Influenza-associated cardiovascular mortality in older adults in Beijing, China: a population-based time-series study

The association between influenza vaccination, cardiovascular mortality and hospitalization: A living systematic review and prospective meta-analysis

BACKGROUND

The effects of seasonal influenza vaccination on cardiovascular disease (CVD) outcomes, including among individuals with established CVD, are uncertain.

METHODS

To evaluate the efficacy and safety of influenza vaccines compared to no vaccines or placebo for preventing all-cause/CVD mortality or all-cause/CVD hospitalization in the general population and in populations with pre-existing CVD, we conducted a living systematic review (LSR) and prospective meta-analysis (PMA). Published randomized controlled trials (RCT) and observational studies between 1994 and 2023 were searched. PRISMA guidelines were followed in the extraction of study details, and risk of bias was assessed using the Cochrane tools. Analyses were stratified by study design and CVD history. Study quality was evaluated using GRADE system. Meta analyses based on random-effects models were performed between July and October 2022. Pooled risk ratios (RRs) for all-cause/CVD mortality and all-cause/CVD hospitalization were main outcomes.

RESULTS

Six published RCTs comprising 12,662 participants (mean age, 62 years; 45 % women; 8,797 with pre-existing CVD) and 37 observational studies comprising 6,311,703 participants (mean age, 49 years; 50 % women; 1,189,955 with pre-existing CVD) were included. Only those RCTs judged to be low risk were included in the analyses, and observational studies at anything greater than moderate risk of bias were excluded. In RCTs, influenza vaccine was not significantly associated with lower all-cause mortality (RR, 0.85; 95 %CI, 0.61-1.17), cardiovascular death (RR, 0.80; 95 %CI, 0.60-1.07), or CVD hospitalization (RR, 0.69; 95 %CI, 0.47-1.02). A statistically significant reduction in all-cause hospitalization (RR, 0.86; 95 %CI, 0.76-0.97) was observed. The evidence level was assessed as moderate for all-cause hospitalization, and low for other outcomes. Overall, observational studies suggested a stronger protective association between influenza vaccination and outcomes, except for CVD hospitalization. Based on RCTs, there was no difference in the effects of influenza vaccination on all-cause mortality among the general population compared to those with pre-existing CVD, although the summary point estimate favored benefits only in those with pre-existing CVD.

CONCLUSIONS

While observational studies suggest that influenza vaccination may be associated with lower all-cause and CVD mortality and all-cause hospitalization, RCTs reported to date suggest a reduction in the risk of all-cause hospitalization but do not provide clear evidence to support preventive effects on mortality (all-cause or CVD) or CVD hospitalization.

Effect of temperature fluctuations in cold seasons on acute myocardial infarction hospitalisations in northeast China: a retrospective observational cohort study

OBJECTIVE

This study aimed to determine the potential influence of ambient temperature on the incidence of acute myocardial infarction (AMI).

DESIGN

A retrospective observational cohort study.

SETTING

Changchun, a northeastern city in China, has a temperate continental humid climate.

PARTICIPANTS

1933 AMI patients admitted to the outpatient department of the First Hospital of Jilin University were included in the study from 1 January 2017 to 31 December 2019.

OUTCOME MEASURE

We explored the effect of daily minimum and maximum temperatures, as well as temperature changes on two adjacent days, on the incidence of daily AMI from 1 to 5 days later in Changchun.

RESULTS

We found that the average daily number of AMI cases was higher from October to April in cold season compared with the period between May and September in warm season. When the daily maximum temperature is ≤-6°C on the -2nd day, the incidence of AMI>3 persons more than doubled (from 8.51% and 10.88% to 20.23%) in the next 2 days (p=0.027); and more than 65% of the days had a maximum temperature fluctuation on |(-2nd day) - (-3rd day)| ≥2°C in these days, the OR of the daily incidence of AMI>3 persons is 3.107 (p=0.018); and in these days with enhanced temperature fluctuations, the proportion of AMI patients with hypertension had increased significantly from 20.83% to 45.39% (p=0.023).

