1
|
Pitti E, Vanni D, Viceconte N, Lembo A, Tanzilli G, Raparelli V, Petrella G, Cicero DO. Metabolic Crosstalk in Multimorbidity: Identifying Compensatory Effects Among Diabetes, Hypertension, and Dyslipidemia. J Endocr Soc 2024; 8:bvae152. [PMID: 39262573 PMCID: PMC11388003 DOI: 10.1210/jendso/bvae152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Indexed: 09/13/2024] Open
Abstract
Context Metabolomics is becoming increasingly popular for detecting markers that indicate the presence of a specific disease. However, it is usually applied to studying individual ailments, yielding results that may not be directly relevant to people with multiple health conditions. Objective Our study proposes a different approach to explore metabolic crosstalk between various disease states. Design Setting and Patients We conducted a study on subjects at medium to high risk of developing coronary artery disease. We measured the plasma levels of 83 metabolites using nuclear magnetic resonance and analyzed the connections between these metabolites and various risk factors such as diabetes, hypertension, and dyslipidemia. Linear regression and multivariate analysis were combined for this purpose. Results Inspection of the metabolic maps created by our analysis helped us efficiently compare profiles. In this way, it was possible to discover opposing metabolic features among single conditions and their combination. Furthermore, we found compensating metabolic effects between diabetes, hypertension, and dyslipidemia involving mainly ketone body metabolism and fatty acid β-oxidation. Conclusion Our study introduces a novel approach to investigating how metabolism reacts to the simultaneous presence of multiple health conditions. This has allowed the detection of potential compensatory effects between diabetes, hypertension, and dyslipidemia, highlighting the complexity of metabolic crosstalk in patients with comorbidities. A better understanding of metabolic crosstalk like this could aid in developing focused treatments, resulting in improved therapeutic results.
Collapse
Affiliation(s)
- Erica Pitti
- Department of Chemical Science and Technology, University of Rome “Tor Vergata,” 00133 Rome, Italy
| | - Domitilla Vanni
- Department of Chemical Science and Technology, University of Rome “Tor Vergata,” 00133 Rome, Italy
| | - Nicola Viceconte
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic and Geriatric Sciences, Sapienza University of Rome, Policlinic Umberto I, 00161 Rome, Italy
| | - Angelo Lembo
- Department of Chemical Science and Technology, University of Rome “Tor Vergata,” 00133 Rome, Italy
| | - Gaetano Tanzilli
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic and Geriatric Sciences, Sapienza University of Rome, Policlinic Umberto I, 00161 Rome, Italy
| | - Valeria Raparelli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Greta Petrella
- Department of Chemical Science and Technology, University of Rome “Tor Vergata,” 00133 Rome, Italy
| | - Daniel O Cicero
- Department of Chemical Science and Technology, University of Rome “Tor Vergata,” 00133 Rome, Italy
| |
Collapse
|
2
|
Meher T, Muhammad T, Ahmed W. Association Between Multimorbidity and Presence of Diagnosed Vision Problems Among the Middle-Aged and Older Population in India. Ophthalmic Epidemiol 2024:1-9. [PMID: 39116402 DOI: 10.1080/09286586.2024.2384061] [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: 11/21/2022] [Revised: 11/28/2023] [Accepted: 07/16/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE The aim of the study was to estimate the prevalence of diagnosed vision problems and to examine the association of single and multiple chronic conditions with vision problems among middle-aged and older adults in India. METHODS The study utilized data from the Longitudinal Ageing Study in India (LASI) Wave 1, (2017-18). Descriptive statistics along with bivariate and multivariable analyses were conducted to achieve the study objectives. RESULTS The prevalence of diagnosed vision problems in the sampled population was 48.2%. The older adults (60+ years) (55.3%) had shown a greater prevalence of vision problems than the middle-aged individuals (41%). Among chronic conditions, hypertension, diabetes, chronic lung diseases, chronic heart diseases, bone related diseases, psychiatric disorders, and high cholesterol were significantly associated with vision problems in the case of both middle-aged and older adults. Furthermore, odds of experiencing vision problems according to the presence of multimorbidity were higher in the middle-aged population [adjusted odds ratio (AOR) = 1.986; confidence interval (CI):1.855-2.126] than in the older population [AOR = 1.746; CI:1.644-1.854]. CONCLUSIONS Middle-aged and older adults with chronic illnesses and multimorbidity were at greater risk of vision problems. Due to the high prevalence of vision problem, interventions aimed at prevention or early detection are warranted.
