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Mills EHA, Møller AL, Gnesin F, Zylyftari N, Jensen B, Christensen HC, Blomberg SN, Kragholm KH, Gislason G, Køber L, Gerds T, Folke F, Lippert F, Torp-Pedersen C, Andersen MP. Association between mortality and phone-line waiting time for non-urgent medical care: a Danish registry-based cohort study. Eur J Emerg Med 2024; 31:127-135. [PMID: 37788126 DOI: 10.1097/mej.0000000000001088] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND AND IMPORTANCE Telephone calls are often patients' first healthcare service contact, outcomes associated with waiting times are unknown. OBJECTIVES Examine the association between waiting time to answer for a medical helpline and 1- and 30-day mortality. DESIGN, SETTING AND PARTICIPANTS Registry-based cohort study using phone calls data (January 2014 to December 2018) to the Capital Region of Denmark's medical helpline. The service refers to hospital assessment/treatment, dispatches ambulances, or suggests self-care guidance. EXPOSURE Waiting time was grouped into the following time intervals in accordance with political service targets for waiting time in the Capital Region: <30 s, 0:30-2:59, 3-9:59, and ≥10 min. OUTCOME MEASURES AND ANALYSIS The association between time intervals and 1- and 30-day mortality per call was calculated using logistic regression with strata defined by age and sex. MAIN RESULTS In total, 1 244 252 callers were included, phoning 3 956 243 times, and 78% of calls waited <10 min. Among callers, 30-day mortality was 1% (16 560 deaths). For calls by females aged 85-110 30-day mortality increased with longer waiting time, particularly within the first minute: 9.6% for waiting time <30 s, 10.8% between 30 s and 1 minute and 9.1% between 1 and 2 minutes. For calls by males aged 85-110 30-day mortality was 11.1%, 12.9% and 11.1%, respectively. Additionally, among calls with a Charlson score of 2 or higher, longer waiting times were likewise associated with increased mortality. For calls by females aged 85-110 30-day mortality was 11.6% for waiting time <30 s, 12.9% between 30 s and 1 minute and 11.2% between 1 and 2 minutes. For calls by males aged 85-110 30-day mortality was 12.7%, 14.1% and 12.6%, respectively. Fewer ambulances were dispatched with longer waiting times (4%/2%) with waiting times <30 s and >10 min. CONCLUSION Longer waiting times for telephone contact to a medical helpline were associated with increased 1- and 30-day mortality within the first minute, especially among elderly or more comorbid callers.
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Affiliation(s)
| | | | - Filip Gnesin
- Department of Cardiology, Nordsjællands Hospital, Hillerød
| | - Nertila Zylyftari
- Department of Cardiology, Nordsjællands Hospital, Hillerød
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup
| | - Britta Jensen
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Aalborg
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, Copenhagen and University of Copenhagen
- Danish Clinical Quality Program - National Clinical Registries (RKKP), Righospitalet, Copenhagen
| | | | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup
- The Danish Heart Foundation
| | - Lars Køber
- Department of Cardiology, Rigshospitalet
| | - Thomas Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup
- Copenhagen Emergency Medical Services, Copenhagen and University of Copenhagen
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen and University of Copenhagen
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg
- Department of Cardiology, Nordsjællands Hospital, Hillerød
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Larsen MB, Blom-Hanssen E, Gnesin F, Kragholm KH, Lass Klitgaard T, Christensen HC, Lippert F, Folke F, Torp-Pedersen C, Ringgren KB. Prodromal complaints and 30-day survival after emergency medical services-witnessed out-of-hospital cardiac arrest. Resuscitation 2024; 197:110155. [PMID: 38423500 DOI: 10.1016/j.resuscitation.2024.110155] [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] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a frequent and lethal condition with a yearly incidence of approximately 5000 in Denmark. Thirty-day survival is associated with the patient's prodromal complaints prior to cardiac arrest. This paper examines the odds of 30-day survival dependent on the reported prodromal complaints among OHCAs witnessed by the emergency medical services (EMS). METHODS EMS-witnessed OHCAs in the Capital Region of Denmark from 2016-2018 were included. Calls to the emergency number 1-1-2 and the medical helpline for out-of-hours were analyzed according to the Danish Index; data regarding the OHCA was collected from the Danish Cardiac Arrest Registry. We performed multiple logistic regression to calculate the odds ratio (OR) of 30-day survival with adjustment for sex and age. RESULTS We identified 311 eligible OHCAs of which 79 (25.4%) survived. The most commonly reported complaints were dyspnea (n = 209, OR 0.79 [95% CI 0.46: 1.36]) and 'feeling generally unwell' (n = 185, OR 1.07 [95% CI 0.63: 1.81]). Chest pain (OR 9.16 [95% CI 5.09:16.9]) and heart palpitations (OR 3.15 [95% CI 1.07:9.46]) had the highest ORs, indicating favorable odds for 30-day survival, while unresponsiveness (OR 0.22 [95% CI 0.11:0.43]) and blue skin or lips (OR 0.30, 95% CI 0.09, 0.81) had the lowest, indicating lesser odds of 30-day survival. CONCLUSION Experiencing chest pain or heart palpitations prior to EMS-witnessed OHCA was associated with higher 30-day survival. Conversely, complaints of unresponsiveness or having blue skin or lips implied reduced odds of 30-day survival.
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Affiliation(s)
- Mia Bang Larsen
- Department of Clinical Medicine, Aalborg University, Denmark.
| | | | - Filip Gnesin
- Department of Cardiology, Nordsjaellands Hospital, Denmark
| | - Kristian Hay Kragholm
- Department of Clinical Medicine, Aalborg University, Denmark; Department of Cardiology, Aalborg University Hospital, Denmark
| | | | | | - Freddy Lippert
- Falck, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Fredrik Folke
- Department of Clinical Medicine, University of Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark; Copenhagen Emergency Medical Services, University of Copenhagen, Denmark
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Frydenlund J, Valentin JB, Norredam M, Frost L, Riahi S, Kragholm KH, Bøggild H, Lip GYH, Johnsen SP. Oral anticoagulation therapy initiation in patients with atrial fibrillation in relation to world region of origin: a register-based nationwide study. Open Heart 2024; 11:e002544. [PMID: 38553012 PMCID: PMC10982797 DOI: 10.1136/openhrt-2023-002544] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/29/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained arrhythmia and results in a high risk of stroke. The number of immigrants is increasing globally, but little is known about potential differences in AF care across migrant populations. AIM To investigate if initiation of oral anticoagulation therapy (OAC) differs for patients with incident AF in relation to country of origin. METHODS A nationwide register-based study covering 1999-2017. AF was defined as a first-time diagnosis of AF and a high risk of stroke. Stroke risk was defined according to guidelines from the European Society of Cardiology (ESC). Poisson regression adjusted for sex, age, socioeconomic position and comorbidity was made to compute incidence rate ratios (IRR) for initiation of OAC. RESULTS The AF population included 254 586 individuals of Danish origin, 6673 of Western origin and 3757 of non-Western origin. Overall, OAC was initiated within -30/+90 days relative to the AF diagnosis in 50.3% of individuals of Danish origin initiated OAC, 49.6% of Western origin and 44.5% of non-Western origin. Immigrants from non-Western countries had significantly lower adjusted IRR of initiating OAC according to all ESC guidelines compared with patients of Danish origin. The adjusted IRRs ranged from 0.73 (95% CI: 0.66 to 0.80) following the launch of the 2010 ESC guideline to 0.89 (95% CI: 0.82 to 0.97) following the launch of the 2001 ESC guideline. CONCLUSION Patients with AF with a high risk of stroke of non-Western origin have persistently experienced a lower chance of initiating OAC compared with patients of Danish origin during the last decades.
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Affiliation(s)
| | | | - Marie Norredam
- Section of Health Services Research Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Hvidovre University Hospital Copenhagen, Copenhagen, Denmark
| | - Lars Frost
- University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Henrik Bøggild
- Public Health and Epidemiology Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Gregory Y H Lip
- Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
- Liverpool Heart & Chest Hospital, Liverpool, UK
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Øvlisen AK, Frandsen LT, Hollaender M, Bredal K, Terkelsen JH, Kragholm KH, Torp-Pedersen C, Melgaard D, Krarup AL. Patients with eosinophilic oesophagitis in Denmark have higher use of psychotropic drugs: A Danish nationwide study of psychotropic drug use in 3367 patients and 16,835 matched comparators. United European Gastroenterol J 2024. [PMID: 38323511 DOI: 10.1002/ueg2.12536] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/29/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Eosinophilic oesophagitis (EoE) is a chronic, immune-mediated disease of the oesophagus. Eosinophilic oesophagitis is associated with a substantial disease burden affecting the quality of life and affecting mental health. There are limited data describing the incidence of psychiatric disorders and the use of psychotropic drugs (PDs) in EoE patients. OBJECTIVES The aim was to investigate whether EoE patients in Denmark have higher use of PDs, contacts with the department of psychiatry, and attempts of suicide or intentional self-harm compared with the general population after being diagnosed with EoE. METHODS This study was a nationwide, population-based register study including 3367 EoE patients and 16,835 age- and sex-matched comparators. A register-based EoE definition was used to identify cases. Incident PD use was extracted from the prescription register and information regarding psychiatric contacts was retrieved from the Danish Psychiatric Central Research Register. RESULTS The 5-year incidence of PD use in EoE patients was 13.8% compared to 7.1% of the matched comparators (Hazard ratio 1.83; confidence interval 1.6-2.0; p ≤ 0.001). Antidepressants were the most frequently prescribed PD, whereas antipsychotics were the least prescribed PD. Increasing age, lower educational level, and comorbidity (Charlson Comorbidity Index score ≥1) were associated with the prescription of PDs. The risk of PD use was lower in men than in women with EoE. CONCLUSION Treatment with PDs were more common in EoE patients after they were diagnosed than in the general Danish population, indicating that EoE patients have an increased risk of psychiatric disorders.
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Affiliation(s)
- Andreas Kiesbye Øvlisen
- Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Line Tegtmeier Frandsen
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Gastroenterology, North Denmark Regional Hospital, Hjørring, Denmark
| | | | - Kasper Bredal
- Faculty of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Kristian Hay Kragholm
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Dorte Melgaard
- Faculty of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Lund Krarup
- Department of Emergency Medicine and Trauma Center, Aalborg University Hospital, Aalborg, Denmark
- Faculty of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
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Kristensen AMD, Pareek M, Kragholm KH, McEvoy JW, Torp-Pedersen C, Prescott EB. Long-term aspirin adherence following myocardial infarction and risk of cardiovascular events. Eur Heart J Qual Care Clin Outcomes 2024:qcae009. [PMID: 38305132 DOI: 10.1093/ehjqcco/qcae009] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND AND AIMS Aspirin is considered mandatory after myocardial infarction (MI). However, its long-term efficacy has been questioned. This study investigated the effectiveness of long-term aspirin after MI. METHODS Patients ≥ 40 years with MI from 2004-2017 who were adherent to aspirin one year after MI were included from Danish nationwide registries. At 2, 4, 6, and 8 years after MI, continued adherence to aspirin was evaluated. Absolute and relative risks of MI, stroke, or death at 2 years from each timepoint were calculated using multivariable logistic regression analysis with average treatment effect modeling standardized for age, sex, and comorbidities. Subgroup analyses were stratified by sex and age > and ≤ 65 years. RESULTS Among 40 114 individuals included, the risk of the composite endpoint was significantly higher for nonadherent patients at all timepoints. The absolute risk was highest at 2-4 years after MI for both adherent (8.34%, 95% confidence interval [CI]: 8.05-8.64%) and nonadherent patients (10.72%, 95% CI: 9.78-11.66%). The relative risk associated with nonadherence decreased from 4 years after index-MI and onwards: 1.41 (95% CI: 1.27-1.55) at 4-6 years and 1.21 (95% CI: 1.06-1.36) at 8-10 years (Ptrend = 0.056). Aspirin nonadherence in women and individuals > 65 years was not associated with increased risk. Pinteraction at each of the timepoints: Age-<0.001, <0.001, 0.002, 0.51; Sex - 0.25, 0.02, 0.02, 0.82. CONCLUSION Nonadherence to long-term aspirin was associated with increased risk of MI, stroke, or death, but not in women or individuals > 65 years. The risk decreased from 4 years after MI with near statistical significance.
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Affiliation(s)
| | - Manan Pareek
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - John William McEvoy
- National Institute for Prevention and Cardiovascular Health, School of Medicine, University of Galway, Ireland
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital-North Zealand Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Denmark
| | - Eva Bossano Prescott
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Mills AAM, Mills EHA, Blomberg SNF, Christensen HC, Møller AL, Gislason G, Køber L, Kragholm KH, Lippert F, Folke F, Andersen MP, Torp-Pedersen C. Ambulance response times and 30-day mortality: a Copenhagen (Denmark) registry study. Eur J Emerg Med 2024; 31:59-67. [PMID: 37788140 DOI: 10.1097/mej.0000000000001094] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND AND IMPORTANCE Ensuring prompt ambulance responses is complicated and costly. It is a general conception that short response times save lives, but the actual knowledge is limited. OBJECTIVE To examine the association between the response times of ambulances with lights and sirens and 30-day mortality. DESIGN A registry-based cohort study using data collected from 2014-2018. SETTINGS AND PARTICIPANTS This study included 182 895 individuals who, during 2014-2018, were dispatched 266 265 ambulances in the Capital Region of Denmark. OUTCOME MEASURES AND ANALYSIS The primary outcome was 30-day mortality. Subgroup analyses were performed on out-of-hospital cardiac arrests, ambulance response priority subtypes, and caller-reported symptoms of chest pain, dyspnoea, unconsciousness, and traffic accidents. The relation between variables and 30-day mortality was examined with logistic regression. RESULTS Unadjusted, short response times were associated with higher 30-day mortality rates across unadjusted response time quartiles (0-6.39 min: 9%; 6.40-8.60 min: 7.5%, 8.61-11.80 min: 6.6%, >11.80 min: 5.5%). This inverse relationship was consistent across subgroups, including chest pain, dyspnoea, unconsciousness, and response priority subtypes. For traffic accidents, no significant results were found. In the case of out-of-hospital cardiac arrests, longer response times of up to 10 min correlated with increased 30-day mortality rates (0-6.39 min: 84.1%; 6.40-8.60 min: 86.7%, 8.61-11.8 min: 87.7%, >11.80 min: 85.5%). Multivariable-adjusted logistic regression analysis showed that age, sex, Charlson comorbidity score, and call-related symptoms were associated with 30-day mortality, but response time was not (OR: 1.00 (95% CI [0.99-1.00])). CONCLUSION Longer ambulance response times were not associated with increased mortality, except for out-of-hospital cardiac arrests.
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Affiliation(s)
| | | | | | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, Copenhagen and University of Copenhagen
- Danish Clinical Quality Program (RKKP), Rigshospitalet
| | - Amalie Lykkemark Møller
- Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen
- Department of Cardiology, Nordsjællands Hospital, Hillerød
- Department of Public Health, University of Copenhagen
| | - Gunnar Gislason
- The Danish Heart Foundation, Copenhagen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup
- Department of Clinical Medicine, University of Copenhagen
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen and University of Copenhagen
| | - Frederik Folke
- Copenhagen Emergency Medical Services, Copenhagen and University of Copenhagen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød
- Department of Public Health, University of Copenhagen
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Frydenlund J, Valentin JB, Norredam M, Bøggild H, Kragholm KH, Riahi S, Frost L, Johnsen SP. Incidence of atrial fibrillation and flutter in Denmark in relation to country of origin: a nationwide register-based study. Scand J Public Health 2024:14034948231205822. [PMID: 38179955 DOI: 10.1177/14034948231205822] [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: 01/06/2024]
Abstract
BACKGROUND Atrial fibrillation and flutter (AF) is the most common sustained arrhythmia with an increasing prevalence in Western countries. However, little is known about AF among immigrants compared to non-immigrants. AIM To examine the incidence of hospital-diagnosed AF according to country of origin. METHOD Immigrants were defined as individuals born outside Denmark by parents born outside Denmark. AF was defined as first-time diagnosis of AF. All individuals were followed from the age of 45 years from 1998 to 2017. The analyses were adjusted for sex, age, comorbidity, contact with the general practitioner and socioeconomic variables. Adjustment was conducted using standardised morbidity ratio weights, standardised to the Danish population in a marginal structural model. RESULTS The study population consisted of 3,489,730 Danish individuals free of AF and 108,914 immigrants free of AF who had emigrated from the 10 most represented countries. A total of 323,005 individuals of Danish origin had an incident hospital diagnosis of AF, among the immigrants 7,300 developed AF. Adjusted hazard rate ratios (HRRs) of AF for immigrants from Iran (0.48 [95%CI:0.35;0.64]), Turkey (0.74 [95%CI:0.67;0.82]) and Bosnia-Herzegovina (0.42 [95%CI:0.22;0.79]) were low compared with Danish individuals. Immigrants from Sweden, Germany and Norway had an adjusted HRR of 1.13 [95%CI:1.03;1.23], 1.12 [95%CI:1.05;1.18] and 1.11 [95%CI:1.03;1.21], respectively (Danish individuals as reference). CONCLUSIONS Substantial variation in the incidence of hospital-diagnosed AF according to country of origin was observed. The results may reflect true biological differences but could also reflect barriers to AF diagnosis for immigrants. Further efforts are warranted to determine the underlying mechanisms.
