FC 046INCIDENCE OF NOSOCOMIAL ACUTE KIDNEY INJURY (AKI) IN A COHORT OF COMMUNITY-DWELLING OLDER ADULTS OVER 8 YEARS OF OBSERVATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Natalie Ebert ◽  
Alice Schneider ◽  
Yanina Balabanova ◽  
Gunnar Brobert ◽  
Dörte Huscher ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Incidence Rates ◽  
Peripheral Artery ◽  
Icd 10 ◽  
Artery Disease ◽  
Age Category

Abstract Background and Aims Acute kidney injury (AKI) is amongst the most common in-hospital complications especially in old age. Epidemiological data on incidence rates (IR) of nosocomial AKI in individuals aged 70+ years, stratified by age, gender and pre-existing diseases are scarce because older adults are usually underrepresented in clinical research. Method We used data from the Berlin Initiative Study (BIS), a longitudinal, population-based cohort of adults aged ≥70 with biennial follow-up visits (including blood and urine tests) in combination with claims data from the AOK Nordost insurance fund to complement information on diagnoses and in-hospital procedures (based on ICD-10 and OPS coding). Nosocomial AKI was defined as documented in-hospital diagnosis (ICD-10: N17.xx) excluding cases with AKI as admission diagnosis. Incidence rates (IR) and 95% confidence intervals (CI) of the first nosocomial AKI were calculated with the number of incident cases during observation divided by the total person-years of follow-up, for AKI cases truncated at the first incidence of nosocomial AKI. IR are reported by age strata, sex and preexisting diseases (diabetes, arterial hypertension, atrial fibrillation, heart failure, angina pectoris, peripheral artery disease and impaired kidney function). Results In 2020 individuals (mean age 80.5 years; 52.6% women), 383 developed nosocomial AKI over the median [IQR] follow up time of 8.8 [5.9-9.3] years (Fig.1). The IR of nosocomial AKI was 26.8 (95%CI 24.1-29.6) per 1000 person years among all patients, with higher IR in men compared to women, and - when stratified by age - lowest IR in age category 70-75 versus the highest IR in age category of ≥ 90 years (Fig.1). IR per 1000 person years were higher in patients with diabetes mellitus (IR: 39.3 vs 22.7), arterial hypertension (IR: 31.1 vs 12.2), chronic heart failure (IR: 41.9 vs 22.3), angina pectoris (IR: 37.6 vs 25.7), peripheral artery disease (IR: 55.0 vs 25.1) and impaired kidney function (IR: 43.3 vs 12.4), respectively (Fig.2). Conclusion Nosocomial AKI is an in-hospital complication common in older adults with IRs rising continuously with age above the age of 70 years. IR of AKI are considerably higher in patients with cardiovascular comorbidities. A better understanding of the patient population at risk is of great clinical relevance when aiming to improve prevention strategies.

scholarly journals TO019PROGNOSTIC VALUE OF ACUTE KIDNEY INJURY AND HEMOCONCENTRATION DURING ACUTE HEART FAILURE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yannis Lombardi ◽  
Franck Boccara ◽  
Kadiatou Baldet ◽  
Stéphane Ederhy ◽  
Pascal Nhan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Clinical Practice ◽  
Prognostic Value ◽  
Serum Proteins ◽  
Kidney Injury ◽  
Hospital Entry ◽  
Furosemide Administration ◽  
Transient Aki

