Abstract 024: Trends in Anatomical Location and Case Fatality of Myocardial Infarction in Four US Communities, 1987–2008: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Jonathan D Newman ◽  
Daichi Shimbo ◽  
Chris Baggett ◽  
Xiaoxi Liu ◽  
Richard Crow ◽  
...  
Keyword(s):  
Case Fatality ◽  
Population Based ◽  
Anatomical Location ◽  
Significant Heterogeneity ◽  
Day Case ◽  
Atherosclerosis Risk In Communities ◽  
St Segment Elevation ◽  
St Segment ◽  
Specific Incident ◽  
Multiple Infarct

INTRODUCTION: Although the incidence of and mortality following ST-segment elevation MI (STEMI) is decreasing, time-trends in STEMI infarct location and associated prognosis have not been examined in a population-based community study. METHODS: We determined 22-year trends in age-adjusted, gender-specific incident hospitalized STEMI and 28-day case fatality among 35–74 year old residents of four ARIC surveillance study communities. STEMI location was assessed by 12-lead electrocardiograms (ECG) from hospital records and was coded as anterior (V2-V5), inferior (II, III, AVF), lateral (I, AVL, V6 alone or with V2-V5) or multiple (2 or more regions) infarct locations using Minnesota coding. Case fatalities were confirmed with linkage to the National Death Index. RESULTS: From 1987 to 2008, there were an estimated 6,108 (fatal or non-fatal) hospitalized STEMIs, with an average annual decrease of −4.0% (95% CI, −4.7, −3.3) in men and −3.1% (95% CI −4.1, −2.1) in women. By infarct location, 37.2% of STEMIs were inferior; 32.8% anterior; 16.8% multiple territories; and 13.2% lateral. Annually, inferior STEMI decreased by −1.5% (95% CI −2.4, −0.6) while STEMI in multiple infarct regions increased by 2.9% (95% CI 1.9, 4.3), Figure. The 28-day case fatality for anterior, inferior and lateral STEMI decreased from 10.9% (95% CI 7.9, 13.9) to 5.1% (95% CI 3.0, 7.2), P < 0.01; from 6.1% (95% CI 4.5, 7.6) to 3.5% (95% CI 2.0, 5.0), P = 0.03; and from 14.8% (95% CI 8.6, 21.1) to 6.3% (95% CI 3.0, 9.6), P = 0.01, respectively. In contrast, no significant change in 28-day case fatality for STEMI in multiple infarct regions was observed. CONCLUSION: Between 1987 and 2008, significant heterogeneity by infarct location was observed for incident STEMI and in 28-day mortality after STEMI. In contrast to STEMI in other infarct locations, the proportion of STEMI involving multiple infarct territories increased over 22 years of surveillance, without improvement in 28-day mortality. These findings may have implications for STEMI surveillance and management.

scholarly journals Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Melissa C. MacKinnon ◽  
Scott A. McEwen ◽  
David L. Pearl ◽  
Outi Lyytikäinen ◽  
Gunnar Jacobsson ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Mortality Rate ◽  
Case Fatality ◽  
Population Based ◽  
Day Case ◽  
Fatality Risk ◽  
E Coli ◽  
Factors Associated ◽  
Case Fatality Risk ◽  
Age And Sex

Abstract Background Escherichia coli is the most common cause of bloodstream infections (BSIs) and mortality is an important aspect of burden of disease. Using a multinational population-based cohort of E. coli BSIs, our objectives were to evaluate 30-day case fatality risk and mortality rate, and determine factors associated with each. Methods During 2014–2018, we identified 30-day deaths from all incident E. coli BSIs from surveillance nationally in Finland, and regionally in Sweden (Skaraborg) and Canada (Calgary, Sherbrooke, western interior). We used a multivariable logistic regression model to estimate factors associated with 30-day case fatality risk. The explanatory variables considered for inclusion were year (2014–2018), region (five areas), age (< 70-years-old, ≥70-years-old), sex (female, male), third-generation cephalosporin (3GC) resistance (susceptible, resistant), and location of onset (community-onset, hospital-onset). The European Union 28-country 2018 population was used to directly age and sex standardize mortality rates. We used a multivariable Poisson model to estimate factors associated with mortality rate, and year, region, age and sex were considered for inclusion. Results From 38.7 million person-years of surveillance, we identified 2961 30-day deaths in 30,923 incident E. coli BSIs. The overall 30-day case fatality risk was 9.6% (2961/30923). Calgary, Skaraborg, and western interior had significantly increased odds of 30-day mortality compared to Finland. Hospital-onset and 3GC-resistant E. coli BSIs had significantly increased odds of mortality compared to community-onset and 3GC-susceptible. The significant association between age and odds of mortality varied with sex, and contrasts were used to interpret this interaction relationship. The overall standardized 30-day mortality rate was 8.5 deaths/100,000 person-years. Sherbrooke had a significantly lower 30-day mortality rate compared to Finland. Patients that were either ≥70-years-old or male both experienced significantly higher mortality rates than those < 70-years-old or female. Conclusions In our study populations, region, age, and sex were significantly associated with both 30-day case fatality risk and mortality rate. Additionally, 3GC resistance and location of onset were significantly associated with 30-day case fatality risk. Escherichia coli BSIs caused a considerable burden of disease from 30-day mortality. When analyzing population-based mortality data, it is important to explore mortality through two lenses, mortality rate and case fatality risk.

