P4533Duration of heart failure and effect of defibrillator implantation in patients with non-ischemic systolic heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M B Elming ◽  
A M Thoegersen ◽  
L Videbaek ◽  
N E Bruun ◽  
H Eiskjaer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Risk Indicators ◽  
Icd Implantation ◽  
Pump Failure ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Changes Over Time ◽  
The Relationship ◽  
Heart Foundation

Abstract Introduction Patients with non-ischemic systolic heart failure have increased risk of sudden cardiac death (SCD) and death from progressive pump failure. Whether the risk of SCD changes over time is unknown. We seek to investigate the relationship between duration of heart failure, mode of death, and effect of implantable cardioverter defibrillator (ICD) implantation. Methods We examined the risk of all-cause death and SCD according to the duration of heart failure among patients with non-ischemic systolic heart failure enrolled in the Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) trial. Patients were divided according to quartiles of heart failure duration (Q1 ≤8 months, Q2 9 ≤18 months, Q3 19 ≤65 months, Q4 ≥66 months). Results A total number of 1116 patients were included. Patients with the longest duration of heart failure were older, more often men, had more comorbidity, and more often received cardiac resynchronizing therapy device. Doubling of heart failure duration was an independent predictor of both all-cause mortality (HR 1.26 95% CI 1.17–1.37, p<0.0001), and SCD (HR 1.29 95% CI 1.11–1.49, p=0.0009). The proportion of deaths caused by SCD was not different between heart failure quartiles (p=0.91), and the effect of ICD implantation on all-cause mortality was not modified by the duration of heart failure (p=0.59). Duration of heart failure and death Conclusions Duration of heart failure predicted both all-cause mortality and risk of SCD independently of other risk indicators. However, the proportion of death caused by SCD did not change with longer duration of heart failure and the effect of ICD was not modified by the duration of heart failure. Acknowledgement/Funding The work was sponsored by The Danish Heart Foundation (Hjerteforeningen) and the Lundbeck Foundation (Lundbeckfonden). The DANISH trial was supported

Prevalence and prognostic association of ventricular arrhythmia in non-ischaemic heart failure patients: results from the DANISH trial

EP Europace ◽  
2020 ◽  
Author(s):  
Rune Boas ◽  
Jens Jakob Thune ◽  
Steen Pehrson ◽  
Lars Køber ◽  
Jens C Nielsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Ventricular Arrhythmia ◽  
Systolic Heart Failure ◽  
Sustained Ventricular Tachycardia ◽  
Icd Implantation ◽  
Premature Ventricular Contractions ◽  
High Burden ◽  
Heart Failure Patients ◽  
All Cause Mortality

Abstract Aims Improved risk stratification to identify non-ischaemic heart failure patients who will benefit from primary prophylactic implantable cardioverter-defibrillator (ICD) is needed. We examined the potential of ventricular arrhythmia to identify patients who could benefit from an ICD. Methods and results A total of 850 non-ischaemic systolic heart failure patients with left ventricle ≤35% and elevated N-terminal pro-brain natriuretic peptides had a 24-h Holter monitor recording performed. We examined present non-sustained ventricular tachycardia (NSVT), defined as ≥3 consecutive premature ventricular contractions (PVCs) with a rate of ≥100/min, and number of PVCs per hour stratified into low (&lt;30) and high burden (≥30) groups. Outcome measures were overall mortality, sudden cardiac death (SCD), and cardiovascular death (CVD). In total, 193 patients died, 49 from SCD and 125 from CVD. Non-sustained ventricular tachycardia (365 patients) was significantly associated with increased all-cause mortality [hazard ratio (HR) 1.47; 95% confidence interval (CI) 1.07–2.03; P = 0.02] and to CVD (HR 1.89; CI 1.25–2.87; P = 0.003). High burden PVC (352 patients) was associated with increased all-cause mortality (HR1.38; CI 1.00–1.90; P = 0.046) and with CVD (HR 1.78; CI 1.19–2.66; P = 0.005). There was no statistically significant association with SCD for neither NSVT nor PVC. In interaction analyses, neither NSVT (P = 0.56) nor high burden of PVC (P = 0.97) was associated with survival benefit from ICD implantation. Conclusion Ventricular arrhythmia in non-ischaemic heart failure patients was associated with a worse prognosis but could not be used to stratify patients to ICD implantation.