Abstract Background and Aims Acute kidney injury (AKI) occurring after diuretic treatment initiation for acute heart failure (AHF) is a common phenomenon, with an incidence estimated between 20 and 50% of AHF hospitalizations. Previous studies found that persistent AKI is associated with poor prognosis. Treatment-induced hemoconcentration is associated with improved prognosis, but several definitions previously used are not suited for clinical practice. Transient AKI, with or without hemoconcentration, is of unsettled prognosis. We aim to determine the independent prognostic value of transient AKI, persistent AKI and hemoconcentration in the context of AHF hospitalization, using practical definitions. Method Data were obtained from the Greater Paris University Hospitals (GPUH) Clinical Data Warehouse. Patients hospitalized for AHF in various GPUH units were included. AHF hospitalization was defined as hospitalization with at least one AHF ICD-10 code and at least one recorded furosemide administration. Bumetanide is rarely used in GPUH hospitals hence it was not considered. AKI in a period of 14 days following first furosemide administration was defined based on KDIGO guidelines. Hemoconcentration was defined as an increase in serum proteins ≥ 5 g/l during the same period. Multivariate logistic regression was performed to determine which characteristics were predictive of AKI. Cox regression of 100 days all-cause mortality using multiple confounders was performed to determine the prognostic value of transient AKI (< 14 days), persistent AKI (≥ 14 days) and hemoconcentration. Patients with AKI upon hospital entry were excluded from regression analyses. AKI and hemoconcentration were treated as time-dependent covariates to adjust for immortality bias. Results Five hundred seventy nine patients were included. Among them, 529 had no AKI upon hospital entry and 513 had at least one recorded serum proteins and creatinine value following furosemide initiation. Median follow-up was 114 days. AKI in a period of 14 days following furosemide initiation occurred in 234 patients (40.4%). At baseline, patients in the AKI group more frequently suffered from chronic kidney disease or presented with clinical and echocardiographic signs of right heart failure. Independent predictors of AKI were arterial hypertension upon furosemide initiation (adjusted OR 1.86 [1.08 – 3.22]), elevated serum creatinine upon furosemide initiation (adjusted OR 1.07 [1.01 – 1.14] per 10 µmol/l increase) and initial intravenous administration of furosemide (adjusted OR 2.42 [1.39 – 4.29]). Death during follow-up occurred in 35% of patients in the AKI group compared to 21% in the non-AKI group (p < 0.001). In multivariate analysis, persistent AKI was independently associated with increased mortality in a period of 100 days following furosemide initiation (adjusted HR 2.31 [1.07 – 4.99]). Transient AKI was not significantly associated with mortality (adjusted HR 0.64 [0.34 – 1.19]). Hemoconcentration was independently associated with decreased mortality (adjusted HR 0.46 [0.27 – 0.79]). Conclusion After furosemide initiation during hospitalization for AHF, persistent AKI (≥ 14 days) was independently associated with increased 100 days mortality. Hemoconcentration, using a definition suited for clinical practice (≥ 5 g/l increase in serum proteins), was independently associated with decreased 100 days mortality. No significant association was found between mortality and transient AKI (< 14 days). Those findings show that laboratory tests at a limited cost – serum proteins and creatinine – are helpful to evaluate treatment response and mortality risk during AHF. Prospective randomized controlled trials are needed to establish diuretic strategies based on both AKI and hemoconcentration.

scholarly journals Acute Coronary Syndrome in Patients with Thrombotic Thrombocytopenic Purpura

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 4-5
Author(s):  
Moataz Ellithi ◽  
Fouad Khalil ◽  
Smitha N Gowda ◽  
Waqas Ullah ◽  
Radowan Elnair ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Thrombotic Microangiopathy ◽  
Kidney Injury ◽  
Coronary Syndrome ◽  
Icd 10 ◽  
History Of ◽  
Artery Disease

