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Pedersen M, Rørth R, Andersen M, Sessa M, Polcwiartek C, Riddersholm S, Gislason G, Kristensen S, Andersen N, Køber L, Søgaard P, Torp-Pedersen C, Kragholm K. One-year incidence of depression, anxiety, or stress disorders following a first-time heart failure diagnosis: A Danish nationwide registry-based study. Am Heart J Plus 2023; 25:100240. [PMID: 38510497 PMCID: PMC10945984 DOI: 10.1016/j.ahjo.2022.100240] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/14/2022] [Accepted: 12/06/2022] [Indexed: 03/22/2024]
Affiliation(s)
- M.W. Pedersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej18-22, 9000 Aalborg, Denmark
| | - R. Rørth
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - M.P. Andersen
- Department of Clinical Research, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - M. Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark
| | - C. Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Hobrovej18-22, 9000 Aalborg, Denmark
| | - S.J. Riddersholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej18-22, 9000 Aalborg, Denmark
| | - G. Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hospitalsvej 1, 2900 Hellerup, Denmark
- The Danish Heart Foundation, Vognmagergade 7,3, 1120 Copenhagen K, Denmark
| | - S.L. Kristensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - N.H. Andersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej18-22, 9000 Aalborg, Denmark
| | - L. Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - P. Søgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej18-22, 9000 Aalborg, Denmark
| | - C. Torp-Pedersen
- Department of Clinical Research, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - K.H. Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej18-22, 9000 Aalborg, Denmark
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark
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Lassen MH, Modin D, Skaarup KG, Claggett B, Solomon SD, Fralick M, Staehr-Jensen JU, Sivapalan P, Schou M, Krause TG, Hviid A, Koeber L, Torp-Pedersen C, Gislason G, Biering-Soerensen T. Risk of acute myocardial infarction, stroke and thromboembolism following COVID-19 vaccination compared to testing positive for COVID-19 infection: a nationwide cohort study of 4.6 mio individuals. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1531] [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
Large randomized controlled trials (RCT) have shown that COVID-19 vaccines are effective at preventing severe COVID-19. However, the RCT's are not powered to detect rare adverse events. It has been reported that the new mRNA based COVID-19 vaccines may increase the risk of thromboembolic and ischemic events. Likewise, thromboembolic and ischemic events are also known complications to infection with SARS-CoV-19. Currently, less is known about the risk-reward relationship of receiving an mRNA-based COVID-19 vaccine versus contracting COVID-19 infection with respect to thromboembolic and ischemic outcomes.
Purpose
To compare the risk of thromboembolic and ischemic events following COVID-19 vaccination to the risk following infection with SARS-CoV-19.
Methods
The study period was from March 2020 to August 2021. All individuals were >18 years old. The population was stratified into two different groups. The vaccinated group consisted of recipients of the first dose of either Moderna (mRNA-1273, n=488,220) or Pfizer-BioNTech (BNT162b2 mRNA, n=3,186,164) vaccines. Individuals who had previously tested positive for SARS-CoV-19 were excluded. The other group consisted of individuals who had tested positive for SARS-CoV-19 in the same period who had not yet received their first vaccination dose (n=233,926). The exposure period for both groups was set to 28 days following vaccination/testing positive for SARS-CoV-19 (Figure 1). Patient level data were obtained on all included individuals using nationwide registries. Primary outcomes were acute myocardial infarction (AMI), ischemic stroke, pulmonary embolism (PE), and deep venous thrombosis (DVT). Odds ratios were obtained from logistic regression models with the vaccinated group acting as reference. Multivariable models were adjusted for demographics and comorbidities.
Results
In the vaccinated group, mean age was 53±19 years and 50.3% were female. In the group of participants testing positive for SARS-CoV-19, mean age was 42.1±17.4 years and 50.2% were female. In total, 773 suffered a stroke, 472 suffered a PE, 500 suffered an AMI, and 484 suffered a DVT during the 28-day exposure period. We observed an increased absolute risk of all outcomes for participants testing positive for SARS-CoV-19 as compared to participants being vaccinated (stroke: 0.049% vs 0.019%, p<0.001), (PE: 0.91% vs 0.0072%, p<0.001), (AMI: 0.021 vs 0.013, p=0.0004), and (DVT: 0.037% vs 0.011%, p<0.001). In multivariable models, participants testing positive for SARS-CoV-19 had a significantly increased risk of all outcomes compared to participants being vaccinated: (stroke: OR: 4.0, 95% CI: [2.9–5.6], p<0.001), (PE: OR: 38.6 95% CI: [30.3–48.5], p<0.001), (AMI: OR: 3.3, 95% CI: [2.1–5.00], p<0.001), and (DVT: OR: 5.3, 95% CI: [3.8–7.5], p<0.001) (Figure 2).
Conclusion
The risks of thromboembolic and ischemic events were substantially higher after SARS-CoV-19 infection than after vaccination in the Danish population.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Gentofte University Hospital
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Affiliation(s)
- M H Lassen
- Gentofte University Hospital, Cardiology , Copenhagen , Denmark
| | - D Modin
- Gentofte University Hospital, Cardiology , Copenhagen , Denmark
| | - K G Skaarup
- Gentofte University Hospital, Cardiology , Copenhagen , Denmark
| | - B Claggett
- Harvard Medical School , Boston , United States of America
| | - S D Solomon
- Harvard Medical School , Boston , United States of America
| | - M Fralick
- University of Toronto , Toronto , Canada
| | | | - P Sivapalan
- Gentofte University Hospital , Gentofte , Denmark
| | - M Schou
- Gentofte University Hospital, Cardiology , Copenhagen , Denmark
| | - T G Krause
- Statens Serum Institut , Copenhagen , Denmark
| | - A Hviid
- Statens Serum Institut , Copenhagen , Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | | | - G Gislason
- Gentofte University Hospital, Cardiology , Copenhagen , Denmark
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Juhl Madsen O, Lamberts MK, Fosboel EL, Gislason G, Olesen JB, Strange JE. Trends in percutaneous left atrial appendage occlusion and 1-year mortality: a nationwide cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2137] [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
Percutaneous left atrial appendage occlusion (LAAO) is increasingly used for stroke prevention in high-risk patients with atrial fibrillation and contraindication for oral anticoagulation. However, studies evaluating comorbidities and mortality remain scarce.
Objectives
The aim of this study was to evaluate changes in patient characteristic over time and 1-year risk of death.
Methods
Using Danish nationwide registers, we included all patients undergoing first-time LAAO between 2013 and 2021. To evaluate changes in patient characteristics, the study population was stratified according to calendar year of LAAO procedure: 2013–2015, 2016–2018, and 2019–2021. Baseline patient characteristics were defined from 10 years prior to date of LAAO procedure. Antithrombotic therapy was defined as claimed prescriptions within 180 days prior to LAAO procedure. Patients were then followed until either emigration, death, one year of full follow-up, or end of study period. Baseline frailty risk was estimated with The Hospital Frailty Risk Score, a validated frailty risk assessment tool based on ICD-10 codes. The 1-year unadjusted risk of death was estimated with the Aalen-Johansen method.
Results
In total, 1,306 patients underwent LAAO. The number of LAAO increased from 201 procedures in 2013–2015 to 586 in 2019–2021. During follow-up, the age of the patients remained stable (2013–2015: median age: 70 years; 2016–2018: median age 69 years; 2019–2021: median age 69 years). Fewer patients had a history of ischemic stroke (2013–2015: 44.3% vs 2019–2021: 27.6%), hemorrhagic stroke (2013–2015: 32.8% vs 2019–2021: 21.0%), and previous bleeding (2013–2015: 71.1% vs 2019–2021: 59.2%). Median CHA2DS2-VASs score decreased over time (2013–2015: 4 vs 2019–2021: 3) and same trend was found in median HAS-BLED score (2013–2015: 3 vs 2019–2021: 2).
In addition, fewer patients were categorized as high frailty risk (2013–2015: 16.9% vs 2019–2021: 8.9%). However, there was an increase in patients with a history of cancer (2013–2015: 11.9% vs 2019–2021: 18.9%). The use of antiplatelet therapy prior to LAAO decreased while the use of oral anticoagulation increased (2013–2015: 50.2% vs 2019–2021: 68.9%) due to a marked increase in non-vitamin K antagonist oral anticoagulants and a decrease in vitamin K antagonists (Figure 1).
In total, 88 (7.22%) patients died within one year of LAAO procedure. The 1-year all-cause mortality risk in each period were similar (2013–2015: 7.0%; 2016–2018: 7.1%; 2019–2021: 6.9%). [Figure 2]
Conclusion
In the years 2013–2021, the annual number of LAAO procedures increased. The age of patients remained stable. Comorbidity burden decreased and fewer patients were at high frailty risk, but the 1-year mortality risks were similar. Our real-life data suggest that profiles of patients undergoing LAAO has changed considerably over time.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - M K Lamberts
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - E L Fosboel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - G Gislason
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J B Olesen
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J E Strange
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
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Christensen DM, Schjerning A, Smedegaard L, Charlot M, Phelps M, Gerds T, Gislason G, Sehested TSG. Development in long-term prognosis of first-time myocardial infarction in relation to use of guideline-recommended treatments: Danish total population cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1311] [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
Evidence from randomized trials during the previous decades have led to several improvements in acute and secondary preventive treatments for myocardial infarction (MI). However, there is a lack of recent knowledge about the implementation of these treatments and how they affected developments in the long-term prognosis of MI.
Purpose
To investigate developments in long-term outcomes after first-time MI and their relation to use of guideline-recommended treatments in a contemporary total population cohort.
Methods
All patients with a first-time MI from 2001 to 2018 were identified through Danish nationwide registries with follow-up through October 6, 2021. The study period was divided into 3-year periods. In each period, the Aalen-Johansen method was used to estimate the absolute 1-year risk for mortality, recurrent MI, heart failure, bleeding hospitalization, and ischemic stroke. The relative frequencies of pharmaceutical treatments and use of coronary procedures were calculated. In each calendar period, the 1-year mortality and recurrent MI risk was standardized to the 2016–2018 distribution of patient characteristics, procedure use, and treatment initiation. Treatment, standardized risks, and recurrent MI risk were evaluated in patients who survived to day 28 post discharge.
Results
In total, 134,884 patients (median age 69 years, 36.5% female) were included and 120,473 survived to day 28 post discharge (median age 68 years, 35.2% female). From 2001–2003 to 2016–2018, the 1-year risks of mortality (23.5% to 12.1%), recurrent MI (6.8% to 3.2%), and ischemic stroke (1.8% to 1.3%) decreased. Risk of heart failure remained relatively stable, whereas the 1-year risk of bleeding hospitalization increased from 2.1% to 3.0%. This pattern remained consistent during very long durations of follow-up (Figure 1). Initiation of statins (58.0% to 86.4%) and adenosine diphosphate receptor inhibitors (42.5% to 85.6%) increased considerably. Use of coronary angiography (37.3% to 84.5%) and percutaneous coronary intervention (24.8% to 63.5%) also increased. There was an attenuated decrease in the standardized 1-year risks of mortality and recurrent MI compared to the observed reference risks: from 8.7% (reference: 11.1%) in 2001–2003 to 6.1% in 2016–2018 for mortality and from 5.6% (reference: 6.8%) in 2001–2003 to 3.1% in 2016–2018 for recurrent MI (Figure 2).
Conclusions
There was a substantial improvement in the long-term risk of mortality and recurrent MI for patients with first-time MI. This improved prognosis was related to an increased use of guideline recommended treatments.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Danish Heart Foundation
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Affiliation(s)
| | | | - L Smedegaard
- Gentofte University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - M Charlot
- Gentofte University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - M Phelps
- Danish Heart Foundation , Copenhagen , Denmark
| | - T Gerds
- University of Copenhagen, Department of Biostatistics , Copenhagen , Denmark
| | - G Gislason
- The Danish Heart Foundation , Copenhagen , Denmark
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Strange JE, Holt A, Christensen DM, Gislason G, Torp-Pedersen C, Hansen ML, Lamberts MK, Schou M, Olesen JB, Fosboel EL, Koeber L, Rasmussen PV. Oral fluoroquinolones and risk of aortic dissection and aortic aneurysm: a nationwide nested case-control study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2732] [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
Oral fluoroquinolones are commonly prescribed antibiotics. Observational studies have shown an association between fluoroquinolone-use and subsequent risk of aortic aneurysm (AA) and aortic dissection (AD) due to a potential collagen degrading effect of fluoroquinolones.
Purpose
To investigate if fluoroquinolone-use was associated with increased rates of AA or AD in patients without known aortic disease. Secondly, to investigate if fluoroquinolone-use was associated with increased all-cause mortality and aortic interventions in high-risk patients with known aortic disease.
Methods
We used a nested case-control study design in which individuals aged 30–100 years from 2003 to 2018 were included from Danish nationwide registers. Exclusion criteria were bicuspid aortic valve, coarctation of the aorta, and connective tissue disease. A main cohort and a secondary high-risk cohort were defined. The main cohort comprised patients without history of AA/AD in which two case definitions were used: 1) A broad case definition of first-time AA/AD. 2) A severe case definition of ruptured AA/AD. The high-risk cohort comprised patients surviving index AA/AD admission in which cases were defined as all-cause mortality and aortic interventions.
Cases were matched on age, sex, and year of inclusion in a 1:30 ratio with controls. For the main cohort, a potential dose-response effect was investigated using groups of cumulative defined daily doses (cDDD) of fluoroquinolones. Hazard ratios (HR) with 95% confidence intervals (CI) for fluoroquinolone-use compared with amoxicillin as an active comparator were obtained from time-dependent Cox regression models using multiple exposure windows.
Results
The main cohort comprised 4.81 million individuals with 43,280 cases. Short-term 30-day, intermediate-term 90-day, and long-term 1-year fluoroquinolone use were all not associated with AA/AD (30-day HR 1.18 [95% CI: 0.84 to 1.66]; 90-day HR 1.12 [95% CI 0.96 to 1.30]; 1-year HR 1.00 [95% CI 0.93 to 1.07]). Using a severe case definition of ruptured AA/AD yielded comparable results. For the dose-response analysis, increasing cDDD did not confer increased rates of AA/AD (1–5 cDDD: Reference group; 6–10 cDDD: HR 1.03 [95% CI: 0.87 to 1.23]; >10 cDDD: HR 1.00 [95% CI 0.83 to 1.29]) (Figure 1).
The secondary high-risk cohort included 20,195 patients surviving index admission with 9,183 cases of all-cause mortality and 1,768 cases of aortic interventions. The 30-day HR for all-cause mortality was 1.21 (95% CI 0.92 to 1.60) and the 60-day HR 1.06 (95% CI 0.89 to 1.26). No association with aortic interventions was found either (Figure 2).
Conclusion
Fluroquinolone-use was not associated with AA/AD. Furthermore, fluoroquinolone-use was not associated with all-cause mortality or aortic interventions in potentially susceptible patients with known aortic disease. These findings do not support an increased risk of AA/AD with fluoroquinolone-use.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J E Strange
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - A Holt
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | | | - G Gislason
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - C Torp-Pedersen
- Nordsjaellands Hospital, Department of Cardiology , Hilleroed , Denmark
| | - M L Hansen
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - M K Lamberts
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - M Schou
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J B Olesen
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - E L Fosboel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - P V Rasmussen
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
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Fredslund Madsen S, Moelager Christensen D, Strange JE, Nourhavesh N, Kumler T, Gislason G, Lamberts M, Sindet-Pedersen C. Increased risk of long-term mortality following pulmonary embolism in Denmark, 2000–2020: a nationwide trend study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1875] [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
New diagnostics and treatment regimens have been introduced in the last 20 years which may have influenced the prognosis of pulmonary embolism (PE). However, there is a lack of studies investigating temporal trend in short- and long-term mortality following PE in different subgroups.
Purpose
We aimed to investigate temporal trends in short- and long-term mortality following PE according to age, sex, and cancer status.
Method
This study was based on data from Danish national registries. All patients with a first-time inpatient hospital diagnosis of PE between the 1st of January 2000 through 3rd of December 2020 were included in the study. Mortality was calculated as the proportion of patients who died within 30 days and 31–365 days, respectively, and were presented with 95% confidence intervals (CI), and additionally stratified into categories of age groups (18–39, 40–59, 60–79, and 80–100 years), sex (male/female) and cancer status (no cancer/cancer). Cancer was defined as a cancer diagnosis registered within 6 months prior to the PE diagnosis.
Results
In total 62,750 patients had a first-time PE during the study period. The mean age of the study population was 68.3 years (sd), and 32,617 (51.9%) were women and 18,719 (29.83%) of patients had cancer. The 30-day mortality for age groups, sex, and cancer status decreased during the study period 2000–2020 (Figure 1A). The 31–365-day mortality for age group 40–59 years increased from 5.7% [95% CI: 3.7–8.5] in 2000 to 9.5% [95% CI: 7.5–11.9] in 2019. Age group 80–100 years increased from 18.5% [95% CI: 14.8–22.8] in 2000 to 23.5% [95% CI: 21.0–26.2] in 2019. No temporal differences were observed for age groups 18–39 and 60–79 years. Mortality for cancer-associated PE increased from 24.8% [95% CI: 19.8–30.6] in 2000 to 29.9% [95% CI: 27.4–32.4] in 2019 (Figure 1B).
Conclusion
Despite overall mortality following PE has improved, our data suggest that short-term mortality following pulmonary embolism has improved considerably while long-term mortality were increased. Future studies should assess whether this phenomenon is due to a different patient risk profile (e.g. cancer) or lack of longer term care (e.g. rehabilitation program, withdrawal of antithrombotic treatment).
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - J E Strange
- Herlev and Gentofte Hospital , Copenhagen , Denmark
| | - N Nourhavesh
- Herlev and Gentofte Hospital , Copenhagen , Denmark
| | - T Kumler
- Herlev and Gentofte Hospital , Copenhagen , Denmark
| | - G Gislason
- Herlev and Gentofte Hospital , Copenhagen , Denmark
| | - M Lamberts
- Herlev and Gentofte Hospital , Copenhagen , Denmark
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7
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El-Chouli M, Johnsen NF, Christensen DM, Malmborg MW, Gislason G. Determinants of poor life satisfaction in adolescents with congenital heart disease or early acquired cardiovascular disease: a nationwide observational study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1822] [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
Life expectancy in patients with congenital heart disease (CHD) and patients with early acquired cardiovascular disease (CVD) has increased due to improved treatments during the last decades. As life expectancy increases, focus on long term quality of life and life satisfaction as well as determining focus areas of preventive initiatives becomes essential.
Purpose
To investigate whether poor life satisfaction in adolescents and young adults with CHD or significant CVD is 1) associated with physical and mental challenges and 2) inversely associated with social support and self-efficacy have a protective effect against low life satisfaction.
Methods
Data from a Danish nationwide cross-sectional study was used to identify all patients with either CHD or significant CVD (e.g., arrhythmia, ischemia) aged 15–24 years with at least one contact to a Danish hospital department of cardiology between 2014–2018. Life satisfaction was measured on a scale of 0–10 and dichotomized into good life satisfaction if the score was >6. Using a logistic regression model with interaction terms for sex and adjusted for age and comorbidities, we estimated the association between physical challenges (New York Heart Association classification, NYHA), mental challenges (concentration limitations or memory limitations), social support, self-efficacy, and life satisfaction.
Results
1961 patients were included, 58% had CHD. Median age was 20 years and 50% were female. NYHA-class III or IV were significantly associated with poor life satisfaction (OR: 0.42 [95CI: 0.26; 0.70]) (Figure 1). Likewise, self-reported memory limitations (OR: 0.79 [95CI: 0.68; 0.91]) and concentration difficulty (OR: 0.60 [95CI: 0.51; 0.70]) were associated with poor life satisfaction (Figure 1). In contrast, reported high self-efficacy (OR: 1.67 [95CI: 1.32; 2.12]) and good social support (OR: 2.16 [95CI: 1.60; 2.93]) were both associated with high life satisfaction (Figure 1). Finally, the association between NYHA class III (OR: 0.94 [95CI: 0.34; 2.59]), memory limitations (OR: 0.79 [95CI: 0.58; 1.07]), concentration limitations (OR: 0.71 [95CI: 0.49; 1.04]), and life satisfaction was not significant among individuals with high self-efficacy but remained significant among individuals with good social support.
