scholarly journals SLEEP APNEA ASSOCIATED COMORBIDITIES AND MORTALITY IN AN OLDER VETERAN POPULATION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S263-S264
Author(s):  
Denise M Kresevic ◽  
muralidahar pallaki ◽  
Christopher J Burant ◽  
Clare Gideon ◽  
Emily Schroeder ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Sleep Apnea ◽  
Mortality Rate ◽  
Population Based ◽  
Older Individuals ◽  
Male Veterans ◽  
The Relationship ◽  
Overall Mortality

Abstract Evidence continues to mount that sleep apnea (SA) occurs in 10-25% of Americans and is associated with significant morbidity and mortality (Schulman 2018). Among veterans, SA has been reported four times more often as compared to other non-veteran cohorts. (Wong 2015). The risk of developing dementia is increased in older individuals with OSA (Shastri, Bangar, & Holmes, 2015). The prevalence and characteristics of older adults with dementia and sleep apnea is not well known and long-term population-based studies on mortality have been lacking. Recent studies have reported overall mortality rates of 19%, in those individuals with SA, an increased rate of 1.5-3 times the mortality rate as compared to those individuals those without SA. Current recommendations support SA screening of high risk individuals including those with symptoms of snoring, fatigue, memory and concentration problems and mood changes. (Krist 2018). Despite a large number of older adults with suspected SA and comorbidities, the majority are not screened, referred, diagnosed and treated. In this VA pilot study of outpatient older male veterans with dementia and SA, N=195, mean age 75.83 years, SD=9.1, 51.3% were white, 37.5% were black. Frequently found comorbidities were: hypertension 88%, congestive heart failure 41%, Diabetes. 62% and, stroke 21%. Of note, among those who died, SA was significantly related to congested heart failure (r=.32, p<.001) and COPD (r=.40, p<.001). The overall mortality rate of 27% was higher than previous reports. Further investigation is needed to better understand the relationship between comorbidities, and SA, screening, treatment and mortality.

Abstract 16177: Race and Sex-specific Long-term Risk of Incident Heart Failure in Adults Stratified by Fasting Glucose Level: Lifetime Risk Pooling Project

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Arjun Sinha ◽  
Hongyan Ning ◽  
Faraz S Ahmad ◽  
Michael Bancks ◽  
Mercedes R Carnethon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Black Women ◽  
Population Based ◽  
Middle Aged ◽  
Individual Level ◽  
Kaplan Meier ◽  
Level Data ◽  
The Life Course

Introduction: While the association of diabetes with heart failure (HF) is well-established, the long-term risk (LR) of incident HF with prediabetes across the life course is not known. Furthermore, race-sex disparities in LR of HF across categories of fasting plasma glucose (FPG) has not been described. To inform HF preventive strategies, we compared the race- and sex-specific LR of HF across categories of FPG in adults. Methods: Individual-level data from adults free of baseline HF was pooled from 6 population-based cohorts stratified by baseline age (40-59, 60-79 years) and race-sex groups. We defined FPG status as normal (<100 mg/dL), prediabetes (FPG 100-125 mg/dL) and diabetes (FPG ≥126 mg/dL or use of antihyperglycemic agents). Modified Kaplan-Meier analysis was performed by FPG strata to estimate the LR of HF (30-year in middle-aged and 20-year in older adults) adjusted for the competing risk of non-HF death. We estimated adjusted hazard ratios (aHR) for HF in each FPG strata using Cox proportional regression models. Results: Of the 40,117 participants, 24% were black and 56% were women. During 638,910 person-years of follow-up, there were 4,846 cases of incident HF. In middle-aged adults, the LR of HF was significantly higher among individuals with prediabetes (6.1 [4.8, 7.4] to 14.4 [9.6, 19.2]%) compared with normal FPG (3.5 [3.0, 4.1] to 11.7 [9.1, 14.3]%). In older adults with prediabetes compared with normal FPG, LR of HF was significantly higher in white men (13.5 [12.0, 14.9]% vs 10.4 [9.2, 11.6]%) and women (12.2 [10.8, 13.6]% vs 7.8 [6.9, 8.7]%) but not in black men (12.2 [9.0, 15.3]% vs 14.6 [11.6, 17.6]%) or women (13.5 [10.1, 16.8]% vs 11.7 [9.4, 14.0]%). Race-sex specific aHR for HF across FPG strata are shown in the table. Conclusions: Compared with normal FPG, prediabetes was associated with significantly greater LR of HF in middle-aged but not in older adults. Of all groups, black women with diabetes qualitatively had a disproportionately higher LR of HF.

scholarly journals Higher Long-term Visit-to-Visit Variability in Fasting Plasma Glucose Predicts New-Onset Heart Failure in the General Population

2021 ◽  
Author(s):  
Yueying Wang ◽  
Wenwei Qi ◽  
Nan Zhang ◽  
Gary Tse ◽  
Guangping Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cox Regression ◽  
Fasting Blood Glucose ◽  
Population Based ◽  
Developing Heart ◽  
Chinese Cohort ◽  
The Relationship ◽  
New Onset

