Abstract 2036: Severe Autonomic Failure in Diabetic Postinfarction-Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Georg Schmidt ◽  
Petra Barthel ◽  
Raphael Schneider ◽  
Axel Bauer ◽  
Elisabeth Arnoldi ◽  
...  
Keyword(s):  
Heart Rate ◽  
Proportional Hazards ◽  
Autonomic Failure ◽  
Multivariable Analysis ◽  
Total Mortality ◽  
Holter Monitoring ◽  
Mortality Rates ◽  
Cox Proportional Hazards ◽  
Mean Heart Rate

Background: Diabetic post-infarction patients are at high risk of subsequent death. Deceleration Capacity (DC) and Heart Rate Turbulence (HRT) are a risk predictors that quantify different aspects of autonomic performance (tone and reflex function). Sever Autonomic Failure (SAF) was assumed if DC and HRT were compromised. This study investigates the predictive value SAF in diabetic post-infarction patients. Patients: 416 consecutive diabetic post-infarction patients, age < <26> 75 years, in sinus rhythm were enrolled. Primary endpoint was total mortality at 5 years. Mean follow-up period was 4.4 years. Methods: DC and HRT were determined according to the published methodology. Severe autonomic failure (SAF) was defined as DC < <26> 4.5 ms and HRT category 2. Cox-proportional hazards analyses were performed with respect to age, history of previous myocardial infarction, mean heart rate, HRV index and arrhythmia count during 24-h Holter monitoring, QRS duration and LVEF, all with prospectively defined dichotomies. Results: During follow-up, 61 patients died. There were 36 cardiac deaths, out of which 23 occurred suddenly. 24 patients presented with SAF, 13 patients with LVEF < <26> 30%. Five-year all-cause mortality rates of patients with and without SAF were 63% and 11%, respectively (Figure , left panel). For LVEF 30%, these figures were 51% and 15% (Figure , right panel). Similar figures were observed for cardiac mortality. In multivariable analysis, presence of SAF indicated a hazard ratio of 5.1 (LVEF 4.2; age 3.5, mean heart rate 1.9). Conclusion: Diabetic post-infarction patients with SAF have a poor outcome, whereas mortality rates of patients without SAF were low.

The Efficacy of Etoposide-Based Therapy in Adult Secondary Hemophagocytic Lymphohistiocytosis

2021 ◽  
pp. 1-9
Author(s):  
Leonard Naymagon ◽  
Douglas Tremblay ◽  
John Mascarenhas
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Proportional Hazards ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Significant Difference ◽  
The Impact

Data supporting the use of etoposide-based therapy in hemophagocytic lymphohistiocytosis (HLH) arise largely from pediatric studies. There is a lack of comparable data among adult patients with secondary HLH. We conducted a retrospective study to assess the impact of etoposide-based therapy on outcomes in adult secondary HLH. The primary outcome was overall survival. The log-rank test was used to compare Kaplan-Meier distributions of time-to-event outcomes. Multivariable Cox proportional hazards modeling was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Ninety adults with secondary HLH seen between January 1, 2009, and January 6, 2020, were included. Forty-two patients (47%) received etoposide-based therapy, while 48 (53%) received treatment only for their inciting proinflammatory condition. Thirty-three patients in the etoposide group (72%) and 32 in the no-etoposide group (67%) died during follow-up. Median survival in the etoposide and no-etoposide groups was 1.04 and 1.39 months, respectively. There was no significant difference in survival between the etoposide and no-etoposide groups (log-rank <i>p</i> = 0.4146). On multivariable analysis, there was no association between treatment with etoposide and survival (HR for death with etoposide = 1.067, 95% CI: 0.633–1.799, <i>p</i> = 0.8084). Use of etoposide-based therapy was not associated with improvement in outcomes in this large cohort of adult secondary HLH patients.

scholarly journals Changes in Plant-Based Diet Quality and Total and Cause-Specific Mortality

Circulation ◽  
2019 ◽  
Vol 140 (12) ◽  
pp. 979-991 ◽  
Author(s):  
Megu Y. Baden ◽  
Gang Liu ◽  
Ambika Satija ◽  
Yanping Li ◽  
Qi Sun ◽  
...  
Keyword(s):  
Diet Quality ◽  
Lower Risk ◽  
Proportional Hazards ◽  
Total Mortality ◽  
Cox Proportional Hazards ◽  
Environmental Benefits ◽  
Health Study ◽  
Specific Mortality ◽  
Cvd Mortality