Right ventricular free wall strain and effect of implantable defibrillator in non-ischemic heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D.H Jensen ◽  
M.B Elming ◽  
R Risum ◽  
J Haarbo ◽  
B Philbert ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Systolic Heart Failure ◽  
Right Ventricular Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Icd Implantation ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract Background Patients with left ventricular systolic heart failure have a significantly increased risk of all-cause mortality and sudden cardiac death. A cardiac magnetic resonance (CMR) sub-study of the Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators (ICDs) in Patients with Nonischemic Systolic Heart Failure on Mortality (DANISH) trial found that in patients who also had reduced right ventricular ejection fraction, ICD implantation significantly increased survival. Recent studies have found that right ventricular free wall strain (RV-FWS) assessed by echocardiography has a similar prognostic power as right ventricular ejection fraction assessed by CMR and RV-FWS determined by echocardiographic may be a more accessible imaging modality to identify patients more likely to benefit from ICD implantation. Purpose To investigate if echocardiographic RV-FWS is related to risk of all-cause death in patients with heart failure and left ventricular systolic dysfunction and whether RV-FWS can identify a sub-group of patients more likely to benefit from ICD implantation. Methods RV-FWS was measured in 343 patients with left ventricular systolic heart failure included in the DANISH trial at our hospital, who underwent an echocardiographic examination before randomization. Cox regression was used to assess the effects of RV-FWS and ICD implantation on all-cause mortality. Impaired RV-FWS was defined as RV-FWS &gt;−20% according to guidelines. Results Median RV-FWS was −19% (quartiles: −24% to −14%). Impaired RV-FWS was present in 186 (54%) patients, and 70 (20.4%) patients died. RV-FWS was related to all-cause mortality both univariably, hazard ratio (HR) 1.07 (95% confidence interval [CI], 1.03–1.11), P=0.001, and adjusted for age, gender, tricuspid annular plane systolic excursion and left ventricular ejection fraction, HR 1.06 (95% CI 1.01–1.10), P=0.009. There was a significant interaction between impaired RV-FWS and effect of ICD, P for interaction=0.045 and ICD implantation significantly reduced mortality in patients with impaired RV-FWS, HR 0.52 (95% CI 0.28–0.96), P=0.04, but not in patients with normal RV-FWS, HR 1.34 (95% CI 0.64–2.82), P=0.44. Conclusion RV-FWS was independently related to all-cause mortality and associated with effect of ICD implantation. With validation in larger studies, impaired RV-FWS may potentially become a candidate for selecting patients for ICD implantation. Impaired RVFWS and effect of ICD Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Danish Heart Foundation

The effect of implantable cardioverter-defibrillator in patients with diabetes and non-ischaemic systolic heart failure

EP Europace ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. 1203-1210 ◽  
Author(s):  
Rasmus Rørth ◽  
Jens Jakob Thune ◽  
Jens C Nielsen ◽  
Jens Haarbo ◽  
Lars Videbæk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sudden Cardiac Death ◽  
Treatment Effect ◽  
Cardiac Death ◽  
Systolic Heart Failure ◽  
Cardiovascular Death ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
All Cause Mortality ◽  
Patients With Diabetes

Abstract Aims Implantable cardioverter-defibrillator (ICD) implantation reduce the risk of sudden cardiac death, but not all-cause death in patients with non-ischaemic systolic heart failure (HF). Whether co-existence of diabetes affects ICD treatment effects is unclear. Methods and results We examined the effect of ICD implantation on risk of all-cause death, cardiovascular death, and sudden cardiac death (SCD) according to diabetes status at baseline in the Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischaemic Systolic Heart Failure on Mortality (DANISH) trial. Outcomes were analysed by use of cumulative incidence curves and Cox regressions models. Of the 1116 patients enrolled, 211 (19%) had diabetes at baseline. Patients with diabetes were more obese, had worse kidney function and more were in New York Heart Association Class III/IV. The risk of device infections and other complications in the ICD group was similar among patients with and without diabetes (6.1% vs. 4.6% P = 0.54). Irrespective of treatment group, diabetes was associated with higher risk of all-cause death, cardiovascular death, and SCD. The treatment effect of ICD in patients with diabetes vs. patients without diabetes was hazard ratio (HR) = 0.92 (0.57–1.50) vs. HR = 0.85 (0.63–1.13); Pinteraction = 0.60 for all-cause mortality, HR = 0.99 (0.58–1.70) vs. HR = 0.70 (0.48–1.01); Pinteraction = 0.25 for cardiovascular death, and HR = 0.81 (0.35–1.88) vs. HR = 0.40 (0.22–0.76); Pinteraction = 0.16 for sudden cardiac death. Conclusion Among patients with non-ischaemic systolic HF, diabetes was associated with higher incidence of all-cause mortality, primarily driven by cardiovascular mortality including SCD. Treatment effect of ICD therapy was not significantly modified by diabetes which might be due to lack of power.

