Presentation and outcomes of mitral valve surgery in France in the recent era: a nationwide perspective

ObjectivesUnbiased information regarding the surgical management of patients with mitral regurgitation (MR) at the nationwide level are scarce and mainly US-based. The Programme de Médicalisation des Systèmes d’Information, a mandatory national database, offers the unique opportunity to assess the presentation and outcomes of all consecutive mitral valve (MV) surgeries performed in France in the contemporary era.MethodsWe collected all MV surgeries performed for MR in France in 2014–2016. MR aetiology was classified as degenerative (DMR), secondary (SMR) or Other (rheumatic or congenital disease and infective endocarditis).ResultsDuring the 3-year period, 18 167 MV surgeries were performed in France (55% repair and 45% replacement; 52% isolated). Age was 66±12 years and 59% were male. Aetiology was DMR in 42%, SMR in 16% and other in 42% including 19% with uncertain aetiologies. Overall, in-hospital mortality was 6.5% and increased with age, female gender, Charlson Comorbidity Index, type of surgery (replacement vs repair), associated surgery (combined vs isolated) and MR aetiology (all p<0.01). In-hospital mortality and rate of death/readmission for heart failure (HF) at 1 year were 3.4% and 13%, respectively for DMR (2.4% and 11% for isolated DMR) and 7.8% and 27%, respectively for SMR (5.5% and 23% for isolated SMR). Repair rate was 55% overall, 68% in DMR and 72% for isolated DMR surgery (70% of all DMR). Repair rates decreased with age, Charlson Comorbidity Index and female sex (all p<0.0001).ConclusionIn this cross-sectional contemporary prospective nationwide database, in-hospital mortality and 1 year rate of death and HF readmission were considerable overall and in all subsets. Repair rates were suboptimal overall especially in the elderly and women subsets. These results underline the need to develop strategies to improve management and outcomes of patients with both DMR and SMR.

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P922Presentation and outcomes of mitral valve surgery in France in the recent era

European Heart Journal ◽

10.1093/eurheartj/ehz747.0517 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Messika Zeitoun ◽

M E S Enriquez-Sarano ◽

P C Candolfi ◽

M G Gilard ◽

B I Iung ◽

...

Keyword(s):

Mitral Valve ◽

Hospital Mortality ◽

The Elderly ◽

Mitral Valve Surgery ◽

Administrative Database ◽

Repair Rate ◽

Public And Private ◽

Center Volume ◽

Secondary Mr ◽

One Year

Abstract Background Contemporary and unbiased information regarding the surgical management of patients with mitral regurgitation (MR) at the Nationwide level are scarce. The PMSI, a mandatory administrative database, offers the unique opportunity to assess the presentation and outcomes of all consecutive mitral valve (MV) surgeries performed in France in the contemporary era. Methods We collected all (isolated or combined) MV surgeries performed for MR in France both in public and private hospitals between 2014 and 2016. Based on an algorithm we developed, MR etiology was classified as degenerative (DMR), secondary (SMR) or OTHER (rheumatic, congenital, infective endocarditis or unknown). Results Between January 2014 and December 2016, 18,167 mitral valve surgeries were performed in France (55% repair and 45% replacement; 52% isolated MV surgery). Mean age was 66±12 years and 59% were male. Etiology was DMR in 42%, SMR in 16% and OTHER in 42%. Among DMR, repair rate was 68% overall and 72% in the subset who underwent an isolated MV surgery (70% of all DMR). Repair rates decreased with age, Charlson index and sex (female) (all P<0.0001). Among SMR, a repair was performed in 39% and a combined surgery in 51%. In-hospital mortality and rate of death / readmission for CHF at one year were 3.4% and 13% respectively for DMR (2.4% and 5.5% respectively for isolated DMR) and 7.8% and 17.8% respectively for SMR (5.5% and 12.4% respectively for isolated SMR). Center volume was associated with a lower in-hospital mortality (p=0.002) but not with higher DMR repair rate (P=0.85). Conclusion In this large administrative contemporary nationwide database, 1) DMR surgery was twice as frequent as SMR and more frequently performed isolated; 2) Repair rates in DMR were suboptimal overall but more critically in the elderly and women subsets. 3) Operative mortality and one-year rate of death and readmission were approximately twice as high in SMR than in DMR and overall considerable even for isolated DMR surgery; and 4) In DMR, center volume had no impact on repair rate but an independent impact on outcome. These results underline the need to develop strategies to improve management and outcomes of patients with both degenerative and secondary MR.

