scholarly journals Epidemiology of potassium derangements among chronic cardiovascular, metabolic and renal conditions: a population-based analysis data from more than 375,000 individuals

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Jimenez ◽  
M Cainzos-Achirica ◽  
D Monterde ◽  
L Garcia-Eroles ◽  
C Enjuanes ◽  
...  
Keyword(s):  
Population Level ◽  
Epidemiological Data ◽  
Analysis Data ◽  
Population Based ◽  
Funding Source ◽  
Close Monitoring ◽  
Angiotensin Ii Receptor ◽  
Healthcare Database ◽  
Converting Enzyme Inhibitors ◽  
Number Of Patients

Abstract Introduction In patients with chronic cardiovascular, metabolic and renal disorders, potassium (K)+ homeostasis is often delicate, especially in the presence of renin-angiotensin-aldosterone system inhibition (RAASI) and/or diuretic therapies. In this context, current clinical practical guidelines for the management of these patients recommend close monitoring of renal function and K+ levels, particularly in the presence of drug titration. Nevertheless, very limited epidemiological data on their importance at a population level is available. Purpose The objectives of the present analysis are to estimate the prevalence of potassium (K+) derangements in five key chronic cardiovascular, metabolic and renal conditions at the population level, its use of RAASI medication and describe potassium derangements among RAASI users. Methods We used data from more than 375,000 individuals 55 years of age or older included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were chronic heart failure (CHF), chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD), and hypertension (HTN). RAASI medications included angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists (MRAs), and rennin inhibitors. Hyperkalemia was defined as K+ levels >5.0 mEq/L and hypokalemia as K+ <3.5 mEq /L Results The prevalence of chronic cardiovascular, metabolic and renal conditions was high, particularly of HTN (48.2–48.9%). The prevalence of hyperkalemia was ranging between 10% and 25% depending of the condition, more frequent in CKD and less frequent in HTN patients. In figure, we display the prevalence of hyperkalemia among individuals with each of the relevant chronic conditions, January 1st, 2016 and January 1st, 2017. Use of at least one RAASI medication was very prevalent in HTN patients (75.2–77.3%). Among RAASI users, the frequency of K+ derangements and mainly of hyperkalemia was very noticeable (12% overall), especially in patients with CKD, CHF, elderly individuals, and users of MRAs. Hypokalemia was less frequent (1%). Conclusion The high prevalence of K+ derangements and predominantly hyperkalemia among RAASI users highlights the real-world relevance of K+ derangements and the importance of close monitoring and management of K+ levels in routine clinical practice. This is likely to benefit a large number of patients, particularly those at higher risk. Figure 1. Prevalence of hyperkalemia Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Josep Comin-Colet and Miguel Cainzos-Achirica have participated in other research projects funded by unrestricted grants from Vifor Pharma

A population-based analysis in 375,233 cases of heart failure stages A, B and C. Real world epidemiology of prevalence and temporal trends in South-European populations

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Jimenez ◽  
M Cainzos-Achirica ◽  
D Monterde ◽  
L Garcia-Eroles ◽  
C Enjuanes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Conditions ◽  
Temporal Trends ◽  
Population Level ◽  
Population Based ◽  
Relative Increase ◽  
Funding Source ◽  
Private Company ◽  
Healthcare Database ◽  
Evolutionary Changes

Abstract Background Prevalence of congestive heart failure (CHF) and predisposing conditions has described previously. Most of these studies evaluated centre-European or north-American populations. However, the prevalence and evolutionary changes of Heart Failure stages A, B and C has not been fully elucidated in Mediterranean cohorts. Purpose To estimate the prevalence of CHF (HF Stage C) and four additional key chronic cardiovascular, metabolic and renal conditions predisposing to the development of CHF (HF Stages A and B) at a population level in a south-European healthcare area. We analysed the evolutionary changes in the prevalence in these five conditions. Methods In a healthcare area of 1,3Millions inhabitants, we extracted health related information of all individuals ≥55 years old. We analysed data of 375,233 individuals included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were CHF, chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD) and hypertension (HTN). Results The prevalence of chronic conditions was high, particularly of HTN (48.2–48.9%) and DM individuals (14.6–14.8%). The other conditions were less frequent, with prevalence around 2–4% for IHD, 5–9% for CKD and 2–4% for CHF (Table). However, the less frequent conditions had a striking upward trend with over 1,500 new prevalent cases per year between 2015 and 2017 for CHF (45% relative increase), more than 2,500 new prevalent cases for IHD (67% relative increase) and more than 4,000 new prevalent cases per year for CKD (44% relative increase). Conclusion In this south European cohort, there were a high prevalence of HTN and DM as risk factors and a significant trend of increasing prevalence in high cost chronic conditions such as CHF, IHD and CKD. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The present study was funded by an unrestricted research grant from Vifor Pharma.