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Affiliation(s)
- Juliane Frydenlund
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Denmark
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Denmark
| | - Marie Norredam
- Danish Research Center for Migration, Ethnicity and Health, Section of Health Services Research, Denmark
- Section of Immigrant Health, Department of Infectious diseases, Hvidovre University Hospital Copenhagen, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Denmark
| | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Denmark
- Department of Clinical Medicine, Aalborg University, Denmark
| | - Lars Frost
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Denmark
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Maksten EF, Jakobsen LH, Modrau B, Jensvoll H, Kragholm KH, Jørgensen JM, Clausen MR, Pedersen RS, Dessau-Arp A, Larsen TS, Poulsen CB, Gang AO, Brown P, El-Galaly TC, Severinsen MT. Risk of dementia among older patients with lymphoma: A Danish nationwide matched cohort study. J Geriatr Oncol 2024; 15:101672. [PMID: 37976653 DOI: 10.1016/j.jgo.2023.101672] [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] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/09/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Treatment of lymphoma can be associated with cognitive challenges, and some patients may fear development of dementia as long-term complication. Studies report a lower risk of dementia after cancer. Some believe this difference to be a protective mechanism of cancer, others believe it to be driven by bias. The risk of developing dementia after lymphoma has not been investigated in a population-based setting. The aim of this study was to identify the risk of being diagnosed with dementia after lymphoma treatment. MATERIALS AND METHODS This Danish nationwide matched cohort study included patients aged ≥65 years with a first-time diagnosis of a non-central nervous system lymphoma between 2005 and 2018 in complete remission after treatment with chemotherapy. Patients diagnosed with dementia or treated with dementia medication before lymphoma diagnosis were excluded. Each patient was matched 1:5 on sex, year of birth, and a modified Charlson comorbidity index. Patients and matched comparators were followed from the corresponding patient's date of complete remission. The risk of developing dementia was calculated using cause-specific hazard ratios (HR), and the cumulative risk was estimated by Aalen-Johansen with death as the competing risk. RESULTS A total of 3,244 patients and 16,220 matched comparators were included in the study. There was no difference in risk of all-cause dementia among patients with lymphoma compared to matched comparators with cause-specific HR of 0.85 (95% confidence interval [CI]: 0.70;1.04). The risk of both Alzheimer's disease and non-Alzheimer's dementia was equal among patients and comparators: HR 0.89 (95% CI: 0.66;1.21) and 0.82 (95% CI: 0.63;1.07), respectively. Stratified by lymphoma subtype, age, or year of diagnosis, the risk of all-cause dementia remained equal among patients and matched comparators. The cumulative risk of all-cause dementia was significantly lower among patients with lymphoma compared to matched comparators (Gray's test p < 0.001), probably reflecting higher mortality in patients with lymphoma. DISCUSSION The risk of all-cause dementia, Alzheimer's disease, and non-Alzheimer's dementia was equal among older patients with lymphoma compared to matched comparators. Our data suggests that risk of developing dementia is not changed after lymphoma treatment.
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Affiliation(s)
- Eva Futtrup Maksten
- Department of Haematology, Clinical Cancer Research Unit, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark; Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark.
| | - Lasse Hjort Jakobsen
- Department of Haematology, Clinical Cancer Research Unit, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark; Department Mathematical Sciences, Aalborg University, Skjernvej 4A, Aalborg 9220, Denmark
| | - Boris Modrau
- Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark; Department of Neurology, Aalborg University Hospital, Ladegaardsgade 5, Aalborg 9000, Denmark
| | - Hilde Jensvoll
- Department of Haematology, University Hospital of North Norway, Hansine Hansens veg 67, Tromsø 9019, Norway
| | - Kristian Hay Kragholm
- Department of Cardiology & Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
| | - Judit Mészáros Jørgensen
- Department of Haematology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N 8200, Denmark
| | | | - Robert Schou Pedersen
- Department of Medicine, Section of Haematology, Regionshospital Goedstrup, Hospitalsparken 15, Herning 7400, Denmark
| | - Andriette Dessau-Arp
- Department of Haematology, Hospital Southwest Jutland, Finsensgade 35, Esbjerg 6700, Denmark
| | - Thomas Stauffer Larsen
- Department of Haematology, Odense University Hospital, J. B. Winsløws Vej 4, Odense C 5000, Denmark
| | - Christian Bjørn Poulsen
- Department of Haematology, Zealand University Hospital, Sygehusvej 10, Roskilde 4000, Denmark
| | - Anne Ortved Gang
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Juliane Maries Vej 6, Copenhagen Ø 2100, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen N 2200, Denmark
| | - Peter Brown
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Juliane Maries Vej 6, Copenhagen Ø 2100, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen N 2200, Denmark
| | - Tarec C El-Galaly
- Department of Haematology, Clinical Cancer Research Unit, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark; Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark; Department of Haematology, Odense University Hospital, J. B. Winsløws Vej 4, Odense C 5000, Denmark
| | - Marianne Tang Severinsen
- Department of Haematology, Clinical Cancer Research Unit, Aalborg University Hospital, Mølleparkvej 4, Aalborg 9000, Denmark; Department of Clinical Medicine, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark
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Al-Hussainy N, Kragholm KH, Lundbye-Christensen S, Torp-Pedersen C, Pareek M, Therkelsen SK, Lip GYH, Riahi S. Gastrointestinal bleeding with direct oral anticoagulants in patients with atrial fibrillation and anaemia. Thromb Res 2023; 232:62-69. [PMID: 37939578 DOI: 10.1016/j.thromres.2023.10.013] [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] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION A high risk of gastrointestinal bleeding has been reported with the use of some direct oral anticoagulants (DOACs). This risk may be of particular concern in individuals with associated anaemia. The aim of this study is to investigate potential differences in the risks of gastrointestinal bleeding and stroke among the four available DOACs in patients with atrial fibrillation (AF) and moderate or severe anaemia. MATERIALS AND METHODS All Danish patients diagnosed with incident AF who had a baseline haemoglobin measurement and subsequently initiated DOAC therapy between 2012 and 2021 were identified through administrative registries. Only patients with moderate or severe anaemia (N = 7269) were included and evaluated regarding the risk of hospitalization for gastrointestinal bleeding and stroke. Standardized absolute 1-year risks of stroke and gastrointestinal bleeding were calculated from multivariable Cox regression analyses. DOACs were compared pairwise RESULTS: Compared with apixaban, both dabigatran and rivaroxaban were associated with a significantly increased risk of gastrointestinal bleeding with standardized 1-year risk ratios of 1.73 (95 % confidence interval [CI], 1.10-2.35) and 1.56 (95 % CI, 1.18-1.93), respectively, while no significant difference was seen in the comparison of apixaban with edoxaban 1.32 (95 % CI, 0.41-2.32). No significant differences in gastrointestinal bleeding were observed with pairwise comparisons of dabigatran, rivaroxaban and edoxaban. Finally, no significant difference in stroke risk among the four DOACs was observed. CONCLUSION In AF patients with moderate or severe anaemia, apixaban was associated with a significantly lower risk of gastrointestinal bleeding than dabigatran and rivaroxaban. No significant difference in stroke risk was observed across all four available DOACs.
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Affiliation(s)
- Nour Al-Hussainy
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Denmark
| | - Manan Pareek
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Gregory Y H Lip
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Sam Riahi
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Søndergaard MM, Freeman P, Kristensen AMD, Chang SM, Nassir K, Mortensen MB, Nørgaard BL, Maeng M, Andersen MP, Søgaard P, Tayal B, Pareek M, Johnsen SP, Køber L, Gislason G, Torp-Pedersen C, Kragholm KH. Education level and the use of coronary computed tomography, functional testing, coronary angiography, revascularization, and outcomes-a 10-year Danish, nationwide, registry-based follow-up study. Eur Heart J Qual Care Clin Outcomes 2023:qcad052. [PMID: 37740574 DOI: 10.1093/ehjqcco/qcad052] [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] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS Coronary computed tomography angiography (CCTA) can guide downstream preventive treatment and improve patient prognosis, but its use in relation to education level remains unexplored. METHODS This nationwide register-based cohort study assessed all residents in Denmark between 2008-2018 without coronary artery disease (CAD) and 50-80 years of age (n = 1 469 724). Residents were divided according to four levels of education: low, lower-mid, higher-mid, and high. Outcomes were CCTA, functional testing, invasive coronary angiography (ICA), revascularization, and major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS Individuals with the lowest education level underwent CCTA (absolute risk [AR] 3.95% individuals aged ≥ 50-59, AR 3.62% individuals aged ≥ 60-69, AR 2.19% individuals aged ≥ 70-80) less often than individuals of lower-mid (AR 4.16%, AR 3.90%, AR 2.41%), higher-mid (AR 4.38%, AR 4.30%, AR 2.45%) and highest education level (AR 3.98%, AR 4.37%, AR 2.30%). Similar differences were observed for functional testing. Conversely, use of ICA, and risks of revascularization and MACCE were more common among individuals of lowest education level. Among patients examined with CCTA (n = 50 234), patients of lowest education level less often underwent functional testing and more likely initiated preventive medication, underwent ICA, revascularization, and experienced MACCE. CONCLUSION Despite tax-financed healthcare in Denmark, individuals of lowest education level were less likely to undergo CCTA and functional testing than persons of higher education level. ICA utilization, revascularization and MACCE risks were higher for individuals of lowest education level. Among CCTA-examined patients, patients of lowest education level were more likely to initiate preventive medication and had the highest risks of revascularization and MACCE when compared to higher education level groups. These findings suggest that the preventive potential of CCTA is underutilized in individuals of lower education level, a proxy for socioeconomic status. Socioeconomic differences in CAD assessment, care, and outcomes are likely even larger without tax-financed healthcare.
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Affiliation(s)
| | - Phillip Freeman
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Su Min Chang
- Houston Methodist DeBakey Heart and Vascular Center, Cardiac Imaging Laboratory, Houston, TX, USA
| | - Khurram Nassir
- Houston Methodist DeBakey Heart and Vascular Center, Preventive Cardiology, Houston, TX, USA
| | | | | | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Bhupendar Tayal
- Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA
| | - Manan Pareek
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Hellerup, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Houston Methodist DeBakey Heart and Vascular Center, Cardiac Imaging Laboratory, Houston, TX, USA
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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11
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Kristensen AMD, Pareek M, Kragholm KH, Torp-Pedersen C, McEvoy JW, Prescott EB. Temporal trends in low-dose aspirin therapy for primary prevention of cardiovascular disease in European adults with and without diabetes. Eur J Prev Cardiol 2023; 30:1172-1181. [PMID: 36947152 DOI: 10.1093/eurjpc/zwad092] [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: 12/31/2022] [Revised: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 03/23/2023]
Abstract
AIMS Aspirin therapy for primary prevention of cardiovascular disease (CVD) is controversial, and guideline recommendations have changed throughout the last decades. We report temporal trends in primary prevention aspirin use among persons with and without diabetes and describe characteristics of incident aspirin users. METHODS AND RESULTS Using Danish nationwide registries, we identified incident and prevalent aspirin users in a population of subjects ≥40 years without CVD eligible for primary preventive aspirin therapy from 2000 through 2020. Temporal trends in aspirin users with and without diabetes were assessed, as were CVD risk factors among incident users. A total of 522 680 individuals started aspirin therapy during the study period. The number of incident users peaked in 2002 (39 803 individuals, 1.78% of the eligible population) and was the lowest in 2019 (11 898 individuals, 0.49%), with similar trends for subjects with and without diabetes. The percentage of incident users with no CVD risk factors [diabetes, hypertension, hypercholesterolemia, or chronic obstructive pulmonary disease (a proxy for smoking)] decreased from 53.9% in 2000 to 30.9% in 2020. The temporal trends in prevalent aspirin users followed a unimodal curve, peaked at 7.7% in 2008, and was 3.3% in 2020. For subjects with diabetes, the peak was observed in 2009 at 38.5% decreasing to 17.1% in 2020. CONCLUSION Aspirin therapy for primary prevention of CVD has decreased over the last two decades. However, the drug remained used in individuals with and without diabetes, and a large proportion of individuals started on aspirin therapy had no CVD risk factors.
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Affiliation(s)
- Anna Meta Dyrvig Kristensen
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen, Denmark
| | - Manan Pareek
- Center for Translational Cardiology and Pragmatic Randomized Trials, Gentofte Hospital, Gentofte Hospitalsvej 8, 2900 Hellerup, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital-North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - John William McEvoy
- National Institute for Prevention and Cardiovascular Health, School of Medicine, National University of Ireland, Moyola Lane, Newcastle, Galway, Ireland
| | - Eva Bossano Prescott
- Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen, Denmark
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12
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Jacob AJ, Abdelkarim O, Zook S, Kragholm KH, Gupta P, Cocker M, Giraldo JR, Doherty JO, Schoebinger M, Schwemmer C, Gulsun MA, Rapaka S, Sharma P, Chang SM. AI-based, automated chamber volumetry from gated, non-contrast CT. J Cardiovasc Comput Tomogr 2023; 17:336-340. [PMID: 37612232 DOI: 10.1016/j.jcct.2023.08.001] [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: 03/22/2023] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Accurate chamber volumetry from gated, non-contrast cardiac CT (NCCT) scans can be useful for potential screening of heart failure. OBJECTIVES To validate a new, fully automated, AI-based method for cardiac volume and myocardial mass quantification from NCCT scans compared to contrasted CT Angiography (CCTA). METHODS Of a retrospectively collected cohort of 1051 consecutive patients, 420 patients had both NCCT and CCTA scans at mid-diastolic phase, excluding patients with cardiac devices. Ground truth values were obtained from the CCTA scans. RESULTS The NCCT volume computation shows good agreement with ground truth values. Volume differences [95% CI ] and correlation coefficients were: -9.6 [-45; 26] mL, r = 0.98 for LV Total, -5.4 [-24; 13] mL, r = 0.95 for LA, -8.7 [-45; 28] mL, r = 0.94 for RV, -5.2 [-27; 17] mL, r = 0.92 for RA, -3.2 [-42; 36] mL, r = 0.91 for LV blood pool, and -6.7 [-39; 26] g, r = 0.94 for LV wall mass, respectively. Mean relative volume errors of less than 7% were obtained for all chambers. CONCLUSIONS Fully automated assessment of chamber volumes from NCCT scans is feasible and correlates well with volumes obtained from contrast study.
