Cardiac rehabilitation is associated with lower 1-year all-cause mortality in primary pulmonary hypertension

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
G Kleinnibbelink ◽  
BJR Buckley ◽  
SL Harrison ◽  
N Williams ◽  
E Fazio-Eynullayeya ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Propensity Score ◽  
Cardiac Rehabilitation ◽  
Circulatory System ◽  
The United States ◽  
Research Network ◽  
Control Group ◽  
Inclusion Criteria ◽  
Term Survival ◽  
Physician Practices

Abstract Funding Acknowledgements Type of funding sources: None. Background. Despite introduction of pharmacological therapies to improve outcomes of pulmonary hypertension (PH), poor long-term survival remains present. Cardiac rehabilitation may be an alternative strategy to improve survival. However, no study directly linked CR to mortality in PH patients. Therefore, adopting a retrospective observational study using a large electronic medical record (EMR) database, the objective of this study was to compare mortality between patients with primary PH with CR versus a propensity-matched control group of PH without CR. Methods. The retrospective analysis was conducted on December 14, 2020 using anonymized data within TriNetX, a global federated health research network with access to EMRs from participating academic medical centres, specialty physician practices, and community hospitals, predominantly in the United States. All patients were aged ≥18 years with primary PH recorded in EMRs at least 18-months before the search date to allow for 1-year follow-up from CR. Using logistic regression, patients with PH with an EMR of CR were 1:1 propensity score-matched with PH patients without CR for age, sex, race, diseases of the respiratory system, disease of the circulatory system, hypertensive disease, heart failure, diabetes mellitus, chronic kidney disease, cerebrovascular disease, cardiovascular procedures and cardiovascular medications. Results. In total, 70,875 patients with primary PH met the inclusion criteria for the control group and 637 patients with primary PH met the inclusion criteria for the CR and exercise cohort (Table 1). Using the propensity score-matched cohort, and excluding patients with outcomes outside the measurement window, mortality at 1-year from CR was proportionally lower with mortality of 13.9% (n = 87 of 628 patients) in the CR and exercise cohort compared to 21.0% (n = 133 of 632 patients) in the controls (OR 0.60, 95% CI 0.45-0.81). Conclusion. In conclusion, the present study of 1,264 patients with primary PH suggests that CR is associated with 40% lower odds of 1-year mortality, when compared to propensity score-matched patients without CR or exercise programmes. Abstract Figure.

scholarly journals Comparison of Long-term outcomes between Lynch sydrome and sporadic colorectal cancer: a propensity score matching analysis

2020 ◽  
Author(s):  
Yun Xu ◽  
Cong Li ◽  
Charlie Zhi-Lin Zheng ◽  
Yu-Qin Zhang ◽  
Tian-An Guo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Control Group ◽  
Sporadic Colorectal Cancer ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Tumor Stages

Abstract Background Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome. Comparison of prognosis between LS and sporadic CRC (SCRC) were rare,with conflicting results. This study aimed to compare the long-term outcomes between patients with LS and SCRC. Methods Between June 2008 and September 2018, a total of 47 patients were diagnosed with LS by genetic testing at Fudan University Shanghai Cancer Center. A 1:2 propensity score matching was performed to obtain homogeneous cohorts from SCRC group. Thereafter, 94 SCRC patients were enrolled as control group. The long-term survival rates between the two groups were compared, and the prognostic factors were also analyzed. Results The 5-year OS rate of LS group was 97.6%, which was significantly higher than of 82.6% for SCRC group (p = 0.029). The 5-year PFS rate showed no significant differences between the two groups (78.0% for LS group vs. 70.6% for SCRC patients; p = 0.262). The 5-year TFS rates in LS group was 62.1% for LS patients, which were significantly lower than of 70.6% for SCRC group (p = 0.039). By multivariate analysis, we found that tumor progression of primary CRC and TNM staging were independent risk factors for OS. Conclusion LS patients have better long-term survival prognosis than SCRC patients. Strict regular follow-up monitoring, detection at earlier tumor stages, and effective treatment are key to ensuring better long-term prognosis.

scholarly journals Neoadjuvant Chemotherapy for Locally Advanced T4 Colon Cancer: A Nationwide Propensity-Score Matched Cohort Analysis

2019 ◽  
Vol 37 (4) ◽  
pp. 292-301 ◽  
Author(s):  
Jan-Marie de Gooyer ◽  
Marlies G. Verstegen ◽  
Jorine ’t Lam-Boer ◽  
Sandra A. Radema ◽  
Rob H.A. Verhoeven ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Propensity Score ◽  
Cohort Analysis ◽  
Locally Advanced ◽  
Group Versus ◽  
Control Group ◽  
Complication Rates ◽  
Term Survival ◽  
T4 Colon Cancer

