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Mattace-Raso F, Goudzwaard JA, Polinder-Bos HA, Tap L. Cardiovascular Risk Management for All Older Patients? J Alzheimers Dis 2023:JAD230382. [PMID: 37393507 DOI: 10.3233/jad-230382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
Current guidelines on cardiovascular risk management are extrapolated to all older adults. It is, however, highly debatable whether recommendations also apply for patients with dementia since previous studies have not included this specific population. Time to benefit as well as higher risk of adverse events play a crucial role in the decision process of prescribing or deprescribing. Regular monitoring is needed in older patients with dementia, in order to make individual-based treatment strategies. Cardiovascular risk management in older patients with dementia should focus on quality of life, preventing cognitive and functional deterioration, and maintaining independence.
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Affiliation(s)
- Francesco Mattace-Raso
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jeannette A Goudzwaard
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Harmke A Polinder-Bos
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Lisanne Tap
- Division of Geriatrics, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Eikelboom WS, Singleton EH, van den Berg E, de Boer C, Coesmans M, Goudzwaard JA, Vijverberg EGB, Pan M, Gouw C, Mol MO, Gillissen F, Fieldhouse JLP, Pijnenburg YAL, van der Flier WM, van Swieten JC, Ossenkoppele R, Kors JA, Papma JM. The reporting of neuropsychiatric symptoms in electronic health records of individuals with Alzheimer's disease: a natural language processing study. Alzheimers Res Ther 2023; 15:94. [PMID: 37173801 PMCID: PMC10176879 DOI: 10.1186/s13195-023-01240-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are prevalent in the early clinical stages of Alzheimer's disease (AD) according to proxy-based instruments. Little is known about which NPS clinicians report and whether their judgment aligns with proxy-based instruments. We used natural language processing (NLP) to classify NPS in electronic health records (EHRs) to estimate the reporting of NPS in symptomatic AD at the memory clinic according to clinicians. Next, we compared NPS as reported in EHRs and NPS reported by caregivers on the Neuropsychiatric Inventory (NPI). METHODS Two academic memory clinic cohorts were used: the Amsterdam UMC (n = 3001) and the Erasmus MC (n = 646). Patients included in these cohorts had MCI, AD dementia, or mixed AD/VaD dementia. Ten trained clinicians annotated 13 types of NPS in a randomly selected training set of n = 500 EHRs from the Amsterdam UMC cohort and in a test set of n = 250 EHRs from the Erasmus MC cohort. For each NPS, a generalized linear classifier was trained and internally and externally validated. Prevalence estimates of NPS were adjusted for the imperfect sensitivity and specificity of each classifier. Intra-individual comparison of the NPS classified in EHRs and NPS reported on the NPI were conducted in a subsample (59%). RESULTS Internal validation performance of the classifiers was excellent (AUC range: 0.81-0.91), but external validation performance decreased (AUC range: 0.51-0.93). NPS were prevalent in EHRs from the Amsterdam UMC, especially apathy (adjusted prevalence = 69.4%), anxiety (adjusted prevalence = 53.7%), aberrant motor behavior (adjusted prevalence = 47.5%), irritability (adjusted prevalence = 42.6%), and depression (adjusted prevalence = 38.5%). The ranking of NPS was similar for EHRs from the Erasmus MC, although not all classifiers obtained valid prevalence estimates due to low specificity. In both cohorts, there was minimal agreement between NPS classified in the EHRs and NPS reported on the NPI (all kappa coefficients < 0.28), with substantially more reports of NPS in EHRs than on NPI assessments. CONCLUSIONS NLP classifiers performed well in detecting a wide range of NPS in EHRs of patients with symptomatic AD visiting the memory clinic and showed that clinicians frequently reported NPS in these EHRs. Clinicians generally reported more NPS in EHRs than caregivers reported on the NPI.
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Affiliation(s)
- Willem S Eikelboom
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Ellen H Singleton
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Casper de Boer
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Michiel Coesmans
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jeannette A Goudzwaard
- Department of Internal Medicine, Section of Geriatrics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Everard G B Vijverberg
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Michel Pan
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Cornalijn Gouw
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Merel O Mol
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Freek Gillissen
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Jay L P Fieldhouse
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Yolande A L Pijnenburg
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - John C van Swieten
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Rik Ossenkoppele
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Janne M Papma
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
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Eikelboom WS, van den Berg E, Coesmans M, Goudzwaard JA, Koopmanschap M, Lazaar N, van Bruchem-Visser RL, Driesen JJM, den Heijer T, Hoogers S, de Jong FJ, Mattace-Raso F, Thomeer EC, Vrenken S, Vroegindeweij LJHM, Zuidema SU, Singleton EH, van Swieten JC, Ossenkoppele R, Papma JM. Effects of the DICE Method to Improve Timely Recognition and Treatment of Neuropsychiatric Symptoms in Early Alzheimer's Disease at the Memory Clinic: The BEAT-IT Study. J Alzheimers Dis 2023:JAD230116. [PMID: 37182887 DOI: 10.3233/jad-230116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are highly prevalent in Alzheimer's disease (AD) and are associated with negative outcomes. However, NPS are currently underrecognized at the memory clinic and non-pharmacological interventions are scarcely implemented. OBJECTIVE To evaluate the effectiveness of the Describe, Investigate, Create, Evaluate (DICE) method™ to improve the care for NPS in AD at the memory clinic. METHODS We enrolled sixty community-dwelling people with mild cognitive impairment or AD dementia and NPS across six Dutch memory clinics with their caregivers. The first wave underwent care as usual (n = 36) and the second wave underwent the DICE method (n = 24). Outcomes were quality of life (QoL), caregiver burden, NPS severity, NPS-related distress, competence managing NPS, and psychotropic drug use. Reliable change index was calculated to identify responders to the intervention. A cost-effectiveness analysis was performed and semi-structured interviews with a subsample of the intervention group (n = 12). RESULTS The DICE method did not improve any outcomes over time compared to care as usual. Half of the participants of the intervention group (52%) were identified as responders and showed more NPS and NPS-related distress at baseline compared to non-responders. Interviews revealed substantial heterogeneity among participants regarding NPS-related distress, caregiver burden, and availability of social support. The intervention did not lead to significant gains in quality-adjusted life years and well-being years nor clear savings in health care and societal costs. CONCLUSION The DICE method showed no benefits at group-level, but individuals with high levels of NPS and NPS-related distress may benefit from this intervention.
