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Sekar, Priya, Haleh C. Heydarian, James F. Cnota, Lisa K. Hornberger, and Erik C. Michelfelder. "Diagnosis of congenital heart disease in an era of universal prenatal ultrasound screening in southwest Ohio." Cardiology in the Young 25, no. 1 (October 10, 2013): 35–41. http://dx.doi.org/10.1017/s1047951113001467.
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AbstractObjectivesDiagnostic ultrasound is widespread in obstetric practice, yet many babies with major congenital heart disease remain undiagnosed. Factors affecting prenatal diagnosis of major congenital heart disease are not well understood. This study aims to document prenatal detection rates for major congenital heart disease in the Greater Cincinnati area, and identify factors associated with lack of prenatal diagnosis.MethodsAll living infants diagnosed with major congenital heart disease by 4 months of age at our centre were prospectively identified. Prenatal care data were obtained by parent interview. Neonatal records were reviewed for postnatal data. Obstetricians were contacted for diagnostic ultrasound data.ResultsA total of 100 infants met the inclusion criteria. In all, 95 infants were analysed, of whom 94 were offered diagnostic ultrasound. In all, 41 had a prenatal diagnosis of major congenital heart disease. The rate of prenatal detection varied by cardiac lesion, with aortic arch abnormalities, semilunar valve abnormalities, and venous anomalies going undetected in this sample. Among subjects without prenatal detection, the highest proportion consisted of those having Level 1 diagnostic ultrasound only (66%). Prenatal detection was not significantly influenced by maternal race, education level, income, or insurance type.ConclusionsDespite nearly universal diagnostic ultrasound, detection rates of major congenital heart disease remain low in southwest Ohio. An educational outreach programme including outflow tract sweeps for community-level obstetrical personnel may improve detection rates.
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Sun, Shu Ping, Zhong Wei Jiang, Hai Bin Wang, and Ting Tao. "Heart Sound Analysis for Discrimination of VSD." Advanced Engineering Forum 2-3 (December 2011): 243–48. http://dx.doi.org/10.4028/www.scientific.net/aef.2-3.243.
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A ventricular septal defect (VSD) is the most common congenital heart disease, which can be cured with a high probability if it is detected in an early stage. In our previous researches on heart sounds (HSs) analysis, the detection methods of heart disease using the cardiac sound characteristic waveforms in time domain or in frequency domain were proposed, and have been succeed in discriminating several heart murmurs. In this paper, we are going to apply these methods to detect VSD. Based on analysis results, a new approach by using the feature parameters both in time domain and in frequency domain is proposed to achieve higher discrimination rates.
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Vojtecky, Mark A., and Michael A. Vojtecky. "The “Heartscore” Program: A Case Study in Limited Evaluation." International Quarterly of Community Health Education 10, no. 2 (July 1989): 167–76. http://dx.doi.org/10.2190/5ufu-gp49-40xv-3jex.
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In greater Youngstown, Ohio coronary heart disease (CHD) is the number one cause of death and disability. Moreover, mortality rates from CHD are higher in this region than in any other part of Ohio. In response to the obvious need for risk reduction programs in this area the “Heartscore” program was created. Heartscore is a hospital-based community health promotion effort designed to help decrease the incidence of death and disability resulting from CHD by increasing the public's awareness of risk factors and the ways that they can be controlled. A total of 2,135 people took part in Heartscore. Resources for a comprehensive evaluation of the Heartscore program were scarce, therefore only a limited evaluation of the screening programs was conducted. Even a limited evaluation, however, can produce useful results. This article describes Heartscore giving particular attention to how information gathered during the evaluation of the screenings is being used to fine-tune Heartscore and to plan more specific interventions.
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Alves-Leon, Soniza Vieira, Moises Pereira Pinto, Maria Emilia Cosenza Andraus, Valeria Coelho Santa Rita Pereira, Isabella D'Andrea Meira, Raquel de Carvalho Oliveira, Shaylla Villas Boas, Claudia Cecilia da Silva Rego, Jorge Paes Barreto Marcondes de Souza, and Roberto Coury Pedrosa. "Syncope in patients with drug-resistant epilepsy without apparent cardiovascular disease." Arquivos de Neuro-Psiquiatria 71, no. 12 (December 1, 2013): 925–30. http://dx.doi.org/10.1590/0004-282x20130179.
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Epilepsy and syncope are clinical conditions with high prevalence rates in the general population, and the differential diagnosis between them is difficult. Objective To assess the frequency of syncope in patients diagnosed with drug-resistant epilepsy (DRE) without apparent heart disease, to investigate the relationship between clinical and electroencephalographic (EEG) changes, and to verify the role of the inclination test (IT). Method An open, prospective study from 2004 to 2006, including 35 consecutive patients from the Epilepsy Program of Hospital Universitário Clementino Fraga Filho who were diagnosed with DRE without apparent heart disease. Results The frequency of syncope was 25.7% (n=9), with a significant prevalence in women. Vasovagal syncope (VVS) was the most frequent diagnosis. Conclusion We found a significant association between syncope and the presence of autonomic symptoms (p=0.005). The IT plays an important role in the differential diagnosis of patients with DRE presenting with autonomic symptoms, regardless of EEG results and brain magnetic resonance imaging (MRI) abnormalities.
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Khamees, Deena, Jennifer Klima, and Sarah H. O'Brien. "Population Screening for Von Willebrand's Disease in Adolescents with Heavy Menstrual Bleeding." Blood 120, no. 21 (November 16, 2012): 477. http://dx.doi.org/10.1182/blood.v120.21.477.477.
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Abstract Abstract 477 Background Heavy menstrual bleeding (HMB) is the most common presenting symptom in women with von Willebrand's disease (VWD), reported in 80–90% of patients. The American Congress of Obstetricians and Gynecologists recommends that VWD screening be performed in all adolescents presenting with severe menorrhagia; however, the frequency of VWD screening in clinical practice remains unknown. Combining administrative health claims data and electronic medical records from a large population of Ohio Medicaid-enrolled adolescents, our objectives were to determine the frequency of 1) VWD screening and 2) new patient evaluations at a hemophilia treatment center in adolescents with HMB. We also sought to determine what patient-level factors predicted VWD screening. Methods The data for this study were obtained from Partners for Kids, an accountable care organization providing health care for Medicaid patients in Central (Columbus, OH and surrounding counties) and Southeastern Ohio (rural counties). Our study population included females 10–17 years of age with two or more ICD-9-CM diagnoses of HMB (626.2, 626.3, 626.8) continuously enrolled in Partners for Kids for at least 6 months prior to and 12 months following first diagnosis of HMB. We defined severe HMB as HMB plus one of the following clinical features appearing in the 12 months following first diagnosis: 1) inpatient stay for HMB, 2) iron deficiency anemia (ICD-9 codes 280.0, 280.8, 280.9), or 3) evidence of blood transfusion (CPT code 36430). We extracted data from Partners for Kids regarding patient age, county of residence, inpatient and outpatient diagnoses and procedures, and laboratory testing. By linking patient name and date of birth to electronic medical records at Nationwide Children's Hospital (the pediatric hemophilia treatment center for Central and Southeastern Ohio), we determined which patients had a hematology visit since time of first HMB diagnosis. Results Our study included 673 patients, 16% of whom met study definition for severe HMB. VWD screening occurred in only 10% of the total study population, but was significantly higher (24%) in patients with severe HMB (p <0.001). Patients living in Central Ohio (location of the region's hemophilia treatment center) were more likely to be screened for VWD (OR 2.1, p <0.03) than patients in Southeastern Ohio. When compared to 15–17 year olds, the youngest patients (aged 10–11 years) were more likely to be screened for VWD (OR 3.6, 95% C.I.: 1.6–8.1, p =0.002), and 12–14 year olds were also more likely to be screened than the oldest patients (OR 2.7, 95% C.I.: 1.5–4.8, p =0.001). Fifty-one (7.6%) patients were seen by the regional hemophilia treatment center. Almost 10% of all patients had a diagnosis of iron deficiency anemia, although only 26% of patients were screened for this common complication of HMB. Though only 3% of the study population (11% of the severe HMB population) was diagnosed with a bleeding disorder within 1 year of diagnosis of HMB, over a third of these (36%) were VWD. The prevalence of platelet function defects was similar to VWD. Discussion Despite recommendations by the American Congress of Obstetricians and Gynecologists, VWD screening is performed in a minority of adolescents with HMB, even among those with the most severe disease. Given the low rates of screening, our population reported frequencies of inherited bleeding disorders in adolescents with HMB are likely under-estimates. The low rate of screening for iron deficiency anemia in adolescents with HMB is also of concern. Future studies are needed to identify and overcome barriers to laboratory screening for inherited bleeding disorders in young women with HMB. 1. Laboratory Evaluation and Final Diagnoses in Adolescents with Heavy Menstrual Bleeding Disclosures: O'Brien: GSK: Consultancy, topic not relevant to this paper Other.
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Dauchet, Luc, Jean Ferrières, Dominique Arveiler, John W. Yarnell, Fred Gey, Pierre Ducimetière, Jean-Bernard Ruidavets, et al. "Frequency of fruit and vegetable consumption and coronary heart disease in France and Northern Ireland: the PRIME study." British Journal of Nutrition 92, no. 6 (December 2004): 963–72. http://dx.doi.org/10.1079/bjn20041286.
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Fruit and vegetable consumption is associated with low CHD risk in the USA and Northern Europe. There is, in contrast, little information about these associations in other regions of Europe. The goal of the present study was to assess the relationship between frequency of fruit and vegetable intake and CHD risk in two European populations with contrasting cardiovascular incidence rates; France and Northern Ireland. The present prospective study was in men aged 50–59 years, free of CHD, who were recruited in France (n 5982) and Northern Ireland (n 2105). Fruit and vegetable intake was assessed by a food-frequency questionnaire. Incident cases of acute coronary events and angina were recorded over a 5-year follow-up. During follow-up there was a total of 249 ischaemic events. After adjustment on education level, smoking, physical activity, alcohol consumption, employment status, BMI, blood pressure, serum total and HDL-cholesterol, the relative risks (RR) of acute coronary events were 0·67 (95% CI 0·44, 1·03) and 0·64 (95% CI 0·41, 0·99) in the 2nd and 3rd tertiles of citrus fruit consumption, respectively (P for trend <0·03). Similar results were observed in France and Northern Ireland. In contrast, the RR of acute coronary events for ‘other fruit’ consumption were 0·70 (95% CI 0·31, 1·56) and 0·52 (95% CI 0·24, 1·14) respectively in Northern Ireland (trend P<0·05) and 1·29 (95% CI 0·69, 2·4) and 1·15 (95% CI 0·68, 1·94) in France (trend P=0·5; interaction P<0·04). There was no evidence for any association between vegetable intake and total CHD events. In conclusion, frequency of citrus fruit, but not other fruits, intake is associated with lower rates of acute coronary events in both France and Northern Ireland, suggesting that geographical or related factors might affect the relationship between fruit consumption and CHD risk.
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LI, SHIYANG, MING YANG, CUNCEN LI, and PING CAI. "ANALYSIS OF HEART RATE FLUCTUATION BASED ON WAVELET ENTROPY." Fluctuation and Noise Letters 07, no. 02 (June 2007): L135—L142. http://dx.doi.org/10.1142/s0219477507003775.
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The regularity of heart rates has a loss in cases of illness and aging. Assessing the dynamics of heart rate fluctuations can provide valuable information about cardiac system. In this paper, heart rate fluctuations and its wavelet entropy (WE) are analyzed to demonstrate its potentials for risk stratification of cardiac diseases. The regularity of heart rate fluctuations is estimated by exploiting the time-frequency localization ability of wavelet analysis and the ability of entropy. The results show that WE for patients with congestive heart failure show a very low value and can be completely separated from health subjects. In addition, the values of WE decrease with aging. The lower the values of WE, the higher the risk of heart disease is. The values of WE also reflect the distribution of the energy of heart rhythm. Significant correlations are demonstrated between WE and the power in the three frequency bands. The results have shown that WE can be used to analyze short, non-stationary data time series both in time domain and in frequency domain simultaneously and can be feasible for the discrimination of the differences of heart rate fluctuations between healthy groups and CHF groups as a diagnostic tool.
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Babaoğlu, Kadir, Murat Deveci, Özlem Kayabey, Gürkan Altun, and Köksal Binnetoğlu. "Prevalence of overweight and obesity among patients with congenital and acquired heart disease in Kocaeli, Turkey." Cardiology in the Young 25, no. 3 (March 25, 2014): 533–38. http://dx.doi.org/10.1017/s1047951114000377.
