IMPACT OF BASELINE RISK STATUS ON OUTCOMES IN THE REPLACE STUDY

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A2311-A2313
Author(s):  
Raymond Benza ◽  
Gerald Simonneau ◽  
Hossein Ghofrani ◽  
Paul Corris ◽  
Stephan Rosenkranz ◽  
...  
Keyword(s):  
Baseline Risk ◽  
Risk Status

SYNCOPE RELATES TO A HIGHER BASELINE RISK STATUS, PULMONARY ARTERY OBSTRUCTIVE BURDEN AND MORTALITY IN ACUTE PULMONARY EMBOLISM

2020 ◽  
Vol 75 (11) ◽  
pp. 2106
Author(s):  
Berhan Keskin ◽  
Ozgur Yasar Akbal ◽  
Seda Tanyeri ◽  
Aykun Hakgor ◽  
Hacer Tokgoz ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Acute Pulmonary Embolism ◽  
Baseline Risk ◽  
Risk Status

Abstract P75: Association Between Caregiving, 30-Day Outcomes, and Baseline Risk Status Among Hospitalized Cardiac Patients

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Lori Mosca ◽  
Brooke Aggarwal ◽  
Heidi Mochari-Greenberger ◽  
Ming Liao ◽  
Niurka Suero-Tejeda ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Participation Rate ◽  
Cardiac Patients ◽  
University Hospital ◽  
Baseline Risk ◽  
Risk Status ◽  
Available N ◽  
Comorbidity Score ◽  
History Of ◽  
Comorbidity Index

BACKGROUND: Caregivers might represent a unique opportunity to improve clinical outcomes among cardiovascular disease (CVD) patients, however prospective data are limited. PURPOSE: To determine if having a caregiver is associated with 30-day clinical outcomes and baseline risk status among hospitalized CVD patients. METHODS: We prospectively studied 4500 consecutive patients admitted to the CVD service line at a university hospital as part of the NHLBI-sponsored F amily Cardiac Caregiver I nvestigation T o Evaluate O utcomes ( FIT-O ) Study. Clinical outcomes included rehospitalization or death within 30-days. Patients [N=4500, 59% white, 62% male, 93% participation rate] completed a standardized interviewer assisted questionnaire in English/Spanish about caregiving (paid or non-paid). In a subsample of patients with baseline data available (n=1324), comorbidities, labs, and medications were analyzed by caregiver status. Comorbidity score was calculated using the Ghali Comorbidity Index (range 0-11). The association between caregiving and clinical outcomes was evaluated by logistic regression adjusted for confounders. RESULTS: At 30-days, 11% (475/4500) of patients had been rehospitalized or had died. Cardiac patients who had a caregiver vs. those who did not were significantly more likely to have been rehospitalized or to have died within 30-days (OR=1.4, 95%CI=1.2-1.7). This association was similar when analyzed by paid (OR=1.7, 95%CI=1.2-2.3) or non-paid (OR=1.2, 95%CI=1.0-1.6) caregiver status, and was not materially altered when adjusted for demographic confounders. In a subsample (n=1324), cardiac patients who had caregivers vs. those who did not were significantly (p<.05) more likely to have a history of diabetes, renal failure, CVD, COPD, creatinine >2.5 mg/dL, HbA1C ≥7%, comorbidity score >1, and take ≥11 medications. The association between caregiving and 30-day outcomes was not significant after adjustment for demographics, baseline risk factors, and comorbidities (OR=1.2, 95%CI=0.4-3.3). CONCLUSION: Cardiac patients who had a caregiver vs. those who did not had significantly higher rehospitalization and mortality rates at 30-days; this association is largely explained by their higher baseline risk status.

Quality management in the prophylaxis of venous thrombembolism - Results of a survey including 464 medical and surgical patients

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 123-130
Author(s):  
Klein-Weigel ◽  
Richter ◽  
Arendt ◽  
Gerdsen ◽  
Härtwig ◽  
...  
Keyword(s):  
Renal Function ◽  
High Risk ◽  
Quality Management ◽  
High Risk Group ◽  
Surgical Patients ◽  
Medical Patients ◽  
Risk Status ◽  
Vte Prophylaxis ◽  
Safety Concerns