03 The prehospital 12 lead electrocardiogram is associated with improved outcomes in patients with acute coronary syndromes presenting to emergency medical services: a nationwide linked cohort study

2021 ◽  
Vol 38 (9) ◽  
pp. A2.1-A2
Author(s):  
Tom Quinn ◽  
Timothy Driscoll ◽  
Lucia Gavalova ◽  
Mary Halter ◽  
Chris P Gale ◽  
...  
Keyword(s):  
Cohort Study ◽  
Emergency Medical Services ◽  
Population Based ◽  
Medical Services ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Emergency Medical ◽  
St Segment ◽  
Coronary Syndromes ◽  
Audit Project

BackgroundUse of the Pre-Hospital 12-lead Electrocardiogram (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS).ObjectivesTo investigate differences in mortality between those who did/did not receive PHECG.MethodsPopulation-based, linked cohort study using Myocardial Ischaemia National Audit Project (MINAP) data from 2010-2017.ResultsOf 330,713 patients, 263,420 (79.6%) had PHECG, 67,293 (20.3%) did not. 30-day mortality was 7.8% overall, 7.1% with PHECG vs 10.9% without PHECG (adjusted Odds Ratio [aOR] 0.772, 95% confidence interval [CI] 0.748-0.795, p<0.001). 1 year mortality was 16.1% overall, 14.2% with PHECG vs 23.2% without (aOR 0.692, 95% CI 0.676-0.708, p<0.001). 144,254 patients had ST segment elevation myocardial infarction (STEMI); 130,240 (90.2%) had PHECG, 30 day mortality 8.8% overall, 8.0% with PHECG vs 15.9% without (aOR 0.588, 95% CI 0.557-0.622, p<0.001), 1 year mortality 13.1% overall, 12.1% with PHECG vs 22.8% without (aOR 0.585, 95% CI 0.557-0.614, p<0.001). 186,459 patients had non-STEMI; 133,180 (71.4%) had PHECG. 30-day mortality 7.1% overall, 6.1% with PHECG vs 9.6% without (aOR 0.677, 95%CI 0.652-0.704, p<0.001), 1 year mortality 18.3% overall, 16.3% with PHECG vs 23.3% without (aOR 0.694, 95% CI 0.676-0.713, p<0.001). 110,571 STEMI patients received primary PCI, 103,741 (93.8%) had PHECG. 30 day mortality 5.4% overall, 5.3% with PHECG vs 7.0% without (aOR 0.739, 95% CI 0.667-0.829, p<0.001). 1 year mortality 8.5% overall, 8.4% with PHECG vs 9.8% without (aOR 0.833, 95% CI 0.762-0.911, p<0.001). 26,127 (18.1%) STEMI patients received no reperfusion; 19,873 (76%) had PHECG. Mortality at 30 days 22.1% overall, 21.3% with PHECG vs 24.7% without (aOR 0.911, 95% CI 0.847-0.980, p=0.013), 1 year mortality 32.2% overall, 30.9% with PHECG, 36.4% without (aOR 0.865, 95% CI 0.810-0.925, p<0.001).ConclusionPHECG was associated with lower mortality at 30 days and 1 year in both STEMI and non-STEMI patients.