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AbstractBackground:Childhood obesity has increased in the last half of the century. The aim of this study was to evaluate the frequency of obesity in the children with congenital or acquired heart disease.Methods:A total of 1410 children were assessed in this study. The study population was composed of 518 children (289 boys, 229 girls) as control group and 892 children (477 boys, 415 girls) as heart disease group. Patients were grouped into four categories: (I) “Clinic control subjects”; (II) “mild heart disease” that has not been treated with either surgical or catheter intervention; (III) congenital heart disease treated with surgical and/or catheter intervention; and (IV) “arrhythmias”. A body mass index ⩾85th percentile was defined as overweight, ⩾95th percentile as obese, and <5th percentile was defined as underweight.Results:We did not detect any association between heart disease and obesity. There was no difference in the rates of overweight, obesity, and underweight between the healthy control subjects and patients with heart disease (8.1%, 13.3%, and 5.0%; 9.0%, 10.7%, and 4.7%, respectively, p=0.145). All subgroups had a similar prevalence of underweight, overweight, and obesity as the healthy control population. Within the heart disease population, the overall prevalence rates for overweight, obesity, and underweight were similar between the boys and girls.Conclusion:Obesity is a common problem in children with heart disease, at least in general population. It is an important additional risk factor for long-term cardiovascular morbidity and mortality in children with heart disease. Precautions to prevent obesity should be a part of paediatric cardiologist’s examination.
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Chung, Jae-Hoon, Nima Milani-Nejad, Jonathan P. Davis, Noah Weisleder, Bryan A. Whitson, Peter J. Mohler, and Paul M. L. Janssen. "Impact of heart rate on cross-bridge cycling kinetics in failing and nonfailing human myocardium." American Journal of Physiology-Heart and Circulatory Physiology 317, no. 3 (September 1, 2019): H640—H647. http://dx.doi.org/10.1152/ajpheart.00163.2019.
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The force-frequency relationship (FFR) is an important regulatory mechanism that increases the force-generating capacity as well as the contraction and relaxation kinetics in human cardiac muscle as the heart rate increases. In human heart failure, the normally positive FFR often becomes flat, or even negative. The rate of cross-bridge cycling, which has been reported to affect cardiac output, could be potentially dysregulated and contribute to blunted or negative FFR in heart failure. We recently developed and herein use a novel method for measuring the rate of tension redevelopment. This method allows us to obtain an index of the rate of cross-bridge cycling in intact contracting cardiac trabeculae at physiological temperature and assess physiological properties of cardiac muscles while preserving posttranslational modifications representative of those that occur in vivo. We observed that trabeculae from failing human hearts indeed exhibit an impaired FFR and a reduced speed of relaxation kinetics. However, stimulation frequencies in the lower spectrum did not majorly affect cross-bridge cycling kinetics in nonfailing and failing trabeculae when assessed at maximal activation. Trabeculae from failing human hearts had slightly slower cross-bridge kinetics at 3 Hz as well as reduced capacity to generate force upon K+ contracture at this frequency. We conclude that cross-bridge kinetics at maximal activation in the prevailing in vivo heart rates are not majorly impacted by frequency and are not majorly impacted by disease. NEW & NOTEWORTHY In this study, we confirm that cardiac relaxation kinetics are impaired in filing human myocardium and that cross-bridge cycling rate at resting heart rates does not contribute to this impaired relaxation. At high heart rates, failing myocardium cross-bridge rates are slower than in nonfailing myocardium.
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Simonova, G., O. Glushanina, Y. Nikitin, S. Malutina, and L. Scherbakova. "MS292 PECULIARITIES OF SYSTOLIC, DIASTOLIC, PULSE BP, HEART RATES AND FREQUENCY OF FATAL CARDIOVASCULAR DISEASE IN SIBERIAN POPULATION WITH METABOLIC SYNDROME." Atherosclerosis Supplements 11, no. 2 (June 2010): 168. http://dx.doi.org/10.1016/s1567-5688(10)70793-5.
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Jiang, Yao, Zhixiang Shen, Jingjing Zhang, Changying Xing, Xiaoming Zha, Chong Shen, Ming Zeng, et al. "Parathyroidectomy Increases Heart Rate Variability and Leptin Levels in Patients with Stage 5 Chronic Kidney Disease." American Journal of Nephrology 44, no. 3 (2016): 245–54. http://dx.doi.org/10.1159/000449018.
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Background: In chronic kidney disease (CKD) patients, decreased heart rate variability (HRV) reflects impaired cardiac automatic nervous function and high risk of cardiovascular disease (CVD). Lower HRV in patients with severe secondary hyperparathyroidism (SHPT), a clinical manifestation of CKD-mineral and bone disorder (CKD-MBD), could be reversed by parathyroidectomy (PTX). It has been proved that leptin interacts with the autonomic nervous function. However, the associations between leptin and HRV in CKD patients and their longitudinal changes in SHPT patients after PTX are still unknown. Methods: This was a cross-sectional study including 141 stage 5 CKD patients, and a prospective study in 36 severe SHPT patients with PTX. HRV was measured by Holter and serum leptin was measured by ELISA. Serum leptin levels were adjusted for body mass index (BMI) and transformed using natural logarithm (lnleptin/BMI). Results: With a gradient of lnleptin/BMI across quartiles from Q1 to Q4 in CKD patients, HRV indices showed no differences among quartiles. Patients in Q1 group had higher mean 24 h heart rates, and lower ln(very low frequency) (lnVLF) than other quartiles, although there were no statistically significant difference. In multivariate stepwise regression, serum leptin/BMI was an independent predictor for low frequency/high frequency. HRV indices and lnleptin/BMI levels were increased in severe SHPT patients after PTX. Compared to other quartiles, SHPT patients in Q1 group had larger improvement of lnVLF after PTX. Conclusion: Circulating leptin levels may be a novel treatment target to reduce CVD risk in advanced CKD-MBD patients.
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Xu, Chenjie, Hongxi Yang, Li Sun, Xinxi Cao, Yabing Hou, Qiliang Cai, Peng Jia, and Yaogang Wang. "Detecting Lung Cancer Trends by Leveraging Real-World and Internet-Based Data: Infodemiology Study." Journal of Medical Internet Research 22, no. 3 (March 12, 2020): e16184. http://dx.doi.org/10.2196/16184.
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Background Internet search data on health-related terms can reflect people’s concerns about their health status in near real time, and hence serve as a supplementary metric of disease characteristics. However, studies using internet search data to monitor and predict chronic diseases at a geographically finer state-level scale are sparse. Objective The aim of this study was to explore the associations of internet search volumes for lung cancer with published cancer incidence and mortality data in the United States. Methods We used Google relative search volumes, which represent the search frequency of specific search terms in Google. We performed cross-sectional analyses of the original and disease metrics at both national and state levels. A smoothed time series of relative search volumes was created to eliminate the effects of irregular changes on the search frequencies and obtain the long-term trends of search volumes for lung cancer at both the national and state levels. We also performed analyses of decomposed Google relative search volume data and disease metrics at the national and state levels. Results The monthly trends of lung cancer-related internet hits were consistent with the trends of reported lung cancer rates at the national level. Ohio had the highest frequency for lung cancer-related search terms. At the state level, the relative search volume was significantly correlated with lung cancer incidence rates in 42 states, with correlation coefficients ranging from 0.58 in Virginia to 0.94 in Oregon. Relative search volume was also significantly correlated with mortality in 47 states, with correlation coefficients ranging from 0.58 in Oklahoma to 0.94 in North Carolina. Both the incidence and mortality rates of lung cancer were correlated with decomposed relative search volumes in all states excluding Vermont. Conclusions Internet search behaviors could reflect public awareness of lung cancer. Research on internet search behaviors could be a novel and timely approach to monitor and estimate the prevalence, incidence, and mortality rates of a broader range of cancers and even more health issues.
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McBride, Cameron L., Julia M. Akeroyd, David J. Ramsey, Vijay Nambi, Khurram Nasir, Erin D. Michos, Ruth L. Bush, et al. "Statin prescription rates and their facility-level variation in patients with peripheral artery disease and ischemic cerebrovascular disease: Insights from the Department of Veterans Affairs." Vascular Medicine 23, no. 3 (March 30, 2018): 232–40. http://dx.doi.org/10.1177/1358863x18758914.
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The 2013 American College of Cardiology/American Heart Association cholesterol guideline recommends moderate to high-intensity statin therapy in patients with peripheral artery disease (PAD) and ischemic cerebrovascular disease (ICVD). We examined frequency and facility-level variation in any statin prescription and in guideline-concordant statin prescriptions in patients with PAD and ICVD receiving primary care in 130 facilities across the Veterans Affairs (VA) health care system between October 2013 and September 2014. Guideline-concordant statin intensity was defined as the prescription of high-intensity statins in patients with PAD or ICVD ≤75 years and at least moderate-intensity statins in those >75 years. We calculated median rate ratios (MRR) after adjusting for patient demographic factors to assess the magnitude of facility-level variation in statin prescribing patterns independent of patient characteristics. Among 194,151 PAD patients, 153,438 patients (79.0%) were prescribed any statin and 79,435 (40.9%) were prescribed a guideline-concordant intensity of statin. PAD patients without ischemic heart disease were prescribed any statin and a guideline-concordant intensity of statin therapy less frequently (69.1% and 28.9%, respectively). Among 339,771 ICVD patients, 265,491 (78.1%) were prescribed any statin and 136,430 (40.2%) were prescribed a guideline-concordant intensity of statin. ICVD patients without ischemic heart disease were prescribed any statin and a guideline-concordant intensity of statin less frequently (70.9% and 30.5%, respectively). MRRs for both PAD and ICVD patients demonstrated a 20% and 28% variation among two facilities in treating two identical patients with statin therapy and guideline-concordant intensity of statin therapy, respectively. The prescription of statins, especially guideline-recommended intensity of statin therapy, is suboptimal in PAD and ICVD patients, with significant facility-level variation not explained by patient-level factors.
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Enwerem, N. M., P. O. Okunji, J. S. Ngwa, S. G. Karavatas, T. V. Fungwe, and T. O. Obisesan. "Prevalence of Parkinson Disease in Hospitalized Patients With Congestive Heart Failure." International Journal of Studies in Nursing 3, no. 2 (January 3, 2018): 23. http://dx.doi.org/10.20849/ijsn.v3i2.371.
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Background: Parkinson's disease (PD) is the second most common neurodegenerative disease, after Alzheimer’s disease, affecting approximately one million persons aged 65 years and above in the United States. Parkinson's disease represents a major medical concern for health professionals, national healthcare bodies and a heavy burden for caregivers. Heart failure occurred twice as frequently in elderly PD patients as in non-PD patients. There is paucity of information on the association of patient and hospital characteristics on the outcomes of inpatient with both congestive heart failure and Parkinson disease.Congestive Heart Failure with PD as a comorbidity will increase the cost of care and health resources. We investigate on the current prevalence and factors that affect the inpatient with both CHF and PD conditions using a longitudinal datasets from National Inpatient Samples. The results obtained from this study will provide information that will reduce frequent readmission, length of stay, total charges and mortality rate in this population.Methods: Data from the National Inpatient Samples (NIS) were extracted and analyzed using ICD 9 codes (CHF 428, PD 332) for the main diagnosis. For continuous variables, we calculated the mean and standard deviations and evaluated significant differences of these factors by Parkinson disease status using the t-test. For categorical variables, we obtained the counts (proportions) and evaluated significant differences using the Chi-square and Fisher’s exact test Propensity score was utilized to match age, gender and race using logistic model for hospital death and generalized linear model for length of stay (LOS) and hospital charges.Result: The overall frequency of Parkinson disease (PD) in congestive heart failure was 1.54 % (n = 10,748). PD patients with CHF were more likely to be males (53.13 %; 5462) and Caucasians (82.24 %; n=8454). The average age of inpatient was approximately 80 years (SD=8.05). Hospital admission, decreases with median household income. Patients with low income ($1 - $38,999) were admitted more with 3002 (29.70%) than those with higher income ($63,000 and more) with 2230 (22.06%). Length of stay (LOS) (p<0.0001) and total charge incurred during hospitalization were less in patients with PD (p< 0.005) (table 1). In these analyses, we found that patients with PD were discharged more from urban non-teaching hospital than urban teaching hospital (p<0.0001).Conclusion: The general characteristics and frequency of the participant in this study are summarized in Table I. Accordingly, characteristics of patients with congestive heart failure with or without Parkinson’s disease did not differ by age, gender, or ethnicity (P>1.000). Similarly, hospital death rates (%) were not different (P>1.000), although hospital length of stay (P<1.000) and total charge incurred during hospitalization were less in patients with PD (p < 0.005)
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Maksimov, Sergey A., M. V. Tabakaev, A. N. Chigisova, and G. V. Artamonova. "RESULTS OF THE COMPLEX RISK FACTOR ASSESSMENT FOR THE CORONARY HEART DISEASE IN WORKING POPULATION." Hygiene and sanitation 97, no. 4 (April 15, 2018): 310–14. http://dx.doi.org/10.18821/0016-9900-2018-97-4-310-314.