Collapse
Affiliation(s)
- Trupti Meher
- Population Studies, International Institute for Population Sciences, Mumbai, India
| | - T Muhammad
- Population Studies, International Institute for Population Sciences, Mumbai, India
- Center for Healthy Aging, Pennsylvania State University, University Park, USA
| | - Waquar Ahmed
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| |
Collapse
|
3
|
Peng A, Zhang B, Wang S, Feng Y, Liu S, Liu C, Li S, Li F, Peng Y, Wan J. Comparison of the value of various complex indexes of blood cell types and lipid levels in coronary heart disease. Front Cardiovasc Med 2023; 10:1284491. [PMID: 38162141 PMCID: PMC10754977 DOI: 10.3389/fcvm.2023.1284491] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Background Inflammation and lipid infiltration play crucial roles in the development of atherosclerosis. This study aimed to investigate the association between various complex indexes of blood cell types and lipid levels with the severity of coronary artery stenosis and their predictive value in coronary heart disease (CHD). Methods The retrospective study was conducted on 3,201 patients who underwent coronary angiography at the Department of Zhongnan Hospital of Wuhan University. The patients were divided into two groups: CHD group and non-CHD group. The CHD group was further classified into three subgroups (mild, moderate, severe) based on the tertiles of their Gensini score or SYNTAX score I. Various complex indexes of blood cell types and lipid levels were compared between the groups. Results It revealed a positive correlation between all complex indexes and the severity of coronary artery stenosis. The systemic inflammation-response index/high-density lipoprotein cholesterol count (SIRI/HDL) exhibited the strongest correlation with both severity scores (Gensini score: r = 0.257, P < 0.001; SYNTAX score I: r = 0.171, P < 0.001). The monocyte to high-density lipoprotein cholesterol ratio (MHR) was identified as a stronger independent risk factor for CHD. However, SIRI/HDL had higher diagnostic efficacy for CHD (sensitivity 66.7%, specificity 60.4%, area under curve 0.680, 95% CI: 0.658-0.701). Notably, the pan-immune-inflammation value multiplied by low-density lipoprotein cholesterol count (PIV × LDL) exhibited the highest sensitivity of 85.2%. Conclusion All complex indexes which we investigated exhibited positive correlations with the severity of coronary artery stenosis. SIRI/HDL demonstrated higher diagnostic efficiency for CHD and a significant correlation with the severity of coronary artery stenosis.
Collapse
Affiliation(s)
- Aihong Peng
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Bing Zhang
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Siyin Wang
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yujia Feng
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shengnan Liu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Cuiyi Liu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shu Li
- Department of Critical Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Fei Li
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yuanyuan Peng
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jing Wan
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| |
Collapse
|
4
|
Soysaler CA, Andrei CL, Ceban O, Sinescu CJ. Comorbidity Patterns in Patients at Cardiovascular Hospital Admission. MEDICINES (BASEL, SWITZERLAND) 2023; 10:medicines10040026. [PMID: 37103781 PMCID: PMC10145375 DOI: 10.3390/medicines10040026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 04/28/2023]
Abstract
Hypertension frequently coexists with obesity, diabetes, hyperlipidemia, or metabolic syndrome, anditsassociation with cardiovascular disease is well established. The identification and management of these risk factors is an important part of overall patient management. In this paper, we find the most relevant patterns of hospitalized patients with cardiovascular diseases, consideringaspects of their comorbidities, such as triglycerides, cholesterol, diabetes, hypertension, and obesity. To find the most relevant patterns, several clusterizations were made, playing with the dimensions of comorbidity and the number of clusters. There are three main patient types who require hospitalization: 20% whose comorbidities are not so severe, 44% with quite severe comorbidities, and 36% with fairly good triglycerides, cholesterol, and diabetes but quite severe hypertension and obesity. The comorbidities, such as triglycerides, cholesterol, diabetes, hypertension, and obesity, were observed in different combinations in patients upon hospital admission.
