Adverse Outcomes with Eccentric Hypertrophy in a Community Based University Cohort with Aortic Stenosis

2021 ◽  
Author(s):  
Steven J. Lavine ◽  
Kirsten Raby
Keyword(s):  
Aortic Stenosis ◽  
Adverse Outcomes ◽  
Community Based ◽  
Eccentric Hypertrophy

scholarly journals Multimorbidity Burden and Adverse Outcomes in a Community‐Based Cohort of Adults with Heart Failure

2018 ◽  
Vol 66 (12) ◽  
pp. 2305-2313 ◽  
Author(s):  
Mayra Tisminetzky ◽  
Jerry H. Gurwitz ◽  
Dongjie Fan ◽  
Kristi Reynolds ◽  
David H. Smith ◽  
...  
Keyword(s):  
Heart Failure ◽  
Adverse Outcomes ◽  
Community Based

scholarly journals Homelessness during COVID-19: Challenges, Responses, and Lessons Learned from Homeless Service Providers in Tippecanoe County, Indiana

2021 ◽  
Author(s):  
Natalia M. Rodriguez ◽  
Alexa M. Lahey ◽  
Justin J. MacNeill ◽  
Rebecca G. Martinez ◽  
Nina E. Teo ◽  
...  
Keyword(s):  
Service Delivery ◽  
Social Services ◽  
Service Providers ◽  
Qualitative Content Analysis ◽  
The United States ◽  
Adverse Outcomes ◽  
Lessons Learned ◽  
Community Based ◽  
Health Crisis ◽  
Community Based Organizations

Abstract Background: The COVID-19 pandemic laid bare some of the United States’ most devastating health and social inequities faced by people experiencing homelessness. Homeless populations experience disproportionate rates of underlying health conditions, stigma and marginalization that often disenfranchise them from health and social services, and living conditions that potentiate the risk of COVID-19 transmission and adverse outcomes. Methods: Guided by the socio-ecological model, this community-based participatory research study examined the impacts of the COVID-19 public health crisis on people experiencing homelessness in Tippecanoe County, Indiana, and the ways in which homeless service providers prepared for, experienced, and responded to the pandemic. Eighteen (18) semi-structured interviews were conducted with representatives of 15 community-based organizations, including shelters and other homeless service providers.Results: Qualitative content analysis revealed multilevel challenges and responses to COVID-19 impact mitigation in this community, including the implementation of diverse safety measures, policies and novel service delivery innovations.Conclusions: Community-based organizations, including homeless shelters, are uniquely qualified to inform pandemic response and disaster risk mitigation in order to respond appropriately to the specific needs of people experiencing homelessness. Many of the emergency measures put in place by homeless service providers in Tippecanoe County, Indiana created opportunities for innovative solutions to longstanding challenges faced by homeless populations that can inform better service delivery moving forward, long after the COVID-19 pandemic. The lessons learned and shared by homeless service providers on the frontline during the COVID-19 pandemic have important implications to improve future disaster response for homeless and other vulnerable populations.

scholarly journals Long Term Clinical Outcomes in Patients with Moderate Aortic Stenosis

2020 ◽  
Vol 23 (3) ◽  
pp. E358-E365
Author(s):  
Han Joon Bae ◽  
Jongmin Hwang ◽  
Seongwook Han ◽  
Seung-Ho Hur ◽  
Jin-Wook Chung ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Aortic Stenosis ◽  
Clinical Outcomes ◽  
Medical Records ◽  
Watchful Waiting ◽  
Adverse Outcomes ◽  
Functional Mitral Regurgitation

Background: While the surgical correction of moderate aortic stenosis (AS) can be deferred with a watchful waiting according to the present guideline, the clinical outcomes for moderate AS with comorbidity have not extensively been studied. We aimed to explore the factors that would contribute to the outcomes of moderate AS with at least five years of follow-up duration. Methods: Medical records review identified patients with moderate aortic valve (AV) stenosis from January 2008 and December 2012. Echocardiographic data were gathered, and the final 5-year clinical outcomes, defined as the composite of cardiovascular (CV) death, admission for heart failure (HF) aggravation, and AV replacement, were evaluated. Results: Among 148 patients (mean age, 69.3 years; mean AV area, 1.24 cm2), 79 had adverse outcomes (16 CV deaths, 32 AV replacements, and 31 HF cases), during a mean follow-up of 5.6 years. The event group showed worse dyspnea of NYHA III-IV and a higher frequency of diabetes mellitus (DM). They had a higher frequency of moderate or moderate-to-severe functional mitral regurgitation (MR) and smaller AV area. In the multivariate analysis, DM (HR 2.29, 95% CI 1.03-5.10), moderate or moderate-to-severe MR (HR 4.84, 95% CI 1.66-10.07), and NYHA III-IV (HR 3.84, 95% CI 1.72-8.56) independently were associated with adverse outcomes. Conclusions: The symptomatic patients with moderate AS had higher events than expected, and early intervention should be considered in case of concomitant MR and DM.