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Material and methods. Three groups of men working in Kemerovo region were formed: 694 “white-collar”, 1674 “blue-collar” and 1612 “coal-miners”. To form the comparison group we used data from the Russian research ESSE-RF in the Kemerovo region (700 men). The following cardiovascular risk factors were assessed: hypercholesterolemia, hypertriglyceridemia, hyperglycemia, obesity, hypertension, smoking, and education level. The coronary heart disease (CHD) was diagnosed on the basis of ECG changes on the Minnesota code, Rose questionnaire, and myocardial infarction. According to the frequency of risk factors and their contribution to the probability of developing the coronary heart disease, there was calculated the total burden of CHD risk factors (Maksimov S.A. et al., 2015). Results .The burden of CHD risk factors in the general population up to 51 years accounts for 308 conventional units. There is a variety of risk factors frequency in the working groups, both inside the groups and in comparison with the general population. Consequently, there are differences in values of CHD risk factors burdens. The “blue-collar” burdens of CHD risk factors corresponding to the general population (304 conventional units). In “white-collar” and “miners” this parameter is lower, respectively, 266 and 259 conventional units. After 50 years, the total burden of CHD risk factors in the population increased to 472 conventional units (1.5 times). Differences of this index in the working groups to the general population after 50 years also increased. Conclusion. The working population is characterized by the low total burden of CHD risk factors compared with the general population. After 50 years, these differences increase, which indicates the deterioration of health with age, stimulates the individual to the termination of employment or the ongoing the work as the healthiest individuals. The lowest rates of CHD risk factors burden have been reported in “miners”, the average - in “white collar”, maximum - in “blue-collar”.
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Rakic, Dusica, and Djordje Jakovljevic. "Frequency and changes in trends of leading risk factors of coronary heart disease in women in the city of Novi Sad during a 20-year period." Vojnosanitetski pregled 69, no. 2 (2012): 163–67. http://dx.doi.org/10.2298/vsp1202163r.
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Backround/Aim. From 1984 to 2004 the city of Novi Sad participated through its Health Center ?Novi Sad? in the international Multinational MONItoring of Trends and Determinants in CArdiovascular Disease (MONICA) project, as one of the 38 research centers in 21 countries around the world. The aim of this study was to determine frequency and changes of trends in leading risk factors of coronary heart disease (CHD) and to analyze the previous trend of movement of coronary event in women in Novi Sad during a 20- year period. Methods. In 2004, the fourth survey within MONICA project was conducted in the city of Novi Sad. The representative sample included 1,041 women between the age of 25 and 74. The prevalence of risk factors in CHD such as smoking, high blood pressure, elevated blood cholesterol, elevated blood glucose and obesity was determined. Also, indicators of risk factors and rates of coronary events in women were compared with the results from MONICA project obtained in previous three screens, as well as with the results from other research centres. ?2-test, linear trend and correlartion coefficient were used in statistical analysis of results obtained. Results. It was observed that during a 20-year period covered by the study, the prevalence of the leading risk factors for the development of CHD in the surveyed women was significantly increasing and in positive correlation with the values of linear trend. Also, the increase of morbidity rates and mortality rates of coronary event were in positive correlation. The decrease was only recorded in the period from 1985-1989 (the implementation of the intervention programme). Conclusion. Upon analysing the increase in prevalence of leading risk factors of CHD and significant increase in the rates of coronary event, we can conclude that health status of women in Novi Sad during a 20-year period was deteriorating.
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Ulmer, C. S. "0812 Nightmares: An Independent Risk Factor For Cardiovascular Disease." Sleep 43, Supplement_1 (April 2020): A309. http://dx.doi.org/10.1093/sleep/zsaa056.808.
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Abstract Introduction Associations between PTSD, sleep and cardiovascular disease are well-established in prior research, but few studies have examined adverse health correlates of nightmares. Nightmares are often called the “hallmark” symptom of PTSD and represent the cardinal sleep-specific manifestation of PTSD. Yet, prior studies have not examined nightmares’ independent contribution to cardiovascular disease risks beyond risks conferred by PTSD. The purpose of this study was to examine associations between nightmares and cardiovascular disease in Veterans with and without PTSD. Methods Participants were Veterans (N=3876; 78% male) serving since September 11, 2001, 1 or 2 tours of duty (73.5%), aged 38 years (SD=10.4), 31% meeting criteria for current PTSD, with equivalent proportions of African-Americans (48%) and Caucasians (48%). Nightmare frequency was assessed using the Davidson Trauma Scale (DTS), with “frequent” defined as occurring at least 2-3 times per week. Self-reported medical issues were assessed using the National Vietnam Veterans Readjustment Study (NVVRS) Self-report Medical Questionnaire. PTSD diagnosis was established using the Structured Clinical Interview for DSM-V. Results Frequent nightmares over the past week were endorsed by 33% of participants. Cardiovascular conditions were endorsed at the following rates: heart problems (6%); diabetes (6.6%); arthrosclerosis (0.5%); hypertension (29.2%); stroke (0.7%); and heart attack (1.2%). After adjusting for age, sex and race, frequent nightmares were associated with heart problems (F=7.50, p=.006), high blood pressure (F=23.84, p<.0001), and heart attack (F=7.19, p=.007). When PTSD was added to the model, these associations remained significant. Conclusion We found that frequent nightmares among Veterans are associated with cardiovascular conditions, even after controlling for the effects of PTSD. Additional research is needed to explore mechanisms explaining these associations and determine if reducing nightmare frequency and severity results in improved cardiovascular health. Support This work was supported by the Department of Veterans VISN 6 MIRECC and ADAPT Centers at the Durham VA Health Care System. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
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Kirgizova, M. A., O. R. Eshmatov, Yu I. Bogdanov, R. E. Batalov, and S. V. Popov. "Antithrombotic therapy in patients with coronary heart disease and atrial fibrillation after direct myocardial revascularization." Siberian Journal of Clinical and Experimental Medicine 35, no. 4 (December 25, 2020): 49–56. http://dx.doi.org/10.29001/2073-8552-2020-35-4-49-56.
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Aim. To evaluate the clinical efficacy and safety of direct oral anticoagulants versus warfarin as part of antithrombotic therapy (ATT), namely, to study the frequency of bleeding and thromboembolic complications in patients with atrial fibrillation (AF) after direct myocardial revascularization in combination with radiofrequency isolation of pulmonary veins.Material and Methods. A total of 44 patients (36 men) aged 44–77 years (average age of 63.5 ± 7.8 years) with coronary heart disease, indications for direct myocardial revascularization, and AF were included in the study from 2014 to 2016. The observation period was 24 months.Results. Warfarin was one of the components of ATT in 20 patients (48%). However, the target values of international normalized ratio (INR) within the therapeutic range for over 70% of the time were achieved only in seven patients. Two patients who were taking warfarin without achieving target INR values for 24 months suffered from ischemic stroke. One patient taking warfarin (without regular INR control) had gastrointestinal bleeding requiring hospitalization and conservative therapy; ten patients had minor bleedings (nasal and gingival bleeding). All patients, who suffered from thromboembolic and hemorrhagic complications and had inadequate warfarin intake, were recommended to switch to direct oral anticoagulants (DOAC). Thirteen patients (29%) were administered with DOAC: five patients took rivaroxaban 20 mg/day, four patients took dabigatran 300 mg/day, and four patients took apixaban 10 mg/day. DOAC therapy was administered in combination with one of the antiplatelet drugs (aspirin or clopidogrel). In the case of DOAC administration, only minor bleedings were observed: one patient had hemorrhoidal bleeding and four patients had nasal bleedings, which did not require hospitalization, medical intervention, or suspension of anticoagulant therapy. There were no other adverse events in patients taking DOAC.Conclusions. Patients administered with DOAC as a part of antithrombotic therapy after coronary bypass surgery and surgical epicardial radiofrequency isolation of the pulmonary veins had lower incidence rates of thromboembolic and hemorrhagic complications compared with the rates in patients taking warfarin. However, no statistically significant differences were found between the groups due to the small sample size.
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Sukumar, Senthil, Max Brodsky, Sarah Hussain, Spero Cataland, and Shruti Chaturvedi. "Cardiovascular Disease Is a Leading Cause of Death in Thrombotic Thrombocytopenic Purpura (TTP) Survivors." Blood 136, Supplement 1 (November 5, 2020): 22–23. http://dx.doi.org/10.1182/blood-2020-138551.
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Introduction: Immune thrombotic thrombocytopenic purpura (iTTP) is a potentially lethal thrombotic microangiopathy; however, prompt therapy with plasma exchange and immunosuppression leads to survival in over 90% of patients. Though TTP survivors were previously thought to return to baseline levels of health, recent reports suggest that TTP survivors have high rates of adverse health sequelae including hypertension, stroke, cognitive impairment, and poor quality of life as well as higher mortality rates compared with an age, race, and sex matched controls population. We conducted this multi-center cohort study to evaluate long term mortality and causes of death in patients that survived their first TTP episode. Methods: All available patients in The Ohio State University and Johns Hopkins Hospital Thrombotic Microangiopathy (TMA) registries were reviewed. Patients with confirmed iTTP based on ADAMTS13 activity <10% during an acute episode were included for analysis. A total of 238 patients met inclusion criteria, with 38 experiencing death during follow up. We evaluated primary and secondary cause of death where applicable. We also collected data on patient demographics, details of TTP history, and comorbidities including hypertension, diabetes, obesity, heart failure, hyperlipidemia, autoimmune conditions, chronic kidney disease, smoking, etc. Mortality was compared with an age, sex and race standardized US population using indirect standardization methods. A multivariable cox regression analysis was used to evaluate risk factors for reduced survival. Results: A total of 222 patients were enrolled in the Ohio State University and Johns Hopkins TTP registries between 2003 and 2020, of which 70.3% were female, and median age at enrollment was 42 (IQR [interquartile range] 29, 55) years. There were 38 deaths over a median follow up of 4 (IQR 0, 11) years (and a total of 1318 patient years of follow up). Characteristics of the study cohort are summarized in Table 1. Of the 38 patients that died, 9 died during their first episode of TTP and 29 died after surviving the first TTP episode. Median age at death among those that survived the first TTP episode was 49 (IQR 39, 65) years. Among survivors of acute TTP, cardiovascular disease was the leading primary cause of death (27.6%) followed by relapsed TTP (27.6%), malignancy (20.7%), infection (13.8%), and other/unknown causes (10.3%) (Table 2). Cardiovascular disease was the primary or secondary cause of death in 31% (9 of 29) patients. Cardiovascular causes of death included myocardial infarction, arrhythmia, decompensated heart failure, stroke, and hypertensive emergency. The median age of death from any cardiovascular cause (primary or secondary) was 49 years. Among TTP survivors, male sex [HR 4.39 (95% CI 1.83-10.52, P=0.001), age [HR 1.03 (95% CI 1.01-1.06), P=0.039] and number of TTP episodes [HR 1.12 (96% CI 1.05-1.21), P=0.001] were risk factors for mortality in a Cox regression model also adjusted for hypertension [HR 0.60 (95% CI 0.26-1.37), P=0.228], CKD [HR 1.38 (95% CI 0.61-3.13, P=0.436] and SLE [HR 1.26 (95% CI 1.04-1.21), P=0.771]. The mortality rate in TTP survivors was significantly higher than the expected mortality rate from an age and sex standardized reference US population (2228.3 per 100,000 person years versus 1273.8 per 100,000 person years, P = 0.007) (Figure 1). The median age at death was also lower in TTP survivors compared with the general population (49 versus 78.7 years). Conclusions: TTP survivors have two-fold higher mortality rate than expected rates from a reference US population, adjusted for age, sex and race. Cardiovascular disease is a leading cause of death in patients that survive their first episode of TTP. This may be due to higher rates of cardiovascular risk factors such as hypertension in TTP survivors. Reduced ADAMTS13 activity is a risk factor for all cause and cardiovascular death in the general population (Sonneveld et al.Arterioscler Thromb Vasc Biol. 2016) and may contribute to cardiovascular death in TTP survivors. Our results highlight the need to screen and aggressively manage cardiovascular risk factors in TTP survivors, and for prospective studies examining the vascular sequelae of TTP. Disclosures Cataland: Ablynx/Sanofi: Consultancy, Research Funding; Alexion: Consultancy, Research Funding. Chaturvedi:Alexion: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees.