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening clinical syndrome characterized by microangiopathy and a variable degree of end-organ ischemic damage. Cardiac involvement has been recognized as a major cause of mortality in these patients (Patschan et al, Nephrol Dial Transplant, 2006; Benhamou et al, J Thromb. Haemost, 2015). In this study, we aim to investigate clinical predictors and outcomes of acute coronary syndrome in the setting of TTP admissions. Methods: The National Inpatient Sample (NIS) was queried for all hospitalizations with a primary diagnosis of thrombotic microangiopathy (ICD- 9-CM code 4466 and ICD-10-CM code M3.11) from 2002 to 2017. Using ICD-9-CM procedure codes (9972), (9971), and (9979), as well as ICD-10-CM procedure codes (6A551Z3) and (6A550Z3) we identified patients who received plasma exchange (PLEX) during the same admission. Due to the wide spectrum of thrombotic microangiopathy diseases, we decided to include only those who received PLEX to get a more specific subpopulation who were presumed to have TTP. We stratified patients based on whether or not they had acute coronary syndrome (ACS) during the admission, defined as presence of any ICD code for either ST-segment elevation myocardial infarction (STEMI), Non-STEMI, or unstable angina. Baseline characteristics and inpatient outcomes were compared between groups. Statistical analysis was performed using SPSS v26 (IBM Corp, Armonk, NY, USA). The odds ratio (OR) and 95% confidence interval (CI) were calculated using the Cochran-Mantel-Haenszel test. A multivariate regression model was deployed to assess predictors of inpatient mortality. Complex weights were used throughout all calculations, enabling appropriate national projections. Results: A total of 15,640 patients with the diagnosis of thrombotic microangiopathy were identified during the studied period. Of those, 6,214 patients had received PLEX treatment during their admission (39.7%). The annual admission rate for TTP was ranging between 5-7/100,000 admissions. Patients had a mean age of 47.8 years; 67% were females, and 46.5% were Caucasian. Stratifying by geographic region, 24% were from the Northeast, 21% from the Midwest, 42% from the South, and 13% from the West. The most common primary payer was private insurance (42.7%). Overall inpatient mortality was 9.1%. The most common complications reported included acute kidney injury (42.5%), followed by acute respiratory failure (14.9%), incident dialysis (14.3%), acute encephalopathy (7.7%), acute heart failure (7.3%), acute cerebrovascular accident (7.2%), and acute coronary syndrome (6.3%). ACS was documented in 6.7% of patients. Compared with patients without ACS, those with ACS were relatively older and had a relatively higher prevalence of coronary artery disease, dyslipidemia, diabetes mellitus, essential hypertension, chronic kidney disease, and heart failure. Patients with ACS had a 3-fold higher in-hospital mortality and a longer mean hospital stay (19 days vs. 15 days, P<0.001). Using stepwise logistic regression, we identified age (aOR 1.03; 95% CI, 1.02 - 1.03; P <0.001), history of heart failure (aOR 2.02; 95% CI, 1.53-2.67; P <0.001), and history of coronary artery disease (aOR 2.69; 95% CI, 2.03 - 3.57; P <0.001) as independent predictors of ACS among patients hospitalized with TTP. On another regression analysis, certain complications were more prevalent in the ACS group including acute cerebrovascular accidents, acute heart failure, acute kidney injury, cardiogenic shock, and respiratory failure. Conclusion: Despite wider utilization of therapeutic plasmapheresis and improved supportive treatments for patients with TTP, associated morbidity and mortality remain significant. We demonstrate from this large retrospective cohort that ACS is an independent predictor of higher morbidity and mortality in TTP patients. We identified older age, history of heart failure, and history of coronary artery disease as independent predictors of ACS among patients admitted with TTP. Further studies are warranted to develop risk stratification models for patients with TTP. Figure Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.: Honoraria, Research Funding, Speakers Bureau.

scholarly journals Association between Hospitalised Vaso-Occlusive Crises and Acute/Chronic Complications in Sickle Cell Disease Patients Aged 16 Years and Older Using the French National Health Insurance Database (SNDS)

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3107-3107
Author(s):  
Jean-Benoît Arlet ◽  
Hannah Lennon ◽  
Miranda Bailey ◽  
Eleonore Herquelot ◽  
Ludovic Lamarsalle ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Pulmonary Hypertension ◽  
Sickle Cell ◽  
Medical Devices ◽  
Research Funding ◽  
Research Study ◽  
Kidney Injury ◽  
Chronic Complications ◽  
Icd 10

