P5586Predictors for not initiating anticoagulant treatment after incident venous thromboembolism: a Danish nationwide study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Albertsen ◽  
P B N Nielsen ◽  
T F O Overvad ◽  
T B L Larsen ◽  
M S Soegaard
Keyword(s):  
Venous Thromboembolism ◽  
Chronic Diseases ◽  
Lupus Erythematosus ◽  
Age Groups ◽  
Additional Patient ◽  
Major Surgery ◽  
Chronic Obstructive ◽  
Anticoagulant Treatment ◽  
Nationwide Study ◽  
Baseline Characteristics

Abstract Background Venous thromboembolism (VTE) is common and potentially fatal. Anticoagulation is the treatment cornerstone but up to one-third do not initiate treatment after incident VTE. Identification of patient characteristics associated with non-initiation may enable identification of individuals in need of additional patient education and intensified clinical follow-up. Purpose To investigate characteristics associated with not initiating anticoagulation after incident VTE in a Danish nationwide study. Methods We linked nationwide Danish health registries to identify consecutive patients with incident VTE between 2000–2016. The outcome was not initiating anticoagulant treatment (warfarin or NOAC) within 30 days after incident VTE diagnosis. Logistic regression was used to identify predictors of treatment non-initiation. Results Among 85,046 patients with incident VTE, 41% (n=34,877) patients had not redeemed a prescription of anticoagulation within 30 days after incident VTE. Age<65, female sex, unprovoked VTE, and chronic diseases were associated with non-initiation (Table). Table 1. Baseline characteristics for incident VTE* patients year 2000–2016 and associated adjusted odds ratios for not initiating anticoagulation† Patients with incident VTE (n=85,046) Adjusted‡ Odds Ratio (95% CI) for not initiating treatment Age, median (IQR), y 65.6 (50.8–77.3) – Age groups, n (%)   0–30 years 4,150 (4.9%) 1.55 (1.45; 1.66)   30–65 years 37,376 (43.9%) 1.24 (1.20; 1.27)   >65 years 43,520 (51.2%) Ref. Females, n (%) 45,119 (53.1%) 1.40 (1.36; 1.44) Unprovoked VTE§, n (%) 53,779 (63.2%) 1.08 (1.06; 1.12) Chronic diseases 10 years within incident VTE   Inflammatory disease¶, n (%) 7,374 (8.7%) 1.07 (1.02; 1.14)   Heart Failure, n (%) 6,242 (7.3%) 1.21 (1.11; 1.32)   Ischemic heart disease, n (%) 11,025 (13.0%) 1.25 (1.19; 1.32)   Chronic obstructive pulmonary disease, n (%) 8,385 (9.9%) 1.02 (0.96; 1.08)   Kidney disease, n (%) 2,626 (3.1%) 1.21 (1.12; 1.32)   Diabetes, n (%) 6,884 (8.1%) 1.13 (1.06; 1.20)   Hypertension, n (%) 233,651 (27.8%) 0.99 (0.94; 1.05) Chronic diseases, n (%)   0 chronic diseases 46,036 (54.1%) Ref.   1–2 chronic diseases 30,462 (35.8%) 1.09 (1.03; 1.15)   >3 chronic diseases 8,548 (10.1%) 1.12 (0.98; 1.28) *Venous thromboembolism. †Defined as not redeeming a prescription on anticoagulant medicine no later than 30 days after an incident VTE diagnosis. ‡Adjusted for age, sex and other baseline characteristics. §Defined as absence of: major surgery, nephrotic syndrome, hormonal replacement therapy, central venous catheter, fracture/trauma and immobilization within 3 months. ¶Combination of inflammatory bowel diseases, lupus erythematosus, psoriasis, rheumatic disorders. Conclusion As much as 41% of patients with a first diagnosis of VTE did not initiate anticoagulant treatment within 30 days after diagnosis. In order to optimize compliance, physicians may consider increased focus on identified predictors associated with non-initiation.

scholarly journals Seroprevalence of Antibodies against Diphtheria, Tetanus and Pertussis in Adult At-Risk Patients