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Affiliation(s)
- Athira J Jacob
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA
| | | | - Salma Zook
- Houston Methodist Hospital, Houston, TX, USA
| | | | - Prantik Gupta
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA
| | - Myra Cocker
- CT R&D Collaborations, Siemens Healthineers, Malvern, PA, USA
| | | | - Jim O Doherty
- CT R&D Collaborations, Siemens Healthineers, Malvern, PA, USA
| | | | | | - Mehmet A Gulsun
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA
| | - Saikiran Rapaka
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA
| | - Puneet Sharma
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ, USA
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13
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Wang W, Battini V, Carnovale C, Noordam R, van Dijk KW, Kragholm KH, van Heemst D, Soeorg H, Sessa M. A novel approach for pharmacological substantiation of safety signals using plasma concentrations of medication and administrative/healthcare databases: a case study using Danish registries for an FDA warning on lamotrigine. Pharmacol Res 2023:106811. [PMID: 37268178 DOI: 10.1016/j.phrs.2023.106811] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 06/04/2023]
Abstract
PHARMACOM-EPI is a novel framework to predict plasma concentrations of drugs at the time of occurrence of clinical outcomes. In early 2021, the U.S. Food and Drug Administration (FDA) issued a warning on the antiseizure drug lamotrigine claiming that it has the potential to increase the risk of arrhythmias and related sudden cardiac death due to a pharmacological sodium channel-blocking effect. We hypothesized that the risk of arrhythmias and related death is due to toxicity. We used the PHARMACOM-EPI framework to investigate the relationship between lamotrigine's plasma concentrations and the risk of death in older patients using real-world data. Danish nationwide administrative and healthcare registers were used as data sources and individuals aged 65 years or older during the period 1996 - 2018 were included in the study. According to the PHARMACOM-EPI framework, plasma concentrations of lamotrigine were predicted at the time of death and patients were categorized into non-toxic and toxic groups based on the therapeutic range of lamotrigine (3-15mg/L). Over 1 year of treatment, the incidence rate ratio (IRR) of all-cause mortality was calculated between the propensities score matched toxic and non-toxic groups. In total, 7286 individuals were diagnosed with epilepsy and were exposed to lamotrigine, 432 of which had at least one plasma concentration measurement The pharmacometric model by Chavez et al. was used to predict lamotrigine's plasma concentrations considering the lowest absolute percentage error among identified models (14.25%, 95% CI: 11.68-16.23). The majority of lamotrigine associated deaths were cardiovascular-related and occurred among individuals with plasma concentrations in the toxic range. The IRR of mortality between the toxic group and non-toxic group was 3.37 [95% CI: 1.44-8.32] and the cumulative incidence of all-cause mortality exponentially increased in the toxic range. Application of our novel framework PHARMACOM-EPI provided strong evidence to support our hypothesis that the increased risk of all-cause and cardiovascular death was associated with a toxic plasma concentration level of lamotrigine among older lamotrigine users.
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Affiliation(s)
- Wenyi Wang
- Department of Human Genetics, Leiden University Medical Center, Leiden, Netherlands; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Vera Battini
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Italy; Department of Drug Design and Pharmacology, University of Copenhagen, Denmark
| | - Carla Carnovale
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Italy
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics; Leiden University Medical Center, Leiden, Netherlands
| | - Ko Willems van Dijk
- Department of Human Genetics, Leiden University Medical Center, Leiden, Netherlands; Department of Internal Medicine, Division Endocrinology, Leiden University Medical Center, Leiden, Netherlands; Leiden Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, Netherlands
| | | | - Diana van Heemst
- Department of Internal Medicine, Section of Gerontology and Geriatrics; Leiden University Medical Center, Leiden, Netherlands
| | - Hiie Soeorg
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, Faculty of Medicine, University of Tartu, Estonia.
| | - Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Denmark.
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14
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Rasmussen SL, Strandbygaard LL, Fuursted K, Kragholm KH, Leutscher P, Rasmussen C. Antibody response in patients with autoimmune inflammatory rheumatic disease after pneumococcal polysaccharide prime vaccination or revaccination. Scand J Rheumatol 2023; 52:174-180. [PMID: 35049423 DOI: 10.1080/03009742.2021.2008602] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of the study was to assess the pneumococcal antibody response in autoimmune inflammatory rheumatic disease (AIIRD) patients receiving 23-valent pneumococcal polysaccharide vaccine (PPV23) as a prime vaccination or revaccination. METHOD Antibodies to 12 serotypes occurring in the commonly applied pneumococcal vaccines in Denmark were measured in AIIRD patients receiving biological disease-modifying anti-rheumatic drug (bDMARD) treatment for rheumatoid arthritis, spondyloarthritis, or psoriatic arthritis. Patients with a non-protective level of pneumococcal antibodies (geometric mean pneumococcal antibody level < 1 μg/mL) were invited to receive vaccination with PPV23 followed by control of antibody titre 3 months later. RESULTS In total, 224 (74%) of 301 patients were included in the analyses, of whom 126 patients had previously received PPV23 vaccination. Post-vaccination antibody measurement revealed that only 80 patients (36%) achieved a protective level of antibodies. In a multivariable logistic regression analysis, significantly more patients without a previous PPV23 vaccination history achieved a protective antibody level compared with patients with a history of PPV23 vaccination less than 5 years ago (p = 0.005). This difference was not seen when comparing the former group with patients vaccinated 5 years ago or more. Methotrexate (MTX) treatment at the time of vaccination was associated with a non-protective antibody level (p < 0.001). CONCLUSION Only 36% of patients with a non-protective antibody level achieved a protective level in response to pneumococcal vaccination. Pneumococcal vaccination within the last 5 years and MTX treatment at the time of vaccination were independently associated with a poor antibody response.
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Affiliation(s)
- S L Rasmussen
- Department of Rheumatology, North Denmark Regional Hospital, Hjoerring, Denmark.,Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - L L Strandbygaard
- Department of Rheumatology, North Denmark Regional Hospital, Hjoerring, Denmark
| | - K Fuursted
- Statens Serum Institut, Bacteriological Special Diagnostics and Reference, Copenhagen, Denmark
| | - K H Kragholm
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - P Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - C Rasmussen
- Department of Rheumatology, North Denmark Regional Hospital, Hjoerring, Denmark.,Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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15
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Lindblad V, Kragholm KH, Eidhammer A, Melgaard D. Discharge time after birth is associated with parity - A retrospective cohort study. Heliyon 2023; 9:e14004. [PMID: 36915540 PMCID: PMC10006520 DOI: 10.1016/j.heliyon.2023.e14004] [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] [Received: 08/26/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/01/2023] Open
Abstract
Background All healthy mothers with uncomplicated births are recommended to be discharged directly from the labour ward a few hours after birth as a change in practice in three hospitals in Denmark. However, despite this practice, there is limited knowledge about when mothers leave the hospital after birth in clinical practice. Objective The aim of this study is to examine 1) when mothers are discharged from hospital after birth, 2) if discharge time from the hospital after birth is associated with parity, and 3) which factors are associated with discharge time. Methods This retrospective study is based on data from the North Denmark Regional Hospital and included mothers giving vaginal birth from March 25, 2019 to April 10, 2021. Results A total of 1990 mothers were included. Nearly 50% of the new mothers stayed at the hospital less than 6 h after birth (26% of primiparous women vs 64% of multiparous women). Primiparous women had an adjusted RR 0.44 (95% CI 0.39-0.49) for discharge ≤6 h, RR 1.71 (95% CI 1.15-2.54) for discharge >6-12 h, and RR 3.76 (95% CI 3.03-4.67) for discharge >48 h after birth compared to multiparous women. Multiparous women's adjusted RR for discharge >6-12 h was 0.15 (95% CI 0.12-0.20) and for discharge >48 h 0.16 (95% CI 0.14-0.20) compared to discharge less than 6 h after birth. Furthermore, smoking, low education level, and younger age were associated with early discharge. Conclusion There is a significant association with parity and discharge time after birth and factors related to discharge time which healthcare professionals should be aware of when planning inpatient and outpatient care. In addition, healthcare professionals should be aware of mothers discharged early who are smoking, of younger age, lower education level or multiparity.
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Affiliation(s)
- Victoria Lindblad
- Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjoerring, Denmark
| | - Kristian Hay Kragholm
- Unit of Clinical Biostatistics and Epidemiology, Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Anya Eidhammer
- Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjoerring, Denmark
| | - Dorte Melgaard
- Centre for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjoerring, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark
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16
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Guldmann SA, Pareek M, Hjuler KF, Kaiser H, Kragholm KH, Egeberg A. Prognostic implications of high-sensitivity cardiac troponin in patients with suspected myocardial infarction with or without psoriasis. JAAD Int 2023; 11:55-58. [PMID: 36865615 PMCID: PMC9972368 DOI: 10.1016/j.jdin.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Sanaz A. Guldmann
- Department of Dermatology and Allergy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Manan Pareek
- Department of Internal Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Kasper F. Hjuler
- National Center of Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Hannah Kaiser
- Department of Dermatology and Allergy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | | | - Alexander Egeberg
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Correspondence to: Alexander Egeberg, MD, PhD, DMSc, Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
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17
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Maksten EF, Jakobsen LH, Kragholm KH, Baech J, Andersen MP, Madsen J, Jørgensen JM, Clausen MR, Pedersen RS, Dessau-Arp A, Larsen TS, Poulsen CB, Gang AO, Brown P, Fonager K, El-Galaly TC, Severinsen MT. Work Disability and Return to Work After Lymphoma: A Danish Nationwide Cohort Study. Clin Epidemiol 2023; 15:337-348. [PMID: 36941977 PMCID: PMC10024509 DOI: 10.2147/clep.s399488] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/23/2023] [Indexed: 03/14/2023] Open
Abstract
Purpose Many patients diagnosed with lymphoma are of working age. Cancer patients are known to have a higher risk of sick leave and disability pension, but this has only been delineated for certain subtypes of lymphoma. Therefore, this study aimed at investigating the overall risk of disability pension for all lymphoma subtypes and at quantifying return to work for patients with lymphoma in work before diagnosis. Patients and Methods Patients aged 18-60 years with lymphoma in complete remission (CR) diagnosed between 2000 and 2019 were included in the study. Using national registers, each patient was matched with five comparators from the general population with same sex, birth year, and level of Charlson Comorbidity Index. Risk of disability pension was calculated from 90 days after CR or end of treatment with competing events (death, retirement pension, early retirement pension, relapse for patients, or lymphoma diagnosis for comparators). Return to work for patients was calculated annually until 5 years after diagnosis for patients employed before diagnosis. Results In total, 4072 patients and 20,360 comparators were included. There was a significant increased risk of disability pension for patients with all types of lymphoma compared to the general population (5-year risk difference: 5.3 (95% confidence interval (CI): 4.4;6.2)). Patients with non-Hodgkin lymphoma were more likely to get disability pension than patients with Hodgkin lymphoma (sex- and age-adjusted 10-year risk difference: 2.9 (95% CI: 0.3;5.5)). One year after diagnosis, 24.5% of the relapse-free patients were on sick leave. Return to work was highest 2 years after diagnosis (82.1%). Conclusion Patients with lymphoma across all subtypes have a significantly higher risk of disability pension. Return to work peaks at 2 years after diagnosis.
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Affiliation(s)
- Eva Futtrup Maksten
- Department of Haematology, Clinical Cancer Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Correspondence: Eva Futtrup Maksten, Department of Haematology, Clinical Cancer Research Unit, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, 9000, Denmark, Tel +45 97663872, Fax + 45 97666323, Email
| | - Lasse Hjort Jakobsen
- Department of Haematology, Clinical Cancer Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department Mathematical Sciences, Aalborg University, Aalborg, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology & Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Joachim Baech
- Department of Haematology, Clinical Cancer Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Jakob Madsen
- Department of Haematology, Clinical Cancer Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Robert Schou Pedersen
- Department of Medicine, Section of Haematology, Regionshospital Goedstrup, Goedstrup, Denmark
| | | | | | | | - Anne Ortved Gang
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Brown
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Fonager
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Tarec C El-Galaly
- Department of Haematology, Clinical Cancer Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marianne Tang Severinsen
- Department of Haematology, Clinical Cancer Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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18
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Møller AL, Rytgaard HCW, Mills EHA, Christensen HC, Blomberg SNF, Folke F, Kragholm KH, Lippert F, Gislason G, Køber L, Gerds TA, Torp-Pedersen C. Hypothetical interventions on emergency ambulance and prehospital acetylsalicylic acid administration in myocardial infarction patients presenting without chest pain. BMC Cardiovasc Disord 2022; 22:562. [PMID: 36550452 PMCID: PMC9783974 DOI: 10.1186/s12872-022-03000-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Myocardial infarction (MI) patients presenting without chest pain are a diagnostic challenge. They receive suboptimal prehospital management and have high mortality. To elucidate potential benefits of improved management, we analysed expected outcome among non-chest pain MI patients if hypothetically they (1) received emergency ambulances/acetylsalicylic acid (ASA) as often as observed for chest pain patients, and (2) all received emergency ambulance/ASA. METHODS We sampled calls to emergency and non-emergency medical services for patients hospitalized with MI within 24 h and categorized calls as chest pain/non-chest pain. Outcomes were 30-day mortality and a 1-year combined outcome of re-infarction, heart failure admission, and mortality. Targeted minimum loss-based estimation was used for all statistical analyses. RESULTS Among 5418 calls regarding MI patients, 24% (1309) were recorded with non-chest pain. In total, 90% (3689/4109) of chest pain and 40% (525/1309) of non-chest pain patients received an emergency ambulance, and 73% (2668/3632) and 37% (192/518) of chest pain and non-chest pain patients received prehospital ASA. Providing ambulances to all non-chest pain patients was not associated with improved survival. Prehospital administration of ASA to all emergency ambulance transports of non-chest pain MI patients was expected to reduce 30-day mortality by 5.3% (CI 95%: [1.7%;9%]) from 12.8% to 7.4%. No significant reduction was found for the 1-year combined outcome (2.6% CI 95% [- 2.9%;8.1%]). In comparison, the observed 30-day mortality was 3% among ambulance-transported chest pain MI patients. CONCLUSIONS Our study found large differences in the prehospital management of MI patients with and without chest pain. Improved prehospital ASA administration to non-chest pain MI patients could possibly reduce 30-day mortality, but long-term effects appear limited. Non-chest pain MI patients are difficult to identify prehospital and possible unintended effects of ASA might outweigh the potential benefits of improving the prehospital management. Future research should investigate ways to improve the prehospital recognition of MI in the absence of chest pain.
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Affiliation(s)
- Amalie Lykkemark Møller
- grid.414092.a0000 0004 0626 2116Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Helene Charlotte Wiese Rytgaard
- grid.5254.60000 0001 0674 042XSection of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Helle Collatz Christensen
- grid.415046.20000 0004 0646 8261Danish Clinical Quality Program (RKKP), National Clinical Registries, Frederiksberg Hospital, Frederiksberg, Denmark ,grid.512919.7Copenhagen Emergency Medical Services, Ballerup, Denmark
| | | | - Fredrik Folke
- grid.512919.7Copenhagen Emergency Medical Services, Ballerup, Denmark ,grid.4973.90000 0004 0646 7373Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Hay Kragholm
- grid.27530.330000 0004 0646 7349Unit of Clinical Biostatistics and Epidemiology, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Freddy Lippert
- grid.512919.7Copenhagen Emergency Medical Services, Ballerup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- grid.4973.90000 0004 0646 7373Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark ,grid.453951.f0000 0004 0646 9598Department of Research, Danish Heart Foundation, Copenhagen, Denmark ,grid.10825.3e0000 0001 0728 0170The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Køber
- grid.475435.4Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Alexander Gerds
- grid.5254.60000 0001 0674 042XSection of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- grid.414092.a0000 0004 0626 2116Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark ,grid.27530.330000 0004 0646 7349Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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19
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Al-Hussainy N, Kragholm KH, Lundbye-Christensen S, Torp-Pedersen C, Pareek M, Therkelsen SK, Lip GYH, Riahi S. Safety and efficacy of direct oral anticoagulants in patients with anaemia and atrial fibrillation: an observational nationwide Danish cohort study. Eur Heart J Qual Care Clin Outcomes 2022; 8:840-851. [PMID: 34931662 DOI: 10.1093/ehjqcco/qcab095] [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] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 12/29/2022]
Abstract
AIMS The aim of this study was to evaluate the risk of stroke and bleeding among patients with atrial fibrillation (AF) treated with direct oral anticoagulants (DOACs) despite anaemia at treatment initiation time. METHODS AND RESULTS All Danish patients (N = 41 321) diagnosed with incident AF, having a baseline haemoglobin (Hb), and subsequently initiated DOAC therapy between 2012 and 2019 were identified through administrative registry databases. Patients with anaemia were subdivided according to the World Health Organization classification of anaemia and evaluated regarding risk of stroke and composite bleeding endpoint [hospitalization due to urogenital, gastrointestinal (GI), or intracranial bleeding or epistaxis]. Standardized absolute 1-year risks of stroke and composite bleeding endpoint were calculated using multivariable Cox regression analyses. The standardized absolute 1-year risk difference for composite bleeding increased by 0.96% [95% confidence interval (CI) 0.38-1.54] for patients with moderate/severe anaemia compared with patients with no anaemia. This risk was mainly driven by an increase in standardized absolute 1-year risk for serious GI bleeding, which increased by 0.41% (95% CI 0.19-0.63). No significant difference in standardized absolute 1-year bleeding risk was observed among patients with mild anaemia compared with patients with no anaemia 0.36% (95% CI -0.10 to 0.82). No significant difference in standardized absolute 1-year risk of stroke was observed among patients with mild anaemia, -0.16% (95% CI -0.13 to 0.15), and moderate/severe anaemia, -0.47% (95% CI -0.16 to 0.19), compared with patients with no anaemia. CONCLUSION For AF patients receiving DOACs, moderate/severe anaemia is a risk factor for serious GI bleeding, while stroke risk is the same regardless of whether anaemia was present at baseline or not.
