1
|
Amir S, Kim H, Hu EA, Ricardo AC, Mills KT, He J, Fischer MJ, Pradhan N, Tan TC, Navaneethan SD, Dobre M, Anderson CAM, Appel LJ, Rebholz CM. Adherence to Plant-Based Diets and Risk of CKD Progression and All-Cause Mortality: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2024; 83:624-635. [PMID: 38103719 PMCID: PMC11034716 DOI: 10.1053/j.ajkd.2023.09.020] [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] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 12/19/2023]
Abstract
RATIONALE & OBJECTIVE Studies have shown that generally healthy individuals who consume diets rich in plant foods have a lower risk of incident chronic kidney disease (CKD) and cardiovascular disease. This study investigated the prospective associations of plant-based diets with the risk of CKD progression and all-cause mortality in individuals with CKD. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 2,539 participants with CKD recruited between 2003-2008 into the Chronic Renal Insufficiency Cohort (CRIC) Study. EXPOSURE Responses on the Diet History Questionnaire were used to calculate scores for the overall plant-based diet index, healthy plant-based diet index, and unhealthy plant-based diet index. OUTCOME (1) CKD progression defined as≥50% estimated glomerular filtration rate decline from baseline or kidney replacement therapy (dialysis, transplant) and (2) all-cause mortality. ANALYTICAL APPROACH Cox proportional hazards models to compute hazard ratios and 95% confidence intervals adjusting for lifestyle, socioeconomic, and clinical covariates. RESULTS There were 977 CKD progression events and 836 deaths during a median follow-up period of 7 and 12 years, respectively. Participants with the highest versus lowest adherence to overall plant-based diets and healthy plant-based diets had 26% (HR, 0.74 [95% CI, 0.62-0.88], P trend<0.001) and 21% (HR, 0.79 [95% CI, 0.66-0.95], P trend=0.03) lower risks of all-cause mortality, respectively. Each 10-point higher score of unhealthy plant-based diets was modestly associated with a higher risk of CKD progression (HR, 1.14 [95% CI, 1.03-1.25) and all-cause mortality (HR, 1.11 [95% CI, 1.00-1.23). LIMITATIONS Self-reported diet may be subject to measurement error. CONCLUSIONS Adherence to an overall plant-based diet and a healthy plant-based diet is associated with a reduced risk of all-cause mortality among individuals with CKD. An unhealthy plant-based was associated with an elevated risk of CKD progression and all-cause mortality. PLAIN-LANGUAGE SUMMARY Plant-based diets are healthful dietary patterns that have been linked to a lower risk of chronic diseases. However, the impact of plant-based diets on clinical outcomes in patients with chronic kidney disease (CKD) is not well established. In 2,539 individuals with CKD, we examined the associations of adherence to 3 different types of plant-based diets with the risks of CKD progression and all-cause mortality. We found that following an overall plant-based diet and a healthy plant-based diet was associated with a lower risk of all-cause mortality. By contrast, following an unhealthy plant-based diet was associated with a higher risk of CKD progression and all-cause mortality. These results suggest that the quality of plant-based diets may be important for CKD management.
Collapse
Affiliation(s)
- Saira Amir
- Department of Medicine, UNC Health Southeastern, Lumberton, North Carolina; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Hyunju Kim
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Ana C Ricardo
- Division of Nephrology, Department of Medicine, University of Illinois, Chicago, Illinois
| | - Katherine T Mills
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Jiang He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Michael J Fischer
- Division of Nephrology, Department of Medicine, University of Illinois, Chicago, Illinois
| | - Nishigandha Pradhan
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Mirela Dobre
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Cheryl A M Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California-San Diego, San Diego, California
| | - Lawrence J Appel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
| |
Collapse
|
2
|
Lehmann F, Schenk LM, Bernstock JD, Bode C, Borger V, Gessler FA, Güresir E, Hamed M, Potthoff AL, Putensen C, Schneider M, Zimmermann J, Vatter H, Schuss P, Hadjiathanasiou A. Elevated Red Cell Distribution Width to Platelet Ratio Is Associated With Poor Prognosis in Patients With Spontaneous, Deep-Seated Intracerebral Hemorrhage. Front Neurol 2021; 12:751510. [PMID: 34867736 PMCID: PMC8634127 DOI: 10.3389/fneur.2021.751510] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
Object: Inflammatory response is an important determinant of subsequent brain injury after deep-seated intracerebral hemorrhage (ICH). The ratio of red blood cell (RBC) distribution width to platelet count (RPR) has been established as a new index to reflect the severity of inflammation. To the best of our knowledge, no association between RPR and prognosis after spontaneous ICH has yet been reported. Methods: In all patients with deep-seated ICH treated at our Neurovascular Center from 2014 to 2020, initial laboratory values were obtained to determine RPR in addition to patient characteristics and known risk factors. Subsequent multivariate analysis was performed to identify independent risk factors for 90-day mortality after deep-seated ICH. Results: Hundred and two patients with deep-seated ICH were identified and further analyzed. Patients with an initial RPR < 0.06 exhibited significantly lower mortality rate after 90 days than those with an initial RPR ≥ 0.06 (27 vs. 57%; p = 0.003). Multivariate analysis identified “ICH score ≥ 3” (p = 0.001), “anemia on admission” (p = 0.01), and “elevated RPR ≥ 0.06” (p = 0.03) as independent predictors of 90-day mortality. Conclusions: The present study constitutes the first attempt to demonstrate that the ratio of RBC distribution width to platelets—as an independent inflammatory marker—might serve for prognostic assessment in deep-seated ICH.
Collapse
Affiliation(s)
- Felix Lehmann
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Lorena M Schenk
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Joshua D Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Christian Bode
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Florian A Gessler
- Department of Neurosurgery, University Hospital Rostock, Rostock, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Christian Putensen
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, Bonn, Germany
| | | | | | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | |
Collapse
|
3
|
Hämmerle P, Eick C, Blum S, Schlageter V, Bauer A, Rizas KD, Eken C, Coslovsky M, Aeschbacher S, Krisai P, Meyre P, Vesin JM, Rodondi N, Moutzouri E, Beer J, Moschovitis G, Kobza R, Di Valentino M, Corino VDA, Laureanti R, Mainardi L, Bonati LH, Sticherling C, Conen D, Osswald S, Kühne M, Zuern CS. Heart Rate Variability Triangular Index as a Predictor of Cardiovascular Mortality in Patients With Atrial Fibrillation. J Am Heart Assoc 2020; 9:e016075. [PMID: 32750290 PMCID: PMC7792265 DOI: 10.1161/jaha.120.016075] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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] [Indexed: 12/21/2022]
Abstract
Background Impaired heart rate variability (HRV) is associated with increased mortality in sinus rhythm. However, HRV has not been systematically assessed in patients with atrial fibrillation (AF). We hypothesized that parameters of HRV may be predictive of cardiovascular death in patients with AF. Methods and Results From the multicenter prospective Swiss‐AF (Swiss Atrial Fibrillation) Cohort Study, we enrolled 1922 patients who were in sinus rhythm or AF. Resting ECG recordings of 5‐minute duration were obtained at baseline. Standard parameters of HRV (HRV triangular index, SD of the normal‐to‐normal intervals, square root of the mean squared differences of successive normal‐to‐normal intervals and mean heart rate) were calculated. During follow‐up, an end point committee adjudicated each cause of death. During a mean follow‐up time of 2.6±1.0 years, 143 (7.4%) patients died; 92 deaths were attributable to cardiovascular reasons. In a Cox regression model including multiple covariates (age, sex, body mass index, smoking status, history of diabetes mellitus, history of hypertension, history of stroke/transient ischemic attack, history of myocardial infarction, antiarrhythmic drugs including β blockers, oral anticoagulation), a decreased HRV index ≤ median (14.29), but not other HRV parameters, was associated with an increase in the risk of cardiovascular death (hazard ratio, 1.7; 95% CI, 1.1–2.6; P=0.01) and all‐cause death (hazard ratio, 1.42; 95% CI, 1.02–1.98; P=0.04). Conclusions The HRV index measured in a single 5‐minute ECG recording in a cohort of patients with AF is an independent predictor of cardiovascular mortality. HRV analysis in patients with AF might be a valuable tool for further risk stratification to guide patient management. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02105844.