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Affiliation(s)
- Willem S Eikelboom
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Michiel Coesmans
- Department of Psychiatry, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jeannette A Goudzwaard
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Marc Koopmanschap
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Najoua Lazaar
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Jan J M Driesen
- Department of Neurology, Franciscus Vlietland, Schiedam, The Netherlands
| | - Tom den Heijer
- Department of Neurology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Susanne Hoogers
- Department of Neurology, Spijkenisse Medical Center, Spijkenisse, The Netherlands
| | - Frank Jan de Jong
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Francesco Mattace-Raso
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Elsbeth C Thomeer
- Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Suzanne Vrenken
- Department of Geriatrics, Spijkenisse Medical Center, Spijkenisse, The Netherlands
| | | | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ellen H Singleton
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - John C van Swieten
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Rik Ossenkoppele
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Clinical Memory Research Unit, Lund University, Malmö, Sweden
| | - Janne M Papma
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Eikelboom WS, van den Berg E, Raso FUSM, van Bruchem‐Visser RL, Goudzwaard JA, de Jong FJ, den Heijer T, Driesen JJM, Vroegindeweij LJ, Thomeer EC, Hoogers SE, Singleton EH, van Swieten JC, Ossenkoppele R, Coesmans M, Papma JM. Evaluating the DICE method to improve early recognition and treatment of neuropsychiatric symptoms in early Alzheimer’s disease. Alzheimers Dement 2022. [DOI: 10.1002/alz.062292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Ellen H. Singleton
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam Netherlands
| | | | - Rik Ossenkoppele
- Lund University Lund Sweden
- Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam Netherlands
| | | | - Janne M. Papma
- Erasmus MC ‐ University Medical Center Rotterdam Netherlands
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Overbeek FCMS, Goudzwaard JA, van Hemmen J, van Bruchem-Visser RL, Papma JM, Polinder-Bos HA, Mattace-Raso FUS. The Multidimensional Prognostic Index Predicts Mortality in Older Outpatients with Cognitive Decline. J Clin Med 2022; 11:jcm11092369. [PMID: 35566497 PMCID: PMC9103737 DOI: 10.3390/jcm11092369] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/03/2022] [Accepted: 04/19/2022] [Indexed: 02/03/2023] Open
Abstract
Since the heterogeneity of the growing group of older outpatients with cognitive decline, it is challenging to evaluate survival rates in clinical shared decision making. The primary outcome was to determine whether the Multidimensional Prognostic Index (MPI) predicts mortality, whilst assessing the MPI distribution was considered secondary. This retrospective chart review included 311 outpatients aged ≥65 years and diagnosed with dementia or mild cognitive impairment (MCI). The MPI includes several domains of the comprehensive geriatric assessment (CGA). All characteristics and data to calculate the risk score and mortality data were extracted from administrative information in the database of the Alzheimer’s Center and medical records. The study population (mean age 76.8 years, men = 51.4%) was divided as follows: 34.1% belonged to MPI category 1, 52.1% to MPI category 2 and 13.8% to MPI category 3. Patients with dementia have a higher mean MPI risk score than patients with MCI (0.47 vs. 0.32; p < 0.001). The HRs and corresponding 95% CIs for mortality in patients in MPI categories 2 and 3 were 1.67 (0.81−3.45) and 3.80 (1.56−9.24) compared with MPI category 1, respectively. This study shows that the MPI predicts mortality in outpatients with cognitive decline.
