Sex-specific temporal trends in ambulatory heart failure incidence, mortality and hospitalisation in Ontario, Canada from 1994 to 2013: a population-based cohort study

ObjectivesTo examine the temporal trends in mortality and heart failure (HF) hospitalisation in ambulatory patients following a new diagnosis of HF.DesignRetrospective cohort studySettingOutpatientParticipantsOntario residents who were diagnosed with HF in an outpatient setting between 1994 and 2013.Primary and secondary outcome measuresThe primary outcome was all-cause mortality within 1 year of diagnosis and the secondary outcome was HF hospitalisation within 1 year. Risks of mortality and hospitalisation were calculated using the Kaplan-Meier method and the relative hazard of death was assessed using multivariable Cox proportional hazard models.ResultsA total of 352 329 patients were studied (50% female). During the study period, there was a greater decline in age standardised 1-year mortality rates (AMR) in men (33%) than in women (19%). Specifically, female AMR at 1 year was 10.4% (95% CI 9.1% to 12.0%) in 1994 and 8.5% (95% CI 7.5% to 9.5%) in 2013, and male AMR at 1 year was 12.3% (95% CI 11.1% to 13.7%) in 1994 and 8.3% (95% CI 7.5% to 9.1%) in 2013. Conversely, age standardised HF hospitalisation rates declined in men (11.4% (95% CI 10.1% to 12.9%) in 1994 and 9.1% (95% CI 8.2% to 10.1%) in 2013) but remained unchanged in women (9.7% (95% CI 8.3% to 11.3%) in 1994 and 9.8% (95% CI 8.6% to 11.0%) in 2013).ConclusionAmong patients with HF over a 20-year period, there was a greater improvement in the prognosis of men compared with women. Further research should focus on the determinants of this disparity and ways to reduce this gap in outcomes.

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Colorectal cancer survival among Ministry of National Guard-Health Affairs (MNG-HA) population 2009–2017: retrospective study

BMC Cancer ◽

10.1186/s12885-021-08705-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mesnad Alyabsi ◽

Fouad Sabatin ◽

Majed Ramadan ◽

Abdul Rahman Jazieh

Keyword(s):

Colorectal Cancer ◽

Distant Metastasis ◽

Cancer Survival ◽

National Guard ◽

Population Based ◽

Risk Of Death ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Increased Risk ◽

Cox Proportional Hazard Models

Abstract Background Colorectal cancer (CRC) is the most diagnosed cancer among males and third among females in Saudi Arabia, with up to two-third diagnosed at advanced stage. The objective of our study was to estimate CRC survival and determine prognostic factors. Methods Ministry of National Guard- Health Affairs (MNG-HA) registry data was utilized to identify patients diagnosed with CRC between 2009 and 2017. Cases were followed until December 30th, 2017 to assess their one-, three-, and five-year CRC-specific survivals. Kaplan-Meier method and Cox proportional hazard models were used to assess survival from CRC. Results A total of 1012 CRC patients were diagnosed during 2009–2017. Nearly, one-fourth of the patients presented with rectal tumor, 42.89% with left colon and 33.41% of the cases were diagnosed at distant metastasis stage. The overall one-, three-, and five-year survival were 83, 65 and 52.0%, respectively. The five-year survival was 79.85% for localized stage, 63.25% for regional stage and 20.31% for distant metastasis. Multivariate analyses showed that age, diagnosis period, stage, nationality, basis of diagnosis, morphology and location of tumor were associated with survival. Conclusions Findings reveal poor survival compared to Surveillance, Epidemiology, and End Results (SEER) population. Diagnoses at late stage and no surgical and/or perioperative chemotherapy were associated with increased risk of death. Population-based screening in this population should be considered.

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Abstract 16571: The Potential Impact of Expanding Cardiac Rehabilitation Coverage in Heart Failure: Insights From Get With the Guidelines Heart Failure

Circulation ◽

10.1161/circ.132.suppl_3.16571 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Jacob P Kelly ◽

Brad G Hammill ◽

Jacob A Doll ◽

G. Michael Felker ◽

Paul A Heidenreich ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Rehabilitation ◽

Adverse Outcomes ◽

P Value ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Cox Proportional Hazard Models ◽