Conclusions
In adolescents and young adults with CHD or early acquired heart disease, reported physical and mental challenges were associated with reduced self-reported life satisfaction. Both reported high self-efficacy and good social support were associated with increased life satisfaction. High self-efficacy among individuals reduced the negative association between mental or physical challenges and life satisfaction. These findings highlight the need for increased focus on promoting self-efficacy and the need for good social support in adolescents and young adults with functional limitations from their CHD or CVD in order to improve their long-term life satisfaction.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Danish Heart Foundation
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Affiliation(s)
- M El-Chouli
- The Danish Heart Foundation , Copenhagen , Denmark
| | - N F Johnsen
- The Danish Heart Foundation , Copenhagen , Denmark
| | | | - M W Malmborg
- The Danish Heart Foundation , Copenhagen , Denmark
| | - G Gislason
- The Danish Heart Foundation , Copenhagen , Denmark
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8
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Christensen DM, El-Chouli M, Strange JE, Nouhravesh N, Sindet-Pedersen C, Schjerning A, Schou M, Gislason G, Sehested TSG. Long-term non-cardiovascular morbidity risk remains elevated following myocardial infarction: a nationwide cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1314] [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
Introduction
Risk of cardiovascular events following myocardial infarction (MI) is high, and secondary preventive treatment is largely focused on reducing future cardiovascular risk. As gradual implementation of guideline-based treatments successfully leads to improved survival, long-term non-cardiovascular morbidity is likely of rising importance following MI.
Purpose
To determine the long-term risk of non-cardiovascular morbidity in a contemporary MI population with the aim of informing the need for and scope of prolonged surveillance.
Methods
We included all patients with a first-time MI in Denmark from 2001–2018 matched on age, sex, and date of discharge with up to 4 general population controls. We used the Aalen-Johansen estimator to estimate 1-year and 5-year risk of non-cardiovascular morbidity with death as a competing risk. Non-cardiovascular morbidity was defined as an in-patient hospital admission for any primary cause excluding cardiovascular diagnoses (International classification of diseases, 10th revision codes: I00–99). We also calculated 2-year and 6-year risks of non-cardiovascular morbidity in a stable population of post-MI patients and matched controls, i.e., participants alive with no hospital admissions for 1 full year following study entry. Finally, we estimated 1-year and 5-year risks of cause-specific non-cardiovascular morbidity.
Results
A total of 124,072 patients with MI who survived to hospital discharge were matched with 496,277 general population controls. Median age was 68 years and 35.5% were female. The 1-year and 5-year risk of non-cardiovascular morbidity was elevated for patients with MI compared to controls: 38.6% (95% confidence interval: 38.3–38.9) vs 15.3% (15.2–15.4) and 64.8% (64.6–65.1) vs 45.8% (45.7–45.9), respectively (Figure 1). Regarding cause-specific morbidity, risks of respiratory disease, gastrointestinal disease, and infectious disease particularly were high (Figure 2). For example, 1-year risk of infection was 4.5% for patients with MI and 1.8% for controls and 5-year risk of respiratory disease was 16.3% for patients with MI and 9.7% for controls. Furthermore, in the stable population (patients with MI, n=50,144; controls, n=159,467, median age 64 years, 33.0% female), risk of non-cardiovascular morbidity remained elevated at 2 years (17.2% [16.8–17.5] vs 11.3% [11.1–11.5]) and 6 years (49.2% [48.7–49.7] vs 39.8% [39.6–40.1]) post MI (Figure 1).
Conclusions
Risk of non-cardiovascular morbidity was high in patients following myocardial infarction, particularly for respiratory disease, gastrointestinal disease, and infectious disease. The risk remained elevated during long-term follow up. The study highlights the importance of additional focus on non-CV morbidity to further improve outcomes.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Danish Heart Foundation
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Affiliation(s)
| | - M El-Chouli
- Danish Heart Foundation , Copenhagen , Denmark
| | - J E Strange
- Gentofte University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - N Nouhravesh
- Gentofte University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - C Sindet-Pedersen
- Gentofte University Hospital, Department of Cardiology , Copenhagen , Denmark
| | | | - M Schou
- Gentofte University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - G Gislason
- Danish Heart Foundation , Copenhagen , Denmark
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9
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Ratcovich H, Sadjadieh G, Linde JJ, Joshi FR, Kelbaek H, Kofoed KF, Koeber LV, Riis Hansen P, Torp-Pedersen C, Elming H, Gislason G, Hoefsten DE, Engstoem T, Holmvang L. The value of coronary computed tomography and very early invasive coronary angiography compared to standard intervention in older patients after non-ST segment elevation acute coronary syndromes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1441] [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 optimal management of patients with non-ST elevation acute coronary syndromes (NSTEACS) remains a challenge. The merits of both computed tomography angiography (CTA) as a rule-out test for significant coronary artery disease and early invasive coronary angiography (ICA) are debated. Furthermore, there are limited data in older NSTEACS patients, who likely have more coronary artery calcification and are at higher risk of ACS-related complications.
Methods
This is a post hoc analysis of patients ≥75 years included in the Very Early Versus Standard Care Invasive Examination and Treatment of Patients with Non-ST-Segment Elevation Acute Coronary Syndrome Trial (VERDICT). The diagnostic accuracy of CTA was investigated in patients without previous coronary artery bypass grafting, renal dysfunction, or atrial fibrillation; the presence of a coronary artery stenosis ≥50% determined by ICA was used as reference. Patients were randomised to very early ICA within 12 hours of diagnosis or standard care (ICA within 48–72 hours of diagnosis) and followed for up to five years. The primary endpoint was the composite of all-cause mortality, nonfatal recurrent MI, hospital admission for refractory myocardial ischaemia or hospital admission for heart failure.
Results
From November 2010 to June 2016, 2147 patients were included in the VERDICT trial. Of these, 452 (21%) patients were ≥75 years of age. Most older patients had a GRACE score >140 (n=388, 88.8%). At the time of admission, older patients had lower levels of haemoglobin, estimated glomerular filtration rate, and left ventricular ejection fraction, and more often displayed elevated troponins and electrocardiogram changes indicating new ischaemia, than those <75 years.
Of patients ≥75 years of age, 161 (35.6%) underwent CTA before ICA. Older patients had significantly higher calcium scores than younger patients (1187±1445 vs. 499±858 Agatston units, p<0.001). 19% of CTAs excluded significant coronary artery disease. The negative predictive value of the CTAs was 94 (95% CI 79–99)% and the sensitivity was 98 (95% CI 94–100)%, figure 1.
The primary endpoint was observed more frequently in patients ≥75 years as compared to younger patients (n=222, 49% vs. n=390, 23%, p<0.001), even after adjustment for allocated treatment (adjusted HR 2.65, 95% CI 2.25–3.13, p<0.001). Among older patients randomised to very early ICA, there were no differences in the cumulated number of primary endpoints compared to older patients randomised to standard ICA (log-rank p=0.36), figure 2.
Conclusion
Among patients ≥75 years old with NSTEACS, CTA showed a high diagnostic accuracy. A very early ICA within 12 hours of diagnosis did not improve long-term composite outcome in these older patients with NSTEACS.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Rigshospitalets Research Foundation
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Affiliation(s)
- H Ratcovich
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - G Sadjadieh
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J J Linde
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - F R Joshi
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - H Kelbaek
- Zealand University Hospital, Department of Cardiology , Roskilde , Denmark
| | - K F Kofoed
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - L V Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - P Riis Hansen
- Herlev-Gentofte University Hospital, Department of Cardiology , Gentofte , Denmark
| | - C Torp-Pedersen
- Herlev-Gentofte University Hospital, Department of Cardiology , Gentofte , Denmark
| | - H Elming
- Zealand University Hospital, Department of Cardiology , Roskilde , Denmark
| | - G Gislason
- Herlev-Gentofte University Hospital, Department of Cardiology , Gentofte , Denmark
| | - D E Hoefsten
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - T Engstoem
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - L Holmvang
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
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10
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Barcella CA, El-Chouli M, Malmborg MW, Folke F, Gislason G. Increased risk of out-of-hospital cardiac arrest in patients with congenital heart disease: a nationwide study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1672] [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
The last four decades witnessed substantial improvements in treatment of congenital heart disease (CHD) leading to most children surviving into adulthood. Currently, the number of adults with CHD surpasses that of children. The shift in the CHD population's age composition necessitates focusing on long-term problems. A significant, but not well-investigated, issue is the risk of out-of-hospital cardiac arrest (OHCA) in adults with CHD.
Purpose
To investigate overall and temporal changes in the rate of OHCA associated with CHD compared with the general population.
Method
We conducted a nested case-control study matching all adult patients with OHCA of presumed cardiac cause between 2001 and 2015 with up to five controls from the entire Danish population on age, sex, date of OHCA and cardiac comorbidities status (at least one among ischemic heart disease, heart failure and presence of implantable cardioverter-defibrillator). Patients with CHD were identified using in- and out-patient hospital diagnoses any time prior to OHCA and divided into two mutually exclusive subgroups, either non-severe or severe CHD. The subclassification of CHD is based on a hierarchical approach previously used, where at least one severe CHD diagnosis is required to be classified as severe.
We used Cox regression models to compute hazard ratios (HRs) and 95% confidence intervals (CI) of OHCA. We stratified on CHD status (non-severe, severe or control), sex and OHCA year group (2001–2008 vs 2009–2015).
Results
We included 35,005 OHCA cases and 175,025 controls: the median age was 72 years, 66.9% were male and 34.6% had cardiac comorbidities. In total, among cases, we identified 103 patients with non-severe CHD and 51 with severe CHD, while, among controls, 247 with non-severe CHD and 69 with severe CHD. Both non-severe and severe CHD were overall associated with higher rates of OHCA compared with the general population: HR 2.11 (95% CI, 1.68–2.66) and HR 3.93 (95% CI, 2.71–5.69), respectively (Figure A). We found similar results when we stratified the analyses according to the presence of cardiac comorbidities at date of OHCA (Figure B) and sex.
When stratified by OHCA year group, we observed stable rates of OHCA associated with non-severe CHD: from HR 2.03 (95% CI, 1.36–3.03) in the period 2001–2008 to HR 2.15 (95% CI, 1.62–2.86) in the period 2009–2015. Conversely, we observed a trend towards decreasing rates of OHCA associated with severe CHD: from HR 5.04 (95% CI, 2.79–9.11) in the period 2001–2008 to HR 3.10 (95% CI, 1.80–5.19) in the period 2009–2015
Conclusions
Non-severe and severe CHD were both associated with higher rates of OHCA compared with the general population. While we observed decreasing rates of OHCA over calendar year for severe CHD, they remained stable for non-severe CHD.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Gentofte University Hospital, Hellerup, Denmark
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Affiliation(s)
- C A Barcella
- The Danish Heart Foundation , Copenhagen , Denmark
| | - M El-Chouli
- The Danish Heart Foundation , Copenhagen , Denmark
| | - M W Malmborg
- Herlev and Gentofte Hospital , Copenhagen , Denmark
| | - F Folke
- Gentofte University Hospital, Department of Cardiology , Gentofte , Denmark
| | - G Gislason
- The Danish Heart Foundation , Copenhagen , Denmark
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11
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Byrne C, Barcella C, Krogager ML, Pareek M, Ringgren KB, Wissenberg M, Folke F, Gislason G, Kober L, Lippert F, Kjaergaard J, Hassager C, Torp-Pedersen C, Lip GYH, Kragholm K. External validation of the simple NULL-PLEASE clinical score in predicting outcomes in men and women with out-of-hospital cardiac arrest. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1515] [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
The NULL-PLEASE score (Nonshockable rhythm, Unwitnessed arrest, Long no-flow or Long low-flow period, blood pH <7.2, Lactate >7.0 mmol/L, End-stage renal disease on dialysis, Age ≥85 years, Still resuscitation, and Extracardiac cause) was developed to help identify patients with out-of-hospital cardiac arrest (OHCA) who are unlikely to survive. Although survival after OHCA differs between sexes, the performance of the NULL-PLEASE score according to sex has not been tested previously.
Purpose
To validate the NULL-PLEASE score separately in men and women in a nationwide setting.
Methods
Using Danish nationwide registry data from 2001–2019, we retrospectively identified male and female OHCA survivors with return of spontaneous circulation (ROSC) or ongoing cardiopulmonary resuscitation at hospital arrival. The primary outcome was 1-day mortality. Secondary outcomes were defined as 30-day mortality and the combination of 1-year mortality or anoxic brain damage. Logistic regression with a NULL-PLEASE score of 0 as reference was used for outcome risk estimation. The predictive ability of the score was assessed using area under the receiver operating characteristics (AUCROC) curves.
Results
A total of 2,601 men (median age 67 years (interquartile range (IQR) 56–76 years), and 1,280 women (median age 69 years (IQR 58–79 years) were included. One-day mortality was 31% in men and 42% in women; 30-day mortality was 56% and 71% in men and women, respectively; and 63% of men and 78% of women experienced the combined outcome. For patients with a NULL-PLEASE score ≥9, absolute risks were: 1-day mortality: 82.0% (95% confidence interval [CI]: 75.6–88.4%) for men and 79.1% (95% CI: 71.3–86.8%) for women; 30-day mortality: 98.6% (95% CI: 96.6–100.0) for men and 97.1% (95% CI: 94.0–100.0%) for women; and the combined outcome: 99.3% (95% CI: 97.9–100.0%) for men and 97.1% (95% CI: 94.0–100.0%) for women. AUCROC values for 1-day mortality were 0.827 (95% CI: 0.811–0.844) for men and 0.736 (95% CI: 0.710–0.763) for women. Results were similar for 30-day mortality and for the combined outcome. ROC curves for all outcomes are shown in Figure 1 (men) and Figure 2 (women). For a NULL-PLEASE score cut-point ≥3 to predict 1-day mortality, the positive predictive value was 91.8% in men and 91.1% in women, with a sensitivity of detecting patients who die of 47.3% in men and 51.8% in women. The corresponding negative predictive value for surviving more than 1 day was 54.6% in men and 37.7% in women, and the specificity of detecting patients who survive was 93.7% in men and 85.3% in women.
Conclusions
In a nationwide OHCA-cohort, the NULL-PLEASE score consistently appeared to perform better in men than in women for all outcomes. Nevertheless, its predictive ability was high among both sexes. Sex-specific differences should not be overlooked in clinical decision-making in patients surviving OHCA.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Heart FoundationThe Danish Foundation TrygFonden
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Affiliation(s)
- C Byrne
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - C Barcella
- Herlev-Gentofte University Hospital , Gentofte , Denmark
| | | | - M Pareek
- Herlev-Gentofte University Hospital , Gentofte , Denmark
| | | | - M Wissenberg
- Herlev-Gentofte University Hospital , Gentofte , Denmark
| | - F Folke
- Herlev-Gentofte University Hospital , Gentofte , Denmark
| | - G Gislason
- Herlev-Gentofte University Hospital , Gentofte , Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - F Lippert
- University of Copenhagen , Copenhagen , Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | | | - G Y H Lip
- Liverpool Heart and Chest Hospital , Liverpool , United Kingdom
| | - K Kragholm
- Aalborg University Hospital , Aalborg , Denmark
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12
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Knigge P, Lundberg S, Wagner AK, Strange JE, Gislason G, Fosboel E, Zahir D, Andersson C, Butt JH, Koeber L, Schou M. Temporal trends in end-stage renal disease in patients with heart failure with or without diabetes: a nationwide study from 2002 to 2017. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.895] [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
Advances in treatment of heart failure (HF) have increased survival rates. However, whether the improved life expectancy for HF patients has resulted in an increased risk of a significant comorbidity like end-stage renal disease (ESRD) is less clear. Renal dysfunction is associated with increased morbidity and mortality in HF and constitutes an important prognostic factor for HF. Further, diabetes (DM) is closely related to both HF and ESRD, but it is unknown how DM affects the risk of ESRD in patients with HF.
Purpose
To investigate temporal trends in ESRD in patients with HF and the subsequent risk of mortality stratified by DM.
Methods
Using Danish nationwide registies, we identified patients, aged 18 to 100 years, with incident HF between 2002 and 2017. The outcomes were ESRD (defined as dialysis treatment), worsening of HF (wHF, defined as rehospitalization for HF) and all-cause mortality. Three study periods were investigated 2002–2006, 2007–2011 and 2012–2017. We estimated crude 5-year incidence rates (per 1000/person-years) of the outcomes stratified by DM. Multivariate Cox regression models were performed for all outcomes stratified by DM. Further, we computed the 1-year all-cause mortality risk after diagnosis with ESRD.
Results
Of 124,141 patients with HF, 50,690 (41%) were women and the median age was 74.5 years [95% confidence interval (CI) 64.5–82.8]. At baseline DM was present in 20% of the patients. These patients were older, more often men and more comorbid than HF patients without DM. Over time (2002–2006 to 2012–2017) the incidence rates of ESRD (9.0 to 7.9 and 2.1 to 1.9 per 1000/person-years for DM and no-DM, respectively) and wHF (124.0 to 124.8 and 84.3 to 81.9 per 1000/person-years for DM and no-DM) remained stable, while all-cause mortality rates decreased (217.0 to 170.3 and 172.9 to 127.8 per 1000/person-years for DM and no-DM). The incidence of ESRD was lower compared with the incidence of wHF and all-cause mortality [Figure 1]. HF patients with DM had significantly higher associated rates of all three outcomes (in 2012–2017 the rates for DM vs no-DM of ESRD: 3.99 [3.27–4.86], wHF: 1.42 [1.36–1.49], all-cause mortality: 1.36 [1.31–1.41]) compared with patients without DM. We found no significant interaction between time period and DM on the rates of outcomes (p>0.05 for all) [Figure 2]. One-year all-cause mortality risk after diagnosis with ESRD was high both for HF patients with and without DM through all time periods (identical risks and 95% CI in 2012–2017: 32% [0.25–0.39]).
Conclusions
We did not observe a change over time in the 5-year risk of ESRD for HF patients. The incidence of ESRD remained low compared to wHF and all-cause mortality. DM was associated with increased rates of all three events, not changed over time. Conversely, all-cause mortality after diagnosis with ESRD was markedly high, irrespectively of DM. Our analyses suggest that ESRD is a less common, but fatal event in HF patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Knigge
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - S Lundberg
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - A K Wagner
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J E Strange
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - G Gislason
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - E Fosboel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - D Zahir
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - C Andersson
- Boston University, Section of Cardiovascular Medicine , Boston , United States of America
| | - J H Butt
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - M Schou
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
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13
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Garred CH, Zahir D, Butt JH, Ravn PB, Bruhn J, Gislason G, Fosboel EL, Torp-Pedersen C, Petrie MC, McMurray JJV, Koeber L, Schou M. Adherence and discontinuation of optimal heart failure therapies according to age. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.966] [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
Guideline-recommended disease-modifying pharmacological therapies for heart failure (HF) with reduced ejection fraction are underutilized, particularly among elderly patients.
Purpose
We examined adherence with and discontinuation of evidence-based HF pharmacotherapy, comprising of angiotensin-converting enzyme inhibitors (ACEi)/angiotensin-II receptor blockers (ARB), beta-blockers (BB) and mineralocorticoid receptor antagonists (MRA), according to age.
Methods
Using Danish nationwide registries, we included patients with a first HF diagnosis between 2011 and 2018. Patients were stratified into three age groups, <65 years (reference group), 65–79 years, and ≥80 years. The average daily drug dose was calculated as median proportions of target doses one year after inclusion. Adherence was estimated by the proportion of days covered (PDC), i.e., the total number of days with the drug available for a patient alive for the whole first year of the follow-up period. Discontinuation was defined as a break of >90 days, and the 5-year risk of discontinuation according to age groups was estimated with the Aalen-Johansen estimator. Multivariable Cox regression models were used to evaluate the treatment discontinuation rate according to age groups.
Results
We included a total of 29,482 patients (<65 9,449 (25.4% female), 65–79 13,746 (33.1%), ≥80 6,287 (46.3%)). Advancing age was associated with lower median proportions of daily target doses (ACEi 100%, 88%, 63%; ARB 75%, 67%, 50%; BB 75%, 56%, 44%), and lower adherence (ACEi/ARB 79.1%, 77.5%, 69.4%; BB 79.1%, 78.6%, 73.8%), in the <65, 65–79 and ≥80 age groups respectively, one year after inclusion. Age ≥80 was associated with a higher 5-year risk of discontinuation; cumulative incidence, ACEi/ARB 41%, 44%, 51%; BB 38%, 35%, 39%, in the same age group order as above (adjusted hazard ratio: ACEi/ARB 1.60 [95% CI, 1.51–1.69]; BB 1.33 [95% CI, 1.25–1.41]). Conversely, the risk of discontinuation of MRAs differed little with age (<65 50%, 65–79 54%, ≥80 56%), although MRA initiation in the most elderly was less frequent (<65 33%, 65–79 33%, ≥80 22%).