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Mills, Geoffrey D., David M. Harris, Xiongwen Chen, and Steven R. Houser. "Intracellular sodium determines frequency-dependent alterations in contractility in hypertrophied feline ventricular myocytes." American Journal of Physiology-Heart and Circulatory Physiology 292, no. 2 (February 2007): H1129—H1138. http://dx.doi.org/10.1152/ajpheart.00375.2006.
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Hypertrophy and failure (H/F) in humans and large mammals are characterized by a change from a positive developed force-frequency relationship (+FFR) in normal myocardium to a flattened or negative developed force-frequency relationship (−FFR) in disease. Altered Ca2+ homeostasis underlies this process, but the role of intracellular Na+ concentration ([Na+]i) in H/F and frequency-dependent contractility reserve is unclear. We hypothesized that altered [Na+]i is central to the −FFR response in H/F feline myocytes. Aortic constriction caused left ventricular hypertrophy (LVH). We found that as pacing rate was increased, contraction magnitude was maintained in isolated control myocytes (CM) but decreased in LVH myocytes (LVH-M). Quiescent LVH-M had higher [Na+]i than CM (LVH-M 13.3 ± 0.3 vs. CM 8.9 ± 0.2 mmol/l; P < 0.001) with 0.5-Hz pacing (LVH-M 14.9 ± 0.5 vs. CM 10.8 ± 0.4 mmol/l; P < 0.001) but were not different at 2.5 Hz (17.0 ± 0.7 vs. control 16.0 ± 0.7 mmol/l; not significant). [Na+]i was altered by patch pipette dialysis to define the effect of [Na+]i on contraction magnitude and action potential (AP) wave shape at slow and fast pacing rates. Using AP clamp, we showed that LVH-M require increased [Na+]i and long diastolic intervals to maintain normal shortening. Finally, we determined the voltage dependence of contraction for Ca2+ current ( ICa)-triggered and Na+/Ca2+ exchanger-mediated contractions and showed that there is a greater [Na+]i dependence of contractility in LVH-M. These data show that increased [Na+]i is essential for maintaining contractility at slow heart rates but contributes to small contractions at fast rates unless rate-dependent AP shortening is prevented, suggesting that altered [Na+]i regulation is a critical contributor to abnormal contractility in disease.
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St. Michel, David, Tracy Donnelly, Towanda Jackson, Bradley Taylor, Rolf N. Barth, Jonathan S. Bromberg, and Joseph R. Scalea. "Assessing Pancreas Transplant Candidate Cardiac Disease: Preoperative Protocol Development at a Rapidly Growing Transplant Program." Methods and Protocols 2, no. 4 (October 17, 2019): 82. http://dx.doi.org/10.3390/mps2040082.
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Pancreas transplant rates, despite improving outcomes, have decreased over the past two decades. This is due, in part, to ageing, increasingly co-morbid pancreas transplant candidates. There is a paucity of published data regarding coronary artery disease (CAD) in this population. To inform peri-operative management strategies, we sought to understand the frequency of CAD among recipients of pancreas transplants at our center. Informed by these data, we sought to develop a standard protocol for evaluation. A retrospective review of pancreas transplants (solitary pancreas and simultaneous pancreas-kidney) was undertaken at the University of Maryland. Transplant outcomes and frequency of cardiac disease were analyzed. Current data were compared with historic controls. Over the study period, 59 patients underwent pancreas transplantation. Coronary architecture was assessed in 38 patients (64.4%). Discrete evidence of CAD was present in 28 of 39 patients (71.7%). All pancreas candidates (n = 21) who underwent left heart catheterization (LHC) demonstrated CAD (100%). No patients experienced myocardial infarction (MI) and no deaths resulted from cardiac disease in the early post-transplant period. Pancreas transplant candidates are at high risk for CAD. At a center in which pancreas transplant rates are increasing, a rigorous cardiac work up revealed that 71.7% of assessed recipients had CAD. Although asymptomatic, 6.8% required coronary artery bypass graft (CABG). Despite increasing age and co-morbid status, pancreas transplant recipients can enjoy excellent results if protocolized preoperative testing is used.
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K, Doddabasava, Prijo Philip, Sumanth Shetty B, Chinthu Sara Jacob, and Subramanyam K. "Gamut of congenital heart diseases in a tertiary center in South India: an ode to echocardiography." International Journal of Contemporary Pediatrics 4, no. 3 (April 25, 2017): 1021. http://dx.doi.org/10.18203/2349-3291.ijcp20171720.
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Background: Echocardiography has supplanted clinical acumen in diagnosis of congenital heart diseases (CHDs). Prevalence rates of CHDs across various regions of the world are subject to change over the course of time, with increasing use of this diagnostic modality. Objective: To assess the prevalence and types of CHDs.Methods: The study was conducted at a tertiary care center in South Karnataka, India. Transthoracic echocardiographic records of all patients suspected to have congenital heart disease, over a period of 60 months were analyzed. Categorization of data into acyanotic and cyanotic congenital heart disease, and further, into different types was done after an exhaustive search. Specific variables such as age, frequency and gender distribution of all kinds of CHDs were computed.Results: Of a total 112,372 pediatric patients who attended our center, 1451 reports of subjects suspected to have CHDs were analyzed. The prevalence was found to be 6.22 per 1000 subjects. Of the 700 subjects (48.24%) with CHD, 664 (94.85%) were diagnosed to have Acyanotic Congenital Heart Disease and 36 (5.14%) were diagnosed to have Cyanotic Congenital Heart Disease. Among the Acyanotic CHD, Atrial Septal Defect (ASD) was found to be the most common (40.21%) seconded by Ventricular Septal Defect (VSD) (21.53%). Among the 36 subjects diagnosed to have Cyanotic CHD, it was found that Tetralogy of Fallot (TOF) was the most commonest lesion (61.11%).Conclusions: Increased utilization of Echocardiography as a diagnostic modality significantly helps to better appreciate ever varying prevalence rates and types of CHDs in different parts of India. Frequent longitudinal studies in this regard help in enhanced allocation of available resources and updating of available databases.
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Govil, Dhruv, Ivan Lin, Tony Dodd, Rhonda Cox, Penny Moss, Sandra Thompson, and Andrew Maiorana. "Identifying culturally appropriate strategies for coronary heart disease secondary prevention in a regional Aboriginal Medical Service." Australian Journal of Primary Health 20, no. 3 (2014): 266. http://dx.doi.org/10.1071/py12117.
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Aboriginal Australians experience high rates of coronary heart disease (CHD) at an early age, highlighting the importance of effective secondary prevention. This study employed a two-stage process to evaluate CHD management in a regional Aboriginal Medical Service. Stage 1 involved an audit of 94 medical records of clients with documented CHD using the Audit and Best Practice in Chronic Disease approach to health service quality improvement. Results from the audit informed themes for focus group discussions with Aboriginal Medical Service clients (n = 6) and staff (n = 6) to ascertain barriers and facilitators to CHD management. The audit identified that chronic disease management was the focus of appointments more frequently than in national data (P < 0.05), with brief interventions for lifestyle modification occurring at similar or greater frequency. However, referrals to follow-up support services for secondary prevention were lower (P < 0.05). Focus groups identified psychosocial factors, systemic shortcomings, suboptimal medication use and variable awareness of CHD signs and symptoms as barriers to CHD management, whereas family support and culturally appropriate education promoted health care. To optimise CHD secondary prevention for Aboriginal people, health services require adequate resources to achieve best-practice systems of follow up. Routinely engaging clients is required to ensure services meet diverse community needs.
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Vener, David F., Christopher F. Tirotta, Dean Andropoulos, and Paul Barach. "Anaesthetic complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease." Cardiology in the Young 18, S2 (December 2008): 271–81. http://dx.doi.org/10.1017/s104795110800303x.
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AbstractCongenital heart defects are the most common cause of death in infants and young children in the developed world. As the mortality in this population has declined to less than 5%, more attention is being focused now on reducing post-procedural morbidities that may seriously impact the patient and their families. Because of multiple reasons, paediatric cardiac surgery and anaesthesia is a perfect model for studying human errors and their impact on patient safety. Congenital cardiac disease is a common lesion causing much morbidity, pain, and loss of life. Over 44,000 surgical procedures are performed yearly to repair congenital cardiac problems in the United States alone. The reduction or elimination of iatrogenic adverse outcomes, given the current mortality rates of 4.2%–4.5%, might lead to as many as 500 children achieving better outcomes or shorter hospitalizations.Efforts to quantify the frequency of complications related to anaesthesia in patients undergoing congenital cardiac surgery have been difficult to date because of the low occurrence of this surgery compared to other surgeries on children and the relatively rare incidence of complications related to anaesthesia in this population. Anaesthesiologists play a crucial role in the reduction, recognition, and timely treatment of medical errors that impact this morbidity. Paediatric cardiac surgery encompasses many complex procedures that are highly dependent upon a sophisticated organizational structure, effective communication, coordinated efforts of multiple individuals working as a team, and high levels of cognitive and technical performance. Human factor error analysis in this patient population has shown how frequently both minor and major errors occur. The goal of this paper is to outline the frequency and sources of these errors and to suggest treatment strategies which may minimize their occurrence.
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Vinciguerra, V., K. J. Propert, M. Coleman, J. R. Anderson, L. Stutzman, T. F. Pajak, N. I. Nissen, G. Frizzera, A. Gottlieb, and J. F. Holland. "Alternating cycles of combination chemotherapy for patients with recurrent Hodgkin's disease following radiotherapy. A prospectively randomized study by the Cancer and Leukemia Group B." Journal of Clinical Oncology 4, no. 6 (June 1986): 838–46. http://dx.doi.org/10.1200/jco.1986.4.6.838.
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A randomized clinical trial of combination chemotherapy for patients who relapsed following primary radiation therapy for Hodgkin's disease was conducted from 1975 to 1981 by the Cancer and Leukemia Group B (CALGB). One hundred thirteen patients were prospectively randomized to receive 12 cycles of either CVPP (CCNU, vinblastine, procarbazine, and prednisone), ABOS (bleomycin, vincristine [Oncovin; Lilly, Indianapolis], doxorubicin [Adriamycin, Adria Laboratories, Columbus, Ohio], and streptozotocin), or alternating cycles of CVPP and ABOS. The median length of observation for patients in this report is 4 years. Toxicities of the three treatment programs were primarily hematologic. Frequencies of complete response were 72% for CVPP, 70% for ABOS, and 82% for CVPP/ABOS (P = .37). Females and patients who had nodular sclerosing disease at initial diagnosis had significantly higher complete response rates. The 5-year disease-free survival for the complete responders was 55%; the 5-year overall survival was 60%. There were no significant differences among the treatments on disease-free survival (P = .78) or overall survival (P = .18). Age under 40 years was the only significant positive prognostic factor for disease-free survival (P = .095) and overall survival (P = .003). This study demonstrates no statistically significant advantage for alternating cycles of combination chemotherapy in affecting complete response frequency, disease-free survival, or overall survival as compared with therapy with CVPP or ABOS alone. However, the power to detect differences in these outcome parameters is somewhat limited by the sample sizes.(ABSTRACT TRUNCATED AT 250 WORDS)
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Qualls, Clifford, and Otto Appenzeller. "Modeling Metabolism and Disease in Bioarcheology." BioMed Research International 2015 (2015): 1–8. http://dx.doi.org/10.1155/2015/548704.
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We examine two important measures that can be made in bioarcheology on the remains of human and vertebrate animals. These remains consist of bone, teeth, or hair; each shows growth increments and each can be assayed for isotope ratios and other chemicals in equal intervals along the direction of growth. In each case, the central data is a time series of measurements. The first important measures are spectral estimates in spectral analyses and linear system analyses; we emphasize calculation of periodicities and growth rates as well as the comparison of power in bands. A low frequency band relates to the autonomic nervous system (ANS) control of metabolism and thus provides information about the life history of the individual of archeological interest. Turning to nonlinear system analysis, we discuss the calculation of SM Pinus’ approximate entropy (ApEn) for short or moderate length time series. Like the concept that regular heart R-R interval data may indicate lack of health, low values of ApEn may indicate disrupted metabolism in individuals of archeological interest and even that a tipping point in deteriorating metabolism may have been reached just before death. This adds to the list of causes of death that can be determined from minimal data.