Expanded Criteria ◽

Get With The Guidelines

Background: In February 2014, coverage for cardiac rehabilitation (CR) was expanded by Centers for Medicare & Medicaid to include patients with chronic symptomatic heart failure (HF) on optimal medical therapy with ejection fraction <35%. Thus, we sought to characterize the patient population newly eligible for CR based on the expanded criteria and their associated outcomes. Methods: We analyzed the Get With The Guidelines-HF registry linked to Medicare claims data from 2008-2012 to assess three groups of patients age 65 or older: previously eligible (due to prior MI, CABG, stable angina, heart valve surgery, or PCI in the previous 12 months), newly eligible, and ineligible for CR. Ineligible patients met neither criteria. Incidence rate was calculated with Kaplan-Meier estimates and Cox proportional hazard models were used to determine the association of events. Results: Among 51,665 HF patients discharged alive, 27.2% (n=14,053) were newly eligible and 14.5% were previously eligible for CR (n=7477). Newly eligible patients were more likely to be black, have atrial fibrillation and EF < 35%, while having fewer previous hospitalizations than patients previously eligible for CR. Newly eligible and ineligible patients had similar risk for 1-year mortality compared with those previously eligible (adjusted Hazard Ratio [HR] 0.95, 95% Confidence Interval [CI] 0.88-1.02, p-value=0.13 and [HR] 1.05, 95% [CI] 0.98-1.13, p-value=0.17, respectively). However, newly eligible and ineligible patients had lower risk for 1-year readmission compared with those previously eligible (adjusted [HR] 0.89, 95% [CI] 0.85-0.93, p-value<0.001 and [HR] 0.94, 95% [CI] 0.90- 0.98, p-value<0.001). Conclusions: The extension of coverage for cardiac rehabilitation has tripled the potentially eligible HF population. As these newly eligible patients are at high risk for adverse outcomes, cardiac rehabilitation should be considered.

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Increased risk of rheumatoid arthritis among patients with endometriosis: a nationwide population-based cohort study

Rheumatology ◽

10.1093/rheumatology/keaa784 ◽

2020 ◽

Author(s):

Yu-Hao Xue ◽

Liang-Tian You ◽

Hsin-Fu Ting ◽

Yu-Wen Chen ◽

Zi-Yun Sheng ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Propensity Scores ◽

Population Based ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Increased Risk ◽

Potential Risks ◽

Using Data

Abstract Objectives Autoimmunity may play a role in endometriosis. The association between endometriosis and RA remains unknown. This study was conducted to identify any evidence for this relationship. Methods This 13-year, nationwide, population-based, retrospective cohort study analysed the risk of RA in a cohort of individuals with endometriosis. We investigated the incidence of RA among patients with endometriosis using data from the Longitudinal Health Insurance Database 2000, which is maintained by the Taiwan National Health Research Institutes. We used propensity scores to match comorbidities in the two cohorts. Kaplan–Meier analysis and Cox proportional hazard model were employed to analyse the association between endometriosis and RA among patients with different potential risks. Results Patients with endometriosis [adjusted hazard ratio (HR) 1.75, 95% CI 1.27, 2.41], aged ≥45 years (adjusted HR 1.50, 95% CI 1.06–2.13) and with autoimmune disease (adjusted HR 6.99, 95% CI 2.84–17.21) had a significantly higher risk of RA. The analyses also showed that when stratified by age, comorbidities and medication use, the risk of RA in patients with endometriosis was also higher than in those without endometriosis. Conclusions This 14-year, nationwide, population-based retrospective cohort study revealed that patients with endometriosis have a higher risk of RA. In the clinical management of patients with RA, rheumatologists should be especially mindful of the possibility of underlying endometriosis.

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3 Advances in treating heart failure

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-fpm.3 ◽

2019 ◽

Vol 95 (1130) ◽

pp. 685.3-686

Author(s):

Martin Cowie

Keyword(s):