Abstract Background Patients with sickle cell disease (SCD) experience a wide range of complications thought to be due to the systemic impact of chronically inflamed vasculature, ongoing haemolysis, multi-cellular adhesion and ischemic damage. These complications impact the health-related quality of life and the life expectancy. One of the most impactful complications is the vaso-occlusive crisis (VOC). Evidence of the relationship between VOC occurrence and the incidence of SCD-related complications is still emerging. Aims To assess the association between hospitalised VOC rates and acute and chronic complications in SCD patients. Methods This study was a retrospective observational cohort study using the French national health insurance's claims database. This database gathers information on hospital records, and primary and secondary care. Between 01-01-2012 and 12-31-2018, all patients 16 years and older suffering from SCD (through a hospital record or Long-Term Disease status with diagnostic ICD-10 codes D57.0-2) were included in the study. Participants were followed-up for at least one year and until 12-31-2018. A hospitalised VOC was defined as a hospital stay of at least one night with a primary or related diagnosis of sickle-cell anaemia with crisis (D57.0), preceded by a transit through the emergency room. The VOC annual rate was defined as the total number of VOCs during the follow-up divided by the number of follow-up years. Patients were categorised by the annual rate of VOCs they experienced into three groups: <1; 1 to <3; ≥3 VOCs per year. Complications [1] known to be experienced by patients with SCD and leading to a hospitalisation were identified during the follow-up using ICD-10 codes reported in the hospital discharge records. Cox proportional hazards models using age as the time scale were used to study the effect of the annualized rate of hospitalised VOCs on the risk of complications, adjusted for sex. Results A total of 17,726 patients were included in the study, of which 65.3% were female -a high proportion partly due to inclusion of women at time of pregnancy hospital stay. Ages ranged from 16 to 99 years and the average age was 35.0 years (±17.8). Overall, 90.3%, 7.4%, and 2.3% of patients experienced <1, 1 to <3, or ≥3 VOCs per year during the follow up period, respectively. Over a median follow up of 7 years, the most common complications requiring a hospital admission were acute chest syndrome (ACS) (18%), sepsis (16%), acute kidney injury (12%), gallstones (10%), and eye disorder (7%). During the follow-up period, compared to <1 hospitalised VOC per year, patients with a rate of ≥3 hospitalised VOCs per year had a statistically significant higher risk of inpatient treated complications: a 19.2 [95%CI 16.0;22.9]-time increase in the risk of osteonecrosis, 16.7[95%CI 12.0;23.2] of pulmonary hypertension, 16.4 [95%CI 13.2;20.5] of pulmonary embolism, 13.3 [95%CI 12.0;14.8] of ACS, 12.8 [95%CI 8.2;20.2] of heart failure, 12.0 [95% CI 10.0;14.4] of eye disorder, 10.0 [95% CI 8.9;11.2] of sepsis, 9.7 [95% CI 8.3;11.4] of acute kidney injury, 6.7 [95% CI 5.7;7.9]of gallstones, 6.3 [95% CI 4.3;9.0] of priapism, 6.1 [95% CI 4.6;8.0] of liver complication, 5.9 [95% CI 4.3;8.0] of central nervous system complications, 3.4 [95% CI 2.0;5.8] of dialysis, 3.2 [95% CI 2.2;4.6] of stroke.. Conclusions Patients frequently experiencing VOCs are at much greater risk of hospitalization for some chronic complications compared to patients rarely experiencing VOCs. The highest association were found for osteonecrosis and pulmonary hypertension or embolism. It could be an additional reason to reinforce treatment of SCD patients with recurrent VOCs. [1] ACS, Sepsis, Acute Kidney Injury, Gall stones, Eye disorder, Osteonecrosis, Liver complication, Stroke, Pulmonary embolism, Dialysis, Central nervous system, Pulmonary hypertension, Heart failure, Priapism, Kidney transplantation, Cardiomegaly Disclosures Arlet: Novartis company: Consultancy, Honoraria, Research Funding; Pfizer: Honoraria; Addmedica: Research Funding. Lennon: HEVA: Ended employment in the past 24 months; IQVIA (contractor to JANSSEN Pharmaceuticals): Current Employment; WHO International Agency for Research on Cancer: Ended employment in the past 24 months. Bailey: Novartis pharmaceuticals: Current Employment. Herquelot: Pharmaceuticals and medical devices companies (BMS, MSD, Merck Sante, Janssen, Cook, Novartis, Pfizer, Takeda, ...): Other: Grants or contracts for our CRO from pharmaceutical and MD industries for research study. Lamarsalle: Pharmaceutical and medical devices comapnies (BMS, BSCI, AstraZeneca, Janssen, Merck, Novartis, Pfizer, Roche, ...): Other: Grants or contracts for our CRO from pharmaceutical and MD industries for research study. Raguideau: Pharmaceutical and medical devices companies (BMS, MSD, Merck Sante, Janssen, Cook, Novartis, Pfizer, Takeda, ...): Other: Grants or contracts for our CRO from pharmaceutical and MD industries for research study. Bartolucci: ADDMEDICA, NOVARTIS, ROCHE, GBT, Bluebird, EMMAUS, HEMANEXT, AGIOS: Consultancy; NOVARTIS, ADDMEDICA, JAZZPHARMA: Other: Lecture fees; Novartis: Other: Steering committee; ADDMEDICA, foundation Fabre, NOVARTIS, Bluebird: Consultancy, Research Funding; INNOVHEM: Other: Cofounder.

scholarly journals Heart failure and contrast-induced acute kidney injury in patients with coronary artery disease

2020 ◽  
Vol 22 (10) ◽  
pp. 61-63
Author(s):  
Olga Iu. Mironova ◽  
◽  
Olga A. Sivakova ◽  
Aleksandr D. Deev ◽  
Viktor V. Fomin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Acute Kidney Injury ◽  
Coronary Artery ◽  
Serum Creatinine ◽  
Contrast Media ◽  
Kidney Injury ◽  
Baseline Serum ◽  
Artery Disease ◽  
Contrast Media Administration