Background: We surveyed the quality of risk stratification politics and monitored the rate of entries to our company-wide protocol for venous thrombembolism (VTE) prophylaxis in order to identify safety concerns. Patients and methods: Audit in 464 medical and surgical patients to evaluate quality of VTE prophylaxis. Results: Patients were classified as low 146 (31 %), medium 101 (22 %), and high risk cases 217 (47 %). Of these 262 (56.5 %) were treated according to their risk status and in accordance with our protocol, while 9 more patients were treated according to their risk status but off-protocol. Overtreatment was identified in 73 (15.7 %), undertreatment in 120 (25,9 %) of all patients. The rate of incorrect prophylaxis was significantly different between the risk categories, with more patients of the high-risk group receiving inadequate medical prophylaxis (data not shown; p = 0.038). Renal function was analyzed in 392 (84.5 %) patients. In those patients with known renal function 26 (6.6 %) received improper medical prophylaxis. If cases were added in whom prophylaxis was started without previous creatinine control, renal function was not correctly taken into account in 49 (10.6 %) of all patients. Moreover, deterioration of renal function was not excluded within one week in 78 patients (16.8 %) and blood count was not re-checked in 45 (9.7 %) of all patients after one week. There were more overtreatments in surgical (n = 53/278) and more undertreatments in medical patients (n = 54/186) (p = 0.04). Surgeons neglected renal function and blood controls significantly more often than medical doctors (p-values for both < 0.05). Conclusions: We found a low adherence with our protocol and substantial over- and undertreatment in VTE prophylaxis. Besides, we identified disregarding of renal function and safety laboratory examinations as additional safety concerns. To identify safety problems associated with medical VTE prophylaxis and “hot spots” quality management-audits proved to be valuable instruments.

Digital risk analysis of cardiovascular diseases: new opportunities for the patients

2008 ◽  
Vol 149 (15) ◽  
pp. 677-684 ◽  
Author(s):  
Csaba Arnold ◽  
Zoltán Englert ◽  
Csaba Szabadhegyi ◽  
Csaba Farsang
Keyword(s):  
Risk Factors ◽  
Cardiovascular Diseases ◽  
Risk Analysis ◽  
Effective Treatment ◽  
Medical History ◽  
Vascular Diseases ◽  
Coronary Risk ◽  
Risk Status ◽  
Long Period ◽  
Graphic Presentation

Authors constructed a software helping the prevention programme of coronary and vascular diseases as the classical risk factors are used for graphic presentation of coronary risk as compared to “normal” risk. By repeated estimation alterations in coronary risk status can be compared to previous ones and thereby help evaluating the changes. This programme is highlighted by the presentation of changes in coronary risk of a patient during a 4-year-long period of her medical history. It is also shown how graphic presentation of risk can support the more effective treatment and patient care.

scholarly journals Influenza vaccination and risk for cardiovascular events: a nationwide self-controlled case series study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Abhijit Sen ◽  
Inger Johanne Bakken ◽  
Ragna Elise Støre Govatsmark ◽  
Torunn Varmdal ◽  
Kaare Harald Bønaa ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Influenza Vaccination ◽  
Lower Risk ◽  
Cardiovascular Events ◽  
Case Series ◽  
Baseline Risk ◽  
Inverse Association ◽  
Relative Risks ◽  
Case Series Study ◽  
Cardiovascular Medications

Abstract Background US and European guidelines diverge on whether to vaccinate adults who are not at high risk for cardiovascular events against influenza. Here, we investigated the associations between influenza vaccination and risk for acute myocardial infarction, stroke and pulmonary embolism during the 2009 pandemic in Norway, when vaccination was recommended to all adults. Methods Using national registers, we studied all vaccinated Norwegian individuals who suffered AMI, stroke, or pulmonary embolism from May 1, 2009 through September 30, 2010. We defined higher-risk individuals as those using anti-diabetic, anti-obesity, anti-thrombotic, pulmonary or cardiovascular medications (i.e. individuals to whom vaccination was routinely recommended); all other individuals were regarded as having lower-risk. We estimated incidence rate ratios with 95% CI using conditional Poisson regression in the pre-defined risk periods up to 180 days following vaccination compared to an unexposed time-period, with adjustment for season or daily temperature. Results Overall, we observed lower risk for cardiovascular events following influenza vaccination. When stratified by baseline risk, we observed lower risk across all three outcomes in association with vaccination among higher-risk individuals. In this subgroup, relative risks were 0.72 (0.59–0.88) for AMI, 0.77 (0.59–0.99) for stroke, and 0.73 (0.45–1.19) for pulmonary embolism in the period 1–14 days following vaccination when compared to the background period. These associations remained essentially the same up to 180 days after vaccination. In contrast, the corresponding relative risks among subjects not using medications were 4.19 (2.69–6.52), 1.73 (0.91–3.31) and 2.35 (0.78–7.06). Conclusion In this nationwide study, influenza vaccination was associated with overall cardiovascular benefit. This benefit was concentrated among those at higher cardiovascular risk as defined by medication use. In contrast, our results demonstrate no comparable inverse association with thrombosis-related cardiovascular events following vaccination among those free of cardiovascular medications at baseline. These results may inform the risk–benefit balance for universal influenza vaccination.

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