Background: Plant-based diets have been associated with lower risk of type 2 diabetes mellitus and cardiovascular disease (CVD) and are recommended for both health and environmental benefits. However, the association between changes in plant-based diet quality and mortality remains unclear. Methods: We investigated the associations between 12-year changes (from 1986 to 1998) in plant-based diet quality assessed by 3 plant-based diet indices (score range, 18–90)—an overall plant-based diet index (PDI), a healthful PDI, and an unhealthful PDI—and subsequent total and cause-specific mortality (1998–2014). Participants were 49 407 women in the Nurses’ Health Study (NHS) and 25 907 men in the Health Professionals Follow-Up Study (HPFS) who were free from CVD and cancer in 1998. Multivariable-adjusted Cox proportional-hazards models were used to estimate hazard ratios (HRs) and 95% CIs. Results: We documented 10 686 deaths including 2046 CVD deaths and 3091 cancer deaths in the NHS over 725 316 person-years of follow-up and 6490 deaths including 1872 CVD deaths and 1772 cancer deaths in the HPFS over 371 322 person-years of follow-up. Compared with participants whose indices remained stable, among those with the greatest increases in diet scores (highest quintile), the pooled multivariable-adjusted HRs for total mortality were 0.95 (95% CI, 0.90–1.00) for PDI, 0.90 (95% CI, 0.85–0.95) for healthful PDI, and 1.12 (95% CI, 1.07–1.18) for unhealthful PDI. Among participants with the greatest decrease (lowest quintile), the multivariable-adjusted HRs were 1.09 (95% CI, 1.04–1.15) for PDI, 1.10 (95% CI, 1.05–1.15) for healthful PDI, and 0.93 (95% CI, 0.88–0.98) for unhealthful PDI. For CVD mortality, the risk associated with a 10-point increase in each PDI was 7% lower (95% CI, 1–12%) for PDI, 9% lower (95% CI, 4–14%) for healthful PDI, and 8% higher (95% CI, 2–14%) for unhealthful PDI. There were no consistent associations between changes in plant-based diet indices and cancer mortality. Conclusions: Improving plant-based diet quality over a 12-year period was associated with a lower risk of total and CVD mortality, whereas increased consumption of an unhealthful plant-based diet was associated with a higher risk of total and CVD mortality.

Relation between resting heart rate and the risk of ventricular tachyarrhythmias in MADIT-RIT

EP Europace ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. 281-287
Author(s):  
Roy Beinart ◽  
Valentina Kutyifa ◽  
Scott McNitt ◽  
David Huang ◽  
Mehmet Aktas ◽  
...  
Keyword(s):  
Heart Rate ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Continuous Measure ◽  
Ventricular Tachyarrhythmias ◽  
Resting Heart Rate ◽  
Icd Therapy ◽  
Kaplan Meier ◽  
Life Threatening

Abstract Aims To explore the association between resting heart rate (RHR) and ventricular tachyarrhythmias (VTA) events among patients who were enrolled in MADIT-RIT. Methods and results Multivariate Cox proportional hazards regression modelling was employed to evaluate the association between baseline RHR [dichotomized at the lower quartile (≤63 b.p.m.) and further assessed as a continuous measure] and the risk for any VTA, fast VTA (&gt;200 b.p.m.), and appropriate implantable cardioverter-defibrillator (ICD) therapy, among 1500 patients who were enrolled in MADIT-RIT. Kaplan–Meier survival analysis showed that at 2 years of follow-up the rate of any VTA was significantly lower among patients with low baseline RHR (≤63 b.p.m.) as compared with faster RHR (11% vs. 19%, respectively; P = 0.001 for the overall difference during follow-up). Similar results were shown for the association with the rate of fast VTA (8% vs. 14%, respectively; P = 0.016), and appropriate ICD therapy (10% vs. 18%, respectively; P = 0.004). Multivariate analysis, after adjustment for medical therapy, showed that low baseline RHR was associated with a significant 45% (P = 0.002) reduction in the VTA risk as compared with faster baseline RHRs. When assessed as a continuous measure, each 10 b.p.m. decrement in RHR was associated with a corresponding 13% (P = 0.014) reduction in the VTA risk. Conclusion In MADIT-RIT, low RHR was independently associated with a lower risk for life-threatening arrhythmic events. These findings suggest a possible role for RHR for improved selection of candidates for ICD therapy.