CONCLUSION

Ambient temperature as environmental factor has a seasonal effect on the incidence of AMI in temperate continental humid climate regions, with a 2-3 days lag. Furthermore, the key factor contributing to the increase in the daily incidence of AMI during the cold season is temperature fluctuations, and maintaining a constant temperature may aid in preventing the occurrence of AMI.

TRIAL REGISTRATION NUMBER

ChiCTR2300068294.

Geographic Variation in Mortality of Acute Myocardial Infarction and Association With Health Care Accessibility in Beijing, 2007 to 2018

Background Little is known about geographic variation in acute myocardial infarction (AMI) mortality within fast-developing megacities and whether changes in health care accessibility correspond to changes in AMI mortality at the small-area level. Methods and Results We included data of 94 106 AMI deaths during 2007 to 2018 from the Beijing Cardiovascular Disease Surveillance System in this ecological study. We estimated AMI mortality for 307 townships during consecutive 3-year periods with a Bayesian spatial model. Township-level health care accessibility was measured using an enhanced 2-step floating catchment area method. Linear regression models were used to examine the association between health care accessibility and AMI mortality. During 2007 to 2018, median AMI mortality in townships declined from 86.3 (95% CI, 34.2-173.8) to 49.4 (95% CI, 30.5-73.7) per 100 000 population. The decrease in AMI mortality was larger in townships where health care accessibility increased more rapidly. Geographic inequality, defined as the ratio of the 90th to 10th percentile of mortality in townships, increased from 3.4 to 3.8. In total, 86.3% (265/307) of townships had an increase in health care accessibility. Each 10% increase in health care accessibility was associated with a -0.71% (95% CI, -1.08% to -0.33%) change in AMI mortality. Conclusions Geographic disparities in AMI mortality among Beijing townships are large and increasing. A relative increase in township-level health care accessibility is associated with a relative decrease in AMI mortality. Targeted improvement of health care accessibility in areas with high AMI mortality may help reduce AMI burden and improve its geographic inequality in megacities.

Driving Time to the Nearest Percutaneous Coronary Intervention-Capable Hospital and the Risk of Case Fatality in Patients with Acute Myocardial Infarction in Beijing

Timely arrival at a hospital capable of percutaneous coronary intervention (PCI) is critical in treating acute myocardial infarction (AMI). We examined the association between driving time to the nearest PCI-capable hospital and case fatality among AMI patients. A total of 142,474 AMI events during 2013-2019 from the Beijing Cardiovascular Disease Surveillance System were included in this cross-sectional study. The driving time from the residential address to the nearest PCI-capable hospital was calculated. Logistic regression was used to estimate the risk of AMI death associated with driving time. In 2019, 54.5% of patients lived within a 15-min drive to a PCI-capable hospital, with a higher proportion in urban than peri-urban areas (71.2% vs. 31.8%, p < 0.001). Compared with patients who had driving times ≤15 min, the adjusted odds ratios (95% CI, p value) for AMI fatality risk associated with driving times 16-30, 31-45, and >45 min were 1.068 (95% CI 1.033-1.104, p < 0.001), 1.189 (95% CI 1.127-1.255, p < 0.001), and 1.436 (95% CI 1.334-1.544, p < 0.001), respectively. Despite the high accessibility to PCI-capable hospitals for AMI patients in Beijing, inequality between urban and peri-urban areas exists. A longer driving time is associated with an elevated AMI fatality risk. These findings may help guide the allocation of health resources.

