scholarly journals Changes in the rate of cardiometabolic and pulmonary events during the COVID-19 pandemic

2021 ◽  
Author(s):  
Alex J Walker ◽  
John Tazare ◽  
George Hickman ◽  
Christopher T Rentsch ◽  
Elizabeth J Williamson ◽  
...  
Keyword(s):  
Heart Failure ◽  
General Population ◽  
Adult Population ◽  
Clinical Event ◽  
Clinical Events ◽  
Respiratory Events ◽  
Hospitalised Patients ◽  
Respiratory Event ◽  
Hospital Acquired ◽  
The Relationship

AbstractBackgroundThere has been extensive speculation about the relationship between COVID-19 and various cardiometabolic and pulmonary conditions. This a complex question: COVID-19 may cause a cardiometabolic or respiratory event; admission for a clinical event may result in hospital-acquired SARS-CoV-2 infection; both may contribute to a patient surpassing the threshold for presenting to services; and the presence of a pandemic may change whether patients present to services at all. To inform analysis of these questions, we set out to describe the overall rate of various key clinical events over time, and their relationship with COVID-19.MethodsWorking on behalf of NHS England, we used data from the OpenSAFELY platform containing data from approximately 40% of the population of England. We selected the whole adult population of 17m patients and within this identified two further mutually exclusive groups: patients who tested positive for SARS-CoV-2 in the community; and patients hospitalised with COVID-19. We report counts of death, DVT, PE, ischaemic stroke, MI, heart failure, AKI and diabetic ketoacidosis in each month between February 2019 and October 2020 within each of: the general population, community SARS-CoV-2 cases, and hospitalised patients with COVID-19. Outcome events were defined using hospitalisations, GP records and cause of death data.ResultsFor all outcomes except death there was a lower count of events in April 2020 compared to April 2019. For most outcomes the minimum count of events was in April 2020, where the decrease compared to April 2019 in events ranged from 5.9% (PE) to 40.0% (heart failure). Despite hospitalised COVID-19 patients making up just 0.14% of the population in April 2020, these patients accounted for an extremely high proportion of cardiometabolic and respiratory events in that month (range of proportions 10.3% (DVT) to 33.5% (AKI)).InterpretationWe observed a substantial drop in the incidence of cardiometabolic and pulmonary events in the non-COVID-19 general population, but high occurrence of COVID-19 among patients with these events. Shortcomings in routine NHS secondary care data, especially around the timing and order of events, make causal interpretations challenging. We caution that the intermediate findings reported here should be used to inform the design and interpretation of any studies using a general population comparator to evaluate the relationship between COVID-19 and other clinical events.

scholarly journals Changes in Respiratory Muscle Strength Following Cardiac Rehabilitation for Prognosis in Patients with Heart Failure

2020 ◽  
Vol 9 (4) ◽  
pp. 952
Author(s):  
Nobuaki Hamazaki ◽  
Kentaro Kamiya ◽  
Shohei Yamamoto ◽  
Kohei Nozaki ◽  
Takafumi Ichikawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Muscle Strength ◽  
Cardiac Rehabilitation ◽  
Respiratory Muscle ◽  
Clinical Event ◽  
Unplanned Readmission ◽  
Respiratory Muscle Strength ◽  
Clinical Events ◽  
Patients With Heart Failure ◽  
The Relationship

Respiratory muscle weakness, frequently observed in patients with heart failure (HF), is reported as a predictor for poor prognosis. Although increased respiratory muscle strength ameliorates exercise tolerance and quality of life in HF patients, the relationship between changes in respiratory muscle strength and patient prognosis remains unclear. A total of 456 patients with HF who continued a 5-month cardiac rehabilitation (CR) were studied. We measured maximal inspiratory pressure (PImax) at hospital discharge as the baseline and five months thereafter to assess the respiratory muscle strength. Changes in PImax during the 5-month observation period (⊿PImax) were examined. We investigated the composite multiple incidence of all-cause death or unplanned readmission after 5-month CR. The relationship between ⊿PImax and the incidence of clinical events was analyzed. Over a median follow-up of 1.8 years, 221 deaths or readmissions occurred, and their rate of incidence was 4.3/100 person-years. The higher ⊿PImax was significantly associated with lower incidence of clinical event. In multivariate Poisson regression model after adjustment for clinical confounding factors, ⊿PImax remained a significant and independent predictor for all-cause death/readmission (adjusted incident rate ratio for ⊿PImax increase of 10 cmH2O: 0.77, 95% confidence interval: 0.70–0.86). In conclusion, the changes in respiratory muscle strength independently predict the incidence of clinical events in patients with HF.