Collapse
Affiliation(s)
- Cezara-Andreea Soysaler
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Emergency Hospital "Bagdasar-Arseni", 050474 Bucharest, Romania
| | - Cătălina Liliana Andrei
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Emergency Hospital "Bagdasar-Arseni", 050474 Bucharest, Romania
| | - Octavian Ceban
- Economic Cybernetics and Informatics Department, The Bucharest University of Economic Studies, 010374 Bucharest, Romania
| | - Crina-Julieta Sinescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Emergency Hospital "Bagdasar-Arseni", 050474 Bucharest, Romania
| |
Collapse
|
5
|
Atrial fibrillation: trends in prevalence and antithrombotic prescriptions in the community. Neth Heart J 2022; 30:459-465. [PMID: 35230637 PMCID: PMC9475006 DOI: 10.1007/s12471-022-01667-x] [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] [Accepted: 01/13/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction In the past decade, the atrial fibrillation (AF) landscape, including the treatment modalities, has drastically changed. This raises the question how AF prevalence and choices in antithrombotic therapy prescription have developed in the community over time. Methods Routine care data from the Julius General Practitioners’ Network (JGPN) were used to calculate the yearly prevalence of AF and to quantify the percentage of all patients who were prescribed a platelet inhibitor, vitamin K antagonist (VKA), non-VKA oral anticoagulant (NOAC) or no antithrombotic medication. To explore whether certain patient characteristics are associated with selective prescription of oral anticoagulants (OAC), we applied logistic regression analyses. Results From 2008 through 2017, the JGPN database included 7459 unique AF patients. During this period, the prevalence of AF increased from 0.4% to 1.4%. The percentage of patients prescribed a VKA declined from 47% to 41%, whereas the percentage of patients prescribed a NOAC rose from 0% to 20%. In patients with new-onset AF, older age, heart failure, diabetes mellitus, vascular disease and dementia were independently associated with a higher likelihood of VKA rather than NOAC prescription. In 2017, 25% of all patients with AF and a CHA2DS2-VASc score ≥ 2 were not prescribed OAC therapy (i.e. 8% with platelet inhibitor monotherapy and 17% without any antithrombotic therapy). Conclusion Between 2008 and 2017, AF prevalence in the community more than tripled. Prescription patterns showed possible ‘channelling’ of VKAs over NOACs in frailer, elderly patients, whereas still about one in every four AF patients with a CHA2DS2-VASc score ≥ 2 was not prescribed any prophylactic OAC therapy. Supplementary Information The online version of this article (10.1007/s12471-022-01667-x) contains supplementary material, which is available to authorized users.
