scholarly journals P1437RELATIONS BETWEEN IMPLEMENTATIONS OF EVIDENCE-BASED TREATMENTS AND IMPROVED OUTCOMES IN PATIENTS STARTING HEMODIALYSIS DURING THE LAST 10 YEARS: EXPERIENCES FROM THE SWEDISH RENAL REGISTRY 2006-2015

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Marie Evans ◽  
Hong Xu ◽  
Maria Stendahl ◽  
Helena Rydell ◽  
Juan Jesus Carrero
Keyword(s):  
Cardiovascular Events ◽  
Regression Models ◽  
Cox Regression ◽  
Phosphate Binders ◽  
Evidence Based ◽  
Risk Of Death ◽  
Evidence Based Treatments ◽  
One Year ◽  
The One ◽  
Over Time

Abstract Background and Aims Although few randomized controlled trials have been able to demonstrate benefits of single treatments in improving outcomes of patients undergoing hemodialysis (HD), the last decades have witnessed significant therapeutic advances. This relates both to the HD treatment itself and to the management of patient complications. We here evaluated temporal changes in the use of evidence-based treatments and survival rates in incident HD patients. Method We included all patients initiating HD in Sweden between 2006-2015 and followed them until the end of 2017. Data were linked to national registries to retrieve information on date of death, cardiovascular events, comorbidity, and drug prescriptions. We first evaluated trends in the use of different HD related therapies and selected key therapeutic targets and medications in 2-year blocks. We then evaluated the incidence of death and major cardiovascular events (MACE) within one and two years from start of dialysis through standardized incidence rates via logistic regression models to account for differences in patient characteristics over time. Via Cox regression models, we explored whether adjustment for implementation of evidence-based treatments (e.g. hemodiafiltration (HDF), frequent HD, working fistula, drugs to control CKD-MBD, anemia) modified the observed survival and MACE risks. Finally, survival trends were also compared against an age-sex-calendar year-matched general Swedish population using standardized incidence ratios. Results We identified 6,612 patients starting HD in Sweden during the study period. There was no difference in mean age or proportion of women over time, but body mass index, serum parathyroid hormone levels and the proportion of patients with cerebrovascular disease, atrial fibrillation and cancer increased. Conversely, mean serum hemoglobin, phosphate and albumin values decreased over time. The proportion of patients who underwent HDF, had more than three HD sessions/week, and had a working fistula increased progressively, as well as the use of phosphate binders (particularly non-calcium), cinacalcet, and vitamin D3. After standardization for differences in demography and comorbidities, the one-year risk of mortality or MACE risk decreased by 7% and 16%, respectively, in 2014/15 compared to 2006/07. Similarly, the two-year risk of death or MACE decreased by 16 and 21%. In multivariable Cox models, we explored the linear association between calendar year blocks and study outcomes. Per 2-year period, the risk of death within one year decreased by 6% (HR 0.94, 95% CI 0.92-1.00), and of MACE by 5% (0.94, 95% CI 0.92-0.98). Adjustment for changes in the evidence-based treatments over time abrogated these associations (HR 1.00, 95% CI 0.91-1.09 for death and 1.00, 95% CI 0.94-1.06 for MACE). Similar results were obtained for 2-year outcomes. Compared with the general population, the one-year risk of death for a HD patient was 6 times higher in 2006/2007 [standardized incidence rate ratio, SIR 6.05 (5.30–6.91)], but decreased to 5.5 times higher in 2014/15 [SIR 5.57 (4.82–6.44)], corresponding to a SIR reduction of 8%. Conclusion In patients initiating HD therapy in Sweden, there has been a gradual implementation of new and established evidence-based treatments during the last 10 years, which was associated with a parallel reduction in the risk of death and MACE.