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Siddiq, Farhan, Malik M. Adil, Ahmed A. Malik, Mushtaq H. Qureshi, and Adnan I. Qureshi. "Effect of Carotid Revascularization Endarterectomy Versus Stenting Trial Results on the Performance of Carotid Artery Stent Placement and Carotid Endarterectomy in the United States." Neurosurgery 77, no. 5 (July 17, 2015): 726–32. http://dx.doi.org/10.1227/neu.0000000000000905.
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Abstract BACKGROUND: CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial) results, published in 2010, showed no difference in the rates of composite outcome (stroke, myocardial infarction, or death) between carotid artery stent placement (CAS) and carotid endarterectomy (CEA). OBJECTIVE: To identify any changes in use and outcomes of CAS and CEA subsequent to the CREST results. METHODS: We estimated the frequency of CAS and CEA procedures in the years 2009 (pre-CREST period) and 2011 (post-CREST period), using data from the National Inpatient Sample (NIS). Demographic and clinical characteristics and in-hospital outcomes of pre- and post-CREST CAS-treated and post-CREST CEA-treated patients were compared with pre-CREST CEA-treated patients. RESULTS: A total of 225 191 patients underwent CEA or CAS in the pre- and post-CREST periods. The frequency of CAS among carotid revascularization procedures did not change after publication of the CREST results (12.3% vs 12.7%, P = .9). In the pre-CREST period, the CAS group (compared with the CEA group) had higher rates of congestive heart failure (P < .001), coronary artery disease (P < .001), and renal failure (P < .001). The post-CREST CAS group had a higher frequency of atrial fibrillation (P = .003), congestive heart failure (P < .0001), coronary artery disease (P < .0001), and renal failure (P = .0001). Discharge with moderate to severe disability (P < .0001) and postprocedure neurological complications (P = .005) were more frequently reported in the post-CREST CAS group. After adjusting for age, sex, and risk factors, the odds ratio (OR) for moderate to severe disability was 1.0 (95% confidence interval [CI]: 0.8-1.2) in the pre-CREST CAS group and 1.4 (95% CI: 1.1-1.7) in the post-CREST CAS group compared with the reference group. The adjusted OR for neurological complications in the pre-CREST CAS group was 1.6 (95% CI: 1.2-2.1, P = .002), and 1.5 (95% CI: 1.1-2.0, P = .01) in the post-CREST CAS group. CONCLUSION: The frequency of CAS and CEA for carotid artery stenosis has not changed after publication of the CREST. The demographics, pretreatment comorbidity profile, and in-hospital complication rates remained unchanged during the 2 time periods.
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Golyshko, Valentina S., V. A. Snezhitskiy, N. V. Matsiyeueskaya, and N. I. Prokopchik. "The frequency and characteristics of cardiovascular pathology in HIV-infected patients (according to aytopsy)." Clinical Medicine (Russian Journal) 95, no. 10 (December 4, 2017): 928–34. http://dx.doi.org/10.18821/0023-2149-2017-95-10-928-934.
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Aim to study the frequency and structure of the cardiovascular diseases (CVD) deaths from HIV-infected patients. A retrospective analysis of medical records of 346 deaths of HIV-infected patients: 225 (65%) males (95% confidence interval - 95% CI 69,8-58,8) and 121 (35%) women (95% CI 30,1-40,1) at the age of 35.0 [32,0;38,0] years. Autopsy was performed in 150 (43,5%) patients (95% CI 38,2-48,6). GCC is installed in 77 (22.3 %) of 346 cases (95% CI of 18.2-26.9) . While 18 (5,2%) patients (95% CI 3,3-8,1) CVD was the main cause of death in 59 (17,1%) - concomitant diseases (95% CI 13,5-1,4). The structure of the CVD were presented with acute heart failure in 17 (4,9%) autopsy cases (95% CI 3,1-7,7) , hydropericardium - 14 (4.0%) of cases (95% CI 2,4-6,7), coronary heart disease in 14 (4.0%) of cases (95% CI 2,4-6,7), cardiomyopathy in 11 (3,2%) cases (95% CI 1,8-5,6), myocarditis in 10 (2.9%) cases (95% CI 1,6-5,2), infective endocarditis in 4 (1.2%) cases (95% CI 0.5-3.0), chronic pulmonary heart, in 4 (1.2%) cases (95% CI 0.5-3.0), effusion in 3 (0.9%) cases (95% CI 0,3 - 2,5). The defeat of the cardiovascular system in HIV-infected patients in 79,2% of cases were formed against the background of generalized of severe opportunistic infections and diseases. In patients not receiving antiretroviral therapy, have higher rates of death AIDS-associated CVD as compared to that in patients receiving therapy: 3,8% (95% CI 1.9-7,3) and 0 respectively (p=0.05).
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Masters, Joan A., Joanne Sabol Stevenson, and Stephen F. Schaal. "The Association Between Moderate Drinking and Heart Rate Variability in Healthy Community-Dwelling Older Women." Biological Research For Nursing 5, no. 3 (January 2004): 222–33. http://dx.doi.org/10.1177/1099800403261324.
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The relationships among moderate alcohol use, autonomic tone, and arrhythmogenesis in older adults have not been adequately studied. Knowledge about these relationships is of increasing importance in light of population aging and recent epidemiological findings that associate moderate alcohol use with decreased rates of coronary artery disease. The purpose of this study was to assess the association between moderate drinking and autonomic tone in older women. Fifty-two Caucasian female participants (age 69 ± 5.2) were enrolled in the study. Autonomic tone was estimated by time-domain and frequency-domain measures of heart rate variability. Multivariate analysis revealed that alcohol consumption rate in the sample accounted for approximately one third of the 24-h variability in the SDNN and the SDANN, measures of variability cycle lengths of 24-h and more than 5-min, respectively. Significant contributions of alcohol consumption rate to the shorter-term time-domain measures rMSSD and ASDNN, all frequency-domain measures, and HR were not confirmed. However, repeated measures ANOVA revealed that, between the hours of 0000 and 0600, women who drank approximately 0.5 to 3 standard drinks per day had significantly lower [log] HF and [log] LF power compared to abstainers and a tendency toward sympathetic predominance during the evening and nighttime hours. The authors discuss the implications of these findings.
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Wang, S.-J., J.-L. Fuh, Y.-H. Young, S.-R. Lu, and B.-C. Shia. "Frequency and Predictors of Physician Consultations for Headache." Cephalalgia 21, no. 1 (February 2001): 25–30. http://dx.doi.org/10.1046/j.1468-2982.2001.00138.x.
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We conducted a population-based headache questionnaire survey including questions on physician consultation for headache in Taipei, Taiwan from August 1997 to June 1998. The participants comprised 3377 subjects aged ≥ 15 years, of whom 328 (9.7%) had a diagnosis of migraine and 1754 (52%) had a diagnosis of non-migraine headache. Migraineurs had a higher physician consultation rate (once or more in the past year) than the subjects with non-migraine headache (54% vs. 31%, P < 0.0001). When frequency ≥ 10 times was taken as 10 times, the analysis showed that migraineurs consulted physicians more often than non-migraine headache subjects (2.36 vs. 0.96, P = 0.04). A small proportion of the subjects with either migraine (12%) or non-migraine headache (6%) accounted for 50% of total consultations within their groups. In addition to old age, low education levels, living in a rural area, migrainous features (nausea and photophobia), and work day loss, predictors of physician consultations also included ‘having been troubled with headache’ (odds ratio (OR) = 1.7) and co-morbidity with hypertension (OR = 1.8) or heart disease (OR = 2.2). Low copayment and unrestricted access to medical care, as well as cultural factors played an important role in the high consultation rates in our headache subjects. Moreover, this study found self-perception of headache impact and co-morbid illnesses were important factors affecting the decision to consult physicians about headache.
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Feng, Zhihong, Tao Wang, Ping Liu, Sipeng Chen, Han Xiao, Ning Xia, Zhiming Luo, Bing Wei, and Xiuhong Nie. "Efficacy of Various Scoring Systems for Predicting the 28-Day Survival Rate among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Requiring Emergency Intensive Care." Canadian Respiratory Journal 2017 (2017): 1–8. http://dx.doi.org/10.1155/2017/3063510.
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We aimed to investigate the efficacy of four severity-of-disease scoring systems in predicting the 28-day survival rate among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring emergency care. Clinical data of patients with AECOPD who required emergency care were recorded over 2 years. APACHE II, SAPS II, SOFA, and MEDS scores were calculated from severity-of-disease indicators recorded at admission and compared between patients who died within 28 days of admission (death group; 46 patients) and those who did not (survival group; 336 patients). Compared to the survival group, the death group had a significantly higher GCS score, frequency of comorbidities including hypertension and heart failure, and age (P<0.05 for all). With all four systems, scores of age, gender, renal inadequacy, hypertension, coronary heart disease, heart failure, arrhythmia, anemia, fracture leading to bedridden status, tumor, and the GCS were significantly higher in the death group than the survival group. The prediction efficacy of the APACHE II and SAPS II scores was 88.4%. The survival rates did not differ significantly between APACHE II and SAPS II (P=1.519). Our results may guide triage for early identification of critically ill patients with AECOPD in the emergency department.
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Nakano, Kazuhiko, Hirotoshi Nemoto, Ryota Nomura, Hiromi Homma, Hideo Yoshioka, Yasuhiro Shudo, Hiroki Hata, et al. "Serotype distribution of Streptococcus mutans a pathogen of dental caries in cardiovascular specimens from Japanese patients." Journal of Medical Microbiology 56, no. 4 (April 1, 2007): 551–56. http://dx.doi.org/10.1099/jmm.0.47051-0.
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The involvement of oral bacteria in the pathogenesis of cardiovascular disease has been studied, with Streptococcus mutans, a pathogen of dental caries, detected in cardiovascular lesions at a high frequency. However, no information is available regarding the properties of S. mutans detected in those lesions. Heart valve specimens were collected from 52 patients and atheromatous plaque specimens from 50 patients, all of whom underwent cardiovascular operations, and dental plaque specimens were taken from 41 of those subjects prior to surgery. Furthermore, saliva samples were taken from 73 sets of healthy mothers (n=73) and their healthy children (n=78). Bacterial DNA was extracted from all specimens, then analysed by PCR with S. mutans-specific and serotype-specific primer sets. The detection rates of S. mutans in the heart valve and atheromatous plaque specimens were 63 and 64 %, respectively. Non-c serotypes were identified with a significantly higher frequency in both cardiovascular and dental plaque samples from the subjects who underwent surgery as compared to serotype c, which was detected in 70–75 % of the samples from the healthy subjects. The serotype distribution in cardiovascular patients was significantly different from that in healthy subjects, suggesting that S. mutans serotype may be related to cardiovascular disease.
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Savale, Laurent, and Alessandra Manes. "Pulmonary arterial hypertension populations of special interest: portopulmonary hypertension and pulmonary arterial hypertension associated with congenital heart disease." European Heart Journal Supplements 21, Supplement_K (December 1, 2019): K37—K45. http://dx.doi.org/10.1093/eurheartj/suz221.
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Abstract Guidelines exist for management of pulmonary arterial hypertension (PAH), but information is limited for certain patient subgroups, including adults with portopulmonary hypertension (PoPH) or with PAH associated with congenital heart disease (PAH-CHD). This article discusses screening, clinical management, and prognosis in PoPH and PAH-CHD and, as such, considers the most recent clinical data and expert advice. A multidisciplinary consultation and follow-up by specialists are crucial for management of both PoPH and PAH-CHD, but each condition presents with unique challenges. Development of PoPH most commonly occurs among patients with liver cirrhosis. Initially, patients may be asymptomatic for PoPH and, if untreated, survival with PoPH is generally worse than with idiopathic PAH (IPAH), so early identification with screening is crucial. PoPH can be managed with PAH-specific pharmacological therapy, and resolution is possible in some patients with liver transplantation. With PAH-CHD, survival rates are typically higher than with IPAH but vary across the four subtypes: Eisenmenger syndrome, systemic-to-pulmonary shunts, small cardiac defects, and corrected defects. Screening is also crucial and, in patients who undergo correction of CHD, the presence of PAH should be assessed immediately after repair and throughout their long-term follow-up, with frequency of assessments determined by the patient’s characteristics at the time of correction. Early screening for PAH in patients with portal hypertension or CHD, and multidisciplinary management of PoPH or PAH-CHD are important for the best patient outcomes.
