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Gao X, Zhang N, Lu L, Gao T, Chou OHI, Wong WT, Chang C, Wai AKC, Lip GYH, Zhang Q, Tse G, Liu T, Zhou J. New-onset syncope in diabetic patients treated with sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors: a Chinese population-based cohort study. Eur Heart J Cardiovasc Pharmacother 2024; 10:103-117. [PMID: 37962962 DOI: 10.1093/ehjcvp/pvad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/17/2023] [Accepted: 11/11/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND AND AIMS Syncope is a symptom that poses an important diagnostic and therapeutic challenge, and generates significant cost for the healthcare system. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated beneficial cardiovascular effects, but their possible effects on incident syncope have not been fully investigated. This study compared the effects of SGLT2i and dipeptidyl peptidase-4 inhibitors (DPP4i) on new-onset syncope. METHODS AND RESULTS This was a retrospective, territory-wide cohort study enrolling type 2 diabetes mellitus (T2DM) patients treated with SGLT2i or DPP4i between 1 January 2015 and 31 December 2020, in Hong Kong, China. The outcomes were hospitalization of new-onset syncope, cardiovascular mortality, and all-cause mortality. Multivariable Cox regression and different approaches using the propensity score were applied to evaluate the association between SGLT2i and DPP4i with incident syncope and mortality. After matching, a total of 37 502 patients with T2DM were included (18 751 SGLT2i users vs. 18 751 DPP4i users). During a median follow-up of 5.56 years, 907 patients were hospitalized for new-onset syncope (2.41%), and 2346 patients died from any cause (6.26%), among which 471 deaths (1.26%) were associated with cardiovascular causes. Compared with DPP4i users, SGLT2i therapy was associated with a 51% lower risk of new-onset syncope [HR 0.49; 95% confidence interval (CI) 0.41-0.57; P < 0.001], 65% lower risk of cardiovascular mortality (HR 0.35; 95% CI 0.26-0.46; P < 0.001), and a 70% lower risk of all-cause mortality (HR 0.30; 95% CI 0.26-0.34; P < 0.001) in the fully adjusted model. Similar associations with syncope were observed for dapagliflozin (HR 0.70; 95% CI 0.58-0.85; P < 0.001), canagliflozin (HR 0.48; 95% CI 0.36-0.63; P < 0.001), and ertugliflozin (HR 0.45; 95% CI 0.30-0.68; P < 0.001), but were attenuated for empagliflozin (HR 0.79; 95% CI 0.59-1.05; P = 0.100) after adjusting for potential confounders. The subgroup analyses suggested that, compared with DPP4i, SGLT2i was associated with a significantly decreased risk of incident syncope among T2DM patients, regardless of gender, age, glucose control status, Charlson comorbidity index, and the association remained constant amongst those with common cardiovascular drugs and most antidiabetic drugs at baseline. CONCLUSION Compared with DPP4i, SGLT2i was associated with a significantly lower risk of new-onset syncope in patients with T2DM, regardless of gender, age, degree of glycaemic control, and comorbidity burden.
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Affiliation(s)
- Xinyi Gao
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Nan Zhang
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Lei Lu
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Tianyu Gao
- School of Physical Education, Jinan University, Guangzhou, China
| | - Oscar Hou In Chou
- Department of Medicine, Division of Clinical Pharmacology and Therapeutics, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
- Diabetes Research Unit, Cardiovascular Analytics Group, PowerHealth Limited, Hong Kong, China
| | - Wing Tak Wong
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Carlin Chang
- Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Qingpeng Zhang
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, and the Musketeers Foundation Institute of Data Science, University of Hong Kong, Hong Kong, China
| | - Gary Tse
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Tong Liu
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Jiandong Zhou
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Division of Health Science, Warwick Medical School, University of Warwick, Coventry, UK
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2
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Leung KSK, Radford D, Huang H, Lakhani I, Li CKH, Hothi SS, Wai AKC, Liu T, Tse G, Lee S. Risk stratification of sudden cardiac death in asymptomatic female Brugada syndrome patients: A literature review. Ann Noninvasive Electrocardiol 2023; 28:e13030. [PMID: 36628595 PMCID: PMC10023885 DOI: 10.1111/anec.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Risk stratification in Brugada syndrome remains a difficult problem. Given the male predominance of this disease and their elevated risks of arrhythmic events, affected females have received less attention. It is widely known that symptomatic patients are at increased risk of sudden cardiac death (SCD) than asymptomatic patients, while this might be true in the male population; recent studies have shown that this association might not be significant in females. Over the past few decades, numerous markers involving clinical symptoms, electrocardiographic (ECG) indices, and genetic tests have been explored, with several risk-scoring models developed so far. The objective of this study is to review the current evidence of clinical and ECG markers as well as risk scores on asymptomatic females with Brugada syndrome. FINDINGS Gender differences in ECG markers, the yield of genetic findings, and the applicability of risk scores are highlighted. CONCLUSIONS Various clinical, electrocardiographic, and genetic risk factors are available for assessing SCD risk amongst asymptomatic female BrS patients. However, due to the significant gender discrepancy in BrS, the SCD risk amongst females is often underestimated, and there is a lack of research on female-specific risk factors and multiparametric risk scores. Therefore, multinational studies pooling female BrS patients are needed for the development of a gender-specific risk stratification approach amongst asymptomatic BrS patients.
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Affiliation(s)
- Keith Sai Kit Leung
- Cardiac Electrophysiology UnitCardiovascular Analytics GroupHong KongChina
- Faculty of Health and Life SciencesAston University Medical SchoolBirminghamUK
| | - Danny Radford
- Kent and Medway Medical SchoolUniversity of Kent and Canterbury Christ Church UniversityCanterburyUK
| | - Helen Huang
- University of Medicine and Health Science, Royal College of Surgeons in IrelandDublinIreland
| | - Ishan Lakhani
- Cardiac Electrophysiology UnitCardiovascular Analytics GroupHong KongChina
| | | | - Sandeep Singh Hothi
- Heart and Lung CentreNew Cross Hospital, Royal Wolverhampton NHS TrustWolverhamptonUK
| | | | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of CardiologyTianjin Institute of Cardiology, Second Hospital of Tianjin Medical UniversityTianjinChina
| | - Gary Tse
- Cardiac Electrophysiology UnitCardiovascular Analytics GroupHong KongChina
- Kent and Medway Medical SchoolUniversity of Kent and Canterbury Christ Church UniversityCanterburyUK
- Emergency Medicine UnitUniversity of Hong KongHong KongChina
| | - Sharen Lee
- Cardiac Electrophysiology UnitCardiovascular Analytics GroupHong KongChina
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Chou OHI, Chang C, Zhou J, Chan J, Leung KSK, Lee TTL, Wong WT, Liu T, Zhang Q, Lee S, Wai AKC, Tse G. Predictive value of neutrophil-to-lymphocyte ratio for atrial fibrillation and stroke in type 2 diabetes mellitus: a population-based cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Neutrophil-to-lymphocyte ratio (NLR) is a routinely available biomarker that reflects systemic inflammation. The study evaluated the predictive value of NLR for ischemic stroke and atrial fibrillation (AF) in patients with type 2 diabetes mellitus.
Methods
This was a population-based cohort study of patients with type 2 diabetes mellitus and complete blood count tests at baseline between January 1st, 2009 to December 31st, 2009 at government-funded hospitals/clinics in Hong Kong. Follow-up was until December 31st, 2019 or death.
Results
A total of 85351 patients (age=67.6±13.2 years old, male=48.8%, follow-up=3101±1441 days) were included. Univariable Cox regression found that increased NLR at quartiles 2, 3 and 4 was significantly associated with higher risks of new onset ischemic stroke (HR: 1.28 [1.20–1.37], P<0.001, HR: 1.41 [1.32–1.51], P<0.001 and HR: 1.38 [1.29–1.47], P<0.001) and AF (hazard ratio [HR]: 1.09 [1.02–1.17], P<0.015; HR: 1.28 [1.20–1.37], P<0.001; HR: 1.39 [1.31–1.49], P<0.001) compared to quartile 1. On multivariable analysis, NLR remained a significant predictor of ischemic stroke risk for quartiles 2 and 3 (quartile 2: HR: 1.14 [1.05, 1.22], p=0.001; quartile 3: HR: 1.14 [1.06, 1.23], p<0.001) but not quartile 4 (HR: 1.08 [0.994, 1.17], p=0.070). By contrast, NLR was not predictive of AF after adjusting for confounders (quartile 2: HR: 0.966 [0.874, 1.07], p=0.499; quartile 3: HR: 0.978 [0.884, 1.08], p=0.661; quartile 4: HR: 1.05 [0.935, 1.16], p=0.462).