Collapse
Affiliation(s)
- Peter Hämmerle
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Christian Eick
- Department of Cardiology University Hospital Tübingen Tübingen Germany
| | - Steffen Blum
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Vincent Schlageter
- Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology Medical University of Innsbruck Austria
| | - Konstantinos D Rizas
- Medizinische Klinik und Poliklinik I Munich University Clinic Munich Germany.,German Center for Cardiovascular Research partner site Munich Heart Alliance Munich Germany
| | - Ceylan Eken
- Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Michael Coslovsky
- Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Stefanie Aeschbacher
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Philipp Krisai
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Pascal Meyre
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | | | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM) University of Bern Switzerland.,Department of General Internal Medicine Inselspital Bern University HospitalUniversity of Bern Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM) University of Bern Switzerland.,Department of General Internal Medicine Inselspital Bern University HospitalUniversity of Bern Switzerland
| | - Jürg Beer
- Department of Medicine Cantonal Hospital of Baden and Molecular Cardiology University Hospital of Zurich Switzerland
| | - Giorgio Moschovitis
- Department of Cardiology EOC Ospedale Regionale di Lugano Lugano Switzerland
| | - Richard Kobza
- Division of Cardiology Luzerner Kantonsspital Luzern Switzerland
| | | | - Valentina D A Corino
- Biosignals Bioimaging and Bioinformatics Laboratory (B3-Lab) Department of Electronics, Information and Bioengineering (DEIB) Politecnico di Milano Milan Italy
| | - Rita Laureanti
- Biosignals Bioimaging and Bioinformatics Laboratory (B3-Lab) Department of Electronics, Information and Bioengineering (DEIB) Politecnico di Milano Milan Italy
| | - Luca Mainardi
- Biosignals Bioimaging and Bioinformatics Laboratory (B3-Lab) Department of Electronics, Information and Bioengineering (DEIB) Politecnico di Milano Milan Italy
| | - Leo H Bonati
- Department of Neurology and Stroke Center University Hospital BaselUniversity of Basel Switzerland
| | - Christian Sticherling
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - David Conen
- Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland.,Population Health Research Institute McMaster University and Hamilton Health Sciences Hamilton Canada
| | - Stefan Osswald
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Michael Kühne
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | - Christine S Zuern
- Department of Cardiology University Hospital Basel Basel Switzerland.,Cardiovascular Research Institute Basel University Hospital Basel Basel Switzerland
| | | |
Collapse
|
4
|
Delesalle G, Bohbot Y, Rusinaru D, Delpierre Q, Maréchaux S, Tribouilloy C. Characteristics and Prognosis of Patients With Moderate Aortic Stenosis and Preserved Left Ventricular Ejection Fraction. J Am Heart Assoc 2020; 8:e011036. [PMID: 30841771 PMCID: PMC6475062 DOI: 10.1161/jaha.118.011036] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [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] [Indexed: 12/31/2022]
Abstract
Background Moderate aortic stenosis (MAS) has not been extensively studied and characterized, as no published study has been specifically devoted to this condition. Methods and Results We aimed to describe the characteristics of patients with MAS and to evaluate their long‐term survival compared with that of the general population. This study included 508 patients (mean±SD age, 75±11 years) with MAS (aortic valve area between 1 and 1.5 cm2; mean±SD aortic valve area, 1.2±0.15 cm2) and preserved left ventricular ejection fraction. Patients were mostly (86.4%) asymptomatic or minimally symptomatic, 78.3% had hypertension, 36.2% were diabetics, and 48.3% had dyslipidemia. Each patient with MAS was matched for the average survival (per year) of all patients of the same age and same sex from our region (Somme department, north of France). During follow‐up (median 47 months), 113 patients (22.2%) underwent aortic valve replacement for severe AS. The mean±SD time between inclusion and surgery was 37±22 months. During follow‐up, 255 patients (50.2%) died. The 6‐year survival of patients with MAS was lower than the expected survival (53±2% versus 65%). In multivariate analysis, age (hazard ratio, 1.04 [95% CI, 1.02–1.05]; P<0.001), prior atrial fibrillation (hazard ratio, 1.35 [95% CI, 1.05–1.73]; P=0.019), and Charlson comorbidity index (hazard ratio, 1.11 [95% CI, 1.05–1.18]; P=0.002) were associated with increased mortality. Aortic valve replacement was associated with better survival (hazard ratio, 0.38 [95% CI, 0.27–0.54]; P<0.001). Conclusions The results of this study show that patients with MAS present many cardiovascular risk factors, a high rate of surgery during follow‐up, and increased mortality compared with the general population mainly related to associated comorbidities. Patients with MAS should, therefore, be managed for their cardiovascular risk factors and comorbidities. They require close follow‐up, especially when the aortic valve area is close to 1 cm2, as aortic valve replacement performed when patients transition to severe AS and develop indications for surgery during follow‐up is associated with better survival.
Collapse
Affiliation(s)
- Geraud Delesalle
- 1 Department of Cardiology Amiens University Hospital Amiens France
| | - Yohann Bohbot
- 1 Department of Cardiology Amiens University Hospital Amiens France.,2 EA 7517 MP3CV Jules Verne University of Picardie Amiens France
| | - Dan Rusinaru
- 1 Department of Cardiology Amiens University Hospital Amiens France.,2 EA 7517 MP3CV Jules Verne University of Picardie Amiens France
| | | | - Sylvestre Maréchaux
- 2 EA 7517 MP3CV Jules Verne University of Picardie Amiens France.,3 Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté libre de Médecine Université Lille Nord de France Lille France
| | - Christophe Tribouilloy
- 1 Department of Cardiology Amiens University Hospital Amiens France.,2 EA 7517 MP3CV Jules Verne University of Picardie Amiens France
| |
Collapse
|
5
|
Sitbon O, Chin KM, Channick RN, Benza RL, Di Scala L, Gaine S, Ghofrani HA, Lang IM, McLaughlin VV, Preiss R, Rubin LJ, Simonneau G, Tapson VF, Galiè N, Hoeper MM. Risk assessment in pulmonary arterial hypertension: Insights from the GRIPHON study. J Heart Lung Transplant 2020; 39:300-309. [PMID: 32061506 DOI: 10.1016/j.healun.2019.12.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 05/03/2019] [Revised: 11/26/2019] [Accepted: 12/29/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Approaches to risk assessment in pulmonary arterial hypertension (PAH) include the noninvasive French risk assessment approach (number of low-risk criteria based on the European Society of Cardiology and European Respiratory Society guidelines) and Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) 2.0 risk calculator. The prognostic and predictive value of these methods for morbidity/mortality was evaluated in the predominantly prevalent population of GRIPHON, the largest randomized controlled trial in PAH. METHODS GRIPHON randomized 1,156 patients with PAH to selexipag or placebo. Post-hoc analyses were performed on the primary composite end-point of morbidity/mortality by the number of low-risk criteria (World Health Organization functional class I-II; 6-minute walk distance >440 m; N-terminal pro-brain natriuretic peptide <300 ng/liter) and REVEAL 2.0 risk category. Hazard ratios and 95% confidence intervals were calculated using Cox proportional hazard models. RESULTS Both the number of low-risk criteria and the REVEAL 2.0 risk category were prognostic for morbidity/mortality at baseline and any time-point during the study. Patients with 3 low-risk criteria at baseline had a 94% reduced risk of morbidity/mortality compared to patients with 0 low-risk criteria and were all categorized as low-risk by REVEAL 2.0. The treatment effect of selexipag on morbidity/mortality was consistent irrespective of the number of low-risk criteria or the REVEAL 2.0 risk category at any time-point during the study. Selexipag-treated patients were more likely to increase their number of low-risk criteria from baseline to week 26 than placebo-treated patients (odds ratio 1.69, p = 0.0002); similar results were observed for REVEAL 2.0 risk score. CONCLUSIONS These results support the association between risk profile and long-term outcome and suggest that selexipag treatment may improve risk profile.