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Greenberg, James A., JoAnn E. Manson, Marian L. Neuhouser, Lesley Tinker, Charles Eaton, Karen C. Johnson, and James M. Shikany. "Chocolate intake and heart disease and stroke in the Women's Health Initiative: a prospective analysis." American Journal of Clinical Nutrition 108, no. 1 (June 21, 2018): 41–48. http://dx.doi.org/10.1093/ajcn/nqy073.
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ABSTRACT Background Three recent meta-analyses found significant prospective inverse associations between chocolate intake and cardiovascular disease risk. Evidence from these meta-analyses suggests that such inverse associations may only apply to elderly individuals or those with pre-existing major chronic disease. Objective We assessed the association between habitual chocolate intake and subsequent incident coronary heart disease (CHD) and stroke, and the potential effect of modification by age. Design We conducted multivariable Cox regression analyses using data from 83,310 postmenopausal women free of baseline pre-existing major chronic disease in the prospective Women's Health Initiative cohort. Chocolate intake was assessed using a food-frequency questionnaire. Physician-adjudicated events or deaths were ascertained up to 30 September 2013. Results After exclusions, there were 3246 CHD and 2624 stroke events or deaths, representing incidence rates of 3.9% and 3.2% during 1,098,091 and 1,101,022 person-years (13.4 y), respectively. We found no association between consumption of chocolate and risk of CHD (P for linear trend = 0.94) or stroke (P = 0.24). The results for CHD and stroke combined were similar (P = 0.30), but were significantly modified by age (P for interaction = 0.02). For women age <65 y at baseline, those who ate 1 oz (28.35 g) of chocolate <1/mo, 1 to <1.5/mo, 1.5 to <3.5/mo, 3.5/mo to <3/wk, and ≥3/wk had HRs (95% CIs) of 1.00 (referent), 1.17 (1.00, 1.36), 1.05 (0.90, 1.22), 1.09 (0.94, 1.25), and 1.27 (1.09, 1.49), respectively (P for linear trend = 0.005). No association was apparent for older women. Conclusion We observed no association between chocolate intake and risk of CHD, stroke, or both combined in participants free of pre-existing major chronic disease. The relation for both combined was modified by age, with a significant positive linear trend and an increased risk in the highest quintile of chocolate consumption among women age <65 y. This trial was registered at clinicaltrials.gov as NCT03453073.
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Kudinov, Vladimir Ivanovich, Maria Sergeevna Nichitenko, Anna Ivanovna Chesnikova, and Natalya Vladimirovna Zolotareva. "Comparative efficacy assessment for various insulin regimens in patients with type 2 diabetes mellitus, ischaemic heart disease and frequent hypoglycemic events." Diabetes mellitus 15, no. 2 (June 15, 2012): 22–26. http://dx.doi.org/10.14341/2072-0351-5514.
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Aims. To study influence of combined treatment with human insulin analogues (insulin aspart and insulin detemir) on glycemic control,insulin resistance and development of ischaemic heart disease (IHD) in patients with type 2 diabetes mellitus (T2DM) and frequenthypoglycemic events in comparison with that of human insulins (soluble and isophane). Materials and methods. 54 patients (mean age 61.2?0.7) with T2DM and IHD participated in this study. All included patients experiencedfrequent mild and moderate hypoglycemic events (3+ episodes per week). We analyzed frequency and severity of hypoglycemia,parameters of glycemic and lipid metabolism, number of ischaemic episodes per day, duration and depth of ST depression, circadianindex, incidence of different types of arrhythmia and conduction abnormalities as measured by Holter ECG monitoring.All patients were subdivided into two groups by random sampling: 21 patient (first group) carried on with human soluble insulin andisophane in an optimized basal-bolus regimen. In 33 patients, comprising second group, treatment was changed for combination ofinsulin aspart (NovoRapid?, Novo Nordisk, Denmark) and insulin detemir (Levemir?, Novo Nordisk, Denmark). Follow-up periodwas set to 6 months. Results. In patients with frequent hypoglycemic experience different types of arrhythmia and heart conduction abnormalities wereobserved in 75.9% of cases. Most patients had complex types of arrhythmic disorders (70.4%) with ventricular extrasystole being themost common one. Signs of myocardial ischaemia were registered in 48.1% of patients.After 6 months of follow-up patients from the second group demonstrated a statistically significant decrease in fasting and postprandiallevels of glycemia (p=0.000001). Both groups also had a significantly lower rate of hypoglycemic events. Moreover, in the second groupall episodes of hypoglycemia were mild and occurred only in 36.4% of cases. Additionally, after 6 months of treatment with humaninsulin analogues ventricular extrasystoles were registered only in 24.2% of patients, while rate and duration of ischaemic episodesdropped to 4.25?1.51 (p=0.012, comparing with first group). Conclusion. Treatment with human insulin analogues NovoRapid? and Levemir? is associated with 1.6% decrease in HbA1c levels.Mild hypoglycemia was 72.2% less frequent, as compared with rates in the group on human soluble and isophane insulin, while moderateand severe hypoglycemic events were not observed at all. In turn, decrease in frequency and severity of hypoglycemia was associatedwith substantial improvement in cardiovascular status due to lower number and duration of ischaemic episodes (including painlessvariant) and lower frequency of heart rhythm disorders.
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Pluymaekers, Nikki AHA, Astrid NL Hermans, Dominik K. Linz, Elton AMP Dudink, Justin GLM Luermans, Bob Weijs, Kevin Vernooy, and Harry JGM Crijns. "Frequency and Determinants of Spontaneous Conversion to Sinus Rhythm in Patients Presenting to the Emergency Department with Recent-onset Atrial Fibrillation: A Systematic Review." Arrhythmia & Electrophysiology Review 9, no. 4 (December 24, 2020): 195–201. http://dx.doi.org/10.15420/aer.2020.34.
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The exact frequency and clinical determinants of spontaneous conversion (SCV) in patients with symptomatic recent-onset AF are unclear. The aim of this systematic review is to provide an overview of the frequency and determinants of SCV of AF in patients presenting at the emergency department. A comprehensive literature search for studies about SCV in patients presenting to the emergency department with AF resulted in 25 articles – 12 randomised controlled trials and 13 observational studies. SCV rates range between 9–83% and determinants of SCV also varied between studies. The most important determinants of SCV included short duration of AF (<24 or <48 hours), low number of episodes, normal atrial dimensions and absence of previous heart disease. The large variation in SCV rate and determinants of SCV was related to differences in duration of the observation period, inclusion and exclusion criteria and in variables used in the prediction models.
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Liu, Qiao, Taiwei Dong, Miaomiao Xi, Licheng Gou, Yang Bai, Lian Hou, Min Li, Li Ou, Feng Miao, and Peifeng Wei. "Tongxinluo Capsule Combined with Atorvastatin for Coronary Heart Disease: A Systematic Review and Meta-Analysis." Evidence-Based Complementary and Alternative Medicine 2021 (July 17, 2021): 1–17. http://dx.doi.org/10.1155/2021/9413704.
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Introduction. Coronary heart disease (CHD) is a common clinical cardiovascular disease, and its morbidity and mortality rates are increasing, which brings a serious burden to the family and society. Dyslipidemia is one of the most important risk factors for CHD. However, it is difficult to reduce blood lipids to an ideal state with the administration of a statin alone. Tongxinluo capsule (TXLC), as a Chinese patent medicine, has received extensive attention in the treatment of CHD in recent years. This systematic review and meta-analysis aim to provide evidence-based medicine for TXLC combined with atorvastatin in the treatment of CHD. Objective. To evaluate systematically the effectiveness and safety of TXLC combined with atorvastatin in the treatment of CHD. Methods. Seven English and Chinese electronic databases (PubMed, Cochrane Library, Embase, CNKI, VIP, CBM, and Wanfang) were searched from inception to January 2020, to search for randomized controlled trials (RCTs) on TXLC combined with atorvastatin in the treatment of CHD. Two researchers independently screened the literature according to the literature inclusion and exclusion criteria and performed quality assessment and data extraction on the included RCTs. We performed a systematic review following Cochrane Collaboration Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and using a measurement tool to assess the methodological quality of systematic reviews (AMSTAR 2). The quality of outcomes was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). And meta-analysis was performed by Review Manager 5.2. Results. A total of 15 RCTs with 1,578 participants were included in this review. Compared to atorvastatin treatment, TXLC combined with atorvastatin treatment showed potent efficacy when it came to the effectiveness of clinical treatment (RR = 1.24; 95% CI, 1.18, 1.29; P < 0.00001 ), total cholesterol (TC; MD = −1.21; 95% CI, −1.53, −0.89; P < 0.00001 ), triacylglycerol (TG; MD = −0.73; 95% CI, −0.81, −0.65; P < 0.00001 ), high-density lipoprotein cholesterol (HDL-C; MD = 0.27; 95% CI, 0.23, 0.31; P < 0.00001 ), low-density lipoprotein cholesterol (LDL-C; MD = –0.72; 95% CI, –0.80, −0.64; P < 0.00001 ), C-reactive protein (CRP; SMD = −2.06; 95% CI, −2.56, −1.57; P < 0.00001 ), frequency of angina pectoris (SMD = −1.41; 95% CI, −1.97, −0.85; P < 0.00001 ), duration of angina pectoris (MD = −2.30; 95% CI, −3.39, −1.21; P < 0.0001 ), and adverse reactions (RR = 0.84; 95% CI, 0.51, 1.39; P = 0.50 ). No serious adverse events or reactions were mentioned in these RCTs. According to the PRISMA guidelines, although all studies were not fully reported in accordance with the checklist item, the reported items exceeded 80% of all items. With the AMSTAR 2 standard, the methodological quality assessment found that 9 studies were rated low quality and 6 studies were rated critically low quality. Based on the results of the systematic review, the GRADE system recommended ranking method was used to evaluate the quality of evidence and the recommendation level. The results showed that the level of evidence was low, and the recommendation intensity was a weak recommendation. Conclusions. TXLC combined with atorvastatin in the treatment of CHD can effectively improve the effectiveness of clinical treatment, significantly reduce the frequency and duration of angina pectoris, decrease blood lipids, and improve inflammatory factors. However, due to the low quality of the literature included in these studies and the variability of the evaluation methods of each study, there is still a need for a more high-quality, large sample, multicenter clinical randomized control for further demonstration.
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Bockmann, Jan-Hendrik, Matin Kohsar, John M. Murray, Vanessa Hamed, Maura Dandri, Stefan Lüth, Ansgar W. Lohse, and Julian Schulze-zur-Wiesch. "High Rates of Liver Cirrhosis and Hepatocellular Carcinoma in Chronic Hepatitis B Patients with Metabolic and Cardiovascular Comorbidities." Microorganisms 9, no. 5 (April 30, 2021): 968. http://dx.doi.org/10.3390/microorganisms9050968.
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Background: The prevalence of metabolic and cardiovascular diseases is rising worldwide. However, little is known about the impact of such disorders on hepatic disease progression in chronic hepatitis B (CHB) during the era of potent nucleo(s)tide analogues (NAs). Methods: We retrospectively analyzed a single-center cohort of 602 CHB patients, comparing the frequency of liver cirrhosis at baseline and incidences of liver-related events during follow-up (hepatocellular carcinoma, liver transplantation and liver-related death) between CHB patients with a history of diabetes, obesity, hypertension or coronary heart disease (CHD). Results: Rates of cirrhosis at baseline and liver-related events during follow-up (median follow-up time: 2.51 years; NA-treated: 37%) were substantially higher in CHB patients with diabetes (11/23; 3/23), obesity (6/13; 2/13), CHD (7/11; 2/11) or hypertension (15/43; 4/43) compared to CHB patients without the indicated comorbidities (26/509; 6/509). Multivariate analysis identified diabetes as the most significant predictor for cirrhosis (p = 0.0105), while comorbidities did not correlate with liver-related events in pre-existing cirrhosis. Conclusion: The combination of metabolic diseases and CHB is associated with substantially increased rates of liver cirrhosis and secondary liver-related events compared to CHB alone, indicating that hepatitis B patients with metabolic comorbidities warrant particular attention in disease surveillance and evaluation of treatment indication.
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Guerrier, Karine, Laurie Mitan, Yu Wang, and Richard J. Czosek. "Risk for prolonged QT interval and associated outcomes in children with early restrictive eating patterns." Cardiology in the Young 26, no. 4 (June 2, 2015): 644–49. http://dx.doi.org/10.1017/s1047951115000785.