Conclusion
NLR is a significant predictor of new onset ischaemic stroke but not AF after adjusting for significant confounders.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- O H I Chou
- The University of Hong Kong, Division of Clinical Pharmacology, Department of Medicine, School of Clinical Medicine , Hong Kong , Hong Kong
| | - C Chang
- Queen Mary Hospital, Department of Medicine , Hong Kong , Hong Kong
| | - J Zhou
- University of Oxford, Nuffield Department of Medicine , Oxford , United Kingdom
| | - J Chan
- Cardiovascular Analytics Group , Hong Kong , Hong Kong
| | - K S K Leung
- Cardiovascular Analytics Group , Hong Kong , Hong Kong
| | - T T L Lee
- The University of Hong Kong, Emergency Medicine Unit, Li Ka Shing Faculty of Medicine , Hong Kong , Hong Kong
| | - W T Wong
- The Chinese University of Hong Kong, School of Life Sciences , Hong Kong , Hong Kong
| | - T Liu
- 2nd Hospital of Tianjin Medical University, Department of Cardiology , Tianjin , China
| | - Q Zhang
- City University of Hong Kong, School of Data Science , Hong Kong , Hong Kong
| | - S Lee
- Cardiovascular Analytics Group , Hong Kong , Hong Kong
| | - A K C Wai
- The University of Hong Kong, Emergency Medicine Unit, Li Ka Shing Faculty of Medicine , Hong Kong , Hong Kong
| | - G Tse
- Kent and Medway Medical School , Canterbury , United Kingdom
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Wong JYH, Luk LYF, Yip TF, Lee TTL, Wai AKC, Ho JWK. Incidence of Emergency Department Visits for Sexual Abuse Among Youth in Hong Kong Before and During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2236278. [PMID: 36264581 PMCID: PMC9585429 DOI: 10.1001/jamanetworkopen.2022.36278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This cohort study assesses the incidence of emergency department (ED) visits in Hong Kong, China, for sexual abuse among youth before and during the COVID-19 pandemic.
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Affiliation(s)
- Janet Yuen Ha Wong
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong SAR, China
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Luke Y. F. Luk
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D4H), Hong Kong Science Park, Hong Kong SAR, China
| | - Tsz Fung Yip
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D4H), Hong Kong Science Park, Hong Kong SAR, China
| | - Teddy Tai Loy Lee
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Abraham Ka Chung Wai
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Accident and Emergency, The University of Hong Kong–Shenzhen Hospital, Shenzhen, China
| | - Joshua W. K. Ho
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Laboratory of Data Discovery for Health Limited (D4H), Hong Kong Science Park, Hong Kong SAR, China
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5
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Lau CH, Yu KHO, Yip TF, Luk LY, Wai AKC, Sit TY, Wong JYH, Ho JWK. An artificial intelligence-enabled smartphone app for real-time pressure injury assessment. Front Med Technol 2022; 4:905074. [PMID: 36212608 PMCID: PMC9541137 DOI: 10.3389/fmedt.2022.905074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022] Open
Abstract
The management of chronic wounds in the elderly such as pressure injury (also known as bedsore or pressure ulcer) is increasingly important in an ageing population. Accurate classification of the stage of pressure injury is important for wound care planning. Nonetheless, the expertise required for staging is often not available in a residential care home setting. Artificial-intelligence (AI)-based computer vision techniques have opened up opportunities to harness the inbuilt camera in modern smartphones to support pressure injury staging by nursing home carers. In this paper, we summarise the recent development of smartphone or tablet-based applications for wound assessment. Furthermore, we present a new smartphone application (app) to perform real-time detection and staging classification of pressure injury wounds using a deep learning-based object detection system, YOLOv4. Based on our validation set of 144 photos, our app obtained an overall prediction accuracy of 63.2%. The per-class prediction specificity is generally high (85.1%–100%), but have variable sensitivity: 73.3% (stage 1 vs. others), 37% (stage 2 vs. others), 76.7 (stage 3 vs. others), 70% (stage 4 vs. others), and 55.6% (unstageable vs. others). Using another independent test set, 8 out of 10 images were predicted correctly by the YOLOv4 model. When deployed in a real-life setting with two different ambient brightness levels with three different Android phone models, the prediction accuracy of the 10 test images ranges from 80 to 90%, which highlight the importance of evaluation of mobile health (mHealth) application in a simulated real-life setting. This study details the development and evaluation process and demonstrates the feasibility of applying such a real-time staging app in wound care management.
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Affiliation(s)
- Chun Hon Lau
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ken Hung-On Yu
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Tsz Fung Yip
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Luke Yik Fung Luk
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Abraham Ka Chung Wai
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Tin-Yan Sit
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Janet Yuen-Ha Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- School of Nursing / Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Hong Kong SAR, China
- Correspondence: Janet Yuen-Ha Wong Joshua Wing Kei Ho
| | - Joshua Wing Kei Ho
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Correspondence: Janet Yuen-Ha Wong Joshua Wing Kei Ho
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6
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Lee TTL, Hui JMH, Lee YHA, Satti DI, Shum YKL, Kiu PTH, Wai AKC, Liu T, Wong WT, Chan JSK, Cheung BMY, Wong ICK, Cheng SH, Tse G. Sulfonylurea Is Associated With Higher Risks of Ventricular Arrhythmia or Sudden Cardiac Death Compared With Metformin: A Population‐Based Cohort Study. J Am Heart Assoc 2022; 11:e026289. [PMID: 36102222 DOI: 10.1161/jaha.122.026289] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background
Commonly prescribed diabetic medications such as metformin and sulfonylurea may be associated with different arrhythmogenic risks. This study compared the risk of ventricular arrhythmia or sudden cardiac death between metformin and sulfonylurea users in patients with type 2 diabetes.
Methods and Results
Patients aged ≥40 years who were diagnosed with type 2 diabetes or prescribed antidiabetic agents in Hong Kong between January 1, 2009, and December 31, 2009, were included and followed up until December 31, 2019. Patients prescribed with both metformin and sulfonylurea or had prior myocardial infarction were excluded. The study outcome was a composite of ventricular arrhythmia or sudden cardiac death. Metformin users and sulfonylurea users were matched at a 1:1 ratio by propensity score matching. The matched cohort consisted of 16 596 metformin users (47.70% men; age, 68±11 years; mean follow‐up, 4.92±2.55 years) and 16 596 sulfonylurea users (49.80% men; age, 70±11 years; mean follow‐up, 4.93±2.55 years). Sulfonylurea was associated with higher risk of ventricular arrhythmia or sudden cardiac death than metformin hazard ratio (HR, 1.90 [95% CI, 1.73–2.08]). Such difference was consistently observed in subgroup analyses stratifying for insulin usage or known coronary heart disease.
Conclusions
Sulfonylurea use is associated with higher risk of ventricular arrhythmia or sudden cardiac death than metformin in patients with type 2 diabetes.