scholarly journals Gastrointestinal carriage of Klebsiella pneumoniae in a general adult population in Norway: a cross-sectional study of risk factors and bacterial genomic diversity

2021 ◽  
Author(s):  
Niclas Raffelsberger ◽  
Marit Andrea Klokkhammer Hetland ◽  
Kristian Svendsen ◽  
Lars Småbrekke ◽  
Iren H. Löhr ◽  
...  
Keyword(s):  
Risk Factors ◽  
Population Structure ◽  
General Population ◽  
Klebsiella Pneumoniae ◽  
Representative Sample ◽  
Adult Population ◽  
Antibiotic Use ◽  
Genomic Diversity ◽  
Prescription Database ◽  
Hospitalised Patients

SummaryBackgroundKlebsiella pneumoniae is a leading public health threat due to its increasing prevalence of antibiotic resistance. Gastrointestinal carriage of K. pneumoniae is a risk factor for subsequent infections in hospitalised patients. We determined risk factors for gastrointestinal carriage and the genomic population structure of K. pneumoniae colonising humans in a representative sample of a general population.Methods2,975 individuals (54% women) ≥40y participating in the population-based Tromsø Study 7 (2015-2016) were included. Faecal samples were screened for K. pneumoniae which were characterised using whole-genome sequencing. Risk factors for carriage were analysed using data from the Norwegian Prescription Database and questionnaires, using multivariable logistic regression.FindingsPrevalence of K. pneumoniae gastrointestinal carriage was 16·3% (95% CI 15·0-17·7%) with no gender difference. Risk factors associated with carriage included age ≥60y, travel to Greece or Asia past 12 months (adjusted odds ratio 1·49, 95% CI 1·11-2·00), Crohn’s disease/ulcerative colitis (2·26, 1·20-4·27), use of protein pump inhibitors (1·62, 1·18-2·22) and non-steroidal anti-inflammatory drugs past six months (1·38, 1·04-1·84), and antibiotic use last month (1·73, 1·05-2·86). Prevalence was higher among those having used combinations of drug classes and decreased over time with respect to preceding antibiotic use. The K. pneumoniae population was diverse with 300 sequence types among 484 isolates distributed across four phylogroups. Among the isolates, 5·2% and 11·6% harboured acquired resistance and virulence factors, respectively.InterpretationIdentification of risk factors for gastrointestinal carriage in a representative sample of a general population allows for identification of individuals that may have a higher risk of extraintestinal infection during hospitalisation. The diverse population structure of K. pneumoniae carriage isolates reflects the ecologically adaptive capacity of the bacterium, and the low antibacterial consumption probably contributes to the low prevalence of resistance in clinical isolates in Norway.

Abstract 2728: Nonadherence to Prescribed Medications Mediates the Link between Anxiety and Event-Free Survival in Patients with Heart Failure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Marla J De Jong ◽  
Debra K Moser ◽  
Misook L Chung ◽  
Jia-Rong Wu
Keyword(s):  
Heart Failure ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Nyha Class ◽  
Event Free Survival ◽  
High Anxiety ◽  
Medication Nonadherence ◽  
Free Survival ◽  
Clinical Events ◽  
The Relationship