Conclusion
Among a nationwide cohort of HF patients, advanced age was associated with lower proportions of daily target doses, lower adherence, and a higher rate of discontinuation of ACEi/ARB and BBs. Focus on treatment adherence and optimal dosages among elderly HF patients could improve outcomes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C H Garred
- Herlev-Gentofte University Hospital , Gentofte , Denmark
| | - D Zahir
- Herlev-Gentofte University Hospital , Gentofte , Denmark
| | - J H Butt
- Rigshospitalet - Copenhagen University Hospital, Cardiology , Copenhagen , Denmark
| | - P B Ravn
- Herlev-Gentofte University Hospital , Gentofte , Denmark
| | - J Bruhn
- Herlev-Gentofte University Hospital , Gentofte , Denmark
| | - G Gislason
- Herlev-Gentofte University Hospital , Gentofte , Denmark
| | - E L Fosboel
- Rigshospitalet - Copenhagen University Hospital, Cardiology , Copenhagen , Denmark
| | | | - M C Petrie
- BHF Glasgow Cardiovascular Research Centre , Glasgow , United Kingdom
| | - J J V McMurray
- BHF Glasgow Cardiovascular Research Centre , Glasgow , United Kingdom
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Cardiology , Copenhagen , Denmark
| | - M Schou
- Herlev-Gentofte University Hospital , Gentofte , Denmark
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14
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Lundberg S, Knigge P, Wagner AK, Strange JE, Gislason G, Andersson C, Biering-Soerensen T, Koeber L, Fosboel E, Schou M. Temporal trends in infection-related hospitalizations in patients with heart failure: a nationwide study from 1997 to 2017. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.896] [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
Over the last 20 years mortality has decreased for patients with heart failure (HF). However, re-hospitalization for HF is still a challenge. Further, whether the improved survival has resulted in increased rates of non HF hospitalization is unknown.
Purpose
This study examined the temporal trends in infection-related hospitalizations among new-onset HF patients and compared it to temporal trends in risk of worsening HF and death.
Methods
The study population included all Danish patients aged between 18 and 100 years old, with new-onset HF (defined according to the ICD10-code system) diagnosed between 1st January 1997 and 31st December 2017. Patients who were diagnosed with any type of cancer up to five years before their HF diagnosis were excluded to avoid cancer related infections.
The outcomes of interest were infections (defined according to the ICD10-code system) and worsening of heart failure (defined as a hospital admission with HF covering at least to dates).
The Aalen Johansen's estimator was used to estimate unadjusted 5-year absolute risk for all outcomes. Furthermore, a multivariate Cox analysis was made, and hazard ratios were estimated for the four time periods presented in a forest plot with the period 1997–2001 being the reference group. Adjustments for sex, age and history of comorbidities were conducted. Additionally, we stratified the infection outcome on different types of infections illustrated in 5-year cumulative incidence curves.
Results
The total population consisted of 147,737 patients. Over time there was a slight decrease in median age (1997–2001: 76.8 years, 2011–2017: 73.1 years) and the patients were more likely to be male (1997–2001: 53.5%, 2011–2017: 60%).
Figure 1 illustrates overall absolute risk of death decreased over time 1997–2001 (62.7% [95% CI 62.2–63.2]) vs. 2011–2017 (57.9% [95% CI 41.5–42.7]). Unadjusted curves for absolute risk showed that patients with HF had a higher risk of infection over time 1997–2001 (16.4% [95% CI 16.0–16.8] vs. 2011–2017 (24.5% [95% CI 24.0–24.9]). In contrast, they have a lower risk of worsening HF 1997–2011 (26.5% [95% CI 26.1–27.0] vs. 2011–2017 (23.2% [95% CI 22.8–23.7]). Adjusted analyses provided the same result for all outcomes illustrated in figure 2.
The risk of infection stratified by infection type, mark the risk of pneumonia infection as the most significant in all subintervals 1997–2001 (11.4% [95% CI 11.1–11.7]) vs. 2011–2017 (16.1% [95% CI 15.7–16.5]). The second most important was the risk of urogenital infection 1997–2001 (3.5% [95% CI 3.31–3.69]) vs. 2011–2017 (7.8% [95% CI 7.52–8.12]).
Conclusion
In this nationwide study, we observed that overall mortality risk and risk of hospitalization for worsening HF decreased from 1997 to 2017. In contrast, an increase in the risk of hospitalization for infection, especially pneumonia infections, increased during the same period. Future HF management programs should include strategies to prevent infections.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Lundberg
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - P Knigge
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - A K Wagner
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J E Strange
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - G Gislason
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - C Andersson
- Boston University, Section of Cardiovascular Medicine , Boston , United States of America
| | - T Biering-Soerensen
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - E Fosboel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - M Schou
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
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15
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Kamil S, Sehested TSG, Blanche P, Houlind K, Lassen JF, Gislason G, Dominguez H. Antiplatelet therapy and risk of adverse cardiovascular events in peripheral artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2321] [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
Antiplatelet therapy has been shown to reduce adverse cardiovascular (CV) events in patients with PAD, but despite the well-established medication benefit, large-scale epidemiological data evaluating antiplatelet agent of choice with low bleeding risk and high antithrombotic effect is sparse.
Purpose
We explored Danish healthcare registers to examine guideline-recommended antiplatelet therapy and associated risk of adverse CV outcomes in patients with PAD.
Methods
All patients with a first-time diagnosis of PAD between January 1, 1997 and December 31, 2016 were identified. Patients alive six months after diagnosis were divided into four treatment groups: aspirin, clopidogrel, dual therapy (DAPT), and no antiplatelet therapy. Logistic regression models were used to estimate 1-year risk of myocardial infarction (MI), stroke, CV death, all-cause mortality, and gastrointestinal (GI) bleeding.
Results
We identified a total of 85,771 PAD patients [median age 70.6 (IQR 63–77 years), 52% male]. The results suggest that compared to no antiplatelet therapy, use of clopidogrel alone significantly decreased 1-year risk of incident MI, stroke, CV death and all-cause mortality with odds ratios 0.56 (CI 0.46–0.68), 0.69 (CI 0.59–0.81), 0.72 (CI 0.56–0.94), and 0.79 (CI 0.65–0.97) respectively. Likewise, aspirin monotherapy was associated with only a marginal reduction in 1-year risk of stroke by 11% and all-cause mortality by 7%. Odds ratios for GI bleeding were estimated to be 1.18 (CI 1.04–1.34), 1.34 (CI 0.94–1.91), and 1.54 (CI 1.05–2.26) for aspirin, clopidogrel, and DAPT groups, respectively.
Conclusion
In this nationwide study, clopidogrel is associated with significantly reduced risk of MI, stroke, CV death and all-cause mortality with low risk of bleeding and appears to support clopidogrel as antiplatelet agent of choice for CV risk reduction in patients with PAD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Kamil
- Gentofte University Hospital, Department of Cardiology , Hellerup , Denmark
| | - T S G Sehested
- Roskilde University Hospital, Cardiology , Roskilde , Denmark
| | - P Blanche
- University of Copenhagen, Public health and Biostatistics , Copenhagen , Denmark
| | - K Houlind
- Lillebaelt Hospital, Department of Vascular Surgery , Kolding , Denmark
| | - J F Lassen
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - G Gislason
- Gentofte University Hospital, Department of Cardiology , Hellerup , Denmark
| | - H Dominguez
- Bispebjerg University Hospital, Department of Cardiology, Frederiksberg , Copenhagen , Denmark
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Strange JE, Christensen DM, Sindet-Pedersen C, Gislason G, Schou M, Oestergaard L, Butt JH, Graversen PL, Koeber L, Olesen JB, Fosboel EL. Readmission after transcatheter aortic valve implantation according to frailty. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2107] [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
Readmissions and time spent hospitalized following transcatheter aortic valve implantation (TAVI) are important parameters of patient autonomy, particularly for frail patients with limited life-expectancy. Yet, such data remain scarce.
Purpose
To investigate actual time spent hospitalized the first year after TAVI. Secondly, to investigate time spent hospitalized according to frailty risk.
Methods
Through Danish, nationwide registries, we included all patients undergoing TAVI and alive at discharge between January 2008 and June 2020. From discharge, patients were followed until death, emigration, end of study period, or one year of follow-up, whichever came first. During follow-up, all in-patient hospital admissions were identified according to ICD-10 diagnosis codes. Length of stay was calculated, and cumulative numbers of days hospitalized was presented. Further, the proportion of patients dying within one year of follow-up was calculated.
Using The Hospital Frailty Risk Score, a validated frailty risk assessment tool, patients were categorized as low, intermediate, and high frailty risk. We then evaluated the time spent hospitalized stratified by frailty risk group.
Results
The study population comprised 5,464 patients undergoing first-time TAVI with a median age of 81 years among whom 55.2% were males. After one year, 445 (8.1%) patients had died. In total, 2,452 (44.9%) of TAVI patients survived one year and were never admitted, whereas 3,012 (55.1%) patients were admitted at least once or died within one year of TAVI. Of these, 1,200 (21.9%) patients were admitted for more than two weeks or died within one year of TAVI (Figure 1).
Regarding frailty, 3,296 (60.3%), 1,965 (36.0%), and 203 (3.7%) patients were classified as low, intermediate, and high frailty risk, respectively. In the low frailty risk group, 6.2% of patients died within one year and 50.4% survived one year without a hospital admission. By contrast, 16.7% of patients in the high frailty risk group died within one year and only 24.6% survived one year without a hospital admission. Further, 17.1% of patients in the low frailty risk group were admitted for more than two weeks or died within one year of TAVI compared with 47.3% in the high frailty risk group (Figure 2).
Conclusion
Readmissions in the first year after transcatheter aortic valve implantation were common and time spent hospitalized after transcatheter aortic valve implantation was significant. Our results were clearly related to frailty, which should be considered for future prevention strategies.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J E Strange
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | | | - C Sindet-Pedersen
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - G Gislason
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - M Schou
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - L Oestergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - J H Butt
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - P L Graversen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
| | - J B Olesen
- Herlev and Gentofte Hospital, Department of Cardiology , Copenhagen , Denmark
| | - E L Fosboel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Center , Copenhagen , Denmark
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Zoerner CR, Pallisgaard JL, Schjerning AM, Toennesen J, Jensen MK, Gislason G, Hansen ML. Temporal trends, characteristics and comorbidities of patients with hypertrophic cardiomyopathy in Denmark from 2005 to 2018: a nationwide cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1737] [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 majority of patients with Hypertrophic cardiomyopathy (HCM) are mildly symptomatic or unaware of their condition, but some develop serious complications such as heart failure, atrial fibrillation (AF) as well as sudden cardiac death. Previous studies have suggested that HCM detection-rates in women are significantly lower than in men. This leads to diagnosis often being delayed to later stages of the disease in women, where symptoms are more severe. Further characterization of HCM patients to improve early detection of adverse outcomes and warning signs might improve long-term outcomes.
Purpose
To describe the characteristics of Danish patients diagnosed with HCM between 2005–2018 and determine trends and changes in these factors over time.
Methods
All patients aged 16 years or older with a diagnosis of HCM between the 1st of January 2005 and the 31st of December 2018 were identified in Danish nationwide administrative registers and included in the study.
Time trends were calculated, and differences analyzed using the Cochran-Armitage trend test and linear regression.
Results
A total of 3856 patients were diagnosed with HCM in the study period and included in the study. The median age at diagnosis was 68 years (IQR 56 and 78 years), 53% were male, and 44% were diagnosed with obstructive HCM, while the number of patients diagnosed with HCM each year overall increased. At the time of diagnosis, 22,3% patients were previously diagnosed with ischemic heart disease, 17% with AF, 7,5% with ischemic stroke, 13,6% with heart failure. Median age and gender distribution remained stable over time, while the proportion of obstructive HCM among the newly diagnosed decreased (p = <0.001) (Figure1). During the study period, there was a significant decrease in the prevalence of heart failure (p = <0.001), ischemic heart disease (p = <0.001), and chronic obstructive pulmonary syndrome (p = <0.001), while the prevalence of AF, hypertension and ischemic stroke remained stable (Figure 2).
Conclusion
Despite previous studies describing a gender gap in patients diagnosed with HCM, gender distribution was near equal in this cohort. The number of patients diagnosed with non-obstructive HCM is increasing and the prevalence of comorbidities such as heart failure, ischemic heart disease, and COPD decreased over time.
Whether these findings are the result of improved early detection of HCM warrants further research and examination.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Herlev-Gentofte Hospital, Denmark
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Affiliation(s)
- C R Zoerner
- Herlev and Gentofte Hospital , Copenhagen , Denmark
| | | | - A M Schjerning
- Zealand University Hospital, Department of Cardiology , Roskilde , Denmark
| | - J Toennesen
- Herlev and Gentofte Hospital , Copenhagen , Denmark
| | - M K Jensen
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - G Gislason
- Herlev and Gentofte Hospital , Copenhagen , Denmark
| | - M L Hansen
- Herlev and Gentofte Hospital , Copenhagen , Denmark
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18
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Theisen CF, Wodschow K, Hansen B, Schullehner J, Gislason G, Ersbøll BK, Ersbøll AK. Drinking water magnesium and cardiovascular mortality: A cohort study in Denmark, 2005-2016. Environ Int 2022; 164:107277. [PMID: 35551005 DOI: 10.1016/j.envint.2022.107277] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Cardiovascular diseases are globally a major cause of death. Magnesium deficiency is associated with several diseases including cardiovascular diseases. OBJECTIVE To examine if a low concentration of magnesium in drinking water is associated with increased cardiovascular mortality and mortality due to acute myocardial infarction and stroke. METHODS A nationwide population-based cohort study using national health registries was used. A total of 4,274,132 individuals aged 30 years or more were included. Magnesium concentration in drinking water was estimated by linkage of residential addresses in the period 2005-2016 with the national drinking water quality monitoring database. The association between magnesium concentration in drinking water and cardiovascular mortality and mortality due to acute myocardial infarction and stroke was examined using a Poisson regression of number of deaths and logarithmic transformation of follow-up time as offset. The incidence rate ratio (IRR) was adjusted for differences in age, sex, calendar year, cohabitation, country of origin, and socioeconomic status. RESULTS Median magnesium concentration in drinking water at inclusion was 12.4 mg/L (range: 1.37-54.2 mg/L). The adjusted IRR for cardiovascular mortality was 0.96 (95% CI: 0.94; 0.97) for the lowest magnesium quintile (<6.5 mg/L) as compared to the highest magnesium quintile (>21.9 mg/L). The adjusted IRR for mortality due to acute myocardial infarction and stroke was 1.22 (1.17; 1.27) and 0.96 (0.93; 0.99), respectively, for the lowest magnesium quintile as compared to the highest quintile A decreasing mortality due to acute myocardial infarction was seen with an increasing magnesium concentration in a dose-response manner. CONCLUSION Low concentrations of magnesium in drinking water were associated with an increased mortality due to acute myocardial infarction. Low concentrations of magnesium in drinking water were associated with decreased cardiovascular mortality, and mortality due to stroke.
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Affiliation(s)
- C F Theisen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; DTU Compute, Technical University of Denmark, Kgs Lyngby, Denmark
| | - K Wodschow
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - B Hansen
- Geological Survey of Denmark and Greenland, GEUS, Aarhus, Denmark
| | - J Schullehner
- Geological Survey of Denmark and Greenland, GEUS, Aarhus, Denmark; Department of Public Health, Research Unit for Environment, Work and Health, Aarhus University, Aarhus, Denmark
| | - G Gislason
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Department of Cardiology, The Cardiovascular Research Centre, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - B K Ersbøll
- DTU Compute, Technical University of Denmark, Kgs Lyngby, Denmark
| | - A K Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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19
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Zoerner CR, Pallisgaard J, Schjerning AM, Toennesen J, Jensen MK, Gislason G, Hansen ML. Atrial fibrillation and stroke risk of patients with hypertrophic cardiomyopathy in denmark from 2005-2018: a nationwide cohort study. Europace 2022. [DOI: 10.1093/europace/euac053.163] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Internal funding: Herlev-Gentofte Cardiovascular Research Department.
Background
Hypertrophic cardiomyopathy (HCM) can be associated with serious complications such as heart failure, atrial fibrillation (AF) and sudden cardiac death. The treatment of AF in HCM patients can be challenging since AF often aggravates symptoms. Previous studies have suggested that HCM patients with AF have an elevated risk of thromboembolism and stroke compared to AF patients without HCM regardless of their CHA2DS2VASc score.
Purpose
To determine the risk of AF and stroke in HCM patients.
Methods
Through the Danish National Registers all patients aged 16 or older diagnosed with HCM between the 1st of January 2005, and the 31st of December 2018 were included in the analysis. The association between HCM, AF, and stroke was investigated using multivariable Cox proportional-hazard analysis adjusted for gender, age, atrial fibrillation, ischemic heart disease, chronic obstructive pulmonary disease, chronic kidney disease and hypertension. Cumulative incidence of AF and stroke was calculated using the Aalen-Johansen estimator, taking death as a competing risk into account.
Results
A total of 3856 patients were included, 2060 (53,4%) were male and median age of 67,8 (IQR 56 and 77,8) years. During the study period, 384 (10%) patients were diagnosed with AF. The risk of AF was significantly lower in males (HR 0,72 (0,59–0,90), p-value = 0.003) and for patients below 60 years (HR 0,18 (0,12–0,27), p-value = <0.001). (Figure 1)
157 (4,1%) of the HCM patients developed stroke. The risk of developing stroke was significantly decreased for patients aged under 60 (HR 0,32 (0,2–0,52), p-value = <0.001). There was no increased risk of stroke comparing genders.
Stroke risk was further analyzed in patients with known AF at time of inclusion, 656 (17%) in total. Compared to patients without AF and adjusted for age, gender and co-morbidities, there was no significant difference in stroke risk between these groups (HR 1.2 (0,81-1,76), p-value = 0.36). (Figure 2)
Conclusion
AF and stroke are common complications in HCM. Women are more susceptible to developing AF than men, and age over 60 at the time of diagnosis was associated with significantly higher risk of AF and stroke. HCM patients with previously known AF did not have a significantly elevated risk of stroke. More research will be needed to further explore these connections.
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Affiliation(s)
- CR Zoerner
- Herlev and Gentofte Hospital, Copenhagen, Denmark
| | | | - AM Schjerning
- Zealand University Hospital, Department of Cardiology, Roskilde, Denmark
| | - J Toennesen
- Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - MK Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - G Gislason
- Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - ML Hansen
- Herlev and Gentofte Hospital, Copenhagen, Denmark
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20
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Toennesen J, Pallisgaard J, Rasmussen PV, Ruwald MH, Zoerner CR, Gislason G, Hansen J, Johannessen A, Worck R, Hansen ML. Recurrence rates of atrial fibrillation ablation according to body mass Index, a nationwide, registry-based danish study. Europace 2022. [DOI: 10.1093/europace/euac053.242] [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: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Novo Nordisk supported the project.
Background
The proportion of people with obesity is rapidly rising, and the number of overweight patients undergoing ablation for atrial fibrillation (AF) is also increasing. The link between body mass index (BMI), and AF prevalence is well-established but the impact of BMI on the risk of recurrent AF after ablation is less elucidated. Therefore, data pertaining to recurrence rates of ablations according to BMI in large, unselected cohorts of patients is still warranted.
Purpose
To examine the risk of recurrent AF after AF ablation by BMI.
Method
Using Danish nationwide registries, all Danish patients above 18 years who underwent first-time AF ablation from January 1st 2010 to December 31st 2018 were identified and included at the date of ablation. The patients were categorized by BMI; underweight: < 18.5 kg/m2; normal weight: 18.5-24 kg/m2; overweight 25-29 kg/m2; obese 30-34 kg/m2; morbidly obese > 34 kg/m2. Recurrent AF was defined using a composite endpoint comprising claimed prescriptions of anti-arrhythmic drugs, hospital admissions due to AF, re-ablation, or electrical cardioversions. The cumulative incidence of recurrent AF by BMI at 1- and 5-year follow-up after a blanking period of 90 days, was estimated using the Aalen-Johansen estimator, takin death as competing risk in to account. The relative rates of recurrent AF by BMI were examined using Cox models adjusted for sex, age, procedure-year, heart failure, ischemic heart disease, chronic obstructive pulmonary disease, chronic kidney disease, hypertension, and diabetes.