scholarly journals P1444CHANGES IN TREATMENTS AND OUTCOMES OF PATIENTS INITIATING PERITONEAL DIALYSIS DURING THE LAST 10 YEARS: DATA FROM SWEDISH RENAL REGISTRY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hong Xu ◽  
Juan Jesus Carrero ◽  
Bengt Lindholm ◽  
Maria Stendahl ◽  
Helena Rydell ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
General Population ◽  
Clinical Outcomes ◽  
Angiotensin Receptor Blockers ◽  
Phosphate Binders ◽  
Risk Of Death ◽  
Management Of Complications ◽  
One Year ◽  
Technique Failure ◽  
Over Time

Abstract Background and Aims The recent years have witnessed several therapeutic improvements regarding both peritoneal dialysis (PD) treatment itself and the prevention and management of complications. We evaluated trends in implementation of therapeutic improvements and their relationship with survival and other relevant clinical outcomes in PD patients from Sweden. Method Using the Swedish Renal Registry (SRR), clinical data from all patients initiating PD in Sweden between 2006 and 2015 were linked to other national healthcare registries to obtain information on vital status, hospitalization and diagnoses during in and out-patient care, along with information on all dispensed drugs, from inclusion to the end of 2017. We first evaluated trends in the use of PD-related treatments and of selected key medications within 2-year blocks. We then evaluated the incidence of death, major cardiovascular events (MACE), technique failure, transplantation and peritonitis episodes within one and two years from PD initiation using standardized incidence rates via logistic regression to account for differences in patient characteristics over time. In subsequent Cox regression models, we studied whether adjustment for implementation of these therapeutic changes modified observed trends in clinical outcomes. Finally, patient survival was compared against the age-sex matched general Swedish population using standardized incidence ratios (SIR). Results 3,312 patients (mean age 63±15 years; 34% women) initiated PD in Sweden during the study period. Across 2-year time blocks, there was no difference over time in the distribution of age, sex or comorbidities with the exception of an increased proportion of patients with chronic pulmonary disease. The proportion of patients undergoing automated peritoneal dialysis and using icodextrin increased over time, while mean standard Kt/V and weekly creatinine clearance did not change. The use of non-calcium phosphate binders, cinacalcet and calcium-channel blockers increased, and the use of angiotensin-converting enzyme inhibitors /angiotensin receptor blockers, erythropoietin, iron, and calcium supplements showed decreasing trends. After standardization for differences in demography and comorbidities, the one-year incidence of peritonitis decreased by 13% and the rate of kidney transplantation increased by 52% in 2014/15 compared to 2006/07. The rates of death, MACE or technique failure did not show differences over time. Similar results were observed with 2-years of follow up and when applying Cox models; Per 2-year period, the risk of peritonitis within one year decreased by 8% (HR 0.92, 95% CI 0.87-0.98) regardless of age, sex, comorbidity and the abovementioned therapeutic changes. The risk of death for PD patients was in 2006/2007 4 times higher [SIR 4.08 (3.15–5.29)] and in 2014/15 3.7 times higher [SIR 3.65 (2.70–4.94)] than the general population, corresponding to a reduction of SIR by 11%. Conclusion During the last 10 years, there has been a gradual implementation of new and established evidence-based treatments in patients starting PD in Sweden. Although survival rates are improving compared to the general population, there were no clear differences in the rates of technique failure, MACE or death across PD patients over time. We observed, however, consistent improvements in peritonitis frequency and access to transplantation.

Mortality after proximal hip fracture in the Singapore population

2005 ◽  
Vol 15 (3) ◽  
pp. 166-170 ◽  
Author(s):  
K.H. Lin ◽  
Y.W. Lim ◽  
Y.J. Wu ◽  
K.S. Lam
Keyword(s):  
Hip Fracture ◽  
Mortality Risk ◽  
Cox Regression ◽  
Regional Hospital ◽  
Age Group ◽  
Risk Of Death ◽  
The Past ◽  
The Mean ◽  
One Year

