scholarly journals Trends and sex differences in characteristics and outcomes in myocardial infarction: a 20-year analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H Li ◽  
Y K Tse ◽  
Q W Ren ◽  
M Z Wu ◽  
S Y Yu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Sex Differences ◽  
Ischemic Stroke ◽  
Ischaemic Stroke ◽  
Public Institution ◽  
Risk Of Death ◽  
Time Interaction ◽  
Increased Risk ◽  
Significant Difference ◽  
Over Time

Abstract Background There are considerable sex differences in patients with myocardial infarction (MI). However, the recent temporal trends in characteristics and outcomes in women vs. men, particularly in an Asian population, remain poorly understood. Purpose We aim to evaluate the sex differences in characteristics and outcomes, and how have these differences evolved over the past 2 decades in patients with MI. Methods From a well-validated territory-wide database in Hong Kong, we included patients with incident acute MI from 1999/01/01 to 2018/12/31. Outcomes of interest include, at 30 days, all-cause death, new-onset heart failure (HF), and ischaemic stroke. Trends in sex differences in baseline characteristics were evaluated using linear and Poisson regression, while differences in outcomes were evaluated using Cox proportional hazard model, adjusted with demographics, comorbidities, and baseline medications. A Fine-Gray model was used to evaluate HF and ischaemic stroke to account for competing risk, with all-cause death defined as competing event. Results A total of 130,218 patients (age 73.6±13.9 years, 40.0% female) were included. Women were older (79.5±11.7 vs. 69.6±13.8 years, P<0.001) and had a more pronounced increasing trend in age over time (interaction P<0.001). Women were also more comorbid overall (Charlson Comorbidity Index [CCI] 1.25 vs 0.85, age-adjusted P<0.001), but the rising trend in CCI over time was less pronounced than in men (interaction P<0.001) (Figure 1). Women had more baseline hypertension, diabetes, and severe renal disease than men (age-adjusted P<0.001), while the increasing trends in these comorbidities were all more pronounced in men than in women (all interaction P<0.001). Women were more likely to have ST-elevation overall (P<0.001). Although the crude 30-day mortality rate was higher in women (32.6% vs 23.9%), after adjustment for confounders, they had a lower risk of death (hazard ratio [HR] 0.97, 95% CI [0.96 to 0.99], P=0.003). There was no significant difference in the decreasing trend in 30-day mortality between both sexes (interaction P=0.787) (Figure 1). Women had a higher risk of developing HF (HR 1.04 [1.01 to 1.08], P=0.012) and ischemic stroke (HR 1.36 [1.24 to 1.48], P<0.001) in 30 days. Among patients aged ≤55 (N=15,324), women (N=2,161, 14.1%) had higher risks of all-cause death (HR 1.61 [1.40 to 1.85], P<0.001), HF (HR 1.64 [1.17 to 2.32], P=0.004), and ischemic stroke (HR 1.69 [1.14 to 2.51], P=0.010) in 30 days, even after adjustment for covariates. The excess mortality in women declined over time (interaction P=0.002). Conclusions Women MI patients were older and more comorbid compared to men, which contributed to the higher risk of death, HF, and ischemic stroke among women. Among young MI patients, the increased risk for adverse outcomes among women was particularly pronounced, though the sex differences in mortality reduced over time. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The Shenzhen Key Medical DisciplineThe Sanming Project of HKU-SZH Cardiology

Effect of education on anxiety and depression in patients with myocardial infarction

2011 ◽  
Vol 26 (S2) ◽  
pp. 133-133
Author(s):  
N. Aghakhani
Keyword(s):  
Myocardial Infarction ◽  
Medical Science ◽  
Anxiety And Depression ◽  
Control Group ◽  
Face To Face ◽  
Risk Of Death ◽  
Increased Risk ◽  
Significant Difference ◽  
Quasi Experimental ◽  
Experimental Group

IntroductionAbout 65 percent of patients with myocardial infarction experience mental and emotional problems like depression and anxiety that causes delay in the return to work, decreased quality of life and increased risk of death.The purpose of this study was to determine the effect of education on anxiety and depression in patients with myocardial infarction in Urmia hospitals in 2009.MethodsThis study was a quasi-experimental study that compares the effect of education on anxiety and depression in patients with myocardial infarction in the Urmia University of medical science hospitals. 124 patients were selected randomly and divided into two groups. The experimental group was educated through face to face training and educational booklet. Control group did not receive any intervention.Level of anxiety and depression was evaluated by using HADS questionnaire at 3 intervals after 48 hours of admission, discharge day and 2 months after discharge.ResultsThere was no significant difference between control and experimental groups before the intervention, But after the intervention, anxiety and depression in the experimental group was significantly less than controls, p < 0.05.ConclusionConsidering the beneficial results obtained from education on reducing anxiety and depression in patients with myocardial infarction, it should be one of the health care goals.