Collapse
|
6
|
Jiang W, Chen H, Liao J, Yang X, Yang B, Zhang Y, Pan X, Lian L, Yang L. The short-term effects and burden of particle air pollution on hospitalization for coronary heart disease: a time-stratified case-crossover study in Sichuan, China. Environ Health 2022; 21:19. [PMID: 35045878 PMCID: PMC8767695 DOI: 10.1186/s12940-022-00832-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/11/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND Coronary heart disease (CHD), the leading cause of death globally, might be developed or exacerbated by air pollution, resulting high burden to patients. To date, limited studies have estimated the relations between short-term exposure to air pollution and CHD disease burden in China, with inconsistent results. Hence, we aimed to estimate the short-term impact and burden of ambient PM pollutants on hospitalizations of CHD and specific CHD. METHODS PM10 and PM2.5 were measured at 82 monitoring stations in 9 cities in Sichuan Province, China during 2017-2018. Based on the time-stratified case-crossover design, the effects of short-term exposure to particle matter (PM) pollution on coronary heart disease (CHD) hospital admissions were estimated. Meanwhile, the linked burden of CHD owing to ambient PM pollution were estimated. RESULTS A total of 104,779 CHD records were derived from 153 hospitals from these 9 cities. There were significant effects of PM pollution on hospital admissions (HAs) for CHD and specific CHD in Sichuan Province. A 10 μg/m3 increase of PM10 and PM2.5 was linked with a 0.46% (95% CI: 0.08, 0.84%), and 0.57% (95% CI: 0.05, 1.09%) increments in HAs for CHD at lag7, respectively. The health effects of air pollutants were comparable modified by age, season and gender, showing old (≥ 65 years) and in cold season being more vulnerable to the effects of ambient air pollution, while gender-specific effects is positive but not conclusive. Involving the WHO's air quality guidelines as the reference, 1784 and 2847 total cases of HAs for CHD could be attributable to PM10 and PM2.5, separately. The total medical cost that could be attributable to exceeding PM10 and PM2.5 were 42.04 and 67.25 million CNY from 2017 to 2018, respectively. CONCLUSIONS This study suggested that the short-term exposure to air pollutants were associated with increased HAs for CHD in Sichuan Province, which could be implications for local environment improvement and policy reference.
Collapse
Affiliation(s)
- Wanyanhan Jiang
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan, China
| | - Han Chen
- State Key Laboratory of Grassland and Agro-ecosystem, School of Life Sciences, Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Jiaqiang Liao
- West China School of Public Health, Sichuan University, No. 17 People's South Road, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Xi Yang
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan, China
| | - Biao Yang
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan, China
| | - Yuqin Zhang
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan, China
| | - Xiaoqi Pan
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan, China
| | - Lulu Lian
- Collaborative Innovation Center for Western Ecological Safety, Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Lian Yang
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan, China.
| |
Collapse
|
7
|
Hospital Admissions Due to Ischemic Heart Diseases and Prescriptions of Cardiovascular Diseases Medications in England and Wales in the Past Two Decades. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137041. [PMID: 34280978 PMCID: PMC8297245 DOI: 10.3390/ijerph18137041] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 12/25/2022]
Abstract
Objectives: The aim of this study was to explore the trend of ischemic heart disease (IHD) admission and the prescriptions of IHD medications in England and Wales. Methods: A secular trends study was conducted during the period of 1999 to 2019. We extracted hospital admission data for patients from all age groups from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Prescriptions of IHD medications were extracted from the Prescription Cost Analysis database from 2004 to 2019. The chi-squared test was used to assess the difference between the admission rates and the difference between IHD medication prescription rates. The trends in IHD-related hospital admission and IHD-related medication prescription were assessed using a Poisson model. The correlation between hospital admissions for IHD and its IHD medication-related prescriptions was assessed using the Pearson correlation coefficient. Results: Our study detected a significant increase in the rate of cardiovascular disease (CVD) medication prescriptions in England and Wales, representing a rise in the CVD medications prescription rate of 41.8% (from 539,334.95 (95% CI = 539,286.30–539,383.59) in 2004 to 764,584.55 (95% CI = 764,545.55–764,623.56) in 2019 prescriptions per 100,000 persons), with a mean increase of 2.8% per year during the past 15 years. This increase was connected with a reduction in the IHD hospital admission rate by 15.4% (from 838.50 (95% CI = 836.05–840.94) in 2004 to 709.78 (95% CI = 707.65–711.92) in 2019 per 100,000 persons, trend test, p < 0.01), with a mean decrease of 1.02% per year during the past 15 years and by 5% (from 747.43 (95% CI = 745.09–749.77) in 1999 to 709.78 (95% CI = 707.65–711.92) in 2019 per 100,000 persons, trend test, p < 0.01) with a mean decrease of 0.25% per year during the past two decades in England and Wales. Conclusion: The rate of hospitalisation due to IHD has decreased in England and Wales during the past two decades. Hospitalisation due to IHD was strongly and negatively correlated with the increase in the rates of dispensing of IHD-related medications. Other factors contributing to this decline could be the increase in controlling IHD risk factors during the past few years. Future studies exploring other risk factors that are associated with IHD hospitalisation are warranted.