The impact of continuous wireless monitoring on adverse device effects in medical and surgical wards: a review of current evidence

Novel technologies allow continuous wireless monitoring systems (CWMS) to measure vital signs and these systems might be favorable compared to intermittent monitoring regarding improving outcomes. However, device safety needs to be validated because uncertain evidence challenges the clinical implementation of CWMS. This review investigates the frequency of device-related adverse events in patients monitored with CWMS in general hospital wards. Systematic literature searches were conducted in PubMed and Embase. We included trials of adult patients in general hospital wards monitored with CWMS. Our primary outcome was the frequency of unanticipated serious adverse device effects (USADEs). Secondary outcomes were adverse device effects (ADEs) and serious adverse device effects (SADE). Data were extracted from eligible studies and descriptive statistics were applied to analyze the data. Seven studies were eligible for inclusion with a total of 1485 patients monitored by CWMS. Of these patients, 54 patients experienced ADEs (3.6%, 95% CI 2.8-4.7%) and no USADEs or SADEs were reported (0%, 95% CI 0-0.31%). The studies of the SensiumVitals® patch, the iThermonitor, and the ViSi Mobile® device reported 28 (9%), 25 (5%), and 1 (3%) ADEs, respectively. No ADEs were reported using the HealthPatch, WARD 24/7 system, or Coviden Alarm Management. Current evidence suggests that CWMS are safe to use but systematic reporting of all adverse device effects is warranted.

Global, regional and national estimates of influenza-attributable ischemic heart disease mortality

BACKGROUND

Influenza virus infection is associated with incident ischemic heart disease (IHD) events. Here, we estimate the global, regional, and national IHD mortality burden attributable to influenza.

METHODS

We used vital registration data from deaths in adults ≥50 years (13.2 million IHD deaths as underlying cause) to assess the relationship between influenza activity and IHD mortality in a non-linear meta-regression framework from 2010 to 2019. This derived relationship was then used to estimate the global influenza attributable IHD mortality. We estimated the population attributable fraction (PAF) of influenza for IHD deaths based on the relative risk associated with a given level of weekly influenza test positivity rate and multiplied PAFs by IHD mortality from the Global Burden of Disease study.

FINDINGS

Influenza activity was associated with increased risk of IHD mortality across all countries analyzed. The mean PAF of influenza for IHD mortality was 3.9% (95% uncertainty interval [UI] 2.5-5.3%), ranging from <1% to 10%, depending on country and year. Globally, 299,858 IHD deaths (95% UI 191,216-406,809) in adults ≥50 years could be attributed to influenza, with the highest rates per 100,000 population in the Central Europe, Eastern Europe and Central Asia Region (32.3; 95% UI 20.6-43.8), and in the North Africa and Middle East Region (26.7; 95% UI 17-36.2).

INTERPRETATION

Influenza may contribute substantially to the burden of IHD. Our results suggest that if there were no influenza, an average of 4% of IHD deaths globally would not occur.

FUNDING

Collaborative study funded by Sanofi Vaccines.

Age-dependent and sex-dependent differences in mortality from influenza-associated cardiovascular diseases among older adults in Shanghai, China: a population-based study

OBJECTIVES

Influenza epidemics lead to substantial morbidity and mortality among older adults. This study aimed to analyse and assess the age-specific and sex-specific differences in mortality rates for cardiovascular disease (CVD) associated with influenza in older adults.

DESIGN

We obtained weekly data on mortality from CVD in adults≥60 years, categorised into five age groups. We used a quasi-Poisson model and adjusted for long-term and seasonal trends and absolute humidity as confounding factors. The male-to-female ratio (M/F ratio) was an indicator for assessing sex differences.

SETTING

Shanghai, China.

PARTICIPANT

We analysed 440 107 CVD deaths in adults aged ≥60 years, including 44 913 cases positive for influenza and 1 927 487 outpatient visits for influenza-like illness from 2010 to 2019.

MAIN OUTCOME MEASURES

Age-specific and sex-specific excess CVD mortality rates in older adults for various combinations of CVDs and influenza viruses.