The aims were to prospectively assess the mortality risk following proximal hip fractures, identify factors predictive of increased mortality and to investigate the time trends in mortality with comparison to previous studies. Prospectively collected data from 68 consecutive patients who had been admitted to a regional hospital from May 2001 to September 2001 were reviewed. The mean age of the patients was 79.3 years old (range, 55–98) and 72.1% females. Patients were followed prospectively to determine the mortality risk associated with hip fracture over a two-year follow-up period. The acute in-hospital mortality rate at six months, one year and two years was 5.9% (4/68), 14.7% (10/68), 20.6% (14/68) and 25% (17/68) respectively. One-year and two-year mortality for those patients who were 80 or older was significantly higher than for other patients and the number of co-morbid illnesses also had significant effect. Cox regression was performed to determine the significant predictors for survival time. It was noted that patients 80 years or older were at higher risk of death compared with those less than 80 years as well as those with higher number of co-morbid illnesses. Our mortality rates have not declined in the past 10 years when compared with previous local studies. We conclude that for this group of patients studied, their mortality at one year and two years could be predicted by their age group and their number of co-morbid illnesses.

scholarly journals One-year mortality after severe COPD exacerbation in Bulgaria

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e2788 ◽  
Author(s):  
Evgeni Mekov ◽  
Yanina Slavova ◽  
Adelina Tsakova ◽  
Marianka P. Genova ◽  
Dimitar T. Kostadinov ◽  
...  
Keyword(s):  
Cox Regression ◽  
Smoking Status ◽  
Good Prognosis ◽  
Severe Exacerbation ◽  
Vitamin D Status ◽  
Copd Patients ◽  
Point Increase ◽  
One Year ◽  
The One

Introduction One-year mortality in COPD patients is reported to be between 4% and 43%, depending on the group examined. Aim To examine the one-year mortality in COPD patients after severe exacerbation and the correlation between mortality and patients’ characteristics and comorbidities. Methods A total of 152 COPD patients hospitalized for severe exacerbation were assessed for vitamin D status, diabetes mellitus (DM), arterial hypertension (AH), and metabolic syndrome (MS). Data were gathered about smoking status and number of exacerbations in previous year. CAT and mMRC questionnaires were completed by all patients. Pre- and post-bronchodilatory spirometry was performed. One-year mortality was established from national death register. Results One-year mortality is 7.2%. DM, MS, and VD are not predictors for one-year mortality. However there is a trend for increased mortality in patients with AH (9.5% vs. 2.1%, p = 0.107). There is increased mortality in patients with mMRC > 2 (11.1 vs. 0%, p = 0.013). The presence of severe exacerbation in the previous year is a risk factor for mortality (12.5% vs. 1.4%, p = 0.009). There is a trend for increased mortality in the group with FEV1 < 50% (11.5 vs. 4.4%, p = 0.094). Cox regression shows 3.7% increase in mortality rate for 1% decrease in FEV1, 5.2% for 1% decrease in PEF, 7.8% for one year age increase and 8.1% for 1 CAT point increase (all p < 0.05). Conclusions This study finds relatively low one-year mortality in COPD patients after surviving severe exacerbation. Grade C and FEV1 > 80% may be factors for good prognosis. Risk factors for increased mortality are age, FEV1 value, severe exacerbation in previous year and reduced quality of life.

scholarly journals Prior lymphopenia is associated with mortality in primary care pneumonia: a cohort study

2020 ◽  
pp. bjgp20X713981
Author(s):  
Fergus W Hamilton ◽  
Rupert Payne ◽  
David T Arnold
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Lymphocyte Count ◽  
Cox Regression ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Risk Of Death ◽  
Increased Risk ◽  
One Year ◽  
The Relationship