Abstract Background: Previous studies suggested an adverse association between higher fasting blood glucose (FBG) and heart failure. However, FBG values fluctuate continuously over time, the association between FBG variability and the risk of heart failure is uncertain.Aims: We investigated the relationship between visit-to-visit variability in FBG and the risk of new-onset heart failure.Methods and Results: This was a population-based cohort study using the Kailuan dataset, which comprises of medical claims and a biennially health checkup information from a Chinese cohort. A total of 98 554 individuals (mean age: 53.63 years) who had at least two health checkups with FBG measurement between 2006 and 2012 without preexisting heart failure were included. FBG variability was calculated using the variability independent of the mean, coefficient of variation, standard deviation, and average successive variability (ARV). Participants were divided into quartiles of ARV. Cox regression was used to identify heart failure. Over a mean follow-up of 6.27 years, 1218 individuals developed heart failure. The incidence of heart failure was 1.97 per 1000 person-years. After adjusting for baseline FBG and other potential confounders, individuals in the highest quartile of the ARV of FBG had 32.6% higher risk of developing heart failure compared to those in the lowest quartile (hazard ratio, 1.326; 95% confidence interval, 1.120-1.570). This association remained significant in patients with or without prevalent hypertension. In subgroup analyses, individuals who were younger (<65 years), without diabetes mellitus or chronic kidney disease, and with a body mass index<25 kg/m2 experienced a higher risk of heart failure.Conclusions: Our data demonstrated that high FBG variability is independently associated with the development of new-onset heart failure. Future studies should explore whether measures to reduce variability can lead to improve clinical outcomes. Trial registration: Chinese Clinical Trial Register, ChiCTR-TNRC-11001489. Registered on 24-08-2011.

Long-term use of vitamin K antagonists and incidence of cancer: a population-based study

Blood ◽  
2011 ◽  
Vol 117 (5) ◽  
pp. 1707-1709 ◽  
Author(s):  
Vittorio Pengo ◽  
Franco Noventa ◽  
Gentian Denas ◽  
Martino F. Pengo ◽  
Umberto Gallo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Study Groups ◽  
Population Based ◽  
Hazard Ratio ◽  
Population Based Study ◽  
Incidence Of Cancer ◽  
Overall Mortality

Abstract Whether long-term use of vitamin K antagonists (VKAs) might affect the incidence of cancer is a longstanding hypothesis. We conducted a population-based study including all cancer- and thromboembolism-free patients of our health area; study groups were defined according to chronic anticoagulant use to VKA-exposed and control groups. Cancer incidence and cancer-related and overall mortality was assessed in both groups. 76 008 patients (3231 VKA-exposed and 72 777 control subjects) were followed-up for 8.2 (± 3.2) years. After adjusting for age, sex, and time-to-event, the hazard ratio of newly diagnosed cancer in the exposed group was 0.88 (95% confidence interval [95% CI] 0.80-0.98; P < .015). VKA-exposed patients were less likely to develop prostate cancer, 0.69 (95% CI 0.50-0.97; P = .008). The adjusted hazard ratio for cancer-related and overall mortality was 1.07 (95% CI 0.92-1.24) and 1.12 (95% CI 1.05-1.19), respectively. These results support the hypothesis that anticoagulation might have a protective effect on cancer development, especially prostate cancer.

Sleep Duration, Sleep Apnea, and Gray Matter Volume

2021 ◽  
pp. 089198872098891
Author(s):  
Regina Eun Young Kim ◽  
Robert Douglas Abbott ◽  
Soriul Kim ◽  
Robert Joseph Thomas ◽  
Chang-Ho Yun ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Sleep Duration ◽  
Gray Matter ◽  
Gray Matter Volume ◽  
Brain Structures ◽  
Brain Regions ◽  
Population Based ◽  
Older Individuals ◽  
Bootstrap Sampling ◽  
Matter Volume

This study aimed to evaluate the effect of sleep duration on brain structures in the presence versus absence of sleep apnea in middle-aged and older individuals. The study investigated a population-based sample of 2,560 individuals, aged 49-80 years. The presence of sleep apnea and self-reported sleep duration were examined in relation to gray matter volume (GMV) in total and lobar brain regions. We identified ranges of sleep duration associated with maximal GMV using quadratic regression and bootstrap sampling. A significant quadratic association between sleep duration and GMV was observed in total and lobar brain regions of men with sleep apnea. In the fully adjusted model, optimal sleep durations associated with peak GMV between brain regions ranged from 6.7 to 7.0 hours. Shorter and longer sleep durations were associated with lower GMV in total and 4 sub-regions of the brain in men with sleep apnea.

scholarly journals INDICATORS OF MORBIDITY AND MORTALITY BY FEMUR FRACTURES IN OLDER PEOPLE: A DECADE-LONG STUDY IN BRAZILIAN HOSPITALS