Heart Failure ◽

Temporal Trends ◽

Holistic Approach ◽

Population Based ◽

Social Needs ◽

Circulatory Support ◽

List Type ◽

Advance Care ◽

The Uk ◽

New Diagnosis

The average age of a person with a new diagnosis of heart failure in the UK is now 80, and such a person is as likely to be female as male, to have 5–6 co-morbidities, and to be frail.1 Delivering appropriate care is a challenge, particularly where the evidence from clinical trials may be in patients who are typically 20 years younger and with less complex medical and social needs. Increased awareness of the need for a more holistic approach, with shared decision making, and advance care planning, is improving the experience and outcome of care, but there is marked variation across the NHS.2 3This talk will briefly summarise some of the recent advances in treating heart failure – particularly for those with systolic impairment of the left ventricle, and for those with valve disease. Mechanical circulatory support has improved greatly in recent years but is only ever an option for a tiny minority of patients. Treatment of co-morbidities, such as atrial fibrillation and diabetes, have also improved the outcome for those with heart failure. Despite much effort, cellular and genetic therapies remain a distant prospect. Digital approaches to care, and self-management, show considerable promise but integrating such approaches into a traditional healthcare system has proven challenging.The prognosis of heart failure has improved dramatically for many patients over the past 30 years –but the residual risk of mortality and urgent hospitalisation means that there is much work to be done.ReferencesConrad N, Judge A, Tran J, et al. Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. Lancet 2018;391:572–580.Chronic heart failure in adults: diagnosis and management (NG106). National Institute for Health and Care Excellence, September 2018. Available at: https://www.nice.org.uk/guidance/ng106Failure to Function: a review of the care received by patients who died in hospital following an admission with acute heart failure. National Confidential Enquiry into Perioperative Deaths, November 2019. Available at: https://www.ncepod.org.uk/2018report2/AHF%20full%20report.pdf

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Primary aldosteronism is associated with risk of urinary bladder stones in a nationwide cohort study

Scientific Reports ◽

10.1038/s41598-021-86749-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Mu-Chi Chung ◽

Cheng-Li Lin ◽

Ming-Ju Wu ◽

Cheng-Hsu Chen ◽

Jeng-Jer Shieh ◽

...

Keyword(s):

Cohort Study ◽

Primary Aldosteronism ◽

Risk Model ◽

Population Based ◽

Bladder Stones ◽

Risk Of Death ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

Taiwan National Health Insurance ◽

Cox Proportional Hazard Models

AbstractWe analyzed database from the Taiwan National Health Insurance to investigate whether primary aldosteronism (PA) increases the risk of bladder stones. This retrospective nationwide population-based cohort study during the period of 1998–2011 compared patients with and without PA extracted by propensity score matching. Cox proportional hazard models and competing death risk model were used to estimate the hazard ratios (HRs), sub-hazard ratios (SHRs) and corresponding 95% confidence intervals (CIs). There were 3442 patients with PA and 3442 patients without PA. The incidence rate of bladder stones was 5.36 and 3.76 per 1000 person-years for both groups, respectively. In adjusted Cox hazard proportional regression models, the HR of bladder stones was 1.68 (95% CI 1.20–2.34) for patients with PA compared to individuals without PA. Considering the competing risk of death, the SHR of bladder stones still indicates a higher risk for PA than a comparison cohort (SHR, 1.79; 95% CI 1.30–2.44). PA, age, sex, and fracture number were the variables significantly contributing to the formation of bladder stones. In conclusion, PA is significantly associated with risk of bladder stones.

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Temporal trends in incidence of atrial fibrillation in primary care records: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2020-042518 ◽

2020 ◽

Vol 10 (12) ◽

pp. e042518

Author(s):

Sílvia C Mendonça ◽

Catherine L Saunders ◽

Jenny Lund ◽

Jonathan Mant ◽

Duncan Edwards

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Cohort Study ◽

Temporal Trends ◽

Population Based ◽

Incidence Rates ◽

Secondary Outcome ◽

Policy Initiatives ◽

Increased Risk ◽

Quality And Outcomes

ObjectivesAtrial fibrillation (AF) is a heart condition associated with a fivefold increased risk of stroke. The condition can be detected in primary care and treatment can greatly reduce the risk of stroke. In recent years, a number of policy initiatives have tried to improve diagnosis and treatment of AF, including local National Health Service schemes and the Quality and Outcomes Framework. We aimed to examine trends in the incidence of recorded AF in primary care records from English practices between 2004 and 2018.DesignLongitudinal cohort study.SettingEnglish primary care electronic health records linked to Index of Multiple Deprivation data.ParticipantsCohort of 3.5 million patients over 40 years old registered in general practices in England, contributing 22 million person-years of observation between 2004 and 2018.Primary and secondary outcome measuresIncident AF was identified through newly recorded AF codes in the patients’ records. Yearly incidence rates were stratified by gender, age group and a measure of deprivation.ResultsIncidence rates were stable before 2010 and then rose and peaked in 2015 at 5.07 (95% CI 4.94 to 5.20) cases per 1000 person-years. Incidence was higher in males (4.95 (95% CI 4.91 to 4.99) cases per 1000 person-years vs 4.12 (95% CI 4.08 to 4.16) in females) and rises markedly with age (0.58 (95% CI 0.56 to 0.59) cases per 1000 person-years in 40–54 years old vs 21.7 (95% CI 21.4 to 22.0) cases in over 85s). The increase in incidence over time was observed mainly in people over the age of 75, particularly men. There was no evidence that temporal trends in incidence were associated with deprivation.ConclusionsChanges in clinical practice and policy initiatives since 2004 have been associated with increased rates of diagnosis of AF up until 2015, but rates declined from 2015 to 2018.

