Anticoagulation for valvular heart disease in community-based practice

2010 ◽  
Vol 103 (02) ◽  
pp. 329-337 ◽  
Author(s):  
Al Ozonoff ◽  
Lori Henault ◽  
Elaine Hylek ◽  
Adam Rose
Keyword(s):  
United States ◽  
Heart Disease ◽  
Incidence Rate ◽  
Valvular Heart Disease ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
The United States ◽  
Major Haemorrhage ◽  
Target Range ◽  
Community Based

SummaryLittle is known about patients who receive oral anticoagulation for valvular heart disease (VHD) in community-based practice. It was this study’s objective to describe the characteristics, management, and outcomes of patients anticoagulated for VHD, compared to patients anticoagulated for atrial fibrillation (AF). We used a nationally-representative cohort of community-based anticoagulation care in the United States. Data collected included indications for therapy, demographics, selected comorbid conditions, international normalised ratio (INR) target ranges, INR control, and clinical outcomes. We identified 1,057 patients anticoagulated for VHD (15.6% of the overall cohort) and 3,396 patients anticoagulated for AF (50.2%). INR variability was similar between the two groups (0.64 vs. 0.69, p = 0.80). Among patients with aortic VHD, for whom a standard (2–3) target INR range is recommended, 461 (84%) had a high target range (2.5–3.5), while 95 (16%) had a standard target range. VHD patients had a higher rate of major haemorrhage compared to AF patients (3.57 vs. 1.78 events per 100 patient-years, incidence rate ratio 2.02, 95% CI 1.33 – 3.06). The rate of stroke/systemic embolus was similar between groups (0.67 vs. 0.97 events per 100 patient-years, incidence rate ratio 0.71, 95% CI 0.32 – 1.57). In our community-based study, approximately 15.6% of patients receiving warfarin were anticoagulated for VHD. VHD patients achieved similar anticoagulation control to patients with AF, as measured by INR variability. Nevertheless, the rate of major haemorrhage was elevated among VHD patients compared to AF patients; this finding requires further investigation.Disclaimer: The opinions expressed in this manuscript do not necessarily represent the views or policies of the United States Department of Veterans Affairs.

scholarly journals AIDS-related Burkitt lymphoma in the United States: what do age and CD4 lymphocyte patterns tell us about etiology and/or biology?

Blood ◽  
2010 ◽  
Vol 116 (25) ◽  
pp. 5600-5604 ◽  
Author(s):  
Mercy Guech-Ongey ◽  
Edgar P. Simard ◽  
William F. Anderson ◽  
Eric A. Engels ◽  
Kishor Bhatia ◽  
...  
Keyword(s):  
United States ◽  
Incidence Rate ◽  
Burkitt Lymphoma ◽  
Rate Ratio ◽  
Hiv Transmission ◽  
Incidence Rate Ratio ◽  
The United States ◽  
Incidence Rates ◽  
Cd4 Lymphocyte ◽  
Cd4 Lymphocytes

Abstract Trimodal or bimodal age-specific incidence rates for Burkitt lymphoma (BL) were observed in the United States general population, but the role of immunosuppression could not be excluded. Incidence rates, rate ratios, and 95% confidence intervals for BL and other non-Hodgkin lymphoma (NHL), by age and CD4 lymphocyte count categories, were estimated using Poisson regression models using data from the United States HIV/AIDS Cancer Match study (1980-2005). BL incidence was 22 cases per 100 000 person-years and 586 for non-BL NHL. Adjusted BL incidence rate ratio among males was 1.6× that among females and among non-Hispanic blacks, 0.4× that among non-Hispanic whites, but unrelated to HIV-transmission category. Non-BL NHL incidence increased from childhood to adulthood; in contrast, 2 age-specific incidence peaks during the pediatric and adult/geriatric years were observed for BL. Non-BL NHL incidence rose steadily with decreasing CD4 lymphocyte counts; in contrast, BL incidence was lowest among people with ≤ 50 CD4 lymphocytes/μL versus those with ≥ 250 CD4 lymphocytes/μL (incidence rate ratio 0.3 [95% confidence interval = 0.2-0.6]). The bimodal peaks for BL, in contrast to non-BL NHL, suggest effects of noncumulative risk factors at different ages. Underascertainment or biological reasons may account for BL deficit at low CD4 lymphocyte counts.

scholarly journals Intradialytic Hypotension and Cardiac Arrhythmias in Patients Undergoing Maintenance Hemodialysis

2020 ◽  
Vol 15 (6) ◽  
pp. 805-812 ◽  
Author(s):  
Finnian R. Mc Causland ◽  
Jim A. Tumlin ◽  
Prabir Roy-Chaudhury ◽  
Bruce A. Koplan ◽  
Alexandru I. Costea ◽  
...  
Keyword(s):  
United States ◽  
Confidence Interval ◽  
Incidence Rate ◽  
Rate Ratio ◽  
Negative Binomial ◽  
Incidence Rate Ratio ◽  
The United States ◽  
Maintenance Hemodialysis ◽  
Intradialytic Hypotension ◽  
Clinically Significant