Anxiety has been linked to adverse outcomes for patients with cardiac disease but the mechanism for this relationship is unknown. Nonadherence to prescribed medications is common in heart disease, particularly heart failure (HF), and may mediate the relationship between anxiety and outcomes. To determine if nonadherence to prescribed medications mediates any relationship between anxiety and clinical outcomes in patients with HF. Patients (N=147; age 61±11 yrs, 44% female, 59% NYHA class III/IV) with chronic HF were followed 389±324 days for clinical events (composite of death, emergency department visit, or hospitalization). Patients completed the anxiety subscale of the Brief Symptom Inventory at baseline. Objective evidence of medication adherence was measured with the Medication Event Monitoring System. Survival and regression analyses were used to test whether medication nonadherence mediated any association between anxiety and outcomes. Patients with highest anxiety had shorter event-free survival than patients with lower anxiety (Fig. ). After adjusting for age, gender, and NYHA class in Cox regression, high anxiety predicted (OR 2.4; p=.001) clinical events. Anxiety predicted medication doses taken (p=.01) and days correct doses taken (p=.008). Medication doses taken (p=.01) and days dose taken (p=.008) also predicted clinical outcomes. Medication nonadherence mediated the relationship between high anxiety and worse outcomes. This is the first study to show that medication nonadherence links anxiety and clinical outcomes. Interventions that decrease anxiety may improve both medication adherence and outcomes.

scholarly journals Three year clinical outcomes in a nationwide, observational, siteless clinical trial of atrial fibrillation screening—mHealth Screening to Prevent Strokes (mSToPS)

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258276
Author(s):  
Steven R. Steinhubl ◽  
Jill Waalen ◽  
Anirudh Sanyal ◽  
Alison M. Edwards ◽  
Lauren M. Ariniello ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Clinical Event ◽  
Newly Diagnosed ◽  
Clinical Events ◽  
High Event ◽  
Asymptomatic Individuals ◽  
New Diagnosis

Background Atrial fibrillation (AF) is common, often without symptoms, and is an independent risk factor for mortality, stroke and heart failure. It is unknown if screening asymptomatic individuals for AF can improve clinical outcomes. Methods mSToPS was a pragmatic, direct-to-participant trial that randomized individuals from a single US-wide health plan to either immediate or delayed screening using a continuous-recording ECG patch to be worn for two weeks and 2 occasions, ~3 months apart, to potentially detect undiagnosed AF. The 3-year outcomes component of the trial was designed to compare clinical outcomes in the combined cohort of 1718 individuals who underwent monitoring and 3371 matched observational controls. The prespecified primary outcome was the time to first event of the combined endpoint of death, stroke, systemic embolism, or myocardial infarction among individuals with a new AF diagnosis, which was hypothesized to be the same in the two cohorts but was not realized. Results Over the 3 years following the initiation of screening (mean follow-up 29 months), AF was newly diagnosed in 11.4% (n = 196) of screened participants versus 7.7% (n = 261) of observational controls (p<0.01). Among the screened cohort with incident AF, one-third were diagnosed through screening. For all individuals whose AF was first diagnosed clinically, a clinical event was common in the 4 weeks surrounding that diagnosis: 6.6% experienced a stroke,10.2% were newly diagnosed with heart failure, 9.2% had a myocardial infarction, and 1.5% systemic emboli. Cumulatively, 42.9% were hospitalized. For those diagnosed via screening, none experienced a stroke, myocardial infarction or systemic emboli in the period surrounding their AF diagnosis, and only 1 person (2.3%) had a new diagnosis of heart failure. Incidence rate of the prespecified combined primary endpoint was 3.6 per 100 person-years among the actively monitored cohort and 4.5 per 100 person-years in the observational controls. Conclusions At 3 years, screening for AF was associated with a lower rate of clinical events and improved outcomes relative to a matched cohort, although the influence of earlier diagnosis of AF via screening on this finding is unclear. These observational data, including the high event rate surrounding a new clinical diagnosis of AF, support the need for randomized trials to determine whether screening for AF will yield a meaningful protection from strokes and other clinical events. Trail registration The mHealth Screening To Prevent Strokes (mSToPS) Trial is registered on ClinicalTrials.gov with the identifier NCT02506244.