Results
The study cohort consisted of 9,229 patients. Median age [IQR] decreased from 64 [60, 75] in the normal weight group to 60 [53, 66] in the morbidly obese. The number of patients with a CHA2DS2-VASc score of 2 or more increased from 48% in normal-weight to 65% in morbidly obese. Use of amiodarone increased by BMI category, while the use of Class 1C anti-arrhythmic medication remained stable.
Figures 1 and 2 show the 1- and 5-year cumulative incidence of recurrent AF, Hazard Ratios (HR), and 95% Confidence Intervals (CI 95%) stratified by BMI categories and depict that the risk of recurrent AF increased incrementally and significantly in overweight groups compared to normal weight patients, both in 1- and 5-year follow-up. Underweight patients demonstrated non-significantly increased risk of recurrent AF, both in 1- and 5-year follow-up.
Conclusion
In this large nationwide study examining recurrent AF post AF ablation, we found that recurrence rates of AF increased incrementally according to BMI, both in short- and long-term follow-up. Therefore, aggressive weight management in overweight patients could potentially provide substantial benefits and improve short- and long-term outcomes after ablation.
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Affiliation(s)
- J Toennesen
- Gentofte University Hospital, Gentofte, Denmark
| | | | | | - MH Ruwald
- Gentofte University Hospital, Gentofte, Denmark
| | - CR Zoerner
- Gentofte University Hospital, Gentofte, Denmark
| | - G Gislason
- Gentofte University Hospital, Gentofte, Denmark
| | - J Hansen
- Gentofte University Hospital, Gentofte, Denmark
| | | | - R Worck
- Gentofte University Hospital, Gentofte, Denmark
| | - ML Hansen
- Gentofte University Hospital, Gentofte, Denmark
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21
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Glinge C, Rossetti S, Bruun Oestergaard L, Stampe NK, Ravn Jacobsen M, Koeber L, Engstroem T, Torp-Pedersen C, Gislason G, Jabbari R, Tfelt-Hansen J. Familial clustering of unexplained heart failure - A Danish nationwide cohort study. Europace 2022. [DOI: 10.1093/europace/euac053.008] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This project has received funding from the European Union’s Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381, and the European Union’s COST programme under acronym PARQ, registered under grant agreement No CA19137.
Background
Although family history of heart failure (HF) is associated with increased risk of HF, the extent to which a family history contributes to the risk of HF needs further investigation.
Purpose
To determine whether a family history of unexplained HF in first-degree relatives (children or sibling) increases the rate of unexplained HF.
Methods
Using Danish nationwide registry data (1978-2017), we identified patients (probands) diagnosed with first unexplained HF (HF without any known comorbidities) in Denmark, and their first-degree relatives. All first-degree relatives were followed from the HF date of the proband and until an event of unexplained HF, exclusion diagnosis, death, emigration, or study end, whichever occurred first. Using the general population as a reference, we calculated adjusted standardized incidence ratios (SIR) of unexplained HF in the three groups of relatives using Poisson regression models.
Results
We identified 57,845 first-degree relatives to individuals previously diagnosed with unexplained HF. Having a family history was associated with a significantly increased unexplained HF rate of 2.08 (95% CI 1.82-2.38) (Figure 1). The estimate was higher among siblings (SIR 4.82 [95% CI 3.17-7.32]). Noteworthy, the rate of HF increased for all first-degree relatives when the proband was diagnosed with HF in a young age (≤50 years, SIR of 3.60 [95% CI 2.37-5.47]) and having >1 proband (SIR of 2.73 [95% CI 1.14-6.56]). The highest estimate of HF was observed if the proband was ≤40 years at diagnosis (6.12 [95% CI 3.39-11.05]) (Figure 2).
Conclusion
A family history of unexplained HF was associated with a two-fold increased rate of unexplained HF among first-degree relatives. If the proband age was ≤40 years, the risk was six-folded. These findings suggest that screening families of unexplained HF with onset below 50 years is indicated.
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Affiliation(s)
- C Glinge
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - S Rossetti
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - L Bruun Oestergaard
- Aalborg University, Department of Health, Science and Technology, Aalborg, Denmark
| | - NK Stampe
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - M Ravn Jacobsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - T Engstroem
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University, Department of Health, Science and Technology, Aalborg, Denmark
| | - G Gislason
- Gentofte University Hospital, Cardiology, Gentofte, Denmark
| | - R Jabbari
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
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22
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Krogager E, Lock-Hansen M, Vibe-Rasmussen P, Dalgaard F, Ruwald M, Zoner C, Toennesen J, Schjerning AM, Gislason G, Pallisgaard JL. Description of flecainide usage from 2005-2018 in the Danish population. Europace 2022. [DOI: 10.1093/europace/euac053.054] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
Flecainide is an antiarrhythmic class 1C agent used to treat cardiac arrhythmias. Due to the risk of pro-arrhythmia and 1:1 conduction with flecainide, concomitant treatment with atrioventricular nodal blocking (AVNB) agents is advised. However, little data exist pertaining to the real-world use of flecainide and concomitant AVNB therapy.
Purpose
We sought to investigate the change over time in the use of flecainide and AVNB agents in relation to patient characteristics.
Methods
Using the Nationwide Danish registers, all Danish patients above 18 years with a redeemed prescription for flecainide between January 1st, 2005, and December 31st, 2018, and included at the date of the first prescription. The use of AVNB agents was identified in the period from 180 days prior to and 180 days after the inclusion date. Individual AVNB agents were divided into beta-blockers, class IV calcium channel blockers, and digoxin.
Results
The study cohort consisted of 6,594 patients with a median [IQR] age increasing from 59 [53-65] years in 2005 to 63 [56-69] in 2018, 59 % were men, and the most frequent arrhythmia diagnosis was AF (90.1%). In total, there were 297 patients starting flecainide in 2005 and 491 in 2018, with the highest number of patients in 2011, with 613 new users (Figure 1). Compared to the 144,215 patients with prevalent atrial fibrillation in Denmark in 2018, the number of patients using flecainide was only 0.3% this year.
The percentage of patients on concomitant AVNB treatment was high throughout the study period, with 93% in 2005 and 95% in 2018, giving an average increase of 0.3% per year over time. The most frequently used AVNB was beta-blockers, and the least frequently used were the class IV calcium channel blockers. (Figure 2)
Over time, the number of patients with concomitant AVNB treatment to flecainide decreased from 94% the first year in flecainide treatment to 90% between the second and third years. Between the firth and sixth year in flecainide treatment, the number was down to 86%.
The number of patients with a diagnosis of ischemic heart disease was 10% in 2005, dropping to 6% in 2018
Conclusions
Flecainide use increased from 2005 to 2018. The use of AVNB was high in patients prescribed with flecainide and increased over time, with beta-blocker as the most frequent.
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Affiliation(s)
- E Krogager
- Copenhagen University Hospital, Department of Cardiology, Gentofte, Denmark
| | - M Lock-Hansen
- Copenhagen University Hospital, Department of Cardiology, Gentofte, Denmark
| | - P Vibe-Rasmussen
- Copenhagen University Hospital, Department of Cardiology, Gentofte, Denmark
| | - F Dalgaard
- Copenhagen University Hospital, Department of Cardiology, Gentofte, Denmark
| | - M Ruwald
- Copenhagen University Hospital, Department of Cardiology, Gentofte, Denmark
| | - C Zoner
- Copenhagen University Hospital, Department of Cardiology, Gentofte, Denmark
| | - J Toennesen
- Copenhagen University Hospital, Department of Cardiology, Gentofte, Denmark
| | - AM Schjerning
- Zealand University Hospital, Cardiology, Roskilde, Denmark
| | - G Gislason
- Copenhagen University Hospital, Department of Cardiology, Gentofte, Denmark
| | - JL Pallisgaard
- Copenhagen University Hospital, Department of Cardiology, Gentofte, Denmark
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23
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Jacobsen PA, Andersen MP, Gislason G, Phelps M, Butt JH, Køber L, Schou M, Fosbøl E, Christensen HC, Torp-Pedersen C, Gerds T, Weinreich UM, Kragholm K. Return to work after COVID-19 infection - A Danish nationwide registry study. Public Health 2022; 203:116-122. [PMID: 35038630 PMCID: PMC8786635 DOI: 10.1016/j.puhe.2021.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/08/2021] [Revised: 11/05/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to explore return to work after COVID-19 and how disease severity affects this. STUDY DESIGN This is a Nationwide Danish registry-based cohort study using a retrospective follow-up design. METHODS Patients with a first-time positive SARS-CoV-2 polymerase chain reaction test between 1 January 2020 and 30 May 2020, including 18-64 years old, 30-day survivors, and available to the workforce at the time of the first positive test were included. Admission types (i.e. no admission, admission to non-intensive care unit [ICU] department and admission to ICU) and return to work was investigated using Cox regression standardised to the age, sex, comorbidity and education-level distribution of all included subjects with estimates at 3 months from positive test displayed. RESULTS Among the 7466 patients included in the study, 81.9% (6119/7466) and 98.4% (7344/7466) returned to work within 4 weeks and 6 months, respectively, with 1.5% (109/7466) not returning. Of the patients admitted, 72.1% (627/870) and 92.6% (805/870) returned 1 month and 6 months after admission to the hospital, with 6.6% (58/870) not returning within 6 months. Of patients admitted to the ICU, 36% (9/25) did not return within 6 months. Patients with an admission had a lower chance of return to work 3 months from positive test (relative risk [RR] 0.95, 95% confidence interval [CI] 0.94-0.96), with the lowest chance in patients admitted to an ICU department (RR 0.54, 95% CI 0.35-0.72). Female sex, older age, and comorbidity were associated with a lower chance of returning to work. CONCLUSION Hospitalised patients with COVID-19 infection have a lower chance of returning to work with potential implications for postinfection follow-up and rehabilitation.
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Affiliation(s)
- P A Jacobsen
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark.
| | - M P Andersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - G Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark; The Danish Heart Foundation, Copenhagen, Denmark
| | - M Phelps
- The Danish Heart Foundation, Copenhagen, Denmark
| | - J H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - L Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - M Schou
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
| | - E Fosbøl
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | | | - C Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - T Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - U M Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - K Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Chamat-Hedemand S, Dahl A, Oestergaard L, Arpi M, Fosboel E, Boel J, Kaur KP, Oestergaard LB, Lauridsen TK, Gislason G, Torp-Pedersen C, Bruun NE. Independent risk factors of mortality in streptococcal infective endocarditis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1713] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Streptococcal bloodstream infection (BSI) is a common cause of infective endocarditis (IE), yet prognostic factors for mortality are poorly investigated.
Purpose
To investigate risk factors associated with in-hospital and one-year mortality in streptococcal IE.
Methods
All patients with a streptococcal BSI, from 2008 to 2017, were included in a regional population-based setup. Based on microbiological identification of phylogenetic relationship, streptococcal species were classified into eight main subgroups: Anginosus, Bovis, Mitis, Mutans, Salivarius, Pyogenic, nutritionally variant streptococci, and S. pneumoniae. Data were crosslinked with nationwide registries for identification of demographics, concomitant hospitalization with IE, medical history, seasonal variation, and socioeconomic status. Patients were followed up until death or a maximum of 365 days after admittance, whichever came first. Using a multivariable adjusted Cox proportional hazard analysis, independent risk factors associated with in-hospital and one-year mortality were identified.
Results
Among 6,224 patients with a streptococcal BSI, 435 (7.0%) patients with streptococcal IE (mean age 69.0 (SD 14.8), 66% men) were included. The in-hospital mortality in IE patients was 11% (n=48), while the one-year mortality was 23% (n=100). Patients infected with species from the Bovis group had the lowest crude one-year mortality (13%), while patients infected with the Salivarius group had the highest crude mortality (36%). The proportion of deaths among women with IE were significantly higher than among men, both in-hospital (15% versus 9%, p=0.04) and after one year (29% versus 20%, p=0.02). Further, patients dying within one year had a significantly higher prevalence of ischemic heart disease (IHD) (p=0.02), congestive heart failure (CHF) (p<0.0001), cerebral vascular disease (CVD) (p=0.004), cancer (p=0.04), chronic obstructive pulmonary disease (COPD) (p=0.01), and renal disease (p=0.01) than survivors. In the adjusted analysis, age (Hazard Ratio (HR) 1.03, p=0.036) and renal disease (HR 2.46, p=0.045) were associated with higher in-hospital mortality. Furthermore, three independent significant factors associated with one-year mortality were identified; CHF (HR 2.18 [95% confidence interval (CI) 1.30–3.63]), cancer (HR 1.95 [95% CI 1.01–3.77]), and age (HR 1.03 [95% CI 1.01–1.05]) (Figure 1). However, patients infected with species from the Bovis group, had significantly lower risk of death at one-year (HR 0.30 [95% CI 0.10–0.89]) (Figure 1).
Conclusion
Having a renal disease at the time of IE diagnosis was associated with a higher in-hospital mortality in patients with streptococcal infective endocarditis. Further, congestive heart failure and cancer were associated with a higher one-year mortality, while the Bovis group was associated with a lower one-year mortality.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Zealand University Hospital Roskilde and Helsefonden (20-B-0340) Figure 1. Adjusted risk of one-year mortality
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Affiliation(s)
- S Chamat-Hedemand
- Zealand University Hospital, Department of Cardiology, Roskilde, Denmark
| | - A Dahl
- Gentofte Hospital - Copenhagen University Hospital, Department of Cardiology, Hellerup, Denmark
| | - L Oestergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Arpi
- Herlev Hospital - Copenhagen University Hospital, Department of Clinical Microbiology, Copenhagen, Denmark
| | - E Fosboel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Boel
- Herlev Hospital - Copenhagen University Hospital, Department of Clinical Microbiology, Copenhagen, Denmark
| | - K P Kaur
- Zealand University Hospital, Department of Cardiology, Roskilde, Denmark
| | - L B Oestergaard
- Gentofte Hospital - Copenhagen University Hospital, Department of Cardiology, Hellerup, Denmark
| | - T K Lauridsen
- Gentofte Hospital - Copenhagen University Hospital, Department of Cardiology, Hellerup, Denmark
| | - G Gislason
- Gentofte Hospital - Copenhagen University Hospital, Department of Cardiology, Hellerup, Denmark
| | - C Torp-Pedersen
- Nordsjaellands Hospital, Department of Cardiology, Hilleroed, Denmark
| | - N E Bruun
- Zealand University Hospital, Department of Cardiology, Roskilde, Denmark
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25
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Davidovski FS, Lassen M, Skaarup K, Olsen FJ, Sengeloev M, Ravnkilde K, Lindberg S, Fritz-Hansen T, Pedersen S, Iversen A, Galatius S, Gislason G, Moegelvang R, Biering-Soerensen T. Prognostic value of layer-specific global longitudinal strain in patients undergoing coronary artery bypass grafting. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.018] [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
Recent improvements in speckle tracking echocardiography have made sectionalized quantification of layer-specific global longitudinal strain (GLS) possible. Prior studies have reported prognostic value of GLS in several cardiac diseases, however, the use of layer-specific strain has not been investigated in patients undergoing coronary artery bypass grafting (CABG).
Purpose
To determine the prognostic value of layer-specific GLS for predicting all-cause mortality after CABG.
Methods
In this retrospective cohort study, consecutive patients undergoing isolated CABG between 2006 and 2011 were included. The patients were followed through nation-wide registries for the endpoint of all-cause mortality. Multivariable Cox regression models adjusted for clinical and echocardiographic baseline characteristics were used to assess the association between layer-specific GLS and all-cause mortality. Cumulative survival was stratified by clinical age and gender-dependent cut-off values for the layer-specific GLS, which was obtained from a large healthy population study.
Results
Of 641 patients included (mean age 67 years, 84% male), 70 (10.9%) died during follow-up (median 3.8 years [IQR: 2.7; 4.9 years]). Patients who died during follow-up were significantly older (71 years vs. 67 years, P = <0.001) and had a lower LVEF (46% vs. 51% P = <0.001). Endocardial GLS (GLSendo) (−14.2% vs. −16.3%, P<0.001), whole wall GLS (−12.1% vs. −13.9%, P<0.001), and epicardial GLS (GLSepi) (−10.6% vs. −12.2%, P<0.001) were all reduced in patients who died during follow-up, and patients with GLS below cut-off had a more than two-fold increased risk of all-cause mortality (Figure 1). The risk of dying increased linearly with decreasing absolute GLS for all layers (p<0.0002 for all layers), (Figure 2). In multivariable models, all layer-specific strain parameters remained significantly associated with all-cause mortality; GLSepi: HR=1.14 (1.05–1.23), p=0.002; GLS: HR=1.12 (1.04–1.20), p=0.002; GLSendo: HR=1.09 (1.03–1.16), p=0.003, per 1% absolute decrease. However, only GLSepi remained significantly associated with mortality when also adjusting for echocardiographic parameters (GLSepi: HR=1.12 (1.00–1.25), p=0.049, per 1% absolute decrease) and separately also after adjusting for the EuroScore II (GLSepi: HR=1.09 (1.00–1.18), p=0.043, per 1% absolute decrease).
Conclusion
Layer-specific GLS is an independent prognosticator of all-cause mortality after CABG. In multivariable models, GLSepi provided significant prognostic value after adjusting for echocardiographic parameters and EuroScore II.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Research grant from Herlev & Gentofte University Hospital's internal research funds. Figure 1. Kaplan-Meier survival estimatesFigure 2. Incidence rate of all-cause mortality
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Affiliation(s)
- F S Davidovski
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - M Lassen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - K Skaarup
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - F J Olsen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - M Sengeloev
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - K Ravnkilde
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Lindberg
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - T Fritz-Hansen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Pedersen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - A Iversen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Galatius
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - R Moegelvang
- University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen, Denmark
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26
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Zylyftari N, Lee CY, Gnesin F, Moeller A, Mills E, Moeller S, Jensen B, Ringgren K, Christensen H, Blomberg N, Tan H, Folke F, Koeber L, Gislason G, Torp-Pedersen C. Prodromal symptoms of out-of-hospital cardiac arrest among patients calling emergency and non-emergency medical help services. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0673] [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
Early identification of individuals at risk of out-of-hospital cardiac arrest (OHCA) remains difficult. Little is known about symptoms presented when contacting a medical helpline prior to OHCA.
Aim
To examine the registered prodromal symptoms when patients phoned to seek medical help prior to OHCA.
Methods
OHCA patients (≥18 years) were identified from the Danish Cardiac Arrest Registry (2014–2018) and linked with calls to the non-emergency (1813-Medical Helpline) and Emergency Medical Services 1–1-2 (112). We examined (1) symptoms registered within 30 days before OHCA, categorized into eight groups and stratified by time-period and call-type; (2) hospital diagnoses and medical prescriptions according to symptom groups within 180 days before these calls.
Results
Among 974 OHCA patients who called in total within 30 days before OHCA, 816 OHCA patients (males 57%, median age 76 years [Q1-Q3: 65–84]) had a registered symptom and some of them called more than once (1,145 calls by 816 patients). Overall, the most reported group of symptoms was “Other” (29%), containing a diverse group of prodromal symptoms registered by the caregiver that did not fit into the other categories (Figure), followed by breathing problems (15%). When stratified by time-period (Figure) the most common symptom group remained “Other”. This was followed by symptoms related to the Central Nervous System (CNS)/Unconsciousness (17%) for the time-period within 0–7 days before OHCA, and by breathing problems (19%) and trauma/exposure (17%) for the time-period within 8–30 days before OHCA (Figure). When stratified by call-type, most patients (60.8%) called the 1813-Medical Helpline, where “Other” (35%) and abdominal/back/urinary (14%) symptom groups were the most common. While breathing problems (24%) and CNS/Unconsciousness (21%) were highly reported among calls to 112. Within 180-days before contact with the medical helpline, independently of the symptom group presented, respiratory-related hospital diagnoses and antibiotic medications were common.
Conclusions
Patients with OHCA who called emergency and non-emergency medical helpline 30 days before OHCA had diverse prodromal symptoms; the largest category were “Other” symptoms, followed by breathing-related symptoms.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 under the ESCAPE-NET program;Helsefonden Figure 1. Classification of the prodromal symptoms among patients that called for medical assistance. Stratified by the time-period within 0–7 days and 8–30 days before OHCA. The number of calls within 0–7 days before OHCA = 471 (399 patients), and the number of calls within 8–30 days before OHCA = 674 (500 patients).