Collapse
Affiliation(s)
- Olivier Sitbon
- Hôpital Universitaire de Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre, France.
| | | | | | | | | | - Sean Gaine
- National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center, member of the German Center of Lung Research, Giessen, Germany; Department of Medicine, Imperial College London, London, United Kingdom
| | - Irene M Lang
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Allgemeines Krankenhaus, Vienna, Austria
| | - Vallerie V McLaughlin
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ralph Preiss
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Lewis J Rubin
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, California
| | - Gérald Simonneau
- Hôpital Universitaire de Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre, France
| | | | - Nazzareno Galiè
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy
| | - Marius M Hoeper
- Department of Respiratory Medicine and German Center of Lung Research, Hannover Medical School, Hannover, Germany
| |
Collapse
|
6
|
Ghosh RM, Griffis HM, Glatz AC, Rome JJ, Smith CL, Gillespie MJ, Whitehead KK, O'Byrne ML, Biko DM, Ravishankar C, Dewitt AG, Dori Y. Prevalence and Cause of Early Fontan Complications: Does the Lymphatic Circulation Play a Role? J Am Heart Assoc 2020; 9:e015318. [PMID: 32223393 PMCID: PMC7428641 DOI: 10.1161/jaha.119.015318] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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] [Indexed: 02/02/2023]
Abstract
Background Recent studies suggest that lymphatic congestion plays a role in development of late Fontan complications, such as protein‐losing enteropathy. However, the role of the lymphatic circulation in early post‐Fontan outcomes is not well defined. Methods and Results This was a retrospective, single‐center study of patients undergoing first‐time Fontan completion from 2012 to 2017. The primary outcome was early Fontan complication ≤6 months after surgery, a composite of death, Fontan takedown, extracorporeal membrane oxygenation, chest tube drainage >14 days, cardiac catheterization, readmission, or transplant. Complication causes were assigned to 1 of 4 groups: (1) Fontan circuit obstruction, (2) ventricular dysfunction or atrioventricular valve regurgitation, (3) persistent pleural effusions in the absence of Fontan obstruction or ventricular dysfunction, and (4) chylothorax or plastic bronchitis. T2‐weighted magnetic resonance imaging sequences were used to assess for lymphatic perfusion abnormality. The cohort consisted of 238 patients. Fifty‐eight (24%) developed early complications: 20 of 58 (34.5%) in group 1, 8 of 58 (14%) in group 2, 18 of 58 (31%) in group 3, and 12 of 58 (20%) in group 4. Preoperative T2 imaging was available for 126 (53%) patients. Patients with high‐grade lymphatic abnormalities had 6 times greater odds of developing early complications (P=0.001). Conclusions There is substantial morbidity in the early post‐Fontan period. Half of those who developed early complications had lymphatic failure or persistent effusions unrelated to structural or functional abnormalities. Preoperative T2 imaging demonstrated that patients with higher‐grade lymphatic perfusion abnormalities were significantly more likely to develop early complications. This has implications for risk stratification and optimization of patients before Fontan palliation.
Collapse
Affiliation(s)
- Reena M Ghosh
- Division of Cardiology Children's Hospital of Philadelphia PA
| | - Heather M Griffis
- Center for Pediatric Clinical Effectiveness Children's Hospital of Philadelphia PA
| | - Andrew C Glatz
- Division of Cardiology Children's Hospital of Philadelphia PA.,Center for Pediatric Clinical Effectiveness Children's Hospital of Philadelphia PA
| | - Jonathan J Rome
- Division of Cardiology Children's Hospital of Philadelphia PA
| | | | | | | | - Michael L O'Byrne
- Division of Cardiology Children's Hospital of Philadelphia PA.,Center for Pediatric Clinical Effectiveness Children's Hospital of Philadelphia PA
| | - David M Biko
- Department of Radiology Children's Hospital of Philadelphia PA
| | | | - Aaron G Dewitt
- Division of Cardiac Critical Care Medicine Children's Hospital of Philadelphia PA
| | - Yoav Dori
- Division of Cardiology Children's Hospital of Philadelphia PA
| |
Collapse
|
7
|
Chaves GSS, Lima de Melo Ghisi G, Britto RR, Grace SL. Maintenance of Gains, Morbidity, and Mortality at 1 Year Following Cardiac Rehabilitation in a Middle-Income Country: A Wait-List Control Crossover Trial. J Am Heart Assoc 2020; 8:e011228. [PMID: 30764702 PMCID: PMC6405675 DOI: 10.1161/jaha.118.011228] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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] [Indexed: 01/23/2023]
Abstract
Background Despite the epidemic of cardiovascular diseases in middle‐income countries, few trials are testing the benefits of cardiac rehabilitation (CR). This trial assessed (1) maintenance of functional capacity, risk factor control, knowledge, and heart‐health behaviors and (2) mortality and morbidity at 6 months following CR in a middle‐income country. Methods and Results Eligible Brazilian coronary patients were initially randomized (1:1:1 concealed) to 1 of 3 parallel arms (comprehensive CR [exercise plus education], exercise‐only CR, or wait‐list control). The CR programs were 6 months in duration, at which point follow‐up assessments were performed. Mortality and morbidity were ascertained from chart and patient or family report (blinded). Controls were then offered CR (crossover). Outcomes were again assessed 6 months later (blinded). ANCOVA was performed for each outcome at 12 months. Overall, 115 (88.5%) patients were randomized, and 62 (53.9%) were retained at 1 year. At 6 months, 23 (58.9%) of those 39 initially randomized to the wait‐list control elected to attend CR. Functional capacity, risk factors, knowledge, and heart‐health behaviors were maintained from 6 to 12 months in participants from both CR arms (all P>0.05). At 1 year, knowledge was significantly greater with comprehensive CR at either time point (P<0.001). There were 2 deaths. Hospitalizations (P=0.03), nonfatal myocardial infarctions (P=0.04), and percutaneous coronary interventions (P=0.03) were significantly fewer with CR than control at 6 months. Conclusions CR participation is associated with lower morbidity, long‐term maintenance of functional capacity, risk factors, and heart‐health behaviors, as well as with greater cardiovascular knowledge compared with no CR. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02575976.