Abstract 3225: Gross Domestic Product and Health Expenditure Associated with Incidence, 30-Day Fatality and Age at Stroke Onset: A Systematic Review

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Luciano Sposato ◽  
Gustavo Saposnik
Keyword(s):  
Socioeconomic Status ◽  
Gross Domestic Product ◽  
Purchasing Power Parity ◽  
Case Fatality ◽  
Population Based ◽  
Stroke Onset ◽  
Power Parity ◽  
Day Case ◽  
Scatter Plots ◽  
Per Capita

Background: Differences in definitions of socioeconomic status (SES) and between study designs hinder their comparability across countries. We aimed to analyze the correlation of three widely used macro-SES indicators with stroke incidence and age at stroke onset. Methods: We selected population-based studies reporting incident stroke risk and/or 30-day case fatality according to pre-specified criteria. We used three macro-SES indicators that are consistently defined by international agencies: per capita gross domestic product adjusted for purchasing power parity (PPP-aGDP), total health expenditures per capita at purchasing power parity (PPP-aTHE) and unemployment rate. We used two-tailed Spearman’s test and scatter-plots for analyzing the correlation of each macro-SES indicator with incident risk of stroke, 30-day case fatality rates, proportion of hemorrhagic strokes and age at stroke onset. Results: Twenty-three manuscripts comprising 30 population-based studies fulfilled the eligibility criteria. Age-adjusted incident risk of stroke using standardized World Health Organization World population, 30-day case fatality rates, proportion of hemorrhagic strokes and age at stroke onset were associated to lower PPP-aGDP and PPP-aTHE ( Table 1 and Figures 2 and 3). There was no correlation between unemployment rates and outcome measures. Table 1. Correlation Analyses of Macro-Indicators of Socioeconomic Status Figures 1. Scatter Plots for PPP-aGDP Figures 2. Scatter Plots for PPP-aTHE Conclusions: Lower PPP-aGDP and PPP-aTHE were associated with higher incident risk of stroke, higher case fatality, greater proportion of hemorrhagic strokes and lower age at stroke onset. As a result, these macro-SES indicators may be used as proxy measures of quality of primary prevention and acute care and considered as important factors for developing strategies aimed at improving worldwide stroke care.

scholarly journals Aneurysmal subarachnoid hemorrhage: long-term trends in incidence and survival in Olmsted County, Minnesota

2020 ◽  
pp. 1-6
Author(s):  
Enrico Giordan ◽  
Christopher S. Graffeo ◽  
Alejandro A. Rabinstein ◽  
Robert D. Brown ◽  
Walter A. Rocca ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Incidence Rate ◽  
Case Fatality Rate ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Case Fatality ◽  
Population Based ◽  
Fatality Rate ◽  
Olmsted County ◽  
Day Case ◽  
Incident Cases

OBJECTIVERecent population-based and hospital cohort studies have reported a decreasing incidence of aneurysmal subarachnoid hemorrhage (aSAH) and declining aSAH-associated case-fatality rates. Principal drivers of these trends are debated, but improvements in smoking cessation and hypertension control may be critical factors.METHODSThe population-based medical records linkage system of the Rochester Epidemiological Project was used to document aSAH incidence and 30-day case fatality rates during a 20-year study period (1996–2016) in Olmsted County, Minnesota. Incidence rates in the study period were compared with data from a previous Olmsted County study concerning aSAH incidence from 1965 to 1995 and with regional trends in tobacco use.RESULTSOne hundred nineteen incident cases of aSAH were included. The median age at hemorrhage was 59 years (range 16–94 years), and 74 patients were female (62.2%). The overall average annual aSAH incidence rate was 4.2/100,000 person-years (P-Y). The aSAH incidence rate decreased from 5.7/100,000 in 1996 to 3.5/100,000 P-Y in 2011–2016. The overall aSAH-associated 30-day case-fatality rate was 21.9% and declined by approximately 0.5% annually. An accelerated decline in the fatality rate (0.9%/year) was observed from 2006–2016. Smoking among adult Olmsted County residents decreased from 20.4% in 2000 to 9.1% in 2018.CONCLUSIONSA decline in the incidence of aSAH and 30-day case-fatality rate from 1996 to 2016 was observed, as well as an accelerated decline of the fatality rate from 2006 to 2016. These findings confirm and extend the trends reported by prior studies in the same population. The decrease in aSAH in the years studied paralleled a noticeable reduction in the population smoking rates.

scholarly journals O2 Mortality following elective and emergency colorectal surgery in patients with cirrhosis: a population-based cohort study