scholarly journals Encounters for foot and ankle pain in UK primary care: a population-based cohort study of CPRD data

2019 ◽  
Vol 69 (683) ◽  
pp. e422-e429 ◽  
Author(s):  
Rachel Ferguson ◽  
David Culliford ◽  
Daniel Prieto-Alhambra ◽  
Rafael Pinedo-Villanueva ◽  
Antonella Delmestri ◽  
...  
Keyword(s):  
General Practice ◽  
Age Groups ◽  
Population Level ◽  
Population Based ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Foot Pain ◽  
Ankle Pain ◽  
Foot Health ◽  
Number Of Patients

BackgroundOlder patients who have foot pain report variation in access to services to manage their foot health. To plan services it is essential to understand the scale and burden of foot pain that exists for GPs.AimTo provide UK-wide population-level data of the frequency of foot and/or ankle pain encounters recorded in general practice.Design and settingPopulation-based cohort design study using data drawn from the UK Clinical Practice Research Datalink (CPRD) from January 2010 to December 2013.MethodAll CPRD data were collected prospectively by participating GPs. The primary outcome was prevalence of GP encounters for foot and/or ankle pain, stratified by age, sex, and different subgroups of causes.ResultsA foot and/or ankle pain encounter was recorded for 346 067 patients, and there was a total of 567 095 recorded encounters (mean per person 1.6, standard deviation [SD] 1.3). The prevalence of recorded encounters of foot and/or ankle pain was 2980 per 100 000 (3%). The number of patients with a recorded encounter of foot and/or ankle pain was 1820 per 100 000 (1.8%). Foot and/or ankle pain encounters were reported across all age groups (54.4% females), with those aged 71–80 years placing the greatest burden on GPs. The most common specified referrals were to orthopaedics (n = 36 881) and physiotherapy (n = 33 987), followed by podiatry (n = 25 980).ConclusionThe burden of foot and/or ankle pain encounters recorded by GPs is not insubstantial, and spans all ages, with a high proportion of referrals to orthopaedics. The authors recommend further exploration of ‘first-contact practitioners’ for foot and/or ankle pain in general practice to alleviate the burden on GPs.

scholarly journals Antihypertensive medication uses and serum ACE2 levels

2020 ◽  
Author(s):  
Valur Emilsson ◽  
Elias F. Gudmundsson ◽  
Thor Aspelund ◽  
Brynjolfur G. Jonsson ◽  
Alexander Gudjonsson ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Renin Angiotensin System ◽  
Serum Levels ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Population Based ◽  
Single Center ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Angiotensin System ◽  
Receptor Blockers

AbstractImportanceRecent reports have shown that hypertension is the most common comorbidity associated with mortality in the current coronavirus disease 2019 (COVID-19). This has been related to the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) as animal studies indicate that these medications increase levels of ACE2, the cellular entry point for the coronavirus SARS-CoV-2. This has prompted clinicians to recommend discontinuing ACEIs and ARBs.ObjectiveTo examine the effect of ACEIs or ARBs treatment on serum levels of ACE2 and other key enzymes in the renin-angiotensin system (RAS).Design, Setting, and ParticipantsA single center population-based study of 5457 Icelanders from the Age, Gene/Environment Susceptibility Reykjavik Study (AGES-RS) of the elderly (mean age 75±6 years) stratified by ACEIs (N = 699) or ARBs (N = 753) treatment.Main Outcomes and MeasuresThe AGES-RS study population was stratified by ACEIs and ARBs medication use and compared for age, body mass index (BMI) (kg/m2), hypertension and type 2 diabetes (T2D) as well as serum levels of renin, ACE and ACE2.ResultsWhile renin and ACE levels were significantly raised in serum of individuals on ACEIs or ARBs treatments, the ACE2 levels remained unaffected.Conclusions and RelevanceTreatment with ACEIs or ARBs does not raise ACE2 levels in serum. Therefore, the present study does not support the proposed discontinuation of these medications among patients affected with COVID-19.Key PointsQuestionDoes treatment with the antihypertensive medications angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) result in elevated levels of the cellular receptor for the coronavirus SARS-CoV-2, ACE2?FindingsIn a single center population-based cohort (AGES-RS), 699 and 753 individuals were either on ACEIs or ARBs treatment, respectively. The serum levels of the key enzymes in the renin-angiotensin system (RAS), renin, ACE and ACE2 were measured in 5457 subjects of the AGES-RS and their serum levels in individuals on ACEIs or ARBs treatment compared to those not using these medications. While renin and ACE were significantly raised in serum of ACEIs and ARBs users, the levels of ACE2 remained unaffected.MeaningThese results do not support the proposed routine discontinuation of ACEIs or ARBs among patients affected with COVID-19.