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Affiliation(s)
- Nour Al-Hussainy
- Department of Medicine, Slagelse Hospital, Ingemannsvej 30, 4200 Slagelse, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,AF Study Group, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Manan Pareek
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark
| | | | - Gregory Y H Lip
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,AF Study Group, Aalborg University Hospital, Aalborg, Denmark
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20
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Pareek M, Kragholm KH, Vaduganathan M, Pallisgaard JL, Byrne C, Kristensen AMD, Biering-Sorensen T, Lee CJ, Bonde AN, Maeng M, Fosbol EL, Kober L, Gislason GH, Bhatt DL, Torp-Pedersen C. Serial high-sensitivity troponin T concentrations and long-term outcomes in patients with suspected acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1348] [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: 11/14/2022] Open
Abstract
Abstract
Background
High-sensitivity troponin assays allow for accurate and rapid rule-in or rule-out of myocardial infarction (MI) among patients with acute-onset chest pain. However, prognostic implications of serial high-sensitivity troponin concentrations are unknown.
Purpose
To determine short- and long-term prognostic implications of high-sensitivity troponin T (hsTnT) concentrations and their changes from baseline, in patients with suspected acute coronary syndrome.
Methods
Retrospective cohort study based on Danish national registries. We identified all patients discharged from the hospital with either MI, unstable angina, suspected MI, or chest pain from January 2012 through December 2019 and merged these individuals with all records of two serial hsTnT measurements obtained ≤7 hours apart during the same hospitalization. The primary outcome was death at days 0–30 and 31–365. Prognostic implications of serial hsTnT were examined in accordance with the 2012 ESC algorithm stratifying patients for normal baseline concentrations and relative changes of 20% and 50% from baseline. In case of a normal baseline concentration, 20% and 50% of the upper reference level (14 ng/l) were used as thresholds instead, i.e., 3 ng/l and 7 ng/l, respectively. Absolute risks were calculated through multivariable logistic regression with average treatment effect modeling (G-formula).
Results
Complete data were available in 28,902 individuals (median age [25th-75th percentile] 65.2 [53.4–75.4] years, 11,632 [40.2%] women). Of these, 11,116 (38.5%) had a final diagnosis of MI, 1518 (5.3%) of unstable angina, and 16,268 (56.3%) of either suspected MI or chest pain. Median baseline hsTnT was 18 ng/l (25th-75th percentile, 10–69), second hsTnT 21 ng/l (25th-75th percentile, 10–248), relative hsTnT change 3.6% (25th-75th percentile, 0–66.7), and time between samples 4.0 hours (25th-75th percentile, 3.2–5.4). Most patients had either two normal hsTnT concentrations (9483, 32.8%) or two elevated hsTnT concentrations (18,235, 63.1%). At 30 days, 796 (2.8%) individuals had died, while an additional 1287 (4.6% of 30-day survivors) died between days 31–365. Baseline hsTnT and the relative hsTnT change both displayed a significant, non-linear association with death and interacted with each other (P<0.001). Tables 1 and 2 show the standardized, absolute risks of death (with 95% confidence intervals) from days 0–30 and from days 31–365, respectively. Patients with two normal hsTnT concentrations had very low mortality rates, irrespective of the magnitude of relative change. Conversely, patients with two elevated hsTnT concentrations consistently had high mortality rates.
Conclusions
This is the first study to assess both short- and long-term outcomes as a function of both baseline hsTnT and its change from first to second measurement. In general, patients with two normal hsTnT concentrations have an excellent prognosis while those with two elevated concentrations require scrutiny.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Pareek
- Brigham and Women'S Hospital, Harvard Medical School , Boston , United States of America
| | | | - M Vaduganathan
- Brigham and Women'S Hospital, Harvard Medical School , Boston , United States of America
| | | | - C Byrne
- Gentofte University Hospital , Gentofte , Denmark
| | | | | | - C J Lee
- Aalborg University Hospital , Aalborg , Denmark
| | - A N Bonde
- Gentofte University Hospital , Gentofte , Denmark
| | - M Maeng
- Aarhus University Hospital , Aarhus , Denmark
| | - E L Fosbol
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - G H Gislason
- Gentofte University Hospital , Gentofte , Denmark
| | - D L Bhatt
- Brigham and Women'S Hospital, Harvard Medical School , Boston , United States of America
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21
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Steensig K, Pareek M, Krarup AL, Sogaard P, Maeng M, Tayal B, Lee CJY, Torp-Pedersen C, Lip GY, Holland-Fischer P, Kragholm KH. Thromboembolism and bleeding in patients with atrial fibrillation and liver disease - A nationwide register-based cohort study: Thromboembolism and bleeding in liver disease. Clin Res Hepatol Gastroenterol 2022; 46:101952. [PMID: 35609823 DOI: 10.1016/j.clinre.2022.101952] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/22/2022] [Accepted: 05/01/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Balancing the risk of thromboembolism and bleeding in patients with liver disease and atrial fibrillation/flutter is particularly challenging. PURPOSE To examine the risks of thromboembolism and bleeding with use/non-use of oral anticoagulation (including vitamin K-antagonists and direct oral anticoagulants) in patients with liver disease and AF. METHODS Danish nationwide register-based cohort study of anticoagulant naive individuals with liver disease, incident atrial fibrillation/flutter, and a CHA2DS2-VASc-score≥1 (men) or ≥2 (women), alive 30 days after atrial fibrillation/flutter diagnosis. Thromboembolism was a composite of ischaemic stroke, transient ischaemic attack, or venous thromboembolism. Bleeding was a composite of gastrointestinal, intracerebral, or urogenital bleeding requiring hospitalisation, or epistaxis requiring emergency department visit or hospital admission. Cause-specific Cox-regression was used to estimate absolute risks and average risk ratios standardised to covariate distributions. Because of significant interactions with anticoagulants, results for thromboembolism were stratified for CHA2DS2-VASc-score, and results for bleeding were stratified for cirrhotic/non-cirrhotic liver disease. RESULTS Four hundred and nine of 1,238 patients with liver disease and new atrial fibrillation/flutter initiated anticoagulants. Amongst patients with a CHA2DS2-VASc-score of 1-2 (2-3 for women), five-year thromboembolism incidence rates were low and similar in the anticoagulant (6.5%) versus no anticoagulant (5.5%) groups (average risk ratio 1.19 [95%CI, 0.22-2.16]). In patients with a CHA2DS2-VASc-score>2 (>3 for women), incidence rates were 16% versus 24% (average risk ratio 0.66 [95%CI, 0.45-0.87]). Bleeding risks appeared higher amongst patients with cirrhotic versus non-cirrhotic disease but were not significantly affected by anticoagulant status. CONCLUSION Oral anticoagulant initiation in patients with liver disease, incident new atrial fibrillation/flutter, and a high CHA2DS2-VASc-score was associated with a reduced thromboembolism risk. Bleeding risk was not increased with anticoagulation, irrespective of the type of liver disease.
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Affiliation(s)
| | - Manan Pareek
- Department of Cardiology, North Zealand Hospital, Hilleroed, Denmark.
| | - Anne Lund Krarup
- Department of Neurogastroenterological Research and Centre for Clinical Research, North Denmark Regional Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
| | - Peter Sogaard
- Department of Cardiology, Aalborg University Hospital, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Denmark
| | - Christina Ji-Young Lee
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark; Department of Clinical Research, North Zealand Hospital, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Denmark; Department of Clinical Research, North Zealand Hospital, Denmark
| | - Gregory Yh Lip
- Department of Cardiology, Aalborg University Hospital, Denmark; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, United Kingdom
| | - Peter Holland-Fischer
- Department of Clinical Medicine, Aalborg University, Denmark; Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Denmark; Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Denmark
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22
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Lyng Lindgren F, Tayal B, Bundgaard Ringgren K, Ascanius Jacobsen P, Hay Kragholm K, Zaremba T, Holmark Andersen N, Møgelvang R, Biering-Sørensen T, Hagendorff A, Schnohr P, Jensen G, Søgaard P. The variability of 2D and 3D transthoracic echocardiography applied in a general population : Intermodality, inter- and intraobserver variability. Int J Cardiovasc Imaging 2022; 38:2177-2190. [PMID: 37726455 DOI: 10.1007/s10554-022-02618-8] [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] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/08/2022] [Indexed: 11/05/2022]
Abstract
Assessment of the left ventricular (LV) function by three-dimensional echocardiography (3DE) is potentially superior to 2D echo echocardiography (2DE) for LV performance assessment. However, intra- and interobserver variation needs further investigation. We examined the intra- and interobserver variability between 2 and 3DE in a general population. In total, 150 participants from the Copenhagen City Heart Study were randomly chosen. Two observers assessed left ventricular ejection fraction (LVEF), end-diastolic (EDV) and end-systolic volumes (ESV) by 2DE and 3DE. Inter-, intraobserver and intermodality variabilities are presented as means of difference (MD), limits of agreement (LoA), coefficient of correlation (r), intraclass correlation coefficients (ICC). The lowest MD and LoA and highest r- and ICC-values was generally seen among the 3D acquisitions, with the 3D EDV interobserver as the best performing estimate (r = 0.95, ICC = 0.94). The largest MD, LoA and lowest r- and ICC-values was found in the interobserver 2D LVEF (r = 0.76, ICC = 0.63. For the intraobserver analysis, there were statistically significant differences between observations for all but 3DE EDV (p = 0.06). For interobserver analysis, there were statistically significant differences between observers for all estimates but 2DE EDV (p = 0.11), 3D ejection fraction (p = 0.9), 3DE EDV (p = 0.11) and 3D ESV (p = 0.15). Three-dimensional echocardiography is more robust and reproducible than 2DE and should be preferred for assessment of LV function.
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Affiliation(s)
- Filip Lyng Lindgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
- Clinical Institute, Aalborg University, Aalborg, Denmark.
| | - Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Bundgaard Ringgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Peter Ascanius Jacobsen
- Clinical Institute, Aalborg University, Aalborg, Denmark
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | | | - Tomas Zaremba
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Rasmus Møgelvang
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Andreas Hagendorff
- Laboratory of Echocardiography, Department of Cardiology-Angiology, University of Leipzig, Leipzig, Germany
| | - Peter Schnohr
- The Copenhagen City Heart Study, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Gorm Jensen
- The Copenhagen City Heart Study, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Clinical Institute, Aalborg University, Aalborg, Denmark
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23
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Yonis H, Porsborg Andersen M, Helen Anna Mills E, Gregers Winkel B, Wissenberg M, Køber L, Gislason G, Folke F, Moesgaard Larsen J, Søgaard P, Torp-Pedersen C, Hay Kragholm K. Duration of Resuscitation and Long-Term Outcome After In-Hospital Cardiac Arrest: A Nationwide Observational Study. Resuscitation 2022; 179:267-273. [PMID: 36007858 DOI: 10.1016/j.resuscitation.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prior studies have investigated the association between duration of resuscitation and short-term outcomes following in-hospital cardiac arrest (IHCA). However, it remains unknown whether there is an association between duration of resuscitation and long-term survival and functional outcomes. METHOD We linked data from the Danish in-hospital cardiac arrest registry with nationwide registries and identified 8,727 patients between 2013 and 2019. Patients were stratified into four groups (A-D) according to quartiles of duration of resuscitation. Standardized average probability of outcomes was estimated using logistic regression. RESULTS Of 8,727 patients, 53.1% (n=4,604) achieved return of spontaneous circulation. Median age was 74 (1st-3rd quartile [Q1-Q3] 65-81 years) and 63.1% were men. Among all IHCA patients the standardized 30-day survival was 62.0% (95% CI 59.8%-64.2%) for group A (< 5 minutes), 32.7% (30.8%-34.6%) for group B (5-11 minutes), 14.4% (12.9%-15.9%) for group C (12-20 minutes) and 8.1% (7.0%-9.1%) for group D (21 minutes or more). Similarly, 1-year survival was also highest for group A (50.4%; 48.2%-52.6%) gradually decreasing to 6.6% (5.6%-7.6%) in group D. Among 30-day survivors, survival without anoxic brain damage or nursing home admission within one-year post-arrest was highest for group A (80.4%; 78.2%-82.6%), decreasing to 73.3% (70.0%-76.6%) in group B, 67.2% (61.7%-72.6%) in group C and 73.3% (66.9%-79.7%) in group D. CONCLUSION Shorter duration of resuscitation attempt during an IHCA is associated with higher 30-day and 1-year survival. Furthermore, we found that the majority of 30-day survivors were still alive 1-year post-arrest without anoxic brain damage or nursing home admission despite prolonged resuscitation.
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Affiliation(s)
- Harman Yonis
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Denmark.
| | | | | | - Bo Gregers Winkel
- Department of Cardiology, Heart Center, Rigshospitalet, Copenhagen University Hospital
| | | | - Lars Køber
- Department of Cardiology, Heart Center, Rigshospitalet, Copenhagen University Hospital
| | - Gunnar Gislason
- Dept of Cardiology, Herlev and Gentofte Hospital, Denmark; The Danish Heart Foundation, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Fredrik Folke
- Dept of Cardiology, Herlev and Gentofte Hospital, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | | | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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24
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Philipsen L, Würtz N, Polcwiartek C, Kragholm KH, Torp-Pedersen C, Nielsen RE, Jensen SE, Attar R. Time trends of coronary procedures, guideline-based drugs and all-cause mortality following acute coronary syndrome in patients with bipolar disorder. Nord J Psychiatry 2022; 77:304-311. [PMID: 35904234 DOI: 10.1080/08039488.2022.2102208] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM This study analyzed time trends in the use of coronary procedures, guideline-based drugs, and 1-year all-cause and presumed cardiovascular mortality (CV) following acute coronary syndrome (ACS) in patients with and without bipolar disorder (BD). METHOD Using Danish registries 497 patients with ACS and BD in the period 1996-2016 were matched 1:2 on age, sex and year of ACS to patients without preexisting psychiatric disease. RESULTS Patients with BD and ACS received fewer coronary angiography (CAG) compared to psychiatric healthy controls (PHC). However, the difference between the populations decreased over time. For percutaneous coronary intervention (PCI) and coronary artery bypass (CABG) no differences in trend over time were found. In general patients with BD redeemed fewer prescriptions of guideline-based tertiary prophylactic drugs compared to PHCs. The difference remains constant over time for all drugs except for acetylsalicylic acid, lipid-lowering drugs and beta blockers, where the difference decreased. The 1-year all-cause mortality gap and the presumed CV mortality gap remained unchanged. CONCLUSION Despite improvements in treatment disparities regarding CAG, acetylsalicylic acid, lipid-lowering drugs and beta-blockers, the treatment gap remained unchanged concerning PCI and CABG. Likewise, patients with BD experienced a lower rate of the remaining redeemed prescriptions. The overall crude mortality risk ratio for patients with BD experiencing ACS remained unchanged over the study period compared to PHC.