Collapse
Affiliation(s)
- Gabriela S S Chaves
- 1 Physical Therapy Department Federal University of Minas Gerais Belo Horizonte Minas Gerais Brazil
| | - Gabriela Lima de Melo Ghisi
- 2 Cardiovascular Prevention and Rehabilitation Program Toronto Rehabilitation Institute University Health Network University of Toronto Canada
| | - Raquel R Britto
- 1 Physical Therapy Department Federal University of Minas Gerais Belo Horizonte Minas Gerais Brazil
| | - Sherry L Grace
- 2 Cardiovascular Prevention and Rehabilitation Program Toronto Rehabilitation Institute University Health Network University of Toronto Canada.,3 School of Kinesiology and Health Science York University Toronto Canada
| |
Collapse
|
8
|
Walker AMN, Drozd M, Hall M, Patel PA, Paton M, Lowry J, Gierula J, Byrom R, Kearney L, Sapsford RJ, Witte KK, Kearney MT, Cubbon RM. Prevalence and Predictors of Sepsis Death in Patients With Chronic Heart Failure and Reduced Left Ventricular Ejection Fraction. J Am Heart Assoc 2019; 7:e009684. [PMID: 30371261 PMCID: PMC6474963 DOI: 10.1161/jaha.118.009684] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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] [Indexed: 11/16/2022]
Abstract
Background Noncardiovascular death is increasingly common in people with chronic heart failure (CHF), yet its causes remain poorly characterized. We aimed to define the prevalence of sepsis death in people with CHF and to ascertain its risk marker profile. Methods and Results We conducted a prospective cohort study of 1802 patients with CHF and left ventricular ejection fraction ≤45% attending CHF clinics in 4 United Kingdom hospitals between 2006 and 2014. Mode of death was defined over a 10.3‐year follow‐up period (mean 4 years). Competing risk regression defined mode‐specific hazard ratios for sepsis, other noncardiovascular, progressive heart failure, and sudden cardiac death in relation to established heart failure prognostic markers. Of 737 deaths, 173 (23.5%) were due to sepsis; respiratory tract infections accounted for 69.9% (n=121) of these events. Those who died from sepsis were older, had higher platelet counts, and had a higher prevalence of chronic obstructive pulmonary disease than those who died from other causes. Sepsis death was independently associated with older age (hazard ratio=1.05; 95% confidence interval 1.03‐1.07), greater prevalence of chronic obstructive pulmonary disease (2.43; 1.74‐3.40), male sex (1.73; 1.16‐2.60), lower log serum vitamin D (0.68; 0.49‐0.95), and higher platelet count (1.002; 1.000‐1.005) than nonsepsis death. Established heart failure prognostic markers exhibited different patterns of association with sepsis death, other noncardiovascular death, progressive heart failure death, and sudden cardiac death. Conclusions Sepsis is a major contributor to death in people with CHF and has a different risk marker profile from other modes of death, suggesting that it may be amenable to targeted preventative strategies.
Collapse
Affiliation(s)
- Andrew M N Walker
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds United Kingdom
| | - Michael Drozd
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds United Kingdom
| | - Marlous Hall
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds United Kingdom
| | - Peysh A Patel
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds United Kingdom
| | - Maria Paton
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds United Kingdom
| | - Judith Lowry
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds United Kingdom
| | - John Gierula
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds United Kingdom
| | - Rowenna Byrom
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds United Kingdom
| | - Lorraine Kearney
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds United Kingdom
| | - Robert J Sapsford
- 2 Department of Cardiology Leeds General Infirmary Leeds Teaching Hospitals NHS Trust Leeds United Kingdom
| | - Klaus K Witte
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds United Kingdom
| | - Mark T Kearney
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds United Kingdom
| | - Richard M Cubbon
- 1 Leeds Institute of Cardiovascular and Metabolic Medicine The University of Leeds United Kingdom
| |
Collapse
|
9
|
Kadri AN, Wilner B, Hernandez AV, Nakhoul G, Chahine J, Griffin B, Pettersson G, Grimm R, Navia J, Gordon S, Kapadia SR, Harb SC. Geographic Trends, Patient Characteristics, and Outcomes of Infective Endocarditis Associated With Drug Abuse in the United States From 2002 to 2016. J Am Heart Assoc 2019; 8:e012969. [PMID: 31530066 PMCID: PMC6806029 DOI: 10.1161/jaha.119.012969] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [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] [Indexed: 02/06/2023]
Abstract
Background There has been an increase in the prevalence of drug abuse (DA) in the national opioid epidemic. With increasing DA, there is an increased risk of infective endocarditis (IE). There are limited recent data evaluating national trends on the incidence and geographical distribution of DA‐IE. We aim to investigate those numbers as well as the determinants of outcome in this patient population. Methods and Results Hospitalized patients with a primary or secondary diagnosis of IE based on the International Classification of Diseases, Ninth and Tenth Revisions (ICD‐9, ICD‐10) were included. We described the national and geographical trends in DA‐IE. We also compared DA‐IE patients’ characteristics and outcomes to those with IE, but without associated drug abuse (non‐DA‐IE) using Poisson regression models. Incidence of DA‐IE has nearly doubled between 2002 and 2016 All US regions were affected, and the Midwest had the highest increase in DA‐IE hospitalizations (annual percent change=4.9%). Patients with DA‐IE were younger, more commonly white males, poorer, had fewer comorbidities, and were more likely to have human immunodeficiency virus, hepatitis C, concomitant alcohol abuse, and liver disease. Their length of stay was longer (9 versus 7 days; P<0.001) and were more likely to undergo cardiac surgery (7.8% versus 6.2%; P<0.001), but their inpatient mortality was lower (6.4% versus 9.1%; P<0.001). Conclusions DA‐IE is rising at an alarming rate in the United States. All regions of the United States are affected, with the Midwest having the highest increase in rate. Young‐adult, poor, white males were the most affected.
Collapse
Affiliation(s)
| | | | - Adrian V Hernandez
- University of Connecticut/Hartford Hospital Evidence-Based Practice Center Hartford CT.,Vicerrectorado de Investigacion Universidad San Ignacio de Loyola (USIL) Lima Peru
| | | | | | | | | | | | - Jose Navia
- Cleveland Clinic Foundation Cleveland OH
| | | | | | | |
Collapse
|
10
|
Schmucker J, Fach A, Mata Marin LA, Retzlaff T, Osteresch R, Kollhorst B, Hambrecht R, Pohlabeln H, Wienbergen H. Efficacy and Safety of Ticagrelor in Comparison to Clopidogrel in Elderly Patients With ST-Segment-Elevation Myocardial Infarctions. J Am Heart Assoc 2019; 8:e012530. [PMID: 31538856 PMCID: PMC6818018 DOI: 10.1161/jaha.119.012530] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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] [Indexed: 11/16/2022]
Abstract
Background Current guidelines recommend the new-generation P2Y12-inhibitor ticagrelor for patients with acute ST-segment-elevation myocardial infarctions (STEMIs). The aim of the present study was to assess efficacy and safety of ticagrelor for elderly patients with STEMI (≥75 years) in an all-comers STEMI registry. Methods and Results Patients with STEMI, aged ≥75 years, treated with primary percutaneous coronary intervention and documented in the Bremen STEMI Registry between 2006 and 2017 entered analysis. The primary efficacy outcome, major adverse cardiac and cerebrovascular events, was defined as a composite of death, myocardial reinfarction, and stroke. The safety outcome was defined as any significant bleeding event within 1 year. To estimate benefit/risk ratio, net adverse clinical events (major adverse cardiac and cerebrovascular events+bleedings) were calculated. Outcomes were estimated in propensity score-matched cohorts to adjust for possible confounders. Of a total of 7466 patients with STEMI, 1087, aged ≥75 years, were selected, of which 552 (51%) received clopidogrel and 535 (49%) received ticagrelor, with similar age (80.9±4.6 versus 80.9±4.6 years) and sex (51% versus 50% female) distributions between treatment arms. The primary efficacy outcome occurred in 32.4% of patients treated with clopidogrel versus 25.5% treated with ticagrelor (P=0.015), with the 1-year mortality rate at 26.8% versus 21.1% (P=0.035). Because there was no difference in the safety outcome (clopidogrel versus ticagrelor, 4.9% versus 5.1%; not significant), net adverse clinical events were higher for clopidogrel than for ticagrelor: 37.3% versus 30.6% (P=0.028). In a propensity score-matched model, the advantage for ticagrelor on major adverse cardiac and cerebrovascular events remained significant (hazard ratio, 0.69; 95% CI, 0.49-0.97; P=0.03), whereas 1-year-mortality (hazard ratio, 0.89; 95% CI, 0.67-1.27; P=0.5) and 1-year bleeding events (hazard ratio, 1.1; 95% CI, 0.4-2.3; P=0.8) did not differ. Conclusions These results from propensity score-matched registry data show that for elderly patients with STEMI, ticagrelor compared with clopidogrel was associated with a reduction in major adverse cardiac and cerebrovascular events without a significant increase in bleeding events within 1 year.