Association between intelligence quotient and violence perpetration in the English general population

2018 ◽  
Vol 49 (08) ◽  
pp. 1316-1323 ◽  
Author(s):  
Louis Jacob ◽  
Josep Maria Haro ◽  
Ai Koyanagi
Keyword(s):  
General Population ◽  
Intelligence Quotient ◽  
Adult Population ◽  
Psychiatric Morbidity ◽  
Outcome Variable ◽  
Cross Sectional ◽  
Violence Perpetration ◽  
Nationally Representative ◽  
The Uk ◽  
The Relationship

AbstractBackgroundData on the relationship between intelligence quotient (IQ) and violence perpetration are scarce and nationally representative data from the UK adult population is lacking. Therefore, our goal was to examine the relationship between IQ and violence perpetration using nationally representative community-based data from the UK.MethodsWe analyzed cross-sectional data from the 2007 Adult Psychiatric Morbidity Survey. IQ was estimated using the National Adult Reading Test (NART). Violence perpetration referred to being in a physical fight or having deliberately hit anyone in the past 5 years. We conducted logistic regression analysis to assess the association between IQ (exposure variable) and violence perpetration (outcome variable).ResultsThere were 6872 participants aged ⩾16 years included in this study. The prevalence of violence perpetration decreased linearly with increasing IQ [16.3% (IQ 70–79) v. 2.9% (IQ 120–129)]. After adjusting for demographic and behavioral factors, childhood adversity, and psychiatric morbidity, compared with those with IQ 120–129, IQ scores of 110–119, 100–109, 90–99, 80–89, and 70–79 were associated with 1.07 [95% confidence interval (CI) 0.63–1.84], 1.90 (95% CI 1.12–3.22), 1.80 (95% CI 1.05–3.13), 2.36 (95% CI 1.32–4.22), and 2.25 (95% CI 1.26–4.01) times higher odds for violence perpetration, respectively.ConclusionsLower IQ was associated with violence perpetration in the UK general population. Further studies are warranted to assess how low IQ can lead to violence perpetration, and whether interventions are possible for this high-risk group.

scholarly journals Assessment of the relationship between serum uric acid levels and liver enzymes activity in Bangladeshi adults

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Noyan Hossain Molla ◽  
Rahanuma Raihanu Kathak ◽  
Abu Hasan Sumon ◽  
Zitu Barman ◽  
Ananya Dutta Mou ◽  
...  
Keyword(s):  
Uric Acid ◽  
General Population ◽  
Serum Uric Acid ◽  
Liver Enzymes ◽  
Multinomial Logistic Regression ◽  
Adult Population ◽  
Enzymes Activity ◽  
Significant Difference ◽  
The Mean ◽  
The Relationship

AbstractSerum uric acid (SUA) level has been suggested to be associated with cardiovascular disease, diabetes and metabolic syndrome. However, little is known about the relationship between SUA and liver enzymes activity in the general population. The present study aimed to assess the relationship between SUA and serum liver enzymes in an adult population in Bangladesh. In this cross-sectional study, a total of 410 blood samples were collected from apparently healthy adults aged > 18 years. SUA, liver enzymes, lipid profile and other biochemical markers were measured in the collected samples by using standard methods. Multinomial logistic regression model was used to assess the relationship between SUA and elevated levels of liver enzymes among the participants. Overall, the prevalence of hyperuricemia was 30.1% with 32.2% in male and 18.6% in female participants. About 33% of the participants had at least one or more elevated levels of liver enzymes. The mean level of SUA was significantly higher in males (389.3 ± 96.9 µmol/L) than in the female (290.4 ± 89.8 µmol/L) subjects (p < 0.001). There was a significant difference in the mean levels of serum ALT and GGT between the male (34.5 ± 16.0 U/L and 26.7 ± 19.5 U/L, respectively) and female (25.0 ± 13.0 U/L and 19.5 ± 13.2 U/L, respectively) participants (p < 0.001 and p < 0.01, respectively). An increasing trend was observed in the mean levels of serum ALT and GGT across the SUA quartile groups (p < 0.001 and p < 0.01, respectively). SUA showed a positive and significant correlation with serum ALT (p < 0.001) and GGT (p < 0.01). In further statistical analysis after adjustment for potential confounders, SUA showed an independent and significant association with serum ALT and GGT in all regression models. In conclusion, SUA was strongly associated with serum levels of ALT and GGT after adjustment for potential confounders. More prospective studies are needed to clarify the complex relationship between SUA and liver enzymes in the general population.