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Affiliation(s)
- Femke C. M. S. Overbeek
- Department of Geriatric Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (F.C.M.S.O.); (J.A.G.); (R.L.v.B.-V.); (H.A.P.-B.)
| | - Jeannette A. Goudzwaard
- Department of Geriatric Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (F.C.M.S.O.); (J.A.G.); (R.L.v.B.-V.); (H.A.P.-B.)
| | - Judy van Hemmen
- Department of Neurology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (J.v.H.); (J.M.P.)
| | - Rozemarijn L. van Bruchem-Visser
- Department of Geriatric Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (F.C.M.S.O.); (J.A.G.); (R.L.v.B.-V.); (H.A.P.-B.)
| | - Janne M. Papma
- Department of Neurology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (J.v.H.); (J.M.P.)
| | - Harmke A. Polinder-Bos
- Department of Geriatric Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (F.C.M.S.O.); (J.A.G.); (R.L.v.B.-V.); (H.A.P.-B.)
| | - Francesco U. S. Mattace-Raso
- Department of Geriatric Medicine, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (F.C.M.S.O.); (J.A.G.); (R.L.v.B.-V.); (H.A.P.-B.)
- Correspondence: ; Tel.: +31-10-7035979
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Kroon HG, van Gils L, Ziviello F, van Wiechen MPH, Ooms JFW, Rahhab Z, El Faquir N, Maugenest AM, Goudzwaard JA, Cummins P, Lenzen M, Kardys I, Daemen J, Mattace-Raso F, de Jaegere PPT, Van Mieghem NM. Clinical consequences of consecutive self-expanding transcatheter heart valve iterations. Neth Heart J 2021; 30:140-148. [PMID: 33914259 PMCID: PMC8881514 DOI: 10.1007/s12471-021-01568-5] [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] [Accepted: 03/24/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To compare early clinical outcomes after transcatheter aortic valve implantation (TAVI) with three consecutive generations of self-expanding valves (SEVs). Methods Clinical endpoints of consecutive patients who underwent TAVI with CoreValve, Evolut R or Evolut PRO were included in a prospective database. Results TAVI was performed with CoreValve (n = 116), Evolut R (n = 160) or Evolut PRO (n = 92). Evolut R and Evolut PRO showed a tendency towards lower permanent pacemaker implantation (PPI) rates compared to CoreValve (CoreValve 27% vs Evolut R 16% vs Evolut PRO 18%, p = 0.091). By multivariable regression analysis CoreValve had a significantly higher risk for PPI (odds ratio (OR) 2.79, 95% confidence interval (CI) 1.31–5.94, p = 0.008) compared to Evolut R, while Evolut R and PRO were similar. Severe paravalvular leakage (PVL) occurred only with CoreValve, but no significant difference was observed in moderate PVL (10% vs 8% vs 6%, p = 0.49). CoreValve had a tendency towards a higher risk for more-than-mild PVL as compared with the Evolut platform (R + PRO) (OR 2.46, 95% CI 0.98–6.16, p = 0.055). No significant differences in all-cause mortality (7% vs 4% vs 1%, p = 0.10), stroke (6% vs 3% vs 2%, p = 0.21) or major vascular complications (10% vs 12% vs 4%, p = 0.14) were observed. Conclusions TAVI with self-expanding valves was safe, and device iterations may result in a lower need for PPI. More-than-mild PVL seemed to occur less often with repositionable technology. Supplementary Information The online version of this article (10.1007/s12471-021-01568-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- H G Kroon
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - L van Gils
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - F Ziviello
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M P H van Wiechen
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J F W Ooms
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Z Rahhab
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - N El Faquir
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A-M Maugenest
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J A Goudzwaard
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - P Cummins
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Lenzen
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - I Kardys
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J Daemen
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - F Mattace-Raso
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - P P T de Jaegere
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - N M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
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7
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Goudzwaard JA, de Ronde-Tillmans MJAG, van Hoorn FED, Kwekkeboom EHC, Lenzen MJ, van Wiechen MPH, Ooms JFW, Nuis RJ, Van Mieghem NM, Daemen J, de Jaegere PPT, Mattace-Raso FUS. Impact of frailty on health-related quality of life 1 year after transcatheter aortic valve implantation. Age Ageing 2020; 49:989-994. [PMID: 32421189 PMCID: PMC7583518 DOI: 10.1093/ageing/afaa071] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) brings symptom relief and improvement in health-related quality of life (HRQoL) in the majority of patients treated for symptomatic, severe aortic stenosis. However, there is a substantial group of patients that do not benefit from TAVI. The aim of this study is to investigate the impact of frailty on HRQoL 1 year after TAVI. METHODS The TAVI Care & Cure Program is an ongoing, prospective, observational study including patients referred for TAVI to our institution. A comprehensive geriatric assessment was performed to evaluate existence of frailty using the Erasmus Frailty Score (EFS). HRQoL was assessed using the EQ-5D-5 L at baseline and 1 year after TAVI. RESULTS 239 patients underwent TAVI and completed HRQoL assessment 1 year after TAVI. Seventy (29.3%) patients were classified as frail (EFS ≥ 3). In non-frail patients, the EQ-5D-5 L index did not change (0.71(± 0.22) to 0.68(± 0.33) points, P = 0.22); in frail patients, the EQ-5D-5 L index decreased from 0.55(±0.26) to 0.44 points (±0.33) (P = 0.022). Frailty was an independent predictor of deteriorated HRQoL 1 year after TAVI (OR 2.24, 95% CI 1.07-4.70, P = 0.003). In frail patients, the absence of peripheral artery disease (OR 0.17, 95% 0.05-0.50, P = 0.001) and renal dysfunction (OR 0.13, 95% CI 0.04-0.41, P = <0.001) at baseline was associated with improved HRQoL 1 year after TAVI. CONCLUSION Frailty is associated with deterioration of HRQoL 1 year after TAVI. Notably, HRQoL did improve in frail patients with no peripheral arterial disease or renal impairment at baseline.