Aim. To assess the influence of heart failure on the risk of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) with indications to diagnostic procedures requiring intra-arterial administration of contrast media. Materials and methods. 1023 patients, who were receiving optimal medical therapy and had indications to coronary angiography and possible coronary angio-plasty, with stable CAD were included in the study. We conducted an observational open prospective cohort study, which was registered in clinicaltrials.gov with ID NCT04014153. CI-AKI was defined as 25% or more increase of baseline serum creatinine, or more than 0.5 mg/dl and was assessed 48 hours after contrast media administration. The primary endpoint was the CI-AKI development according to KDIGO criteria. Most of the patients, included in the study, were males aged 66.3±10 years with arterial hypertension and overweight (BMI 29.14±5 kg/m2). Results. The study included 1023 patients, 76 suffered from heart failure. The rate of CI-AKI in this group was 13.2% (10 patients). The rate of CI-AKI using the absolute creatinine rise definition was 4% cases (3 cases). Conclusion. Female patients suffering from heart failure with higher levels of serum creatinine and low glomerular filtration rate need more attention, less amount of contrast and adequate preventive measures before contrast media administration in order to lower the risk of CI-AKI development.

scholarly journals Incidence of myocardial infarction, heart failure, and cardiovascular mortality in patients with peripheral artery disease: nationwide trends between 1997 and 2016

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Kamil ◽  
T S G Sehested ◽  
K Houlind ◽  
J F Lassen ◽  
G Gislason ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Peripheral Artery Disease ◽  
Cumulative Incidence ◽  
Incidence Rates ◽  
Peripheral Artery ◽  
The Past ◽  
Artery Disease ◽  
First Time ◽  
Time Diagnosis

Abstract Background Over the past decades there has been a shift in cardiovascular (CV) risk factors with improved outcomes. Updated trends in incidence of myocardial infarction (MI) and heart failure (HF) in peripheral artery disease (PAD) are warranted. Purpose We aimed to investigate trends in the incidence of MI, HF, and CV mortality in PAD patients during the past two decades. Methods Nationwide registers were used to identify all patients aged ≥18 years, with first-time diagnosis of PAD between 1997 and 2016. Age-standardized incidence rates per 1,000 person-years (IR) were calculated to estimate trends of MI, HF, and CV mortality. Furthermore, risk of MI, HF, and CV mortality was estimated by 1-year cumulative-incidence with death as competing risk. Results A total of 136,746 patients with first-time diagnosis of PAD were included. Mean age was 70.01 [IQR 61–77 years], and 53.05% of the identified patients were male. The 1-year cumulative-incidence of MI in patients with PAD were 1.88% for year 1997–2000, 2.12% for year 2001–2005, 1.59% for year 2006–2010, and 1.32% for year 2011–2016, respectively. The 1-year cumulative-incidence of HF in patients with PAD were 1.71%, 1.48%, 1.25%, and 1.11% for the 1997–2000, 2001–2005, 2006–2010, and 2011–2016 year-groups, respectively. Furthermore the 1-year cumulative-incidence of CV mortality in patients with PAD were 12.0%, 9.41%, 8.75%, and 7.80% for the 1997–2000, 2001–2005, 2006–2010, and 2011–2016 year-groups, respectively. Likewise, the age-standardized incidence rates pr. 1,000 person-years showed increasing trends of MI up until 2002 with an estimated annual percent change (APC) of +0.6 (95% CI 3.3–16.1, p-value 0.2). After year 2002 the IR decreased significantly with an estimated APC of −5.0 (95% CI 3.7–6.3, p<0.0001). The age-standardized IR for HF decreased with an estimated APC of −3.3 (95% CI 2.0–4.6, p<0.0001), and similarly for CV death decreased by −3.5 (95% CI 3.0–4.0, p<0.0001). Conclusion The incidence of MI and HF in patients with PAD has significantly decreased over time together with a subsequent decline in CV mortality. This may suggest that the improvements in preventive strategies aimed at reducing CV risk are effective and contributes to lower incidence of MI and HF and thereby improved mortality rates in the past two decades. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Quinine exposure and the risk of acute kidney injury: a population-based observational study of older people