1245 Cheyne-Stokes Respiration and Circulation Time—A Case to Add to the Mystery

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A474-A475
Author(s):  
Sajeer Bhura ◽  
Nawaz Rupani ◽  
Mona Massoud ◽  
Susmita Chowdhuri ◽  
Q Afifa Shamim-Uzzaman
Keyword(s):  
Heart Failure ◽  
Cycle Length ◽  
Supplemental Oxygen ◽  
Circulation Time ◽  
Diagnostic Study ◽  
Icd Implantation ◽  
First Case ◽  
Respiratory Events ◽  
Respiratory Event ◽  
Single Night

Abstract Introduction Lung-to-finger circulation time (LFCT), the time taken for the circulation to reach the fingertips from the lungs, has been shown to correlate inversely with cardiac function (Hosokawa et al. 2015). LFCT can be measured on PSG as the time from the start of rebreathing after a central respiratory event to the nadir of the oxygen desaturation on the SpO2 signal. Patients with congestive heart failure (CHF) have been found to have increased LFCT, with even longer LFCT in patients with Cheyne-Stokes Respirations (CSR). We are reporting a case where LFCT increased throughout a single night by more than 40%. Report of Case A 66-year-old diabetic male with ischemic cardiomyopathy (LVEF 25%), CVA with residual L-sided paresthesias, CKD-IV and hypertension was diagnosed with severe CSA and OSA (AHI 31.5, CAI 13.9, OAI 0.0, MAI 0.2, hypopnea index of 17.4, minimum SpO2 of 80%; supine AHI 56.1). CSR was not mentioned on this diagnostic study. On his titration study, CPAP and BPAP failed to treat CSA, but ASV effectively treated his sleep-disordered breathing; however, he could not be started on ASV due to HFrEF. On a repeat titration after ICD implantation, CSR was prominent in the supine position, on both CPAP and BPAP S/T therapy. Cycle length progressively increased from 40 seconds at the beginning to 57 seconds at the end of the recording, an increase of 42% throughout the night. Circulation time also increased from 31 seconds to over 40 seconds. Scorable central respiratory events resolved but periodicity persisted. Conclusion To our knowledge, this is the first case of CSR with such progressive prolongation in cycle length during a single night. It again raises the question of the role of BPAP S/T in CSR with heart failure, and clarification of the potential use of supplemental oxygen in such situations.

scholarly journals Trends in Frailty and Use of Evidence-Based Pharmacotherapy for Heart Failure in Australian Hospitalised Patients: An Observational Study

2021 ◽  
Vol 10 (24) ◽  
pp. 5780
Author(s):  
Yogesh Sharma ◽  
Chris Horwood ◽  
Paul Hakendorf ◽  
Campbell Thompson
Keyword(s):  
Heart Failure ◽  
P Value ◽  
Evidence Based ◽  
P Values ◽  
Frailty Status ◽  
Frail Patients ◽  
Hospitalised Patients ◽  
Tertiary Hospitals ◽  
The Relationship ◽  
Current Risk

Frailty increases morbidity and mortality in heart failure (HF) patients. Current risk-adjustment models do not include frailty-status and the relationship between frailty and pharmacotherapy is unclear. This study explored trends in frailty over time and its relationship with prescription of heart failure specific pharmacotherapy in hospitalised HF patients. We used the Hospital Frailty Risk Score (HFRS) to determine frailty status of patients ≥18 years admitted between 2015–2019 at two tertiary hospitals in Australia. Patients with an HFRS ≥ 5 were classified as frail. In the 3706 patients with a mean (SD) age of 76.1 (14.4) years, 876 (23.6%) were classified as frail. HFRS was weakly correlated with age (r = 0.16) and Charlson-index (r = 0.35) (both p values < 0.001). Whilst frailty was more common in older HF patients (28.9% of patients ≥80 years), 15.1% of patients ≤65 years of age were also found to be frail. The proportion of frail patients increased from 19.4% in 2015 to 29.2% in 2019 despite no significant change in age during this period. The proportion of patients who received heart failure specific pharmacotherapy decreased from 86.7% in 2015 to 82.9% in 2019 (p value = 0.03) and frail patients were significantly less likely to be prescribed HF specific pharmacotherapy than non-frail patients (77.4% vs. 85.9%, p < 0.001).

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