Assessing the effectiveness of adjuvant chemoradiotherapy after cholecystectomy in patients with gallbladder cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 455-455
Author(s):  
Grant McLeod Van der Voort ◽  
Brendan Martin ◽  
Tarita Thomas
Keyword(s):  
Gallbladder Cancer ◽  
Concurrent Chemoradiotherapy ◽  
Proportional Hazards ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Adjuvant Chemoradiotherapy ◽  
Eligibility Criteria ◽  
Prospective Data ◽  
Facility Type

455 Background: The study was conducted to compare the overall survival for patients receiving concurrent chemoradiotherapy (CCRT) versus radiotherapy (RT) or chemotherapy (CT) alone after cholecystectomy in patients with gallbladder cancer. Methods: Patients with gallbladder cancer who had surgical resection from 2004 to 2015 were identified in the National Cancer Database. The proportional hazards assumption for each predictor was assessed using Martingale residuals. Significance was then determined using univariable and multivariable Cox proportional hazards frailty models that allow for clustering of patients within their treatment facility type. Results: A total of 7,258 gallbladder cancer patients who had undergone cholecystectomy met eligibility criteria: 1,509 (20.8%) received CCRT, 283 (3.9%) received RT alone, 1,368 (18.9%) received CT alone, and 4,098 (56.5%) received no adjuvant therapy. The median survival for this patient sample was 29.11 months with median follow-up of 59.10 months. On multivariable analysis, the hazard of death at any given time for patients who received adjuvant CCRT following surgery was 20% (HR = 0.80, 95 CI: 0.73-0.87) lower than those who only underwent surgery alone (p < .0001). By contrast, the hazard of death at any given time for patients who received CT following surgery was 33% (HR = 1.33, 95 CI: 1.22-1.44) higher than those who only underwent surgery (p <.0001). Conclusions: CCRT is associated with improved OS compared with CT or RT alone after cholecystectomy in patients with gallbladder cancer, suggesting that adjuvant CCRT should be used in this population although prospective data is needed to validate these findings.

Abstract P021: Association Of Resting Heart Rate With All-cause And Cardiovascular Mortality: Sprint

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Steven J Mould ◽  
Elsayed Z Soliman ◽  
Yashashwi Pokharel ◽  
Elijah Beaty ◽  
Prashant Bhave ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Cardiovascular Mortality ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Channel Blockers ◽  
Resting Heart Rate ◽  
Autonomic Tone

Introduction: Elevated resting heart rate (RHR) has been shown to be associated with both all-cause and cardiovascular mortality. Prior studies have provided conflicting estimates of the strength of each association. To explore the relationship between RHR and competing mortality risks, we sought to compare the association between RHR and cardiovascular and non-cardiovascular mortality among participants in the Systolic Blood Pressure Intervention Trial (SPRINT). Methods: Eligible SPRINT participants had baseline RHR, longitudinal follow-up, and were not using beta blockers or non-dihydropyridine calcium channel blockers. Mortality was classified by a treatment-blinded adjudication committee as cardiovascular if secondary to coronary heart disease, stroke, sudden cardiac death, or congestive heart failure. Multivariable Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CI) for cardiovascular and non-cardiovascular mortality, separately, associated with a 10 beats per minute increase in RHR. Results: Among 5,571 eligible SPRINT participants (67.1 ± 9.4 years, 33.8% female, 63.8% white, mean RHR 70.4±11.8 beats per minute) over a median 3.8 years of follow-up, there were 56 cardiovascular deaths and 176 non-cardiovascular deaths. In models adjusted for age, sex, race, prior cardiovascular disease, smoking, systolic blood pressure, creatinine, total cholesterol, high-density lipoprotein cholesterol, and trial treatment assignment, higher RHR (per ten beat-per-minute increase) was associated with both cardiovascular (HR 1.17, 95% CI 1.02-1.35) and non-cardiovascular mortality (HR 1.27, 95% CI 1.13-1.43). Conclusions: Elevated RHR was associated with both cardiovascular and non-cardiovascular mortality, suggesting that RHR may serve as a marker of both global health rather and cardiovascular health. Higher RHR may reflect imbalance in autonomic tone and further studies are needed to explore the mechanisms of these associations.4

Abstract TMP112: Subsequent Hemorrhage in Children With Untreated Brain Arteriovenous Malformation: Higher Risk With Unbalanced Inflow and Outflow Angioarchitecture

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Li Ma ◽  
Yu Chen ◽  
Yuanli Zhao
Keyword(s):  
Risk Factors ◽  
Proportional Hazards ◽  
Multivariable Analysis ◽  
Venous Drainage ◽  
Cox Proportional Hazards ◽  
Arteriovenous Shunt ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Venous Ectasia