Indexes of the erythropoietin level in the blood plasma of chronic heart failure patients with anemia

2018 ◽  
Vol 29 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Kamala Kh. Zahidova
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Blood Plasma ◽  
Combined Therapy ◽  
Functional Class ◽  
Enzyme Linked Immunosorbent Assay ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Disease Modifying Drugs ◽  
Number Of Patients

AbstractBackground:Anemia aggravates the disease course and the survival rate of chronic heart failure (CHF) patients. The purpose of the study was to investigate the level of erythropoietin (EPO) in CHF patients with anemic syndrome, with the aim to more accurately assess the severity of the disease and its treatment, depending on the anemia degree.Methods:Patients with ischemic CHF of I–IV functional class (FC) with and without anemia were examined (total number of patients=208, patients with anemia=174). The EPO was determined using the enzyme-linked immunosorbent assay. Before treatment, the patients underwent the following medical therapy: angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, long-acting nitrates, diuretics, digoxin, and beta-blockers at individual doses. Depending on the plasma EPO level, the CHF patients with anemia were divided into four randomized groups in terms of treatment.Results:Normal erythropoietinemia was found in 36.2% of the CHF patients with anemic syndrome (I–III FC), hypoerythropoietinemia in 44.8% (III–IV FC), and hypererythropoietinemia in 18.96% (III–V FC). The EPO level in the blood plasma of the patients with I–II FC CHF with hypoerythropoietinemia, who were treated with methoxy polyethylene glycol-epoetin β (MEB), increased by 2.2 times. Combination therapy with disease-modifying drugs and MEB led to a significant increase in the plasma EPO level in the CHF patients with hypoerythropoietinemia.Conclusions:It was shown that the EPO level in patients with CHF and anemia did not always drop. Hypererythropoietinemia in patients with CHF and anemia leads to an unfavorable treatment prediction. This necessitates the investigation of the EPO level in all patients with CHF before and after treatment, with the aim of correcting the anemic syndrome. The research showed that the combined therapy of patients with CHF and anemia using MEB medication and iron with regard to the EPO level in the blood plasma improved their overall physical condition, reduced heart failure symptoms and hospitalization frequency, and demonstrated a clear tendency to reduce the general mortality rate.

scholarly journals In search of potential predictors of erythropoiesis-stimulating agents (ESAs) hyporesponsiveness: a population-based study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Ylenia Ingrasciotta ◽  
Viviana Lacava ◽  
Ilaria Marcianò ◽  
Francesco Giorgianni ◽  
Giovanni Tripepi ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Binary Logistic Regression ◽  
Roc Curves ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Population Based ◽  
Outpatient Setting ◽  
Local Health ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Erythropoiesis Stimulating Agents

Abstract Background Evidences show that around 20% of biosimilar or originator erythropoiesis-stimulating agents (ESAs) users are hyporesponsive. Controversial post-marketing data exist on the predictors of ESA hyporesponsiveness. The aim of this study was to identify predictors of ESA hyporesponsiveness in patients with chronic kidney disease (CKD) or cancer in clinical practice. Methods During the years 2009–2015, a multi-center, population-based, cohort study was conducted using claims databases of Treviso and Caserta Local Health Units (LHUs). All incident ESA users were characterized at baseline and the differences between the baseline hemoglobin (Hb) value, that is the Hb registered within 30 days prior to the first ESA dispensing (index date, ID) and each outcome Hb value (registered between 30 and 180 days after ID) were calculated and defined as delta Hb (ΔHb). Incident ESA users were defined as hyporesponsive if, during follow-up, they registered at least one ΔHb < 0 g/dL. Including all potential predictors of ESA hyporesponsiveness and stratifying by indication for use, univariate and multivariate binary logistic regression models and Receiver Operating Characteristic (ROC) curves were carried out. Results `In general, 1080 incident ESA users (CKD: 57.0%; cancer: 43.0%) were identified. In CKD, predictors of ESA hyporesponsiveness were C-reactive protein (OR = 1.2, 95% CI: 1.0–1.5; P-value = 0.060) and high levels of baseline Hb (OR = 1.7, 95% CI: 1.2–2.2; P-value< 0,001), the latter being also predictor of ESA hyporesponsiveness in cancer (OR = 1.7, 95% CI: 1.1–2.4; P-value = 0.007). Both in CKD and in cancer, the type of ESA, biosimilar or originator, was not a predictor of ESA hyporesponsiveness. In CKD, concomitant use of iron preparations (OR = 0.3, 95% CI: 0.2–0.7; P-value = 0.002) and of high dosage of angiotensin-converting enzyme inhibitors/angiotensin II-receptor blockers (OR = 0.5, 95% CI: 0.3–0.9; P-value = 0.022) were protective factors against ESA hyporesponsiveness. Conclusions The study confirmed traditional potential predictors of hyporesponsiveness to ESA. The use of biosimilar or originator ESA was not a predictor of hyporesponsiveness in an outpatient setting from two large Italian areas. A better knowledge of the predictors of ESA response would allow a better anemia management to improve patients’ quality of life.