Introduction: Neoadjuvant chemotherapy (CT) for locally advanced colon cancer (LACC) could potentially lead to tumor shrinkage, eradication of micrometastases, and prevention of tumor cell shedding during surgery. This retrospective study investigates the surgical and oncological outcomes of preoperative CT for LACC. Methods: Using the Netherlands Cancer Registry, data of patients with stage II or III colon cancer, diagnosed between 2008 and 2016 was collected. A propensity score matching (PSM; 1:2) was performed and compared patients with clinical tumor (cT) 4 colon cancer who were treated with neoadjuvant CT to patients with cT4 colon cancer treated with adjuvant CT (Fig. 1). Results: A total of 192 patients treated with neoadjuvant CT were compared to 1,954 patients that received adjuvant CT. After PSM, 149 patients in the neoadjuvant group were compared to 298 patients in the control group. No significant differences were found in baseline characteristics after PSM. After neoadjuvant CT, a significant response was observed in 13 (9%) patients with 5 (4%) patients showing a complete response. Complete resection margins (R0) were achieved in 77% in the neoadjuvant group versus 86% in the adjuvant treated group (p = 0.037). Significantly less tumor positive lymph nodes were found in the neoadjuvant group (median 0 vs. 2, p < 0.001). Major complication rates and 5-year overall survival did not differ between both groups (67–65%, p = 0.87). Conclusion: Neoadjuvant CT seems safe and feasible with similar long-term survival compared to patients who are treated with adjuvant CT.

The influence of race and treatment choice in 16,508 men treated either conservatively, with radiotherapy, or surgically for clinically localized prostate cancer.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 210-210
Author(s):  
P. Sooriakumaran ◽  
T. Field ◽  
M. John ◽  
R. Leung ◽  
A. Tewari
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Watchful Waiting ◽  
The United States ◽  
Research Network ◽  
Localized Prostate Cancer ◽  
Term Survival ◽  
Long Term Survival ◽  
Treatment Choices

210 Background: There are known variations in cancer survival based on race and treatment choices. We report the long-term survival probability, based on race, in 16,508 men with localized prostate cancer treated either conservatively or by radiotherapy or radical prostatectomy. Methods: We extracted survival data from tumor registries of six Cancer Research Network sites in the United States. Patients were stratified into four racial groups: Caucasians, African Americans, Hispanics, and Asians. The Cox proportional-hazards regression model was used to compare long-term survival in the three treatment groups. Kaplan-Meier survival curves and competing risk analysis was also performed. Results: Survival was improved for patients who underwent radical prostatectomy compared to radiotherapy or watchful waiting. This was true for all patients combined (Table) as well as for all races individually. Radiotherapy had at least equivalent survival outcomes as watchful waiting in all groups. The differences between treatments were greater for overall survival than for prostate cancer specific survival in all groups, though the extent of the differences varied by race. Conclusions: Radical prostatectomy increases survival in men with localized prostate cancer compared to both radiotherapy and watchful waiting, especially for Caucasian men. Radiotherapy was at least equivalent to watchful waiting for all races. Racial disparities in outcome may influence treatment choices for men with clinically localized prostate cancer. [Table: see text] [Table: see text]

Propensity score analysis of the association between maternal exposure to second-hand tobacco smoke and birth defects in Northwestern China

2022 ◽  
pp. 1-8
Author(s):  
Jing Li ◽  
Yujiao Du ◽  
Fengyi Qu ◽  
Hui Jing ◽  
Hong Yan ◽  
...  
Keyword(s):  
Propensity Score ◽  
Birth Defects ◽  
Tobacco Smoke ◽  
Circulatory System ◽  
Maternal Exposure ◽  
Shaanxi Province ◽  
Sensitivity Analyses ◽  
Control Group ◽  
Exposure Group ◽  
Shs Exposure

Abstract Previous studies have suggested that maternal active smoking can increase the risk of birth defects, but evidence on second-hand tobacco smoke (SHS) is limited. We aimed to assess the association between maternal exposure to SHS and birth defects in a Chinese population. The data were based on a large-scale cross-sectional survey conducted in Shaanxi Province, China. Considering the characteristics of survey design and the potential impact of confounding factors, we adopted propensity score matching (PSM) to match the SHS exposure group and the non-exposure group to attain a balance of the confounders between the two groups. Subsequently, conditional logistic regression was employed to estimate the effect of SHS exposure on birth defects. Furthermore, sensitivity analyses were conducted to verify the key findings. After nearest neighbor matching of PSM with a ratio of 2 and a caliper width of 0.03, there were 6,205 and 12,410 participants in the exposure and control group, respectively. Pregnant women exposed to SHS were estimated to be 58% more likely to have infants with overall birth defects (OR = 1.58, 95% CI: 1.30–1.91) and 75% more likely to have infants with circulatory system defects (OR = 1.75, 95% CI: 1.26–2.44). We also observed that the risk effect of overall birth defects had an increasing trend as the frequency of exposure increased. Additionally, sensitivity analyses suggested that our results had good robustness. These results indicate that maternal exposure to SHS likely increases the risk of overall birth defects, especially circulatory system defects, in Chinese offspring.