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Predictors of in-hospital mortality in epilepsy and epileptic seizures in the elderly populace – A cross sectional study from rural India

Epilepsy Research ◽

10.1016/j.eplepsyres.2021.106564 ◽

2021 ◽

Vol 171 ◽

pp. 106564

Author(s):

Archana Verma ◽

Ganga Prasad Vaishya ◽

Debora J. Mathew ◽

Alok Kumar

Keyword(s):

Hospital Mortality ◽

Epileptic Seizures ◽

The Elderly ◽

Cross Sectional Study ◽

Rural India ◽

Sectional Study ◽

Cross Sectional

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Risk factors for severe outcomes in people with diabetes hospitalised for COVID-19: a cross-sectional database study

BMJ Open ◽

10.1136/bmjopen-2021-051237 ◽

2021 ◽

Vol 11 (7) ◽

pp. e051237

Author(s):

Emilio Ortega ◽

Rosa Corcoy ◽

Mònica Gratacòs ◽

Francesc Xavier Cos Claramunt ◽

Manel Mata-Cases ◽

...

Keyword(s):

Hospital Mortality ◽

Invasive Mechanical Ventilation ◽

The Elderly ◽

Cross Sectional Study ◽

Cross Sectional ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Male Sex ◽

Poor Outcomes ◽

The Relationship

AimThis study’s objective was to assess the risk of severe in-hospital complications of patients admitted for COVID-19 and diabetes mellitus (DM).DesignThis was a cross-sectional study.SettingsWe used pseudonymised medical record data provided by six general hospitals from the HM Hospitales group in Spain.Outcome measuresMultiple logistic regression analyses were used to identify variables associated with mortality and the composite of mortality or invasive mechanical ventilation (IMV) in the overall population, and stratified for the presence or absence of DM. Spline analysis was conducted on the entire population to investigate the relationship between glucose levels at admission and outcomes.ResultsOverall, 1621 individuals without DM and 448 with DM were identified in the database. Patients with DM were on average 5.1 years older than those without. The overall in-hospital mortality was 18.6% (N=301), and was higher among patients with DM than those without (26.3% vs 11.3%; p<0.001). DM was independently associated with death, and death or IMV (OR=2.33, 95% CI: 1.7 to 3.1 and OR=2.11, 95% CI: 1.6 to 2.8, respectively; p<0.001). In subjects with DM, the only variables independently associated with both outcomes were age >65 years, male sex and pre-existing chronic kidney disease. We observed a non-linear relationship between blood glucose levels at admission and risk of in-hospital mortality and death or IMV. The highest probability for each outcome (around 50%) was at random glucose of around 550 mg/dL (30.6 mmol/L), and the risks flattened above this value.ConclusionThe results confirm the high burden associated with DM in patients hospitalised with COVID-19 infection, particularly among men, the elderly and those with impaired kidney function. Moreover, hyperglycaemia on admission was strongly associated with poor outcomes, suggesting that personalised optimisation could help to improve outcome during the hospital stay.

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Family functioning of elderly with depressive symptoms

Revista da Escola de Enfermagem da USP ◽

10.1590/s0080-623420140000300012 ◽

2014 ◽

Vol 48 (3) ◽

pp. 469-476 ◽

Cited By ~ 6

Author(s):

Rosely Almeida Souza ◽

Gislaine Desani da Costa ◽

Cintia Hitomi Yamashita ◽

Fernanda Amendola ◽

Jaqueline Correa Gaspar ◽

...