scholarly journals T138. ADOLESCENT ONSET OF PSYCHOSIS IMPACTS SEGREGATION OF CORTICO-SUBCORTICAL NETWORKS DURING DEVELOPMENT

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S283-S283
Author(s):  
Daniel Ilzarbe ◽  
Inmaculada Baeza ◽  
Elena De la Serna ◽  
Mireia Rosa ◽  
Olga Puig-Navarro ◽  
...  
Keyword(s):  
Resting State ◽  
Fixed Effects ◽  
Neurodevelopmental Disorder ◽  
Mixed Effect ◽  
Significant Group ◽  
Time Interaction ◽  
Increased Risk ◽  
Significant Difference ◽  
Over Time

Abstract Background Functional connectivity (FC) during the resting-state is reduced in schizophrenia, especially within the Default Mode Network (DMN) (Dong 2018), and between the hippocampus, striatum and ventral tegmental area (VTA), which together conform a Midbrain Network (Gangadin 2019). Cross-sectional studies in adult samples have reported altered FC between dopamine synthesizing centers in midbrain and cortical areas in schizophrenia (Martino 2018). Conceptualizing schizophrenia as a neurodevelopmental disorder, we hypothesize that these changes may take place in early ages, prior to the clinical onset of psychosis. Therefore, we aim to examine FC of the DMN and Midbrain networks longitudinally in adolescents at increased risk of developing psychosis compared with youth with early onset psychosis and healthy volunteers (HV). Methods This longitudinal case-control study encompassed adolescents (12.6–18.9 years old) with psychosis risk syndrome (PRS; n=47), first episode of psychosis (FEP; n=59), and age and sex-matched HV (n=34). Fourteen out of the 30 PRS with follow-up assessment developed psychosis (t-PRS). Resting-state fMRI data was available for 88 subjects at baseline and follow-up [no significant differences in relation to drop-outs]: 10 t-PRS re-scanned at 3–12 months (at transition), and 14 PRS who did not transited (nt-PRS), 35 FEP; and 29 HV re-scanned at 10–36 month follow-up. After exclusion due to poor acquisition or excess movement, the final sample encompassed: 27 FEP, 9 t-PRS, 12 nt-PRS and 28 HV. Individual time series were extracted from Regions of Interest (ROI): for the DMN, the medial Prefrontal Cortex (mPFC), precuneus (PC), and bilateral temporo-parietal junction (Schilbach 2016); and for the Midbrain Network, the associative and limbic striatum, VTA and subiculum (Gangadin 2019). The orthogonal parameters of movement, white matter and cerebrospinal fluid (and their derivatives) and head motion scrubbing regressors were regressed out before performing the correlations. Multivariate mixed-effect models were estimated, including group (4), time and group by time interaction as fixed effects; and time and individual variability as random effects. Results There were no significant differences within-network FC. There was a significant group by time interaction in FC between the two networks (p = .02), driven by VTA-PC (pFDR = .02) and VTA-mPFC (pFDR = .04). Post-hoc analyses showed a significant reduction in FC in nt-PRS over time (psFDR ≤ .03), with FEP and t-PRS showing an opposite pattern (psFDR ≤ .01) in both networks. There was a trend-level reduction in FC over time in HV (ps ≤ .09), which showed significant differences relative to FEP (ps ≤ .04) in the VTA-PC and VTA-mPFC, and with t-PRS in the VTA-PC (p = .02). There was no significant difference between HV and nt-PRS. Cumulative dose of antipsychotics was negatively correlated with FC between mPFC-VTA in FEP at follow-up (r = -.41; p = .04); yet group by time effects survived when used as covariable. Sex, socio-economic status or global intelligence quotient did not exert significant effects. Discussion Our findings suggest that the onset of psychosis during adolescence impacts on the age-normative reduction of FC between the DMN and Midbrain networks, characteristic of the network segregation which takes place during typical brain functional development (Satterthwaite 2013). Antipsychotic medication on cortico-subcortical FC appear to have a reversing effect on these findings, although longitudinal group differences in network connectivity persist despite controlling for this effect. Our data sheds light on the changes in the organization of brain function taking place in the early stages of psychosis, coinciding with a key developmental period.