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Affiliation(s)
- N Zylyftari
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
| | - C.J.-Y Lee
- Department of Cardiology, Nordsjaellands Hospital, Hilleroed, Denmark
| | - F Gnesin
- Department of Cardiology, Nordsjaellands Hospital, Hilleroed, Denmark
| | - A.L Moeller
- Department of Cardiology, Nordsjaellands Hospital, Hilleroed, Denmark
| | - E.H.A Mills
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - S.G Moeller
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
| | - B Jensen
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg, Denmark
| | - K.B Ringgren
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - H.C Christensen
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - N.F Blomberg
- Copenhagen University Hospital, Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - H.L Tan
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands (The)
| | - F Folke
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
| | - L Koeber
- The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - G.H Gislason
- The Danish Heart Foundation, Copenhagen, Denmark
| | - C Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Hilleroed, Denmark
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27
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Yonis H, Winkel B, Andersen MP, Wissenberg M, Kober L, Gislason G, Larsen JM, Folke F, Pedersen CT, Sogaard P, Kragholm K. Duration of resuscitation efforts and long-term prognosis following in-hospital cardiac arrest (IHCA). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1542] [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 decision to terminate resuscitation efforts can be challenging. Notably, the association between duration of resuscitation and long-term survival and functional outcomes after in-hospital cardiac arrest (IHCA) is unknown.
Purpose
To examine 30-day and 1-year survival stratified by duration of resuscitation efforts. Further, to report long term outcome (1-year survival) without anoxic brain damage or nursing home admission among 30-day IHCA survivors.
Methods
We included all patients with IHCA from 13 Danish hospitals between January 1st, 2013 to December 31st, 2015. Patients were only included if there was clinical indication for a resuscitation attempt. Data on IHCA was obtained from the DANARREST database, which was linked to national registries to retrieve information on patient characteristics, survival, anoxic brain damage and nursing home admission. Patients were stratified into four groups (A-D) according to quartiles of duration of resuscitation efforts: Group A (<5 minutes), group B (5–11 minutes), group C (12–20 minutes) and group D (≥21 minutes).
Using multivariable regression analysis, outcomes were standardized for patient age, sex, Charlson Comorbidity Index, witnessed arrest, monitored arrest, cardiopulmonary resuscitation (CPR) prior to arrival of the in-hospital cardiac arrest team and defibrillation.
Results
The study population comprised of 1868 patients, median age was 74 (1st-3rd quartile [Q1-Q3] 65–81 years) and 65.0% were men. In total, 52.1% (n=973) of the patients achieved return of spontaneous circulation (ROSC). The overall median duration of resuscitation was 12 min (Q1-Q3 5–21 min).
The standardized absolute chance of 30-day survival was 63.6% (95% CI 58.0%-69.0%) for group A, 34.0% (95% CI 29.7%-38.2%) for group B, 14.1% (95% CI 10.7%-17.5%) for group C and 9.0% (95% CI 6.8%-11.8%) for group D. Similarly, the chance of 1-year survival was highest for group A (51.5%; 95% CI 46.3%-56.7%) gradually decreasing to 7.0% (95% CI 4.5%-9.5%) in group D (Fig. 1).
Among 30-day survivors of an IHCA, the standardized absolute chance of survival without anoxic brain damage or nursing home admission within one-year post-arrest was highest for patients resuscitated in group A (83.2%; 95% CI 78.4%-88.1%), decreasing to 72.3% (95% CI 64.5%-80.0%) in group B, 68.3% (95% CI 55.3%-81.2%) in group C and 71.1% (95% CI 54.2%-88.0%) in group D (Fig. 2).
Conclusion
Short time to ROSC after in-hospital cardiac arrest is associated with better long-term prognosis. However, the majority of 30-day survivors are alive 1-year post-arrest without anoxic brain damage and without need for nursing home admission despite prolonged resuscitation.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- H Yonis
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - B Winkel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Heart Center, Copenhagen, Denmark
| | - M P Andersen
- Nordsjællands Hospital, Department of Cardiology, Hillerød, Denmark
| | - M Wissenberg
- Copenhagen University Hospital, Department of Cardiology, Herlev and Gentofte, Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Heart Center, Copenhagen, Denmark
| | - G Gislason
- Copenhagen University Hospital, Department of Cardiology, Herlev and Gentofte, Denmark
| | - J M Larsen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - F Folke
- Copenhagen University Hospital, Department of Cardiology, Herlev and Gentofte, Denmark
| | - C T Pedersen
- Nordsjællands Hospital, Department of Cardiology, Hillerød, Denmark
| | - P Sogaard
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - K Kragholm
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
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Benson CS, Dalgaard F, Rasmussen PV, Hansen ML, Lamberts M, Ruwald MH, Pallisgaard J, Gislason G, Torp-Pedersen C, Uffe Bodtger U, Jensen M, Rasmussen DB. Beta-blocker treatment in atrial fibrillation with chronic obstructive pulmonary disease: a Danish nationwide study from 1995 to 2015. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0289] [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
Atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD) often coexist. Beta-blockers are a mainstay of treatment in AF and are considered safe in COPD patients after myocardial infarction, though real-life studies have demonstrated significant under-use. Little is known on the utilization patterns in patients with AF and COPD.
Purpose
To investigate the temporal trends of beta-blocker utilization in patients following first diagnosis of AF in a hospital setting, with and without concomitant COPD, and determine clinical factors associated with beta-blocker use.
Methods
A nationwide study from 1995 to 2015 using data from the comprehensive Danish health registers. All patients with first registered AF diagnosis in a hospital setting were included. Beta-blocker use was identified by claimed prescriptions within 90 days following AF diagnosis. Factors associated with beta-blocker use or non-use in COPD patients during the most recent period (2010–2015) was examined using multivariable logistic regression and presented as odds ratios (OR) with 95% confidence intervals (95% CI).
Results
A total of 264 180 patients were included, of these 31 981 (12.1%) had COPD. Patients with concurrent COPD were older than those without COPD (median age 76 vs. 74 years), the proportion of males was similar (54%) and patients with COPD had more comorbidities, particularly cardiovascular disease. Across the 21-year study period, fewer patients with COPD used beta-blockers after AF diagnosis, than those without COPD (38.8% vs. 53.2%, p<0.001). Beta-blocker use increased in both groups during the study period (Figure 1). Nevertheless, the proportion of users was consistently lower among patients with COPD, although the difference was smaller during the most contemporary year (2015: 55.5% vs. 61.6% in COPD vs. non-COPD respectively).
Predictors for decreased beta-blocker use included high age, COPD severity represented by use of triple inhaled therapy (OR 0.84 [95% CI 0.77–0.92]), and a history of frequent COPD exacerbations (OR 0.80 [95% CI 0.74–0.86]) (Figure 2).
In a subgroup of COPD patients with complete clinical data from the Danish Register of COPD, severe airflow limitation (Forced Expiratory Volume in 1 second <30% of predicted) and high grade of dyspnoea (Modified Medical Research Council Dyspnoea scale 3–4) were associated with decreased odds for beta-blocker use (OR 0.48 [95% CI 0.38–0.59] and OR 0.67 [95% CI 0.55–0.80], respectively).
Conclusions
Beta-blocker use in patients with AF and concurrent COPD have increased considerably over a 21-year period yet remained less used than in patients without COPD. The severity of COPD was a strong negative predictor for beta-blocker use following AF diagnosis, suggesting a fear for adverse effects. The lower use of beta-blocker treatment in patients with severe COPD and AF might suggest underuse and warrants further evaluation.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Naestved - Slagelse - Ringsted Hospitals, Region Sjaelland, Denmark Figure 1. Temporal trends of beta-blocker useFigure 2. Factors associated with beta-blocker use
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Affiliation(s)
- C S Benson
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - F Dalgaard
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - P V Rasmussen
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M L Hansen
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Lamberts
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M H Ruwald
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Pallisgaard
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - G Gislason
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Torp-Pedersen
- Nordsjaellands Hospital, Department of Cardiology and Clinical Research, Copenhagen, Denmark
| | - U Uffe Bodtger
- University of Southern Denmark, Institute of Regional Health Research, Copenhagen, Denmark
| | - M Jensen
- Hvidorve Hospital, Department of Cardiology, Copenhagen, Denmark
| | - D B Rasmussen
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
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Malmborg M, Carlson N, Schmiegelow MDS, Gerds T, Schou M, Kistorp C, Torp-Pedersen C, Gislason G. Sex-differences in initiation of renin-angiotensin system inhibitors in patients with type 2 diabetes diagnosed with albuminuria. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2967] [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
Renin-angiotensin system inhibitors (RASi) are the preferred drug of choice in patients with type 2 diabetes (T2D) and albuminuria to prevent progression of chronic renal disease and cardiovascular complications. However, it is unknown whether sex-differences exist in the initiation of RASi in patients with T2D and albuminuria, and potential sex-differences in the effect of RASi on all-cause death in these patients remains untested.
Purpose
To examine potential sex-differences in the initiation of RASi in patients with T2D and albuminuria, and secondly whether these sex-differences are associated with mortality risk.
Methods
Using Danish nationwide registers, we included patients with their first albumin-creatinine ratio (ACR; index date) of ≥30 mg/g between 1 January 2014 and 20 March 2019 in patients with T2D with no prior end-stage renal disease, no acute renal failure within 90 days, and no claimed prescriptions of RASi within 15 years. We used multiple Cox regression to study the hazard ratio (HR; men vs women) of 30-day RASi initiation. In 30-day survivors, we used another multiple Cox regression to compare mortality between patients who initiated RASi and patients who did not yet initiate RASi. Reported were the sex-specific standardized 1-year risk differences for fixed comorbidity distribution according to RASi treatment.
Results
In 20,440 patients (44% women), 1,190 men and 682 women initiated RASi treatment within 30 days after index. The adjusted rate of RASi initiation was higher in men compared to women (HR 1.34 [1.22; 1.48]). This association was observed regardless of hypertension (no: HR 1.35 [1.20; 1.52]; yes: HR 1.34 [1.14; 1.57]) and ACR-group ((30–300] mg/g: HR 1.35 [1.22; 1.49]; ≥300 mg/g: HR 1.30 [0.98; 1.73]), although borderline significant for ACR ≥300 mg/g (p=0.071). The association declined with descending estimated glomerular filtration rate (eGFR) and was not significant for eGFR group (15–60] (eGFR (90–120]: HR 1.45 [1.28; 1.65]; (60–90]: HR 1.25 [1.06; 1.47]; (15–60]: HR 1.07 [0.77; 1.48]). 30 days after index, 49 patients (37% women) had died, and 9 patients (33% women) had emigrated. In 30-day survivors, the standardized 1-year mortality risk was 1.9% [1.4; 2.4] in men who readily initiated RASi, and 3.3% [3.0; 3.7] in men who did not (absolute reduction: 1.5% [0.9; 2.0]). In contrast, the absolute reduction was not significant in women (0.1% [−0.5; 0.8]). Standardizing according to sex, the associated 1-year mortality risk was 3.4% [3.1; 3.7] in men without RASi, and 2.8% [2.5; 3.0] in women (absolute risk difference 0.6% [0.3; 0.9]). In contrast, men with RASi were borderline significantly associated with a lower 1-year mortality risk compared to women with RASi (absolute risk difference 0.8% [0.0; 1.5], p=0.042).
Conclusions
In patients with T2D and albuminuria, men are more likely to initiate RASi within 30 days, and RASi appears to be associated with greater benefit on 1-year mortality risk in men.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Figure 1Figure 2
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Affiliation(s)
- M Malmborg
- The Danish Heart Foundation, Copenhagen, Denmark
| | - N Carlson
- The Danish Heart Foundation, Copenhagen, Denmark
| | | | - T Gerds
- The Danish Heart Foundation, Copenhagen, Denmark
| | - M Schou
- Herlev Hospital - Copenhagen University Hospital, Cardiology, Copenhagen, Denmark
| | - C Kistorp
- Copenhagen University Hospital, Endocrinology, Copenhagen, Denmark
| | | | - G Gislason
- The Danish Heart Foundation, Copenhagen, Denmark
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Sun G, Yafasova A, Andersson C, McMurray J, Jhund P, Docherty K, Faurschou M, Nielsen C, Shams-Eldin A, Gislason G, Torp-Pedersen C, Fosboel E, Koeber L, Butt J. Age- and Sex-Specific Rates of Heart Failure and other Adverse Cardiovascular Outcomes in Systemic Sclerosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0849] [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
Age at disease onset and sex appear to modify the disease course in patients with systemic sclerosis (SSc). Although patients with SSc have a higher risk of adverse cardiovascular outcomes than people without SSc, there are few data on age- and sex-specific risks of heart failure (HF) and other adverse cardiovascular outcomes in patients with SSc.
Objectives
To investigate the long-term rates of HF and other adverse cardiovascular outcomes (including arrhythmias, myocardial infarction, ischemic stroke, venous thromboembolism, and pulmonary hypertension) in a nationwide cohort of patients with SSc compared with the background population according to age and sex, separately.
Methods
Using Danish nationwide registries, all patients >18 years with newly diagnosed SSc (1996–2018) were identified. SSc patients were matched at a 1:4 ratio by age, sex, and comorbidities with controls from the background population without SSc. Rates of outcomes according to age (above/below median age) and sex were compared between cases and controls using Cox regression.
Results
Of the 2,019 patients diagnosed with SSc, 1,569 patients were matched with 6,276 controls from the background population (median age 55 years, 80.4% women). SSc was associated with a higher rate of HF in both women (HR 2.99 [95% CI, 2.18–4.09]) and men (HR 3.01 [1.83–4.95]) (Pfor interaction=0.88), with similar findings for other cardiovascular outcomes.For age interaction, SSc was associated with an increased rate of HF in patients <55 years (HR 4.14 [2.54–6.74]) and ≥55 years (HR 2.74 [1.98–3.78]), with similar effect of younger and older groups on HF (P for interaction=0.21), and other cardiovascular outcomes.
Conclusions
SSc was associated with an increased long-term rate of cardiovascular outcomes compared with a matched background population, with similar extent in different gender and age groups.
Funding Acknowledgement
Type of funding sources: None. Adjusted hazard ratios according to sexAdjusted hazard ratios according to age
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Affiliation(s)
- G.L Sun
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - A Yafasova
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - C Andersson
- Boston University, Department of Medicine, Boston, United States of America
| | - J.J.V McMurray
- Cardiovascular Research Centre of Glasgow, Glasgow, United Kingdom
| | - P.S Jhund
- Cardiovascular Research Centre of Glasgow, Glasgow, United Kingdom
| | - K.F Docherty
- Cardiovascular Research Centre of Glasgow, Glasgow, United Kingdom
| | - M Faurschou
- Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - C.T Nielsen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - A Shams-Eldin
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - G.H Gislason
- Herlev and Gentofte Hospital, Copenhagen, Denmark
| | | | - E.L Fosboel
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - J.H Butt
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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Garcia R, Rajan D, Barcella C, Svane J, Warming P, Jabbari R, Gislason G, Torp-Petersen C, Folke F, Tfelt-Hansen J. Racial disparities in out-of-hospital cardiac arrest in Denmark. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0647] [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
Introduction
American studies have pointed out racial disparities regarding sudden cardiac death occurrence and outcomes. Black individuals have higher sudden cardiac death rates and lower survival compared with white subjects (1). Although income and social status partly explain differences in outcomes (2), sudden cardiac death is 2-fold higher in black individuals after adjustment on these characteristics (3,4).
In Denmark, immigrants account for 9.1% of the population (5) but to date, no data exists regarding Out-of-Hospital Cardiac Arrest (OHCA) incidence.
Purpose
The main objective of this study was to compare the incidence of OHCA among native and immigrant individuals between 2001 and 2014 in Denmark.
Methods
This nationwide study included all patients identified from the Danish Cardiac Arrest Registry with OHCA of presumed cardiac cause between 18 and 80 years from 2001 to 2014 (6).
The primary outcome was OHCA occurrence defined as a clinical condition of cardiac arrest resulting in resuscitation efforts either by bystanders or by EMS personnel. The immigrant status was defined as native or immigrant according to the national database from Statistics Denmark. An immigrant was defined as a person born abroad whose both parents were either foreign citizens or born abroad.
The odds ratio of OHCA between immigrants and native Danes were adjusted according to age, sex, income, and education level.
Results
A total of 33,730 OHCA were recorded between 2001 and 2014. Among them, 1,684 occurred in immigrants and 32,046 in natives. Compared to natives, immigrant victims of OHCA were younger (62.0 [51.0, 71.0] vs. 66.0 [56.0, 74.0], p<0.001), and more often had a history of diabetes (20.5% vs. 14.0; p<0.001), myocardial infarction (11.9% vs. 8.7%; p<0.001) and chronic heart failure (17.0% vs. 14.7%; p<0.01). Female proportion was not statistically different between the two groups (30.2% vs. 31.3% of immigrants and natives respectively; p=0.32).
The incidence of OHCA was 61.0/100,000 person-years in natives and 35.0/100,000 person-years in immigrants (OR=0.57; 95% CI 0.54–0.60; p<0.001). Between 2001 and 2014, the OHCA incidence decreased from 71.4 [67.9–75.0] to 70.9 [68.2–73.6]/100 000 person-years in natives (p=0.99) and from 40.2 [30.8–51.5] to 36.5 [31.1–42.6] /100,000 person-years in immigrants (p=0.91) (Figure).
After logistic regression, compared to natives, the immigrant status was associated with 0.61-fold odds of OHCA when adjusting on age and sex (OR=0.61; 95% CI 0.59–0.65; p<0.001), and 0.65-fold odds of OHCA when adjusting on age, sex, income, and education level (OR=0.66; 95% CI 0.63–0.70; p<0.001).
Conclusion
This is the first study assessing the incidence of OHCA in immigrants versus natives in a European country. Despite higher cardiovascular burden, the incidence of OHCA was lower in immigrants even when adjusted on sex, age, income, and education reflecting a selection of individuals migrating to Denmark.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Fédération Française de Cardiologie
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Affiliation(s)
- R Garcia
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - D Rajan
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - C.A Barcella
- Gentofte University Hospital, Copenhagen, Denmark
| | - J Svane
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - P.E Warming
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - R Jabbari
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - G.H Gislason
- Gentofte University Hospital, Copenhagen, Denmark
| | | | - F Folke
- Gentofte University Hospital, Copenhagen, Denmark
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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Kamil S, Sehested TSG, Houlind K, Lassen JF, Gislason G, Dominguez H. Incidence of myocardial infarction, heart failure, and cardiovascular mortality in patients with peripheral artery disease: nationwide trends between 1997 and 2016. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2039] [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
Over the past decades there has been a shift in cardiovascular (CV) risk factors with improved outcomes. Updated trends in incidence of myocardial infarction (MI) and heart failure (HF) in peripheral artery disease (PAD) are warranted.
Purpose
We aimed to investigate trends in the incidence of MI, HF, and CV mortality in PAD patients during the past two decades.
Methods
Nationwide registers were used to identify all patients aged ≥18 years, with first-time diagnosis of PAD between 1997 and 2016. Age-standardized incidence rates per 1,000 person-years (IR) were calculated to estimate trends of MI, HF, and CV mortality. Furthermore, risk of MI, HF, and CV mortality was estimated by 1-year cumulative-incidence with death as competing risk.
Results
A total of 136,746 patients with first-time diagnosis of PAD were included. Mean age was 70.01 [IQR 61–77 years], and 53.05% of the identified patients were male. The 1-year cumulative-incidence of MI in patients with PAD were 1.88% for year 1997–2000, 2.12% for year 2001–2005, 1.59% for year 2006–2010, and 1.32% for year 2011–2016, respectively. The 1-year cumulative-incidence of HF in patients with PAD were 1.71%, 1.48%, 1.25%, and 1.11% for the 1997–2000, 2001–2005, 2006–2010, and 2011–2016 year-groups, respectively. Furthermore the 1-year cumulative-incidence of CV mortality in patients with PAD were 12.0%, 9.41%, 8.75%, and 7.80% for the 1997–2000, 2001–2005, 2006–2010, and 2011–2016 year-groups, respectively. Likewise, the age-standardized incidence rates pr. 1,000 person-years showed increasing trends of MI up until 2002 with an estimated annual percent change (APC) of +0.6 (95% CI 3.3–16.1, p-value 0.2). After year 2002 the IR decreased significantly with an estimated APC of −5.0 (95% CI 3.7–6.3, p<0.0001). The age-standardized IR for HF decreased with an estimated APC of −3.3 (95% CI 2.0–4.6, p<0.0001), and similarly for CV death decreased by −3.5 (95% CI 3.0–4.0, p<0.0001).