P2627Diffuse coronary artery disease and effect of implantable cardioverter-defibrillators in patients with non-ischaemic systolic heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Byrne ◽  
O Ahlehoff ◽  
F Pedersen ◽  
S Pehrson ◽  
J C Nielsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Atherosclerosis ◽  
Systolic Heart Failure ◽  
Implantable Cardioverter Defibrillators ◽  
Icd Implantation ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
Artery Disease ◽  
Cardioverter Defibrillators ◽  
Danish Study

Abstract Background Implantable defibrillators reduce mortality in patients with ischaemic heart failure. The recent Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators in Patients With Non-Ischaemic Systolic Heart Failure on Mortality (DANISH) found no overall effect on all-cause mortality with ICD implantation. Coronary artery disease (CAD) as the cause of heart failure had to be ruled out prior to inclusion into DANISH, but patients could have diffuse atherosclerosis, one- or two-vessel disease on the qualifying coronary angiogram if the investigator did not find that the degree of CAD could explain the severely reduced left ventricular ejection fraction. It is unknown if concomitant coronary atherosclerosis is related to outcome in patients with non-ischaemic cardiomyopathy and whether the effect of implanting an ICD is different in patients with non-ischaemic cardiomyopathy and coronary atherosclerosis. Purpose The aim of this study was to investigate the association between coronary atherosclerosis and all-cause mortality in patients with non-ischaemic systolic heart failure and the effect of ICD implantation in these patients. Methods Of the 1116 patients from the DANISH study, 838 patients with available coronary angiography data were included in this subgroup analysis. Patients were considered to have coronary atherosclerosis if the invasive cardiologist described diffuse atherosclerosis or coronary stenosis. We used cox regression to assess the relationship between coronary atherosclerosis and mortality and between ICD implantation and mortality in patients with and without coronary atherosclerosis. Data are presented as hazard ratios with 95% confidence intervals. Results Of the 838 patients, 266 (32%) had coronary atherosclerosis, 216 (81%) of whom were reported as having atherosclerosis without stenoses. Patients with coronary atherosclerosis were significantly older (median age 67 years vs 61 years), more often male (77% vs 70%) and had a higher prevalence of diabetes (30% vs 17%). In univariable analysis, coronary atherosclerosis was a significant predictor of all-cause mortality (HR, 1.41; 95% CI, 1.04–1.91; P=0.03). However, the association between coronary atherosclerosis and all-cause mortality disappeared when adjusting for age, gender and diabetes (HR 1.02, 0.75–1.41, P=0.88). Adjusted hazard ratios are shown in Figure 1. There was no association between ICD treatment and all-cause mortality in patients with or without coronary atherosclerosis (HR 0.94; 0.58–1.52; P=0.79 vs HR 0.82; 0.56–1.20; P=0.30), P for interaction=0.67. Figure 1 Conclusions In patients with non-ischaemic systolic heart failure, the concomitant presence of coronary atherosclerosis was associated with increased mortality. However, this association was not independent of other risk factors. ICD implantation was not associated with mortality risk in patients either with or without concomitant coronary atherosclerosis. Acknowledgement/Funding TrygFonden (Copenhagen, DK), Medtronic (US) and St. Jude Medical (US)

Long-term Follow-up of the The Danish Study to Assess theEfficacy of ICDs in Patients with Non-ischemic Systolic HeartFailure on Mortality (DANISH)

Circulation ◽  
2021 ◽  
Author(s):  
Adelina Yafasova ◽  
Jawad H. Butt ◽  
Marie B. Elming ◽  
Jens C. Nielsen ◽  
Jens Haarbo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Cardiovascular Death ◽  
Control Group ◽  
Icd Implantation ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Overall Survival Benefit