scholarly journals Risk of ischemic stroke in patients with acute myocardial infarction and new atrial fibrillation: a nationwide analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Fauchier ◽  
A Bisson ◽  
A Bodin ◽  
J Herbert ◽  
T Genet ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of

Abstract Background In patients with acute myocardial infarction (AMI), history of atrial fibrillation (AF) and new onset AF during the early phase may be associated with a worse prognosis. Whether both conditions are associated with a similar risk of stroke and should be similarly managed is a matter of debate. Methods Based on the administrative hospital-discharge database, we collected information for all patients treated with AMI between 2010 and 2019 in France. The adverse outcomes were investigated during follow-up. Results Among 797,212 patients with STEMI or NSTEMI, 146,922 (18.4%) had history of AF, and 11,824 (1.5%) had new AF diagnosed between day 1 and day 30 after AMI. Patients with new AF were older and had more comorbidities than those with no AF but were younger and had less comorbidities than those with history of AF. Both groups with history of AF or new AF had less frequent STEMI and anterior MI, less frequent use of percutaneous coronary intervention but more frequent HF at the acute phase than patients with no AF. During follow-up (mean [SD] 1.8 [2.4] years, median [interquartile range] 0.7 [0.1–3.1] years), 163,845 deaths and 20,168 ischemic strokes were recorded. Using Cox multivariable analysis, compared to patients with no AF, history of AF was associated with a higher risk of death during follow-up (adjusted hazard ratio HR 1.06 95% CI 1.05–1.08) while this was not the case for patients with new AF (adjusted HR 0.98 95% CI 0.95–1.02). By contrast, both history of AF and new AF were associated with a higher risk of ischemic stroke during follow-up compared to patients with no AF: adjusted hazard ratio HR 1.29 95% CI 1.25–1.34 for history of AF, adjusted HR 1.72 95% CI 1.59–1.85 for new AF. New AF was associated with a higher risk of ischemic stroke than history of AF (adjusted HR 1.38 95% CI 1.27–1.49). Conclusion In a large and systematic nationwide analysis, AF first recorded in the first 30 days after AMI was associated with an increased risk of ischemic stroke. Specific management should be considered in order to improve outcomes in these patients after AMI. Funding Acknowledgement Type of funding source: None

scholarly journals Effect of sex differences on prognosis of intravenous thrombolysis: data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China)

2020 ◽  
pp. svn-2020-000351 ◽  
Author(s):  
Hongyu Zhou ◽  
Weiqi Chen ◽  
Yuesong Pan ◽  
Yue Suo ◽  
Xia Meng ◽  
...  
Keyword(s):  
Sex Differences ◽  
Ischemic Stroke ◽  
Ischaemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Statistical Significance ◽  
Intravenous Thrombolysis ◽  
Chinese Patients ◽  
Nihss Score ◽  
Significant Difference

Background and purposePrevious studies have reported conflicting results as to whether women have poorer functional outcome than men after thrombolytic therapy. This study aims to investigate the relationship between sex differences and the prognosis of intravenous thrombolysis in Chinese patients with acute ischaemic stroke.MethodsThe patients enrolled in this study were from the Chinese Acute Ischemic Stroke Thrombolysis Monitoring and Registration study. The primary outcome was poor functional outcome, defined as a 3-month modified Rankin score of 3–6. The safe outcome was symptomatic intracranial haemorrhage (SICH) and mortality within 7 days and 90 days. Multiple Cox regression model was used to correct the potential covariates to evaluate the association between sex disparities and prognosis. Furthermore, the interaction of preonset Rankin scores, baseline National Institute of Health Stroke Scale (NIHSS) scores and Trial of Org 10172 in Acute Stroke Treatment (TOAST) types was statistically analysed.ResultsA total of 1440 patients were recruited, including 541 women and 899 men. The baseline information indicated that women were older at the time of onset (66.2±11.2 years vs 61.0±11.3 years, p<0.001), and more likely to have a history of atrial fibrillation (25.3% vs 11.2%, p<0.001), and had a higher NIHSS score on admission (12.3±6.8 vs 11.6±6.7, p=0.04). According to the prognosis analysis of unsatisfactory functional recovery, there was no significant difference between women and men (45.9% vs 37.1%; adjusted OR 1.01, 95% CI 0.75 to 1.37). As for the safe outcome, the proportion of SICH and mortality in women is relatively high but did not reach statistical significance. There was no significant interaction with sex, age, preonset Rankin score, NIHSS score, TOAST classification and the prognosis of intravenous thrombolysis.ConclusionsFor Chinese patients with ischaemic stroke, although women are older and more severe at the time of onset, the prognosis after intravenous thrombolysis is not significantly different from men.