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Affiliation(s)
- Line Philipsen
- Student, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Nanna Würtz
- Student, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Investigation and Cardiology, Nordsjællands Hospital, Hillerød, Denmark.,Department of Health Sciences and Technology, Aalborg University, Aalborg, Denmark
| | - Rene Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Svend Eggert Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rubina Attar
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Cardiology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden
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Lyngbye K, Melgaard D, Lindblad V, Kragholm KH, Eidhammer A, Westmark S, Maimburg RD. Do women's perceptions of their childbirth experiences change over time? A six-week follow-up study in a Danish population. Midwifery 2022; 113:103429. [PMID: 35901608 DOI: 10.1016/j.midw.2022.103429] [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] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate how women's perception of the childbirth experience developed during the postpartum period. The secondary aim was to explore how selected birth interventions were subjectively perceived as part of the birth experience. DESIGN A prospective cohort study comparing childbirth experience, assessed at one and six weeks postpartum, using the Childbirth Experience Questionnaire (CEQ). SETTING A regional hospital in the northern part of Denmark, with 1,400 childbirths annually. PARTICIPANTS A total of 201 women with low-risk births who gave birth at North Denmark Regional Hospital were included in this study. We included both nulliparous and multiparous women. MEASUREMENTS AND FINDINGS More than 50% of the women changed their perceptions about their childbirth experience after six weeks. After six weeks the overall CEQ score and the domains 'Participation' and 'Professional support' had a lower CEQ score compared to scores obtained one week postpartum, although differences were small. Induction of labor, augmentation of labor, emergency caesarean section, epidural analgesia, and use of nitrous oxide were associated with a lower CEQ score. KEY CONCLUSIONS Women assessed their overall birth experience more negatively at six weeks postpartum compared to one week postpartum. Some interventions in the labor process influenced the women's assessment of their experiences negatively. IMPLICATIONS FOR PRACTICE Paying attention to preventive initiatives to ensure the women a spontaneous birth, if possible, may be essential to create positive perceptions of the childbirth experience.
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Affiliation(s)
- Kristine Lyngbye
- Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Bispensgade 37, Hjoerring 9800, Denmark.
| | - Dorte Melgaard
- Centre of Clinical Research, North Denmark Regional Hospital, Bispensgade 37, Hjoerring 9800, Denmark; Department of Clinical Medicine and Centre for Clinical Research, Aalborg University, Soendre Skovvej 15, Aalborg 9000, Denmark
| | - Victoria Lindblad
- Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Bispensgade 37, Hjoerring 9800, Denmark
| | - Kristian Hay Kragholm
- Unit of Clinical Biostatistics and Epidemiology - Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9000, Denmark
| | - Anya Eidhammer
- Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Bispensgade 37, Hjoerring 9800, Denmark
| | - Signe Westmark
- Centre of Clinical Research, North Denmark Regional Hospital, Bispensgade 37, Hjoerring 9800, Denmark
| | - Rikke Damkjær Maimburg
- Department of Clinical Medicine, Department of Obstetrics and Gynecology, Palle Juul-Jensens Boulevard 103, Aarhus 8200, Denmark; School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith NSW, Sydney 2751, Australia
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26
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Øvlisen AK, Jakobsen LH, Kragholm KH, Nielsen RE, Nully Brown P, Dahl‐Sørensen RB, Frederiksen H, Mannering N, Josefsson PL, Ludvigsen Al‐Mashhadi A, Jørgensen JM, Dessau‐Arp A, Clausen MR, Pedersen RS, Torp‐Pedersen C, Severinsen MT, El‐Galaly TC. Mental health among patients with non-Hodgkin lymphoma: A Danish nationwide study of psychotropic drug use in 8750 patients and 43 750 matched comparators. Am J Hematol 2022; 97:749-761. [PMID: 35298039 PMCID: PMC9310853 DOI: 10.1002/ajh.26538] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/21/2022] [Accepted: 03/07/2022] [Indexed: 11/12/2022]
Abstract
Psychological distress following cancer diagnosis may lead to mental health complications including depression and anxiety. Non-Hodgkin lymphomas (NHLs) include indolent and aggressive subtypes for which treatment and prognosis differ widely. Incident use of psychotropic drugs (PDs-antidepressants, antipsychotics, and anxiolytics) and its correlation to lymphoma types can give insights into the psychological distress these patients endure. In this prospective matched cohort study, we used nationwide population-based registries to investigate the cumulative risk of PD use in NHL patients compared to a sex- and age-matched cohort from the Danish background population. In addition, contact patterns to psychiatric departments and incident intentional self-harm or completed suicide were explored. In total, 8750 NHL patients and 43 750 matched comparators were included (median age 68; male:female ratio 1.6). Median follow-up was 7.1 years. Two-year cumulative risk of PD use was higher in NHL patients (16.4%) as compared to the matched comparators (5.1%, p < .01); patients with aggressive NHL subtypes had the highest incidence. Prescription rates were higher in the first years after diagnosis but approached the rate of the matched population 5 years into survivorship in aggressive NHLs, whereas patients with indolent subtypes continued to be at higher risk. NHL patients had a slightly higher two-year risk of suicide/intentional self-harm (0.3%) as compared to the matched comparators (0.2%, p = .01). These results demonstrate that mental health complications among NHL patients are frequent. Routine assessment for symptoms of depression and anxiety should be consider as part of standard follow-up of NHL patients.
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Affiliation(s)
- Andreas Kiesbye Øvlisen
- Department of Hematology Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Lasse Hjort Jakobsen
- Department of Hematology Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Kristian Hay Kragholm
- Unit of Epidemiology and Biostatistics Aalborg University Hospital Aalborg Denmark
- Department of Cardiology Aalborg University Hospital Aalborg Denmark
| | - René Ernst Nielsen
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Department of Psychiatry Aalborg University Hospital Aalborg Denmark
| | - Peter Nully Brown
- Department of Hematology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | | | | | | | | | | | | | | | | | | | - Christian Torp‐Pedersen
- Unit of Epidemiology and Biostatistics Aalborg University Hospital Aalborg Denmark
- Department of Cardiology and Clinical Research Nordsjællands Hospital Hillerød Denmark
| | - Marianne Tang Severinsen
- Department of Hematology Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Clinical Cancer Research Unit Aalborg University Hospital Aalborg Denmark
| | - Tarec Christoffer El‐Galaly
- Department of Hematology Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Clinical Cancer Research Unit Aalborg University Hospital Aalborg Denmark
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27
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Kristensen AMD, Pareek M, Kragholm KH, Sehested TSG, Olsen MH, Prescott EB. Unstable Angina as a Component of Primary Composite Endpoints in Clinical Cardiovascular Trials: Pros and Cons. Cardiology 2022; 147:235-247. [PMID: 35537418 PMCID: PMC9393841 DOI: 10.1159/000524948] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/29/2022] [Indexed: 11/19/2022]
Abstract
Background Unstable angina (UA) is a component of acute coronary syndrome that is only occasionally included in primary composite endpoints in clinical cardiovascular trials. The aim of this paper is to elucidate the potential benefits and disadvantages of including UA in such contexts. Summary UA comprises <10% of patients with acute coronary syndromes in contemporary settings. Based on the pathophysiological similarities, it is ideal as a part of a composite endpoint along with myocardial infarction (MI). By adding UA as a component of a primary composite endpoint, the number of events and feasibility of the trial should increase, thus decreasing size and costs of trials. Furthermore, UA has both economic and quality of life implications on a societal and an individual level. However, there are important challenges associated with the use of UA as an endpoint. With the introduction of high-sensitivity troponins, the number of individuals diagnosed with UA has decreased to rather low levels, with a reciprocal increase in the number of MI. In addition, UA is particularly challenging to define given the subjective assessment of the index symptoms, rendering a high risk of bias. To minimize bias, strict criteria are warranted, and events should be adjudicated by a blinded endpoint adjudication committee. Key messages UA should only be chosen as a component of a primary composite endpoint in cardiovascular trials after thoroughly evaluating the pros and cons. If it is chosen to include UA, appropriate precautions should be taken to minimize possible bias.
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Affiliation(s)
- Anna Meta Dyrvig Kristensen
- Department of Cardiology, Copenhagen University Hospital − Bispebjerg and Frederiksberg, Copenhagen, Denmark
- *Anna Meta Dyrvig Kristensen,
| | - Manan Pareek
- Department of Cardiology, Copenhagen University Hospital − Herlev and Gentofte, Copenhagen, Denmark
| | | | - Thomas Steen Gyldenstierne Sehested
- Department of Cardiology, Copenhagen University Hospital − Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Michael Hecht Olsen
- Division of Cardiology, Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Eva Bossano Prescott
- Department of Cardiology, Copenhagen University Hospital − Bispebjerg and Frederiksberg, Copenhagen, Denmark
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28
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Pareek M, Vaduganathan M, Byrne C, Mikkelsen AD, Kristensen AMD, Biering-Sørensen T, Kragholm KH, Omar M, Olsen MH, Bhatt DL. Intensive blood pressure control in patients with a history of heart failure: the Systolic Blood Pressure Intervention Trial (SPRINT). Eur Heart J Cardiovasc Pharmacother 2022; 8:E12-E14. [PMID: 34902012 PMCID: PMC9071486 DOI: 10.1093/ehjcvp/pvab085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/20/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Manan Pareek
- Heart & Vascular Center, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
- Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Muthiah Vaduganathan
- Heart & Vascular Center, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
| | - Christina Byrne
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Astrid Duus Mikkelsen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Institute of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Massar Omar
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Michael Hecht Olsen
- Division of Cardiology, Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Deepak L Bhatt
- Corresponding author. Tel: +1 857 307 4071, Fax: +1 857 307 1955,
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29
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Petersen LT, Riddersholm S, Andersen DC, Polcwiartek C, Lee CJY, Lauridsen MD, Fosbøl E, Christiansen CF, Pareek M, Søgaard P, Torp-Pedersen C, Rasmussen BS, Kragholm KH. Temporal trends in patient characteristics, presumed causes, and outcomes following cardiogenic shock between 2005 and 2017: a Danish registry-based cohort study. Eur Heart J Acute Cardiovasc Care 2021; 10:1074-1083. [PMID: 34648620 DOI: 10.1093/ehjacc/zuab084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/31/2021] [Accepted: 09/20/2021] [Indexed: 12/30/2022]
Abstract
AIMS Most cardiogenic shock (CS) studies focus on acute coronary syndrome (ACS). Contemporary data on temporal trends in patient characteristics, presumed causes, treatments, and outcomes of ACS- and in particular non-ACS-related CS patients are sparse. METHODS AND RESULTS Using nationwide medical registries, we identified patients with first-time CS between 2005 and 2017. Cochrane-Armitage trend tests were used to examine temporal changes in presumed causes of CS, treatments, and outcomes. Among 14 363 CS patients, characteristics remained largely stable over time. As presumed causes of CS, ACS (37.1% in 2005 to 21.4% in 2017), heart failure (16.3% in 2005 to 12.0% in 2017), and arrhythmias (13.0% in 2005 to 10.9% in 2017) decreased significantly over time; cardiac arrest increased significantly (11.3% in 2005 to 24.5% in 2017); and changes in valvular heart disease were insignificant (11.5% in 2005 and 11.6% in 2017). Temporary left ventricular assist device, non-invasive ventilation, and extracorporeal membrane oxygenation use increased significantly over time; intra-aortic balloon pump and mechanical ventilation use decreased significantly. Over time, 30-day and 1-year mortality were relatively stable. Significant decreases in 30-day and 1-year mortality for patients presenting with ACS and arrhythmias and a significant increase in 1-year mortality in patients presenting with heart failure were seen. CONCLUSION Between 2005 and 2017, we observed significant temporal decreases in ACS, heart failure, and arrhythmias as presumed causes of first-time CS, whereas cardiac arrest significantly increased. Although overall 30-day and 1-year mortality were stable, significant decreases in mortality for ACS and arrhythmias as presumed causes of CS were seen.
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Affiliation(s)
- Line Thorgaard Petersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | | | | | - Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Christina J-Y Lee
- Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup Denmark.,Department of Cardiology, Nordsjaellands Hospital, Dyrehavevej 29, 3400 Hilleroed, Denmark
| | - Marie Dam Lauridsen
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Rigshospitalet University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Skejby, Denmark
| | - Manan Pareek
- Brigham and Women's Hospital, Heart & Vascular Center, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.,Department of Internal Medicine, Yale New Haven Hospital, Yale University School of Medicine, 20 York St, New Haven 06510, CT, USA.,Department of Cardiology and Clinical Epidemiology, North Zealand Hospital, Dyrehavevej 29, 3400 Hilleroed, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Department of Cardiology, Nordsjaellands Hospital, Dyrehavevej 29, 3400 Hilleroed, Denmark.,Department of Public Health, University of Copenhagen, Noerregade 10, 1165 Copenhagen, Denmark
| | - Bodil Steen Rasmussen
- Department of Anaesthesiology and Intensive Care Medicine, Aalborg University Hospital, Hobrogen 18-22, 9000 Alborg, Denmark.,Clinical Institute, Aalborg University, Soendre Skovvej 15, 9000 Alborg, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
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30
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Mortensen MB, Gaur S, Frimmer A, Bøtker HE, Sørensen HT, Kragholm KH, Niels Peter SR, Steffensen FH, Jensen RV, Mæng M, Kanstrup H, Blaha MJ, Shaw LJ, Dzaye O, Leipsic J, Nørgaard BL, Jensen JM. Association of Age With the Diagnostic Value of Coronary Artery Calcium Score for Ruling Out Coronary Stenosis in Symptomatic Patients. JAMA Cardiol 2021; 7:36-44. [PMID: 34705022 DOI: 10.1001/jamacardio.2021.4406] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [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: 01/16/2023]
Abstract
Importance The diagnostic value is unclear of a 0 coronary artery calcium (CAC) score to rule out obstructive coronary artery disease (CAD) and near-term clinical events across different age groups. Objective To assess the diagnostic value of a CAC score of 0 for reducing the likelihood of obstructive CAD and to assess the implications of such a CAC score and obstructive CAD across different age groups. Design, Setting, and Participants This cohort study obtained data from the Western Denmark Heart Registry and had a median follow-up time of 4.3 years. Included patients were aged 18 years or older who underwent computed tomography angiography (CTA) between January 1, 2008, and December 31, 2017, because of symptoms that were suggestive of CAD. Data analysis was performed from April 5 to July 7, 2021. Exposures Obstructive CAD, which was defined as 50% or more luminal stenosis. Main Outcomes and Measures Proportion of individuals with obstructive CAD who had a CAC score of 0. Risk-adjusted diagnostic likelihood ratios were used to assess the diagnostic value of a CAC score of 0 for reducing the likelihood of obstructive CAD beyond clinical variables. Risk factors associated with myocardial infarction and death were estimated. Results A total of 23 759 symptomatic patients, of whom 12 771 (54%) had a CAC score of 0, were included. This cohort had a median (IQR) age of 58 (49-65) years and was primarily composed of women (13 160 [55%]). Overall, the prevalence of obstructive CAD was relatively low across all age groups, ranging from 3% (39 of 1278 patients) in those who were younger than 40 years to 8% (52 of 619) among those who were 70 years or older. In patients with obstructive CAD, 14% (725 of 5043) had a CAC score of 0, and the prevalence varied across age groups from 58% (39 of 68) among those who were younger than 40 years, 34% (192 of 562) among those aged 40 to 49 years, 18% (268 of 1486) among those aged 50 to 59 years, 9% (174 of 1963) among those aged 60 to 69 years, to 5% (52 of 964) among those who were 70 years or older. The added diagnostic value of a CAC score of 0 decreased at a younger age, with a risk factor-adjusted diagnostic likelihood ratio of a CAC score of 0 ranging from 0.68 (approximately 32% lower likelihood of obstructive CAD than expected) in those who were younger than 40 years to 0.18 (approximately 82% lower likelihood than expected) in those who were 70 years or older. The presence of obstructive vs nonobstructive CAD among those with a CAC score of 0 was associated with a multivariable adjusted hazard ratio of 1.51 (95% CI, 0.98-2.33) for myocardial infarction and all-cause death; however, this hazard ratio varied from 1.80 (95% CI, 1.02-3.19) in those who were younger than 60 years to 1.24 (95% CI, 0.64-2.39) in those who were 60 years or older. Conclusions and Relevance This cohort study found that the diagnostic value of a CAC score of 0 to rule out obstructive CAD beyond clinical variables was dependent on age, with the added diagnostic value being smaller for younger patients. In symptomatic patients who were younger than 60 years, a sizable proportion of obstructive CAD occurred among those without CAC and was associated with an increased risk of myocardial infarction and all-cause death.