Collapse
|
8
|
Li Y, Li F, Zheng Y, Wang P, Jiang M, Li X. Hierarchical age estimation mechanism with adaBoost-based deep instance weighted fusion. J EXP THEOR ARTIF IN 2020. [DOI: 10.1080/0952813x.2020.1764633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Yongming Li
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing, China
- Collaborative Innovation Center for Brain Science, Chongqing University, Chongqing, China
| | - Fan Li
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing, China
| | - Yuanlin Zheng
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing, China
| | - Pin Wang
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing, China
| | - Mingfeng Jiang
- School of Information Science and Technology, Zhejiang Sci-Tech University, Hangzhou, China
| | - Xinke Li
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing, China
| |
Collapse
|
9
|
Comorbidity in patients with cardiovascular disease in primary care: a cohort study with routine healthcare data. Br J Gen Pract 2019; 69:e398-e406. [PMID: 31064742 DOI: 10.3399/bjgp19x702725] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/15/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Comorbidity is a major public health issue, which challenges health care configured around single diseases. AIM To provide an overview of frequent disease combinations of one and two additional chronic diseases and groups among patients with cardiovascular disease (CVD) in general practice. DESIGN AND SETTING Medical record data from the Julius General Practitioners' Network of 226 670 patients registered in 2015-2016 in Utrecht, the Netherlands, were collected and examined. METHOD Prevalences and combinations of one and two comorbid conditions were determined, by age and sex, in four populations of patients with CVD: heart failure, peripheral arterial disease (PAD), coronary heart disease (CHD), or stroke. Using logistic regression analyses, the authors examined whether comorbid conditions were significantly more prevalent in patients with a specific cardiovascular condition compared with those without. RESULTS Low vision, diabetes mellitus, back/neck problems, osteoarthritis, chronic obstructive pulmonary disease (COPD), and cancer were the most prevalent non-cardiovascular conditions and ranked in the top five of non-cardiovascular comorbid conditions in the different CVDs studied, irrespective of patient age and sex. Of these, diabetes, COPD, and low vision were statistically significantly more prevalent in all four cardiovascular conditions when compared with patients without the respective disease. Over the life span, the majority of the comorbid conditions were most prevalent in patients with heart failure, directly followed by those with PAD; they were less prevalent in patients with CHD and stroke. CONCLUSION Comorbid conditions are very common in patients with CVD, even in younger age groups. To ensure efficient and effective treatment, organisational adaptations may be required in the healthcare system to accommodate comorbid conditions in patients with CVD.
