2021] [Accepted: 03/15/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The risk of cognitive impairment in patients with atrial fibrillation is significantly increased. Its occurrence may be related to blood hypercoagulable state and immune inflammatory reaction. Platelets can mediate immune inflammatory response, but there is no evidence about the relationship between platelet count and cognitive function in patients with atrial fibrillation. PURPOSE To explore whether there is a certain correlation between platelet count and cognitive function in patients with atrial fibrillation. METHODS A cross-sectional study was conducted in a single center in China, including 254 patients with atrial fibrillation. Cognitive function assessment and clinical and laboratory examinations were performed on all participants. After adjusting the related confounding factors, the relationship between platelet count and cognitive function was analyzed. RESULTS A total of 254 subjects with an average age of 59.71 ± 11.14 years were included. The average platelet count was 208.15 ± 68.30, and the average score of cognitive function was 19.29 ± 6.78. Result of fully adjusted binary logistic regression showed platelet count was negatively associated with the cognitive function score after adjusting confounders (hazard ratio (HR) = 0.000, 95%CI -0.01, 0.01). A nonlinear relationship was detected between platelet count and the cognitive function score, whose point was 230. The effect sizes and the confidence intervals of the left and right sides of the inflection point were 0.03 (0.01-0.05, P for nonlinearity = 0.011) and -0.03 (-0.05-0.00, P for nonlinearity = 0.023), respectively. CONCLUSION Platelets have a nonlinear relationship with cognitive function in patients with atrial fibrillation. This finding suggests that, in patients with atrial fibrillation, platelets should be maintained at about 230.
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Affiliation(s)
- Dandan Sun
- Department of Cardiology of Affiliated Hospital, Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China
| | - Quanliang Wang
- Department of Cardiology of Affiliated Hospital, Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China
| | - Jie Kang
- Department of Cardiology of Affiliated Hospital, Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China
| | - Jie Zhou
- Department of Cardiology of Affiliated Hospital, Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China
| | - Ruijuan Qian
- Department of Cardiology of Affiliated Hospital, Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China
| | - Wenqing Wang
- Department of Cardiology of Affiliated Hospital, Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China
| | - Haichen Wang
- Department of Cardiology of Affiliated Hospital, Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China
| | - Qingyun Zhang
- Department of Cardiology of Affiliated Hospital, Jining Medical University, 89# Guhuai Road, Rencheng District, Jining City 272000, Shandong Province, China
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