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Affiliation(s)
- Teddy Tai Loy Lee
- Department of Emergency Medicine School of Clinical Medicine, The University of Hong Kong Hong Kong China
- Diabetes Research Unit, Cardiovascular Analytics Group China‐UK Collaboration Hong Kong China
| | - Jeremy Man Ho Hui
- Diabetes Research Unit, Cardiovascular Analytics Group China‐UK Collaboration Hong Kong China
| | - Yan Hiu Athena Lee
- Diabetes Research Unit, Cardiovascular Analytics Group China‐UK Collaboration Hong Kong China
| | - Danish Iltaf Satti
- Diabetes Research Unit, Cardiovascular Analytics Group China‐UK Collaboration Hong Kong China
| | - Yuki Ka Ling Shum
- Diabetes Research Unit, Cardiovascular Analytics Group China‐UK Collaboration Hong Kong China
| | - Pias Tang Hoi Kiu
- Diabetes Research Unit, Cardiovascular Analytics Group China‐UK Collaboration Hong Kong China
| | - Abraham Ka Chung Wai
- Department of Emergency Medicine School of Clinical Medicine, The University of Hong Kong Hong Kong China
| | - Tong Liu
- Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University Tianjin China
| | - Wing Tak Wong
- School of Life Sciences, State Key Laboratory of Agrobiotechnology (CUHK), The Chinese University of Hong Kong Hong Kong China
| | - Jeffrey Shi Kai Chan
- Diabetes Research Unit, Cardiovascular Analytics Group China‐UK Collaboration Hong Kong China
| | - Bernard Man Yung Cheung
- Division of Clinical Pharmacology School of Clinical Medicine, The University of Hong Kong Hong Kong China
| | - Ian Chi Kei Wong
- Department of Pharmacology and Pharmacy University of Hong Kong Hong Kong China
- UCL School of Pharmacy Medicines Optimisation Research and Education (CMORE) London United Kingdom
| | - Shuk Han Cheng
- Department of Infectious Diseases and Public Health City University of Hong Kong Hong Kong China
| | - Gary Tse
- Diabetes Research Unit, Cardiovascular Analytics Group China‐UK Collaboration Hong Kong China
- Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University Tianjin China
- Kent and Medway Medical School Canterbury United Kingdom
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Chan JSK, Satti DI, Lee YHA, Hui JMH, Lee TTL, Chou OHI, Wai AKC, Ciobanu A, Liu Y, Liu T, Roever L, Biondi-Zoccai G, Zhang Q, Cheung BMY, Zhou J, Tse G. High visit-to-visit cholesterol variability predicts heart failure and adverse cardiovascular events: a population-based cohort study. Eur J Prev Cardiol 2022; 29:e323-e325. [PMID: 35653641 DOI: 10.1093/eurjpc/zwac097] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Jeffrey Shi Kai Chan
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Danish Iltaf Satti
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Yan Hiu Athena Lee
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Jeremy Man Ho Hui
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Teddy Tai Loy Lee
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.,Emergency Medicine Unit, Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Oscar Hou In Chou
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Ana Ciobanu
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.,Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine and Cardiology, Theodor Burghele Clinical Hospital, Bucharest, Romania
| | - Ying Liu
- Heart Failure and Structural Cardiology Division, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, 116021, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Leonardo Roever
- Departamento de Pesquisa Clinica, Universidade Federal de Uberlandia, Uberlandia, MG, Brazil
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong
| | - Bernard Man Yung Cheung
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Jiandong Zhou
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Gary Tse
- Family Medicine Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China.,Kent and Medway Medical School, Canterbury CT2 7FS, United Kingdom
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8
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Lee YHA, Zhou J, Hui JMH, Liu X, Lee TTL, Hui K, Chan JSK, Wai AKC, Wong WT, Liu T, Ng K, Lee S, Dee EC, Zhang Q, Tse G. Risk of New-Onset Prostate Cancer for Metformin Versus Sulfonylurea Use in Type 2 Diabetes Mellitus: A Propensity Score-Matched Study. J Natl Compr Canc Netw 2022; 20:674-682.e15. [PMID: 35714677 DOI: 10.6004/jnccn.2022.7010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to compare the risks of new-onset prostate cancer between metformin and sulfonylurea users with type 2 diabetes mellitus (T2DM). METHODS This population-based retrospective cohort study included male patients with T2DM presenting to public hospitals/clinics in Hong Kong between January 1, 2000, and December 31, 2009. We only included patients prescribed either, but not both, metformin or sulfonylurea. All patients were followed up until December 31, 2019. The primary outcome was new-onset prostate cancer and the secondary outcome was all-cause mortality. One-to-one propensity score matching was performed between metformin and sulfonylurea users based on demographics, comorbidities, antidiabetic and cardiovascular medications, fasting blood glucose level, and hemoglobin A1c level. Subgroup analyses based on age and use of androgen deprivation therapy were performed. RESULTS The final study cohort consisted of 25,695 metformin users (mean [SD] age, 65.2 [11.8] years) and 25,695 matched sulfonylurea users (mean [SD] age, 65.3 [11.8] years) with a median follow-up duration of 119.6 months (interquartile range, 91.7-139.6 months) after 1:1 propensity score matching of 66,411 patients. Metformin users had lower risks of new-onset prostate cancer (hazard ratio, 0.80; 95% CI, 0.69-0.93; P=.0031) and all-cause mortality (hazard ratio, 0.89; 95% CI, 0.86-0.92; P<.0001) than sulfonylurea users. Metformin use was more protective against prostate cancer but less protective against all-cause mortality in patients aged <65 years (P for trend <.0001 for both) compared with patients aged ≥65 years. Metformin users had lower risk of all-cause mortality than sulfonylurea users, regardless of the use of androgen deprivation therapy (P for trend <.0001) among patients who developed prostate cancer. CONCLUSIONS Metformin use was associated with significantly lower risks of new-onset prostate cancer and all-cause mortality than sulfonylurea use in male patients with T2DM.
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Affiliation(s)
- Yan Hiu Athena Lee
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, China.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jeremy Man Ho Hui
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.,Department of Medicine, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Xuejin Liu
- School of Educational Science, Kaili University, Kaili City, Guizhou, China
| | - Teddy Tai Loy Lee
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.,Department of Emergency Medicine, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Kyle Hui
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Jeffrey Shi Kai Chan
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Abraham Ka Chung Wai
- Department of Emergency Medicine, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Wing Tak Wong
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Kenrick Ng
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sharen Lee
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | | | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Gary Tse
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration.,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.,Kent and Medway Medical School, Canterbury, Kent, United Kingdom
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Zhou J, Lakhani I, Chou O, Leung KSK, Lee TTL, Wong MV, Li Z, Wai AKC, Chang C, Wong ICK, Zhang Q, Tse G, Cheung BMY. Clinical characteristics, risk factors and outcomes of cancer patients with COVID-19: A population-based study. Cancer Med 2022; 12:287-296. [PMID: 35642123 PMCID: PMC9348317 DOI: 10.1002/cam4.4888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Cancer patients may be susceptible to poorer outcomes in COVID-19 infection owing to the immunosuppressant effect of chemotherapy/radiotherapy and cancer growth, along with the potential for nosocomial transmission due to frequent hospital admissions. METHODS This was a population-based retrospective cohort study of COVID-19 patients who presented to Hong Kong public hospitals between 1 January 2020 and 8 December 2020. The primary outcome was a composite endpoint of requirement for intubation, ICU admission and 30-day mortality. RESULTS The following study consisted of 6089 COVID-19 patients (median age 45.9 [27.8.1-62.7] years; 50% male), of which 142 were cancer subjects. COVID-19 cancer patients were older at baseline and tended to present with a higher frequency of comorbidities, including diabetes mellitus, hypertension, chronic obstructive pulmonary disease, ischemic heart disease, ventricular tachycardia/fibrillation and gastrointestinal bleeding (p < 0.05). These subjects also likewise tended to present with higher serum levels of inflammatory markers, including D-dimer, lactate dehydrogenase, high sensitivity troponin-I and C-reactive protein. Multivariate Cox regression showed that any type of cancer presented with an almost four-fold increased risk of the primary outcome (HR: 3.77; 95% CI: 1.63-8.72; p < 0.002) after adjusting for significant demographics, Charlson comorbidity index, number of comorbidities, past comorbidities and medication history. This association remained significant when assessing those with colorectal (HR: 5.07; 95% CI: 1.50-17.17; p < 0.009) and gastrointestinal malignancies (HR: 3.79; 95% CI: 1.12-12.88; p < 0.03), but not with lung, genitourinary, or breast malignancies, relative to their respective cancer-free COVID-19 counterparts. CONCLUSIONS COVID-19 cancer patients are associated with a significantly higher risk of intubation, ICU admission and/or mortality.
