Investigating Coordination of Hospital Departments in Delivering Healthcare for Acute Coronary Syndrome Patients Using Data-Driven Network Analysis

Abstract Aims Persons living with HIV (PLWH) have increased cardiovascular mortality, which may in part be due to differences in the management of acute coronary syndromes (ACS). The purpose of this study was to compare the in-hospital and post-discharge management and outcomes of ACS among persons with and without HIV. Methods and results This was a retrospective cohort study using data from Symphony Health, a data warehouse. All patients admitted between 1 January 2014 and 31 December 2016 with ACS were identified by International Classification of Diseases billing codes. Multivariate logistic regression models were used to examine in-hospital, 30-day and 12-month event rates between groups. A total of 1 125 126 individuals were included, 6612 (0.59%) with HIV. Persons living with HIV were younger (57.4 ± 10.5 vs. 67.4 ± 12.9 years, P< 0.0001) and had more medical comorbidities. Acute coronary syndrome type did not differ significantly with HIV status. Persons living with HIV were less likely to undergo coronary angiography (35.2% vs. 37.2%, adjusted OR 0.87, 95% CI 0.83–0.92, P < 0.0001), and those with both HIV and STEMI underwent fewer drug-eluting stents (60.1% vs. 68.5%, adjusted OR 0.81, 95% CI 0.68–0.96, P = 0.016). Persons living with HIV had higher adjusted rates of inpatient mortality (OR 1.29, 95% CI 1.15–1.44; P < 0.0001), 30-day readmission (OR 1.18, 95% CI 1.09–1.27; P < 0.0001) and 12-month mortality (OR 1.32, 95% CI 1.22–1.44; P < 0.0001). Twelve months following discharge, PLWH filled cardiac medications at lower rates. Conclusion In a contemporary cohort of persons hospitalized for ACS, PLWH received less guideline-supported interventional and medical therapies and had worse clinical outcomes. Strategies to optimize care are warranted in this unique population.

Download Full-text

Abstract 14328: Relation of Lipoprotein(a) Levels to Incident Diabetes and Modification by Alirocumab Treatment: An Analysis of the Odyssey Outcomes Trial

Circulation ◽

10.1161/circ.142.suppl_3.14328 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Gregory G Schwartz ◽

Michael Szarek ◽

Marie Baccara-dinet ◽

Vera A Bittner ◽

Deepak L Bhatt ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cohort Studies ◽

Pcsk9 Inhibitors ◽

Lipoprotein A ◽

Pcsk9 Inhibitor ◽

Coronary Syndrome ◽

Emerging Therapies ◽

Lower Baseline ◽

Healthy Cohort ◽

Using Data

Background: Cohort studies and clinical trials have shown a greater prevalence of diabetes among subjects with lower levels of lipoprotein(a) [Lp(a)]. Some healthy cohort studies have shown a greater incidence of new onset diabetes (NOD) among those with lower Lp(a). It is unknown whether the risk of NOD associates with Lp(a) levels in patients (pts) with established cardiovascular disease or whether pharmacologic reduction of Lp(a) with PCSK9 inhibitors modulates this risk. Objective: Using data from the ODYSSEY OUTCOMES trial that compared the PCSK9 inhibitor alirocumab (ALI) with placebo (PBO) in pts with recent acute coronary syndrome, we examined whether NOD was related to baseline Lp(a) level and whether any such relationship was modified by ALI treatment. Methods and Results: Lp(a) was measured with a mass assay in 13,480 trial pts without diabetes at baseline; median (IQR) baseline Lp(a) was 21.9 mg/dL (6.9-61.1); median follow-up was 2.7 years. Intensive statin therapy was utilized in 89%. In the PBO group, NOD was greatest in Quartile 1 and least in Quartile 4 of baseline Lp(a) ( Figure , 4.6 vs 3.1 cases per 100 pt-years, P trend 0.0003). ALI lowered Lp(a) by a median of 23% from baseline. Absolute median reduction in Lp(a) with ALI ranged from nil in baseline Lp(a) Quartile 1 to 15 mg/dL in Quartile 4. Treatment HR (ALI/PBO) for NOD was neutral overall (0.95, 95% CI 0.85-1.05) but varied across baseline Lp(a) quartiles from 0.79 (0.64-0.96) in Quartile 1 to 1.09 (0.87-1.38) in Quartile 4 ( Figure , P trend =0.025). Conclusion: In pts with recent acute coronary syndrome, there is greater NOD among those with lower baseline Lp(a) levels. ALI has an overall neutral effect on NOD: In pts with low baseline Lp(a), ALI has minimal effect on Lp(a) levels and tends to reduce NOD. In pts with high baseline Lp(a), ALI reduces Lp(a) levels with a non-significant excess of NOD. The findings may have implications for emerging therapies that reduce Lp(a) more substantially than PCSK9 inhibitors.

Download Full-text

Soziale Netzwerkanalysen zum mittelhochdeutschen Artusroman oder: Vorgreiflicher Versuch, Märchenhaftigkeit des Erzählens zu messen

Das Mittelalter ◽

10.1515/mial-2019-0005 ◽

2019 ◽

Vol 24 (1) ◽

pp. 54-70

Author(s):

Manuel Braun ◽

Nora Ketschik

Keyword(s):

Social Network ◽

Statistical Analysis ◽

Social Network Analysis ◽

Network Analysis ◽

Fairy Tales ◽

Simple Form ◽

Data Driven ◽

Arthurian Romance ◽

Arthurian Romances ◽

Using Data

Abstract This article discusses the question of how complex the narrations of Arthurian romances are by comparing them to the ‘simple form’ of fairy tales. In order to achieve this, we identify properties of the European folktale, which we then compare with an Arthurian text corpus consisting of Hartmann von Aue’s ‘Erec’ and ‘Iwein’ as well as Wolfram von Eschenbach’s ‘Parzival’. The typological investigation is carried out using data-driven methods, primarily Social Network Analysis, and focuses on various aspects of characters. By doing this, we gain an in-depth understanding of the relationships between Arthurian romances and fairy tales and of the differences within the genre of the Arthurian romance itself. We show that the results of statistical analysis refuse clear interpretation, thus providing new insights into the well-known objects.

Download Full-text