Background and objectivesPatients receiving maintenance hemodialysis (HD) have a high incidence of cardiac events, including arrhythmia and sudden death. Intradialytic hypotension (IDH) is a common complication of HD and is associated with development of reduced myocardial perfusion, a potential risk factor for arrhythmia.Design, setting, participants, & measurementsWe analyzed data from the Monitoring in Dialysis study, which used implantable loop recorders to detect and continuously monitor electrocardiographic data from patients on maintenance HD (n=66 from the United States and India) over a 6-month period (n=4720 sessions). Negative binomial mixed effects regression was used to test the association of IDH20 (decline in systolic BP >20 mm Hg from predialysis systolic BP) and IDH0–20 (decline in systolic BP 0–20 mm Hg from predialysis systolic BP) with clinically significant arrhythmia (bradycardia≤40 bpm for ≥6 seconds, asystole≥3 seconds, ventricular tachycardia ≥130 bpm for ≥30 seconds, or patient-marked events) during HD.ResultsThe median age of participants was 58 (25th–75th percentile, 49–66) years; 70% were male; and 65% were from the United States. IDH occurred in 2251 (48%) of the 4720 HD sessions analyzed, whereas IDH0–20 occurred during 1773 sessions (38%). The number of sessions complicated by least one intradialytic clinically significant arrhythmia was 27 (1.2%) where IDH20 occurred and 15 (0.8%) where IDH0–20 occurred. Participants who experienced IDH20 (versus not) had a nine-fold greater rate of developing an intradialytic clinically significant arrhythmia (incidence rate ratio, 9.4; 95% confidence interval, 3.0 to 29.4), whereas IDH0–20 was associated with a seven-fold higher rate (incidence rate ratio, 7.2; 95% confidence interval, 2.1 to 25.4).ConclusionsIDH is common in patients on maintenance HD and is associated with a greater risk of developing intradialytic clinically significant arrhythmia.

Abstract 163: High Burden of Valvulopathy in Heart Failure: A Moving Target

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Enoch Agunanne ◽  
Aamer Abbas ◽  
Debabrata Mukherjee
Keyword(s):  
United States ◽  
Heart Failure ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
Heart Diseases ◽  
Medical Center ◽  
Care Facility ◽  
The United States ◽  
Study Objective ◽  
Valvular Heart Diseases

Background: The lifetime risk of developing Heart Failure (HF) is 20% for Americans ≥40 years of age. In the United States, greater than 650,000 new HF cases are diagnosed annually. About 5.1 million persons in the United States have clinically manifest HF. Additionally, HF has high absolute mortality rates of approximately 50% within 5 years of diagnosis. HF carries substantial health and economic burden. It is the primary diagnosis in >1 million hospitalizations annually. Patients hospitalized for HF are at high risk for all-cause re hospitalization. The total cost of HF care in the United States exceeds $30 billion annually. Objective: The study objective was to investigate the prevalence of valvular heart disease among patients hospitalized for HF in a largely Hispanic population. Methods: This is a retrospective study with aims inclusive of: analyzing the hospitalization and 4 months, 6 months, 2 year- re-hospitalization rates of HF in University Medical Center between Oct 2010 and Oct 2013; evaluating the association between valvular heart disease and hospitalizations for HF. Inclusion criteria were: admission/re hospitalizations with HF (with reduced, preserved and borderline EF). Echocardiographic determination of at least moderate valvular disease was utilized in this study as significant. Exclusion criteria were: patients lost to follow-up, death in hospital, transfer to another acute care facility, and discharge against medical advice. Demographics were also collected. Results: Hospitalizations involving 195 patients (120 men and 75 women) were randomly analyzed. The racial spread showed 77.4% (151 of 195) Hispanics and 22.6% (44 of 195) non-Hispanics. Out of the 195 index hospitalizations, the 4 month, 6 months and 2 years rehospitalization visits were 17.4% (34 of 195), 22.5% (44 of 195) and 38.5% (75 of 195) respectively. The prevalence of significant valvular heart disease was 45.9% (90 of 195), while the prevalence of no valvular heart disease was 54.1% (105 of 195) (p < 0.05). Conclusion: Multiple, prior studies have shown that valvular heart diseases have a comparatively low association with clinical Heart Failure. This study raises a valid point that in some population groups (the Hispanic), the burden of valvular heart disease may be greater than has been published in other groups. This calls for more studies, and has lots of potential implications in Heart Failure management.