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Affiliation(s)
- Jiandong Zhou
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Ishan Lakhani
- Cardiovascular Analytics Group, Laboratory of Cardiovascular PhysiologyHong KongChina
| | - Oscar Chou
- Li Ka Shing Faculty of MedicineUniversity of Hong KongHong KongChina
| | | | | | - Michelle Vangi Wong
- Cardiovascular Analytics Group, Laboratory of Cardiovascular PhysiologyHong KongChina
| | - Zhen Li
- Department of RadiologyTongji Hospital of Tongji Medical College of Huazhong University of Science and TechnologyWuhanChina
| | | | - Carlin Chang
- Division of Neurology, Department of MedicineUniversity of Hong KongHong KongChina
| | - Ian Chi Kei Wong
- Department of Pharmacology and PharmacyUniversity of Hong KongHong KongChina,Medicines Optimisation Research and Education (CMORE)UCL School of PharmacyLondonUK
| | - Qingpeng Zhang
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Gary Tse
- Cardiovascular Analytics Group, Laboratory of Cardiovascular PhysiologyHong KongChina,Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina,Kent and Medway Medical SchoolCanterburyKentUK
| | - Bernard Man Yung Cheung
- Division of Clinical Pharmacology, Department of MedicineUniversity of Hong KongHong KongChina
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Zhou J, Zhang G, Chang C, Chou OHI, Lee S, Leung KSK, Wong WT, Liu T, Wai AKC, Cheng SH, Zhang Q, Tse G. Metformin versus sulphonylureas for new onset atrial fibrillation and stroke in type 2 diabetes mellitus: a population-based study. Acta Diabetol 2022; 59:697-709. [PMID: 35112189 DOI: 10.1007/s00592-021-01841-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 12/18/2021] [Indexed: 11/01/2022]
Abstract
AIMS To gain insights on the cardiovascular effects of metformin and sulphonylurea, the present study compares the rates of incident atrial fibrillation, stroke, cardiovascular mortality and all-cause mortality between metformin and sulphonylurea users in type 2 diabetes mellitus. METHODS This was a retrospective population-based cohort study of type 2 diabetes mellitus patients receiving either sulphonylurea or metformin monotherapy between January 1, 2000, and December 31, 2019. The primary outcome was new-onset AF or stroke. Secondary outcomes were cardiovascular, non-cardiovascular and all-cause mortality. Propensity score matching (1:2 ratio) between sulphonylurea and metformin users was performed, based on demographics, CHA-DS-VASc score, past comorbidities and medication use. Cox regression was used to identify significant risk factors. Competing risk analysis was conducted using cause-specific and subdistribution hazard models. Sensitivity analyses using propensity score stratification, high-dimensional propensity score and inverse probability of treatment weighting were conducted. Subgroup analyses were conducted for age and gender in the matched cohort. RESULTS A total of 36,228 sulphonylurea users and 72,456 metformin users were included in the propensity score-matched cohort. Multivariable Cox regression showed that sulphonylurea users had higher risks of incident AF (hazard ratio [HR]: 2.89, 95% confidence interval [CI]: 2.75-3.77; P < 0.0001), stroke (HR: 3.23, 95% CI: 3.01-3.45; P < 0.0001), cardiovascular mortality (HR: 3.60, 95% CI: 2.62-4.81; P < 0.0001) and all-cause mortality (HR: 4.35, 95% CI: 3.16-4.75; P < 0.0001) compared to metformin users. Similarly, significant results were observed using cause-specific and subdistribution hazard models. Sensitivity analysis using techniques based on the propensity score also yielded similar results. CONCLUSIONS Sulphonylurea use was associated with higher risks of incident AF, stroke, cardiovascular mortality and all-cause mortality compared to metformin. Males and patients older than 65 years with sulphonylurea use were exposed to the highest risks.
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Affiliation(s)
- Jiandong Zhou
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Guoming Zhang
- Emergency Department, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, China
| | - Carlin Chang
- Department of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Oscar Hou In Chou
- Department of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China
- Diabetes Research Unit, Cardiovascular Analytics Group, UK-China Collaboration, Hong Kong, China
| | - Sharen Lee
- Diabetes Research Unit, Cardiovascular Analytics Group, UK-China Collaboration, Hong Kong, China
| | - Keith Sai Kit Leung
- Aston Medical School, Aston University, Birmingham, UK
- Emergency Medicine Unit, Li Ka Shing, Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wing Tak Wong
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, Li Ka Shing, Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shuk Han Cheng
- School of Biomedical Sciences, City University of Hong Kong, Hong Kong, China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Kowloon City, Hong Kong, China.
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
- Kent and Medway Medical School, Canterbury, UK.
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Lee YHA, Zhou J, Hui JMH, Liu X, Lee TTL, Hui K, Wai AKC, Wong WT, Liu T, Ng K, Lee S, Dee EC, Chan JSK, Zhang Q, Tse G. EPR22-112: Risk of Prostate Cancer for Metformin Versus Sulphonylurea Monotherapy in Type 2 Diabetes Mellitus: A Propensity Score-Matched Retrospective Cohort Study. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Xuejin Liu
- 3 Kaili University, Kaili City, Guizhou, China
| | - Teddy Tai Loy Lee
- 1 Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
- 4 Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kyle Hui
- 1 Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Abraham Ka Chung Wai
- 4 Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Tong Liu
- 6 Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Kenrich Ng
- 7 University College London Hospitals NHS Foundation Trust, London, UK
| | - Sharen Lee
- 1 Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | | | | | | | - Gary Tse
- 1 Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
- 6 Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
- 9 Kent and Medway Medical School, Canterbury, Kent, CT2 7NT, UK
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Chou OHI, Zhou J, Lee TTL, Kot T, Lee S, Wai AKC, Wong WT, Zhang Q, Cheng SH, Liu T, Vassiliou VS, Cheung BMY, Tse G. Comparisons of the risk of myopericarditis between COVID-19 patients and individuals receiving COVID-19 vaccines: a population-based study. Clin Res Cardiol 2022; 111:1098-1103. [PMID: 35333945 PMCID: PMC8951670 DOI: 10.1007/s00392-022-02007-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022]
Abstract
Background Both COVID-19 infection and COVID-19 vaccines have been associated with the development of myopericarditis. The objective of this study is to (1) analyse the rates of myopericarditis after COVID-19 infection and COVID-19 vaccination in Hong Kong, (2) compared to the background rates, and (3) compare the rates of myopericarditis after COVID-19 vaccination to those reported in other countries. Methods This was a population-based cohort study from Hong Kong, China. Patients with positive RT-PCR test for COVID-19 between 1st January 2020 and 30th June 2021 or individuals who received COVID-19 vaccination until 31st August were included. The main exposures were COVID-19 positivity or COVID-19 vaccination. The primary outcome was myopericarditis. Results This study included 11,441 COVID-19 patients from Hong Kong, four of whom suffered from myopericarditis (rate per million: 326; 95% confidence interval [CI] 127–838). The rate was higher than the pre-COVID-19 background rate in 2019 (rate per million: 5.5, 95% CI 4.1–7.4) with a rate ratio of 55.0 (95% CI 21.4–141). Compared to the background rate, the rate of myopericarditis among vaccinated subjects in Hong Kong was similar (rate per million: 5.5; 95% CI 4.1–7.4) with a rate ratio of 0.93 (95% CI 0.69–1.26). The rates of myocarditis after vaccination in Hong Kong were comparable to those vaccinated in the United States, Israel, and the United Kingdom. Conclusions COVID-19 infection was associated with significantly higher rate of myopericarditis compared to the vaccine-associated myopericarditis. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-022-02007-0.
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Affiliation(s)
- Oscar Hou In Chou
- Division of Clinical Pharmacology, Department of Medicine, School of Clinical Medicine, University of Hong Kong, Hong Kong, China.,Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China
| | - Jiandong Zhou
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Teddy Tai Loy Lee
- Department of Emergency Medicine, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Thompson Kot
- Department of Anaesthesia, Princess Margaret Hospital, Hong Kong, China
| | - Sharen Lee
- Epidemiology Research Unit, Cardiovascular Analytics Group, Hong Kong, China
| | - Abraham Ka Chung Wai
- Department of Emergency Medicine, School of Clinical Medicine, University of Hong Kong, Hong Kong, China
| | - Wing Tak Wong
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Shuk Han Cheng
- Department of Infectious Diseases and Public Health, City University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Vassilios S Vassiliou
- Department of Cardiology, Norwich Medical School, University of East Anglia, Norfolk, UK. .,Norwich and Norwich University Hospital, Colney Lane, Norwich, NR4 7UQ, UK.
| | - Bernard Man Yung Cheung
- Division of Clinical Pharmacology, Department of Medicine, School of Clinical Medicine, University of Hong Kong, Hong Kong, China. .,Department of Medicine, Honorary Consultant, Queen Mary Hospital, Hong Kong, China.
| | - Gary Tse
- Division of Clinical Pharmacology, Department of Medicine, School of Clinical Medicine, University of Hong Kong, Hong Kong, China. .,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China. .,Kent and Medway Medical School, Canterbury, Kent, UK.