Vaccines ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 18
Author(s):  
Lise Boey ◽  
Eline Bosmans ◽  
Liane Braz Ferreira ◽  
Nathalie Heyvaert ◽  
Melissa Nelen ◽  
...  
Keyword(s):  
At Risk ◽  
Chronic Diseases ◽  
Age Groups ◽  
Chronic Obstructive ◽  
Solid Organ ◽  
Recent Infection ◽  
Vaccination Programs ◽  
Vaccine Preventable Diseases ◽  
Increased Risk ◽  
Risk Patients

Patients with chronic diseases are at increased risk of complications following infection. It remains, however, unknown to what extend they are protected against vaccine-preventable diseases. We assessed seroprevalence of antibodies against diphtheria, tetanus and pertussis to evaluate whether current vaccination programs in Belgium are adequate. Antibody titers were assessed with a bead-based multiplex assay in serum of 1052 adults with chronic diseases. We included patients with diabetes mellitus type 1 (DM1) (n = 172), DM2 (n = 77), chronic kidney disease (n = 130), chronic obstructive pulmonary disease (COPD) (n = 170), heart failure (n = 77), HIV (n = 196) and solid organ transplant (SOT) recipients (n = 230). Factors associated with seroprevalence were analysed with multiple logistic regression. We found seroprotective titers in 29% for diphtheria (≥0.1 IU/mL), in 83% for tetanus (≥0.1 IU/mL) and 22% had antibodies against pertussis (≥5 IU/mL). Seroprotection rates were higher (p < 0.001) when vaccinated within the last ten years. Furthermore, diphtheria seroprotection decreased with age (p < 0.001). Tetanus seroprotection was less reached in women (p < 0.001) and older age groups (p < 0.001). For pertussis, women had more often a titer suggestive of a recent infection or vaccination (≥100 IU/mL, p < 0.01). We conclude that except for tetanus, the vast majority of at-risk patients remains susceptible to vaccine-preventable diseases such as diphtheria and pertussis.

Development of Sex-Stratified Prediction Models for Recurrent Venous Thromboembolism: A Danish Nationwide Cohort Study

2020 ◽  
Vol 120 (05) ◽  
pp. 805-814 ◽  
Author(s):  
Ida Ehlers Albertsen ◽  
Mette Søgaard ◽  
Samuel Zachary Goldhaber ◽  
Gregory Piazza ◽  
Flemming Skjøth ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Treatment Duration ◽  
Prediction Models ◽  
Cox Regression ◽  
External Validation ◽  
Risk Scores ◽  
Major Surgery ◽  
Anticoagulant Treatment ◽  
Cox Regression Analysis ◽  
Recurrent Venous Thromboembolism

Abstract Objective To optimize decision making for anticoagulant treatment duration after incident venous thromboembolism, we derived and internally validated two clinically applicable sex-specific prediction models for venous thromboembolism recurrence, discarding the traditional categorization of provoked and unprovoked venous thromboembolism. Methods This study was based on data from Danish nationwide registries. We identified all routine care in- and outpatients with completed anticoagulant treatment for incident venous thromboembolism from 2012 through 2017. The outcome was recurrent venous thromboembolism within 2 years. Risk scores were derived using Cox regression analysis and a backward selection process on a set of 24 potential predictors. Performance was assessed through calibration and discrimination using bootstrap techniques to internally validate the scores. Results The study included 11,519 patients. Risk scores under the joint acronym AIM-SHA-RP were developed. Age, Incident pulmonary embolism, and recent Major surgery were predictors for both sexes; Statin treatment, Heart disease and Antiplatelet treatment were predictors specifically for men, while chronic Renal disease and recent Pneumonia or sepsis were predictors specifically for women. The risk scores were well calibrated and identified a low- (< 5%), intermediate- (5–10%), and high-risk (> 10%) group for both sexes. Generally, discriminative capacities, as measured by the c-statistic, were limited. Conclusion We developed two clinically applicable risk scores to estimate the risk of recurrent venous thromboembolism after completed anticoagulant treatment. The risk scores can potentially guide treatment duration of anticoagulation after incident venous thromboembolism but require further external validation before implemented in clinical practice.