scholarly journals Epidemiology of craniopharyngiomas: a population based study in Malta

2021 ◽  
Author(s):  
Sarah Craus ◽  
Mark Gruppetta
Keyword(s):  
Prevalence Rate ◽  
Adult Population ◽  
Epidemiological Data ◽  
Population Based ◽  
Incidence Rates ◽  
Adult Onset ◽  
Population Based Study ◽  
Background Population ◽  
Number Of Patients ◽  
Significant Difference

Background: Despite being benign tumours, craniopharyngiomas are challenging to manage and can cause significant morbidity and mortality in both the paediatric and adult population. The aim of the study was to analyse epidemiology of craniopharyngioma, patient and tumour characteristics through a population-based study in Malta, enabling a better quantification of the disease burden. Method: A thorough research was carried out to identify the number of patients who were diagnosed with craniopharyngiomas. Epidemiological data, including both Standardised incidence rates (SIR) and prevalence rates were established in a well-defined population. For incidence estimates, patients who were diagnosed between 2008 and 2019 were included. The background population formed 4.8 million patient-years at risk. Result: 29 subjects were identified and included in our study. The overall SIR was 0.3/100,000/year, with a higher SIR for males compared to females (0.4/100,000/year and 0.2/100,000/year, respectively). The highest SIR was recorded in the 10-19 year age group. The estimated prevalence rate amounted to 5.27/100,000 people, with a lower prevalence rate for childhood onset when compared to the adult-onset category (2.03/100,000 vs 3.24/100,000 people). The median longest tumour diameter was 31.0mm (IQR 21-41), with statistically significant difference between childhood- and adult-onset disease; 43.0mm (IQR 42.5-47.25) vs 27.0mm (IQR 20.55-31.55) (P=0.011). Conclusion: Through this population-based study, accurate and up-to-date prevalence and incidence rates for craniopharyngiomas are reported. These provide a clearer reflection of the true health burden of the disease.

Comparison of management and outcomes of ST-segment elevation myocardial infarction patients in Estonia, Hungary, Norway and Sweden according to national ongoing registries

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Bloendal ◽  
T Ainla ◽  
P Andreka ◽  
R Edfors ◽  
S Halvorsen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Beta Blockers ◽  
International Comparisons ◽  
Funding Source ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background There is a high need for real-world international comparisons of management of patients with acute myocardial infarction. In Europe Estonia, Hungary, Norway and Sweden are among the few countries with national ongoing acute myocardial infarction registries with a high degree of completeness of data. Purpose To compare the management and outcome of hospitalized ST-segment elevation myocardial infarction (STEMI) patients in four European countries with a national ongoing myocardial infarction registry. Methods We compared patient baseline characteristics, use of in-hospital procedures and medications at discharge as well as 30-day and 1-year mortality for all patients admitted with STEMI during 2014–2017 using EMIR (Estonia; n=4,584), HUMIR (Hungary; n=23,685), NOMIR (Norway; n=12,414; data available for years 2013–2016) and SWEDEHEART (Sweden; n=23,342). Country-level results were compared as aggregated data. Results Mean age ranged from 65 to 69 years (table 1). Estonia and Hungary had compared to Norway and Sweden a higher proportion of women (resp. 39%; 38% vs. 29%; 31%), as well as patients with hypertension (resp. 79%; 72% vs. 39%; 50%), diabetes (resp. 21%; 27% vs. 14%; 19%) and peripheral artery disease (resp. 9% vs. 6%; 4%). Proportion of current smokers was highest in Norway (38%) and lowest in Sweden (27%). Rates of discharge medications were generally high. The results for in-hospital procedures and mortality are shown in table 1. Estonia had the lowest rates of dual antiplatelet treatment (78%) and statins (86%). Norway had the lowest rates of beta-blockers (80%) and angiotensin converting enzyme inhibitors/ angiotensin II receptor blockers (61%). Conclusions This cross-country comparison of four national European registries provide new insights into differences in risk factors, treatment regiments and outcomes of patients with STEMI. There are several possible reasons for the observed differences, including differences in underlying expected mortality in the populations, inclusion-criteria and coverage of the registries and variable definitions, that need to be further explored. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Estonian Research Council

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