Collapse
Affiliation(s)
- Johannes Schmucker
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser Bremen Germany
| | - Andreas Fach
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser Bremen Germany
| | | | - Tina Retzlaff
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser Bremen Germany
| | - Rico Osteresch
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser Bremen Germany
| | - Bianca Kollhorst
- Leibniz-Institut für Präventionsforschung und Epidemiologie Bremen Germany
| | - Rainer Hambrecht
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser Bremen Germany
| | - Hermann Pohlabeln
- Leibniz-Institut für Präventionsforschung und Epidemiologie Bremen Germany
| | - Harm Wienbergen
- Bremer Institut für Herz- und Kreislaufforschung am Klinikum Links der Weser Bremen Germany
| |
Collapse
|
11
|
Kim H, Caulfield LE, Garcia-Larsen V, Steffen LM, Coresh J, Rebholz CM. Plant-Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults. J Am Heart Assoc 2019; 8:e012865. [PMID: 31387433 PMCID: PMC6759882 DOI: 10.1161/jaha.119.012865] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [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] [Indexed: 02/07/2023]
Abstract
Background Previous studies have documented the cardiometabolic health benefits of plant‐based diets; however, these studies were conducted in selected study populations that had narrow generalizability. Methods and Results We used data from a community‐based cohort of middle‐aged adults (n=12 168) in the ARIC (Atherosclerosis Risk in Communities) study who were followed up from 1987 through 2016. Participants’ diet was classified using 4 diet indexes. In the overall plant‐based diet index and provegetarian diet index, higher intakes of all or selected plant foods received higher scores; in the healthy plant‐based diet index, higher intakes of only the healthy plant foods received higher scores; in the less healthy plant‐based diet index, higher intakes of only the less healthy plant foods received higher scores. In all indexes, higher intakes of animal foods received lower scores. Results from Cox proportional hazards models showed that participants in the highest versus lowest quintile for adherence to overall plant‐based diet index or provegetarian diet had a 16%, 31% to 32%, and 18% to 25% lower risk of cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality, respectively, after adjusting for important confounders (all P<0.05 for trend). Higher adherence to a healthy plant‐based diet index was associated with a 19% and 11% lower risk of cardiovascular disease mortality and all‐cause mortality, respectively, but not incident cardiovascular disease (P<0.05 for trend). No associations were observed between the less healthy plant‐based diet index and the outcomes. Conclusions Diets higher in plant foods and lower in animal foods were associated with a lower risk of cardiovascular morbidity and mortality in a general population.
Collapse
Affiliation(s)
- Hyunju Kim
- Center for Human Nutrition Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD.,Welch Center for Prevention, Epidemiology, and Clinical Research Baltimore MD.,Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Laura E Caulfield
- Center for Human Nutrition Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Vanessa Garcia-Larsen
- Center for Human Nutrition Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Lyn M Steffen
- Division of Epidemiology and Community Health University of Minnesota School of Public Health Minneapolis MN
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research Baltimore MD.,Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Casey M Rebholz
- Welch Center for Prevention, Epidemiology, and Clinical Research Baltimore MD.,Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| |
Collapse
|
12
|
Adeoye AM, Ovbiagele B, Akinyemi JO, Ogah OS, Akinyemi R, Gebregziabher M, Wahab K, Fakunle AG, Akintunde A, Adebayo O, Aje A, Tiwari HK, Arnett D, Agyekum F, Appiah LT, Amusa G, Olunuga TO, Onoja A, Sarfo FS, Akpalu A, Jenkins C, Lackland D, Owolabi L, Komolafe M, Faniyan MM, Arulogun O, Obiako R, Owolabi M. Echocardiographic Abnormalities and Determinants of 1-Month Outcome of Stroke Among West Africans in the SIREN Study. J Am Heart Assoc 2019; 8:e010814. [PMID: 31142178 PMCID: PMC6585359 DOI: 10.1161/jaha.118.010814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Little is known about the relationship between echocardiographic abnormalities and outcome among patients with acute stroke. We investigated the pattern and association of baseline echocardiographic variables with 1‐month disability and mortality among patients with stroke in the SIREN (Stroke Investigative Research and Education Network) study. Methods and Results We enrolled and followed up consecutive 1020 adult patients with acute stroke with baseline transthoracic echocardiography from west Africa. To explore the relationship between echocardiographic variables and 1‐month disability (using modified Rankin scale >3) and fatality, regression models were fitted. Relative risks were computed with 95% CIs. The participants comprised 60% men with a mean age of 59.2±14.6 years. Ischemic stroke was associated with smaller aortic root diameter (30.2 versus 32.5, P=0.018) and septal (16.8 versus 19.1, P<0.001) and posterior wall thickness at systole (18.9 versus 21.5, P=0.004). Over 90% of patients with stroke had abnormal left ventricular (LV) geometry with eccentric hypertrophy predominating (56.1%). Of 13 candidate variables investigated, only baseline abnormal LV geometry (concentric hypertrophy) was weakly associated with 1‐month disability (unadjusted relative risk, 1.80; 95% CI, 0.97–5.73). Severe LV systolic dysfunction was significantly associated with increased 1‐month mortality (unadjusted relative risk, 3.05; 95% CI, 1.36–6.83). Conclusions Nine of 10 patients with acute stroke had abnormal LV geometry and a third had systolic dysfunction. Severe LV systolic dysfunction was significantly associated with 1 month mortality. Larger studies are required to establish the independent effect and unravel predictive accuracy of this association.
Collapse
Affiliation(s)
- Abiodun M Adeoye
- 1 Center for Genomic and Precision Medicine University of Ibadan Ibadan Nigeria
| | - Bruce Ovbiagele
- 2 Department of Neurology University of California San Francisco CA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mayowa Owolabi
- 1 Center for Genomic and Precision Medicine University of Ibadan Ibadan Nigeria
| |
Collapse
|
13
|
Abstract
OBJECTIVE To determine the specific Score of Neonatal Acute Physiology (SNAP-II) cut-off scores associated with outcomes in extremely preterm infants, and to examine its contribution to predictive models that include nonmodifiable birth predictors. STUDY DESIGN Retrospective observational study of 9240 infants born at 22-28 weeks' gestation and admitted to the Canadian Neonatal Network from 2010 to 2015. Outcomes included early and hospital mortality, composite of mortality/morbidity and individual morbidities. The SNAP-II cut-off to predict each outcome was determined using the Youden index. Additional contributions were evaluated using a base model that adjusted for gestational age, birth weight z-score and sex and by comparing the area under the curve (AUC). RESULTS The mortality/morbidity rate was 63% (5859/9240). Specific SNAP-II cut-offs ranged from 12 to 20 and were associated with each adverse outcome. Adding SNAP-II cut-offs to predictive models that included birth variables significantly improved (p < .05) the prediction of early mortality (AUC 0.84 versus 0.79), hospital mortality (AUC 0.80 versus 0.78), mortality/morbidity (AUC 0.76 versus 0.75), and severe neurological injury (AUC 0.69 versus 0.66) but had little or no effect on predictive models for retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, and nosocomial infection. CONCLUSIONS SNAP-II cut-offs were independently associated with each adverse outcome and using the proposed SNAP-II cut-offs improved the performance of predictive models for certain short-term outcomes.