scholarly journals Adverse outcomes after noncardiac surgery in patients with aortic stenosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ying-Hsuan Tai ◽  
Chuen-Chau Chang ◽  
Chun-Chieh Yeh ◽  
Yih-Giun Cherng ◽  
Ta-Liang Chen ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Aortic Stenosis ◽  
General Anesthesia ◽  
Noncardiac Surgery ◽  
Neuraxial Anesthesia ◽  
Adverse Outcomes ◽  
Perioperative Risk ◽  
Anesthetic Techniques

AbstractWhether aortic stenosis (AS) increases perioperative risk in noncardiac surgery remains controversial. Limited information is available regarding adequate anesthetic techniques for patients with AS. Using the reimbursement claims data of Taiwan’s National Health Insurance, we performed propensity score matching analyses to evaluate the risk of adverse outcomes in patients with or without AS undergoing noncardiac surgery between 2008 and 2013. We also compared the perioperative risk of AS patients undergoing general anesthesia or neuraxial anesthesia. Multivariable logistic regressions were applied to calculate the adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for postoperative mortality and major complications. The matching procedure generated 9741 matched pairs for analyses. AS was significantly associated with 30-day in-hospital mortality (aOR 1.31, 95% CI 1.03–1.67), acute renal failure (aOR 1.42, 95% CI 1.12–1.79), pneumonia (aOR 1.16, 95% CI 1.02–1.33), stroke (aOR 1.14, 95% CI 1.01–1.29), and intensive care unit stay (aOR 1.38, 95% CI 1.27–1.49). Compared with neuraxial anesthesia, general anesthesia was associated with increased risks of acute myocardial infarction (aOR 3.06, 95% CI 1.22–7.67), pneumonia (aOR 1.80, 95% CI 1.32–2.46), acute renal failure (aOR 1.82, 95% CI 1.11–2.98), and intensive care (aOR 4.05, 95% CI 3.23–5.09). The findings were generally consistent across subgroups. AS was an independent risk factor for adverse events after noncardiac surgery. In addition, general anesthesia was associated with greater postoperative complications in AS patients compared to neuraxial anesthesia. This real-world evidence suggests that neuraxial anesthesia should not be contraindicated in patients with AS.

scholarly journals Community-based bilingual doulas for migrant women in labour and birth – findings from a Swedish register-based cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ulrika Byrskog ◽  
Rhonda Small ◽  
Erica Schytt
Keyword(s):  
Nitrous Oxide ◽  
Pain Relief ◽  
Hospital Stay ◽  
Birth Outcomes ◽  
Well Being ◽  
Adverse Outcomes ◽  
Obstetric Outcomes ◽  
Migrant Women ◽  
Community Based ◽  
Nulliparous Women