2020 ◽  
Vol 49 (6) ◽  
pp. 1042-1047 ◽  
Author(s):  
Andrew D S Duncan ◽  
Simona Hapca ◽  
Nicosha De Souza ◽  
Daniel Morales ◽  
Samira Bell
Keyword(s):  
Older Adults ◽  
Acute Kidney Injury ◽  
Adult Population ◽  
Case Series ◽  
Kidney Injury ◽  
Population Based ◽  
Health Board ◽  
Increased Risk ◽  
Rate Ratios

Abstract Objectives to establish and quantify any observable association between the exposure to community prescriptions for quinine and acute kidney injury (AKI) events in a population of older adults. Design two observational studies using the same dataset, a retrospective longitudinal cohort study and a self-controlled case series (SCCS). Setting NHS health board in Scotland. Participants older adults (60+ years) who received quinine prescriptions in Tayside, Scotland, between January 2004 and December 2015. The first study included 12,744 individuals. The SCCS cohort included 5,907 people with quinine exposure and more than or equal to one AKI event. Main outcome measured in the first study, multivariable logistic regression was used to calculate odds ratios (ORs) for AKI comparing between episodes with and without recent quinine exposure after adjustment for demographics, comorbidities and concomitant medications. The SCCS study divided follow-up for each individual into periods ‘on’ and ‘off’ quinine, calculating incidence rate ratios (IRRs) for AKI adjusting for age. Results during the study period, 273,596 prescriptions for quinine were dispensed in Tayside. A total of 13,616 AKI events occurred during follow-up (crude incidence 12.5 per 100 person-years). In the first study, exposure to quinine before an episode of care was significantly associated with an increased probability of AKI (adjusted OR = 1.27, 95% confidence interval (CI) 1.21–1.33). In the SCCS study, exposure to quinine was associated with an increased relative incidence of AKI compared to unexposed periods (IRR = 1.20, 95% CI 1.15–1.26), with the greatest risk observed within 30 days following quinine initiation (IRR = 1.48, 95% CI 1.35–1.61). Conclusion community prescriptions for quinine in an older adult population are associated with an increased risk of AKI.

scholarly journals Positive and negative well-being of older adults with symptomatic peripheral artery disease: A population-based investigation

2020 ◽  
Vol 9 ◽  
pp. 204800402096171
Author(s):  
Snorri Bjorn Rafnsson ◽  
Gerry Fowkes
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Life Satisfaction ◽  
Depressive Symptoms ◽  
Peripheral Artery Disease ◽  
Well Being ◽  
Peripheral Artery ◽  
Artery Disease

Objective We investigated positive and negative subjective well-being in relation to lower-extremity peripheral artery disease (PAD) in a sample of older adults. Method 4760 participants in the English Longitudinal Study of Ageing (ELSA) provided baseline data on symptomatic PAD, sociodemographic characteristics, lifestyle risk factors, and co-morbid conditions. Baseline and two-year follow-up data were available for life satisfaction, quality of life, and depressive symptoms. Results Participants with PAD symptoms had lower baseline levels of life satisfaction (β = −0.03, p < .05) and quality of life (β = −0.04, p < .01), and more depressive symptoms (β = 0.03, p < .05). These associations remained statistically significant in multivariate analyses. Baseline PAD did not, however, influence well-being levels at two-year follow-up. Discussion Greater awareness of the potential for chronic vascular morbidity to disrupt the lives of older adults is needed to inform effective multidisciplinary support and interventions that help maintain the quality of life of those affected.

scholarly journals Hypoxia-inducible factor 1 (HIF-1) as a biomarker of acute kidney injury in patients with acute decompensation of chronic heart failure

Kardiologiia ◽  
2019 ◽  
Vol 59 (2S) ◽  
pp. 25-30
Author(s):  
E. V. Efremova ◽  
A. M. Shutov ◽  
E. R. Makeeva ◽  
M. V. Menzorov ◽  
E. R. Sakaeva ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Chronic Heart Failure ◽  
Kidney Function ◽  
Filtration Rate ◽  
Hypoxia Inducible Factor ◽  
Kidney Injury ◽  
Hypoxia Inducible Factor 1 ◽  
Acute Decompensation