Instruction: Children with brain arteriovenous malformations (bAVM) are at risk of life-threatening hemorrhage in their early lives. Our aim was to analyze various angiographic features of bAVM in conjunction with other morphological risk factors to predict the risk of subsequent hemorrhage during follow-up in children. Methods: We identified all consecutive children admitted to our institution for bAVMs between July 2009 and September 2015. Children with at least 1 month of treatment-free follow-up after diagnosis were included in further analysis. The effects of bAVM features on hemorrhagic presentation were studied. Annual rates of AVM rupture as well as several potential risk factors for subsequent hemorrhage were analyzed using Kaplan-Meier analyses and Cox proportional hazards regression models. Results: We identified 110 patients with a mean follow-up period of 2.1 years (range, 1 month-15.4 years). The average annual risk of hemorrhage from untreated AVMs was 4.3%. Risk factors predicting hemorrhagic presentation in multivariable analysis were no generalized venous ectasia, deep venous drainage, fast arteriovenous shunt, and deep location. No generalized venous ectasia in conjunction with fast arteriovenous shunt was predictive of subsequent hemorrhage (RR, 7.55; 95%CI, 1.96-29.06). The annual rupture risk was 11.1% in bAVMs without generalized venous ectasia but with fast arteriovenous shunt. Conclusions: bAVM angiographic features suggesting unbalanced inflow and outflow might be helpful to identify children at higher risk for hemorrhage. No generalized venous ectasia and fast artriovenous shunt might be associated with an increased risk for hemorrhagic presentation and subsequent hemorrhage in pediatric patients with untreated bAVM.

Antidepressant-Treated Patients in Ambulatory Care

1996 ◽  
Vol 169 (5) ◽  
pp. 647-654 ◽  
Author(s):  
Kerstin Bingefors ◽  
Dag Isacson ◽  
Lars Von Knorring ◽  
Björn Smedby ◽  
Kristina Wicknertz
Keyword(s):  
Ambulatory Care ◽  
Service Use ◽  
Proportional Hazards ◽  
Antidepressant Treatment ◽  
Total Mortality ◽  
Cox Proportional Hazards ◽  
Medical Disease ◽  
Prescription Drug Use

BackgroundNon-institutionalised patients treated with antidepressants have been shown to have indicators of a generalised vulnerability, such as high rates of health service use and excessive prescription drug use. Therefore, mortality in this patient group is of interest.MethodAll first-incidence antidepressant users in a defined population during a five-year period were identified. Their total mortality during a nine-year follow-up was analysed. Cox proportional hazards regression was used to analyse total mortality, and mortality in cardiovascular disease, controlling for baseline chronic medical disease.ResultsAntidepressant treatment at the index date was a statistically significant predictor for increased long-term mortality in the over-65s, even when controlling for pre-existing chronic medical disease. Baseline ischaemic heart disease and concurrent antidepressant treatment significantly predicted mortality from cardiovascular causes.ConclusionPrescribed antidepressant treatment identifies patients who are at risk of increased mortality. For the physician in ambulatory care, knowledge of a patient's antidepressant treatment history may be a valuable tool in managing patient care.

scholarly journals Association of hysterectomy and invasive epithelial ovarian and tubal cancer: A cohort study within UKCTOCS

2021 ◽  
Author(s):  
Julie Taylor ◽  
Matthew Burnell ◽  
Andy Ryan ◽  
Chloe Karpinskyj ◽  
Jatinderpal Kalsi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Proportional Hazards ◽  
Prediction Models ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Multiple Sources ◽  
Bilateral Oophorectomy ◽  
Ovarian Cancer Screening ◽  
Tubal Cancer

Objective: To investigate the association between hysterectomy with conservation of one or both adnexa and ovarian and tubal cancer. Design: Prospective cohort study. Setting: 13 NHS Trusts in England, Wales and Northern Ireland. Population: 202,506 postmenopausal women recruited between 2001-2005 to the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and followed up until 31 December 2014. Methods: Multiple sources (questionnaires, hospital notes, Hospital Episodes Statistics, national cancer/death registries, ultrasound reports) were used to obtain accurate data on hysterectomy (with conservation of one or both adnexa) and outcomes censored at bilateral oophorectomy, death, ovarian/tubal cancer diagnosis, loss to follow-up or 31 December 2014. Cox proportional hazards regression models were used to assess the association. Main outcome measures: Invasive epithelial ovarian and tubal cancer (WHO 2014) on independent outcome review. Results: Hysterectomy with conservation of one or both adnexa was reported in 41,912 (20.7%; 41,912/202,506) women. Median follow up was 11.1years (IQR 9.96-12.04), totalling >2.17million women-years. Among women who had undergone hysterectomy, 0.55% (231/41912) were diagnosed with ovarian/tubal cancer, compared with 0.59% (945/160594) of those with intact uterus. Multivariable analysis showed no evidence of an association between hysterectomy and invasive epithelial ovarian/tubal cancer (RR=0.98, 95%CI 0.85-1.13, p=0.765). Conclusions: This large cohort study provides further independent validation that hysterectomy is not associated with alteration of invasive epithelial ovarian and tubal cancer risk. This data is important both for clinical counselling and for refining risk prediction models.