scholarly journals Predicting COVID-19 mortality with electronic medical records

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Hossein Estiri ◽  
Zachary H. Strasser ◽  
Jeffy G. Klann ◽  
Pourandokht Naseri ◽  
Kavishwar B. Wagholikar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Information ◽  
Age Groups ◽  
Prognostic Models ◽  
Smoking History ◽  
Risk Scores ◽  
Gradient Boosting ◽  
Chronic Obstructive ◽  
Clinical Expertise ◽  
History Of

AbstractThis study aims to predict death after COVID-19 using only the past medical information routinely collected in electronic health records (EHRs) and to understand the differences in risk factors across age groups. Combining computational methods and clinical expertise, we curated clusters that represent 46 clinical conditions as potential risk factors for death after a COVID-19 infection. We trained age-stratified generalized linear models (GLMs) with component-wise gradient boosting to predict the probability of death based on what we know from the patients before they contracted the virus. Despite only relying on previously documented demographics and comorbidities, our models demonstrated similar performance to other prognostic models that require an assortment of symptoms, laboratory values, and images at the time of diagnosis or during the course of the illness. In general, we found age as the most important predictor of mortality in COVID-19 patients. A history of pneumonia, which is rarely asked in typical epidemiology studies, was one of the most important risk factors for predicting COVID-19 mortality. A history of diabetes with complications and cancer (breast and prostate) were notable risk factors for patients between the ages of 45 and 65 years. In patients aged 65–85 years, diseases that affect the pulmonary system, including interstitial lung disease, chronic obstructive pulmonary disease, lung cancer, and a smoking history, were important for predicting mortality. The ability to compute precise individual-level risk scores exclusively based on the EHR is crucial for effectively allocating and distributing resources, such as prioritizing vaccination among the general population.

Clinical Outcomes of Incidental Venous Thromboembolism in Cancer and Noncancer Patients: The SWIss Venous ThromboEmbolism Registry (SWIVTER)

2020 ◽  
Author(s):  
David Spirk ◽  
Tim Sebastian ◽  
Stefano Barco ◽  
Martin Banyai ◽  
Jürg H. Beer ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Mortality Rate ◽  
Recurrence Rate ◽  
Anticoagulation Therapy ◽  
Early Mortality ◽  
Recurrence Rates ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Baseline Characteristics

Abstract Objective In patients with cancer-associated venous thromboembolism (VTE), the risk of recurrence is similar after incidental and symptomatic events. It is unknown whether the same applies to incidental VTE not associated with cancer. Methods and Results We compared baseline characteristics, anticoagulation therapy, all-cause mortality, and VTE recurrence rates at 90 days between patients with incidental (n = 131; 52% without cancer) and symptomatic (n = 1,931) VTE included in the SWIss Venous ThromboEmbolism Registry (SWIVTER). After incidental VTE, 114 (87%) patients received anticoagulation therapy for at least 3 months. The mortality rate was 9.2% after incidental and 8.4% after symptomatic VTE for hazard ratio (HR) 1.10 (95% confidence interval [CI] 0.49–2.50). After adjustment for competing risk of death, recurrence rate was 3.1 versus 2.8%, respectively, for sub-HR 1.07 (95% CI 0.39–2.93). These results were consistent among cancer (mortality: 15.9% vs. 12.6%; HR 1.32, 95% CI 0.67–2.59; recurrence: 4.8% vs. 4.7%; HR 1.02, 95% CI 0.30–3.42) and noncancer patients (mortality: 2.9% vs. 2.1%; HR 1.37, 95% CI 0.33–5.73; recurrence: 1.5% vs. 2.3%; HR 0.63, 95% CI 0.09–4.58). Patients with incidental VTE who received anticoagulation therapy for at least 3 months had lower mortality (4% vs. 41%) and recurrence rate (1% vs. 18%) compared with those who did not. Conclusion In SWIVTER, more than half of incidental VTE events occurred in noncancer patients who often received anticoagulation therapy. Among noncancer patients, early mortality and recurrence rates were similar after incidental versus symptomatic VTE. Our findings suggest that anticoagulation therapy for incidental VTE may be beneficial regardless of the presence of cancer.

scholarly journals Validity and responsiveness of the Daily- and Clinical visit-PROactive Physical Activity in COPD (D-PPAC and C-PPAC) instruments