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13
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Zhou J, Lee S, Liu X, Iltaf Satti D, Tai Loy Lee T, Hou In Chou O, Chang C, Roever L, Tak Wong W, Ka Chung Wai A, Liu T, Zhang Q, Tse G. Hip fractures risks in edoxaban versus warfarin users: A propensity score-matched population-based cohort study with competing risk analyses. Bone 2022; 156:116303. [PMID: 34973496 DOI: 10.1016/j.bone.2021.116303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The three direct oral anticoagulants (DOAC), rivaroxaban, apixaban and dabigatran have been associated with lower risks of fractures compared to warfarin. However, no large scale studies have explored the associations with the newest DOAC, edoxaban, with fracture risk. The present study aims to elucidate the effects of edoxaban on the risk of hip fracture amongst elderly patients by comparing the incidence of new onset hip fracture between edoxaban and warfarin users in a Chinese population. METHODS This was a retrospective population-based cohort study of patients with edoxaban or warfarin use between January 1st, 2016 and December 31st, 2019 in Hong Kong, China. Patients with less than one-month exposure, medication switching between warfarin and edoxaban, those who died within 30 days after drug exposure, prior human immunodeficiency virus infection, age <50 years old, and those with prior hip fractures were excluded. Propensity score matching (1:2) between edoxaban and warfarin users using the nearest neighbour method was performed based on demographics, prior comorbidities, and use of different medications. The study outcomes were new onset hip fractures, medically attended falls and all-cause mortality. RESULTS A total of 5014 patients including 579 edoxaban users and 4435 warfarin users (median age: 70 years old [interquartile range (IQR): 62-79], 56.66% males) with a median follow-up of 637.5 (IQR: 320-1073) days were included. In the matched cohort, edoxaban users had significantly lower rates of new onset hip fractures, medically attended falls and all-cause mortality. The protective value of edoxaban use against new onset hip fracture (hazard ratio [HR]: 0.13, 95% confidence interval [CI]: [0.03-0.54], p = 0.0051), medically attended falls (HR: 0.47, [0.29-0.75], p = 0.0018) and all-cause mortality (HR: 0.61, [0.42-0.87], p = 0.0059) in comparison to warfarin use persisted after matching. The significant relationship between edoxaban use and lower fracture risk was preserved in all sensitivity analyses using different approaches using the propensity score. CONCLUSIONS Edoxaban use is associated with lower risks of new onset hip fractures, medically attended falls and mortality risks compared to warfarin after propensity score matching.
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Affiliation(s)
- Jiandong Zhou
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Sharen Lee
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Xuejin Liu
- School of Educational Science, Kaili University, Kaili City, Guizhou, China
| | - Danish Iltaf Satti
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Teddy Tai Loy Lee
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration; Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Oscar Hou In Chou
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration; Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Carlin Chang
- Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Wing Tak Wong
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Qingpeng Zhang
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Gary Tse
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China; Kent and Medway Medical School, Canterbury, UK.
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14
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Satti DI, Zhou J, Lee S, Liu X, Lee TTL, Chou OHI, Chang C, Roever L, Wong WT, Wai AKC, Liu T, Zhang Q, Tse G. HIP FRACTURES RISKS IN EDOXABAN VERSUS WARFARIN USERS: A PROPENSITY SCORE-MATCHED POPULATION-BASED COHORT STUDY WITH COMPETING RISK ANALYSES. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02752-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Zhou J, Lee S, Leung KSK, Wai AKC, Liu T, Liu Y, Chang D, Wong WT, Wong ICK, Cheung BMY, Zhang Q, Tse G. Incident heart failure and myocardial infarction in sodium-glucose cotransporter-2 vs. dipeptidyl peptidase-4 inhibitor users. ESC Heart Fail 2022; 9:1388-1399. [PMID: 35132823 PMCID: PMC8934922 DOI: 10.1002/ehf2.13830] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 12/22/2022] Open
Abstract
Aims This study aimed to compare the rates of major cardiovascular adverse events in sodium‐glucose cotransporter‐2 inhibitors (SGLT2I) and dipeptidyl peptidase‐4 inhibitors (DPP4I) users in a Chinese population. SGLT2I and DPP4I are increasingly prescribed for type 2 diabetes mellitus patients. However, few population‐based studies are comparing their effects on incident heart failure or myocardial infarction. Methods and results This was a population‐based retrospective cohort study using the electronic health record database in Hong Kong, including type 2 diabetes mellitus patients receiving either SGLT2I or DPP4I from 1 January 2015 to 31 December 2020. Propensity score matching was performed in a 1:1 ratio based on demographics, past comorbidities, and non‐SGLT2I/DPP4I medications with nearest neighbour matching (caliper = 0.1). Univariable and multivariable Cox models were used to identify significant predictors for new‐onset heart failure, new‐onset myocardial infarction, cardiovascular mortality, and all‐cause mortality. Sensitivity analyses with competing risk models and multiple propensity score matching approaches were conducted. A total of 41 994 patients (58.89% males, median admission age at 58 years old, interquartile range [IQR]: 51.2–65.3) were included with a median follow‐up of 5.6 years (IQR: 5.32–5.82). In the matched cohort, SGLT2I use was significantly associated with lower risks of new‐onset heart failure (hazard ratio [HR]: 0.73, 95% confidence interval [CI]: [0.66, 0.81], P < 0.0001), myocardial infarction (HR: 0.81, 95% CI: [0.73, 0.90], P < 0.0001), cardiovascular mortality (HR: 0.67, 95% CI: [0.53, 0.84], P < 0.001), and all‐cause mortality (HR: 0.26, 95% CI: [0.24, 0.29], P < 0.0001) after adjusting for significant demographics, past comorbidities, and non‐SGLT2I/DPP4I medications. Conclusions SGLT2 inhibitors are protective against adverse cardiovascular events including new‐onset heart failure, myocardial infarction, cardiovascular mortality, and all‐cause mortality. The prescription of SGLT2I is preferred when taken into consideration individual cardiovascular and metabolic risk profiles in addition to drug–drug interactions.