Abstract Background Community-based bilingual doula (CBD) services have been established to respond to migrant women’s needs and reduce barriers to high quality maternity care. The aim of this study was to compare birth outcomes for migrant women who received CBD support in labour with birth outcomes for (1) migrant women who experienced usual care without CBD support, and (2) Swedish-born women giving birth during the same time period and at the same hospitals. Methods Register study based on data retrieved from a local CBD register in Gothenburg, the Swedish Medical Birth Register and Statistics Sweden. Birth outcomes for migrant women with CBD support were compared with those of migrant women without CBD support and with Swedish-born women. Associations were investigated using multivariable logistic regression, reported as odds ratios (aORs) with 95% confidence intervals (CI), adjusted for birth year, maternal age, marital status, hypertension, diabetes, BMI, disposable income and education. Results Migrant women with CBD support (n = 880) were more likely to have risk factors for adverse pregnancy outcomes than migrant women not receiving CBD support (n = 16,789) and the Swedish-born women (n = 129,706). In migrant women, CBD support was associated with less use of pain relief in nulliparous women (epidural aOR 0.64, CI 0.50–0.81; bath aOR 0.64, CI 0.42–0.98), and in parous women with increased odds of induction of labour (aOR 1.38, CI 1.08–1.76) and longer hospital stay after birth (aOR 1.19, CI 1.03–1.37). CBD support was not associated with non-instrumental births, perineal injury or low Apgar score. Compared with Swedish-born women, migrant women with CBD used less pain relief (nulliparous women: epidural aOR 0.50, CI 0.39–0.64; nitrous oxide aOR 0.71, CI 0.54–0.92; bath aOR 0.55, CI 0.36–0.85; parous women: nitrous oxide aOR 0.68, CI 0.54–0.84) and nulliparous women with CBD support had increased odds of emergency caesarean section (aOR 1.43, CI 1.05–1.94) and longer hospital stay after birth (aOR 1.31, CI 1.04–1.64). Conclusions CBD support appears to have potential to reduce analgesia use in migrant women with vulnerability to adverse outcomes. Further studies of effects of CBD support on mode of birth and other obstetric outcomes and women’s experiences and well-being are needed.

Evaluating the Outcomes for Bereaved People Supported by a Community-Based Suicide Bereavement Service

Crisis ◽  
2020 ◽  
Vol 41 (6) ◽  
pp. 437-444
Author(s):  
Marc Gehrmann ◽  
Sara Dawn Dixon ◽  
Victoria Suzanne Visser ◽  
Mark Griffin
Keyword(s):  
Online Survey ◽  
Adverse Outcomes ◽  
Community Based ◽  
Cross Sectional ◽  
The Past ◽  
Adverse Impacts ◽  
Suicide Bereavement ◽  
Cross Sectional Design ◽  
Changes Over Time ◽  
Grief Reactions

Abstract. Background: Postvention services aim to support people bereaved by suicide and reduce the adverse impacts associated with suicide bereavement. StandBy Support After Suicide is a community-based suicide bereavement service that provides support and a coordinated response for people bereaved by suicide. Aims: We aimed to evaluate the effectiveness of the StandBy service in reducing suicidality, grief reactions associated with suicide bereavement, and social isolation among clients. Method: A retrospective cross-sectional design using an online survey was used to compare StandBy clients with people bereaved by suicide who did not access the StandBy service. Results: Among people whose most recent loss to suicide was within the past 12 months, people supported by StandBy were significantly less likely to be at risk of suicidality, experience a loss of social support, and experience social loneliness compared with people bereaved by suicide who had not accessed the StandBy service. Limitations: Owing to the use of a cross-sectional design, it was not possible to determine changes over time. Conclusion: Postvention in the form of a community-based crisis intervention, at the time of or close to a suicide, is effective in reducing adverse outcomes associated with suicide bereavement, and an important aspect of suicide prevention.

Transcatheter aortic valve replacement

2010 ◽  
pp. 652-668
Author(s):  
John G. Webb ◽  
Fabian Nietlispach
Keyword(s):  
United States ◽  
Heart Disease ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
The Elderly ◽  
The United States ◽  
Community Based ◽  
Transcatheter Aortic Valve

Aortic stenosis (AS) is the most common valvular heart disease for which patients undergo valve replacement. Although the condition may develop in mid-life in association with a congenitally bicuspid valve, AS is for the most part a disease of the elderly, as demonstrated by a recent community-based study in the United States which reported a prevalence in those older than 75 years of age of 4.6%. Medically treated severe symptomatic AS has been associated with predictable clinical deterioration and a poor survival, reportedly averaging 2–3 years after the onset of symptoms.

scholarly journals A clinical risk score of myocardial fibrosis predicts adverse outcomes in aortic stenosis

2015 ◽  
Vol 37 (8) ◽  
pp. 713-723 ◽  
Author(s):  
Calvin W.L. Chin ◽  
David Messika-Zeitoun ◽  
Anoop S.V. Shah ◽  
Guillaume Lefevre ◽  
Sophie Bailleul ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Myocardial Fibrosis ◽  
Risk Score ◽  
Adverse Outcomes ◽  
Clinical Risk Score ◽  
Clinical Risk
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