Thorax ◽  
2021 ◽  
Vol 76 (3) ◽  
pp. 228-238
Author(s):  
Judith Garcia-Aymerich ◽  
Milo A Puhan ◽  
Solange Corriol-Rohou ◽  
Corina de Jong ◽  
Heleen Demeyer ◽  
...  
Keyword(s):  
Physical Activity ◽  
Internal Consistency ◽  
Full Range ◽  
Large Population ◽  
Minimal Important Difference ◽  
Age Groups ◽  
Forced Expiratory Volume ◽  
Test Reliability ◽  
Chronic Obstructive ◽  
Clinical Visit

BackgroundThe Daily-PROactive and Clinical visit-PROactive Physical Activity (D-PPAC and C-PPAC) instruments in chronic obstructive pulmonary disease (COPD) combines questionnaire with activity monitor data to measure patients’ experience of physical activity. Their amount, difficulty and total scores range from 0 (worst) to 100 (best) but require further psychometric evaluation.ObjectiveTo test reliability, validity and responsiveness, and to define minimal important difference (MID), of the D-PPAC and C-PPAC instruments, in a large population of patients with stable COPD from diverse severities, settings and countries.MethodsWe used data from seven randomised controlled trials to evaluate D-PPAC and C-PPAC internal consistency and construct validity by sex, age groups, COPD severity, country and language as well as responsiveness to interventions, ability to detect change and MID.ResultsWe included 1324 patients (mean (SD) age 66 (8) years, forced expiratory volume in 1 s 55 (17)% predicted). Scores covered almost the full range from 0 to 100, showed strong internal consistency after stratification and correlated as a priori hypothesised with dyspnoea, health-related quality of life and exercise capacity. Difficulty scores improved after pharmacological treatment and pulmonary rehabilitation, while amount scores improved after behavioural physical activity interventions. All scores were responsive to changes in self-reported physical activity experience (both worsening and improvement) and to the occurrence of COPD exacerbations during follow-up. The MID was estimated to 6 for amount and difficulty scores and 4 for total score.ConclusionsThe D-PPAC and C-PPAC instruments are reliable and valid across diverse COPD populations and responsive to pharmacological and non-pharmacological interventions and changes in clinically relevant variables.

scholarly journals Digital Interventions for Psychological Comorbidities in Chronic Diseases—A Systematic Review

2021 ◽  
Vol 11 (1) ◽  
pp. 30
Author(s):  
Marta Maisto ◽  
Barbara Diana ◽  
Sonia Di Tella ◽  
Marta Matamala-Gomez ◽  
Jessica Isbely Montana ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Diseases ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Design Elements ◽  
Digital Interventions ◽  
Digital Contents ◽  
Psychological Comorbidities ◽  
Quantitative Synthesis ◽  
Meta Analyses

Chronic diseases represent one of the main causes of death worldwide. The integration of digital solutions in clinical interventions is broadly diffused today; however, evidence on their efficacy in addressing psychological comorbidities of chronic diseases is sparse. This systematic review analyzes and synthesizes the evidence about the efficacy of digital interventions on psychological comorbidities outcomes of specific chronic diseases. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of PubMed, PsycInfo, Scopus and Web of Science databases was conducted. Only Randomized Controlled Trials (RCTs) were considered and either depression or anxiety had to be assessed to match the selection criteria. Of the 7636 identified records, 17 matched the inclusion criteria: 9 digital interventions on diabetes, 4 on cardiovascular diseases, 3 on Chronic Obstructive Pulmonary Disease (COPD) and one on stroke. Of the 17 studies reviewed, 14 found digital interventions to be effective. Quantitative synthesis highlighted a moderate and significant overall effect of interventions on depression, while the effect on anxiety was small and non-significant. Design elements making digital interventions effective for psychological comorbidities of chronic diseases were singled out: (a) implementing a communication loop with patients and (b) providing disease-specific digital contents. This focus on “how” to design technologies can facilitate the translation of evidence into practice.

scholarly journals Anticoagulant treatment satisfaction with warfarin and direct oral anticoagulants for venous thromboembolism