Impact of hepatitis C virus antibody positivity on mortality and causes of death in people living with HIV in Georgia

2019 ◽  
Vol 30 (12) ◽  
pp. 1185-1193
Author(s):  
Nikoloz Chkhartishvili ◽  
Natalia Bolokadze ◽  
Nino Rukhadze ◽  
Natia Dvali ◽  
Akaki Abutidze ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Proportional Hazards ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
People Living With Hiv ◽  
Hcv Therapy ◽  
Living With Hiv ◽  
Related Mortality

Hepatitis C co-infection in people living with HIV (PLWH) is common in Georgia. Antiretroviral therapy (ART) is widely available in the country since 2004, and from 2011, patients have unlimited access to hepatitis C virus (HCV) treatment. A retrospective nationwide cohort study included adult PLWH diagnosed between 2004–2016, who were followed up until 31 December 2017. Predictors of mortality were assessed in Cox proportional hazards regression model. A total of 4560 persons contributed 22,322 person-years (PY) of follow-up, including 2058 (45.1%, 10,676 PY) anti-HCV+ patients. After the median 4.1 years of follow-up, 954 persons died, including 615 anti-HCV+ patients. Persons with HCV had higher overall mortality compared to HIV monoinfection (5.76/100 PY vs. 2.91/100 PY, p < 0.0001). In multivariable analysis, anti-HCV positivity was significantly associated with mortality (adjusted hazard ratio: 1.42, 95% CI: 1.09–1.85). Among anti-HCV+ persons, liver-related mortality due to viral hepatitis before the availability of HCV therapy (2004–2011) was 2.11 cases per 100 PY and this decreased to 0.79 cases per 100 PY after 2011 (p < 0.0001). AIDS remained the leading cause of death prior to and after 2011. Wide availability of ART and anti-HCV therapy translated into a significant decline in mortality including due to liver-related causes. Improving earlier diagnosis will decrease excess AIDS-related mortality among people living with HIV/HCV co-infection.

Substitution of unprocessed and processed red meat with poultry or fish and total and cause-specific mortality

2021 ◽  
pp. 1-15
Author(s):  
Tine Bjerg Nielsen ◽  
Anne Mette Lund Würtz ◽  
Anne Tjønneland ◽  
Kim Overvad ◽  
Christina Catherine Dahm
Keyword(s):  
Proportional Hazards ◽  
Total Mortality ◽  
Red Meat ◽  
Cox Proportional Hazards ◽  
Processed Meat ◽  
Cox Proportional Hazards Models ◽  
Total Death ◽  
Baseline Information ◽  
Processed Red Meat

Abstract Recent studies found positive associations between intake of red meat and processed meat and total mortality, however substitution of red meat with poultry and fish has been poorly investigated. We aimed to investigate associations for substitutions of red meat (unprocessed/processed) and total mortality and deaths due to cancer or cardiovascular disease (CVD). We used data from the Danish Diet, Cancer and Health cohort, including 57,053 participants aged 50-64y at baseline. Information on diet was collected through a validated 192-item food frequency questionnaire. Information regarding total mortality, deaths due to cancer and deaths due to CVD was obtained by record linkage. Cox proportional hazards models were used to estimate the HR of 150g/week substitutions of red meat with poultry or fish. During a follow-up (mean 16.1 years), 8,840 deaths occurred (4,567 were due to cancer; 1,816 due to CVD). The adjusted HR (95% CI) for total death when substituting 150g/week total red meat with poultry was 0.96 (0.95; 1.00) and with fish 0.99 (0.97; 1.01). Corresponding HRs for cancer death or CVD death were similar. Substitution of processed red meat with fish or poultry was more consistently associated with a lower mortality than substitution of unprocessed red meat. For example, the adjusted HR (95% CI) for total death when substituting 150g/week processed red meat with poultry was 0.95 (0.92; 0.98). We found that replacing processed red meat with poultry or fish was associated with a lower risk of total mortality and deaths due to cancer, but not deaths due to CVD.

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