scholarly journals 343 Atrial Fibrillation, Orthostatic Hypotension and Cerebral Perfusion – Data from The Irish Longitudinal Study on Ageing

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Triona McNicholas ◽  
Paul Claffey ◽  
Susie O'Callaghan ◽  
Robert Briggs ◽  
Louise Newman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Longitudinal Study ◽  
Linear Regression ◽  
Orthostatic Hypotension ◽  
Frontal Lobe ◽  
Blood Pressure Measurement ◽  
Mixed Effects ◽  
Community Dwelling ◽  
P Value ◽  
The Impact

Abstract Background It is thought that cerebral hypoperfusion in Atrial Fibrillation (AF) increases the risk of falls, cognitive impairment, and worse outcome in stroke. This aim of this study is to assess frontal lobe perfusion in response to active stand, and to assess the impact of OH on this association. Methods Data from wave 3 of The Irish Longitudinal Study on Ageing were used, a cohort study of community-dwelling adults aged over 50. Frontal lobe perfusion in response to orthostasis was measured using near infra-red spectroscopy (NIRS), reported as tissue saturation index (TSI%). Orthostatic hypotension (OH) was assessed using beat-to-beat blood pressure measurement. Linear regression assessed whether AF was associated with lower baseline TSI. Mixed effects linear regression assessed whether TSI differed across specific time points – 10, 20, 30, 40 60, 90, and 120 seconds. The analysis were repeated including an interaction with OH to assess the impact of OH on this association. Results There was no difference in baseline TSI in participants with AF compared to those without. Mixed effects models demonstrated lower TSI at 10 seconds in AF (β -0.52; 95% CI -0.88, -0.16; p-value 0.004), at 40 seconds (β -0.40; 95% CI -0.76, -0.04; p-value 0.031) and at 60 seconds (β -0.40; 95% CI --0.76, -0.04; p-value 0.028). Including an interaction with OH found that in isolated AF, TSI was lower at 10 seconds (β -0.62; 95% CI -1.04, -0.19; p-value 0.005). Those with both AF and OH had lower TSI at 40 (β -0.89; 95% CI -1.55, -0.24; p-value 0.007), 60 (β -0.89; 95% CI -1.54, -0.23; p-value 0.008) and 90 (β -0.68; 95% CI -1.33, -0.03; p-value 0.041) seconds. Conclusion There is evidence that frontal lobe perfusion is lower during orthostasis in individuals with AF, and that the presence of OH modifies this association.

scholarly journals Cardiovascular risk after hospitalisation for unexplained syncope and orthostatic hypotension

Heart ◽  
2017 ◽  
Vol 104 (6) ◽  
pp. 487-493 ◽  
Author(s):  
Ekrem Yasa ◽  
Fabrizio Ricci ◽  
Martin Magnusson ◽  
Richard Sutton ◽  
Sabina Gallina ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Orthostatic Hypotension ◽  
Cardiovascular Events ◽  
Hospital Admissions ◽  
Cox Regression ◽  
All Cause Mortality ◽  
Unexplained Syncope ◽  
The Impact

ObjectiveTo investigate the relationship of hospital admissions due to unexplained syncope and orthostatic hypotension (OH) with subsequent cardiovascular events and mortality.MethodsWe analysed a population-based prospective cohort of 30 528 middle-aged individuals (age 58±8 years; males, 40%). Adjusted Cox regression models were applied to assess the impact of unexplained syncope/OH hospitalisations on cardiovascular events and mortality, excluding subjects with prevalent cardiovascular disease.ResultsAfter a median follow-up of 15±4 years, 524 (1.7%) and 504 (1.7%) participants were hospitalised for syncope or OH, respectively, yielding 1.2 hospital admissions per 1000 person-years for each diagnosis. Syncope hospitalisations increased with age (HR, per 1 year: 1.07, 95% CI 1.05 to 1.09), higher systolic blood pressure (HR, per 10 mm Hg: 1.06, 95% CI 1.01 to 1.12), antihypertensive treatment (HR: 1.26, 95% CI 1.00 to 1.59), use of diuretics (HR: 1.77, 95% CI 1.31 to 2.38) and prevalent cardiovascular disease (HR: 1.59, 95% CI 1.14 to 2.23), whereas OH hospitalisations increased with age (HR: 1.11, 95% CI 1.08 to 1.12) and prevalent diabetes (HR: 1.82, 95% CI 1.23 to 2.70). After exclusion of 1399 patients with prevalent cardiovascular disease, a total of 473/464 patients were hospitalised for unexplained syncope/OH before any cardiovascular event. Hospitalisation for unexplained syncope predicted coronary events (HR: 1.85, 95% CI 1.49 to 2.30), heart failure (HR: 2.24, 95% CI 1.65 to 3.04), atrial fibrillation (HR: 1.84, 95% CI 1.50 to 2.26), aortic valve stenosis (HR: 2.06, 95% CI 1.28 to 3.32), all-cause mortality (HR: 1.22, 95% CI 1.09 to 1.37) and cardiovascular death (HR: 1.72, 95% CI 1.23 to 2.42). OH-hospitalisation predicted stroke (HR: 1.66, 95% CI 1.24 to 2.23), heart failure (HR: 1.78, 95% CI 1.21 to 2.62), atrial fibrillation (HR: 1.89, 95% CI 1.48 to 2.41) and all-cause mortality (HR: 1.14, 95% CI 1.01 to 1.30).ConclusionsPatients discharged with the diagnosis of unexplained syncope or OH show higher incidence of cardiovascular disease and mortality with only partial overlap between these two conditions.