2021 ◽  
Author(s):  
Margaret C. Fang ◽  
Alan S. Go ◽  
Priya A. Prasad ◽  
Jin-Wen Hsu ◽  
Dongjie Fan ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Treatment Satisfaction ◽  
Clinical Characteristics ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Treatment Options ◽  
Laboratory Monitoring ◽  
Routine Laboratory ◽  
Anticoagulant Treatment ◽  
The Difference

AbstractTreatment options for patients with venous thromboembolism (VTE) include warfarin and direct oral anticoagulants (DOACs). Although DOACs are easier to administer than warfarin and do not require routine laboratory monitoring, few studies have directly assessed whether patients are more satisfied with DOACs. We surveyed adults from two large integrated health systems taking DOACs or warfarin for incident VTE occurring between January 1, 2015 and June 30, 2018. Treatment satisfaction was assessed using the validated Anti-Clot Treatment Scale (ACTS), divided into the ACTS Burdens and ACTS Benefits scores; higher scores indicate greater satisfaction. Mean treatment satisfaction was compared using multivariable linear regression, adjusting for patient demographic and clinical characteristics. The effect size of the difference in means was calculated using a Cohen’s d (0.20 is considered a small effect and ≥ 0.80 is considered large). We surveyed 2217 patients, 969 taking DOACs and 1248 taking warfarin at the time of survey. Thirty-one point five percent of the cohort was aged ≥ 75 years and 43.1% were women. DOAC users were on average more satisfied with anticoagulant treatment, with higher adjusted mean ACTS Burdens (50.18 v. 48.01, p < 0.0001) and ACTS Benefits scores (10.21 v. 9.84, p = 0.046) for DOACs vs. warfarin, respectively. The magnitude of the difference was small (Cohen’s d of 0.29 for ACTS Burdens and 0.12 for ACTS Benefits). Patients taking DOACs for venous thromboembolism were on average more satisfied with anticoagulant treatment than were warfarin users, although the magnitude of the difference was small.

scholarly journals Determinants of COVID-19 preventive behaviours among adults with chronic diseases in the USA: an analysis of the nationally representative COVID-19 impact survey

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044600
Author(s):  
Jessica Y. Islam ◽  
Denise C. Vidot ◽  
Marlene Camacho-Rivera
Keyword(s):  
Chronic Diseases ◽  
Rural Areas ◽  
Prevalence Ratio ◽  
Face Mask ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
High School Degree ◽  
The Usa ◽  
Nationally Representative

BackgroundPreventive behaviours have been recommended to control the spread of SARS-CoV-2. Adults with chronic diseases (CDs) are at higher risk of COVID-19-related mortality compared to the general population. Our objective was to evaluate adherence to COVID-19 preventive behaviours among adults without CDs compared with those with CDs and identify determinants of non-adherence to COVID-19 preventive behaviours.Study designCross-sectional.Setting and participantsWe used data from the nationally representative COVID-19 Impact Survey (n=10 760) conducted in the USA.Primary measuresAdults with CDs were categorised based on a self-reported diagnosis of diabetes, high blood pressure, heart disease/heart attack/stroke, asthma, chronic obstructive pulmonary disease (COPD), bronchitis or emphysema, cystic fibrosis, liver disease, compromised immune system, or cancer (54%).ResultsCompared with adults without CDs, adults with CDs were more likely to adhere to preventive behaviours including wearing a face mask (χ2-p<0.001), social distancing (χ2-p<0.001), washing or sanitising hands (χ2-p<0.001), and avoiding some or all restaurants (χ2-p=0.002) and public or crowded places (χ2-p=0.001). Adults with a high school degree or below [Adjusted prevalence ratio (aPR):1.82, 95% Confidence interval (CI)1.04 to 3.17], household income <US$50 000 (aPR:2.03, 95% CI 1.34 to 2.72), uninsured (aPR:1.65, 95% CI1.09 to 2.52), employed (aPR:1.48, 95% CI 1.02 to 2.17), residing in rural areas (aPR:1.70, 95% CI 1.01 to 2.85) and without any CD (aPR:1.78, 95% CI 1.24 to 2.55) were more likely to not adhere to COVID-19 preventive behaviours.ConclusionAdults with CDs are more likely to adhere to recommended COVID-19 preventive behaviours. Public health messaging targeting specific demographic groups and geographic areas, such as adults without CD or adults living in rural areas, should be prioritised.

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