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Haemorrhage rates of ruptured and unruptured brain arteriovenous malformation after radiosurgery: a nationwide population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2019-036606 ◽

2020 ◽

Vol 10 (10) ◽

pp. e036606

Author(s):

Cien-Leong Chye ◽

Kuo-Wei Wang ◽

Han-Jung Chen ◽

Shyh-An Yeh ◽

James Taoqian Tang ◽

...

Keyword(s):

Cohort Study ◽

Proportional Hazards ◽

Gamma Knife Radiosurgery ◽

Bleeding Risk ◽

Population Based ◽

Cox Proportional Hazards ◽

Treatment Modalities ◽

Secondary Outcome ◽

Research Database ◽

Kaplan Meier

ObjectivesThe present nationwide population-based cohort study aims to assess the effectiveness of gamma knife radiosurgery (GKS) on ruptured and unruptured brain arteriovenous malformations (AVMs) by evaluating the haemorrhage rates.DesignA nationwide, retrospective cohort study.SettingTaiwan National Health Insurance Research Database (NHIRD).ParticipantsAn observational study of 1515 patients who were diagnosed with brain AVMs between 1997 and 2013 from the Taiwan NHIRD.Primary outcome and secondary outcome measuresWe performed a survival analysis using the Kaplan-Meier method. Multivariate Cox proportional hazards regression models were used to explore the relationship between treatment modalities (GKS vs non-GKS) and haemorrhage, adjusted for age and sex.ResultsThe GKS and non-GKS groups included 317 and 1198 patients, respectively. Patients in the GKS group (mean±SD, 33.08±15.48 years of age) tended to be younger than those in the non-GKS group (37.40±17.62) (p<0.001). The 15-year follow-up revealed that the rate of bleeding risk was lower in the GKS group than in the non-GKRS group (adjusted HR (aHR) 0.61; 95% CI 0.40 to 0.92). The bleeding risk of ruptured AVMs was significantly lower in GKS group than in the non-GKS group (aHR 0.34; 95% CI 0.19 to 0.62). On the other hand, the bleeding risk of unruptured AVMs was higher in the GKS group than in the non-GKS group (aHR 1.95; 95% CI 1.04 to 3.65). In the unruptured AVM group, the incidence of bleeding was significantly higher among patients in the GKS group that were of >40 years of age (aHR 3.21; 95% CI 1.12 to 9.14).ConclusionsGKS is safe and it reduces the risk of haemorrhage in patients with ruptured AVMs. The administration of GKS to patients with unruptured AVMs who are above the age of 40 years old male might increase the risk of haemorrhage.

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Etoricoxib and Diclofenac Might Reduce the Risk of Dementia in Patients with Osteoarthritis: A Nation-Wide, Population-Based Retrospective Cohort Study

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000485176 ◽

2018 ◽

Vol 45 (5-6) ◽

pp. 262-271 ◽

Cited By ~ 3

Author(s):

Yu-Hao Xue ◽

Yu-Shin Peng ◽

Hsin-Fu Ting ◽

Jason Peijer Hsieh ◽

Yu-Kai Huang ◽

...

Keyword(s):

Cohort Study ◽

Population Based ◽

Cox Proportional Hazard Model ◽

Proportional Hazard ◽

Newly Diagnosed ◽

Proportional Hazard Model ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Insurance Database ◽

Wide Population

Introduction: This population-based cohort study investigates the association between osteoarthritis (OA) and dementia as well as the connection between NSAIDs and dementia. Methods: We chose the samples from the Taiwan Longitudinal Health Insurance Database and then divided them into two groups, which were then matched 1: 1 by propensity score. The first group was the OA group that contained patients with newly diagnosed OA and the second group was the non-OA group. We used the χ2 test, Student t test, Kaplan-Meier analysis, and Cox proportional hazard model for different purposes. Results: The prevalence of dementia in the OA group was higher than that in the non-OA group. The adjusted hazard ratio of the former was 1.42 (95% CI, 1.30–1.54). We also found that etoricoxib and diclofenac might reduce the incidence of dementia. Conclusion: Patients with OA might have a higher risk of dementia. Both etoricoxib and diclofenac might lower the risk of dementia in patients with OA.