Abstract WP198: Sex Differences in Outcomes After Stroke in Patients With Diabetes in Ontario, Canada

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mandip S Dhamoon ◽  
John W Liang ◽  
Limei Zhou ◽  
Melissa Stamplecoski ◽  
Moira Kapral ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sex Differences ◽  
Ischemic Stroke ◽  
Lower Risk ◽  
Disease Risk ◽  
Population Coverage ◽  
Risk Of Death ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Full Population

Background: Diabetes is a cardiovascular disease risk factor that exerts a higher risk for coronary heart disease and stroke among females compared to males. Outcomes after first stroke in those with diabetes are not well characterized, especially by sex and age, and studies have been limited by short follow-up and biased samples. We sought to calculate the sex- and age-specific risk of cardiovascular outcomes after ischemic stroke among those with diabetes using a study with full population coverage. Methods: Using population-based demographic and administrative health care databases in Ontario, Canada, we selected all patients with diabetes hospitalized with first ischemic stroke between 4/1/2002 and 3/31/2012. Participants were followed for death, stroke, and myocardial infarction (MI). Kaplan-Meier survival analysis and Fine-Gray competing risk models were used to estimate hazards and adjusted hazards of outcomes by sex and age strata. Models were adjusted for demographics and vascular risk factors. Sensitivity analysis including adjustment for medication use was performed in those aged >=65 years. Results: There were 25495 ischemic stroke patients with diabetes. The incidence of death was higher in women than in men (14.08 per 100 person-years [95% CI 13.73-14.44] vs. 11.89 [11.60-12.19]), but was lower after adjustment for age and other risk factors (adjusted hazard ratio [HR] 0.95 [0.92-0.99]). The incidence of recurrent stroke was similar in women and men, but men were more likely to be readmitted for MI (1.99 per 100 person-years [1.89-2.10] vs 1.58 [1.49-1.68] among females). In multivariable models, females had a lower risk of readmission for any event (HR 0.96 [95% CI 0.93-0.99]). Conclusions: In this retrospective study with full population coverage among diabetics with index stroke in Ontario, there was a higher unadjusted rate of death among females compared to males, and higher unadjusted incidence of MI among males. In adjusted models, females had a lower risk of death compared to males, although the increased risk of MI among males persisted. These findings confirm and quantify sex differences in outcomes after stroke in patients with diabetes.

scholarly journals Sex Differences in Mortality after Myocardial Infarction: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Neda Shafiabadi Hassani ◽  
Reza Pirdehghan ◽  
Mohammadhossein Mozafarybazargany ◽  
Roya Sepahvandi ◽  
Zeynab Khodaprast ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Sex Differences ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Increased Risk

Abstract BACKGROUND: We aimed to examine sex differences in mortality after myocardial infarction. METHODS: This retrospective cohort study included all first admitted patients 50 years or older with acute myocardial infarction hospitalized in Rajaei hospital of Karaj city, Iran, between 23th March 2013 and 1th January 2020. Data was retrieved from the hospital information system (HIS) database, including patient’s demographic and socioeconomic characteristics, medical history, acute myocardial infarction (AMI) type, treatment and procedures, and outcome of hospitalization. Simple and multivariate cox regression models were used to assess the association of gender with in-hospital mortality after AMI. Results were presented as crude and adjusted hazard ratios along with their 95% confidence interval (HR (95% CI).RESULTS: Results from the multivariable Cox regression analysis revealed that females had a higher risk of death than males after ST segment Elevation MI (STEMI) (adjusted HR (95% CI): 1.64 (1.15 – 2.36), P=0.007). However, in subgroup analysis by age groups, this significant increased risk was observed only in female patients aged 50 to 64 years than their male counterparts. There was no significant differences between males and females after non-STEMI and unspecified MI.CONCLUSIONS: Based on our findings, women aged 50 to 64 years may be more likely to die during hospitalization after STEMI than men.