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Affiliation(s)
- Jiandong Zhou
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sharen Lee
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China
| | - Keith Sai Kit Leung
- Emergency Medicine Unit, Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ying Liu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dong Chang
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Wing Tak Wong
- School of Life Sciences, State Key Laboratory of Agrobiotechnology (CUHK), The Chinese University of Hong Kong, Hong Kong, China
| | - Ian Chi Kei Wong
- Department of Pharmacology and Pharmacy, University of Hong Kong, Hong Kong, China
| | - Bernard Man Yung Cheung
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Gary Tse
- Diabetes Research Unit, Cardiovascular Analytics Group, Hong Kong, China.,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.,Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.,Kent and Medway Medical School, Canterbury, Kent, UK
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16
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Mui JV, Zhou J, Lee S, Leung KSK, Lee TTL, Chou OHI, Tsang SL, Wai AKC, Liu T, Wong WT, Chang C, Tse G, Zhang Q. Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors vs. Dipeptidyl Peptidase-4 (DPP4) Inhibitors for New-Onset Dementia: A Propensity Score-Matched Population-Based Study With Competing Risk Analysis. Front Cardiovasc Med 2021; 8:747620. [PMID: 34746262 PMCID: PMC8566991 DOI: 10.3389/fcvm.2021.747620] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/17/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction: The effects of sodium-glucose cotransporter 2 inhibitors (SGLT2I) and dipeptidyl peptidase-4 inhibitors (DPP4I) on new-onset cognitive dysfunction in type 2 diabetes mellitus remain unknown. This study aimed to evaluate the effects of the two novel antidiabetic agents on cognitive dysfunction by comparing the rates of dementia between SGLT2I and DPP4I users. Methods: This was a population-based cohort study of type 2 diabetes mellitus patients treated with SGLT2I and DPP4I between January 1, 2015 and December 31, 2019 in Hong Kong. Exclusion criteria were <1-month exposure or exposure to both medication classes, or prior diagnosis of dementia or major neurological/psychiatric diseases. Primary outcomes were new-onset dementia, Alzheimer's, and Parkinson's. Secondary outcomes were all-cause, cardiovascular, and cerebrovascular mortality. Results: A total of 13,276 SGLT2I and 36,544 DPP4I users (total n = 51,460; median age: 66.3 years old [interquartile range (IQR): 58–76], 55.65% men) were studied (follow-up: 472 [120–792] days). After 1:2 matching (SGLT2I: n = 13,283; DPP4I: n = 26,545), SGLT2I users had lower incidences of dementia (0.19 vs. 0.78%, p < 0.0001), Alzheimer's (0.01 vs. 0.1%, p = 0.0047), Parkinson's disease (0.02 vs. 0.14%, p = 0.0006), all-cause (5.48 vs. 12.69%, p < 0.0001), cerebrovascular (0.88 vs. 3.88%, p < 0.0001), and cardiovascular mortality (0.49 vs. 3.75%, p < 0.0001). Cox regression showed that SGLT2I use was associated with lower risks of dementia (hazard ratio [HR]: 0.41, 95% confidence interval [CI]: [0.27–0.61], P < 0.0001), Parkinson's (HR:0.28, 95% CI: [0.09–0.91], P = 0.0349), all-cause (HR:0.84, 95% CI: [0.77–0.91], P < 0.0001), cardiovascular (HR:0.64, 95% CI: [0.49–0.85], P = 0.0017), and cerebrovascular (HR:0.36, 95% CI: [0.3–0.43], P < 0.0001) mortality. Conclusions: The use of SGLT2I is associated with lower risks of dementia, Parkinson's disease, and cerebrovascular mortality compared with DPP4I use after 1:2 ratio propensity score matching.
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Affiliation(s)
- Jonathan V Mui
- Diabetes Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Sharen Lee
- Diabetes Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Keith Sai Kit Leung
- Emergency Medicine Unit, Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Teddy Tai Loy Lee
- Emergency Medicine Unit, Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Oscar Hou In Chou
- Emergency Medicine Unit, Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shek Long Tsang
- Diabetes Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Wing Tak Wong
- State Key Laboratory of Agrobiotechnology (CUHK), School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Carlin Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.,Kent and Medway Medical School, Canterbury, United Kingdom
| | - Qingpeng Zhang
- Diabetes Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
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17
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Zhou J, Lee S, Wong WT, Waleed KB, Leung KSK, Lee TTL, Wai AKC, Liu T, Chang C, Cheung BMY, Zhang Q, Tse G. Gender-specific clinical risk scores incorporating blood pressure variability for predicting incident dementia. J Am Med Inform Assoc 2021; 29:335-347. [PMID: 34643701 DOI: 10.1093/jamia/ocab173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The present study examined the gender-specific prognostic value of blood pressure (BP) and its variability in the prediction of dementia risk and developed a score system for risk stratification. MATERIALS AND METHODS This was a retrospective, observational population-based cohort study of patients admitted to government-funded family medicine clinics in Hong Kong between January 1, 2000 and March 31, 2002 with at least 3 blood pressure measurements. Gender-specific risk scores for dementia were developed and tested. RESULTS The study consisted of 74 855 patients, of whom 3550 patients (incidence rate: 4.74%) developed dementia over a median follow-up of 112 months (IQR= [59.8-168]). Nonlinear associations between diastolic/systolic BP measurements and the time to dementia presentation were identified. Gender-specific dichotomized clinical scores were developed for males (age, hypertension, diastolic and systolic BP and their measures of variability) and females (age, prior cardiovascular, respiratory, gastrointestinal diseases, diabetes mellitus, hypertension, stroke, mean corpuscular volume, monocyte, neutrophil, urea, creatinine, diastolic and systolic BP and their measures of variability). They showed high predictive strengths for both male (hazard ratio [HR]: 12.83, 95% confidence interval [CI]: 11.15-14.33, P value < .0001) and female patients (HR: 26.56, 95% CI: 14.44-32.86, P value < .0001). The constructed gender-specific scores outperformed the simplified systems without considering BP variability (C-statistic: 0.91 vs 0.82), demonstrating the importance of BP variability in dementia development. CONCLUSION Gender-specific clinical risk scores incorporating BP variability can accurately predict incident dementia and can be applied clinically for early disease detection and optimized patient management.
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Affiliation(s)
- Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China
| | - Wing Tak Wong
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Khalid Bin Waleed
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, China
| | - Keith Sai Kit Leung
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Teddy Tai Loy Lee
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Carlin Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Bernard Man Yung Cheung
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.,Kent and Medway Medical School, Canterbury, UK
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18
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Ganotice FA, Fan KKH, Ng ZLH, Tsoi FHS, Wai AKC, Worsley A, Lin X, Tipoe GL. The short version of students' perceptions of interprofessional clinical education-revised (SPICE-R3): a confirmatory factor analysis. J Interprof Care 2021; 36:135-143. [PMID: 33910463 DOI: 10.1080/13561820.2021.1879751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The Students' Perceptions of Physician-Pharmacist Interprofessional Clinical Education and its revision (SPICE, SPICE-R) were designed to understand medicine and pharmacy students' perceptions of interprofessional education and collaborative practice in managing complex health problems. The SPICE-R authors, however, suggested for additional items for subscales "roles and responsibilities for collaborative care" and "patient outcomes from collaborative practice". We added two items and introduced SPICE-R3 to differentiate it from the 10-item SPICE-R2 and to adapt the scale to a wider range of healthcare members. We administered the SPICE-R3 to healthcare students at the height of the COVID-19 outbreak in Hong Kong in February 2020. Using data from 225 students from Chinese medicine, medicine, nursing, and pharmacy, confirmatory factor analysis indicated nine items having acceptable item coefficients. Our data obtained a good fit to the three-factor, nine-item model suggesting construct validity. Results of the between-network analysis suggest that the three subscales of SPICE-R3 correlated systematically with other theoretically relevant variables in the nomological network suggesting convergent validity. The SPICE-R3 is a valid measure to examine Hong Kong healthcare students' interprofessional attitudes in online interprofessional education even during the pandemic. Implications and directions for future research are provided.
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Affiliation(s)
- Fraide A Ganotice
- Bau Institute of Medical and Health Sciences Education, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Kelvin Kai Hin Fan
- Bau Institute of Medical and Health Sciences Education, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Zoe Lai Han Ng
- Bau Institute of Medical and Health Sciences Education, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Francis Hang Sang Tsoi
- Bau Institute of Medical and Health Sciences Education, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Abraham Ka Chung Wai
- Bau Institute of Medical and Health Sciences Education, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Alan Worsley
- Bau Institute of Medical and Health Sciences Education, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Xiang Lin
- Bau Institute of Medical and Health Sciences Education, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - George L Tipoe
- Bau Institute of Medical and Health Sciences Education, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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19
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Kwok CYT, Wong MS, Chan KL, Kwan MP, Nichol JE, Liu CH, Wong JYH, Wai AKC, Chan LWC, Xu Y, Li H, Huang J, Kan Z. Spatial analysis of the impact of urban geometry and socio-demographic characteristics on COVID-19, a study in Hong Kong. Sci Total Environ 2021; 764:144455. [PMID: 33418356 PMCID: PMC7738937 DOI: 10.1016/j.scitotenv.2020.144455] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/04/2020] [Accepted: 12/06/2020] [Indexed: 05/11/2023]
Abstract
The World Health Organization considered the wide spread of COVID-19 over the world as a pandemic. There is still a lack of understanding of its origin, transmission, and treatment methods. Understanding the influencing factors of COVID-19 can help mitigate its spread, but little research on the spatial factors has been conducted. Therefore, this study explores the effects of urban geometry and socio-demographic factors on the COVID-19 cases in Hong Kong. For each patient, the places they visited during the incubation period before going to hospital were identified, and matched with corresponding attributes of urban geometry (i.e., building geometry, road network and greenspace) and socio-demographic factors (i.e., demographic, educational, economic, household and housing characteristics) based on the coordinates. The local cases were then compared with the imported cases using stepwise logistic regression, logistic regression with case-control of time, and least absolute shrinkage and selection operator regression to identify factors influencing local disease transmission. Results show that the building geometry, road network and certain socio-economic characteristics are significantly associated with COVID-19 cases. In addition, the results indicate that urban geometry is playing a more important role than socio-demographic characteristics in affecting COVID-19 incidence. These findings provide a useful reference to the government and the general public as to the spatial vulnerability of COVID-19 transmission and to take appropriate preventive measures in high-risk areas.