Conclusion
The incidence of MI and HF in patients with PAD has significantly decreased over time together with a subsequent decline in CV mortality. This may suggest that the improvements in preventive strategies aimed at reducing CV risk are effective and contributes to lower incidence of MI and HF and thereby improved mortality rates in the past two decades.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Kamil
- Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
| | - T S G Sehested
- Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
| | - K Houlind
- Lillebaelt Hospital, Department of Vascular Surgery, Kolding, Denmark
| | - J F Lassen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - G Gislason
- Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
| | - H Dominguez
- Bispebjerg University Hospital, Department of Cardiology, Frederiksberg, Copenhagen, Denmark
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van Dongen L, de Goede P, Moeller S, Eroglu T, Folke F, Gislason G, Blom M, Elders P, Torp-Pedersen C, Tan H. Temporal variation in out-of-hospital cardiac arrest occurrence in individuals with or without diabetes. Resusc Plus 2021; 8:100167. [PMID: 34604822 PMCID: PMC8473536 DOI: 10.1016/j.resplu.2021.100167] [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: 06/17/2021] [Revised: 08/24/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Out-of-hospital cardiac arrest (OHCA) occurrence has been shown to exhibit a circadian rhythm, following the circadian rhythm of acute myocardial infarction (AMI) occurrence. Diabetes mellitus (DM) is associated with changes in circadian rhythm. We aimed to compare the temporal variation of OHCA occurrence over the day and week between OHCA patients with DM and those without. Methods In two population-based OHCA registries (Amsterdam Resuscitation Studies [ARREST] 2010-2016, n = 4163, and Danish Cardiac Arrest Registry [DANCAR], 2010-2014, n = 12,734), adults (≥18y) with presumed cardiac cause of OHCA and available medical history were included. Single and double cosinor analysis was performed to model circadian variation of OHCA occurrence. Stratified analysis of circadian variation was performed in patients with AMI as immediate cause of OHCA. Results DM patients (22.8% in ARREST, 24.2% in DANCAR) were older and more frequently had cardiovascular risk factors or previous cardiovascular disease. Both cohorts showed 24 h-rhythmicity, with significant amplitudes in single and double cosinor functions (P-range < 0.001). In both registries, a morning peak (10:00-11:00) and an evening peak (20:00-21:00) was observed in both DM and non-DM patients. No septadian variation was observed in either DM or non-DM patients (P-range 0.13-84). Conclusions In these two population-based OHCA registries, we observed a similar circadian rhythm of OHCA occurrence in DM and non-DM patients.
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Affiliation(s)
- L.H. van Dongen
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Experimental and Clinical Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - P. de Goede
- Laboratory of Endocrinology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Hypothalamic Integration Mechanisms Group, Netherlands Institute for Neuroscience (NIN), an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - S. Moeller
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - T.E. Eroglu
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Experimental and Clinical Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - F. Folke
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
- Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - G. Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - M.T. Blom
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Experimental and Clinical Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - P.J.M. Elders
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice Medicine, Amsterdam Public Health Institute, De Boelelaan 1117, Amsterdam, Netherlands
| | - C. 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, Denmark
| | - H.L. Tan
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Experimental and Clinical Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
- Corresponding author at: Amsterdam UMC, Academic Medical Center, Heart Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Carlson N, Nelveg-Kristensen KE, Freese Ballegaard E, Feldt-Rasmussen B, Hornum M, Kamper AL, Gislason G, Torp-Pedersen C. Increased vulnerability to COVID-19 in chronic kidney disease. J Intern Med 2021; 290:166-178. [PMID: 33452733 PMCID: PMC8014284 DOI: 10.1111/joim.13239] [Citation(s) in RCA: 24] [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] [Received: 09/20/2020] [Accepted: 12/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The significance of chronic kidney disease on susceptibility to COVID-19 and subsequent outcomes remains unaddressed. OBJECTIVE To investigate the association of estimated glomerular filtration rate (eGFR) on risk of contracting COVID-19 and subsequent adverse outcomes. METHODS Rates of hospital-diagnosed COVID-19 were compared across strata of eGFR based on conditional logistic regression using a nested case-control framework with 1:4 matching of patients diagnosed with COVID-19 with controls from the Danish general population on age, gender, diabetes and hypertension. Risk of subsequent severe COVID-19 or death was assessed in a cohort study with comparisons across strata of eGFR based on adjusted Cox regression models with G-computation of results to determine 60-day risk standardized to the distribution of risk factors in the sample. RESULTS Estimated glomerular filtration rate was inversely associated with rate of hospital-diagnosed COVID-19: eGFR 61-90 mL/min/1.73m2 HR 1.13 (95% CI 1.03-1.25), P = 0.011; eGFR 46-60 mL/min/1.73m2 HR 1.26 (95% CI 1.06-1.50), P = 0.008; eGFR 31-45 mL/min/1.73m2 HR 1.68 (95% CI 1.34-2.11), P < 0.001; and eGFR ≤ 30 mL/min/1.73m2 3.33 (95% CI 2.50-4.42), P < 0.001 (eGFR > 90 mL/min/1.73m2 as reference), and renal impairment was associated with progressive increase in standardized 60-day risk of death or severe COVID-19; eGFR > 90 mL/min/1.73m2 13.9% (95% CI 9.7-15.0); eGFR 90-61 mL/min/1.73m2 16.1% (95% CI 14.5-17.7); eGFR 46-60 mL/min/1.73m2 17.8% (95% CI 14.7-21.2); eGFR 31-45 mL/min/1.73m2 22.6% (95% CI 18.2-26.2); and eGFR ≤ 30 mL/min/1.73m2 23.6% (95% CI 18.1-29.1). CONCLUSIONS Renal insufficiency was associated with progressive increase in both rate of hospital-diagnosed COVID-19 and subsequent risk of adverse outcomes. Results underscore a possible vulnerability associated with impaired renal function in relation to COVID-19.
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Affiliation(s)
- N Carlson
- From the, Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark.,The Research Department, The Danish Heart Foundation, Copenhagen, Denmark
| | - K-E Nelveg-Kristensen
- From the, Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark
| | - E Freese Ballegaard
- From the, Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark
| | - B Feldt-Rasmussen
- From the, Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark
| | - M Hornum
- From the, Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark
| | - A-Lise Kamper
- From the, Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark
| | - G Gislason
- The Research Department, The Danish Heart Foundation, Copenhagen, Denmark.,Department of Cardiovascular Research, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - C Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Hilleroed, Denmark
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Brainin P, Lindberg S, Olsen F, Pedersen S, Iversen A, Galatius S, Fritz-Hansen T, Gislason G, Soegaard P, Moegelvang R, Biering-Soresen T. Prognostic utility of early systolic lengthening by speckle tracking in patients undergoing coronary artery bypass graft. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.181] [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
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Independent Research Fund Denmark
Background
Early systolic lengthening (ESL), a paradoxical stretch of myocardial fibers, has been linked to myocardial viability and contractile dysfunction. We assessed the long-term prognostic potential of ESL in coronary artery bypass graft (CABG) patients.
Methods
We retrospectively included patients (n = 709; mean age 68 years; 85% men) who underwent speckle tracking echocardiography (median 15 days) prior to CABG. Endpoints were cardiovascular death (CVD) and all-cause mortality. We assessed amplitude of ESL (%), defined as peak positive strain, and duration of ESL (ms), determined as time from Q-wave on the ECG to peak positive strain. We applied Cox proportional hazards models adjusted for the clinical risk tool, EuroSCORE II.
Results
During median follow-up of 3.8 years [IQR 2.7 to 4.9 years], 45 (6%) experienced CVD and 80 (11%) died. In survival analyses adjusted for EuroSCORE II, amplitude of ESL was associated with CVD (HR 1.37 [95%CI 1.13 to 1.66], P = 0.001) and all-cause mortality (HR 1.31 [95%CI 1.13 to 1.54], P = 0.001). Similar findings applied to duration of ESL and CVD (HR 1.17 [95%CI 1.08 to 1.26], P < 0.001) and all-cause mortality (HR 1.14 [95%CI 1.07 to 1.21], P < 0.001). The prognostic value of ESL amplitude was modified by sex (P interaction < 0.05), such that it was greater in women for both endpoints (Figure 1A-B). When adding ESL duration to EuroSCORE II, the net reclassification index improved significantly for both CVD and all-cause mortality.
Conclusions
Assessment of ESL provides independent and incremental prognostic information in addition to the EuroSCORE II for CVD and all-cause mortality in CABG patients. The prognostic value was greater in women.
Abstract Figure. Prognostic value of ESL amplitude by sex
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Affiliation(s)
- P Brainin
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Lindberg
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - F Olsen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Pedersen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - A Iversen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Galatius
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - T Fritz-Hansen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - P Soegaard
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - R Moegelvang
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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Ravnkilde K, Skaarup K, Grove GL, Modin D, Nielsen AB, Falsing MM, Iversen AZ, Pedersen S, Fritz-Hansen T, Galatius S, Jespersen T, Shah A, Gislason G, Biering-Soerensen T. Longitudinal change in cardiac structure and function following acute coronary syndrome stratified by culprit coronary artery lesion site. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.144] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Acute coronary syndrome (ACS) has adverse consequences for the myocardium and subsequent cardiac function and structure. No reports exist comparing the differences in impact of culprit coronary artery lesion site on longitudinal remodeling and changes left ventricular structure and function.
Method
A total of 299 ACS patients treated with PCI were included in the present study. All patients had two echocardiographic examinations performed. The first was performed median 2 (IQR: 1; 3) days following PCI, while the second was performed median 240 (IQR: 81; 881) days after the first. Patients were grouped based on culprit coronary artery lesion (left anterior descending artery (LAD), right coronary artery (RCA) and circumflex artery (Cx)). Patients with multiple lesions were excluded from the present study. Univariable linear regression analysis was utilised to assess the association between culprit coronary artery lesion site and longitudinal change in cardiac structure and function.
Results
Mean age was 63 ± 11 years and 77% were male. At follow-up, mean left ventricular ejection fraction was 42 ± 9% and global longitudinal strain (GLS) was -13 ± 4%. Culprit coronary artery lesion was allocated as follows; 168 ACS patients were treated in LAD, 95 patients were treated in RCA, and 36 patients were treated in Cx. In the linear regression analysis, LAD patients displayed a greater improvement in GLS (b =-0.116, p = 0.048) compared to the two other lesion sites. LAD patients had the poorest GLS at both baseline and follow-up echocardiography (Figure). RCA lesions were associated with the largest decrease in left atrial maximum volume (LAVmax) (b = -0.156, p = 0.011) and the largest increase in relative wall thickness (RWT) (b = 0.139, p = 0.030), consequently resulting in an LAVmax smaller and an RWT larger at follow-up than other lesion sites (Figure). Lastly, Cx lesions were significantly associated with the largest decrease in ratio between peak early diastolic transmitral flow velocity and peak early diastolic mitral annular tissue velocity (E/e’) (b = -0.262, P <0.001). Cx lesion patients were observed to have elevated E/e’ at baseline, which generally normalised at follow-up (Figure).
Conclusion
The present study suggests that culprit coronary artery lesion site has a differential impact on cardiac remodeling. This information can potentially aid the clinical understanding of cardiac structure and function following ACS according to coronary artery lesion site.
Abstract Figure
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Affiliation(s)
- K Ravnkilde
- Gentofte University Hospital, Gentofte, Denmark
| | - K Skaarup
- Gentofte University Hospital, Gentofte, Denmark
| | - GL Grove
- Gentofte University Hospital, Gentofte, Denmark
| | - D Modin
- Gentofte University Hospital, Gentofte, Denmark
| | - AB Nielsen
- Gentofte University Hospital, Gentofte, Denmark
| | - MM Falsing
- Gentofte University Hospital, Gentofte, Denmark
| | - AZ Iversen
- Gentofte University Hospital, Gentofte, Denmark
| | - S Pedersen
- Gentofte University Hospital, Gentofte, Denmark
| | | | - S Galatius
- Frederiksberg University Hospital, Department of Cardiology, Frederiksberg, Denmark
| | - T Jespersen
- Gentofte University Hospital, Gentofte, Denmark
| | - A Shah
- Brigham And Women"S Hospital, Harvard Medical School, Department of Cardiology, Boston, United States of America
| | - G Gislason
- Gentofte University Hospital, Gentofte, Denmark
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Olsen FJ, Mogelvang R, De Knegt MC, Galatius S, Pedersen S, Modin D, Ravnkilde K, Gislason G, Biering-Sorensen T. Left ventricular end-diastolic pressure is associated with left atrial functional measures by echocardiography. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.015] [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
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation
Background
Assessment of maximal LA volume (LAVmax) is recommended in imaging guidelines but evidence suggests additional value of functional LA measures. How extended measures of LA function associate to left ventricular filling pressure has not been fully explored.
Purpose
To investigate the association between functional LA measures and left ventricular end-diastolic pressure (LVEDP)
Methods
Patients suspected of coronary artery disease referred for angiography had simultaneous left heart catheterization performed for invasive pressure measurements. LVEDP > 12mmHg was considered elevated. LA measurements by echocardiography included: LAVmax, minimal LA volume (LAVmin), total LA emptying fraction (total LAEF), passive LA emptying fraction (passive LAEF), and active LA emptying fraction (active LAEF).
Results
Of 43 patients, 28 (65%) had elevated LVEDP. These patients more frequently had coronary vessel disease (VD) and impaired LA mechanics by all accounts except by LAVmax.
All LA measures except LAVmax were associated with LVEDP in unadjusted linear regression analyses, however, only LA emptying fractions remained associated with LVEDP after adjusting for age and VD (2.6 (1.2-4.0) mmHg increase, p = 0.001, per 5% decrease in total LAEF; 1.4 (0.1-2.8) mmHg increase, p = 0.040, per 5% decrease in active LAEF; 1.8 (0.1-3.4) mmHg increase, p = 0.038, per 5% decrease in passive LAEF).
In logistic regression, passive LAEF was significantly associated with elevated LVEDP (figure), and this was also the case after adjusting for age and VD (OR = 1.11 (1.01-1.21), p = 0.023, per 1% decrease). Similar findings were made in subgroup analyses among patients without dilated LA and patients without conventional indicators of elevated filling pressure.
Conclusion
Left ventricular end-diastolic pressure is significantly associated with LA functional measures but not LA volumes. Additionally, passive LAEF is associated with elevated LVEDP. Future studies examining LA function should include all components of LAEF.
Abstract Figure.
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Affiliation(s)
- FJ Olsen
- Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - R Mogelvang
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - MC De Knegt
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - S Galatius
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - S Pedersen
- Dept. of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - D Modin
- Dept. of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - K Ravnkilde
- Dept. of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - G Gislason
- Dept. of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T Biering-Sorensen
- Dept. of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Falkentoft A, Zareini B, Wichmand C, Hansen T, Selmer C, Schou M, Gaede P, Staehr P, Hlatky M, Torp-Pedersen C, Gislason G, Bruun N, Ruwald A. Socioeconomic position influences the risk of first-time cardiovascular event in patients with type 2 diabetes in spite of equal access to healthcare – a Danish nationwide cohort study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2807] [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
Social inequality poses a major public health challenge. Low socioeconomic position has been associated with cardiovascular disease in patients without diabetes. Yet, the association between socioeconomic position, type 2 diabetes, and first-time cardiovascular disease has not previously been investigated in a nationwide cohort from a country with equal access to healthcare.
Purpose
To examine the association between socioeconomic position and development of first-time major adverse cardiovascular events (MACE) in a Danish nationwide population of patients with incident type 2 diabetes.
Methods
Using the Danish nationwide registers, we identified all Danish residents with newly diagnosed type 2 diabetes between 2000 and 2017. Patients aged 40–79 years, without a history of ischemic heart disease and/or stroke were included. Income was used as a surrogate for socioeconomic position, and was assessed as quartiles of inflation adjusted, mean five-year income prior to index. Multivariable Cox proportional hazard analyses were used to assess the association between income and the primary composite outcome of ischemic stroke, acute myocardial infarction, and cardiovascular mortality (MACE). We assessed income as a time-dependent variable and adjusted for age, gender, calendar year, baseline comorbidities, and medication.
Results
In total 107,612 patients were included with a median age of 63 (interquartile range [IQR] 55–70) years and a median follow-up time of 6.8 (IQR 3.5–10.6) years. Patients in the lowest income quartile were older (median age 69 vs. 60 years) and more likely to be female (53.3% vs 36.7%) compared with the highest quartile (all P<0.0001). The 10-year risk of MACE decreased with higher income quartile: 30.3% (n=6814) in 1st quartile, 23.4% (n=4760) in 2nd quartile; 19.1% (n=3861) in 3rd quartile; 16.0% (n=3042) in 4th quartile (P<0.0001). In adjusted analysis, using the highest quartile as reference, the relative risk of MACE was inversely proportional to income (P-trend<0.0001): hazard ratio (HR) 1.59 (95% confidence interval [95% CI] 1.52–1.66) in 1st quartile; HR 1.42 (95% CI 1.36–1.49) in 2nd quartile; 1.20 (95% CI 1.14–1.25) in 3rd quartile. We found age specific differences in the risk of MACE between the younger (40–64 years) and the older (65–79 years) patients (P-interaction = 0.007). In stratified adjusted analysis, the youngest age group were associated with higher HR's compared to the oldest age group (Figure). The absolute unadjusted risk of MACE was highest in the elderly with low income.
Conclusions
Despite equal access to healthcare, low socioeconomic position was independently associated with an increased risk of first-time MACE in patients with incident type 2 diabetes. The finding was significant across age groups with the highest relative risks of MACE among younger patients. Our results indicate the importance of prevention strategies targeting patients with low socioeconomic position.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Zealand University Hospital Roskilde
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Affiliation(s)
- A.C Falkentoft
- Zealand University Hospital, Cardiology, Roskilde, Denmark
| | - B Zareini
- Gentofte University Hospital, Cardiology, Gentofte, Denmark
| | - C Wichmand
- Zealand University Hospital, Cardiology, Roskilde, Denmark
| | - T.B Hansen
- Zealand University Hospital, Cardiology, Roskilde, Denmark
| | - C Selmer
- Bispebjerg University Hospital, Endocrinology, Copenhagen, Denmark
| | - M Schou
- Herlev Hospital, Department of Cardiology, Herlev, Denmark
| | - P.H Gaede
- Slagelse Hospital, Endocrinology, Slagelse, Denmark
| | - P.B Staehr
- North Denmark Regional Hospital, Cardiology, Hjoerring, Denmark
| | - M.A Hlatky
- Stanford University School of Medicine, Department of Health Research and Policy, Stanford, United States of America
| | - C Torp-Pedersen
- Nordsjaellands Hospital, Department of clinical investigation and cardiology, Hilleroed, Denmark
| | - G.H Gislason
- Gentofte University Hospital, Cardiology, Gentofte, Denmark
| | - N.E Bruun
- Zealand University Hospital, Cardiology, Roskilde, Denmark
| | - A.C Ruwald
- Zealand University Hospital, Cardiology, Roskilde, Denmark
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Binding C, Olesen J, Lee C, Sindet-Petersen C, Pedersen C, Gislason G, Bonde A. Men who live alone have high risk of NOAC discontinuation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2425] [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/Introduction
Patients with atrial fibrillation (AF), who are considered at risk of stroke, are treated with oral anticoagulants (OACs), and non-vitamin K antagonist oral anticoagulants (NOACs) are preferred over vitamin K antagonists in recent guidelines. Poor NOAC compliance among patients with AF could result in an increased risk of thromboembolism and major bleeding, however, it has yet to be evaluated how cohabitant status and gender affects compliance with NOAC treatment among patients with AF.
Purpose
The aim of this study was to evaluate the risk of NOAC discontinuation among patients with AF according to cohabitant status and gender.
Methods
Using the Danish national registries we identified and included patients with AF aged 40–90 years in treatment with NOAC. The study period was from 2013 to 2017, and patients were followed for two years, or until death, outcome or emigration. The main outcome was discontinuation of NOAC-treatment for at least 30 days. Absolute risks were calculated as cumulative incidences using the Aalen Johansen estimator, and multiple covariate adjusted Cox regressions were used to calculate hazard ratios (HR).