5233Interleukin-1 blockade with Anakinra in ST-segment elevation acute myocardial infarction: Results from the VCUART3 study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Abbate ◽  
C R Trankle ◽  
M J Lipinski ◽  
D Kadariya ◽  
J M Canada ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Inflammatory Response ◽  
Composite Endpoint ◽  
Once Daily ◽  
St Segment Elevation ◽  
Risk Of Death ◽  
St Segment ◽  
Increased Risk ◽  
Significant Difference

Abstract Background ST-segment elevation myocardial infarction (STEMI) is associated with an intense inflammatory response that predicts an increased risk of death and heart failure (HF). In the current study we tested whether anakinra, a recombinant Interleukin-1 (IL-1) receptor antagonist, given once daily (standard dose) or twice daily reduced systemic inflammation in patients with STEMI. Methods We enrolled patients with STEMI within 12 hours of presentation at 3 sites. After revascularization, patients were randomly assigned to receive anakinra 100 mg twice daily, anakinra 100 mg once daily alternating with placebo once daily every 12 hours, or placebo twice daily, for 14 days in a 1:1:1 ratio. The primary efficacy outcome was the area under the curve for C-reactive protein levels (CRP-AUC) using a high-sensitivity assay at 14 days comparing anakinra (both arms) versus placebo followed by a comparison between each of the anakinra arms with placebo. Two pre-specified exploratory clinical efficacy endpoints, adjudicated by a blinded event committee, were assessed: a composite endpoint of all-cause death for any reason or incidence of HF (defined as new-onset HF requiring hospitalization or a new prescription of a loop diuretic, D+HF) and a composite endpoint of death and HF hospitalization (D+HHF) at 1 year. Data are expressed as median and interquartile range or number and percentage. Kaplan-Meyer survival curves were compared using Log-rank test (Mantel-Cox). (ClinicalTrials.gov number, NCT01950299) Results Of 311 patients screened, 99 subjects (80 [81%] males, 57 [58%] Caucasians, 55 [49–62] years of age) were randomly assigned to anakinra twice daily (N=31), anakinra once daily (N=33) or placebo (N=35). There were no significant imbalances in the demographic characteristics between groups (all P>0.05). The CRP-AUC was significantly lower in the anakinra group than in the placebo group (67 [39–120] versus 214 [131–394] mg/dl, P<0.001; and P<0.001 for each anakinra arm versus placebo separately, without significant differences between the two anakinra arms, P=0.41). Treatment with anakinra was associated with a significant reduction versus placebo in the incidence of D+HF (6/64 [9.4%] versus 9/35 [25.7%], P=0.046), and of D+HHF (0/64 [0] versus 4/35 [11.4%], P=0.011), without any significant difference between the two anakinra arms. Anakinra was not associated with any treatment-related serious adverse events, nor with excess infections compared with placebo (14.1% vs 14.3%, P=0.87). Conclusions Among patients with STEMI, IL-1 blockade significantly reduced the systemic inflammatory response compared with placebo, without any significant difference between standard or high dose regimens. Prespecified exploratory analyses on clinical endpoints demonstrate reduced incidence of HF and reduced HF hospitalizations, supporting the concept of beneficial effects with IL-1 blockade in patients with acute myocardial infarction. Acknowledgement/Funding Funded by NHLBI 1R34HL121402; Drug supply from Swedish Orphan Biovitrum

scholarly journals The evolving characteristics and outcomes of acute myocardial infarction in Hong Kong, 1999–2018

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H L Li ◽  
Y K Tse ◽  
Q W Ren ◽  
M Z Wu ◽  
S Y Yu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hong Kong ◽  
Mortality Rate ◽  
Haemorrhagic Stroke ◽  
Public Institution ◽  
Risk Of Death ◽  
Medical Discipline ◽  
St Elevation ◽  
Over Time