Collapse
Affiliation(s)
- Marc Beltempo
- a Department of Pediatrics , McGill University Health Centre , Montreal , Canada.,b Maternal-Infant Care Research Centre, Mount Sinai Hospital , Toronto , Canada
| | - Prakesh S Shah
- b Maternal-Infant Care Research Centre, Mount Sinai Hospital , Toronto , Canada.,c Department of Paediatrics , Mount Sinai Hospital and University of Toronto , Toronto , Canada
| | - Xiang Y Ye
- b Maternal-Infant Care Research Centre, Mount Sinai Hospital , Toronto , Canada
| | - Jehier Afifi
- d Department of Pediatrics , Dalhousie University and IWK Health Centre , Halifax , Canada
| | - Shoo Lee
- b Maternal-Infant Care Research Centre, Mount Sinai Hospital , Toronto , Canada.,c Department of Paediatrics , Mount Sinai Hospital and University of Toronto , Toronto , Canada
| | - Douglas D McMillan
- d Department of Pediatrics , Dalhousie University and IWK Health Centre , Halifax , Canada
| | | |
Collapse
|
14
|
Dunlay SM, Strand JJ, Wordingham SE, Stulak JM, Luckhardt AJ, Swetz KM. Dying With a Left Ventricular Assist Device as Destination Therapy. Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.116.003096. [PMID: 27758809 DOI: 10.1161/circheartfailure.116.003096] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [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: 03/07/2016] [Accepted: 09/02/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the ability of left ventricular assist device as destination therapy (DT-LVAD) to prolong survival for many patients with advanced heart failure, little is known about the eventual end-of-life care that patients with DT-LVAD receive. METHODS AND RESULTS All patients undergoing DT-LVAD at the Mayo Clinic in Rochester, Minnesota, from January 1, 2007, to September 30, 2014, who subsequently died before July 1, 2015, were included. Information about end-of-life care was obtained from documentation in the electronic medical record. Of 89 patients who died with a DT-LVAD, the median (25th-75th percentile) time from left ventricular assist device implantation to death was 14 (4-31) months. The most common causes of death were multiorgan failure (26%), hemorrhagic stroke (24%), and progressive heart failure (21%). Nearly half (46%) of the patients saw palliative care within 1 month before death; however, only 13 (15%) patients enrolled in hospice a median 11 (range 1-315) days before death. Most patients (78%) died in the hospital, of which 88% died in the intensive care unit. In total, 49 patients had their left ventricular assist device deactivated before death, with all but 3 undergoing deactivation in the hospital. Most patients died within an hour of left ventricular assist device deactivation and all within 26 hours. CONCLUSIONS In contrast to the general heart failure population, most patients with DT-LVAD die in the hospital and few use hospice. Further work is needed to understand these differences and to determine whether patients with DT-LVAD are receiving optimal end-of-life care.
Collapse
Affiliation(s)
- Shannon M Dunlay
- From the Department of Cardiovascular Diseases (S.M.D.), the Division of Health Care Policy and Research, Department of Health Sciences Research (S.M.D.), the Division of General Internal Medicine, Department of Medicine (J.J.S.), and the Division of Cardiovascular Surgery, Department of Surgery (J.M.S., A.J.L.), Mayo Clinic, Rochester, MN; Division of Hematology & Medical Oncology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ (S.E.W.); and Department of Medicine and Center for Palliative & Supportive Care, University of Alabama Birmingham, and the Birmingham Veterans Affairs Medical Center, AL (K.M.S.).
| | - Jacob J Strand
- From the Department of Cardiovascular Diseases (S.M.D.), the Division of Health Care Policy and Research, Department of Health Sciences Research (S.M.D.), the Division of General Internal Medicine, Department of Medicine (J.J.S.), and the Division of Cardiovascular Surgery, Department of Surgery (J.M.S., A.J.L.), Mayo Clinic, Rochester, MN; Division of Hematology & Medical Oncology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ (S.E.W.); and Department of Medicine and Center for Palliative & Supportive Care, University of Alabama Birmingham, and the Birmingham Veterans Affairs Medical Center, AL (K.M.S.)
| | - Sara E Wordingham
- From the Department of Cardiovascular Diseases (S.M.D.), the Division of Health Care Policy and Research, Department of Health Sciences Research (S.M.D.), the Division of General Internal Medicine, Department of Medicine (J.J.S.), and the Division of Cardiovascular Surgery, Department of Surgery (J.M.S., A.J.L.), Mayo Clinic, Rochester, MN; Division of Hematology & Medical Oncology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ (S.E.W.); and Department of Medicine and Center for Palliative & Supportive Care, University of Alabama Birmingham, and the Birmingham Veterans Affairs Medical Center, AL (K.M.S.)
| | - John M Stulak
- From the Department of Cardiovascular Diseases (S.M.D.), the Division of Health Care Policy and Research, Department of Health Sciences Research (S.M.D.), the Division of General Internal Medicine, Department of Medicine (J.J.S.), and the Division of Cardiovascular Surgery, Department of Surgery (J.M.S., A.J.L.), Mayo Clinic, Rochester, MN; Division of Hematology & Medical Oncology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ (S.E.W.); and Department of Medicine and Center for Palliative & Supportive Care, University of Alabama Birmingham, and the Birmingham Veterans Affairs Medical Center, AL (K.M.S.)
| | - Angela J Luckhardt
- From the Department of Cardiovascular Diseases (S.M.D.), the Division of Health Care Policy and Research, Department of Health Sciences Research (S.M.D.), the Division of General Internal Medicine, Department of Medicine (J.J.S.), and the Division of Cardiovascular Surgery, Department of Surgery (J.M.S., A.J.L.), Mayo Clinic, Rochester, MN; Division of Hematology & Medical Oncology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ (S.E.W.); and Department of Medicine and Center for Palliative & Supportive Care, University of Alabama Birmingham, and the Birmingham Veterans Affairs Medical Center, AL (K.M.S.)
| | - Keith M Swetz
- From the Department of Cardiovascular Diseases (S.M.D.), the Division of Health Care Policy and Research, Department of Health Sciences Research (S.M.D.), the Division of General Internal Medicine, Department of Medicine (J.J.S.), and the Division of Cardiovascular Surgery, Department of Surgery (J.M.S., A.J.L.), Mayo Clinic, Rochester, MN; Division of Hematology & Medical Oncology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ (S.E.W.); and Department of Medicine and Center for Palliative & Supportive Care, University of Alabama Birmingham, and the Birmingham Veterans Affairs Medical Center, AL (K.M.S.)
| |
Collapse
|
15
|
Pitts R, Gunzburger E, Ballantyne CM, Barter PJ, Kallend D, Leiter LA, Leitersdorf E, Nicholls SJ, Shah PK, Tardif JC, Olsson AG, McMurray JJV, Kittelson J, Schwartz GG. Aldosterone Does Not Predict Cardiovascular Events Following Acute Coronary Syndrome in Patients Initially Without Heart Failure. J Am Heart Assoc 2017; 6:JAHA.116.004119. [PMID: 28073769 PMCID: PMC5523625 DOI: 10.1161/jaha.116.004119] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Aldosterone may have adverse effects in the myocardium and vasculature. Treatment with an aldosterone antagonist reduces cardiovascular risk in patients with acute myocardial infarction complicated by heart failure (HF) and left ventricular systolic dysfunction. However, most patients with acute coronary syndrome do not have advanced HF. Among such patients, it is unknown whether aldosterone predicts cardiovascular risk. Methods and Results To address this question, we examined data from the dal‐OUTCOMES trial that compared the cholesteryl ester transfer protein inhibitor dalcetrapib with placebo, beginning 4 to 12 weeks after an index acute coronary syndrome. Patients with New York Heart Association class II (with LVEF <40%), III, or IV HF were excluded. Aldosterone was measured at randomization in 4073 patients. The primary outcome was a composite of coronary heart disease death, nonfatal myocardial infarction, stroke, hospitalization for unstable angina, or resuscitated cardiac arrest. Hospitalization for HF was a secondary endpoint. Over a median follow‐up of 37 months, the primary outcome occurred in 366 patients (9.0%), and hospitalization for HF occurred in 72 patients (1.8%). There was no association between aldosterone and either the time to first occurrence of a primary outcome (hazard ratio for doubling of aldosterone 0.92, 95% confidence interval 0.78‐1.09, P=0.34) or hospitalization for HF (hazard ratio 1.38, 95% CI 0.96‐1.99, P=0.08) in Cox regression models adjusted for covariates. Conclusions In patients with recent acute coronary syndrome but without advanced HF, aldosterone does not predict major cardiovascular events. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00658515.