scholarly journals 3423 Poorer Outcomes Among Septic Patients with Protein Energy Malnutrition

2019 ◽  
Vol 3 (s1) ◽  
pp. 124-124
Author(s):  
Adeyinka Charles Adejumo ◽  
Olalekan Akanbi ◽  
Lydie Pani
Keyword(s):  
Clinical Outcomes ◽  
Primary Care Physicians ◽  
Protein Energy Malnutrition ◽  
Community Dwelling ◽  
P Value ◽  
Protein Energy ◽  
Propensity Matching ◽  
Study Population ◽  
Clinical Conditions ◽  
The Impact

OBJECTIVES/SPECIFIC AIMS: Protein Energy Malnutrition (PEM) could compromise the body’s defense systems resulting in sepsis, which further depletes calorie stores. Among hospitalized patients, we investigate 1) the relationship between PEM and sepsis, 2) the impact of PEM on trends in mortality from sepsis, and 3) the influence of PEM on clinical outcomes of sepsis. METHODS/STUDY POPULATION: Using the 2014 Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (NIS) patient’s discharge records, we identified patients with sepsis, PEM, and other clinical conditions with ICD-9-CM codes. After stratifying sepsis into two: uncomplicated (without shock) and complicated (with shock), we estimated the adjusted odds (aOR) of developing sepsis (total, uncomplicated and complicated) with PEM. Then, we selected hospitalizations with sepsis from 2007-2014 years of the HCUP-NIS, and calculated the trend in mortality from sepsis, stratified by PEM status, as an effect modifier. Finally, we matched PEM to no PEM (1:1) using a greedy algorithm-based propensity methodology and estimated the effect of having mortality, complicated sepsis and 10 other clinical outcomes and healthcare utilization (SAS 9.4). RESULTS/ANTICIPATED RESULTS: PEM was associated with higher odds for sepsis (aOR:3.97[3.89-4.05]), and complicated vs. uncomplicated sepsis (1.74[1.67-1.81]). Although mortality in sepsis has been trending down from 2007-2014 (−1.19%/year, p-trend<0.0001), the decrease was less pronounced among those with PEM vs. no-PEM (−0.86%/year vs. −1.29%/year, p-value < 0.0001). After propensity matching, PEM was associated with higher mortality (1.35[1.32-1.37]), cost ($160,724[159,517-161,940] vs. $86,650[85,931-87,375]), length of stay (14.76[14.68-14.84] vs. 8.49[8.45-8.56] days), and worse outcomes in general. DISCUSSION/SIGNIFICANCE OF IMPACT: PEM is a risk factor of sepsis and associated with poorer outcomes among septic patients. A concerted effort involving primary care physicians, nutritionists, nurses in identifying, preventing, and treatment of PEM in the community-dwelling individuals before hospitalization might mitigate against these devastating outcomes.

scholarly journals 342 The Association Between Benzodiazepine Use and Falls, and the Impact of Sleep Quality on this Association: Data from TILDA

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Louise Marron ◽  
Ricardo Segurado ◽  
Paul Claffey ◽  
Rose Anne Kenny ◽  
Triona McNicholas
Keyword(s):  
Older Adults ◽  
Sleep Quality ◽  
Effect Size ◽  
Community Dwelling ◽  
Public Health Issue ◽  
P Value ◽  
Poor Sleep ◽  
Daytime Somnolence ◽  
Falling Asleep ◽  
The Impact