Abstract Background: Lymphopenia (reduced lymphocyte count) during infections such as pneumonia is common and is associated with increased mortality. Little is known about the relationship between lymphocyte count prior to developing infections and mortality risk. Aim: To identify whether patients with lymphopenia who develop pneumonia have increased risk of death. Design and Setting: A cohort study in the Clinical Practice Research Datalink (CPRD), linked to national death records. This database is representative of the UK population, and is extracted from routine records. Methods: Patients aged >50 years with a pneumonia diagnosis were included. We measured the relationship between lymphocyte count and mortality, using a time-to-event (multivariable Cox regression) approach, adjusted for age, sex, social factors, and potential causes of lymphopenia. Our primary analysis used the most recent test prior to pneumonia. The primary outcome was 28 day, all-cause mortality. Results: 40,909 participants with pneumonia were included from 1998 until 2019, with 28,556 having had a lymphocyte test prior to pneumonia (median time between test and diagnosis 677 days). When lymphocyte count was categorised (0-1×109/L, 1-2×109/L, 2-3×109/L, >3×109/L, never tested), both 28-day and one-year mortality varied significantly: 14%, 9.2%, 6.5%, 6.1% and 25% respectively for 28-day mortality, and 41%, 29%, 22%, 20% and 52% for one-year mortality. In multivariable Cox regression, lower lymphocyte count was consistently associated with increased hazard of death. Conclusion: Lymphopenia is an independent predictor of mortality in primary care pneumonia. Even low-normal lymphopenia (1-2×109/L) is associated with an increase in short- and long-term mortality compared with higher counts.

scholarly journals Risk factors associated with the development of death events during the first year of follow-up after pulmonary thromboembolism

2019 ◽  
pp. 80-85
Author(s):  
S. A. Berns ◽  
E. A. Schmidt ◽  
A. G. Neeshpapa ◽  
A. A. Potapenko ◽  
K. V. Smirnov ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Anticoagulant Therapy ◽  
Severe Heart Failure ◽  
First Year ◽  
Factors Associated ◽  
Risk Of Death ◽  
One Year ◽  
The One

Purpose: to identify the factors associated with the development of death events during the year follow-up after hospitalization for pulmonary embolism (PE). Materials and methods: 93 patients with PE discharged to the outpatient stage of observation were studied. 45 (61,6%) patients were female with an average age of 66 years. The examination of patients at the stage of inclusion in the study consisted of standard methods of examination for this pathology. The diagnosis was confirmed by multislice computed tomography. Follow-up was 12 months. Statistical analysis was performed using the MedCalc Version 16.2.1. Results: during the one-year follow-up period 62 (66,7%) patients with PE were alive but 11 patients (11,8%) died, and no information was obtained about 20 patients. The causes of death were as follows: the development of recurrent PE – 4 (36,4%) patients, cancer – 3 patients (27,3%), stroke – 2 (18,1%), one patient (9,1%) died due to severe heart failure and one – myocardial infarction. A comparative analysis in the groups of alive patients (n = 62) and patients with a fatal events (n = 11) showed that the dead patients were older (78 (68; 81) vs. 65 (49; 75) years; p = 0,003), had a higher PESI score (119,0 (99,7; 137,2) vs. 88,0 (68,0; 108,0); p = 0,016) and were less compliant to prolonged anticoagulant therapy during the one year of observation (45,5% of patients (n = 5) vs. 82,3% ( = 51); p = 0,015). The ROC curve determined that a high risk of death during the one year after PE is associated with age over 70 years (p = 0,0001) and more than 95 points by PESI in the hospital period (p = 0,0001). Conclusion: The death events were developed in 11,8% of cases in patients with pulmonary embolism during the first year of follow-up. The death outcomes were significantly associated with elderly age, intermediate and high risk by PESI in the hospital period and low compliance to anticoagulant therapy extended during the year after pulmonary embolism.

P3601Association of cdkn2b rs2891168 polymorphism with wall motion index score and the development of major adverse cardiovascular events within one year following ST elevation myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F A Magamedkerimova ◽  
F A Magamedkerimova ◽  
E N Ivantsov ◽  
N R Khasanov ◽  
E V Valeeva ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Events ◽  
Wall Motion ◽  
St Elevation Myocardial Infarction ◽  
Major Adverse Cardiovascular Events ◽  
Kaplan Meier ◽  
St Elevation ◽  
One Year ◽  
The One ◽  
Cdkn2b Gene