Collapse
Affiliation(s)
- Reynaria Pitts
- Cardiology Section, VA Medical Center and University of Colorado School of Medicine, Denver, CO
| | | | | | | | | | - Lawrence A Leiter
- Division of Endocrinology & Metabolism, Li Ka Shing Knowledge Institute and Keenan Research Centre for Biomedical Science, St Michael's Hospital, University of Toronto, Canada
| | | | - Stephen J Nicholls
- South Australian Health and Medical Research Institute, University of Adelaide, Australia
| | | | | | | | | | - John Kittelson
- University of Colorado School of Public Health, Aurora, CO
| | - Gregory G Schwartz
- Cardiology Section, VA Medical Center and University of Colorado School of Medicine, Denver, CO
| |
Collapse
|
16
|
Boulouis G, Morotti A, Brouwers HB, Charidimou A, Jessel MJ, Auriel E, Pontes-Neto O, Ayres A, Vashkevich A, Schwab KM, Rosand J, Viswanathan A, Gurol ME, Greenberg SM, Goldstein JN. Noncontrast Computed Tomography Hypodensities Predict Poor Outcome in Intracerebral Hemorrhage Patients. Stroke 2016; 47:2511-6. [PMID: 27601380 DOI: 10.1161/strokeaha.116.014425] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 06/17/2016] [Accepted: 08/02/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Noncontrast computed tomographic (CT) hypodensities have been shown to be associated with hematoma expansion in intracerebral hemorrhage (ICH), but their impact on functional outcome is yet to be determined. We evaluated whether baseline noncontrast CT hypodensities are associated with poor clinical outcome. METHODS We performed a retrospective review of a prospectively collected cohort of consecutive patients with primary ICH presenting to a single academic medical center between 1994 and 2016. The presence of CT hypodensities was assessed by 2 independent raters on the baseline CT. Unfavorable outcome was defined as a modified Rankin score >3 at 90 days. The associations between CT hypodensities and unfavorable outcome were investigated using uni- and multivariable logistic regression models. RESULTS During the study period, 1342 patients presented with ICH and 800 met restrictive inclusion criteria (baseline CT available for review, and 90-day outcome available). Three hundred and four (38%) patients showed hypodensities on CT, and 520 (65%) patients experienced unfavorable outcome. In univariate analysis, patients with unfavorable outcome were more likely to demonstrate hypodensities (48% versus 20%; P<0.0001). After adjustment for age, admission Glasgow coma scale, warfarin use, intraventricular hemorrhage, baseline ICH volume, and location, CT hypodensities were found to be independently associated with an increase in the odds of unfavorable outcome (odds ratio 1.70, 95% confidence interval [1.10-2.65]; P=0.018). CONCLUSIONS The presence of noncontract CT hypodensities at baseline independently predicts poor outcome and comes as a useful and widely available addition to our ability to predict ICH patients' clinical evolution.
Collapse
Affiliation(s)
- Gregoire Boulouis
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.).
| | - Andrea Morotti
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - H Bart Brouwers
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Andreas Charidimou
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Michael J Jessel
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Eitan Auriel
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Octavio Pontes-Neto
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Alison Ayres
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Anastasia Vashkevich
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Kristin M Schwab
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Jonathan Rosand
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Anand Viswanathan
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Mahmut E Gurol
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Steven M Greenberg
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Joshua N Goldstein
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| |
Collapse
|
17
|
Shore S, Smolderen KG, Spertus JA, Kennedy KF, Jones PG, Zhao Z, Wang TY, Arnold SV. Clinical Relevance of Rehospitalizations for Unstable Angina and Unplanned Revascularization Following Acute Myocardial Infarction. J Am Heart Assoc 2016; 5:JAHA.115.003129. [PMID: 27543798 PMCID: PMC5015270 DOI: 10.1161/jaha.115.003129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 11/20/2022]
Abstract
Background Rehospitalizations following acute myocardial infarction for unplanned coronary revascularization and unstable angina (UA) are often included as parts of composite end points in clinical trials. Although clearly costly, the clinical relevance of these individual components has not been described. Methods and Results Patients enrolled in a prospective, 24‐center, US acute myocardial infarction registry were followed for 1 year after an acute myocardial infarction for rehospitalizations, that were independently adjudicated by experienced cardiologists. Patients who did and did not experience UA or revascularization rehospitalization were propensity matched using greedy matching. Among 3283 patients with acute myocardial infarction who were included, mean age was 59 years, 33% were female, and 70% were white. Rehospitalization rates for UA and unplanned revascularization at 1 year were 5.0% and 4.1%, respectively. After propensity matching, we included 2433 patients in the UA rehospitalization group and 2410 in the unplanned revascularization group. Using weighted proportional hazards Cox regression, there was no significant association between a rehospitalization for UA and 5‐year all‐cause mortality (9.6% versus 13.8%; adjusted hazard ratio 0.87, 95% CI 0.60–1.16). Patients rehospitalized for unplanned revascularization had a lower 5‐year mortality risk (7.0% versus 15.1%; hazard ratio 0.68, 95% CI 0.50–0.92) compared with those without such rehospitalizations. Nevertheless, patients with UA and unplanned revascularization had a substantially greater hazard of subsequent rehospitalizations compared with patients without such events (UA: hazard ratio 4.36, 95% CI 3.48–5.47; revascularization: hazard ratio 4.38, 95% CI 3.53–5.44). Conclusions Rehospitalizations for UA and unplanned revascularization in the year after an acute myocardial infarction are associated with higher risks of subsequent rehospitalizations but not with mortality.