Background: The Danish Study to Assess the Efficacy of Implantable Cardioverter-Defibrillators (ICDs) in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) found that primary-prevention ICD implantation was not associated with an overall survival benefit in patients with non-ischemic systolic heart failure during a median follow-up of 5.6 years, though there was a beneficial effect on all-cause mortality in patients ≤70 years. This study presents an additional four years of follow-up data from DANISH. Methods: In DANISH, 556 patients with non-ischemic systolic heart failure were randomized to receive an ICD and 560 to receive usual clinical care and followed until June 30, 2016. In this long-term follow-up study, patients were followed until May 18, 2020. Analyses were conducted for the overall population and according to age (≤70 and >70 years). Results: During a median follow-up of 9.5 years (25 th -75 th percentile, 7.9-10.9 years), 208/556 patients (37%) in the ICD group and 226/560 patients (40%) in the control group died. Compared with the control group, the ICD group did not have significantly lower all-cause mortality (HR 0.89 [95%CI,0.74-1.08]; P=0.24). In patients ≤70 years (n=829), all-cause mortality was lower in the ICD group than the control group (117/389 [30%] vs 158/440 [36%]; HR 0.78 [95%CI,0.61-0.99]; P=0.04), whereas in patients >70 years (n=287), all-cause mortality was not significantly different between the ICD and control group (91/167 [54%] vs 68/120 [57%]; HR 0.92 [95%CI,0.67-1.28]; P=0.75). Cardiovascular death showed similar trends (overall, 147/556 [26%] vs 164/560 [29%], HR 0.87 [95%CI,0,70-1.09], P=0.20; ≤70 years, 87/389 [22%] vs 122/440 [28%], HR 0.75 [95%CI,0.57-0.98], P=0.04; >70 years, 60/167 [36%] vs 42/120 [35%], HR 0.97 [95%CI,0.65-1.45], P=0.91). The ICD group had a significantly lower incidence of sudden cardiovascular death in the overall population (35/556 [6%] vs 57/560 [10%]; HR 0.60 [95%CI,0.40-0.92]; P=0.02) and in patients ≤70 years (19/389 [5%] vs 49/440 [11%]; HR 0.42 [95%CI,0.24-0.71]; P=0.0008), but not in patients >70 years (16/167 [10%] vs 8/120 [7%]; HR 1.34 [95%CI,0.56-3.19]; P=0.39). Conclusions: During a median follow-up of 9.5 years, ICD implantation did not provide an overall survival benefit in patients with non-ischemic systolic heart failure. In patients ≤70 years, ICD implantation was associated with a lower incidence of all-cause mortality, cardiovascular death, and sudden cardiovascular death. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00542945.

scholarly journals Prediction of all-cause mortality with malnutrition assessed by controlling nutritional status score in patients with heart failure: a systematic review and meta-analysis

2021 ◽  
pp. 1-8
Author(s):  
Huiyang Li ◽  
Peng Zhou ◽  
Yikai Zhao ◽  
Huaichun Ni ◽  
Xinping Luo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Nutritional Status ◽  
Meta Analysis ◽  
Predictive Values ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Conut Score

Abstract Objective: The aim of this meta-analysis was to investigate the association between malnutrition assessed by the controlling nutritional status (CONUT) score and all-cause mortality in patients with heart failure. Design: Systematic review and meta-analysis. Settings: A comprehensively literature search of PubMed and Embase databases was performed until 30 November 2020. Studies reporting the utility of CONUT score in prediction of all-cause mortality among patients with heart failure were eligible. Patients with a CONUT score ≥2 are grouped as malnourished. Predictive values of the CONUT score were summarized by pooling the multivariable-adjusted risk ratios (RR) with 95 % CI for the malnourished v. normal nutritional status or per point CONUT score increase. Participants: Ten studies involving 5196 patients with heart failure. Results: Malnourished patients with heart failure conferred a higher risk of all-cause mortality (RR 1·92; 95 % CI 1·58, 2·34) compared with the normal nutritional status. Subgroup analysis showed the malnourished patients with heart failure had an increased risk of in-hospital mortality (RR 1·78; 95 % CI 1·29, 2·46) and follow-up mortality (RR 2·01; 95 % CI 1·58, 2·57). Moreover, per point increase in CONUT score significantly increased 16% risk of all-cause mortality during the follow-up. Conclusions: Malnutrition defined by the CONUT score is an independent predictor of all-cause mortality in patients with heart failure. Assessment of nutritional status using CONUT score would be helpful for improving risk stratification of heart failure.

scholarly journals The association between serum selenium concentration and prognosis in patients with heart failure in a Chinese population

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zhiliang Zhang ◽  
Chao Chang ◽  
Yuxin Zhang ◽  
Zhiyong Chai ◽  
Jinbei Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chinese Population ◽  
Selenium Concentration ◽  
Chinese Patients ◽  
Serum Selenium ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Serum Selenium Concentration ◽  
Baseline Information