Results
We included 32,380 patients with AF in NOAC treatment, where 16.8% were men living alone (median age 72 years), 25.8% were women living alone (median age 79 years), 37.2% were men living with a partner (median age 70 years), and 20.2% were women living with a partner (median age 79 years). Absolute two-year risk of NOAC discontinuation was highest among men living alone (Cumulative Incidence (CI) 0.19; 95% CI: 0.17 to 0.20), followed by men living with a partner (CI 0.18; 0.17 to 0.19), women living with a partner (CI 0.16; 0.15 to 0.17), and women living alone (CI 0.13; 0.12 to 0.14). After adjustment, living alone was associated with an increased risk of NOAC discontinuation among men (HR 1.15, 95% CI: 1.05 to 1.26), but not among women (HR 1.04, 95% CI: 0.93 to 1.15, interaction p=0.32). In an analysis evaluating gender, we found that being male was associated with a significantly higher risk of NOAC-discontinuation (HR 1.18, CI: 1.10 to 1.25) compared to women.
Results were similar when we used 60 days discontinuation instead of 30 days discontinuation as outcome.
Conclusion
Gender and cohabitant status was significantly associated with risk of NOAC discontinuation. Male gender and living alone was associated with a higher risk of NOAC discontinuation among patients with AF in a nationwide population.
Adjusted relative two-year risks
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Binding
- Gentofte University Hospital, Gentofte, Denmark
| | - J.B Olesen
- Gentofte University Hospital, Gentofte, Denmark
| | - C Lee
- Gentofte University Hospital, Gentofte, Denmark
| | | | | | - G Gislason
- Gentofte University Hospital, Gentofte, Denmark
| | - A Bonde
- Gentofte University Hospital, Gentofte, Denmark
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Ravn Jacobsen M, Engstroem T, Torp-Pedersen C, Gislason G, Glinge C, Holmvang L, Pedersen F, Koeber L, Jabbari R, Soerensen R. Efficacy and safety of clopidogrel, ticagrelor, and prasugrel in an all-comers population of patients with ST-segment elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1768] [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
Until 2009, aspirin and clopidogrel were recommended for most patients with acute coronary syndrome (ACS). After 2009, this recommendation was changed to aspirin combined with prasugrel or ticagrelor since randomised trials had demonstrated reduced cardiovascular mortality and ischemic events, however with a slight increase in bleeding risk. Randomised clinical trials often include selected patients and the results may not be generalisable to an all-comers population of high-risk ACS patients.
Purpose
To compare efficacy and safety of clopidogrel, ticagrelor, and prasugrel in all-comers patients with ST-segment elevation myocardial infarction (STEMI).
Methods
The Eastern Danish Heart Registry was utilised to identify all consecutive STEMI patients admitted to the capital region from 2009–2016. By individual linkage to Danish nationwide registries, claimed drug prescriptions and end points were obtained. Patients alive a week after discharge were included and stratified according to clopidogrel, ticagrelor, or prasugrel treatment, and followed for 18 months. The risk of the primary efficacy end point (a composite of all-cause mortality, recurrent myocardial infarction, and ischemic stroke) and the safety end point (bleeding events leading to hospital admission) were assessed by multivariate Cox proportional-hazard models.
Results
In total, 4841 STEMI patients were included (clopidogrel [n=1222], ticagrelor [n=1820], prasugrel [n=1799]). The median age was 66 (IQR 57–76) for clopidogrel, 64 (IQR 54–73) for ticagrelor, and 59 (IQR 51–67) for prasugrel, and only 19% were women of the prasugrel treated patients (29% for clopidogrel, 25% for ticagrelor). Treatment with anticoagulant therapy was 21% for clopidogrel treated patients (4% for ticagrelor, 5% for prasugrel). Number of events and incidence rates/100 years (IR) for the primary efficacy end point were 165 (IR 9.7) for clopidogrel, 134 (IR 5.1) for ticagrelor, and 107 (IR 4.1) for prasugrel, and for bleeding events 57 (IR 3.3) for clopidogrel, 60 (IR 2.3) for ticagrelor, and 55 (IR 2.1) for prasugrel treatment. Compared with clopidogrel, a reduction in the primary efficacy end point was found in patients treated with both ticagrelor (HR 0.47, 95% CI 0.36–0.63, p<0.001) and prasugrel (HR 0.49, 95% CI 0.36–0.67, p<0.001) with no difference in bleeding events (HR 0.71, 95% CI 0.45–1.13, p=0.15 and HR 0.72, 95% CI 0.44–1.17, p=0.18, respectively). No differences were found between prasugrel and ticagrelor treated patients for the primary efficacy end point (HR 0.83, 95% CI 0.60–1.16, p=0.28) or safety end point (HR 0.97, 95% CI 0.61–1.54, p=0.90).
Conclusion
Ticagrelor and prasugrel treatment in all-comers STEMI patients were associated with reduced rates of all-cause mortality and ischemic events without an increase in bleeding events when compared with clopidogrel treatment. No differences in efficacy or safety were found between prasugrel and ticagrelor treated patients.
Efficacy+safety end points at 18 months
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Ravn Jacobsen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - T Engstroem
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - C Torp-Pedersen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, Gentofte, Denmark
| | - C Glinge
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - L Holmvang
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - F Pedersen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - R Jabbari
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - R Soerensen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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Chamat S, Dahl A, Oestergaard L, Arpi M, Fosboel E, Boel J, Oestergaard L, Lauridsen T, Gislason G, Torp-Pedersen C, Bruun N. Prevalence of infective endocarditis in streptococcal bloodstream infections is dependent on streptococcal species. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2015] [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
Streptococci frequently cause infective endocarditis (IE), yet the prevalence of IE in patients with bloodstream infections (BSIs) caused by different streptococcal species is unknown.
Purpose
To investigate the prevalence of IE in BSIs with different streptococcal species.
Methods
We included all patients with streptococcal BSIs, from 2008 to 2017, in a population-based setup. Based on microbiological identification of phylogenetic relationship, streptococcal species were classified into eight main groups: Anginosus, Bovis, Mitis, Mutans, Salivarius, Pyogenic, S. pneumoniae, and “other streptococci”. Using nationwide registries, we determined the prevalence of IE at streptococcal group level and at species level. In a multivariable logistic regression analysis, we investigated the risk of IE according to streptococcal species with S. pneumoniae as reference and adjusted for age, sex, ≥3 positive blood culture (BC) bottles, native valve disease, prosthetic valve, previous IE, and cardiac device.
Results
In 6,506 cases with streptococcal BSIs (mean age 68.1 years (SD 16.2), 52.8% men), the IE prevalence was 7.1% (95% CI: 6.5–7.8%). For the most common streptococcal species (>5% of BSIs), the IE prevalence was: S. pneumoniae 1.2% (95% CI: 0.8–1.6%), S. dysgalactiae 6.4% (95% CI: 4.9–8.2%), S. pyogenes 1.9% (95% CI: 0.9–3.3%), S. agalactiae 9.1% (95% CI: 6.6–12.1%), S. anginosus 4.8% (95% CI: 3.0–7.3%), and S. mitis/oralis 19.4% (95% CI: 15.6–23.5%) (Figure 1). For moderately common streptococcal species (1–5% of BSIs), the IE prevalence was: S. gallolyticus 30.2% (95% CI: 24.3–36.7%), S. salivarius 5.8% (95% CI: 2.9–10.1%), S. sanguinis 34.6% (95% CI: 26.6–43.3%), S. parasanguinis 10.3% (95% CI: 5.2–17.7), and S. gordonii 44.2% (95% CI: 34.0–54.8%). For uncommon streptococcal species (0.1–1% of BSIs), the highest IE prevalence was in S. mutans with 47.9% (95% CI: 33.3–62.8%). In a multivariable adjusted analysis using S. pneumoniae as a reference, we identified that all species except S. pyogenes were associated with a significantly higher IE risk (Figure 1). The highest associated IE risk was found in S. mutans (OR 81.3, 95% CI: 37.6–176), S. gordonii (OR 80.8, 95% CI: 43.9–149), S. sanguinis (OR 59.1, 95% CI: 32.6–107), S. gallolyticus (OR 31.0, 95% CI: 18.8–51.1), and S. mitis/oralis (OR 31.6, 95% CI: 19.8–50.5) (Figure 1).
Conclusion
The prevalence of IE in streptococcal BSIs is highly species dependent with the lowest IE prevalence observed in S. pneumoniae and S. pyogenes BSIs, whereas S. mutans, S. gordonii, S. sanguinis, S. gallolyticus and S. mitis/oralis had the highest IE prevalence and the highest associated IE risk after adjusting for IE risk factors.
Figure 1. Risk of IE in streptococcal BSIs
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Herlev-Gentofte University Hospital
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Affiliation(s)
- S Chamat
- Zealand University Hospital, Department of Cardiology, Roskilde, Denmark
| | - A Dahl
- Gentofte University Hospital, Copenhagen, Denmark
| | - L Oestergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Arpi
- Herlev Hospital - Copenhagen University Hospital, Department of Clinical Microbiology, Copenhagen, Denmark
| | - E Fosboel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Boel
- Herlev Hospital - Copenhagen University Hospital, Department of Clinical Microbiology, Copenhagen, Denmark
| | | | | | - G Gislason
- Gentofte University Hospital, Copenhagen, Denmark
| | - C Torp-Pedersen
- Hillerod Hospital, Department of Cardiology and Clinical Research, Hillerod, Denmark
| | - N.E Bruun
- Zealand University Hospital, Department of Cardiology, Roskilde, Denmark
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Olsen F, Darkner S, Gotze J, Chen X, Henningsen K, Pehrson S, Gislason G, Svendsen J, Biering-Sorensen T. Association between natriuretic peptides and left atrial structural and functional properties in atrial fibrillation following catheter ablation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0487] [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
Atrial natriuretic peptides (ANP) and brain natriuretic peptides (BNP) are acutely released from the atrial myocytes upon increased mechanical distension of the atria. The relationship between imaging measures of left atrial (LA) structure and function and natriuretic peptides following catheter ablation (CA) have not been clearly delineated.
Purpose
To characterize the relationship between LA structure and function and natriuretic peptides.
Methods
We performed an echocardiographic substudy of a randomized trial of AF patients scheduled for CA. Echocardiographic measurements included: LA volume at end-systole (LAVi), at end-diastole (LAEDVi), emptying fraction (LAEF), LA reservoir strain (LAs), and global longitudinal strain (GLS). Patients were stratified by tertiles of mid-regional proANP (MR-proANP) concentrations in circulation (<92 pmol/l, 92–146 pmol/l, >146 pmol/l), and NT-proBNP (<10pmol/l, 10–38 pmol/l, >38 pmol/l). Linear regressions were performed to compare baseline echocardiographic measures to natriuretic peptide concentrations at baseline, 1 month, 3 months and 6 months of follow-up. MR-proANP and NT-proBNP were logarithm transformed in these analyses. Multivariable adjustments were made for: age, gender, AF subtype, AF burden, rhythm during echocardiogram, rhythm at study visit for blood sampling, time known with AF, beta-blocker use, and CHA-2DS2-VASc score.
Results
We included 101 patients with AF. The mean age was 58 years, 82% were men, 46% had persistent AF. Increasing tertiles of MR-proANP at baseline were associated with abnormal LA size and function (3rd vs 1st tertile: LAVi: 42mL/m2 vs 32mL/m2; LAEDVi: 31mL/m2 vs 20mL/m2; LAEF: 38% vs 26%; LAs: 27% vs 19%; GLS: −18% vs −14%) whereas both LA and left ventricular measures were associated with increasing NT-proBNP concentrations at baseline. After multivariable adjustments, only LA volumes and LAEF remained significantly associated with MR-proANP, whereas only LA volumes and GLS remained significantly associated with NT-proBNP. At follow-up, impaired LA function associated with persistently elevated concentrations, which was not the case for LAVi (figure).
Conclusion
MR-proANP reflects LA dysfunction better than NT-proBNP. Measures of LA function rather than LAVi associates with persistently elevated natriuretic peptide concentrationsw, which may indicate that functional measures are more closely associated with evidence of LA myocardial stretch than LAVi.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The Danish Heart Foundation
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Affiliation(s)
- F.J Olsen
- Dept. of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - S Darkner
- Dept. of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - J.P Gotze
- Rigshospitalet - Copenhagen University Hospital, Dept. of Clinical Biochemistry, Copenhagen, Denmark
| | - X Chen
- Dept. of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - K Henningsen
- Dept. of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - S Pehrson
- Dept. of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - G Gislason
- Dept. of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J.H Svendsen
- Dept. of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - T Biering-Sorensen
- Dept. of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Malmborg M, Schmiegelow M, Schou M, Gislason G. Compliance in primary prevention with statins and associations with cardiovascular risk and death in a low-risk diabetes population. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3068] [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
Contemporary data exploring cardiovascular risk associated with primary prevention statin treatment according to compliance, in a low-risk diabetes population are limited.
Purpose
To investigate whether primary prevention with statins and high adherence to statins reduce the associated risk of cardiovascular events or death in a low-risk diabetes population.
Methods
By use of Danish nationwide registers, we included 59,985 patients with newly diagnosed diabetes aged 40–79 years between 1 January 2005 until 31 June 2010 with no atherosclerotic cardiovascular disease, heart failure or chronic kidney failure prior to 18 months following diabetes diagnosis (index). Individuals were considered treated with statins if they were in treatment at diabetes diagnosis or initiated treatment within the first 6 months following diabetes diagnosis. Among individuals who were treated within the first 6 months, we calculated the proportion of the days covered (PDC) of statins within one year prior to index. We standardized 5-year risks of the combined end-point of myocardial infarction, ischemic stroke or all-cause mortality according to age at index, sex, atrial fibrillation, chronic obstructive pulmonary disease, cancer, ethnicity, year at index, highest attained educational level and claimed prescriptions of antidiabetic, antihypertensive, non-statin lipid-lowering drugs and anticoagulant drugs. Reported were standardized 5-year risk differences of the composite outcome between untreated vs. treated, including PDC, by sex and age-group.
Results
Following 6 months from the diagnosis of diabetes, 38,029 (63%) individuals were treated with statins, and among individuals treated with statins 23,894 (63%) individuals had a PDC-level of ≥80%. Any use of statins was associated with a lower standardized 5-year risk of the composite outcome (not covered: 15.1% 95% confidence intervals [CI] 14.7–16.0; covered 11.0% [CI 10.7–11.4]), corresponding to a risk difference of 4.1% [CI 3.5–4.6]. The standardized 5-year risks differed by sex, but the risk reductions were similar between men (4.3% [CI 3.5–5.0]) and women (3.9% [CI 3.1–4.7]), and the standardized risk reduction increased with advancing age-group (age 40–49 1.1% [0.2–1.9], 50–59 2.4% [1.5–3.3], 60–69 4.2% [3.2–5.2], 70–79 8.3% [6.7–9.9]. A statin PDC-level of <80% was associated with an increased standardized risk difference (reference PDC≥80%; PDC=60–80% 1.6% [CI 0.7–2.5]; PDC=40–60% 2.1% [CI 0.9–3.3], PDC=20–40% 4.1% [CI 2.8–5.5], PDC<20% 3.2% [CI 2.0–4.5]).
Conclusions
In 18-month surviving low-risk patients with diabetes, use of statins was associated with a lower 5-year risk of cardiovascular events or death, but a high adherence was important to maintain this effect. The reduced risk associated with statins was similar in men and women, and the magnitude of associated risk reduction increased with advancing age.
Standardized 5-year risk differences
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Danish Heart Foundation
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Affiliation(s)
- M Malmborg
- The Danish Heart Foundation, Copenhagen, Denmark
| | | | - M Schou
- Herlev Hospital, Cardiology, Herlev, Denmark
| | - G Gislason
- The Danish Heart Foundation, Copenhagen, Denmark
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Alhakak A, Ostergaard L, Butt J, Vinther M, Philbert B, Jacobsen P, Petersen J, Gislason G, Torp-Pedersen C, Kober L, Fosbol E, Mogensen U, Weeke P. Mortality after implantable cardioverter defibrillators in dialysis patients: a nationwide study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0791] [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
Although randomized clinical trials have shown that implantable cardioverter defibrillators (ICDs) reduce mortality in selected patients, patients on dialysis are excluded from these trials. Thus, data on mortality risk after ICD implantation in these patients are sparse.
Purpose
To examine all-cause mortality in patients receiving an ICD according to dialysis status and to identify factors associated with all-cause mortality in patients on dialysis.
Methods
Using Danish nationwide registries from 2000–2017, all patients ≥18 years old undergoing first-time ICD implantation were included. Patients on dialysis were identified prior to ICD implantation and followed for up to five years. The cumulative incidence of all-cause mortality according to dialysis status was assessed. Factors associated with all-cause mortality after ICD implantation in dialysis patients were examined using multivariable Cox proportional hazard regression.
Results
A total of 14,681 ICD patients were identified, of which 218 (1.5%) were on dialysis prior to ICD implantation. Compared with ICD patients not on dialysis, those on dialysis were younger (median age 64 years [IQR: 58–70] vs. 66 years [IQR: 57–72], p=0.02), more likely to receive an ICD for secondary prophylaxis (69.7% vs 53.7%), and had more comorbidities including ischaemic heart disease (60.6% vs. 46.3%), diabetes (28.4% vs. 20.4%), and peripheral vascular disease (10.1% vs. 5.6%) (p for all <0.05).
The median time to death among ICD patients on dialysis and not on dialysis were 1.3 years (IQR: 0.4–2.8 years] and 2.2 years [IQR: 1.0–3.5 years], respectively.
One-year mortality among ICD patients on dialysis (13.0%) was significantly higher compared with ICD patients not on dialysis (4.7%), p<0.001 (Figure). Five-year mortality was significantly higher in ICD patients on dialysis than those not on dialysis (42.2% vs 23.6%), p<0.001 (Figure).
Factors associated with increased risk of all-cause mortality among ICD patients on dialysis were age ≥65 years at time of implantation (reference: age <65 years) (HR 1.90 [95% CI: 1.13–3.19]), primary prophylactic ICD (HR 1.81 [95% CI 1.08–3.05]), and diabetes (HR 1.87 [95% CI 1.14–3.07]). Sex, ischaemic heart disease, heart failure, stroke, chronic obstructive pulmonary disease, and malignancy were not associated with the risk of mortality (p>0.05 for all).
Cardiovascular causes of death were common both in patients with- and without dialysis, 69.6% and 60.0%, respectively.
Conclusion
Five-year mortality in ICD patients on dialysis was 42% and twice as high compared with ICD patients not on dialysis. Age ≥65 years, primary prophylactic indication, and diabetes were factors associated with increased mortality. Careful evaluation of the potential benefit from an ICD implantation in dialysis patients is important considering the overall high mortality rates.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Alhakak
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - L Ostergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J.H Butt
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Vinther
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - B.T Philbert
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - P.K Jacobsen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J.K Petersen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - G.H Gislason
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Torp-Pedersen
- North Zealand Hospital, Department of Clinical Research and Cardiology, Hillerod, Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - E Fosbol
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - U.M Mogensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - P.E Weeke
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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Saed Alhakak A, Biering-Sorensen S, Mogelvang R, Jensen G, Schnohr P, Iversen A, Gislason G, Biering-Sorensen T. The prognostic value of left ventricular mechanical dyssynchrony in predicting incident atrial fibrillation and ischemic stroke in the general population. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0082] [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
Left ventricular mechanical dyssynchrony (LVMD) is a predictor of many cardiovascular outcomes including ventricular arrhythmias. However, the prognostic value of LVMD in predicting incident atrial fibrillation (AF) in participants from the general population is currently unknown.
Purpose
The aim of this study was to investigate if LVMD can be used to predict AF and ischemic stroke in the general population.
Methods
A total of 1282 participants (mean age 57±16 years, 42% male) from the general population underwent a health examination including two-dimensional speckle tracking echocardiography. LVMD was calculated as the standard deviation of the regional time-to-peak strain from the three apical views. The primary endpoint was incident AF at follow-up. All participants with known AF and prior stroke at baseline were excluded (n=84). The secondary endpoint consisted of the composite of AF and ischemic stroke.
Results
During a median follow-up of 16 years, 148 participants (12%) were diagnosed with incident AF and 88 (7%) experienced an ischemic stroke, resulting in 236 (19%) experiencing the composite outcome. The risk of AF increased incrementally with increasing tertile of LVMD, being approximately 2-fold higher in the 3rd tertile as compared to the 1st tertile (HR 1.79; 95% CI (1.22–2.63), p=0.003; figure).