Keyword(s):

Depressive Symptoms ◽

Family Functioning ◽

Family Health ◽

Female Gender ◽

Well Being ◽

The Elderly ◽

Cross Sectional Study ◽

Cross Sectional ◽

Dysfunctional Family ◽

The Family

Objective: To classify families of elderly with depressive symptoms regarding their functioning and to ascertain the presence of an association between these symptoms, family functioning and the characteristics of the elderly. Method: This was an observational, analytical, cross-sectional study performed with 33 teams of the Family Health Strategy in Dourados, MS. The sample consisted of 374 elderly divided into two groups (with and without depressive symptoms). The instruments for data collection were a sociodemographic instrument, the GeriatricDepression Scale (15 items) and the Family Apgar. Results: An association was observed between depressive symptoms and family dysfunction, female gender, four or more people living together, and physical inactivity. Conclusion: The functional family may represent effective support for the elderly with depressive symptoms, because it offers a comfortable environment that ensures the well-being of its members. The dysfunctional family can barely provide necessary care for the elderly, which can exacerbate depressive symptoms. 

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Prevalence of falls in elderly in Brazil: a countrywide analysis

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2011000900015 ◽

2011 ◽

Vol 27 (9) ◽

pp. 1819-1826 ◽

Cited By ~ 69

Author(s):

Fernando Vinholes Siqueira ◽

Luiz Augusto Facchini ◽

Denise Silva da Silveira ◽

Roberto Xavier Piccini ◽

Elaine Tomasi ◽

...

Keyword(s):

Low Socioeconomic Status ◽

Urban Areas ◽

Female Gender ◽

The Elderly ◽

Cross Sectional Study ◽

Cross Sectional ◽

Low Socioeconomic ◽

The North ◽

High Prevalence ◽

Falls In Elderly

We conducted a cross-sectional study of a sample of 6,616 elderly living in urban areas of 100 municipalities in 23 Brazilian states, who responded to questions on the occurrence of falls in the 12 months prior to the interview, and occurrence of fractures due to the falls. The prevalence of falls among the elderly was 27.6% (95%CI: 26.5-28.7). Among those reporting falls, 11% had suffered fractures as a result. Of the elderly, 36% had received guidance about the precautions necessary to prevent falls, and about 1% had required surgery. Falls were associated with female gender, older age, low socioeconomic status, obesity and sedentary lifestyles. The prevalence of falls differed significantly between the North and other regions of Brazil. The study shows a high prevalence of falls, and underlines the need for preventive strategies targeting modifiable risk factors.

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The age-adjusted Charlson comorbidity index in minimally invasive mitral valve surgery

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz240 ◽

2019 ◽

Vol 56 (6) ◽

pp. 1124-1130 ◽

Cited By ~ 1

Author(s):

Jan-Philipp Minol ◽

Vanessa Dimitrova ◽

Georgi Petrov ◽

Robert Langner ◽

Udo Boeken ◽

...

Keyword(s):

Mitral Valve ◽

Adverse Events ◽

Minimally Invasive ◽

Predictive Value ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Valve Repair ◽

Comorbidity Index ◽

Sts Score ◽

Perioperative Course

Abstract OBJECTIVES Mitral valve repair is the preferred method used to address mitral valve regurgitation, whereas transcatheter mitral valve repair is recommended for high-risk patients. We evaluated the risk-predictive value of the age-adjusted Charlson comorbidity index (aa-CCI) in the setting of minimally invasive mitral valve surgery. METHODS The perioperative course and 1-year follow-up of 537 patients who underwent isolated or combined minimally invasive mitral valve surgery were evaluated for 1-year mortality as the primary end point and other adverse events. The predictive values of the EuroSCORE II and STS score were compared to that of the aa-CCI by a comparative analysis of receiver operating characteristic curves. Restricted cubic splines were applied to find optimal aa-CCI cut-off values for the increased likelihood of experiencing the predefined adverse end points. Consequently, the perioperative course and postoperative outcome of the aa-CCI ≥8 patients and the remainder of the sample were analysed. RESULTS The predictive value of the aa-CCI does not significantly differ from those of the EuroSCORE II or STS score. Patients with an aa-CCI ≥8 were identified as a subgroup with a significant increase of mortality and other adverse events. CONCLUSIONS The aa-CCI displays a suitable predictive ability for patients undergoing minimally invasive mitral valve surgery. In particular, multimorbid or frail patients may benefit from the extension of the objectively assessed parameters, in addition to the STS score or EuroSCORE II. Patients with an aa-CCI ≥8 have a very high surgical risk and should receive very careful attention.