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Affiliation(s)
- Coco Yin Tung Kwok
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Man Sing Wong
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China; Research Institute for Sustainable Urban Development, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China.
| | - Ka Long Chan
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Mei-Po Kwan
- Department of Geography and Resource Management, and Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Hong Kong, China; Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, 3584 CB Utrecht, The Netherlands
| | | | - Chun Ho Liu
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Janet Yuen Ha Wong
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Lawrence Wing Chi Chan
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Yang Xu
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Hon Li
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Jianwei Huang
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Zihan Kan
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Hong Kong, China
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20
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Zhou J, Lee S, Wang X, Li Y, Wu WKK, Liu T, Cao Z, Zeng DD, Leung KSK, Wai AKC, Wong ICK, Cheung BMY, Zhang Q, Tse G. Development of a multivariable prediction model for severe COVID-19 disease: a population-based study from Hong Kong. NPJ Digit Med 2021; 4:66. [PMID: 33833388 PMCID: PMC8032826 DOI: 10.1038/s41746-021-00433-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/03/2021] [Indexed: 12/13/2022] Open
Abstract
Recent studies have reported numerous predictors for adverse outcomes in COVID-19 disease. However, there have been few simple clinical risk scores available for prompt risk stratification. The objective is to develop a simple risk score for predicting severe COVID-19 disease using territory-wide data based on simple clinical and laboratory variables. Consecutive patients admitted to Hong Kong’s public hospitals between 1 January and 22 August 2020 and diagnosed with COVID-19, as confirmed by RT-PCR, were included. The primary outcome was composite intensive care unit admission, need for intubation or death with follow-up until 8 September 2020. An external independent cohort from Wuhan was used for model validation. COVID-19 testing was performed in 237,493 patients and 4442 patients (median age 44.8 years old, 95% confidence interval (CI): [28.9, 60.8]); 50% males) were tested positive. Of these, 209 patients (4.8%) met the primary outcome. A risk score including the following components was derived from Cox regression: gender, age, diabetes mellitus, hypertension, atrial fibrillation, heart failure, ischemic heart disease, peripheral vascular disease, stroke, dementia, liver diseases, gastrointestinal bleeding, cancer, increases in neutrophil count, potassium, urea, creatinine, aspartate transaminase, alanine transaminase, bilirubin, D-dimer, high sensitive troponin-I, lactate dehydrogenase, activated partial thromboplastin time, prothrombin time, and C-reactive protein, as well as decreases in lymphocyte count, platelet, hematocrit, albumin, sodium, low-density lipoprotein, high-density lipoprotein, cholesterol, glucose, and base excess. The model based on test results taken on the day of admission demonstrated an excellent predictive value. Incorporation of test results on successive time points did not further improve risk prediction. The derived score system was evaluated with out-of-sample five-cross-validation (AUC: 0.86, 95% CI: 0.82–0.91) and external validation (N = 202, AUC: 0.89, 95% CI: 0.85–0.93). A simple clinical score accurately predicted severe COVID-19 disease, even without including symptoms, blood pressure or oxygen status on presentation, or chest radiograph results.
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Affiliation(s)
- Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China
| | - Xiansong Wang
- Li Ka Shing Institute of Health Sciences, Hong Kong, China
| | - Yi Li
- Department of Cardiothoracic Surgery, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, Hubei, Wuhan, China
| | | | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhidong Cao
- Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Daniel Dajun Zeng
- Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Keith Sai Kit Leung
- Emergency Medicine Unit, LKS Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, LKS Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Ian Chi Kei Wong
- Department of Pharmacology and Pharmacy, University of Hong Kong, Pokfulam, Hong Kong, China.,Medicines Optimisation Research and Education (CMORE), UCL School of Pharmacy, London, United Kingdom
| | | | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China.
| | - Gary Tse
- Department of Cardiothoracic Surgery, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, Hubei, Wuhan, China.
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21
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Zhou J, Tse G, Lee S, Liu T, Cao Z, Zeng DD, Leung KSK, Wai AKC, Wong ICK, Cheung BMY, Zhang Q. Interaction effects between angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and steroid or antiviral therapies in COVID-19: A population-based study. J Med Virol 2021; 93:2635-2641. [PMID: 33638553 PMCID: PMC8013691 DOI: 10.1002/jmv.26904] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, Hong Kong, China
| | | | - Sharen Lee
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tong Liu
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, China
| | - Zhidong Cao
- Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Daniel Dajun Zeng
- Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Keith Sai Kit Leung
- Emergency Medicine Unit, University of Hong Kong, Pokfulam, Hong Kong, China
| | | | - Ian Chi Kei Wong
- Department of Pharmacology and Pharmacy, University of Hong Kong, Pokfulam, Hong Kong, China.,Medicines Optimisation Research and Education (CMORE), UCL School of Pharmacy, London, UK
| | | | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, Hong Kong, China
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22
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Zhou J, Leung KSK, Kong D, Lee S, Liu T, Wai AKC, Chang C, Zhang Q, Tse G. Low rates of liver injury in edoxaban users: Evidence from a territory-wide observational cohort study. Clin Cardiol 2021; 44:886-889. [PMID: 33590891 PMCID: PMC8259145 DOI: 10.1002/clc.23570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 01/15/2023] Open
Affiliation(s)
- Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Keith Sai Kit Leung
- Aston Medical School, Aston University, Birmingham, UK.,Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China
| | - Dicken Kong
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Carlin Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Gary Tse
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China.,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
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23
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Wong JYH, Wai AKC, Zhao S, Yip F, Lee JJ, Wong CKH, Wang MP, Lam TH. Association of Individual Health Literacy with Preventive Behaviours and Family Well-Being during COVID-19 Pandemic: Mediating Role of Family Information Sharing. Int J Environ Res Public Health 2020; 17:ijerph17238838. [PMID: 33261157 PMCID: PMC7730256 DOI: 10.3390/ijerph17238838] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022]
Abstract
Objective: We tested a model of individual health literacy information sharing with family members, personal preventive behaviours and family well-being during the Coronavirus Disease 2019 (COVID-19) pandemic in Hong Kong. Methods: We analysed data of 1501 randomly selected Chinese adults from a cross-sectional survey in Hong Kong from 9 to 23 April, 2020. Individual health literacy about COVID-19 with the items extracted from the questionnaire in World Health Organization Risk Communication and Community Engagement (RCCE) Action Plan Guidance for COVID-19 preparedness and response, COVID-19 information sharing with family members, preventive behaviours against COVID-19 and family well-being were measured. Structural equation modelling analysis tested the proposed model. Findings: COVID-19 information sharing with family members partially mediated the association between individual health literacy and personal preventive behaviours. The direct effect of 0.24 was shown, and the indirect effect through COVID-19 information sharing with family members was small at 0.03 (Z = 3.66, p < 0.001). Family well-being was associated with personal preventive behaviours against COVID-19. The model was adjusted for sex, age, and socioeconomic status factors and had good fit with RMSEA = 0.04, CFI = 0.98, TLI = 0.96, and SRMR = 0.02. Conclusion: COVID-19 information sharing with family members was a partial mediator between individual health literacy and personal preventive behaviours against COVID-19. Strategies for enhancing health literacy and preventive measures against COVID-19 are needed to promote family well-being in the pandemic.
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Affiliation(s)
- Janet Yuen Ha Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (J.Y.H.W.); (S.Z.); (J.J.L.)
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (A.K.C.W.); (F.Y.)
| | - Shengzhi Zhao
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (J.Y.H.W.); (S.Z.); (J.J.L.)
| | - Faustina Yip
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (A.K.C.W.); (F.Y.)
| | - Jung Jae Lee
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (J.Y.H.W.); (S.Z.); (J.J.L.)
| | - Carlos King Ho Wong
- Department of Family Medicine & Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China;
| | - Man Ping Wang
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; (J.Y.H.W.); (S.Z.); (J.J.L.)