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Affiliation(s)
- Jeannette A Goudzwaard
- Erasmus MC University Medical Center, Section of Geriatrics, Department of Internal Medicine, Rotterdam, The Netherlands
| | | | - Fleurance E D van Hoorn
- Erasmus MC University Medical Center, Section of Geriatrics, Department of Internal Medicine, Rotterdam, The Netherlands
| | - Eline H C Kwekkeboom
- Erasmus MC University Medical Center, Section of Geriatrics, Department of Internal Medicine, Rotterdam, The Netherlands
| | - Mattie J Lenzen
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Maarten P H van Wiechen
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Joris F W Ooms
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Rutger-Jan Nuis
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Joost Daemen
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Peter P T de Jaegere
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Francesco U S Mattace-Raso
- Erasmus MC University Medical Center, Section of Geriatrics, Department of Internal Medicine, Rotterdam, The Netherlands
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Van Wiechen MP, Ooms JF, Hokken TW, De Ronde-Tillmans MJ, Goudzwaard JA, Daemen J, De Jaegere PP, Mattace-Raso FU, Van Mieghem NM. Pathways Towards Lean TAVR. Structural Heart 2020. [DOI: 10.1080/24748706.2020.1765056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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9
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Goudzwaard JA, de Ronde-Tillmans MJAG, de Jager TAJ, Lenzen MJ, Nuis RJ, van Mieghem NM, Daemen J, de Jaegere PPT, Mattace-Raso FUS. Incidence, determinants and consequences of delirium in older patients after transcatheter aortic valve implantation. Age Ageing 2020; 49:389-394. [PMID: 32091096 PMCID: PMC7577406 DOI: 10.1093/ageing/afaa001] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 06/21/2019] [Revised: 11/15/2019] [Accepted: 01/07/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND delirium is an event leading to negative health outcomes and increased mortality in patients. The aim of this study is to investigate the incidence, determinants and consequences of post-operative delirium (POD) in older patients undergoing transcatheter aortic valve implantation (TAVI). METHODS The TAVI Care and Cure program is a prospective, observational registry in patients referred for TAVI at Erasmus University Medical Centre. The presence of delirium was evaluated by daily clinical assessment by a geriatrician pre- and up to 3 days post-TAVI. Mortality data were obtained from the Dutch Civil Registry. RESULTS A total of 543 patients underwent TAVI between January 2014 and December 2017. Overall, the incidence of POD was 14% (75/543 patients) but declined from 18% in 2014 to 7% in 2017 (P = 0.009). Patients who developed POD were older (81.9 ± 5.8 versus 78.6 ± 8.3 years, P < 0.001), had higher prevalence of renal dysfunction and prior stroke (54% versus 40%, P = 0.02; 31% versus 18%, P = 0.01) and were more often frail (32% versus 25%, P = 0.02). From a procedural perspective, general anesthesia (odds ratios (OR), 2.31; 95% CI, 1.40-3.83; P = 0.001), non-transfemoral access (OR, 2.37; 95% CI, 1.20-4.70; P = 0.01) and longer procedural time (OR, 1.01; 95% CI, 1.01-1.02; P < 0.001) were significantly associated with POD. One-year survival rate was 68% among patients who had suffered a POD and was 85% in patients without a POD (hazard ratio's 1.8 (95% CI 1.01-3.10), P = 0.045). CONCLUSION POD frequently occurs after TAVI and is associated with increased mortality. It might be speculated that patient selection and the minimalistic approach of TAVI may reduce the frequency of delirium.