Abstract Background Benzodiazepines (BZD) are associated with adverse effects, particularly in older adults. Previous research has shown an association between BZDs and falls and BZDs have been shown to impact sleep quality. The aim of this study is to assess the association between BZD use and falls, and the impact of sleep quality on this association, in community dwelling adults aged over 50. Methods Data from the first wave of The Irish Longitudinal Study on Ageing were used. Participants were classed as BZD users or non-users and asked if they had fallen in the last year, and whether any of these falls were unexplained. Sleep quality was assessed via self-reported trouble falling asleep, daytime somnolence, and early-rising. Logistic regression assessed for an association between BZD use and falls, and the impact of sleep quality on this association was assessed by categorising based on BZD use and each sleep quality variable. Results Of 8,175 individuals, 302 (3.69%) reported taking BZDs. BZD use was associated with falls, controlling for con-founders (OR 1.40; 1.08, 1.82; p-value 0.012). There was no significant association between BZDs and unexplained falls, controlling for con-founders (OR 1.41; 95% CI 0.95, 2.10; p-value 0.09), however a similar effect size to all falls was evident. Participants who take BZDs and report daytime somnolence (OR 1.93; 95% CI 1.12, 3.31; p-value 0.017), early-rising (OR 1.93; 95% CI 1.20, 3.11; p-value 0.007) or trouble falling asleep (OR 1.83; 95% CI 1.12, 2.97; p-value 0.015), have an increased odds of unexplained falls. Conclusion BZD use is associated with falls, with larger effect size in BZD users reporting poor sleep quality in community dwelling older adults. Appropriate prescription of and regular review of medications such as BZDs is an important public health issue.

scholarly journals EFFECT OF PHYSICAL CONDITIONING ON STUDENT BASIC SKILLS GYMNASTICS

2020 ◽  
Vol 39 (1) ◽  
pp. 207-216
Author(s):  
Endang Rini Sukamti ◽  
Ratna Budiarti ◽  
Risti Nurfadhila
Keyword(s):  
Linear Regression ◽  
Basic Skills ◽  
High Standard ◽  
P Value ◽  
Physical Conditioning ◽  
Basic Skill ◽  
High Standard Deviation ◽  
Parenting Students ◽  
The Impact ◽  
Collection Methods

Physical conditioning was considered as a strong foundation for developing techniques from different fields. The aims of this study was to determine the impact of physical conditioning in parenting students or athletes gymnastic basic skills. The study was a surveyed research. The study sampling was 82 students aged between 18-19 years from Sport sciences, exactly coaching sciences. Data collection methods used checks and measurements of bio motor and gymnastic fundamental skills. Data analysis using correlation and linear regression to predict the future competence. The results showed that: there was significant correlation between the physical conditioning items and gymnastics basics skills, but there is also strong significant linear regression (p: .032<.05)  from physical conditioning with basic skill of Gymnastics. The standing balance (r = .728) and broad jump (r = .751) were found more influenced for gymnastic basic skills. There was a great significant different between the pre-test and posttest gymnastic basic skills means with p value < .001. The high standard deviation between the items showed the different adaptation of the subjects according to the physical conditioning. In conclusion physical conditioning was found as parenting for developing the gymnastic basic skills.

scholarly journals Comparison of the Overtime Fasting Plasma Glucose Between Patients Receiving Angiotensin Receptor Blocker (ARB) and Non-ARB Drugs

2021 ◽  
Vol 44 (1) ◽  
pp. 11-20
Author(s):  
Namtip Burapakiat ◽  
Tharntip Sangsuwan ◽  
Silom Jamulitrat ◽  
Thammasin Ingviya ◽  
Napakkawat Buathong
Keyword(s):  
Linear Regression ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Angiotensin Receptor Blocker ◽  
Mixed Effects ◽  
Receptor Blocker ◽  
Angiotensin Receptor ◽  
Hypertensive Patients ◽  
Fasting Plasma ◽  
The Impact

Background: Previous studies have shown a relationship between renin angiotensin aldosterone system (RAAS) and insulin resistance. This in turn can delay the onset of diabetes mellitus (DM). The impact of angiotensin receptor blocker (ARB) on the fasting plasma glucose (FPG) level is not clear. Objective: To compare the overtime FPG between ARB and non-ARB using. Methods: A retrospective-longitudinal cohort study, data were collected from medical records of hypertensive patients who were not diagnosed DM in 2007 and 2008, each patient was followed up 10 years. The association between antihypertensive drugs and FPG by multilevel mixed-effects linear regression was evaluated. Multistate Markov chain model was used to evaluate the probability to become pre-DM or DM stage. Results: Of 822 patients, 571 patients were excluded and 251 patients met criteria for analysis. From multilevel mixed-effects linear regression, ARB usage was associated with a nonsignificant decreased FPG when adjusted with visit (mean FPG change, -0.98; 95% CI, -2.65 to 0.69; P = .25) and with visit plus glomerular filtration rate (mean FPG change, -1.89, 95% CI, -4.88 to 1.19; P = .24). The probability of change in 10 years from normal to pre-DM stage was 0.41 and 0.38, normal to DM stage was 0.03 and 0.01, pre-DM to DM stage was 0.08 and 0.04, in non-ARB and ARB group, respectively. Conclusions: ARB tended to decrease probability to become DM. Thus, physicians should prescribe ARB in hypertensive patients to prevent new-onset DM.  