Collapse
|
10
|
Nedkoff L, Goldacre R, Greenland M, Goldacre MJ, Lopez D, Hall N, Knuiman M, Hobbs M, Sanfilippo FM, Wright FL. Comparative trends in coronary heart disease subgroup hospitalisation rates in England and Australia. Heart 2019; 105:1343-1350. [PMID: 30948515 PMCID: PMC6711344 DOI: 10.1136/heartjnl-2018-314512] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/20/2019] [Accepted: 02/12/2019] [Indexed: 12/21/2022] Open
Abstract
Background Population-based coronary heart disease (CHD) studies have focused on myocardial infarction (MI) with limited data on trends across the spectrum of CHD. We investigated trends in hospitalisation rates for acute and chronic CHD subgroups in England and Australia from 1996 to 2013. Methods CHD hospitalisations for individuals aged 35–84 years were identified from electronic hospital data from 1996 to 2013 for England and Australia and from the Oxford Region and Western Australia. CHD subgroups identified were acute coronary syndromes (ACS) (MI and unstable angina) and chronic CHD (stable angina and ‘other CHD’). We calculated age-standardised and age-specific rates and estimated annual changes (95% CI) from age-adjusted Poisson regression. Results From 1996 to 2013, there were 4.9 million CHD hospitalisations in England and 2.6 million in Australia (67% men). From 1996 to 2003, there was between-country variation in the direction of trends in ACS and chronic CHD hospitalisation rates (p<0.001). During 2004–2013, reductions in ACS hospitalisation rates were greater than for chronic CHD hospitalisation rates in both countries, with the largest subgroup declines in unstable angina (England: men: −7.1 %/year, 95% CI −7.2 to –7.0; women: −7.5 %/year, 95% CI −7.7 to –7.3; Australia: men: −8.5 %/year, 95% CI −8.6 to –8.4; women: −8.6 %/year, 95% CI −8.8 to –8.4). Other CHD rates increased in individuals aged 75–84 years in both countries. Chronic CHD comprised half of all CHD admissions, with the majority involving angiography or percutaneous coronary intervention. Conclusions Since 2004, rates of all CHD subgroups have fallen, with greater declines in acute than chronic presentations. The slower declines and high proportion of chronic CHD admissions undergoing coronary procedures requires greater focus.
Collapse
Affiliation(s)
- Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Raphael Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, England
| | - Melanie Greenland
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael J Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, England
| | - Derrick Lopez
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Nick Hall
- Unit of Health-Care Epidemiology, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, England
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael Hobbs
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - F Lucy Wright
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
11
|
Piepoli MF. Editor’s presentation. Eur J Prev Cardiol 2018; 25:227-229. [DOI: 10.1177/2047487318756841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit, Cardiology, G da Saliceto Hospital, Piacenza, Emilia, Romagna, Italy
| |
Collapse
|
12
|
Leibowitz D, Jacobs JM, Lande-Stessman I, Gilon D, Stessman J. Cardiac structure and function predicts functional decline in the oldest old. Eur J Prev Cardiol 2017; 25:263-269. [PMID: 29164920 DOI: 10.1177/2047487317744365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background This study examined the association between cardiac structure and function and the deterioration in activities of daily living (ADLs) in an age-homogenous, community-dwelling population of patients born in 1920-1921 over a five-year follow-up period. Design Longitudinal cohort study. Methods Patients were recruited from the Jerusalem Longitudinal Cohort Study, which has followed an age-homogenous cohort of Jerusalem residents born in 1920-1921. Patients underwent home echocardiography and were followed up for five years. Dependence was defined as needing assistance with one or more basic ADL. Standard echocardiographic assessment of cardiac structure and function, including systolic and diastolic function, was performed. Reassessment of ADLs was performed at the five-year follow-up. Results A total of 459 patients were included in the study. Of these, 362 (79%) showed a deterioration in at least one ADL at follow-up. Patients with functional deterioration had a significantly higher left ventricular mass index and left atrial volume with a lower ejection fraction. There was no significant difference between the diastolic parameters the groups in examined. When the data were examined categorically, a significantly larger percentage of patients with functional decline had an abnormal left ventricular ejection fraction and left ventricular hypertrophy. The association between left ventricular mass index and functional decline remained significant in all multivariate models. Conclusions In this cohort of the oldest old, an elevated left ventricular mass index, higher left atrial volumes and systolic, but not diastolic dysfunction, were predictive of functional disability.