RESULTS

Variations were observed in the excess mortality from CVD, ischaemic heart disease (IHD) and stroke depending on the influenza types/subtypes in different age and sex categories. The ≥85 years group had the highest excess mortality rates per 100 000 persons for CVD, IHD and stroke, while influenza A (H3N2) virus accounted for the highest mortality from CVD, IHD and stroke in people aged ≥65 years. Older men had a significantly lower influenza-associated IHD mortality rate than women, with an M/F ratio of 0.77 (p<0.05).

CONCLUSIONS

Excess mortality rates for CVDs associated with influenza increased with age in older adults. The risk for influenza-associated IHD mortality was significantly higher in older women than men. Our findings will help implement targeted health strategies, including the promotion of influenza vaccination and early therapeutic intervention for the older population with CVD, to curb the influenza burden effectively.

HIPEC as a risk factor for postoperative coagulopathy after cytoreductive surgery for peritoneal metastases

AIM OF THE STUDY

Postoperative coagulopathy is a poorly investigated condition after Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC). This study aims to evaluate the occurrence and risk factors of coagulative disorders after surgery for peritoneal metastases.

PATIENTS AND METHODS

The records were extracted from a prospectively maintained database of consecutive patients who underwent CRS between January 2018 and September 2020. The study was approved by the local Ethics Committee. For each patient, the coagulation profile (CP), which included international normalized ratio (INR), partial thromboplastin time (aPTT), and platelets (PLTS) before surgery, intensive care unit admission,1st, 3rd, 5th postoperative day (POD) and the day before discharge was collected. Risk factors for postoperative coagulopathy were identified at multivariate analysis.

RESULTS

During the study period, 125 patients were included in the study. Among these, 48 (38.4%) underwent CRS only, and 77 (61.6%) CRS followed by HIPEC. Twenty-one patients (16.8%) developed severe coagulopathy, 5 (10.4%) after CRS and 16 (20.8%) after CRS-HIPEC. At multivariate analysis, HIPEC and blood loss ≥ 500 ml represented independent risk factors for severe alteration of INR > 1.5 (p = 0.05, OR 1.2) and PLTS < 75 10⁹/L (p = 0.03, OR 1.3), respectively.

CONCLUSION

HIPEC is an independent risk factor for postoperative coagulopathy after CRS. Further studies are necessary to assess the usefulness of the point-of-care test in patients treated with CRS-HIPEC.

Association between influenza vaccination, all-cause mortality and cardiovascular mortality: a protocol for a living systematic review and prospective meta-analysis

INTRODUCTION

Influenza virus infection is known to increase the risk of cardiovascular events, especially in populations with pre-existing cardiovascular disease (CVD). Considering that influenza is vaccine preventable, international guidelines recommend high-risk populations with CVD receive an influenza vaccine every year. However, there are various classifications of recommendations and levels of evidence. Previous systematic reviews concluded uncertain evidence on influenza vaccine efficacy for preventing cardiovascular events in the general population or in populations with pre-existing CVD. Limited safety data of influenza vaccines were reported for populations with pre-existing CVD. Randomised controlled trials with larger sample sizes relative to previous studies are emerging, the findings of these trials are likely to be highly influential on summary efficacy estimates.

METHODS AND ANALYSIS

We aim to perform a living systematic review and a prospective meta-analysis to evaluate the efficacy and safety of influenza vaccines compared with no vaccines or placebo for preventing mortality or CVD events in the general population and in populations with pre-existing CVD. Any types of randomised controlled trial and observational study meeting the Population, Intervention, Comparator, Outcome and Study design criteria for the research question will be selected for inclusion. The living systematic review status will be maintained for 3 years with an update for every 6 months. Mainstream medical literature databases will be independently searched by two authors with predefined strategies. Two authors will perform the risk of bias assessment with consensus. Narrative synthesis and meta-analyses will be performed to summarise the results.

ETHICS AND DISSEMINATION

Formal ethical review is not required as this study does not involve primary data collection. We will publish results of the living systematic review and prospective meta-analysis in a peer-reviewed journal. Findings will also be presented at relevant meetings.

PROSPERO REGISTRATION NUMBER

CRD42021222519.