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Affiliation(s)
- Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Johns Hopkins, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Sara Gaur
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Attila Frimmer
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sand Rønnow Niels Peter
- Department of Cardiology, University Hospital of Southwest Jutland and Institute of Regional Health Research, University of Southern Denmark, Denmark
| | | | | | - Michael Mæng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Helle Kanstrup
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael J Blaha
- Johns Hopkins, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Leslee J Shaw
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, New York
| | - Omar Dzaye
- Johns Hopkins, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Jonathon Leipsic
- Department of Radiology, St Paul's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
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31
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Kragholm KH, Lindgren FL, Zaremba T, Freeman P, Andersen NH, Riahi S, Pareek M, Køber L, Torp-Pedersen C, Søgaard P, Hagendorff A, Tayal B. Mortality and ventricular arrhythmia after acute myocarditis: a nationwide registry-based follow-up study. Open Heart 2021; 8:openhrt-2021-001806. [PMID: 34675133 PMCID: PMC8532546 DOI: 10.1136/openhrt-2021-001806] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 08/04/2021] [Accepted: 10/01/2021] [Indexed: 12/20/2022] Open
Abstract
Objective Incidence and severity of acute myocarditis vary significantly in previous reports and there is a lack of epidemiological studies on the short-term risks of mortality, heart failure and ventricular arrhythmias in patients with acute myocarditis. Therefore, study aims were to examine 90-day risks of mortality, heart failure (HF) and ventricular arrhythmias in patients with acute myocarditis in comparison to age-matched and sex-matched background population controls. Methods In this nationwide register-based follow-up study of patients hospitalised with myocarditis between 2002 and 2018 in Denmark, 90-day risks of all-cause mortality, HF, ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation (VF)), cardiac arrest and implantable cardioverter-defibrillator (ICD) implantation were compared with age-matched and sex-matched controls from the background population (1:5 matching). Absolute risks standardised to the age, sex and comorbidity distribution of the entire study population were derived from multivariable Cox regression. Results A total of 2523 patients hospitalised with myocarditis were included. Median age was 48 years (Q1–Q3: 30–69) and 67.7% were men. Comorbidity burden was more pronounced among patients with myocarditis relative to controls. Standardised 90-day all-cause mortality risk was 4.9% for patients with acute myocarditis versus 0.3% for controls (p<0.001). Ninety-day standardised risks for other endpoints were 7.5% versus 0.1% for HF, 1.9% versus <0.1% for VF/VF/arrest risk and 1.6% versus <0.1% for ICD implantation (all p<0.001). Conclusions In this large nationwide register-based follow-up study, patients hospitalised with myocarditis had significantly higher 90-day risks of all-cause mortality, HF, ventricular arrhythmias, cardiac arrest and ICD implantation compared with background population controls.
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Affiliation(s)
- Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark .,Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Tomas Zaremba
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Phillip Freeman
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Manan Pareek
- Department of Cardiology, Nordsjællands Hospital, Hillerod, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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32
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Pareek M, Byrne C, Mikkelsen AD, Dyrvig Kristensen AM, Vaduganathan M, Biering-Sorensen T, Kragholm KH, Mortensen MB, Singh A, Olsen MH, Bhatt DL. Marital status, cardiovascular events, and intensive blood pressure lowering among men and women in the Systolic Blood Pressure Intervention Trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2312] [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
Background
Married persons may have lower rates of mortality and cardiovascular disease (CV) than unmarried persons although data regarding potential differences between men and women are conflicting. The Systolic Blood Pressure Intervention Trial (SPRINT) found that intensive versus standard blood pressure (BP) control reduced CV morbidity and mortality in high-risk patients. We hypothesized that marital status would influence CV event risk and the impact of intensive BP control, and that these effects would vary according to sex.
Purpose
To assess the risks of CV events and mortality according to marital status in a high-risk population, and to assess if marital status modified the effect of intensive versus standard BP control.
Methods
SPRINT was a randomized, controlled, open-label trial of 9361 individuals at high CV risk, at least 50 years of age, without diabetes, and with a systolic BP 130–180 mmHg. Participants were randomized to either intensive or standard BP control and followed for median 3.2 years (range 0–4.8 years). The primary efficacy endpoint was the composite of acute coronary syndromes, stroke, heart failure, or CV death. Secondary efficacy endpoints included the individual components of the primary endpoint and all-cause death. Event risk according to marital status, including variation of the effects of intensive BP control, was evaluated using multivariable Cox proportional-hazards regression with interaction analyses. The group of subjects who were married or living in a marriage-like relationship served as baseline.
Results
Information on marital status was available for 8762 (93.6%) individuals. A total of 4863 (55.5%) were married or in a marriage-like relationship, 3149 (35.9%) were widowed, divorced, or separated, and 750 (8.6%) were never married. Marital status did not differ between patients randomized to intensive versus standard BP control (P=0.51). The risk of the primary endpoint was not significantly affected by marital status (P>0.05), in neither men nor women (P-interaction>0.05). The same was true for its individual components except the risk of CV death which was higher among never married men (adjusted hazard ratio [aHR], 3.29, 95% confidence interval [CI]: 1.34–8.09; P=0.009; P-sex-interaction=0.99). The risk of all-cause death was higher among widowed, divorced, or separated men (aHR, 1.90, 95% CI: 1.35–2.67; P<0.001) and among never married men (aHR, 2.53, 95% CI: 1.51–4.26; P<0.001), but not women belong to these groups (P>0.05; P-sex-interaction=0.24) (Figure). Associations were not modified by age (P-interaction>0.05). Marital status did not modify the effect of intensive BP control for any of the endpoints (P-interaction>0.05).
Conclusions
In SPRINT, never married men had higher risks of both CV death and all-cause death while widowed, divorced, or separated men had a higher risk of all-cause death. The risks and benefits of intensive BP control were not affected by marital status.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- M Pareek
- Brigham and Women's Hospital, Boston, United States of America
| | - C Byrne
- Bispebjerg University Hospital, Copenhagen, Denmark
| | | | | | - M Vaduganathan
- Brigham and Women's Hospital, Boston, United States of America
| | | | | | | | - A Singh
- Brigham and Women's Hospital, Boston, United States of America
| | | | - D L Bhatt
- Brigham and Women's Hospital, Boston, United States of America
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Pareek M, Byrne C, Mikkelsen AD, Dyrvig Kristensen AM, Vaduganathan M, Biering-Sorensen T, Kragholm KH, Mortensen MB, Singh A, Olsen MH, Bhatt DL. Greater event rates in high-risk patients with a history of heart disease: from the Systolic Blood Pressure Intervention Trial (SPRINT). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2313] [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
Background
The Systolic Blood Pressure Intervention Trial (SPRINT) found that intensive versus standard blood pressure (BP) control reduced cardiovascular (CV) morbidity and mortality in patients at high CV risk. Effects were consistent among patients with and without prevalent CV disease. However, it is unknown whether the benefits and risks of intensive BP control are affected by the specific type of heart disease.
Purpose
To assess the risks of incident CV events and safety events in patients with individual types of heart disease, and to assess if the presence of heart disease modified the effect of intensive versus standard BP control.
Methods
SPRINT was a randomized, controlled trial comprising 9,361 individuals ≥50 years of age at high CV risk, without diabetes, and with a systolic BP 130–180 mmHg. Participants were randomized to intensive or standard BP control. The primary efficacy endpoint was the composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from CV causes. The primary safety endpoint was the composite of serious adverse events. We assessed event risk in patients with self-reported heart disease versus those without and further assessed the safety and efficacy of intensive BP control, including relevant interactions, in these individuals, using multivariable Cox proportional-hazards regression.
Results
Of 9361 participants, 326 (3.5%) reported a history of congestive heart failure, 760 (8.1%) of myocardial infarction, 1206 (12.9%) of angina, and 1830 (19.6%) of atrial fibrillation, atrial flutter, or irregular heartbeat. The prevalence of these conditions did not significantly differ between patients randomized to intensive versus standard BP control (P>0.05 for all). At median 3.2 years (range 0–4.8 years), congestive heart failure (adjusted hazard ratio [aHR], 1.94, 95% confidence interval [CI], 1.45–2.61; P<0.001), myocardial infarction (aHR, 1.73, 95% CI, 1.33–2.25; P<0.001), angina (aHR, 1.41, 95% CI, 1.09–1.84; P=0.01), and atrial fibrillation, atrial flutter, or irregular heartbeat (aHR, 1.36, 95% CI, 1.12–1.64; P=0.002) were all independently associated with the primary endpoint (Figure). All conditions except prior myocardial infarction were also associated with composite serious adverse events (P=0.24 for myocardial infarction, P<0.05 for all others). A history of angina modified the efficacy of intensive versus standard BP control, i.e., patients without angina appeared to benefit from intensive BP control (aHR, 0.66, 95% CI, 0.54–0.80; P<0.001) while those with angina did not (aHR, 1.04, 95% CI, 0.76–1.44; P=0.80) (P=0.02 for interaction). No significant interactions were detected for the primary safety endpoint.
Conclusions
In SPRINT, a history of any type of heart disease was associated with a greater risk for both efficacy and safety events. Patients with angina did not appear to derive benefit from intensive BP control.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- M Pareek
- Brigham and Women's Hospital, Boston, United States of America
| | - C Byrne
- Bispebjerg University Hospital, Copenhagen, Denmark
| | | | | | - M Vaduganathan
- Brigham and Women's Hospital, Boston, United States of America
| | | | | | | | - A Singh
- Brigham and Women's Hospital, Boston, United States of America
| | | | - D L Bhatt
- Brigham and Women's Hospital, Boston, United States of America
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Byrne C, Pareek M, Vaduganathan M, Mikkelsen AD, Kristensen AMD, Biering-Sorensen T, Kragholm KH, Mortensen MB, Singh A, Olsen MH, Bhatt DL. Primary health insurance and cardiovascular outcomes in the systolic blood pressure intervention trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2314] [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: 11/12/2022] Open
Abstract
Abstract
Background
The Systolic Blood Pressure Intervention Trial (SPRINT) found that intensive versus standard blood pressure (BP) control reduced cardiovascular (CV) morbidity and mortality in high-risk patients. Although antihypertensive therapies were provided at no cost to trial participants, patients were covered by various entities. Insurance coverage provides a unique dimension of risk assessment and may provide additional prognostic information in this setting.
Purpose
To assess the risks of incident CV events and safety events in a high CV risk population according to type of health insurance, and to assess if insurance type interacted with the effect of intensive versus standard BP control.
Methods
SPRINT was a randomized, controlled trial conducted across 102 US sites of 9,361 high-risk adults ≥50 years, without diabetes, and with a systolic BP 130–180 mmHg at screening. Study participants were randomized to intensive (target systolic BP <120mmHg) or standard BP control (target systolic BP <140mmHg) and followed for median 3.2 years (range 0–4.8 years). The primary efficacy endpoint was the composite of acute coronary syndromes, stroke, heart failure, or CV death. The primary safety endpoint was the composite of serious adverse events. The risk of efficacy and safety events according to type of health insurance, including the effect of intensive BP control in each subgroup, was evaluated using multivariable Cox proportional-hazards regression with interaction analyses. Private/other insurance type served as the reference group.
Results
Of 9361 participants, 3980 (42.5%) were covered by private/other insurance, 1483 (15.8%) by a Veterans Affairs (VA) health plan, 2691 (28.8%) by Medicare, 207 (2.2%) by Medicaid, and 1000 (10.7%) were uninsured. Insurance coverage distribution was well-balanced between the two study arms (P>0.05). Compared with patients who had private/other insurance, the risk of the primary endpoint was significantly higher among Medicaid beneficiaries (adj. hazard ratio [HR], 1.81, 95% confidence interval [CI], 1.09–3.00; P=0.02). The risk of death was similarly highest among Medicaid patients (adj. HR, 2.08, 95% CI, 1.08–4.02; P=0.03) and was also significantly higher among VA patients (adj. HR, 1.49, 95% CI, 1.11–2.99; P=0.008) (Figure). Serious adverse events were more common in the VA population (HR, 1.12, 95% CI, 1.01–1.23; P=0.03). Insurance type did not modify the efficacy and safety of intensive BP control (P>0.05 for all interactions).
Conclusions
In SPRINT, Medicaid beneficiaries were at significantly greater risk for experiencing a primary CV event. Medicaid patients and VA patients both had higher mortality than those covered by private/other insurance. The risks and benefits of intensive BP control were not affected by insurance type.
Funding Acknowledgement
Type of funding sources: None. Risk of death and health insurace type
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Affiliation(s)
- C Byrne
- Bispebjerg University Hospital, Copenhagen, Denmark
| | - M Pareek
- Brigham and Women'S Hospital, Harvard Medical School, Heart & Vascular Center, Boston, United States of America
| | - M Vaduganathan
- Brigham and Women'S Hospital, Harvard Medical School, Heart & Vascular Center, Boston, United States of America
| | | | | | - T Biering-Sorensen
- Gentofte Hospital - Copenhagen University Hospital, Department of Cardiology, Hellerup, Denmark
| | - K H Kragholm
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - M B Mortensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - A Singh
- Brigham and Women'S Hospital, Harvard Medical School, Heart & Vascular Center, Boston, United States of America
| | - M H Olsen
- Holbaek Hospital, Department of Internal Medicine, Holbaek, Denmark
| | - D L Bhatt
- Brigham and Women'S Hospital, Harvard Medical School, Heart & Vascular Center, Boston, United States of America
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Byrne C, Pareek M, Vaduganathan M, Biering-Sørensen T, Krogager ML, Kragholm KH, Steensig K, Mortensen MB, Mishra SR, McCullough MJ, Desai NR, Torp-Pedersen C, Olsen MH, Bhatt DL. Serum Potassium and Mortality in High-Risk Patients: SPRINT. Hypertension 2021; 78:1586-1594. [PMID: 34601970 DOI: 10.1161/hypertensionaha.121.17736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Christina Byrne
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark (C.B.)
| | - Manan Pareek
- Brigham and Women's Hospital, Heart & Vascular Center (M.P., M.V., T.B.-S., D.L.B.), Harvard Medical School, Boston, MA.,Department of Cardiology, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT (M.P., N.R.D.).,Department of Cardiology and Clinical Epidemiology, North Zealand Hospital, Hillerød, Denmark (M.P., C.T.-P.)
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital, Heart & Vascular Center (M.P., M.V., T.B.-S., D.L.B.), Harvard Medical School, Boston, MA
| | - Tor Biering-Sørensen
- Brigham and Women's Hospital, Heart & Vascular Center (M.P., M.V., T.B.-S., D.L.B.), Harvard Medical School, Boston, MA.,Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark (T.B.-S.).,Institute of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (T.B.-S.)
| | - Maria Lukács Krogager
- Department of Cardiology, Aalborg University Hospital, Denmark (M.L.K., K.H.K., K.S., C.T.-P.)
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Denmark (M.L.K., K.H.K., K.S., C.T.-P.)
| | - Kamilla Steensig
- Department of Cardiology, Aalborg University Hospital, Denmark (M.L.K., K.H.K., K.S., C.T.-P.)
| | | | - Shiva Raj Mishra
- World Heart Federation, Salim Yusuf Emerging Leaders Program, Geneva, Switzerland (S.R.M.)
| | - Megan J McCullough
- Massachusetts General Hospital Corrigan Minehan Heart Center (M.J.M.S), Harvard Medical School, Boston, MA
| | - Nihar R Desai
- Department of Cardiology, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT (M.P., N.R.D.)