Transcatheter aortic valve replacement

2010 ◽  
pp. 652-668
Author(s):  
John G. Webb ◽  
Fabian Nietlispach
Keyword(s):  
United States ◽  
Heart Disease ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
The Elderly ◽  
The United States ◽  
Community Based ◽  
Transcatheter Aortic Valve

Aortic stenosis (AS) is the most common valvular heart disease for which patients undergo valve replacement. Although the condition may develop in mid-life in association with a congenitally bicuspid valve, AS is for the most part a disease of the elderly, as demonstrated by a recent community-based study in the United States which reported a prevalence in those older than 75 years of age of 4.6%. Medically treated severe symptomatic AS has been associated with predictable clinical deterioration and a poor survival, reportedly averaging 2–3 years after the onset of symptoms.

scholarly journals PCV24 INCREMENTAL DIRECT HEALTHCARE EXPENDITURES OF VALVULAR HEART DISEASE IN THE UNITED STATES

2019 ◽  
Vol 22 ◽  
pp. S122
Author(s):  
P. Mallow ◽  
J. Chen ◽  
M. Moore ◽  
C. Gunnarsson ◽  
J. Rizzo
Keyword(s):  
United States ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
The United States ◽  
Healthcare Expenditures

scholarly journals The Annual Cannabis Holiday and Fatal Traffic Crashes

2019 ◽  
Author(s):  
Sam Harper ◽  
Adam Palayew
Keyword(s):  
United States ◽  
Rate Ratio ◽  
Reporting System ◽  
Incidence Rate Ratio ◽  
The United States ◽  
Traffic Crashes ◽  
Impaired Driving ◽  
Fatal Crashes ◽  
Before And After ◽  
The Impact

Background: Cannabis use has been linked to impaired driving and fatal accidents. Prior evidence suggests the potential for population-wide effects of the annual cannabis celebration on April 20th ("4/20"), but evidence to date is limited.Methods: We used data from the Fatal Analysis Reporting System for the years 1975-2016 to estimate the impact of "4/20" on drivers involved in fatal traffic crashes occurring between 1620h and 2359h in the United States. We compared the effects of 4/20 to those for other major holidays, and evaluated whether the impact of "4/20" had changed in recent years. Results: Between 1992-2016 "4/20" was associated with an increase in the number of drivers involved in fatal crashes (Incidence rate ratio [IRR]: 1.12, 95% CI 0.97 to 1.28) relative to control days one week before and after, but not when compared with control days one and two weeks before and after (IRR 1.05, 95% CI 0.92 to 1.28) or all days of the year (IRR 0.98, 95% CI 0.88 to 1.10). Across all years we found little evidence to distinguish excess drivers involved in fatal crashes on 4/20 from routine daily variations. Conclusions: There is little evidence to suggest population-wide effects of the annual cannabis holiday on the number of drivers involved in fatal traffic crashes.

scholarly journals Assessment and effect of a gap between new-onset epilepsy diagnosis and treatment in the US

Neurology ◽  
2019 ◽  
Vol 92 (19) ◽  
pp. e2197-e2208 ◽  
Author(s):  
Linda Kalilani ◽  
Edward Faught ◽  
Hyunmi Kim ◽  
Chakkarin Burudpakdee ◽  
Arpamas Seetasith ◽  
...  
Keyword(s):  
Health Care ◽  
Incidence Rate ◽  
Validation Study ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
The United States ◽  
Emergency Department Visits ◽  
Primary Study ◽  
Newly Diagnosed ◽  
Epilepsy Diagnosis

ObjectiveTo estimate the treatment gap between a new epilepsy diagnosis and antiepileptic drug (AED) initiation in the United States.MethodsRetrospective claims-based cohort study using Truven Health MarketScan databases (commercial and supplemental Medicare, calendar years 2010–2015; Medicaid, 2010–2014) and a validation study using PharMetrics Plus Database linked to LRx claims database (2009–2014). Persons met epilepsy diagnostic criteria, had an index date (first epilepsy diagnosis) with a preceding 2-year baseline (1 year for persons aged 1 to <2 years; none for persons <1 year), and continuous medical and pharmacy enrollment without epilepsy/seizure diagnosis or AED prescription during baseline. Outcomes included percentage of untreated persons (no AED prescription) up to 3 years' follow-up and comparative outcomes (incidence rate ratio: untreated persons/treated persons), including medical events and health care resource utilization.ResultsIn the primary study, 59,970 persons met selection (or inclusion) criteria; 36.7% of persons with newly diagnosed epilepsy remained untreated up to 3 years after diagnosis. In the validation study (N = 30,890), 31.8% of persons remained untreated up to 3 years after diagnosis. Lack of AED treatment was associated with an adjusted incidence rate ratio (95% confidence interval) of 1.2 (1.2–1.3) for medical events, 2.3 (2.2–2.3) for hospitalizations, and 2.8 (2.7–2.9) for emergency department visits.ConclusionsOne-third of newly diagnosed persons remain untreated up to 3 years after epilepsy diagnosis. The increased risk of medical events and health care utilization highlights the consequences of delayed treatment after epilepsy diagnosis, which might be preventable.

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