Abstract Background The burden of myocardial infarction (MI) with its assorted comorbid complications is increasing parallel to rising life expectancy. Careful characterisation of patient characteristics and identification of short- and long-term complications is critical to their management. Nonetheless, data on the evolving profiles of patient features and outcomes, particularly in an Asian population, remain sparse. Purpose We aim to describe the evolving characteristics and outcomes of MI patients in Hong Kong in the past 2 decades. Methods From a well-validated territory-wide database in Hong Kong, we included patients with incident acute MI from 1999/01/01 to 2018/12/31. The primary outcome was 30-day all-cause death, while secondary outcomes include haemorrhagic stroke, and pneumonia, at both 30 days and 5 years. Temporal trends in baseline characteristics were evaluated using Poisson regression, while trends in outcomes were evaluated using Cox proportional hazard model, adjusted with demographics, comorbidities, and baseline medications. Results A total of 130,218 patients (age 73.6±13.9 years, 40.0% female) were included. Over time, while there was no change in the proportion of females (P=0.196), the increase in mean age (APC 0.23% [0.21 to 0.24], P&lt;0.001) was concordant with the increase in mean CCI (APC 5.1%, [4.8 to 5.3], P&lt;0.001), with more patients suffering from baseline comorbidities (Figure 1; range of APC 1.7% to 4.3%; all P&lt;0.001). The proportion of ST elevation increased significantly (APC 2.5% [2.4 to 2.5], P&lt;0.001). The adjusted all-cause 30-day mortality rate decreased increased significantly (APC 0.3% [0.1 to 0.5], P=0.005). The increasing trend was significant in older patients (≥70 years), non-ST elevation, and female, while there was a decreasing trend mortality rate in ST elevation and young patients; no significant trend was observed in male. Strikingly, there is an alarming increase in the rate of haemorrhagic stroke (APC 3.4% [2.3 to 4.4], P&lt;0.001) and pneumonia (APC 1.5% [1.3 to 1.7], P&lt;0.001) at 30 days (Figure 2). Although the rate of 5-year all-cause death declined slightly (APC −0.8% [−0.9 to −0.6], P&lt;0.001), there were increasing rates of haemorrhagic stroke (APC 1.0% [0.3 to 1.7], P=0.004) and pneumonia (APC 3.8% [3.6 to 4.1], P&lt;0.001). Patients who were older, had ST elevation, and more comorbid were more likely to develop pneumonia. Conclusions Patients with MI have evolved to be older and more comorbid. Alarmingly, despite reduction in long-term all-cause death over time, the reduction was small; risk of death in short-term significantly increased and patients suffer from more complications including haemorrhagic stroke and pneumonia. These results highlight the emergence of extra-cardiac outcomes that drive poor prognosis and accentuate the need to develop tailored strategies to tackle these potentially lethal complications. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The Shenzhen Key Medical Discipline; The Sanming Project of HKU-SZH Cardiology

scholarly journals Maternal mortality in six low and lower-middle income countries from 2010 to 2018: risk factors and trends

2020 ◽  
Vol 17 (S3) ◽  
Author(s):  
Melissa Bauserman ◽  
Vanessa R. Thorsten ◽  
Tracy L. Nolen ◽  
Jackie Patterson ◽  
Adrien Lokangaka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Maternal Mortality ◽  
Maternal Deaths ◽  
Middle Income ◽  
Maternal Risk ◽  
Live Births ◽  
Middle Income Countries ◽  
Risk Of Death ◽  
Increased Risk ◽  
Over Time

Abstract Background Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. Methods We analyzed data from women enrolled in the NICHD Global Network for Women’s and Children’s Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. Results We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites. Conclusions The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030. Trial registration The MNHR is registered at NCT01073475.

scholarly journals Prospective associations between ECG abnormalities and death or myocardial infarction in a cohort of 980 employed, middle-aged Swedish men

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Lennart Dimberg ◽  
Bo Eriksson ◽  
Per Enqvist
Keyword(s):  
Myocardial Infarction ◽  
Health Examination ◽  
Individual Level ◽  
Increased Risk ◽  
Significant Difference ◽  
Ethical Approval ◽  
Independent Association ◽  
Repeat Examination ◽  
Normal Ecgs ◽  
Ecg Abnormalities

Abstract Background In 1993, 1000 randomly selected employed Swedish men aged 45–50 years were invited to a nurse-led health examination with a survey on life style, fasting lab tests, and a 12-lead ECG. A repeat examination was offered in 1998. The ECGs were classified according to the Minnesota Code. Upon ethical approval, endpoints in terms of MI and death over 25 years were collected from Swedish national registers with the purpose of analyzing the independent association of ECG abnormalities as risk factors for myocardial infarction and death. Results Seventy-nine of 977 participants had at least one ECG abnormality 1993 or 1998. One hundred participants had a first MI over the 25 years. Odds ratio for having an MI in the group that had one or more ECG abnormality compared with the group with two normal ECGs was estimated to 3.16. 95%CI (1.74; 5.73), p value 0.0001. One hundred fifty-seven participants had died before 2019. For death, similarly no statistically significant difference was shown, OR 1.52, 95%CI (0.83; 2.76). Conclusions Our study suggests that presence of ST- and R-wave changes is associated with an independent 3–4-fold increased risk of MI after 25 years follow-up, but not of death. A 12-lead resting ECG should be included in any MI risk calculation on an individual level.

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