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Epidemiology, North Zealand Hospital, Hillerød, Denmark (M.P., C.T.-P.).,Department of Cardiology, Aalborg University Hospital, Denmark (M.L.K., K.H.K., K.S., C.T.-P.)
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital, Denmark (M.H.O.).,Department of Regional Health Research, University of Southern Denmark (M.H.O.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital, Heart & Vascular Center (M.P., M.V., T.B.-S., D.L.B.), Harvard Medical School, Boston, MA
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Tayal B, Freeman P, Ericsson F, Kragholm KH, Andersen NH, Hagendorff A, Aaroe J, Sogaard P, Zaremba T. Characterisation of patients with and without cardiac magnetic resonance imaging abnormalities presenting with myocardial infarction with non-obstructive coronary arteries (MINOCA). Acta Cardiol 2021; 76:760-768. [PMID: 32594904 DOI: 10.1080/00015385.2020.1785134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of the current study is to determine the characteristics of myocardial infarction with non-obstructive coronary arteries (MINOCA) patients with and without cardiac magnetic resonance (CMR) abnormalities. METHODS We evaluated patients admitted with a presentation of acute myocardial infarction (MI) with no coronary obstruction on invasive angiography in our institution between 2012 and 2017. Patients with prior cardiac disease, myocarditis, Takotsubo cardiomyopathy and type 2 myocardial infarction were excluded. Myocardial fibrosis was determined by late gadolinium enhancement (LGE). Patients were divided into two groups based on the presence or absence of CMR abnormalities (LGE or oedema). Major adverse cardiovascular events (MACE) were defined as non-fatal MI, all-cause mortality, ventricular arrythmias or heart failure hospitalisation at follow-up. RESULTS Thirty-four patients fulfilling the inclusion criteria were identified. Myocardial changes with CMR were observed in 20 (59%) patients with signs of subendocardial infarct by LGE in 13 (38%) patients, transmural infarct by LGE in 6 (18%) patients and one patient had myocardial oedema. ECG and echocardiographic features were similar between patients with and without CMR abnormalities. Troponin T was significantly higher among patients with CMR abnormalities. The median duration of follow-up was 702 (IQR 456-1394) days. Two patients had MACE (both heart failure). One of them had LGE changes. CONCLUSIONS A significant number of patients with MINOCA have ischaemic LGE changes or myocardial wall oedema. The patients with CMR abnormalities have similar ECG and echocardiographic features except higher biomarker, highlighting the role of CMR in patients with MINOCA.
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Affiliation(s)
- Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Phillip Freeman
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Filip Ericsson
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Andreas Hagendorff
- Department of Cardiology, University Hospital of Leipzig, Leipzig, Germany
| | - Jens Aaroe
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Sogaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Tomas Zaremba
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Jacobsen PA, Kragholm KH, Torp-Pedersen C, Janssen DJA, Spruit MA, Weinreich UM. Employment Status, Readmission and Mortality After Acute Exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:2257-2265. [PMID: 34385815 PMCID: PMC8352575 DOI: 10.2147/copd.s319840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The understanding of whether and to what extent employment status affects readmission and mortality is limited in patients with COPD. Aim To explore how employment status affects readmission and mortality after first admission to the hospital with acute exacerbation of COPD (AECOPD). Methods This study used Danish national registry-based data. All patients admitted for the first time to the hospital between 1999 and 2014 with a diagnosis of AECOPD, age 35–59, without a previous asthma diagnosis were included in the study. Employment status effect on 30-, 90-, and 365-day readmission and mortality was examined using logistic regression, adjusting for relevant confounders. Results A total of 11,850 COPD patients were included in the study of which 3563 (30%) were working, 1368 (12%) unemployed, 840 (7%) on sick leave, and 6079 (51%) receiving early retirement. Patients receiving early retirement had, compared to patients working, an adjusted increased likelihood of readmission at 30, 90, and 365 days (odds ratio (OR) 1.26 (CI95% (1.06–1.49)), 1.33 (CI95% (1.16–1.53)), and 1.48 (CI95% (1.33–1.66)), respectively). An increased likelihood was also seen in unemployed at 365 days follow-up (OR 1.44 (CI95% (1.22–1.68))). Early retirement was associated with an increased mortality at 30, 90, and 365 days (OR 1.39 (CI95% (1.07–1.80)) 1.37 (CI95% (1.09–1.79)) and 1.48 (CI95% (1.25–1.75)), respectively). An increased likelihood was also seen in patients receiving sick leave (OR 1.57 (CI95% (1.21–2.04))). Conclusion Patients with COPD who are not working at the time of first admission have a higher likelihood of readmission and mortality.
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Affiliation(s)
- Peter Ascanius Jacobsen
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Kristian Hay Kragholm
- The Clinical Institute, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Daisy J A Janssen
- Department of Research and Development, Ciro, Horn, the Netherland.,Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Martijn A Spruit
- Department of Research and Development, Ciro, Horn, the Netherland.,Nutrim School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,The Clinical Institute, Aalborg University, Aalborg, Denmark
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Meaidi M, Støvring H, Rostgaard K, Torp-Pedersen C, Kragholm KH, Andersen M, Sessa M. Pharmacoepidemiological methods for computing the duration of pharmacological prescriptions using secondary data sources. Eur J Clin Pharmacol 2021; 77:1805-1814. [PMID: 34247270 DOI: 10.1007/s00228-021-03188-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/02/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE In pharmacoepidemiology, correctly defining the exposure period of pharmacological treatment is a challenging step when information on the time in treatment is missing or incomplete. METHODS In this review, we describe several methods for defining exposure to pharmacological treatments using secondary data sources that lack such information. RESULTS AND CONCLUSION Several methods for assessing the duration of redeemed prescriptions and combining them into temporal sequences are available. We present a set of considerations to make researchers aware of the potentials and pitfalls of these methods that may aid in minimizing biases in research using these methods. Additionally, we highlight that, to date, there is no one-size-fits-all solution. Thus, the choice of method should be based on their area of applicability combined with a careful mapping to the research scenario under investigation.
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Affiliation(s)
- Marianne Meaidi
- Department of Drug Design and Pharmacology, University of Copenhagen, Jagtvej 160, 2100, København Ø, Denmark
| | - Henrik Støvring
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | | | | | - Morten Andersen
- Department of Drug Design and Pharmacology, University of Copenhagen, Jagtvej 160, 2100, København Ø, Denmark
| | - Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Jagtvej 160, 2100, København Ø, Denmark.
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Møller AL, Mills EHA, Gnesin F, Jensen B, Zylyftari N, Christensen HC, Blomberg SNF, Folke F, Kragholm KH, Gislason G, Fosbøl E, Køber L, Gerds TA, Torp-Pedersen C. Impact of myocardial infarction symptom presentation on emergency response and survival. Eur Heart J Acute Cardiovasc Care 2021; 10:1150-1159. [PMID: 33951728 DOI: 10.1093/ehjacc/zuab023] [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] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/24/2021] [Accepted: 03/23/2021] [Indexed: 11/12/2022]
Abstract
AIMS We examined associations between symptom presentation and chance of receiving an emergency dispatch and 30-day mortality among patients with acute myocardial infarction (MI). METHODS AND RESULTS Copenhagen, Denmark has a 24-h non-emergency medical helpline and an emergency number 1-1-2 (equivalent to 9-1-1). Both services register symptoms/purpose of calls. Among patients with MI as either hospital diagnosis or cause of death within 72 h after a call, the primary symptom was categorized as chest pain, atypical symptoms (breathing problems, unclear problem, central nervous system symptoms, abdominal/back/urinary, other cardiac symptoms, and other atypical symptoms), unconsciousness, non-informative symptoms, and no recorded symptoms. We identified 4880 emergency and 3456 non-emergency calls from patients with MI. The most common symptom was chest pain (N = 5219) followed by breathing problems (N = 556). Among patients with chest pain, 95% (3337/3508) of emergency calls and 76% (1306/1711) of non-emergency calls received emergency dispatch. Mortality was 5% (163/3508) and 3% (49/1711) for emergency/non-emergency calls, respectively. For atypical symptoms 62% (554/900) and 17% (137/813) of emergency/non-emergency calls received emergency dispatch and mortality was 23% (206/900) and 15% (125/813). Among unconscious, patients 99%/100% received emergency dispatch and mortality was 71%/75% for emergency/non-emergency calls. Standardized 30-day mortality was 4.3% for chest pain and 15.6% for atypical symptoms, and associations between symptoms and emergency dispatch remained in subgroups of age and sex. CONCLUSION Myocardial infarction patients presenting with atypical symptoms when calling for help have a reduced chance of receiving an emergency dispatch and increased 30-day mortality compared to MI patients with chest pain.
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Affiliation(s)
| | | | - Filip Gnesin
- Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, Hillerød 2400, Denmark
| | - Britta Jensen
- Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, Aalborg 9220, Denmark
| | - Nertila Zylyftari
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, Hellerup 2900, Denmark
| | | | - Stig Nikolaj Fasmer Blomberg
- Copenhagen Emergency Medical Services, Telegrafvej 5, Ballerup 2750, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, Hellerup 2900, Denmark.,Copenhagen Emergency Medical Services, Telegrafvej 5, Ballerup 2750, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark
| | - Kristian Hay Kragholm
- Unit of Clinical Biostatistics and Epidemiology, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, Hellerup 2900, Denmark.,Department of Research, Danish Heart Foundation, Vognmagergade 7, Copenhagen 1120, Denmark.,The National Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen 1455, Denmark
| | - Emil Fosbøl
- Departmet of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Lars Køber
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen 2200, Denmark.,Departmet of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark
| | - Thomas Alexander Gerds
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, 1353, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, Hillerød 2400, Denmark.,Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9100, Denmark
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Hagengaard L, Andersen MP, Polcwiartek C, Larsen JM, Larsen ML, Skals RK, Hansen SM, Riahi S, Gislason G, Torp-Pedersen C, Søgaard P, Kragholm KH. Socioeconomic differences in outcomes after hospital admission for atrial fibrillation or flutter. Eur Heart J Qual Care Clin Outcomes 2021. [PMID: 31560375 DOI: 10.1093/ehjqcco/qcz053.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS To examine socioeconomic differences in care and outcomes in a 1-year period beginning 30 days after hospital discharge for first-time atrial fibrillation or flutter (AF) hospitalization. METHODS AND RESULTS This nationwide register-based follow-up cohort study investigated AF 30-day discharge survivors in Denmark during 2005-2014 and examined associations between patient's socioeconomic status (SES) and selected outcomes during a 1-year follow-up period beginning 30 days post-discharge after first-time hospitalization for AF. Patient SES was defined in four groups (lowest, second lowest, second highest, and highest) according to each patient's equivalized income. SES of the included 150 544 patients was: 27.7% lowest (n = 41 648), 28.1% second lowest (n = 42 321), 23.7% second highest (n = 35 656), and 20.5% highest (n = 30 919). Patients of lowest SES were older and more often women. Within 1-year follow-up, patients of lowest SES were less often rehospitalized or seen in outpatient clinics due to AF, or treated with cardioversion or ablation and were slightly more often diagnosed with stroke and heart failure (HF) and significantly more likely to die (16.1% vs. 14.9%, 11.3% and 8.1%). Hazard ratios for all-cause mortality were 0.64 (95% confidence interval 0.61-0.68) for highest vs. lowest SES, adjusted for CHA2DS2-VASc score, chronic obstructive pulmonary disease, rate- and rhythm-controlling drugs, and cohabitation status. CONCLUSION In 30-day survivors of first-time hospitalization due to AF, lowest SES is associated with increased 1-year all-cause and cardiovascular mortality and fewer cardioversions, ablations, readmissions, and outpatient contacts due to AF. Our findings indicate a need for socially differentiated rehabilitation following hospital discharge for first-time AF.
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Affiliation(s)
- Louise Hagengaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Mikkel Porsborg Andersen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark.,Department of Clinical Research, Nordsjællands Hospital, Dyrehvaevej 29, 3400 Hillerød, Denmark
| | - Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark.,Division of Cardiology, Duke University Medical Center, Erwin Road, Durham, NC 27710, USA
| | - Jacob Mosgaard Larsen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Mogens Lytken Larsen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Regitze Kuhr Skals
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Steen Møller Hansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark.,Department of Clinical Research, Nordsjællands Hospital, Dyrehvaevej 29, 3400 Hillerød, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Kristian Hay Kragholm
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, 9000 Aalborg, Denmark.,Department of Cardiology, Hjørring Regional Hospital, Bispensgade 37, 9800 Hjørring, Denmark
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41
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Søndergaard MM, Riis J, Bodker KW, Hansen SM, Nielsen J, Graff C, Pietersen AH, Nielsen JB, Tayal B, Polcwiartek C, Torp-Pedersen C, Soegaard P, Kragholm KH. Associations between left bundle branch block with different PR intervals, QRS durations, heart rates and the risk of heart failure: a register-based cohort study using ECG data from the primary care setting. Open Heart 2021; 8:openhrt-2020-001425. [PMID: 33574021 PMCID: PMC7880100 DOI: 10.1136/openhrt-2020-001425] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
Aim Left bundle branch block (LBBB) is associated with an increased risk of heart failure (HF). We assessed the impact of common ECG parameters on this association using large-scale data. Methods and results Using ECGs recorded in a large primary care population from 2001 to 2011, we identified HF-naive patients with a first-time LBBB ECG. We obtained information on sex, age, emigration, medication, diseases and death from Danish registries. We investigated the association between the PR interval, QRS duration, and heart rate and the risk of HF over a 2-year follow-up period using Cox regression analysis. Of 2471 included patients with LBBB, 464 (18.8%) developed HF during follow-up. A significant interaction was found between QRS duration and heart rate (p<0.01), and the analyses were stratified on these parameters. Using a QRS duration <150 ms and a heart rate <70 beats per minute (bpm) as the reference, all groups were statistically significantly associated with the development of HF. Patients with a QRS duration ≥150 ms and heart rate ≥70 bpm had the highest risk of developing HF (HR 3.17 (95% CI 2.41 to 4.18, p<0.001). There was no association between the PR interval and HF after adjustment. Conclusion Prolonged QRS duration and higher heart rate were associated with increased risk of HF among primary care patients with LBBB, while no association was observed with PR interval. Patients with LBBB with both a prolonged QRS duration (≥150 ms) and higher heart rate (≥70 bpm) have the highest risk of developing HF.
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Affiliation(s)
| | - Johannes Riis
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Steen Møller Hansen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Nielsen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Claus Graff
- Department of Health, Science and Technology, Aalborg University Faculty of Health Sciences, Aalborg, Denmark
| | - Adrian Holger Pietersen
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hillerod, Denmark
| | - Jonas Bille Nielsen
- University of Copenhagen, Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark.,Department of Cardiology, Laboratory of Molecular Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bhupendar Tayal
- Department of Cardiology, Hospital Vendsyssel in Hjørring, Hjorring, Denmark
| | - Christoffer Polcwiartek
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
| | | | - Peter Soegaard
- Cardiology Clinic Heart-Lung, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Hay Kragholm
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Cardiology, Regional Hospital North Jutland, Hjorring, Denmark
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Hagengaard L, Polcwiartek C, Andersen MP, Sessa M, Krogager ML, Gislason G, Schou M, Torp-Pedersen C, Søgaard P, Kragholm KH. Incident atrial fibrillation and risk of psychoactive drug redemptions and psychiatric hospital contacts: a Danish Nationwide Register-based Follow-up Study. Eur Heart J Qual Care Clin Outcomes 2021; 7:76-82. [PMID: 32502251 DOI: 10.1093/ehjqcco/qcaa048] [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] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/21/2020] [Accepted: 06/02/2020] [Indexed: 11/12/2022]
Abstract
AIMS To investigate whether incident atrial fibrillation or flutter (AF) diagnosis increases the risk of psychiatric outcomes compared with the general population. METHODS AND RESULTS First-time AF patients and population controls naive to psychiatric disease or filled prescriptions for psychotropic drugs were identified in Danish nationwide registries during 2005-14. AF patients were matched 1:2 with exposure density matching. Patients and controls were compared for 1-year cumulative incidences of depression, anxiety, and stress disorders, and for filled drug prescriptions for antidepressant, anxiolytic, selected antipsychotics, and hypnotics. Lastly, we examined 1-year cumulative incidences of a composite endpoint of the above-mentioned diagnoses or drug redemptions. We included 146 377 AF patients and 292 754 matched controls, 55% men and median age 74 (25-75% 65-82) years. AF patients had significantly higher cumulative incidences of composite endpoints. Furthermore, filled prescriptions for anxiolytics and hypnotics were significantly higher for AF patients compared with healthy population controls. The cumulative incidence of the composite endpoint was significantly higher in AF patients relative to controls 11.1% vs. 8.3%. For the composite endpoint, a significantly higher risk was apparent both in unadjusted (HR: 2.76, 95% CI: 2.67-2.85) and adjusted (HR: 2.51, 95% CI: 2.43-2.60) models for AF patients vs. controls in the first 3 months after study inclusion. CONCLUSION First-time AF patients were significantly more likely to have psychiatric outpatient or hospital contacts and to fill prescriptions for psychotropic drugs compared with healthy population controls. The risk was significantly elevated only during the first 3 months after AF diagnosis.