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Affiliation(s)
- Jeannette A Goudzwaard
- Erasmus MC University Medical Center, Section of Geriatrics, Department of Internal Medicine, Rotterdam, The Netherlands
| | | | - Tom A J de Jager
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Mattie J Lenzen
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Rutger-Jan Nuis
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Joost Daemen
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Peter P T de Jaegere
- Erasmus MC University Medical Center, Department of Cardiology, Thoraxcenter, Rotterdam, The Netherlands
| | - Francesco U S Mattace-Raso
- Erasmus MC University Medical Center, Section of Geriatrics, Department of Internal Medicine, Rotterdam, The Netherlands
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10
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Nuis RJ, Goudzwaard JA, de Ronde-Tillmans MJAG, Kroon H, Ooms JF, van Wiechen MP, Geleijnse ML, Zijlstra F, Daemen J, Van Mieghem NM, Mattace-Raso FUS, Lenzen MJ, de Jaegere PPT. Impact of Valvulo-Arterial Impedance on Long-Term Quality of Life and Exercise Performance After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2020; 13:e008372. [PMID: 31937136 DOI: 10.1161/circinterventions.119.008372] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In aortic stenosis, valvulo-arterial impedance (Zva) estimates the overall left ventricular afterload (valve and arterial component). We investigated the association of Zva (≥5 versus <5 mm Hg mL-1 m-2) on quality of life (QOL) and exercise performance (EP) ≥1 year after transcatheter aortic valve replacement (TAVR). METHODS The study population consists of 250 TAVR patients in whom baseline Zva and follow-up QOL was prospectively assessed using EuroQOL-5-dimensions instruments; EP was assessed in 192 patients who survived ≥1 year after TAVR using questionnaires related to daily activities. In 124 patients, Zva at 1-year was also available and was used to study the change in Zva (baseline to 1 year) on QOL/EP. RESULTS Elevated baseline Zva was present in 125 patients (50%). At a median of 28 (IQR, 17-40) months, patients with elevated baseline Zva were more limited in mobility (88% versus 71%; P=0.004), self-care (40% versus 25%; P=0.019), and independent daily activities (taking a shower: 53% versus 38%, P=0.030; walking 100 meter: 76% versus 54%, P=0.001; and walking stairs: 74% versus 54%, P=0.011). By multivariable analysis, elevated Zva predicted unfavorable QOL (lower EuroQOL-5-dimensions-Utility Index, odds ratio, 1.98; CI, 1.15-3.41) and unfavorable EP (any limitation in ≥3 daily activities, odds ratio, 2.55; CI, 1.41-4.62). After TAVR, the proportion of patients with elevated Zva fell from 50% to 21% and remained 21% at 1 year and was found to be associated with more limitations in mobility, self-care, and daily activities compared with patients with Zva <5 mm Hg mL-1 m-2. CONCLUSIONS Elevated Zva was seen in half of patients and predicted unfavorable long-term QOL and EP. At 1 year after TAVR, the prevalence of elevated Zva was 21% but remained associated with poor QOL/EP.
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Affiliation(s)
- Rutger-Jan Nuis
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Jeannette A Goudzwaard
- Section of Geriatrics, Department of Internal Medicine (J.A.G., F.U.S.M.-R.), Erasmus MC, Rotterdam, the Netherlands
| | - Marjo J A G de Ronde-Tillmans
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Herbert Kroon
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Joris F Ooms
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Maarten P van Wiechen
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Marcel L Geleijnse
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Felix Zijlstra
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Francesco U S Mattace-Raso
- Section of Geriatrics, Department of Internal Medicine (J.A.G., F.U.S.M.-R.), Erasmus MC, Rotterdam, the Netherlands
| | - Mattie J Lenzen
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Peter P T de Jaegere
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
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11
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De Ronde-Tillmans MJAG, Goudzwaard JA, El Faquir N, van Mieghem NM, Mattace-Raso FUS, Cummins PA, Lenzen MJ, de Jaegere PPT. TAVI Care and Cure, the Rotterdam multidisciplinary program for patients undergoing transcatheter aortic valve implantation: Design and rationale. Int J Cardiol 2019; 302:36-41. [PMID: 31859111 DOI: 10.1016/j.ijcard.2019.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/25/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The capacity of TAVI-programs and numbers of sites performing TAVI has rapidly increased. This necessitated the initiation of the Rotterdam TAVI Care & Cure Program, aiming to improve patient-centered care during the TAVI pathway. METHODS Consenting patients with severe aortic stenosis and an indication for TAVI will be included. The TAVI Care & Cure program will facilitate prognostic contributions to improve outcomes, patient satisfaction and quality of life in patients with valvular heart disease who are treated with a transcatheter aortic valve implantation in collaboration with the departments of cardiology, cardio-thoracic surgery, anesthesiology and geriatrics. CONCLUSION With a single center observational registry, we aim to assess the TAVI patient clinical pathway, focusing on pre, peri and post interventional variables including functional status and HRQoL. We will evaluate the patient's complexity by applying an extended multidisciplinary approach, which includes a systematic application of geriatric assessments of frailty and cognitive function.
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Affiliation(s)
| | - Jeannette A Goudzwaard
- Erasmus Medical Center, Section of Geriatrics, Department of Internal Medicine, the Netherlands
| | - Nahid El Faquir
- Erasmus Medical Center, Department of Cardiology, Thoraxcenter, the Netherlands
| | | | | | - Paul A Cummins
- Erasmus Medical Center, Department of Cardiology, Thoraxcenter, the Netherlands
| | - Mattie J Lenzen
- Erasmus Medical Center, Department of Cardiology, Thoraxcenter, the Netherlands
| | - Peter P T de Jaegere
- Erasmus Medical Center, Department of Cardiology, Thoraxcenter, the Netherlands.