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AbstractAimThis study aimed to describe the frequency of QTc prolongation in children with restrictive eating disorders early in the course of disease admitted for inpatient therapy, to determine the frequency of associated ventricular arrhythmia, and to evaluate the relationship between QTc interval and concomitant electrolyte abnormalities and rate of weight loss.MethodsThis was a retrospective cohort study of patients aged 11–25 years with early restrictive eating disorders.ResultsIn all, 82 patients met the inclusion criteria (84% female). In total, 9.8% had prolonged QTc interval during hospitalisation. Patients with prolonged QTc had significantly higher resting heart rates (p=0.006), but there was no association with hypokalaemia (p=0.31), hypomagnesaemia (p=0.43), hypophosphataemia (p=1), or rate of weight loss (p=1).ConclusionMild QTc prolongation in patients with restrictive eating disorders is not related to electrolyte abnormalities or rate of weight loss in this population, suggesting that investigation about other potential risk factors of prolonged QTc interval may be warranted.
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Sel, Kutay, Ebru Aypar, Yasemin Nuran Dönmez, Emil Aliyev, Hakan Hayrettin Aykan, Tevfik Karagöz, and Dursun Alehan. "Palivizumab compliance in congenital heart disease patients: factors related to compliance and altered lower respiratory tract infection viruses after palivizumab prophylaxis." Cardiology in the Young 30, no. 6 (May 19, 2020): 818–21. http://dx.doi.org/10.1017/s1047951120001092.
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AbstractBackground:Lower respiratory tract infections caused by respiratory syncytial virus can be severe during infancy, which requires admission to the hospital. These infections may be more severe especially in patients with congenital heart disease. Passive immunisation with palivizumab, a monoclonal antibody, is recommended in high-risk infants. We tried to determine the compliance rates, factors affecting compliance, and also other microorganisms responsible for lower respiratory tract infections after palivizumab prophylaxis in these patients.Methods:We evaluated patients’ compliance to prophylaxis with palivizumab in two consecutive respiratory syncytial virus seasons from pharmacy records. We also investigated factors affecting compliance and the frequency of hospitalisations for lower respiratory tract infections. We investigated the causative microorganisms detected in hospitalised patients.Results:In this study, 86.7% of the desired number of injections was achieved in 176 patients in two seasons. Out of these, 117 patients (66.4%) received all the doses they were prescribed. Although not statistically significant, compliance to prophylaxis was higher in male patients, cyanotic patients, those who started under 1 year old, and who lived in the city centre. Human metapneumovirus, parainfluenza type 3, and bocavirus were detected in the hospitalised patients.Conclusion:Patients with congenital heart disease can survive the period of infancy with less problem by making palivizumab prophylaxis more effective, and awareness about non- respiratory syncytial virus factors may be a guide for the development of new treatments.
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Mishina, Irina E., Anton A. Gudukhin, Andrei M. Sarana, and Stanislav P. Urazov. "Analysis of modern practice of remote forms of medical consultations and dispensary observation of patients with ischemic heart disease (literature review)." CardioSomatics 10, no. 1 (March 15, 2019): 42–50. http://dx.doi.org/10.26442/22217185.2019.1.190186.
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Aim. To describe modern opinions about the role of remote technologies in the dispensary observation of patients with cardiovascular diseases. Materials and methods. The data of 57 scientific sources published in the russian and foreign press in 1984-2018 are considered. Results and conclusion. It is generally recognized that patients with myocardial infarction need cardiac rehabilitation, but the frequency of their participation in its programs remains low due to transport problems, unwillingness to leave home due to anxiety and depression, and to change the mode of the day due to the need for ambulant visits, etc. Modern achievements of telemedicine solve these problems and allow doctors to monitor the status of patients remotely. All types of telemetry devices have some advantages: external cardiomonitoring systems in real time quickly collect and transmit the most complete information without the participation of the patient, standard non-loop and loop recorders are inexpensive and widely available, and adhesive patch recorders are very easy to use and increase compliance. The use of mobile applications and SMS in the framework of remote cardiorehabilitation has not been sufficiently studied, but data on their effectiveness in correcting the behavior of patients have already been collected. Experts have not yet come to a consensus on the effectiveness of complex tele-cardiorehabilitation, including telemetry, telecoaching and teleconsulting, but many studies have shown that it is a worthy alternative to traditional rehabilitation programs, as it has higher rates of attendance.
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Hoffmann-Vold, Anna-Maria, Øyvind Midtvedt, Anders H. Tennøe, Torhild Garen, May Brit Lund, Trond M. Aaløkken, Arne K. Andreassen, et al. "Cardiopulmonary Disease Development in Anti-RNA Polymerase III-positive Systemic Sclerosis: Comparative Analyses from an Unselected, Prospective Patient Cohort." Journal of Rheumatology 44, no. 4 (January 15, 2017): 459–65. http://dx.doi.org/10.3899/jrheum.160867.
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Objective.Extensive skin disease and renal crisis are hallmarks of anti-RNA polymerase III (RNAP)-positive systemic sclerosis (SSc), while lung and heart involvement data are conflicting. Here, the aims were to perform time-course analyses of interstitial lung disease (ILD) and pulmonary hypertension (PH) in the RNAP subset of a prospective unselected SSc cohort and to use the other autoantibody subsets as comparators.Methods.The study cohort included 279 patients with SSc from the observational Oslo University Hospital cohort with complete data on (1) SSc-related autoantibodies, (2) paired, serial analyses of lung function and fibrosis by computed tomography, and (3) PH verified by right heart catheterization.Results.RNAP was positive in 33 patients (12%), 79% of which had diffuse cutaneous SSc. Pulmonary findings were heterogeneous; 49% had no signs of fibrosis while 18% had > 20% fibrosis at followup. Forced vital capacity at followup was < 80% in 39% of the RNAP subset, comparable to the antitopoisomerase subset (ATA; 47%), but higher than anticentromere (ACA; 13%). Accumulated frequency of PH in the RNAP subset (12%) was lower than in ACA (18%). At 93% and 78%, the 5- and 10-year survival rates in RNAP were comparable to the ATA and ACA subsets.Conclusion.In this cohort, the RNAP subset was marked by cardiopulmonary heterogeneity, ranging from mild ILD to development of severe ILD in 18%, and PH development in 12%. These data indicate that cardiopulmonary risk stratification early in the disease course is particularly important in RNAP-positive SSc.
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Faulkner, Melissa Spezia, Laurie Quinn, James H. Rimmer, and Barry H. Rich. "Cardiovascular Endurance and Heart Rate Variability in Adolescents With Type 1 or Type 2 Diabetes." Biological Research For Nursing 7, no. 1 (July 2005): 16–29. http://dx.doi.org/10.1177/1099800405275202.
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Background. Incidence rates of both type 1 and type 2 diabetes mellitus (DM) are increasing in youth and may eventually contribute to premature heart disease in early adulthood. This investigation explored the influence of type of diabetes, gender, body mass index (BMI), metabolic control (HbA1c), exercise beliefs and physical activity on cardiovascular endurance (CE), and heart rate variability (HRV). Differences in exercise beliefs, physical activity, HRV, and CE in youth with type 1 versus type 2 DM were determined. Methods. Adolescents with type 1 DM (n = 105) or with type 2DM (n = 27) completed the Exercise Belief Instrument and the Physical Activity Recall. Twenty-four HRV measures were obtained via Holter monitoring and analyzed using SpaceLabs Vision Premier™ software system. The McMaster cycle test was used to measure CE (V02peak). Results. Regardless of the type of DM, females and those with higher BMI, poorer metabolic control, and lower amounts of physical activity tended to have lower levels of CE. Exercise beliefs consistently predicted both frequency and time domain HRV measures. Measures of exercise beliefs, self-reported physical activity, CE (V02peak), and HRV were significantly lower in adolescents with type 2 DM in comparison to those with type 1 DM. Conclusions and Recommendations. Early findings of poor physical fitness, lower HRV, fewer positive beliefs about exercise, and less active lifestyles highlight the importance of developing culturally sensitive interventions for assisting youth to make lifelong changes in their physical activity routines. Females, those with poorer metabolic control, and minority youth with type 2 DM may be particularly vulnerable to later cardiovascular disease.
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Day, Jonathan R., Ashwin Gupta, Calvin Abro, Kyungsuk Jung, Lakshmanan Krishnamurti, Clifford Takemoto, and Ruchika Goel. "Risk Factors and Cardiovascular Disease (CVD) Related Outcomes in Hospitalized Patients with Hemophilia 10 Year Follow up." Blood 136, Supplement 1 (November 5, 2020): 30–31. http://dx.doi.org/10.1182/blood-2020-136486.
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Introduction: Comprehensive management for patients with hemophilia has drastically improved outcomes, quality of care, and longevity. Because of increases in life span, patients with hemophilia may be at risk for other chronic conditions including cardiovascular disease (CVD). Though initially it was thought that hemophilia might have been protective for cardiovascular disease further research has shown that CVD remains a significant risk for the aging hemophilia population. This study aims to determine the prevalence of risk factors and outcomes for CVD in hospitalized adult and pediatric patients with the discharge diagnosis of Hemophilia A or B compared to patients without Hemophilia. We examine longitudinal changes over the previous decade. WMethods: The Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) was utilized for analysis of years 2007 and 2017. The NIS uses a stratified probability sample of 20% of all inpatient discharges (representing more than 97% of the US population). Hemophilia-A and B were identified using ICD-9 code 286.0 and 286.1, ICD-10 codes D66 and D67 respectively and sampling weights were applied to generate nationally representative estimates. Cardiovascular risk factors and outcomes were determined by evaluating ICD-9 codes for 2007 data and ICD-10 codes for 2017 data. For comparative historical data, 2007 NIS data from a prior published study [Goel et al., Hemophilia (2012), 18, 688-692] were used. The NIS is a de-identified, publicly available data set. This study was deemed exempt from review from the Johns Hopkins Institutional Review Board. This analysis was conducted in accordance with the HCUP data use agreement guidelines. Results: In 2017, there were 10,555 admissions with Hemophilia A or B listed as one of all diagnoses. The mean age of hemophilia patients was 44.31 years compared to 49.57. years for all admissions. The most prevalent risk factor in 2017 was hypertension (32.4% for admissions with hemophilia as compared to 35.3% for all admissions) followed by hyperlipidemia (19.4% compared to 27.5%), diabetes (17.4% compared to 22.8%) and obesity (10.8% compared to 14.4%). CVD outcomes, in descending order of frequency were atherosclerotic coronary artery disease (11.6% for admissions with hemophilia compared to 16.9% for all admissions), heart failure (10.2% compared to 14.2%), acute myocardial infarction (AMI) (2.2% compared to 3.9%), and stroke (2.2% compared to 2.4% respectively). Comparing to 10 year prior data, in 2007, there were 9,737 admissions with Hemophilia A or B listed as one of all diagnoses. The mean age of hemophilia patients was 30.89 years compared to 47.16 years for all admissions. The most prevalent risk factor in 2007 was hypertension (27.0% in admissions with hemophilia compared to 36.7% for all admissions); followed by diabetes (11.2% compared to 18.5%), hyperlipidemia (9.5% compared to 17%), and obesity (3.6% compared to 5.8%). CVD outcomes, in descending order of frequency were, atherosclerotic coronary artery disease (10.1% compared to 16.7%), heart failure (6.6% compared to 10.8%), AMI (2.1% compared to 2.4%), and stroke (2.0% compared to 1.7%). Between 2007 and 2017 the crude prevalence rates of all CVD risk factors as well as CVD outcomes generally increased for admissions with hemophilia as well as all-cause hospitalizations. Conclusions: The frequency of all CVD risk factors (obesity, diabetes, hypertension, and hyperlipidemia) as well as CVD outcomes (atherosclerosis, congestive heart failure, AMI, and stroke) increased between 2007 and 2017 in hospitalized patients both with and without hemophilia. While the unadjusted prevalence rates for all CVD risk factors and CVD outcomes were less in hospitalized patients with hemophilia compared to the general hospitalized population in both 2007 and 2017, CVD remains a significant risk for the hemophilia population. An improved understanding of the various risk factors will help to improve CVD outcomes in the aging hemophilia population. Disclosures Takemoto: Genentech: Membership on an entity's Board of Directors or advisory committees; Novartis: Other: DSMB Aplastic Anemia Trial.
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Tanyeri, Seda, Ozgur Y. Akbal, Berhan Keskin, Aykun Hakgor, Ali Karagoz, Hacer Ceren Tokgoz, Cem Dogan, et al. "Impact of the updated hemodynamic definitions on diagnosis rates of pulmonary hypertension." Pulmonary Circulation 10, no. 3 (July 2020): 204589402093129. http://dx.doi.org/10.1177/2045894020931299.