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Affiliation(s)
- Louise Hagengaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Christoffer Polcwiartek
- Department of Clinical Medicine, Aalborg University, Denmark.,Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Department of Experimental Medicine, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Maria Lukacs Krogager
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Denmark.,Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark.,Departmant of Cardiology, Hjørring Regional Hospital, Hjørring, Denmark
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43
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Mortensen MB, Dzaye O, Steffensen FH, Bøtker HE, Jensen JM, Rønnow Sand NP, Kragholm KH, Sørensen HT, Leipsic J, Mæng M, Blaha MJ, Nørgaard BL. Impact of Plaque Burden Versus Stenosis on Ischemic Events in Patients With Coronary Atherosclerosis. J Am Coll Cardiol 2020; 76:2803-2813. [DOI: 10.1016/j.jacc.2020.10.021] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 01/25/2023]
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44
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Mortensen MB, Steffensen FH, Bøtker HE, Jensen JM, Rønnow Sand NP, Kragholm KH, Kanstrup H, Sørensen HT, Leipsic J, Blaha MJ, Nørgaard BL. Heterogenous Distribution of Risk for Cardiovascular Disease Events in Patients With Stable Ischemic Heart Disease. JACC Cardiovasc Imaging 2020; 14:442-450. [PMID: 33221243 DOI: 10.1016/j.jcmg.2020.08.039] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The authors sought to assess the distribution of 5-year risk of cardiovascular disease (CVD) events (myocardial infarction, revascularizations, ischemic stroke) and death among symptomatic patients with varying degrees of coronary artery disease (CAD) ascertained from computed tomography angiography (CTA). BACKGROUND CTA is used increasingly as the first-line test for evaluating patients with symptoms suggestive of CAD. This creates the daily clinical challenge of best using the information available from CTA to guide appropriate downstream allocation of preventive treatments. METHODS Among 21,275 patients from the Western Denmark Heart Registry, the authors developed a model predicting 5-year risk for CVD and death based on traditional risk factors and CAD severity. Only events occurring >90 days after CTA were included. RESULTS During a median follow-up of 4.2 years, 1,295 CVD events and deaths occurred. The median 5-year risk for events was 4% (interquartile range: 3% to 8%), and ranged from <5% to >50% in individual patients. The degree of CAD severity was the strongest risk factor; however, traditional risk factors also contributed significantly to risk. Thus, risk distributions in patients with varying degree of CAD overlapped considerably, and patients with extensive nonobstructive CAD could have higher estimated risk than patients with obstructive CAD (stenosis >50%). Among patients with obstructive CAD, 12% had 5-year risk <10% whereas 24% had risk >20%. A similar large overlap in risk was found when revascularizations were excluded from the endpoint. CONCLUSIONS The 5-year risk for CVD events and death varies substantially in symptomatic patients undergoing CTA, even in the presence of obstructive CAD. These results provide support for individual risk assessment to improve potential benefit when allocating preventive therapies following CTA.
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Affiliation(s)
| | - Flemming Hald Steffensen
- Department of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southwest Jutland and Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | | | - Helle Kanstrup
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA
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45
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Ringgren KB, Mills EHA, Christensen EF, Mortensen RN, Torp-Pedersen C, Kragholm KH. Mortality and return to work in patients transported by emergency ambulance after involvement in a traffic accident. BMC Emerg Med 2020; 20:90. [PMID: 33183237 PMCID: PMC7659079 DOI: 10.1186/s12873-020-00382-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction/background Traffic accidents constitute a common reason for injury. Little is known about long-term outcomes for patients following a traffic accident. Therefore, in this present paper, we examine 1-day, 30-day and 1-year mortality, and return to work (RTW) during a 1-year period. Methods Patients (between 18 and 65 years of age) who had an ambulance dispatched to them following a traffic accident and who were employed prior to the accident were identified from the Electronic Prehospital Emergency Patient (amPHI™) database in the North Denmark Region (catchment population ≈600,000) during 2006–2014. Outcomes of 1- and 30- and 365-day mortality and 1-year return to work (RTW), with mortality as competing risk. We stratified by intensive care unit (ICU) admission; and the anatomical region of injury (head/neck, thorax, abdomen, extremities and multiple injuries) is reported. Results Of 6072 patients in our study population, 59 (1%) died within 1 day and 76 (1.3%) within 30 days; 88 (1.5%) were dead within a year. Thirty-day mortality was 1.7% for the 290 patients admitted to the ICU, and 1.2% for the remaining 5782 patients. Within the study population, RTW rate was 92.7% (N = 5984). RTW was 84.8% among 290 ICU-admitted patients versus 93.1% for the remaining 5782 patients. RTW rate was 94.6% for the 1793 patients discharged with a diagnosis of head/neck injury. Of 671 patients with a discharge diagnosis for the thoracic region, 92.6% returned to work. Of 402 patients with abdominal injury diagnoses, 90.8% returned to work. Of 1603 patients discharged with a diagnosis of extremity injury, the RTW rate was 93.6%. Of 192 patients with a discharge diagnosis of injury in multiple regions, 91.7% returned to work. Conclusion Overall, mortality rates were low and RTW rates high in patients who had an ambulance dispatched due to a traffic accident. Those admitted to the ICU had the lowest RTW rate, yet still around 80% returned to work.
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Affiliation(s)
- Kristian Bundgaard Ringgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. .,Center for Prehospital and Emergency Research, Department of Clinical Medicine Aalborg University and Clinic of Internal and Emergency Medicine Aalborg University Hospital, Aalborg, Denmark.
| | | | - Erika Frischknecht Christensen
- Center for Prehospital and Emergency Research, Department of Clinical Medicine Aalborg University and Clinic of Internal and Emergency Medicine Aalborg University Hospital, Aalborg, Denmark
| | | | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Center for Prehospital and Emergency Research, Department of Clinical Medicine Aalborg University and Clinic of Internal and Emergency Medicine Aalborg University Hospital, Aalborg, Denmark
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46
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Modin D, Claggett B, Sindet-Pedersen C, Lassen MCH, Skaarup KG, Jensen JUS, Fralick M, Schou M, Lamberts M, Gerds T, Fosbøl EL, Phelps M, Kragholm KH, Andersen MP, Køber L, Torp-Pedersen C, Solomon SD, Gislason G, Biering-Sørensen T. Acute COVID-19 and the Incidence of Ischemic Stroke and Acute Myocardial Infarction. Circulation 2020; 142:2080-2082. [PMID: 33054349 PMCID: PMC7682795 DOI: 10.1161/circulationaha.120.050809] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Daniel Modin
- Department of Cardiology (D.M., C.S.-P., M.C.H.L., K.G.S., M.S., M.L., G.G., T.B.-S.), University of Copenhagen, Denmark
| | - Brian Claggett
- Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.D.S.)
| | - Caroline Sindet-Pedersen
- Department of Cardiology (D.M., C.S.-P., M.C.H.L., K.G.S., M.S., M.L., G.G., T.B.-S.), University of Copenhagen, Denmark
| | - Mats Christian Højbjerg Lassen
- Department of Cardiology (D.M., C.S.-P., M.C.H.L., K.G.S., M.S., M.L., G.G., T.B.-S.), University of Copenhagen, Denmark
| | - Kristoffer Grundtvig Skaarup
- Department of Cardiology (D.M., C.S.-P., M.C.H.L., K.G.S., M.S., M.L., G.G., T.B.-S.), University of Copenhagen, Denmark
| | - Jens Ulrik Stæhr Jensen
- Respiratory Medicine Section, Department of Internal Medicine (J.U.S.J.), University of Copenhagen, Denmark.,Herlev & Gentofte Hospital, and Institute of Clinical Medicine, Faculty of Health Sciences (J.U.S.J., M.S., L.K., G.G.), University of Copenhagen, Denmark
| | - Michael Fralick
- Sinai Health System and the Department of Medicine, University of Toronto, Canada (M.F.)
| | - Morten Schou
- Department of Cardiology (D.M., C.S.-P., M.C.H.L., K.G.S., M.S., M.L., G.G., T.B.-S.), University of Copenhagen, Denmark.,Herlev & Gentofte Hospital, and Institute of Clinical Medicine, Faculty of Health Sciences (J.U.S.J., M.S., L.K., G.G.), University of Copenhagen, Denmark
| | - Morten Lamberts
- Department of Cardiology (D.M., C.S.-P., M.C.H.L., K.G.S., M.S., M.L., G.G., T.B.-S.), University of Copenhagen, Denmark
| | - Thomas Gerds
- Department of Biostatistics (T.G.), University of Copenhagen, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, Rigshospitalet (E.L.F., L.K.), University of Copenhagen, Denmark
| | | | - Kristian Hay Kragholm
- Unit of Clinical Biostatistics and Epidemiology (K.H.K.), Aalborg University Hospital, Denmark.,Department of Cardiology (K.H.K.), Aalborg University Hospital, Denmark
| | | | - Lars Køber
- Herlev & Gentofte Hospital, and Institute of Clinical Medicine, Faculty of Health Sciences (J.U.S.J., M.S., L.K., G.G.), University of Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet (E.L.F., L.K.), University of Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark (M.P.A., C.T.-P.)
| | - Scott D Solomon
- Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.D.S.)
| | - Gunnar Gislason
- Department of Cardiology (D.M., C.S.-P., M.C.H.L., K.G.S., M.S., M.L., G.G., T.B.-S.), University of Copenhagen, Denmark.,Herlev & Gentofte Hospital, and Institute of Clinical Medicine, Faculty of Health Sciences (J.U.S.J., M.S., L.K., G.G.), University of Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology (D.M., C.S.-P., M.C.H.L., K.G.S., M.S., M.L., G.G., T.B.-S.), University of Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences (T.B.-S.), University of Copenhagen, Denmark
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Davidsen L, Kragholm KH, Aldahl M, Polcwiartek C, Torp-Pedersen C, Soegaard P, Freeman P. Long-term impact of baseline anaemia on clinical outcomes following percutaneous coronary intervention in stable angina. Open Heart 2020; 7:openhrt-2020-001319. [PMID: 33004620 PMCID: PMC7534726 DOI: 10.1136/openhrt-2020-001319] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/22/2020] [Accepted: 08/24/2020] [Indexed: 01/09/2023] Open
Abstract
Background In patients with stable angina (SA), the clinical benefits of percutaneous coronary intervention (PCI) reside almost exclusively within the realm of symptomatic improvement rather than improvement in hard clinical endpoints. The benefits of PCI should always be balanced against its potential short-term and long-term risks. Common among these risks is the presence of anaemia and its interaction with poor clinical outcomes and increased morbidity; this study aims to elucidate the impact of anaemia on long-term clinical outcomes of this patient group. Methods From Danish national registries, we identified patients with SA treated with PCI who had a haemoglobin measurement maximum of 90 days prior to PCI procedure. Anaemia was defined as haemoglobin <130 and <120 g/L in men and women, respectively. Follow-up was up to 3 years after PCI, and Cox regression was used to estimate HRs with 95% CIs of hospitalisation due to bleeding, acute coronary syndrome (ACS) and all-cause mortality in patients with anaemia compared with patients without anaemia. Results Of 2837 included patients, 14.6% had anaemia prior to PCI. During follow-up, 93 patients (3.3%) had a bleeding episode, which was higher in patients with anaemia (5.8%) compared with patients without anaemia (2.8%). A total of 213 patients (7.5%) developed ACS, which was higher in patients with anaemia (10.6%) compared with patients without anaemia (7.0%). Furthermore, 185 patients (6.5%) died, with a mortality rate of 18.1% in patients with anaemia compared with 4.5% in patients without anaemia. In multivariable analyses, anaemia was associated with a significantly increased risk of bleeding (HR 1.69; 95% CI 1.04 to 2.73; P 0.033), ACS (HR 1.47; 95% CI 1.04 to 2.10; P 0.031) and all-cause mortality (HR 2.41; 95% CI 1.73 to 3.30; P <0.001). Conclusion Anaemia in patients with SA was significantly associated with bleeding, ACS and all-cause mortality following PCI.
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Affiliation(s)
- Line Davidsen
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark
| | - Kristian Hay Kragholm
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark.,Department of Cardiology, Regionshospital Nordjylland, Hjørring, Nordjylland, Denmark
| | - Mette Aldahl
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark
| | - Christoffer Polcwiartek
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark.,Department of Cardiology and Clinical Medicine, Aalborg University Hospital, Aalborg, Nordjylland, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Epidemiology, Aalborg Universitetshospital, Aalborg, Denmark.,Department of Health, Science and Technology, Aalborg Universitet Det Sundhedsvidenskabelige Fakultet, Aalborg, Denmark.,Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Peter Soegaard
- Department of Cardiology and Clinical Medicine, Aalborg University Hospital, Aalborg, Nordjylland, Denmark
| | - Phillip Freeman
- Department of Cardiology and Clinical Medicine, Aalborg University Hospital, Aalborg, Nordjylland, Denmark
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48
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Mortensen MB, Steffensen FH, Bøtker HE, Jensen JM, Rønnow Sand NP, Kragholm KH, Kanstrup H, Sørensen HT, Leipsic J, Blaha MJ, Nørgaard BL. CAD Severity on Cardiac CTA Identifies Patients With Most Benefit of Treating LDL-Cholesterol to ACC/AHA and ESC/EAS Targets. JACC Cardiovasc Imaging 2020; 13:1961-1972. [DOI: 10.1016/j.jcmg.2020.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/09/2020] [Accepted: 03/23/2020] [Indexed: 12/20/2022]
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49
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Frary JMC, Pareek M, Byrne C, Vaduganathan M, Biering-Sørensen T, Rujic D, Kragholm KH, Olesen TB, Olsen MH, Bhatt DL. Intensive blood pressure control appears to be effective and safe in patients with peripheral artery disease: the Systolic Blood Pressure Intervention Trial. Eur Heart J Cardiovasc Pharmacother 2020; 7:e38-e40. [PMID: 32853332 DOI: 10.1093/ehjcvp/pvaa102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 01/22/2023]
Affiliation(s)
| | - Manan Pareek
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark.,Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA.,Department of Internal Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christina Byrne
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Tor Biering-Sørensen
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA.,Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Institute of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dragana Rujic
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | | | | | - Michael Hecht Olsen
- Division of Cardiology, Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
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50
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Krogager ML, Pareek M, Kragholm KH, Byrne C, Vaduganathan M, Biering-Sørensen T, Rujic D, Olesen TB, Olsen MH, Bhatt DL. Intensive vs. standard blood pressure control and vascular procedures: insights from the Systolic Blood Pressure Intervention Trial (SPRINT). Eur Heart J Cardiovasc Pharmacother 2020; 7:e35-e37. [PMID: 32722801 DOI: 10.1093/ehjcvp/pvaa093] [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] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
| | - Manan Pareek
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA.,Department of Internal Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | | | - Christina Byrne
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Tor Biering-Sørensen
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA.,Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Institute of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dragana Rujic
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | | | - Michael Hecht Olsen
- Division of Cardiology, Department of Internal Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
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