Collapse
Affiliation(s)
- David Leibowitz
- 1 Heart Institute, Hebrew University Hadassah Medical School, Israel
| | - Jeremy M Jacobs
- 2 Department of Geriatrics and Rehabilitation, Hebrew University Hadassah Medical School, Israel
| | - Irit Lande-Stessman
- 2 Department of Geriatrics and Rehabilitation, Hebrew University Hadassah Medical School, Israel
| | - Dan Gilon
- 1 Heart Institute, Hebrew University Hadassah Medical School, Israel
| | - Jochanan Stessman
- 2 Department of Geriatrics and Rehabilitation, Hebrew University Hadassah Medical School, Israel
| |
Collapse
|
13
|
Nedkoff L, Lopez D, Goldacre M, Sanfilippo F, Hobbs M, Wright FL. Identification of myocardial infarction type from electronic hospital data in England and Australia: a comparative data linkage study. BMJ Open 2017; 7:e019217. [PMID: 29133337 PMCID: PMC5695341 DOI: 10.1136/bmjopen-2017-019217] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/24/2017] [Accepted: 09/29/2017] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To determine the utility of International Classification of Diseases (ICD) codes in investigating trends in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) using person-linked electronic hospitalisation data in England and Western Australia (WA). METHODS All hospital admissions with myocardial infarction (MI) as the principal diagnosis were identified from 2000 to 2013 from both jurisdictions. Fourth-digit ICD-10 codes were used to delineate all MI types-STEMI, NSTEMI, unspecified and subsequent MI. The annual frequency of each MI type was calculated as a proportion of all MI admissions. For all MI and each MI type, age-standardised rates were calculated and age-adjusted Poisson regression models used to estimate annual percentage changes in rates. RESULTS In 2000, STEMI accounted for 49% of all MI admissions in England and 59% in WA, decreasing to 35% and 25% respectively by 2013. Less than 10% of admissions were recorded as NSTEMI in England throughout the study period, whereas by 2013, 70% of admissions were NSTEMI in WA. Unspecified MI comprised 60% of all MI admissions in England by 2013, compared with <1% in WA. Trends in age-standardised rates differed for all MI (England, -2.7%/year; WA, +1.7%/year), underpinned by differing age-adjusted trends in NSTEMI (England, -6.1%/year; WA, +10.2%/year). CONCLUSION Differences between the proportion and trends for MI types in English and WA data were observed. These were consistent with the coding standards in each country. This has important implications for using electronic hospital data for monitoring MI and identifying MI types for outcome studies.
Collapse
Affiliation(s)
- Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Derrick Lopez
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Michael Goldacre
- Unit of Health-Care Epidemiology, Nuffield Department of Public Health, University of Oxford, Oxford, UK
| | - Frank Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Michael Hobbs
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - F Lucy Wright
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
14
|
Koopman C, Vaartjes I, Blokstra A, Verschuren WMM, Visser M, Deeg DJH, Bots ML, van Dis I. Trends in risk factors for coronary heart disease in the Netherlands. BMC Public Health 2016; 16:835. [PMID: 27543113 PMCID: PMC4992244 DOI: 10.1186/s12889-016-3526-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 06/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Favourable trends in risk factor levels in the general population may partly explain the decline in coronary heart disease (CHD) morbidity and mortality. Our aim was to present long-term national trends in established risk factors for CHD. METHODS Data were obtained from five data sources including several large scale population based surveys, cohort studies and general practitioner registers between 1988 and 2012. We applied linear regression models to age-standardized time trends to test for statistical significant trends. Analyses were stratified by sex and age (younger <65 and older ≥65 years adults). RESULTS The results demonstrated favourable trends in smoking (except in older women) and physical activity (except in older men). Unfavourable trends were found for body mass index (BMI) and diabetes mellitus prevalence. Although systolic blood pressure (SBP) and total cholesterol trends were favourable for older persons, SBP and total cholesterol remained stable in younger persons. CONCLUSIONS Four out of six risk factors for CHD showed a favourable or stable trend. The rise in diabetes mellitus and BMI is worrying with respect to CHD morbidity and mortality.