Actuality.Impaired kidney function adversely influences both immediate and remote prognosis for patients with chronic heart failure (CHF). However, early detection and prediction of acute kidney injury (AKI) are understudied.The aimof study was to investigate hypoxia-inducible factor 1 (HIF-1) as a biomarker for early diagnosis of AKI and determining prognosis in patients with acute decompensated CHF (ADCHF).Materials and methods:84 patients admitted for ADCHF (18 women; mean age, 61.4±7.1) were evaluated. ADCHF was diagnosed in accordance with SEHF guidelines for diagnosis and treatment of chronic heart failure (RCS, 2016). AKI was diagnosed according to KDIGO criteria (2012). HIF-1, N-terminal pro B-type natriuretic peptide (NТ-proBNP), and erythropoietin were measured in blood serum. The follow-up period lasted for 12 months.Results:AKI was diagnosed in 27 (32.1 %) patients. Level of HIF-1 was 1.27±0.63 ng / ml; NТ-proBNP – 2469.6 (interquartile range (IQR), 1312.2; 3300.0) pg / ml; eryhthropoietin – 56.0 mIU / ml (IQR, 13.2; 68.1). No correlation was found between HIF-1 and glomerular filtration rate, NТ-proBNP, or erythropoietin. Differences in biomarker levels were not observed between patients with and without AKI; however, HIF-1 was higher in the group of deceased patients than in the group of survived patients (1.64±0.9 vs. 1.17±0.44 ng / ml, р=0.004), which was not observed for NТ-proBNP and erythropoietin.Conclusion.AKI was observed in every third patient with ADCHF. In ADCHF, HIF-1 was not correlated with the kidney function; however, a relationship was found between the HIF-1 level and prediction for patients with CHF.

scholarly journals The Costs and Cardiovascular Benefits in Patients with Peripheral Artery Disease Receiving a Fourth-Generation Synchronous Telehealth Program (Preprint)

2020 ◽  
Author(s):  
Jenkuang Lee ◽  
Chi-Sheng Hung ◽  
Ching-Chang Huang ◽  
Ying-Hsien Chen ◽  
Hui-Wen Wu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Ischemic Stroke ◽  
Lower Risk ◽  
Cardiovascular Events ◽  
Control Group ◽  
Peripheral Artery ◽  
Coronary Syndrome ◽  
Artery Disease

BACKGROUND Patients with peripheral artery disease (PAD) are at high risk for major cardiovascular events (MACE), including myocardial infarction, stroke, and hospitalization for heart failure. We have previously shown the clinical efficacy of a 4th-generation synchronous telehealth program for some patients, but the costs and cardiovascular benefits of the program for PAD patients remain unknown. OBJECTIVE The telehealth program is now widely used by higher-risk cardiovascular patients to prevent further cardiovascular events. This study investigated whether patients with PAD would also have better cardiovascular outcomes after participating in the 4th-generation synchronous telehealth program. METHODS This was a retrospective cohort study. We screened 5062 patients with cardiovascular diseases who were treated at National Taiwan University Hospital and then enrolled 391 patients with the diagnosis of PAD. Of these patients, 162 took part in the telehealth program, while 229 did not and thus served as control patients. Inverse probability of treatment weighting (IPTW) based on the propensity score was used to mitigate possible selection bias. Follow-up outcomes included heart failure hospitalization (HFH), acute coronary syndrome (ACS), stroke, and all-cause readmission during the 1-year follow-up period and through the last follow-up. RESULTS The mean follow-up duration was 3.1 ± 1.8 years for the patients who participated in the telehealth program and 3.2 ± 1.8 years for the control group. The telehealth program patients exhibited lower risk of ischemic stroke than the control group in the first year after IPTW (0.9% vs. 3.5%; hazard ratio [HR] 0.24, 95% CI 0.07–0.80). The 1-year composite endpoint of vascular accident, including acute coronary syndrome and stroke, was also significantly lower in the telehealth program group after IPTW (2.4% vs. 5.2%; [HR] 0.46, 95% CI 0.21–0.997). At the end of the follow-up, the telehealth program group continued to exhibit a significantly lower rate of ischemic stroke than the control group after IPTW (0.9% vs. 3.5%; [HR] 0.52, 95% CI 0.28–0.93). Furthermore, the medical costs of the telehealth program patients were not higher than those of the control group, whether in terms of outpatient, emergency department, hospitalization, or total costs. CONCLUSIONS The PAD patients who participated in the 4th-generation synchronous telehealth program exhibited lower risk of ischemic stroke events over both mid- and long-term follow-up periods. However, larger scale and prospective randomized clinical trials are needed to confirm our findings.

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