2020 ◽  
Vol 28 (3) ◽  
pp. 142-148
Author(s):  
VIVIANE CRISTINA ULIANA PETERLE ◽  
JOÃO CARLOS GEBER JUNIOR ◽  
WILLIAN DARWIN JUNIOR ◽  
ALEXANDRE VASCONCELOS LIMA ◽  
PAULO EMILIANO BEZERRA JUNIOR ◽  
...  
Keyword(s):  
Older Adults ◽  
Mortality Rate ◽  
Average Length ◽  
Federal District ◽  
Population Based ◽  
Northern Region ◽  
Level Of Evidence ◽  
Average Length Of Stay ◽  
Femur Fractures ◽  
Unified Health System

ABSTRACT Objective: To evaluate the profile of femur fractures in older adults in Brazil between 2008 and 2018. Methods: Population-based time series study with data from the Department of Informatics of the Unified Health System (Datasus), including 480,652 hospitalizations, of adults from 60 years and over, with hip fracture (ICD10-S72). Results: There was an increase of 76.9% in the hospitalization register (mean 5.87%/year) and an average incidence rate of 19.46 fractures for every 10,000 older adults. In total, 68% of hospitalizations were female, 28% from São Paulo. The average length of stay was 8.9 days, being higher in the Northern Region (11.8) and in the Federal District (18.7). Average mortality rate was 5%, being higher in men (5.45%) and over 80 years old. Northeast Region had the lowest mortality rate (3.54%). Southeast Region had the highest rate (5.53%). Total cost of hospitalizations was R$ 1.1 billion, with an average of R$ 100 million/year. Average cost per hospitalization was higher in the Southern Region (R$ 2,491.00). Conclusion: Femoral fracture is an important cause of mortality among older adults, with a higher incidence in women but higher mortality in men, with high cost to the system and regional differences. Level of Evidence II, Economic and decision analyses - developing an economic or decision model.

scholarly journals Depression and empathy in health professionals who work in the long-term care institutions for older adults

2021 ◽  
Vol 15 (3) ◽  
pp. 381-386
Author(s):  
Marina Miranda Borges ◽  
Ana Julia de Lima Bomfim ◽  
Marcos Hortes Nisihara Chagas
Keyword(s):  
Older Adults ◽  
Health Professionals ◽  
Long Term Care ◽  
Cross Sectional Study ◽  
Reactivity Index ◽  
Cross Sectional ◽  
Term Care ◽  
Patient Health ◽  
The Relationship

ABSTRACT Empathy is an important factor to guarantee the quality of care provided in the long-term care institutions (LTCIs) for older adults, and depression is a factor that affects the health of the professional and, consequently, the care. Thus, it is important that studies are conducted on the relationship of these variables in this context. Objective: The aim of this study is to verify the relationship between empathy and depressive symptoms among health professionals working in the LTCIs. Methods: A cross-sectional study was carried out at LTCIs in the state of São Paulo, Brazil. The final sample was constituted by 101 health professionals (i.e., caregivers and nursing technicians) with direct participation in the care of institutionalized older adults. The instruments were used as follows: the Interpersonal Reactivity Index (IRI) to assess empathy and the Patient Health Questionnaire-9 (PHQ-9) for the diagnosis of depression. For the analyses, the patients were divided into groups with and without depression, according to the score of the PHQ-9. Results: The prevalence of depression among health professionals was 19.8%. Significant statistical differences were found between the groups for the total score of the IRI (p=0.029), for the emotional domain (p=0.023), and for the personal distress (p=0.009). Conclusions: The findings indicate that the presence of depression among health professionals at LTCIs is related to the higher levels of empathy, especially in the emotional domain. Thus, future studies that contribute to understanding how care must be provided with empathy, but without harming the health of the professional, should be carried out.

scholarly journals Obstructive Sleep Apnea in Heart Failure: Review of Prevalence, Treatment with Continuous Positive Airway Pressure, and Prognosis

2018 ◽  
Vol 45 (3) ◽  
pp. 151-161 ◽  
Author(s):  
Himad K. Khattak ◽  
Faisal Hayat ◽  
Salpy V. Pamboukian ◽  
Harvey S. Hahn ◽  
Brian P. Schwartz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Preserved Ejection Fraction ◽  
Obstructive Sleep ◽  
Artery Disease ◽  
The Relationship

Obstructive sleep apnea is a sleep-related breathing disorder that has a major impact on cardiovascular function. It has been associated with hypertension, coronary artery disease, cardiac arrhythmias, sudden cardiac death, and heart failure. This review focuses on the relationship between obstructive sleep apnea and heart failure with either reduced or preserved ejection fraction. We discuss the pathophysiology of obstructive sleep apnea, as well as its prevalence, treatment outcomes with continuous positive airway pressure, and prognosis in these 2 distinct types of heart failure. We also identify areas in which further work is needed to improve our understanding of this association in heart failure patients.

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