Collapse
Affiliation(s)
- C Koopman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (STR 6.131), P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. .,Dutch Heart Foundation, The Hague, The Netherlands.
| | - I Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (STR 6.131), P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - A Blokstra
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - W M M Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (STR 6.131), P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - M Visser
- Department of Health Sciences, EMGO+ Institute, VU University, Amsterdam, The Netherlands.,Department of Dietetics and Nutrition Sciences, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - D J H Deeg
- Department of Health Sciences, EMGO+ Institute, VU University, Amsterdam, The Netherlands
| | - M L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (STR 6.131), P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - I van Dis
- Dutch Heart Foundation, The Hague, The Netherlands
| |
Collapse
|
15
|
Xanthos PD, Gordon BA, Begg S, Nadurata V, Kingsley MIC. A comparison of age-standardised event rates for acute and chronic coronary heart disease in metropolitan and regional/remote Victoria: a retrospective cohort study. BMC Public Health 2016; 16:391. [PMID: 27169563 PMCID: PMC4865014 DOI: 10.1186/s12889-016-3081-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/04/2016] [Indexed: 11/11/2022] Open
Abstract
Background Acute and chronic coronary heart disease (CHD) pose different burdens on health-care services and require different prevention and treatment strategies. Trends in acute and chronic CHD event rates can guide service implementation. This study evaluated changes in acute and chronic CHD event rates in metropolitan and regional/remote Victoria. Methods Victorian hospital admitted episodes with a principal diagnosis of acute CHD or chronic CHD were identified from 2005 to 2012. Acute and chronic CHD age-standardised event rates were calculated in metropolitan and regional/remote Victoria. Poisson log-link linear regression was used to estimate annual change in acute and chronic CHD event rates. Results Acute CHD age-standardised event rates decreased annually by 2.9 % (95 % CI, −4.3 to −1.4 %) in metropolitan Victoria and 1.7 % (95 % CI, −3.2 to −0.1 %) in regional/remote Victoria. In comparison, chronic CHD age-standardised event rates increased annually by 4.8 % (95 % CI, +3.0 to +6.5 %) in metropolitan Victoria and 3.1 % (95 % CI, +1.3 to +4.9 %) in regional/remote Victoria. On average, age-standardised event rates for regional/remote Victoria were 30.3 % (95 % CI, 23.5 to 37.2 %) higher for acute CHD and 55.3 % (95 % CI, 47.1 to 63.5 %) higher for chronic CHD compared to metropolitan Victoria from 2005 to 2012. Conclusion Annual decreases in acute CHD age-standardised event rates might reflect improvements in primary prevention, while annual increases in chronic CHD age-standardised event rates suggest a need to improve secondary prevention strategies. Consistently higher acute and chronic CHD age-standardised event rates were evident in regional/remote Victoria compared to metropolitan Victoria from 2005 to 2012.
Collapse
Affiliation(s)
- Paul D Xanthos
- Discipline of Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Brett A Gordon
- Discipline of Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Voltaire Nadurata
- Department of Cardiology, Bendigo Health Care Group, Bendigo, Victoria, Australia
| | - Michael I C Kingsley
- Discipline of Exercise Physiology, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.
| |
Collapse
|
16
|
Alfredsson J, Alexander KP. Multiple Chronic Conditions in Older Adults with Acute Coronary Syndromes. Clin Geriatr Med 2016; 32:291-303. [PMID: 27113147 DOI: 10.1016/j.cger.2016.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Older adults presenting with acute coronary syndromes (ACSs) often have multiple chronic conditions (MCCs). In addition to traditional cardiovascular (CV) risk factors (ie, hypertension, hyperlipidemia, and diabetes), common CV comorbidities include heart failure, stroke, and atrial fibrillation, whereas prevalent non-CV comorbidities include chronic kidney disease, anemia, depression, and chronic obstructive pulmonary disease. The presence of MCCs affects the presentation (eg, increased frequency of type 2 myocardial infarctions [MIs]), clinical course, and prognosis of ACS in older adults. In general, higher comorbidity burden increases mortality following MI, reduces utilization of ACS treatments, and increases the importance of developing individualized treatment plans.
Collapse
Affiliation(s)
- Joakim Alfredsson
- Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA
| | - Karen P Alexander
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA.
| |
Collapse
|
17
|
Weil TP. Patient falls in hospitals: An increasing problem. Geriatr Nurs 2015; 36:342-7. [DOI: 10.1016/j.gerinurse.2015.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 07/08/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
|