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We evaluated whether updated pulmonary hypertension definitive criteria proposed in sixth World Symposium on Pulmonary Hypertension had an impact on diagnosis of overall pulmonary hypertension and pre-capillary and combined pre- and post-capillary phenotypes as compared to those in European Society of Cardiology/European Respiratory Society 2015 pulmonary hypertension Guidelines. Study group comprised the retrospectively evaluated 1300 patients (age 53.1 ± 18.8 years, female 807, 62.1%) who underwent right heart catheterization with different indications between 2006 and 2018. Mean pulmonary arterial pressure ≥25 mmHg (European Society of Cardiology) and PAMP (mean pulmonary arterial pressure) >20 mmHg (World Symposium on Pulmonary Hypertension) right heart catheterization definitions criteria were used, respectively. For pre-capillary pulmonary hypertension, pulmonary artery wedge pressure ≤15 mmHg and pulmonary vascular resistance ≥3 Wood units criteria were included in the both definitions. Normal mean pulmonary arterial pressure (<21 mmHg), borderline mean pulmonary arterial pressure elevation (21–24 mmHg), and overt pulmonary hypertension (≥25 mmHg) were documented in 21.1, 9.8, and 69.1% of the patients, respectively. The pre-capillary and combined pre- and post-capillary pulmonary hypertension were noted in 2.9 and 1.1%, 8.7 and 2.5%, and 34.6 and 36.6% of the patients with normal mean pulmonary arterial pressure, borderline, and overt pulmonary hypertension subgroups, respectively. The World Symposium on Pulmonary Hypertension versus European Society of Cardiology/European Respiratory Society definitions resulted in a net 9.8% increase in the diagnosis of overall pulmonary hypertension whereas increases in the pre-capillary pulmonary hypertension and combined pre- and post-capillary pulmonary hypertension diagnosis were only 0.8 and 0.3%, respectively. The re-definition of mean pulmonary arterial pressure threshold seems to increase the frequency of the overall pulmonary hypertension diagnosis. However, this increase was mainly originated from those in post-capillary pulmonary hypertension subgroup whereas its impact on pre-capillary and combined pre- and post-capillary pulmonary hypertension was negligible. Moreover, criteria of pre-capillary pulmonary vascular disease and combined pre- and post-capillary phenotypes were still detectable even in the presence of normal mean pulmonary arterial pressure. The obligatory criteria of pulmonary vascular resistance ≥3 Wood units seems to keep specificity for discrimination between pre-capillary versus post-C pulmonary hypertension after lowering the definitive mean pulmonary arterial pressure threshold to 20 mmHg.
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Labrosciano, Clementine, Tracy Air, Rosanna Tavella, John F. Beltrame, and Isuru Ranasinghe. "Readmissions following hospitalisations for cardiovascular disease: a scoping review of the Australian literature." Australian Health Review 44, no. 1 (2020): 93. http://dx.doi.org/10.1071/ah18028.
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Objective International studies suggest high rates of readmissions after cardiovascular hospitalisations, but the burden in Australia is uncertain. We summarised the characteristics, frequency, risk factors of readmissions and interventions to reduce readmissions following cardiovascular hospitalisation in Australia. Methods A scoping review of the published literature from 2000–2016 was performed using Medline, EMBASE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases and relevant grey literature. Results We identified 35 studies (25 observational, 10 reporting outcomes of interventions). Observational studies were typically single-centre (11/25) and reported readmissions following hospitalisations for heart failure (HF; 10/25), acute coronary syndrome (7/25) and stroke (6/25), with other conditions infrequently reported. The definition of a readmission was heterogeneous and was assessed using diverse methods. Readmission rate, most commonly reported at 1 month (14/25), varied from 6.3% to 27%, with readmission rates of 10.1–27% for HF, 6.5–11% for stroke and 12.7–17% for acute myocardial infarction, with a high degree of heterogeneity among studies. Of the 10 studies of interventions to reduce readmissions, most (n=8) evaluated HF management programs and three reported a significant reduction in readmissions. We identified a lack of national studies of readmissions and those assessing the cost and resource impact of readmissions on the healthcare system as well as a paucity of successful interventions to lower readmissions. Conclusions High rates of readmissions are reported for cardiovascular conditions, although substantial methodological heterogeneity exists among studies. Nationally standardised definitions are required to accurately measure readmissions and further studies are needed to address knowledge gaps and test interventions to lower readmissions in Australia. What is known about the topic? International studies suggest readmissions are common following cardiovascular hospitalisations and are costly to the health system, yet little is known about the burden of readmission in the Australian setting or the effectiveness of intervention to reduce readmissions. What does this paper add? We found relatively high rates of readmissions following common cardiovascular conditions although studies differed in their methodology making it difficult to accurately gauge the readmission rate. We also found several knowledge gaps including lack of national studies, studies assessing the impact on the health system and few interventions proven to reduce readmissions in the Australian setting. What are the implications for practitioners? Practitioners should be cautious when interpreting studies of readmissions due the heterogeneity in definitions and methods used in Australian literature. Further studies are needed to test interventions to reduce readmissions in the Australians setting.
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Selçuk, Murat, Muhammed Keskin, Tufan Çınar, Nuran Günay, Selami Doğan, Vedat Çiçek, Şahhan Kılıç, et al. "Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure." Journal of Cardiovascular and Thoracic Research 13, no. 2 (April 24, 2021): 141–45. http://dx.doi.org/10.34172/jcvtr.2021.26.
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Introduction:The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF). Methods:A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis. Results: A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95%CI:0.76-0.97). Conclusion: The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases.
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Guenette, Jordan A., Andrew H. Ramsook, Satvir S. Dhillon, Joseph H. Puyat, Mounir Riahi, Alexander R. Opotowsky, and Jasmine Grewal. "Ventilatory and sensory responses to incremental exercise in adults with a Fontan circulation." American Journal of Physiology-Heart and Circulatory Physiology 316, no. 2 (February 1, 2019): H335—H344. http://dx.doi.org/10.1152/ajpheart.00322.2018.
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Many adults with single-ventricle congenital heart disease who have undergone a Fontan procedure have abnormal pulmonary function resembling restrictive lung disease. Whether this contributes to ventilatory limitations and increased dyspnea has not been comprehensively studied. We recruited 17 Fontan participants and 17 healthy age- and sex-matched sedentary controls. All participants underwent complete pulmonary function testing followed by a symptom-limited incremental cardiopulmonary cycle exercise test with detailed assessments of dyspnea and operating lung volumes. Fontan participants and controls were well matched for age, sex, body mass index, height, and self-reported physical activity levels (all P > 0.05), although Fontan participants had markedly reduced cardiorespiratory fitness and peak work rates ( P < 0.001). Fontan participants had lower values for most pulmonary function measurements relative to controls with 65% of Fontan participants showing evidence of a restrictive ventilatory defect. Relative to controls, Fontan participants had significantly higher breathing frequency, end-inspiratory lung volume (% total lung capacity), ventilatory inefficiency (high ventilatory equivalent for CO2), and dyspnea intensity ratings at standardized absolute submaximal work rates. There were no between-group differences in qualitative descriptors of dyspnea. The restrictive ventilatory defect in Fontan participants likely contributes to their increased breathing frequency and end-inspiratory lung volume during exercise. This abnormal ventilatory response coupled with greater ventilatory inefficiency may explain the increased dyspnea intensity ratings in those with a Fontan circulation. Interventions that enhance the ventilatory response to exercise in Fontan patients may help optimize exercise rehabilitation interventions, resulting in improved exercise tolerance and exertional symptoms. NEW & NOTEWORTHY This is the first study to comprehensively characterize both ventilatory and sensory responses to exercise in adults that have undergone the Fontan procedure. The majority of Fontan participants had a restrictive ventilatory defect. Compared with well-matched controls, Fontan participants had increased breathing frequency, end-inspiratory lung volume, and ventilatory inefficiency. These abnormal ventilatory responses likely form the mechanistic basis for the increased dyspnea intensity ratings observed in our Fontan participants during exercise.
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Gazizyanova, V. M., O. V. Bulashova, E. V. Hazova, N. R. Hasanov, and V. N. Oslopov. "Clinical features and prognosis in heart failure patients with chronic obstructive pulmonary diseases." Kardiologiia 59, no. 6S (July 24, 2019): 51–60. http://dx.doi.org/10.18087/cardio.2674.
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Background. Multimorbidity is a specific characteristic of the modern patient with chronic heart failure (CHF) which significantly changes clinical course, prognosis of the syndrome, leads to socio‑economic losses and makes significant adjustments to treatment tactics. The goal is to study the clinical features and prognosis of patients with CHF in combination with chronic obstructive pulmonary disease (COPD). Materials and methods. We studied 183 HF patients, including with stable CHF, including 105 with CHF combined with COPD. The clinical phenotype was assessed by its belonging to the functional class and the severity of COPD. A 6‑minute walk test (6‑MWT), spirometry, echocardioscopy, testing on a scale assessing the clinical condition, quality of life were studied. The end points during the year were: all‑cause mortality and cardiovascular mortality, myocardial infarction, stroke, pulmonary embolism, and hospitalization rates due to acute decompensation of CHF. Results. The clinical phenotype of CHF combined with COPD was characterized by a high frequency of smoking, low quality of life and exercise tolerance. Respiratory dysfunction in CHF in combination with COPD was characterized by mixed disorders (68.4%), in CHF without lung disease, restrictive (25.6%). Cardiovascular mortality in comorbid pathology was 4.0%, in CHF without COPD – 4.6%; myocardial infarction was observed 1.7 times more often with lung disease than in patients with CHF only (16.8% and 10.8%); stroke was observed exclusively in comorbid pathology (8.9%). The combined endpoint (all cardiovascular events) with CHF in combination with COPD was achieved 2.3 times more often in comparison with patients with COPD only (29.7% and 15.4%). Hospitalization due to acute decompensation of CHF occurred 2 times more often with CHF in combination with COPD than without it (32.7% and 15.4%) with a tendency to increase as the left ventricular ejection fraction decreased. Conclusion. The results of the study demonstrate that COPD contributes to the formation of the clinical phenotype of CHF from the standpoint of the mutual influence of the characteristics of the cardiovascular and respiratory systems, and also aggravates the prognosis that requires an integrated approach to the differential diagnosis and individualization of pharmacotherapy.
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Lian, Jiangshan, Xi Jin, Shaorui Hao, Huan Cai, Shanyan Zhang, Lin Zheng, Hongyu Jia, et al. "Analysis of Epidemiological and Clinical Features in Older Patients With Coronavirus Disease 2019 (COVID-19) Outside Wuhan." Clinical Infectious Diseases 71, no. 15 (March 25, 2020): 740–47. http://dx.doi.org/10.1093/cid/ciaa242.
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Abstract Background The outbreak of coronavirus disease 2019 (COVID-19) has become a large threat to public health in China, with high contagious capacity and varied mortality. This study aimed to investigate the epidemiological and clinical characteristics of older patients with COVID-19 outside Wuhan. Methods A retrospective study was performed, with collecting data from medical records of confirmed COVID-19 patients in Zhejiang province from 17 January to 12 February 2020. Epidemiological, clinical, and treatment data were analyzed between older (≥ 60 years) and younger (< 60 years) patients. Results A total of 788 patients with confirmed COVID-19 were selected; 136 were older patients with corresponding mean age of 68.28 ± 7.31 years. There was a significantly higher frequency of women in older patient group compared with younger patients (57.35% vs 46.47%, P = .021). The presence of coexisting medical conditions was significantly higher in older patients compared with younger patients (55.15% vs 21.93%, P < .001), including the rate of hypertension, diabetes, heart disease, and chronic obstructive pulmonary disease. Significantly higher rates of severe clinical type (older vs younger groups: 16.18% vs 5.98%, P < .001), critical clinical type (8.82% vs 0.77%, P < .001), shortness of breath (12.50% vs 3.07%, P < .001), and temperature of > 39.0°C (13.97% vs 7.21%, P = .010) were observed in older patients compared with younger patients. Finally, higher rates of intensive care unit admission (9.56% vs 1.38%, P < .001) and methylprednisolone application (28.68% vs 9.36%, P < .001) were also identified in older patients compared with younger ones. Conclusions The specific epidemiological and clinical features of older COVID-19 patients included significantly higher female sex, body temperature, comorbidities, and rate of severe and critical type disease.