Collapse
Affiliation(s)
| | - Kim G Smolderen
- Ghent University, Ghent, Belgium Mid America Heart Institute, Kansas City, MO University of Missouri Kansas City, Kansas City, MO
| | - John A Spertus
- Mid America Heart Institute, Kansas City, MO University of Missouri Kansas City, Kansas City, MO
| | | | | | - Zhenxiang Zhao
- Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN
| | | | - Suzanne V Arnold
- Mid America Heart Institute, Kansas City, MO University of Missouri Kansas City, Kansas City, MO
| |
Collapse
|
18
|
Deb S, Tu JV, Austin PC, Ko DT, Rocha R, Mazer CD, Kiss A, Fremes SE. Impact of South Asian Ethnicity on Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery: A Large Population-Based Propensity Matched Study. J Am Heart Assoc 2016; 5:JAHA.116.003941. [PMID: 27451460 PMCID: PMC5015415 DOI: 10.1161/jaha.116.003941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Indexed: 01/30/2023]
Abstract
Background Ethnicity is an important predictor of coronary artery bypass graft surgery (CABG) outcomes. South Asians (SA), one of the largest ethnic groups with a high burden of cardiovascular disease, are hypothesized to have inferior outcomes after CABG compared to other ethnic groups. Given the paucity and controversy of literature in this area, the objective of this study was to examine the impact of SA versus the general population (GP) on long‐term outcomes following CABG. Method and Results Using administrative databases and a surname algorithm, 83 850 patients (SA: 2653, GP: 81 197) who underwent isolated CABG in Ontario, Canada from 1996 to 2007 were identified; mean follow‐up was 9.1±3.9 years. SA were younger (SA: 61.7±9.4, GP: 64.1±10.0 years, standardized difference=0.25) with more cardiac risk factors, including diabetes (SA: 54.1%, GP: 34.9%, standardized difference =0.40). Propensity‐score matching resulted in 2473 matched pairs between SA and GP with all baseline covariates being balanced (standardized difference <0.1). Being a SA compared to the GP was protective against freedom from major adverse cardiac and cerebrovascular events, defined by all‐cause death, myocardial infarction, stroke, or coronary reintervention: Adjusted Cox‐proportional hazard ratio 0.91, 95% CI (0.83–0.99), adjusted‐P=0.04; this was also true for freedom from all‐cause mortality: hazard ratio 0.81, 95% CI (0.72–0.91), adjusted P=0.0004. The adjusted proportion of major adverse cardiac and cerebrovascular events was lower in the SA (SA: 34.7%, GP: 37.8%, McNemar P=0.03), driven largely by all‐cause mortality (SA: 20.4%, GA: 24.3%, McNemar P=0.001). Conclusions Contrary to existing notions, our study finds that being a SA is protective with respect to freedom from long‐term major adverse cardiac and cerebrovascular events and mortality after CABG. More studies are required to corroborate and explore causal factors of these findings.
Collapse
Affiliation(s)
- Saswata Deb
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada Institute of Health Policy Management and Evaluation, University of Toronto, Ontario, Canada
| | - Jack V Tu
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada Institute of Health Policy Management and Evaluation, University of Toronto, Ontario, Canada Institute of Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - Peter C Austin
- Institute of Health Policy Management and Evaluation, University of Toronto, Ontario, Canada Institute of Clinical and Evaluative Sciences, Toronto, Ontario, Canada Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Dennis T Ko
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada Institute of Health Policy Management and Evaluation, University of Toronto, Ontario, Canada Institute of Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - Rodolfo Rocha
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - C David Mazer
- Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Alex Kiss
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada Institute of Health Policy Management and Evaluation, University of Toronto, Ontario, Canada
| |
Collapse
|
19
|
Affiliation(s)
- David M Fergusson
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Joseph M Boden
- Christchurch Health and Development Study, Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| |
Collapse
|
20
|
Affiliation(s)
- Leonard A Kaminsky
- Clinical Exercise Physiology Program, Human Performance Laboratory, Ball State University, Muncie, IN (L.A.K., A.K.M.)
| | - Alexander H K Montoye
- Clinical Exercise Physiology Program, Human Performance Laboratory, Ball State University, Muncie, IN (L.A.K., A.K.M.)
| |
Collapse
|
21
|
Affiliation(s)
- Rajiv Chowdhury
- Department of Public Health and Primary Care, University of Cambridge, United Kingdom (R.C., M.S.)
| | - Laura Johnson
- School for Policy Studies, University of Bristol, United Kingdom (L.J.)
| | - Marinka Steur
- Department of Public Health and Primary Care, University of Cambridge, United Kingdom (R.C., M.S.)
| |
Collapse
|
22
|
Howard DPJ, Banerjee A, Fairhead JF, Perkins J, Silver LE, Rothwell PM. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation 2013; 127:2031-7. [PMID: 23599348 DOI: 10.1161/circulationaha.112.000483] [Citation(s) in RCA: 508] [Impact Index Per Article: 46.2] [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: 12/21/2022]
Abstract
BACKGROUND Acute aortic dissection is a preventable life-threatening condition. However, there have been no prospective population-based studies of incidence or outcome to inform an understanding of risk factors, strategies for prevention, or projections for future clinical service provision. METHODS AND RESULTS We prospectively determined incidence and outcomes of all acute aortic dissections in a population of 92 728 in Oxfordshire, United Kingdom, from 2002 to 2012. Among 155 patients with 174 acute aortic events, 54 patients had 59 thoracoabdominal aortic dissections (52 incident events: 6/100 000, 95% confidence interval, 4-7; 37 Stanford type A, 15 Stanford type B; 31 men, mean age=72.0 years). Among patients with type A incident events, 18 (48.6%) died before hospital assessment (61.1% women). The 30-day fatality rate was 47.4% for patients with type A dissections who survived to hospital admission and 13.3% for patients with type B dissections, although subsequent 5-year survival rates were high (85.7% for type A; 83.3% for type B). Even though 67.3% of patients were on antihypertensive drugs, 46.0% of all patients had at least 1 systolic BP ≥180 mm Hg in their primary care records over the preceding 5 years, and the proportion of blood pressures in the hypertensive range (>140/90 mm Hg) averaged 56.0%. Premorbid blood pressure was higher in patients with type A dissections that were immediately fatal than in those who survived to admission (mean/standard deviation pre-event systolic blood pressure=151.2/19.3 versus 137.9/17.9; P<0.001). CONCLUSIONS Uncontrolled hypertension remains the most significant treatable risk factor for acute aortic dissection. Prospective population-based ascertainment showed that hospital-based registries will underestimate not only incidence and case fatality, but also the association with premorbid hypertension.
Collapse
Affiliation(s)
- Dominic P J Howard
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | | | | | | | | | | | | |
Collapse
|
23
|
Bell EF, Hansen NI, Morriss FH, Stoll BJ, Ambalavanan N, Gould JB, Laptook AR, Walsh MC, Carlo WA, Shankaran S, Das A, Higgins RD. Impact of timing of birth and resident duty-hour restrictions on outcomes for small preterm infants. Pediatrics 2010; 126:222-31. [PMID: 20643715 PMCID: PMC2924191 DOI: 10.1542/peds.2010-0456] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [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: 01/25/2023] Open
Abstract
OBJECTIVE The goal was to examine the impact of birth at night, on the weekend, and during July or August (the first months of the academic year) and the impact of resident duty-hour restrictions on mortality and morbidity rates for very low birth weight infants. METHODS Outcomes were analyzed for 11,137 infants with birth weights of 501 to 1250 g who were enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry in 2001-2005. Approximately one-half were born before the introduction of resident duty-hour restrictions in 2003. Follow-up assessments at 18 to 22 months were completed for 4508 infants. Mortality rate, short-term morbidities, and neurodevelopmental outcome were examined with respect to the timing of birth. RESULTS There was no effect of the timing of birth on mortality rate and no impact on the risks of short-term morbidities except that the risk of retinopathy of prematurity (stage > or =2) was higher after the introduction of duty-hour restrictions and the risk of retinopathy of prematurity requiring operative treatment was lower for infants born during the late night than during the day. There was no impact of the timing of birth on neurodevelopmental outcome except that the risk of hearing impairment or death was slightly lower among infants born in July or August. CONCLUSION In this network, the timing of birth had little effect on the risks of death and morbidity for very low birth weight infants, which suggests that staffing patterns were adequate to provide consistent care.
Collapse
Affiliation(s)
- Edward F. Bell
- Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | | | | | | | | | - Jeffrey B. Gould
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Abbot R. Laptook
- Department of Pediatrics, Brown University, Providence, Rhode Island
| | - Michele C. Walsh
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Abhik Das
- RTI International, Rockville, Maryland
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | | |
Collapse
|