scholarly journals Exercise‐Based Cardiac Rehabilitation and All‐Cause Mortality Among Patients With Atrial Fibrillation

2021 ◽  
Author(s):  
Benjamin J. R. Buckley ◽  
Stephanie L. Harrison ◽  
Elnara Fazio‐Eynullayeva ◽  
Paula Underhill ◽  
Deirdre A. Lane ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Propensity Score ◽  
Cardiac Rehabilitation ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Research Network ◽  
Lower Odds ◽  
All Cause Mortality ◽  
Long Term Impact

Background There is limited evidence of long‐term impact of exercise‐based cardiac rehabilitation (CR) on clinical end points for patients with atrial fibrillation (AF). We therefore compared 18‐month all‐cause mortality, hospitalization, stroke, and heart failure in patients with AF and an electronic medical record of exercise‐based CR to matched controls. Methods and Results This retrospective cohort study included patient data obtained on February 3, 2021 from a global federated health research network. Patients with AF undergoing exercise‐based CR were propensity‐score matched to patients with AF without exercise‐based CR by age, sex, race, comorbidities, cardiovascular procedures, and cardiovascular medication. We ascertained 18‐month incidence of all‐cause mortality, hospitalization, stroke, and heart failure. Of 1 366 422 patients with AF, 11 947 patients had an electronic medical record of exercise‐based CR within 6‐months of incident AF who were propensity‐score matched with 11 947 patients with AF without CR. Exercise‐based CR was associated with 68% lower odds of all‐cause mortality (odds ratio, 0.32; 95% CI, 0.29–0.35), 44% lower odds of rehospitalization (0.56; 95% CI, 0.53–0.59), and 16% lower odds of incident stroke (0.84; 95% CI, 0.72–0.99) compared with propensity‐score matched controls. No significant associations were shown for incident heart failure (0.93; 95% CI, 0.84–1.04). The beneficial association of exercise‐based CR on all‐cause mortality was independent of sex, older age, comorbidities, and AF subtype. Conclusions Exercise‐based CR among patients with incident AF was associated with lower odds of all‐cause mortality, rehospitalization, and incident stroke at 18‐month follow‐up, supporting the provision of exercise‐based CR for patients with AF.

scholarly journals Exercise-Based Cardiac Rehabilitation Associates with Lower Major Adverse Cardiovascular Events in People with Stroke

2021 ◽  
pp. 1-5
Author(s):  
Benjamin J.R. Buckley ◽  
Stephanie L. Harrison ◽  
Elnara Fazio-Eynullayeva ◽  
Paula Underhill ◽  
Deirdre A. Lane ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cardiac Rehabilitation ◽  
Cardiovascular Events ◽  
Recurrent Stroke ◽  
Routine Care ◽  
Research Network ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Events ◽  
Lower Odds

<b><i>Background:</i></b> The risk of major adverse cardiovascular events is substantially increased following a stroke. Although exercise-based cardiac rehabilitation has been shown to improve prognosis following cardiac events, it is not part of routine care for people following a stroke. We therefore investigated the association between cardiac rehabilitation and major adverse cardiovascular events for people with stroke. <b><i>Methods:</i></b> This retrospective analysis was conducted on June 20, 2021, using anonymized data within TriNetX, a global federated health research network with access to electronic medical records from participating healthcare organizations, predominantly in the USA. All participants were aged ≥18 years with cerebrovascular disease and at least 2 years of follow-up. People with stroke and an electronic medical record of exercise-based cardiac rehabilitation were 1:1 propensity score matched to people with stroke but without cardiac rehabilitation using participant characteristics, comorbidities, cardiovascular procedures, and cardiovascular medications. <b><i>Results:</i></b> Of 836,923 people with stroke and 2-year follow-up, 2,909 met the inclusion for the exercise-based cardiac rehabilitation cohort. Following propensity score matching (<i>n</i> = 5,818), exercise-based cardiac rehabilitation associated with 53% lower odds of all-cause mortality (odds ratio 0.47, 95% confidence interval: 0.40–0.56), 12% lower odds of recurrent stroke (0.88, 0.79–0.98), and 36% lower odds of rehospitalization (0.64, 0.58–0.71), compared to controls. No significant association between cardiac rehabilitation and incident atrial fibrillation was observed. <b><i>Conclusion:</i></b> Exercise-based cardiac rehabilitation prescribed for people following a stroke associated with significantly lower odds of major adverse cardiovascular events at 2 years, compared to usual care.