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The risk of metachronous cancers in patients with small-intestinal carcinoid tumors: a US population-based study

Endocrine Related Cancer ◽

10.1530/erc-11-0392 ◽

2012 ◽

Vol 19 (3) ◽

pp. 381-387 ◽

Cited By ~ 12

Author(s):

Sunil Amin ◽

Richard R P Warner ◽

Steven H Itzkowitz ◽

Michelle Kang Kim

Keyword(s):

Small Bowel ◽

Population Based ◽

Proportional Hazard ◽

Population Based Study ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Increased Risk ◽

Before And After ◽

Cox Proportional Hazard Models ◽

Small Intestinal

Small-intestinal carcinoids (SIC) are the most common small-bowel malignancies. We sought to determine the risk of developing SIC before and after other primary malignancies (PM) and the prognosis of patients with SIC, with and without another PM. We used the Surveillance, Epidemiology, and End Results database to identify patients diagnosed with SICs between 1973 and 2007. Multiple primary-standardized incidence ratios were calculated as an approximation of relative risk (RR) to explore the association of SICs with metachronous malignancies. Survival analysis was performed using Kaplan–Meier methods and Cox proportional-hazard models. Among 8331 patients with SICs, 2424 (29%) had another PM at some time. The most common sites were prostate (26.2%), breast (14.3%), colon (9.1%), lung/bronchus (6.3%), and bladder (5.3%). Overall, 67% of patients had a PM diagnosed before SIC (pre-SIC), 33% after SIC (post-SIC), and 8% had a PM both before and after SIC. Among the pre-SIC group, the risk of future SIC was increased after cancers of the small bowel (RR 11.86 (95% CI: 6.13–20.72)), esophagus (4.05 (1.10–10.36)), colon (1.39 (1.05–1.81)), kidney (1.93 (1.12–3.09)), prostate (1.38 (1.17–1.62)), and leukemia (2.15 (1.18–3.61)). Among the post-SIC group, there was an increased risk of future PM of the small bowel (8.78 (4.54–15.34)), liver (2.49 (1.08–4.91)), prostate (1.25 (1.0–1.53)), and thyroid (2.73 (1.10–5.62)). Compared to patients with only SIC, those with a PM pre-SIC had worse mean survival (57.9 vs 40.9 months, HR 1.55 (1.42–1.69), P<0.001). In conclusion, almost one-third of patients with SICs have an associated metachronous primary tumor. When these primaries occur prior to (but not after) the SIC diagnosis, the prognosis is worse than with an initial SIC. The type of malignancies associated with SICs may guide future screening efforts.

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Risk of early neurodevelopmental disorders associated with in utero exposure to valproate and other antiepileptic drugs: a nationwide cohort study in France

Scientific Reports ◽

10.1038/s41598-020-74409-x ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 2

Author(s):

Joël Coste ◽

Pierre-Olivier Blotiere ◽

Sara Miranda ◽

Yann Mikaeloff ◽

Hugo Peyre ◽

...

Keyword(s):

Cohort Study ◽

Antiepileptic Drugs ◽

Neurodevelopmental Disorders ◽

Speech Therapy ◽

Population Based ◽

In Utero ◽

In Utero Exposure ◽

Cox Proportional Hazard ◽

Increased Risk ◽

Cox Proportional Hazard Models

Abstract Information available on the risks of neurodevelopmental disorders (NDs) associated with in utero exposure to valproate (VPA) and to other antiepileptic drugs (AEDs) is limited. A nationwide population-based cohort study was conducted based on comprehensive data of the French National Health Data System (SNDS). Liveborn infants without brain malformation, born between January 2011 and December 2014, were followed from birth up to December 2016. NDs were identified based on diagnoses of mental or behavioural disorders and utilization of speech therapy, orthoptic or psychiatric services. The risk of NDs was compared between children exposed in utero to AED monotherapy and unexposed children, using Cox proportional hazard models adjusted for maternal and neonatal characteristics. The cohort included 1,721,990 children, 8848 of whom were exposed in utero to AED monotherapy. During a mean follow-up of 3.6 years, 15,458 children had a diagnosis of mental or behavioural disorder. In utero exposure to VPA was associated with an increased risk of NDs overall (aHR: 3.7; 95% CI 2.8–4.9) and among children born to a mother without mental illness (aHR 5.1; 95% CI 3.6–7.3). A dose–response relationship was demonstrated and the risk of NDs was more particularly increased for an exposure to VPA during the second or third trimesters of pregnancy. Among the other AEDs, only pregabalin was consistently associated with an increased risk of NDs (aHR: 1.5; 95% CI 1.0–2.1). This study confirms a four to fivefold increased risk of early NDs associated with exposure to VPA during pregnancy. The risk associated with other AEDs appears much lower.

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