LVMD was a univariable predictor of AF with 7% increased risk per 10ms increase in LVMD (per 10ms: HR 1.07; 95% CI (1.03–1.12), p<0.001). The association remained significant even after multivariable adjustment for age, sex, body mass index, hypertension, diabetes, previous ischemic heart disease, systolic blood pressure, diastolic blood pressure, heart rate, smoking, plasma proBNP, left ventricular ejection fraction <50%, global longitudinal strain, left atrial volume index (LAVI) and E/e' (per 10ms increase: HR 1.06; 95% CI (1.01–1.12), p=0.018).
LVMD was also a univariable predictor of the composite outcome of AF and ischemic stroke (per 10ms increase: HR 1.07; 95% CI (1.04–1.11), p<0.001). After multivariable adjustment for the same clinical and echocardiographic parameters, LVMD remained an independent predictor of the composite outcome (per 10ms: HR 1.07; 95% CI (1.03–1.11), p=0.001).
Additionally, LVMD provided incremental prognostic information with regard to predicting AF as assessed by a significant increase in the net reclassification improvement (NRI) index beyond the CHARGE-AF score (continuous NRI, 0.300; 95% CI, 0.022–0.503). Furthermore, LVMD provided additional incremental prognostic information, when added to both the CHARGE-AF score and the LAVI (continuous NRI, 0.269; 95% CI, 0.004–0.499).
Conclusion
In a low risk general population, LVMD provides novel prognostic information on the long-term risk of AF and ischemic stroke. In addition, LVMD provides incremental prognostic information beyond the CHARGE-AF score and LAVI in predicting AF in the general population.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | - R Mogelvang
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - G.B Jensen
- Frederiksberg University Hospital, Copenhagen City Heart Study, Frederiksberg, Denmark
| | - P Schnohr
- Frederiksberg University Hospital, Copenhagen City Heart Study, Frederiksberg, Denmark
| | - A.Z Iversen
- Gentofte University Hospital, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, Copenhagen, Denmark
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Dalsgaard Jensen A, Smerup M, Bundgaard H, Butt J, Bruun N, Torp-Pedersen C, Gislason G, Iversen K, Koeber L, Oestergaard L, Fosboel E. Surgical treatment for infective endocarditis over three decades: a nationwide study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2016] [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
An increasing number of patients with infective endocarditis (IE) are treated surgically over time. It is important to know how this affects patient outcome. Current studies are mainly from tertiary centres which may bias estimations of outcomes. We have therefore conducted a nationwide study of surgical outcomes during admission for IE over three decades.
Purpose
We set out to examine temporal trends in use of valve surgery for IE and these patients' characteristics and related outcomes in Denmark in the period 1998–2017.
Methods
Using Danish nationwide registries, we included patients with first-time IE (1998–2017). The study population was categorized into four groups of five-year intervals (1998–2002, 2003–2007, 2008–2012, 2012–2017). Annual number of patients with IE and the proportion who underwent valve surgery during admission were reported. Kaplan-Meier estimates and multivariable logistic regression analyses were used to compare the associated 30-day mortality risk between calendar periods. Kaplan-Meier estimates and multivariable adjusted Cox proportional hazard analyses were used compare the associated 1-year mortality risk between calendar periods.
Results
A total of 8,455 patients with first-time IE were identified in the period of 1998–2017 of which 1,906 (22.5%) underwent valve surgery (1998–2002; N=320, 2003–2007; N=468, 2008–2012; N=528, 2013–2017; N=595). The proportion of patients who underwent surgery was 21.5% in 1998 and 19.4% in 2017 (P=0.02 for trend). See figure.
For patients undergoing surgery, the median age and proportion of males increased from 58.3 years (P25-P75: 48.2–67.4) and 69.1% to 66.7 years (P25-P75: 55.2–73.0) and 73.1% in 1998–2002 and 2013–2017, respectively. Patients had an increasing burden of comorbidities including diabetes (10.3% to 14.3%), hypertension (16.9% to 37.5%) and renal disease (9.1% to 9.6%) across calendar periods. The 30-day mortality risk for patients with IE who underwent valve surgery was 10.0% (1998–2002), 10.8% (2003–2007), 6.4% (2008–2012) and 8.5% (2013–2017), respectively (P=0.09). One-year mortality risk for patients with IE who underwent valve surgery was 16.7% (1998–2002), 21.2% (2003–2007), 15.2% (2008–2012) and 16.6% (2013–2017), respectively (P=0.08). The declining 30-day and 1-year mortality was statistically significant over time when adjusting for patient characteristics (P=0.01 and P≤0.0001, respectively).
Conclusion
From a nationwide, unselected cohort of patients with first-time IE, around 1/5 undergo surgery during admission. Surgical IE-cases are older and sicker now compared to 10–20 years ago. In spite of this, there was a trend towards a decreased associated 30-day and 1-year mortality over time. Our data show a lower rate of surgery in IE than in most prior studies and we believe that this is due to the nationwide, unselected nature of our study.
Infective endocarditis and surgery
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Dalsgaard Jensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M.H Smerup
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J.H Butt
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - N.E Bruun
- Zealand University Hospital, Department of Cardiology, Roskilde, Denmark
| | - C Torp-Pedersen
- Hillerod Hospital, Department of Cardiology and Clinical Research, Hillerod, Denmark
| | - G Gislason
- Herlev Hospital, Department of Cardiology, Herlev, Denmark
| | - K Iversen
- Herlev Hospital, Department of Emergency Medicine, Herlev, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - L Oestergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - E.L Fosboel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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Pareek M, Kragholm K, Byrne C, Pallisgaard J, Lee C, Bonde A, Fosboel E, Gislason G, Koeber L, Bhatt D, Torp-Pedersen C. Serial changes in high-sensitivity troponin I levels indicate poorer prognosis in patients with suspected acute coronary syndrome who fail to reach a level greater than the 99th percentile. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1603] [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
According to the fourth universal definition of myocardial infarction (MI) consensus paper, patients with changing troponins who do not reach a concentration greater than the 99th percentile may still be at high risk and should be followed closely.
Purpose
To determine long-term prognostic implications of high-sensitivity troponin I (hs-TnI) levels and their relative change (Δ) from baseline in subjects with suspected acute coronary syndrome (ACS).
Methods
We conducted a retrospective cohort study through individual participant-level linkage between Danish national registries. Subjects with a final discharge diagnosis of acute MI, unstable angina, suspected MI, or chest pain from October 2013 through December 2016 who had a record of at least two serial hs-TnI (Dimension Vista®, Siemens Healthineers, Erlangen, Germany; 99th percentile: 45 ng/l) measurements during hospitalization comprised the study population. Kaplan-Meier analysis and multivariable Cox regression, incorporating the competing risk of death, were used to examine the prognostic implications of serial hs-TnI. Subjects were categorized according to whether their first and second hs-TnI were normal/elevated as well as Δhs-TnI and its direction, the latter using cut-offs for Δhs-TnI rises and/or falls of 20% and 50%, extrapolated from the recommendations for troponin T. The primary outcome was a composite of death from cardiovascular causes, recurrent MI, or repeat revascularization (i.e. not including the index event unless the patient died) at 12 months.
Results
A total of 14,514 individuals (mean age 62.2 years, 46.6% women) were included of whom 3407 (23.5%) had a final diagnosis of MI, 667 (4.6%) of unstable angina, and 10,440 (71.9%) of either suspected MI or chest pain. Median baseline hs-TnI was 15 ng/l (25.3% elevated), second hs-TnI 15 ng/l (29.4% elevated), Δhs-TnI 0%, and time between samples 6.2 hours. At 12 months, 909 (6.3%) first primary events had occurred. Baseline hs-TnI and Δhs-TnI both displayed a significant, non-linear association with the primary outcome (P<0.001). The Figure shows the prognostic implications of serial hs-TnI. Overall, subjects with two consecutively elevated hs-TnI had the highest 12-month event risk (15.7%), followed by those who went from a normal to an elevated hs-TnI (9.9%), those who went from an elevated to a normal hs-TnI (4.2%), and those with two normal hs-TnI (2.7%). Most either had no significant Δhs-TnI (−20% to 20%: 74.9%) or a large positive Δhs-TnI (>50%: 17.5%). Individuals with any Δhs-TnI (>20% in either direction) had a worse prognosis than those without. This was also true for the group of individuals with two normal hs-TnI (event risk 7.8% in those with a Δhs-TnI >20% versus 2.3% in those without, P<0.001).
Conclusions
Δhs-TnI was an important determinant of poorer prognosis in subjects with suspected ACS, even among individuals who did not reach a concentration greater than the 99th percentile.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Pareek
- Nordsjaellands Hospital, Hilleroed, Denmark
| | | | - C Byrne
- Bispebjerg University Hospital, Copenhagen, Denmark
| | | | - C.J Lee
- Aalborg University Hospital, Aalborg, Denmark
| | - A.N Bonde
- Gentofte University Hospital, Gentofte, Denmark
| | - E.L Fosboel
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | | | - L.V Koeber
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - D.L Bhatt
- Brigham and Women's Hospital, Boston, United States of America
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Madelaire C, Blanche P, Gustafsson F, Kober L, Torp-Pedersen C, Banke A, Kristensen S, Andersson C, Gislason G, Schou M. One-year mortality risk after new onset comorbidity and worsening heart failure in patients with chronic heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0982] [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
Heart failure (HF) is a progressive disease characterized by risk of congestion and often accompanied by a significant burden of comorbidities. At the time of HF diagnosis, these are associated with a poor outcome, but it is relatively unknown whether hospitalization due to new-onset comorbidities carries the same subsequent mortality risk as hospitalization for worsening HF.
Purpose
To assess one-year mortality risk after hospitalization due to new-onset chronic comorbidity compared to a hospitalization with worsening HF in a nationwide cohort of patients with HF.
Methods
In Danish administrative registers, we identified all patients, aged 40–95 years with a first-time HF diagnosis from 2000 through 2016. Patients were included if they survived the initial 120 days and collected prescribed renin-angiotensin system inhibitor and beta-blocker. In analyses stratified on age and baseline burden of comorbidity (based on Charlson Comorbidity Index (CCI) excluding myocardial infarction and HF, we estimated absolute one-year mortality risk continuously during follow-up, using landmarking and flexible semi-parametric methods. If a patient had a comorbidity hospitalization equivalent to an increase in his/ her CCI or a HF hospitalization, one-year mortality risk was estimated immediately hereafter. In analyses assuming constant risks during follow-up, we calculated absolute risks and risk ratios for new comorbidity- or HF hospitalizations compared to patients without events.
Results
We included 81,788 patients, median age 72 (Q1-Q3:63–80), 36% women. At baseline, 57% had CCI=0, 22% CCI=1, 9% CCI=2 and 12% CCI≥3. High age and baseline CCI were associated with increased mortality risk throughout follow-up. Both new comorbidity- and HF hospitalizations at any time during follow-up were associated with increased mortality risk (p<0.001) (Figure), and the risk was approximately constant over time. Among patients with baseline CCI=0, new-onset comorbidity (incident increase in CCI) was associated with a higher mortality risk than a HF hospitalization in all age groups, risk ratios with “no event” as reference: Age 40–64: 5.4 (95%-CI: 4.5–6.4) vs 2.5 (95%-CI: 2.1–2.9); age 65–74: 4.2 (95%-CI: 3.7–4.7) vs 2.2 (95%-CI: 1.9–2.5); age 75–84: 3.4 (95%-CI: 3.2–3.7) vs 2.3 (95%-CI: 2.1–2.5) and age 85–95: 2.6 (95%-CI: 2.4–2.8) vs 2.2 (95%-CI: 2.0–2.4) (figure). Across all strata, new-onset comorbidity was associated with at least similar risk as a HF hospitalization at any time during follow-up.
Conclusions
For patients with HF, hospitalization for new-onset chronic comorbidity was associated with at least the same mortality risk as worsening HF, independently of age. This finding highlights the prognostic impact of comorbidity for patients with HF and warrants further investigations in the mechanisms underlying the mortality.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Danish Heart Foundation
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Affiliation(s)
- C Madelaire
- Gentofte University Hospital, department of cardiology, the cardiovascular research center, Copenhagen, Denmark
| | - P Blanche
- University of Copenhagen, Department of Biostatistics, Copenhagen, Denmark
| | - F Gustafsson
- Rigshospitalet - Copenhagen University Hospital, Department of cardiology, Copenhagen, Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Department of cardiology, Copenhagen, Denmark
| | - C Torp-Pedersen
- Hillerod Hospital, Department of cardiology and clinical research, Hillerod, Denmark
| | - A Banke
- Odense University Hospital, Department of cardiology, Odense, Denmark
| | - S.L Kristensen
- Rigshospitalet - Copenhagen University Hospital, Department of cardiology, Copenhagen, Denmark
| | - C Andersson
- Gentofte University Hospital, department of cardiology, the cardiovascular research center, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, department of cardiology, the cardiovascular research center, Copenhagen, Denmark
| | - M Schou
- Gentofte University Hospital, department of cardiology, the cardiovascular research center, Copenhagen, Denmark
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Haxha S, Pedersen-Bjergaard U, Nielsen J, Pallisgaard J, Devereux R, Okin P, Gislason G, Torp-Pedersen C, Bang C. Cornell voltage left ventricular hypertrophy predicts all-cause mortality better than Sokolow-Lyon voltage in patients with and without diabetes – data from 183,749 primary care ECGs. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3042] [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
Cornell voltage criteria (CL) and Sokolow-Lyon criteria (SL) for electrocardiographic left ventricular hypertrophy (ECG-LVH) are well known predictors of cardiovascular outcome. However, their predictive value may differ according to patient type and remains to be further tested in diabetic mellitus (DM) patients.
Purpose
The present study aims to determine the prevalence of each ECG-LVH criteria and their respective predictive value in DM patients.
Method
A retrospective cohort study of individuals age >40 years with digital ECGs from primary care were collected during 2001 to 2011. Data on medication, comorbidity, and outcomes were collected from Danish nationwide registries. DM was defined if individuals were prescribed oral antidiabetics or insulin, if they were diagnosed with DM type I or II, or had a HbA1c>48 mmol/l. Cox multivariable analysis was used for estimating hazard ratio (HR) and 95% confidence intervals (95% CI) for all-cause mortality during follow-up of up to 17 years.
Results
Included were 183,749 individuals with a digital ECG collected in primary care. A total of 13,003 (7.1%) individuals had DM, they were older (65.8 vs. 61.3 years), had more myocardial infarction (16.1% vs. 5.2%), stroke (14.4% vs. 6.2%), hypertension (35.1% vs. 13.2%), CL LVH (8.0% vs. 5.6%) and more were males (53.3% vs. 45.3%) compared to the non-DM individuals (all p<0.001). CL identified a larger percentage of LVH in DM compared to non-DM individuals (8.0% vs. 5.6%, p<0.001), whereas SL identified similar percentage LVH in DM and non-DM individuals (8.5% vs. 8.1%, p=0.068). In multivariable adjusted analysis CL LVH remained strongly associated with all-cause mortality [HR 1.45 (95% CI: 1.42–1.48)] compared to SL LVH which found only a modest association [HR 1.06 (95% CI: 1.03–1.10)] (Figure 1). Of note, the association of CL LVH and all-cause mortality was even stronger than DM per se. There was no interaction with DM and either ECG LVH criteria (p>0.45).
Conclusion
Cornell Voltage Left Ventricular Hypertrophy is a strong predictor of mortality in patients with and without diabetes and an independent risk factor compared to hypertension and diabetes. The predictive value was substantially stronger than Sokolow-Lyon Voltage criteria for hypertrophy.
Figure 1. LVH and all-cause mortality
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Haxha
- Nordsjaellands Hospital, Department of Cardiology, Hilleroed, Denmark
| | | | - J.B Nielsen
- Glostrup University Hospital, Department of Cardiology, Glostrup, Denmark
| | - J Pallisgaard
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - R.B Devereux
- Weill Cornell Medicine, Department of Medicine, New York City, United States of America
| | - P.M Okin
- Weill Cornell Medicine, Department of Medicine, New York City, United States of America
| | - G.H Gislason
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Torp-Pedersen
- Nordsjaellands Hospital, Department of Cardiology, Hilleroed, Denmark
| | - C.N Bang
- Nordsjaellands Hospital, Department of Cardiology, Hilleroed, Denmark
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50
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Holt A, Zareini B, Rajan D, Schou M, Gislason G, Schjerning A, McGettigan P, Blanche P, Torp-Pedersen C, Lamberts M. Effect of beta blocker therapy following myocardial infarction in optimally treated patients in the reperfusion era – a Danish, nationwide, and registry-based cohort study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3390] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and purpose
European and American cardiovascular treatment guidelines advocate for two and three years of beta-blocker (BB) treatment, respectively, following myocardial infarction (MI). Contemporary continued efficacy of longer-term use of BB in stable coronary artery disease has been debated in the era of reperfusion. We aim to investigate the cardio-protective effect associated with BB treatment in patients following MI.
Methods
Using nationwide databases, we included optimally treated patients with first-time MI undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) during admission and treated with both acetyl-salicylic acid and statins post-discharge between 2003 and 2017. Patients with prior history of MI, BB use or any other possible indication or contraindication for BB treatment (heart failure, cardiac arrhythmias or procedures, asthma, chronic obstructive pulmonary disease) were excluded. Continued BB exposure was defined as two redeemed prescriptions within the first 180 days following discharge, one of them within 90 days. Follow-up began 180 days following discharge in patients alive and with no further cardiovascular events or procedures prior. Patients were followed for a maximum of three years. Primary outcomes were cardiovascular death and recurrent MI in patients stratified by BB treatment using adjusted Cox regression models.
Results
A total of 27,068 patients optimally treated for MI were included (57% acute PCI, 26% sub-acute PCI, 17% CAG without intervention). At study start 180 days following MI, 79% of the patients were on BB treatment (median age 61 years, 75% male) and 21% were not (median age 62 years, 69% male). Cumulative incidence of cardiovascular death and recurrent MI did not differ significantly comparing patients on BB treatment with patients not on BB treatment (Figure). In multivariable analyses, BB treatment was associated with a similar risk of cardiovascular death and recurrent MI compared to the patients not receiving BB treatment (hazard ratios with [95% confidence intervals] correspondingly; 0.89 [0.68–1.17] and 1.02 [0.89–1.18]) (Figure 1). When stratifying the cohort according to calendar year and type of procedure during admission, we found similar results as the main analysis. No interaction for sex was found.
Conclusions
In this nationwide cohort study of optimally treated patients following MI at 180 days in the reperfusion era, we found a very good prognosis with only 1.2% suffering cardiovascular death and 4.7% suffering a recurrent MI within three years. In total 79% of patients were receiving BB treatment, but we found no difference suggesting BB to be associated with an improved cardiovascular prognosis. These findings challenge current clinical practice and guideline recommendation, suggesting that the role of long-term BB use may be obsolete among optimally treated MI patients. Further investigations, preferably a randomized trial, are warranted.
Figure 1
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Ib Mogens Kristiansens Almene Fond, Snedkermester Sophus Jacobsen og Hustru Astrid Jacobsens Fond
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Affiliation(s)
- A Holt
- Herlev and Gentofte Hospital, Department of Cardiovascular Research, Copenhagen, Denmark
| | - B Zareini
- Herlev and Gentofte Hospital, Department of Cardiovascular Research, Copenhagen, Denmark
| | - D Rajan
- Herlev and Gentofte Hospital, Department of Cardiovascular Research, Copenhagen, Denmark
| | - M Schou
- Herlev and Gentofte Hospital, Department of Cardiovascular Research, Copenhagen, Denmark
| | - G.H Gislason
- Herlev and Gentofte Hospital, Department of Cardiovascular Research, Copenhagen, Denmark
| | - A.M Schjerning
- Zealand University Hospital, Department of Cardiology, Roskilde, Denmark
| | - P McGettigan
- William Harvey Research Institute, Department of Pharmacology, London, United Kingdom
| | - P Blanche
- University of Copenhagen, Department of Bio Statistics, Copenhagen, Denmark
| | - C Torp-Pedersen
- Aalborg University Hospital, Unit of Epidemiology and Health Sciences, Aalborg, Denmark
| | - M Lamberts
- Herlev and Gentofte Hospital, Department of Cardiovascular Research, Copenhagen, Denmark
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