Influenza vaccine improves cardiovascular outcomes in patients with coronary artery disease: A systematic review and meta-analysis

BACKGROUND

There are inconsistent data on the clinical benefit of the influenza vaccine on cardiovascular outcomes in patients with coronary artery disease (CAD). Therefore, the aim of our study was to evaluate the effect of the influenza vaccine on cardiovascular outcomes in CAD patients.

METHODS

We searched four electronic databases from inception to September 21, 2021. Randomized controlled trials (RCTs) assessing the efficacy of influenza vaccine in CAD patients were included. The primary outcome was major adverse cardiovascular events (MACE) and secondary outcomes were all-cause mortality, cardiovascular mortality, and myocardial infarction. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Effect sizes were expressed as risk ratio (RR) with its 95% confidence interval (CI). All meta-analyses were performed using a random-effects model.

RESULTS

Five RCTs involving 4211 patients were included. The mean age ranged from 54.5 to 67 years and 75% of patients were men. Influenza vaccine significantly reduced the risk of MACE (RR, 0.63; 95% CI, 0.51-0.77), all-cause mortality (RR, 058; 95% CI, 0.4-0.84) and cardiovascular mortality (RR, 0.53; 95% CI, 0.38-0.74) compared to control group. The risk of myocardial infarction was similar between both groups (RR, 0.69; 95% CI, 0.47-1.02). The certainty of the evidence was low for MACE, all-cause mortality, and cardiovascular mortality and was very low for myocardial infarction.

CONCLUSIONS

Our review shows that the influenza vaccine may reduce cardiovascular events in CAD patients. Therefore, we suggest that it be actively applied as part of secondary prevention in this population.

Trends and Inequalities in the Incidence of Acute Myocardial Infarction among Beijing Townships, 2007-2018

Acute myocardial infarction (AMI) poses a serious disease burden in China, but studies on small-area characteristics of AMI incidence are lacking. We therefore examined temporal trends and geographic variations in AMI incidence at the township level in Beijing. In this cross-sectional analysis, 259,830 AMI events during 2007–2018 from the Beijing Cardiovascular Disease Surveillance System were included. We estimated AMI incidence for 307 consistent townships during consecutive 3-year periods with a Bayesian spatial model. From 2007 to 2018, the median AMI incidence in townships increased from 216.3 to 231.6 per 100,000, with a greater relative increase in young and middle-aged males (35–49 years: 54.2%; 50–64 years: 33.2%). The most pronounced increases in the relative inequalities was observed among young residents (2.1 to 2.8 for males and 2.8 to 3.4 for females). Townships with high rates and larger relative increases were primarily located in Beijing’s northeastern and southwestern peri-urban areas. However, large increases among young and middle-aged males were observed throughout peri-urban areas. AMI incidence and their changes over time varied substantially at the township level in Beijing, especially among young adults. Targeted mitigation strategies are required for high-risk populations and areas to reduce health disparities across Beijing.

[Quality in sports orthopedics and traumatology: more than just return to play]

Quality assessment is gaining in importance in sports orthopedics and traumatology. Structural, process and results quality are differentiated as central quality dimensions in healthcare. Structural quality is understood to mean the capabilities of the institution involved in patient care with its human and material resources. Structural quality can be documented using institutional certificates (e.g. knee center of the German Knee Society, DKG) or personal certificates (e.g. DKG knee surgeon). Process quality evaluates all medical, nursing and administrative activities that are involved in the care process. The outcome quality describes changes in the patient's state of health that can be attributed to medical, nursing and physiotherapeutic measures. The measurement of the outcome quality can be broken down into objective and subjective parameters. In terms of subjective parameters patient reported outcome measures (PROM) play a major role. Another quality initiative in recent years can be seen in healthcare research. In this context medical registers play a role in which long-term healthcare data are prospectively collated and involves data on the quality of the process and outcome. The outcome quality is also the focus of value-based reimbursement systems.