- Correspondence:
| | - Tai Hing Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China;
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24
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Zhao SZ, Wong JYH, Luk TT, Wai AKC, Lam TH, Wang MP. Mental health crisis under COVID-19 pandemic in Hong Kong, China. Int J Infect Dis 2020; 100:431-433. [PMID: 32947051 PMCID: PMC7492140 DOI: 10.1016/j.ijid.2020.09.030] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 01/29/2023] Open
Abstract
Objectives To compare the mental health burden before and during the COVID-19 outbreak and identify the vulnerable groups by sociodemographic factors. Methods We analyzed repeated cross-sectional data from the Hong Kong Family and Health Information Trend Survey (FHInTS) in 2016 (N = 4036) and 2017 (N = 4051) and the COVID-19 Health Information Survey (CoVHInS) in April 9–23, 2020 (N = 1501) using population-based random samples of general adults by landline telephone and online panel. Stress (Perceived Stress Scale 4), anxiety symptoms (General Anxiety Disorders 2), depression symptoms (Patient Health Questionnaire-2), subjective happiness (4-point Likert item), and sociodemographic factors were collected. Results Compared with 2016 and 2017, the stress level increased by 28.3%, prevalence of anxiety increased by 42.3%, and the depression symptoms and unhappiness have doubled (all P for trends <0.001) during the COVID-19 outbreak. The increases in stress levels were significantly larger among older and less educated respondents (P for interactions <0.001). Conclusion Hong Kong had a mental health emergency even with no lockdown and well-managed outbreaks. Older and under-privileged people will suffer most. Public mental health interventions are urgently needed particularly for the older adults and individuals with primary or lower education attainment.
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Affiliation(s)
- Sheng Zhi Zhao
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Janet Yuen Ha Wong
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, LKS Faculty of Medicine, The University of Hong Kong, Pokulam, Hong Kong Special Administrative Region
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region.
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25
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Lam RPK, Cheung ACK, Wai AKC, Wong RTM, Tse TS. The de Winter ECG pattern occurred after ST-segment elevation in a patient with chest pain. Intern Emerg Med 2019; 14:807-809. [PMID: 30600528 DOI: 10.1007/s11739-018-02013-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Rex Pui Kin Lam
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 512, 5/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China.
| | - Arthur Chi Kin Cheung
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 512, 5/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 512, 5/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Ronald Tat Ming Wong
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 512, 5/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Tak Sun Tse
- Department of Cardiology, Gleneagles Hong Kong Hospital, 1 Nam Fung Path, Wong Chuk Hang, Hong Kong Special Administrative Region, China
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26
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Abstract
This article briefly reviews the development of emergency medicine (EM) in Hong Kong with particular focus on the parallel development of training in EM at the undergraduate level. The practice of EM in Hong Kong started more than 50 years ago but the development of the specialty progressed slowly until the 1980s. Since then, although there have been major advances in postgraduate training, the specialty still features poorly in undergraduate medical training. We compared emergency medicine training in Hong Kong, Australia, USA, UK and Singapore, in order to identify areas in the medical curriculum where EM could contribute more to undergraduate medical training. The growth of EM in Hong Kong depends on recruiting good trainees who are attracted by what they observe and what they learn during their undergraduate EM clerkship.
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27
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Wai AKC, Cameron P, Cheung CK, Mak P, Rainer TH. Out-of-Hospital Cardiac Arrest in a Teaching Hospital in Hong Kong: Descriptive Study Using the Utstein Style. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To describe, using the Utstein template, the characteristics of patients presenting with out-of-hospital cardiac arrest to a university teaching hospital in the New Territories of Hong Kong, and to evaluate survival. Design Prospective study. Setting The emergency department of a teaching hospital in the New Territories, Hong Kong. Participants Patients older than 12 years with non-traumatic out-of-hospital cardiac arrest who were transported to the hospital between 1 July 2002 and 31 December 2002. Main outcome measures Demographic data, characteristics of cardiac arrest and response time intervals of the emergency medical service presented according to the Utstein style, and also survival to hospital discharge rate. Results A total of 124 patients were included (49.2% male; mean age 71.9 years). The majority of cardiac arrests occurred in patients' home. The overall bystander cardiopulmonary resuscitation (CPR) rate was 15.3% (19/124). The most common electrocardiographic rhythm at scene was asystole, whilst pulseless ventricular tachycardia (VT)/ventricular fibrillation (VF) was found in 18.0%. The overall survival was 0.8% (1/124), and survival to hospital discharge was significantly higher for patients with VF or pulseless VT than those patients with other rhythms of cardiac arrest (11.1% versus 0%). The median witnessed/recognised collapse to defibrillation time was 14 minutes. The median prehospital time interval from collapse/recognition to arrival at hospital was 33 minutes. Conclusion The prognosis of out-of-hospital cardiac arrest in Hong Kong was poor. Major improvements in every component of the chain of survival are necessary.
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Rotheray KR, Cheung PSY, Cheung CSK, Wai AKC, Chan DYS, Rainer TH, Graham CA. What is the relationship between the Glasgow coma scale and airway protective reflexes in the Chinese population? Resuscitation 2011; 83:86-9. [PMID: 21787740 DOI: 10.1016/j.resuscitation.2011.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 06/20/2011] [Accepted: 07/16/2011] [Indexed: 11/18/2022]
Abstract
AIM To describe the relationship of gag and cough reflexes to Glasgow coma score (GCS) in Chinese adults requiring critical care. METHOD Prospective observational study of adult patients requiring treatment in the trauma or resuscitation rooms of the Emergency Department, Prince of Wales Hospital, Hong Kong. A long cotton bud to stimulate the posterior pharyngeal wall (gag reflex) and a soft tracheal suction catheter were introduced through the mouth to stimulate the laryngopharynx and elicit the cough reflex. Reflexes were classified as normal, attenuated or absent. RESULTS A total of 208 patients were recruited. Reduced gag and cough reflexes were found to be significantly related to reduced GCS (p=0.014 and 0.002, respectively). Of 33 patients with a GCS≤8, 12 (36.4%) had normal gag reflexes and 8 (24.2%) had normal cough reflexes. 23/62 (37.1%) patients with a GCS of 9-14 had absent gag reflexes, and 27 (43.5%) had absent cough reflexes. In patients with a normal GCS, 22.1% (25/113) had absent gag reflexes and 25.7% (29) had absent cough reflexes. CONCLUSIONS Our study has shown that in a Chinese population with a wide range of critical illness (but little trauma or intoxication), reduced GCS is significantly related to gag and cough reflexes. However, a considerable proportion of patients with a GCS≤8 have intact airway reflexes and may be capable of maintaining their own airway, whilst many patients with a GCS>8 have impaired airway reflexes and may be at risk of aspiration. This has important implications for airway management decisions.
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Affiliation(s)
- K R Rotheray
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong
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Wai AKC, Kwok WO, Chan MS, Graham CA, Rainer TH. Patients' perceptions of nasopharyngeal aspiration in the emergency department of a teaching hospital in Hong Kong. Emerg Med J 2007; 24:35-6. [PMID: 17183041 PMCID: PMC2658151 DOI: 10.1136/emj.2006.039701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Nasopharyngeal aspiration (NPA) is the preferred method for collecting specimens for viral culture in patients with respiratory tract infection. As virus identification may influence admission and treatment decisions, it is important to perform NPA in the emergency department. The test may be uncomfortable and poorly tolerated. This prospective study investigated patients' perceptions of NPA. Patients in the emergency department with upper respiratory tract infection undergoing NPA between 9 March 2005 and 12 August 2005 were included. 86 patients (mean (SD) age 47 (23) years; 49 women) were recruited. 22 (26%) patients complained that NPA was very uncomfortable, 59 (69%) reported that it was mildly uncomfortable and 5 (6%) patients reported no discomfort. On a 10-point scale, the median discomfort score was 4. 29 (34%) patients stated that NPA was more uncomfortable than blood taking, 19 (22%) patients felt that both were similar and 38 (44%) patients felt that NPA was less uncomfortable (p value not significant). NPA performed in the emergency department is well tolerated and should be considered in emergency departments when results may influence patient management.
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Affiliation(s)
- A K C Wai
- Accident & Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Administrative Region
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