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
A Adiamah ◽  
C J Crooks ◽  
J S Hammond ◽  
P Jepsen ◽  
J West ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Cohort Study ◽  
Proportional Hazards ◽  
Postoperative Mortality ◽  
Case Fatality ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Decompensated Cirrhosis ◽  
Day Case ◽  
Emergency Colectomy

Abstract Introduction This population based cohort study, aimed to quantify the risk of mortality following colectomy in patients with cirrhosis by urgency of surgery and stage of cirrhosis. Method Linked primary and secondary-care electronic healthcare data from England was used to identify all patients undergoing colectomy from January 2001 to December 2017. Patients were classified into three cohorts, non-cirrhotics, compensated cirrhotics and decompensated cirrhosis and followed up for 90-days from the date of surgery. Cox proportional hazards models were used to estimate the hazard ratio (HR) of postoperative mortality. Result A total of 36380 eligible patients were included. Of these, 248(0.7%) had liver cirrhosis and 70% had compensated disease. The proportion undergoing a colectomy who had a diagnosis of cirrhosis increased from 0.40% in 2001 to 1.07% in 2017 (χ2(16, N = 36380)=50.53, P &lt; 0.0001). Following elective colectomy, 90-day case fatality was 4% in non-cirrhotics , 7% in compensated cirrhotics and 10% in decompensated cirrhotics. Following emergency colectomy 90-day case fatality was higher, it was 16% in non-cirrhotics, 35% in compensated cirrhotics and 41% in decompensated cirrhotics. This corresponded to an adjusted 2-fold (HR 2.57(95% CI 1.75–3.76)) and 3-fold (3.43(95% CI 2.02–5.83)) increased mortality rate in compensated and decompensated cirrhotics respectively compared to non-cirrhotics following emergency colectomy. Conclusion Over the study period, the proportion of patients undergoing colectomy who had liver cirrhosis increased to 1 in every 100 colectomies. The 90-day case fatality rates were high in all patients with cirrhosis in both emergency and elective settings but the greatest mortality risk was seen in those with decompensation following emergency surgery. Take-home Message 1 in 100 colectomy procedures are in patients with cirrhosis. These cirrhotic patients have a very high risk of postoperative mortality, especially, emergency colectomy in patients with decompensated cirrhosis.

Abstract 185: Declining Subarachnoid Hemorrhage Case-Fatality Rates in a Population

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jason Mackey ◽  
Kathleen Alwell ◽  
Jane C Khoury ◽  
Charles J Moomaw ◽  
Matthew L Flaherty ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Hospital Setting ◽  
Case Fatality ◽  
The United States ◽  
Population Based ◽  
Day Case ◽  
Physician Review ◽  
Time Period ◽  
Medical Advances ◽  
The Impact

Introduction: In the last few decades there have been several medical advances in the care of patients with subarachnoid hemorrhage (SAH). But few population-based studies (and none in the United States) have examined outcomes in the same population over time. Methods: All SAHs among residents of the Greater Cincinnati/Northern Kentucky (GCNK) region at least 20 years of age were identified using ICD-9 codes 430-436 and verified via study physician review in four distinct study periods. An incidence rate for each time period was calculated. Baseline characteristics, including demographics, risk factors, and functional status, were ascertained, along with hospital discharge modified Rankin score and all-cause 30- and 90-day case-fatality. Results: We identified 78 SAHs among residents of the GCNK region in 1988, 85 from 7/1993 to 6/1994, 95 in 1999, and 91 in 2005. The incidence of SAH in the four study periods (age-, race-, and sex-adjusted to the 2000 US population) was 9.4, 9.3, 10.0, and 9.0 per 100,000, respectively. Of the 349 SAHs in the study periods, 326 were diagnosed in an ED or hospital setting, while 23 were diagnosed on autopsy alone. All-cause 30- and 90-day case-fatality rates declined significantly from 1988 to 2005 ( Table ), even when all autopsy-alone cases were excluded. Conclusions: While the incidence of SAH remained stable in this population-based region, the 30-day and 90-day case-fatality rates declined significantly. Advances in surgical and medical management, along with systems-based changes such as the emergence of neurocritical care units, have likely led to reduced case-fatality. Future studies should explore the impact of specific factors related to improved case-fatality rates.

Sign in / Sign up

Export Citation Format

Share Document