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12
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Goudzwaard JA, Disegna E, de Ronde-Tillmans MJ, Lenzen MJ, de Jaegere PP, Mattace-Raso FU. Short-term changes of blood pressure and aortic stiffness in older patients after transcatheter aortic valve implantation. Clin Interv Aging 2019; 14:1379-1386. [PMID: 31447550 PMCID: PMC6683966 DOI: 10.2147/cia.s211328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/29/2019] [Indexed: 11/25/2022] Open
Abstract
Background Both aortic valve stenosis and aortic stiffness are moderators of arterio ventricular coupling and independent predictors of cardiovascular morbidity and mortality. Studies on the effect of transcatheter aortic valve implantation (TAVI) on aortic functional properties are limited. We performed a study to investigate the possible short-term changes in aortic stiffness and other aortic functional properties after TAVI in older patients. Methods TAVI Care&Cure is an observational ongoing study including consecutive patients undergoing a TAVI procedure. Central and peripheral hemodynamic measurements were measured non invasively 1 day before (T-1) and 1 day after (T+1) TAVI using a validated oscillometric method using a brachial cuff (Mobil-O-Graph). Results 40 patients were included. Mean aortic valve area at baseline was 0.76±0.24 cm2. Indices of severity of aortic valve stenosis improved significantly. Systolic blood pressure (SBP) dropped by 8.5%, from 130.3±22.9 mmHg to 119.5±15.8 mmHg (p=0.005). Diastolic blood pressure (DBP) dropped by 13.1% from 74.8±14.5 mmHg to 65.0±11.3 mmHg (p<0.001). The arterial pulse wave velocity (aPWV) decreased from 12.05±1.99 m/s to 11.6±1.56 m/s (p=0.006). Patients with high aPWV at baseline showed a significantly larger reduction in SBP in comparison to patients with low aPWV: – 20.3 mmHg (−14.1%) vs – 3.1 mmHg (−2.6%), respectively (p=0.033). The same trend was found for the DBP: −16.2 (−20.4%) vs −4.5 mmHg (−6.3%) for high vs low aPWV at baseline (p=0.037). Conclusion We found short-term changes in blood pressure and aortic stiffness after TAVI. The amplitude of the changes was the largest in patients with elevated aortic stiffness at baseline.
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Affiliation(s)
- Jeannette A Goudzwaard
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eleonora Disegna
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marjo Jag de Ronde-Tillmans
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mattie J Lenzen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter Pt de Jaegere
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Francesco Us Mattace-Raso
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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13
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Eikelboom WS, Singleton E, van den Berg E, Coesmans M, Mattace Raso F, van Bruchem RL, Goudzwaard JA, de Jong FJ, Koopmanschap M, den Heijer T, Driesen JJM, Vroegindeweij LJHM, Thomeer EC, Hoogers SE, Dijkstra AA, Zuidema SU, Pijnenburg YAL, Scheltens P, van Swieten JC, Ossenkoppele R, Papma JM. Early recognition and treatment of neuropsychiatric symptoms to improve quality of life in early Alzheimer's disease: protocol of the BEAT-IT study. Alzheimers Res Ther 2019; 11:48. [PMID: 31122267 PMCID: PMC6533693 DOI: 10.1186/s13195-019-0503-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/07/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are very common in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia and are associated with various disadvantageous clinical outcomes including a negative impact on quality of life, caregiver burden, and accelerated disease progression. Despite growing evidence of the efficacy of (non)pharmacological interventions to reduce these symptoms, NPS remain underrecognized and undertreated in memory clinics. The BEhavioural symptoms in Alzheimer's disease Towards early Identification and Treatment (BEAT-IT) study is developed to (1) investigate the neurobiological etiology of NPS in AD and (2) study the effectiveness of the Describe, Investigate, Create, Evaluate (DICE) approach to structure and standardize the current care of NPS in AD. By means of the DICE method, we aim to improve the quality of life of AD patients with NPS and their caregivers who visit the memory clinic. This paper describes the protocol for the intervention study that incorporates the latter aim. METHODS We aim to enroll a total of 150 community-dwelling patients with MCI or AD and their caregivers in two waves. First, we will recruit a control group who will receive care as usual. Next, the second wave of participants will undergo the DICE method. This approach consists of the following steps: (1) describe the context in which NPS occur, (2) investigate the possible causes, (3) create and implement a treatment plan, and (4) evaluate whether these interventions are effective. Primary outcomes are the quality of life of patients and their caregivers. Secondary outcomes include NPS change, caregiver burden, caregivers' confidence managing NPS, psychotropic medication use, the experiences of patients and caregivers who underwent the DICE method, and the cost-effectiveness of the intervention. CONCLUSIONS This paper describes the protocol of an intervention study that is part of the BEAT-IT study and aims to improve current recognition and treatment of NPS in AD by structuring and standardizing the detection and treatment of NPS in AD using the DICE approach. TRIAL REGISTRATION The trial was registered on the Netherlands Trial Registry ( NTR7459 ); registered 6 September 2018.