Abstract Introduction According to the GRACE registry the largest amount of deaths occurs in the first year after ST elevation myocardial infarction (STEMI). Purpose To investigate the incidence of Major Adverse Cardiovascular Events (MACE), which include cardiovascular death, nonfatal myocardial infarction, nonfatal stroke one year after STEMI and Wall Motion Index Score (WMSI) in patients with different genotypes A/G of rs2891116 polymorphism in CDKN2B gene. Materials and methods A total of 141 patients, diagnosed with STEMI based on the Third Universal Definition of Myocardial Infarction (ESC, 2013) were included in the study, composed of 52 females and 89 males. The study group mean age was 63.8±11.8 years. Informed consent was obtained. During hospitalization echocardiography was performed and a blood sample was taken for genetic testing. Over the one-year period MACE were recorded. 17 patients were lost to follow up. Data was analysed using Kaplan-Meier estimator; to compare differences between groups log-rank test was applied; continuous data analysis was performed by Mann-Whitney test. The measured genotype frequencies fit the Hardy-Weinberg equilibrium (p>0.05). Results Kaplan-Meier survival analysis revealed that in patients with AA genotype the proportion of individuals who experienced MACE over the one year period after STEMI was higher in comparison with AG genotype carriers (log rank p=0.022). Participants with GG genotype did not show significant differences compared to other genotypes carriers (Picture 1). WMSI value in patients with AA genotype was higher (Me = 1.25; Q(0.25) = 1.13; Q(0.75) = 1.56) than in AG genotype carriers (Me = 1.13; Q(0.25) = 1.13; Q(0.75) = 1.25; p=0.037). In participants with GG genotype compared to AA and AG the WMSI value was not significantly different (Me = 1.19; Q(0.25) = 1.13; Q(0.75) = 1.32). Picture 1 Conclusions Genotype AA in CDKN2B gene rs2891168 in patients after STEMI is associated with higher probability of the development of MACE over the one year period after the index event, compared to AG genotype carriers. Participants with AA genotype exhibited a higher WMSI value after STEMI compared to patients with AG genotype.

Immediate Risk for Cardiovascular Events in Hip Fracture Patients: A Population-Based Cohort Study

2021 ◽  
Author(s):  
Warrington W Q Hsu ◽  
Chor-Wing Sing ◽  
Gloria H Y Li ◽  
Kathryn C B Tan ◽  
Bernard M Y Cheung ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Cardiovascular Events ◽  
Population Based ◽  
Competing Risk ◽  
Major Adverse Cardiovascular Events ◽  
Early Management ◽  
Risk Of Death ◽  
One Year ◽  
Subsequent Risk

Abstract Background Emerging evidence showed that bone metabolism and cardiovascular diseases (CVD) are closely related. We previously observed a potential immediate risk of cardiovascular mortality after hip fracture. However, whether there is an immediate risk of cardiovascular events after hip fracture is unclear. The aim of this study was to evaluate the risk for major adverse cardiovascular events (MACEs) between patients having experienced falls with and without hip fracture. Methods This retrospective population-based cohort study used data from a centralized electronic health record database managed by Hong Kong Hospital Authority. Patients having experienced falls with and without hip fracture were matched by propensity score (PS) at a 1:1 ratio. Adjusted associations between hip fracture and risk of MACEs were evaluated using competing risk regression after accounting for competing risk of death. Results Competing risk regression showed that hip fracture was associated with increased one-year risk of MACEs (hazard ratio [HR], 1.27; 95% CI, 1.21 to 1.33; p&lt;0.001), with a 1-year cumulative incidence difference of 2.40% (1.94% to 2.87%). The HR was the highest in the first 90-day after hip fracture (HR of 1.32), and such an estimate was continuously reduced in 180-day, 270-day, and 1-year after hip fracture. Conclusions Hip fracture was associated with increased immediate risk of MACEs. This study suggested that a prompt evaluation of MACE among older adults aged 65 years and older who are diagnosed with hip fracture irrespectively of cardiovascular risk factors may be important, as early management may reduce subsequent risk of MACE.