Hiring Practices of Exercise Physiologist in Cardiac Rehabilitation Programs among Mid-Atlantic States in the United States

2016 ◽  
Vol 5 (3) ◽  
pp. 32-36 ◽  
Author(s):  
Allison Hope Bowersock ◽  
William Alexander Breeding ◽  
Carmel Alexander Sheppard
Keyword(s):  
United States ◽  
Patient Education ◽  
Cardiac Rehabilitation ◽  
Science Curriculum ◽  
Exercise Physiology ◽  
Clinical Skill ◽  
The United States ◽  
Hiring Practices ◽  
Clinical Settings ◽  
Rehabilitation Programs

Purpose: The purpose of this survey was to identify factors that may be influencing the appreciation of exercise physiology as a discipline as demonstrated by hiring practices in regional clinical settings. Methods: A telephone survey was administered to 33 cardiac rehabilitation programs in 5 states in the Mid-Atlantic region of the United States (Kentucky, North Carolina, Tennessee, Virginia, and West Virginia). Results: The distribution of nurses and exercise physiologists (EPs) employed by the 33 facilities varied by state, but overall there were 86 nurses and 55 EPs working among the surveyed facilities. Of the 33 surveyed facilities, 12 (36%) reported a preference for hiring nurses over EPs; only 4 (12%) reported a preference for hiring EPs over nurses. The remaining facilities (n = 17; 52%) reported no preference (n = 12; 36%) or that the decision depends on a variety of factors (n = 5; 15%). Several common themes were identified from respondents. These included that, compared to nurses, EPs have greater expertise in exercise prescription and better understanding of safe exercise progression for patients. However, nurses were believed to possess greater assessment and clinical skill with an emphasis on emergency response preparedness and greater general patient education skills. Conclusion: Academic programs that prepare students for careers as EPs employed in clinical settings may benefit from additional coursework and internship site selection that focus on clinical assessment skills, emergency preparedness, and patient education to reinforce their work in an exercise science curriculum.

Impact of intrawound vancomycin powder on prevention of surgical site infection after posterior spinal surgery

2021 ◽  
pp. 1-9
Author(s):  
Hiroki Ushirozako ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Go Yoshida ◽  
Tatsuya Yasuda ◽  
...  
Keyword(s):  
Propensity Score ◽  
Spinal Surgery ◽  
Control Group ◽  
Control Groups ◽  
Propensity Score Model ◽  
Significant Difference ◽  
Surgical Data ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
And Control

OBJECTIVESurgical site infection (SSI) after posterior spinal surgery is one of the severe complications that may occur despite administration of prophylactic antibiotics and the use of intraoperative aseptic precautions. The use of intrawound vancomycin powder for SSI prevention is still controversial, with a lack of high-quality and large-scale studies. The purpose of this retrospective study using a propensity score–matched analysis was to clarify whether intrawound vancomycin powder prevents SSI occurrence after spinal surgery.METHODSThe authors analyzed 1261 adult patients who underwent posterior spinal surgery between 2010 and 2018 (mean age 62.3 years; 506 men, 755 women; follow-up period at least 1 year). Baseline and surgical data were assessed. After a preliminary analysis, a propensity score model was established with adjustments for age, sex, type of disease, and previously reported risk factors for SSI. The SSI rates were compared between patients with intrawound vancomycin powder treatment (vancomycin group) and those without (control group).RESULTSIn a preliminary analysis of 1261 unmatched patients (623 patients in the vancomycin group and 638 patients in the control group), there were significant differences between the groups in age (p = 0.041), body mass index (p = 0.013), American Society of Anesthesiologists classification (p < 0.001), malnutrition (p = 0.001), revision status (p < 0.001), use of steroids (p = 0.019), use of anticoagulation (p = 0.033), length of surgery (p = 0.003), estimated blood loss (p < 0.001), and use of instrumentation (p < 0.001). There was no significant difference in SSI rates between the vancomycin and control groups (21 SSIs [3.4%] vs 33 SSIs [5.2%]; OR 0.640, 95% CI 0.368–1.111; p = 0.114). Using a one-to-one propensity score–matched analysis, 444 pairs of patients from the vancomycin and control groups were selected. There was no significant difference in the baseline and surgical data, except for height (p = 0.046), between both groups. The C-statistic for the propensity score model was 0.702. In the score-matched analysis, 12 (2.7%) and 24 (5.4%) patients in the vancomycin and control groups, respectively, developed SSIs (OR 0.486, 95% CI 0.243–0.972; p = 0.041). There were no systemic complications related to the use of vancomycin.CONCLUSIONSThe current study showed that intrawound vancomycin powder was useful in reducing the risk of SSI after posterior spinal surgery by half, without adverse events. Intrawound vancomycin powder use is a safe and effective procedure for SSI prevention.

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