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Affiliation(s)
- Willem S. Eikelboom
- Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Ellen Singleton
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Esther van den Berg
- Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Michiel Coesmans
- Department of Psychiatry, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Francesco Mattace Raso
- Department of Internal Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Rozemarijn L. van Bruchem
- Department of Internal Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Jeannette A. Goudzwaard
- Department of Internal Medicine, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Frank Jan de Jong
- Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Marc Koopmanschap
- Erasmus School of Health Policy & Management, Erasmus University, PO Box 1738, 3000 DR Rotterdam, the Netherlands
| | - Tom den Heijer
- Department of Neurology, Franciscus Gasthuis, PO Box 10900, 3004 BA Rotterdam, the Netherlands
| | - Jan J. M. Driesen
- Department of Neurology, Franciscus Vlietland, PO Box 215, 3100 AE Schiedam, the Netherlands
| | | | - Elsbeth C. Thomeer
- Department of Neurology, Maasstad Hospital, PO Box 9100, 3007 AC Rotterdam, the Netherlands
| | - Susanne E. Hoogers
- Department of Neurology, Spijkenisse Medical Center, PO Box 777, 3200 GA Spijkenisse, the Netherlands
| | - Anke A. Dijkstra
- Department of Anatomy and Neurosciences, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Sytse U. Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, PO Box 30,001, 9700 RB Groningen, the Netherlands
| | - Yolande A. L. Pijnenburg
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - John C. van Swieten
- Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Rik Ossenkoppele
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
- Clinical Memory Research Unit, Lund University, Simrisbanvägen 14, 212 24 Malmö, Sweden
| | - Janne M. Papma
- Department of Neurology, Erasmus MC University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
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14
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Epskamp C, Goudzwaard JA, Fiets E, Zuetenhorst JM, Polee MB, van de Geijn GJM, van Schaik RHN, Birnie E, Hamberg P. Mannose binding lectin and prediction of risk for chemotherapy induced febrile neutropenia in patients with a solid tumor. Cancer Invest 2019; 37:156-162. [PMID: 30907154 DOI: 10.1080/07357907.2019.1582660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Mannose-binding lectin (MBL) - deficient patients who undergo chemotherapy for a solid tumor might have an increased risk developing febrile neutropenia (FN). We investigated in a prospective cohort study relations between MBL-serum levels and polymorphisms in MBL promotor genotypes (-550H/L and -221X/Y) on incidence and severity of FN. Risk of FN was 17.9% in MBL-deficient and 22.5% in MBL-sufficient patients (RR = 0.796, p = 0.45). Median MBL serum levels at baseline were respectively 1.39 µg/mL and 1.09 µg/mL (p = 0.92) in patients with and without FN. In conclusion, serum MBL and MBL genotypes (-550H/L and -221X/Y) do not determine the risk for developing FN.
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Affiliation(s)
- Cynthia Epskamp
- a Department of Internal Medicine , Franciscus Gasthuis , Rotterdam , The Netherlands
| | - Jeannette A Goudzwaard
- b Department of Internal Medicine , Erasmus University Medical Center,'s , Rotterdam , The Netherlands
| | - Edward Fiets
- c Department of Internal Medicine , Medical Center Leeuwarden , Leeuwarden , The Netherlands
| | - Johanna M Zuetenhorst
- a Department of Internal Medicine , Franciscus Gasthuis , Rotterdam , The Netherlands
| | - Marco B Polee
- c Department of Internal Medicine , Medical Center Leeuwarden , Leeuwarden , The Netherlands
| | | | - Ron H N van Schaik
- b Department of Internal Medicine , Erasmus University Medical Center,'s , Rotterdam , The Netherlands
| | - Erwin Birnie
- e Department of Statistics and Education , Franciscus Gasthuis , Rotterdam , The Netherlands
| | - Paul Hamberg
- a Department of Internal Medicine , Franciscus Gasthuis , Rotterdam , The Netherlands
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15
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Boerlage AA, van Rosmalen J, Cheuk-Alam-Balrak JM, Goudzwaard JA, Tibboel D, van Dijk M. Validation of the Rotterdam Elderly Pain Observation Scale in the Hospital Setting. Pain Pract 2019; 19:407-417. [PMID: 30554464 DOI: 10.1111/papr.12756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 11/13/2018] [Accepted: 11/16/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Rotterdam Elderly Pain Observation Scale (REPOS) has been proven useful to assess pain in noncommunicative and cognitively impaired nursing home residents. We evaluated whether the REPOS is also reliable and valid for pain assessment in the hospital setting. METHODS In this prospective multicenter observational study, surgical patients were observed perioperatively at bedside and internal medicine patients were filmed during a possible painful moment and at rest. Pain behavior was assessed from the video recordings with the REPOS and the Pain Assessment Checklist for seniors with Severe Dementia-Dutch language (PACSLAC-D). Longitudinal associations between REPOS score and numeric rating scale pain ratings from observers and nurses (NRSobs and NRSproxy ) corrected for patients' gender were assessed with linear mixed models. RESULTS In total, 72 patients were included; 118 observations of surgical and 68 observations of internal medicine patients were analyzed. Interobserver reliability between the researcher and 2 other observers was good, with Cohen's kappa values of 0.71 (confidence interval [CI] 0.59 to 0.83) and 0.84 (CI 0.74 to 0.94), respectively. The intraobserver reliability of the principal investigator was good, with Cohen's kappa 0.82 (CI 0.67 to 0.91). Linear mixed modeling revealed correlation values between the REPOS and NRSobs of 0.67 and the REPOS and NRSproxy of 0.73. Optimal sensitivity (78%) and specificity (90%) for the detection of pain were found with a REPOS cutoff score of ≥3, using an NRS score of ≥4 as the reference value. CONCLUSIONS The REPOS is reliable and valid for the assessment of postoperative and chronic pain in hospital patients who cannot self-report pain.