scholarly journals Is orthostatic hypotension and co-existing supine and seated hypertension associated with future falls in community-dwelling older adults? Results from The Irish Longitudinal Study on Ageing (TILDA)

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252212
Author(s):  
Orna A. Donoghue ◽  
Matthew D. L. O’Connell ◽  
Robert Bourke ◽  
Rose Anne Kenny
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Longitudinal Study ◽  
Orthostatic Hypotension ◽  
Community Dwelling ◽  
Effect Sizes ◽  
Important Indicator ◽  
Supine Hypertension ◽  
Risk Of Falls ◽  
Community Dwelling Older Adults

Orthostatic hypotension (OH) often co-exists with hypertension. As increasing age affects baroreflex sensitivity, it loses its ability to reduce blood pressure when lying down. Therefore, supine hypertension may be an important indicator of baroreflex function. This study examines (i) the association between OH and future falls in community-dwelling older adults and (ii) if these associations persist in those with co-existing OH and baseline hypertension, measured supine and seated. Data from 1500 community-dwelling adults aged ≥65 years from The Irish Longitudinal Study on Ageing (TILDA) were used. Continuous beat-to-beat blood pressure was measured using digital photoplethysmography during an active stand procedure with OH defined as a drop in systolic blood pressure (SBP) ≥20 mmHg and/or ≥10 mm Hg in diastolic blood pressure (DBP) within 3 minutes of standing. OH at 40 seconds (OH40) was used as a marker of impaired early stabilisation and OH sustained over the second minute (sustained OH) was used to indicate a more persistent deficit, similar to traditional OH definitions. Seated and supine hypertension were defined as SBP ≥140 mm Hg or DBP ≥90 mm Hg. Modified Poisson models were used to estimate relative risk of falls (recurrent, injurious, unexplained) and syncope occurring over four year follow-up. OH40 was independently associated with recurrent (RR = 1.30, 95% CI = 1.02,1.65), injurious (RR = 1.43, 95% CI = 1.13,1.79) and unexplained falls (RR = 1.55, 95% CI = 1.13,2.13). Sustained OH was associated with injurious (RR = 1.55, 95% CI = 1.18,2.05) and unexplained falls (RR = 1.63, 95% CI = 1.06,2.50). OH and co-existing hypertension was associated with all falls outcomes but effect sizes were consistently larger with seated versus supine hypertension. OH, particularly when co-existing with hypertension, was independently associated with increased risk of future falls. Stronger effect sizes were observed with seated versus supine hypertension. This supports previous findings and highlights the importance of assessing orthostatic blood pressure behaviour in older adults at risk of falls and with hypertension. Observed associations may reflect underlying comorbidities, reduced cerebral perfusion or presence of white matter hyperintensities.

scholarly journals Blood Pressure Variability and Incidence of New-Onset Atrial Fibrillation

Hypertension ◽  
2020 ◽  
Vol 75 (2) ◽  
pp. 309-315 ◽  
Author(s):  
So-Ryoung Lee ◽  
You-Jung Choi ◽  
Eue-Keun Choi ◽  
Kyung-Do Han ◽  
Euijae Lee ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Variability ◽  
Blood Pressure Measurement ◽  
Population Based ◽  
Increased Risk ◽  
Complete Set ◽  
The Impact ◽  
Fourth Quartile

Blood pressure variability is a well-known risk factor for cardiovascular disease, but its association with atrial fibrillation (AF) is uncertain. We aimed to evaluate the association between visit-to-visit blood pressure variability and incident AF. This population-based cohort study used database from the Health Screening Cohort, which contained a complete set of medical claims and a biannual health checkup information of the Koran population. A total of 8 063 922 individuals who had at least 3 health checkups with blood pressure measurement between 2004 and 2010 were collected after excluding subjects with preexisting AF. Blood pressure variability was defined as variability independence of the mean and was divided into 4 quartiles. During a mean follow-up of 6.8 years, 140 086 subjects were newly diagnosed with AF. The highest blood pressure variability (fourth quartile) was associated with an increased risk of AF (hazard ratio, 95% CI; systolic blood pressure: 1.06, 1.05–1.08; diastolic blood pressure: 1.07, 1.05–1.08) compared with the lowest (first quartile). Among subjects in the fourth quartile in both systolic and diastolic blood pressure variability, the risk of AF was 7.6% higher than those in the first quartile. Moreover, this result was consistent in both patients with or without prevalent hypertension. In subgroup analysis, the impact of high blood pressure variability on AF development was stronger in high-risk subjects, who were older (≥65 years), with diabetes mellitus or chronic kidney disease. Our findings demonstrated that higher blood pressure variability was associated with a modestly increased risk of AF.

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