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A data-driven medication score predicts 10-year mortality among aging adults

Scientific Reports ◽

10.1038/s41598-020-72045-z ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Paavo Häppölä ◽

Aki S. Havulinna ◽

Tõnis Tasa ◽

Nina J. Mars ◽

Markus Perola ◽

...

Keyword(s):

Charlson Comorbidity Index ◽

The Elderly ◽

Data Driven ◽

Mortality Data ◽

Point Increase ◽

Medication Score ◽

Health Differences ◽

Comorbidity Index ◽

Aging Adults ◽

Aging Societies

Abstract Health differences among the elderly and the role of medical treatments are topical issues in aging societies. We demonstrate the use of modern statistical learning methods to develop a data-driven health measure based on 21 years of pharmacy purchase and mortality data of 12,047 aging individuals. The resulting score was validated with 33,616 individuals from two fully independent datasets and it is strongly associated with all-cause mortality (HR 1.18 per point increase in score; 95% CI 1.14–1.22; p = 2.25e−16). When combined with Charlson comorbidity index, individuals with elevated medication score and comorbidity index had over six times higher risk (HR 6.30; 95% CI 3.84–10.3; AUC = 0.802) compared to individuals with a protective score profile. Alone, the medication score performs similarly to the Charlson comorbidity index and is associated with polygenic risk for coronary heart disease and type 2 diabetes.

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IMPACT OF ADVANCED AGE AND CHARLSON COMORBIDITY INDEX ON IN-HOSPITAL OUTCOMES IN SURGICAL AND TRANSCATHETER MITRAL VALVE REPAIR

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)31832-7 ◽

2019 ◽

Vol 73 (9) ◽

pp. 1225

Author(s):

Sanjay Venkatesh ◽

Hanumantha Rao Jogu ◽

Sameer Arora ◽

Paula D. Strassle ◽

Chinmay Patel ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Charlson Comorbidity Index ◽

Advanced Age ◽

Valve Repair ◽

Hospital Outcomes ◽

Transcatheter Mitral Valve Repair ◽

Comorbidity Index

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Prevalence and Correlates of Physical Disability and Functional Limitation among Elderly Rural Population in Nigeria

Journal of Aging Research ◽

10.4061/2011/369894 ◽

2011 ◽

Vol 2011 ◽

pp. 1-13 ◽

Cited By ~ 6

Author(s):

I. S. Abdulraheem ◽

A. R. Oladipo ◽

M. O. Amodu

Keyword(s):

Physical Disability ◽

Assessment Tool ◽

Functional Limitations ◽

Functional Limitation ◽

Sampling Technique ◽

Female Gender ◽

The Elderly ◽

Elderly Persons ◽

Cross Sectional ◽

Increased Risk

Background. The number of people surviving into old age is increasing, and it has now become a global phenomenon. Studies on the prevalence and correlates of physical disability and functional limitation among elderly Nigerians are scanty.Methodology. This is a community-based cross-sectional study conducted in 3 local government areas (LGAs) in Nigeria, using a multistage sampling technique. Functional limitations of 1824 elderly persons were tested using Tinetti performance-oriented mobility assessment tool (TPOMAT) and self-reported activities of daily living (ADL). ADL disability of ten, six, and five basic items were compared.Results. The prevalence ratios (PRs) of physical disability using the ten, six, and five basic ADL items were 28.3 (95% CI 25.2–31. 5), 15.7 (95% CI 13.4–19.8), and 12.1 (95% CI 9.8–15.3), respectively, while functional limitation was 22.5 (95% CI 18.1–24.4). Increased risk of disability was independently associated with female gender PR 3.6 (95% CI 1.5–7.4), advanced age ≥75 years; PR 22.2 (95% CI 14.5, 36.8), arthritis PR 3.7 (95% CI 2.6–4.6), stroke PR 4.8 (95% CI 3.7–7.9) and diabetes PR 6.1 (95% CI 4.3–7.1).Conclusions. The findings from this study are pointers to unmet needs of the elderly disabled Nigerians.

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