scholarly journals Prosthetic-joint Infections: Mortality Over The Last 10 Years

2019 ◽  
Vol 4 (4) ◽  
pp. 198-202 ◽  
Author(s):  
Arnaud Fischbacher ◽  
Olivier Borens
Keyword(s):  
Surgical Treatment ◽  
University Hospital ◽  
Cumulative Mortality ◽  
Risk Of Death ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Significant Difference ◽  
One Year ◽  
The One

Abstract. Background: There is a constant increase of joint arthroplasties to improve the quality of life of an ever-aging population. Although prosthetic-joint infections are rare, with an incidence of 1-2%, they represent a serious complication in terms of morbidity and mortality. Infection related mortality is known to be approaching 8% at one year. The aim of this retrospective study is to reassess the one and two-year mortality over the last ten years.Methods: Patients treated for prosthetic joint infection at the University Hospital of Lausanne (Switzerland) between 2006 and 2016 were included. The one and two-year cumulative mortality depending on sex, age, type of prosthesis, infecting organism and type of surgical treatment were computed.Results: 363 patients (60% hips, 40% knees) were identified with a median age of 70 years. The one-year cumulative mortality was 5.5% and it was 7.3% after two years. No difference was seen between hip and knee prostheses, but the mortality was higher in men than in women and increased with age. Furthermore, there was a significant difference depending of the germ with enterococci infections associated with a higher risk of death. Finally, patients treated with a one-stage or two-stage exchange had a lower mortality than those treated with debridement and retention.Conclusion: The mortality is still high and differs according to sex, age, infecting organism and type of surgical treatment. There is a need of studies to improve the management of patients at risk of increased mortality.

scholarly journals Association Between Implementation Of Novel Therapies And Improved Survival In Patients Starting Hemodialysis: The Swedish Renal Registry 2006-2015

2020 ◽  
Author(s):  
Marie Evans ◽  
Hong Xu ◽  
Helena Rydell ◽  
Karl-Göran Prütz ◽  
Bengt Lindholm ◽  
...  
Keyword(s):  
General Population ◽  
Cox Regression ◽  
Survival Rates ◽  
Hemodialysis Patients ◽  
Phosphate Binders ◽  
Short Term ◽  
Ultrafiltration Rate ◽  
Risk Of Death ◽  
Major Cardiovascular Events ◽  
Laboratory Biomarkers

Abstract Background The recent years have witnessed significant therapeutic advances for patients on hemodialysis. We evaluated temporal changes in treatments practices and survival rates among incident hemodialysis patients. Methods Observational study of patients initiating hemodialysis in Sweden 2006-2015. Trends of hemodialysis-related practices, medications, and routine laboratory biomarkers were evaluated. The incidence of death and major cardiovascular events (MACE) across calendar years were compared against the age-sex-matched general population. Via Cox regression, we explored whether adjustment for implementation of therapeutic advances modified observed survival and MACE risks. Results Among 6,612 patients, age and sex were similar, but the burden of co-morbidities increased over time. The proportion of patients receiving treatment by hemodiafiltration, &gt;3 sessions/week, lower ultrafiltration rate, and working fistulas increased progressively, as did use of non-calcium phosphate binders, cinacalcet, and vitamin D3. The standardized 1-year mortality decreased from 13.2% in 2006/07 to 11.1% in 2014/15. The risk of death decreased by 6% (HR 0.94, 95% CI 0.90-0.99) every two years, and the risk of MACE by 4% (HR 0.96; 0.92-1.00). Adjustment for changes in treatment characteristics abrogated these associations (HR 1.00; 0.92-1.09 for death and 1.00; 0.94-1.06 for MACE). Compared with the general population, the risk of death declined from 6 times higher 2006/2007 [standardized incidence rate ratio, sIRR 6.0 (5.3–6.9)], to 5.6 higher 2014/15 [sIRR 5.57 (4.8–6.4)]. Conclusions Gradual implementation of therapeutic advances over the last decade was associated with a parallel reduction in short-term risk of death and MACE among hemodialysis patients.

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