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Affiliation(s)
- Anneke A Boerlage
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Jeannette A Goudzwaard
- Section of Geriatrics, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Monique van Dijk
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Section of Nursing Science, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
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16
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Varewijck AJ, Brugts MP, Frystyk J, Goudzwaard JA, Uitterlinden P, Waaijers AM, Feng Y, Dimitrov DS, Lamberts SW, Hofland LJ, Janssen JA. Circulating insulin-like growth factors may contribute substantially to insulin receptor isoform A and insulin receptor isoform B signalling. Mol Cell Endocrinol 2013; 365:17-24. [PMID: 22982059 PMCID: PMC6959542 DOI: 10.1016/j.mce.2012.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 08/30/2012] [Accepted: 08/30/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Only a fraction of circulating insulin-like activity is due to insulin itself. The aim of this study was to determine total serum insulin-like activity mediated via the insulin receptor isoform A (IR-A) and isoform B (IR-B) by using kinase receptor activation (KIRA) assays specific for the IR-A and IR-B. METHODS The IR-A and IR-B KIRA assays use human embryonic kidney cells which have been transfected with the human IR-A or IR-B gene and quantify serum-mediated phosphorylation of the IR. RESULTS Both IR KIRA assays were sensitive (detection limit 32 pmol/L) and precise (intra- and inter assay CV: <12% and <15%). The EC₅₀s of insulin, IGF-I and IGF-II were 1.4, 11.2 and 6.7 nmol/L for the IR-A KIRA assay, and 1.3, 31.0 and 15.7 nmol/L for the IR-B KIRA assay. The operational range of both assays allowed for determination of total insulin-like activity in human serum. Analysis of serum samples showed that there was a significant positive correlation between serum insulin-like and immunoreactive insulin concentrations (IR-A: r = 0.56, p = 0.01, IR-B: r = 0.68, p = 0.001). Importantly, addition of IGF-I or IGF-II antibodies to human serum samples could substantially decrease the endpoint signal in both KIRA assays. CONCLUSIONS We showed that serum IGF-I and IGF-II may substantially contribute to IR signalling. Since IR isoform specific KIRA assays also take into account the contribution of IGFs present in serum on IR signalling, they may help to gain more insight into the roles of IGF mediated IR-A and IR-B activation in health and disease.
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Affiliation(s)
- Aimee J. Varewijck
- Division of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Michael P. Brugts
- Division of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Jan Frystyk
- The Medical Research Laboratories, Institute of Clinical Medicine, Faculty of Health Sciences & Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jeannette A. Goudzwaard
- Division of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Pieter Uitterlinden
- Division of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Adriana M. Waaijers
- Division of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Yang Feng
- Protein Interactions Group, CCRNP, NCI-Frederick, NIH, Frederick, MD 21702, United States
| | - Dimiter S. Dimitrov
- Protein Interactions Group, CCRNP, NCI-Frederick, NIH, Frederick, MD 21702, United States
| | - Steven W.J. Lamberts
- Division of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Leo J. Hofland
- Division of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Joseph A.M.J.L. Janssen
- Division of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
- Corresponding author. Address: Department of Internal Medicine, Erasmus MC, Room D-443, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. Tel.: +31 (0)10 7033975; fax: +31 (0)10 7033268. (J.A.M.J.L. Janssen)
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Varewijck AJ, Goudzwaard JA, Brugts MP, Lamberts SWJ, Hofland LJ, Janssen JAMJL. Insulin glargine is more potent in activating the human IGF-I receptor than human insulin and insulin detemir. Growth Horm IGF Res 2010; 20:427-431. [PMID: 21055982 DOI: 10.1016/j.ghir.2010.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 09/16/2010] [Accepted: 10/10/2010] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate whether human insulin (HI) and insulin analogues differ in their ability to activate the human IGF-I receptor (IGF-IR), the human insulin receptor A (IR-A) and the human insulin receptor B (IR-B) in vitro. METHODS HI, short-acting insulin analogues (insulin aspart; insulin lispro) and long-acting insulin analogues (insulin glargine; insulin detemir) were compared by using kinase receptor activation (KIRA) bioassays specific for IGF-IR, IR-A or IR-B, respectively. These assays quantify ligand activity by measuring receptor auto-phosphorylation upon ligand binding. HI and insulin analogues were tested in a range from 0.1 to 100 nM. RESULTS Short-acting analogues: Overall, short-acting insulin analogues did not differ substantially from HI, nor from each other. Insulin lispro was slightly more potent than HI and insulin aspart in activating the IGF-IR, only reaching statistical significance at 100 nM (p<0.01). Long-acting analogues: At <10 nM insulin glargine was as potent as HI in activating the IRs and IGF-IR. At 10-100 nM insulin glargine was significantly more potent than HI in activating the IR-B (p<0.05) and IGF-IR (p<0.001). Insulin glargine was more potent than insulin detemir in activating all three receptors (p<0.001). Insulin detemir was less potent than HI in activating the IRs at 1-10 nM (p<0.01) and IGF-IR at >1 nM (p<0.05). CONCLUSIONS Insulin glargine was more potent in activating the IGF-IR than HI and insulin detemir. Since KIRA bioassays do not mimic the exact in vivo situation, further research is needed to find out whether our data have implications for clinical use of insulin glargine.
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Affiliation(s)
- A J Varewijck
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, Rotterdam, The Netherlands
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