AbstractWhether Selenium (Se) deficiency relates with adverse prognosis in Chinese patients with heart failure (HF) is still unknown. This study aimed to investigate the association of serum Se level and the outcomes of patients with HF in a Chinese population. Patients with HF and serum Se examination were retrospectively included. Baseline information were collected at patient’s first admission. The primary and secondary outcomes were all-cause mortality and rehospitalization for HF during follow-up, respectively. The study participants were divided into quartiles according to their serum Se concentrations. The Cox proportional hazard models were adopted to estimate the association of serum Se levels with observed outcomes. A total of 411 patients with HF with a mean age of 62.5 years were included. The mean serum level of Se was 68.3 ± 27.7 µg/L. There was nonsignificant difference of baseline characterizes between the four quartile groups. In comparison with patients in the highest quartile, those with the lowest quartile (17.40–44.35 µg/L) were associated with increased risk of all-cause mortality [adjusted hazard ratios (95% CI) 2.32 (1.43–3.77); Ptrend = 0.001]. Our study suggested that a lower serum Se level was significantly associated with increased risk of all-cause mortality in patients with HF.

scholarly journals Calcium Channel Autoantibodies Predicted Sudden Cardiac Death and All-Cause Mortality in Patients with Ischemic and Nonischemic Chronic Heart Failure

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Haiyun Yu ◽  
Juanhui Pei ◽  
Xiaoyan Liu ◽  
Jingzhou Chen ◽  
Xian Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multivariate Analysis ◽  
Sudden Cardiac Death ◽  
Chronic Heart Failure ◽  
Cardiac Death ◽  
Independent Predictor ◽  
All Cause Mortality ◽  
Patient Prognosis ◽  
The Relationship

The purpose of this study was to evaluate whether CC-AAbs levels could predict prognosis in CHF patients. A total of 2096 patients with CHF (841 DCM patients and 1255 ICM patients) and 834 control subjects were recruited. CC-AAbs were detected and the relationship between CC-AAbs and patient prognosis was analyzed. During a median follow-up time of 52 months, there were 578 deaths. Of these, sudden cardiac death (SCD) occurred in 102 cases of DCM and 121 cases of ICM. The presence of CC-AAbs in patients was significantly higher than that of controls (bothP<0.001). Multivariate analysis revealed that positive CC-AAbs could predict SCD (HR 3.191, 95% CI 1.598–6.369 for DCM; HR 2.805, 95% CI 1.488–5.288 for ICM) and all-cause mortality (HR 1.733, 95% CI 1.042–2.883 for DCM; HR 2.219, 95% CI 1.461–3.371 for ICM) in CHF patients. A significant association between CC-AAbs and non-SCD (NSCD) was found in ICM patients (HR = 1.887, 95% CI 1.081–3.293). Our results demonstrated that the presence of CC-AAbs was higher in CHF patients versus controls and corresponds to a higher incidence of all-cause death and SCD. Positive CC-AAbs may serve as an independent predictor for SCD and all-cause death in these patients.

scholarly journals Osteoarthritis, mobility-related comorbidities and mortality: an overview of meta-analyses

2020 ◽  
Vol 12 ◽  
pp. 1759720X2098121
Author(s):  
Gustavo Constantino de Campos ◽  
Raman Mundi ◽  
Craig Whittington ◽  
Marie-Josée Toutounji ◽  
Wilson Ngai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Ischemic Attack ◽  
Meta Analyses ◽  
The Relationship ◽  
Related Mortality

Aims: The objective of this review was to examine the relationship between osteoarthritis (OA) and mobility-related comorbidities, specifically diabetes mellitus (DM) and cardiovascular disease (CVD). It also investigated the relationship between OA and mortality. Methods: An overview of meta-analyses was conducted by performing two targeted searches from inception to June 2020. The association between OA and (i) DM or CVD ( via PubMed and Embase); and (ii) mortality ( via PubMed) was investigated. Meta-analyses were selected if they included studies that examined adults with OA at any site and reported associations between OA and DM, CVD, or mortality. Evidence was synthesized qualitatively. Results: Six meta-analyses met inclusion criteria. One meta-analysis of 20 studies demonstrated a statistically significant association between OA and DM, with pooled odds ratio of 1.41 (95% confidence interval: 1.21, 1.65; n = 1,040,175 patients). One meta-analysis of 15 studies demonstrated significantly increased risk of CVD among OA patients, with a pooled risk ratio of 1.24 (1.12, 1.37, n = 358,944 patients). Stratified by type of CVD, OA was shown to be associated with increased heart failure (HF) and ischemic heart disease (IHD) and reduced transient ischemic attack (TIA). There was no association reported for stroke or myocardial infarction (MI). Three meta-analyses did not find a significant association between OA (any site) and all-cause mortality. However, OA was found to be significantly associated with cardiovascular-related death across two meta-analyses. Conclusion: The identified meta-analyses reported significantly increased risk of both DM and CVD (particularly, HF and IHD) among OA patients. It was not possible to confirm consistent directional or causal relationships. OA was found to be associated with increased mortality, but mostly in relation to CVD-related mortality, suggesting that further study is warranted in this area.

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