Abstract P002: Gender Differences in Atrial Fibrillation Hospitalizations

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Sahar Naderi ◽  
Yun Wang ◽  
JoAnne Foody
Keyword(s):  
Atrial Fibrillation ◽  
Gender Differences ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Age And Gender ◽  
Skilled Nursing ◽  
High Prevalence ◽  
Prevalence Of Depression ◽  
History Of ◽  
And Gender

Background: While there are recognized gender differences in cardiovascular disease, little is known regarding the role of gender in atrial fibrillation (AF). We therefore sought to determine differences in characteristics of AF hospitalization between men and women. Methods: Data from the 2009-2010 Healthcare Cost and Utilization Project were used to model AF hospitalizations as a function of patient age and gender. Results: Of 192,846 AF hospitalizations, 50% of patients were female. Mean age was 74 years versus 66 years for men. Figure I shows AF hospitalizations stratified by age and gender. Women were less likely than men to have diabetes (24 vs 25%, p<0.001), chronic kidney disease (11.2 vs 12.2%, p<0.001), and obesity (12.2 vs 12.9%, p<0.001). They were more likely to have a history of stroke (2.0 vs 1.7%, p<0.001), hypertension (68.7 vs 62.5%, p<0.001), and depression (9.6 vs 5.4%, p<0.001). Females were more likely to be admitted from the emergency room (72.9 vs 66.6%, p<0.001), were hospitalized longer (mean days 3.6 vs 3.3, p<0.001), and were more likely to be discharged to a skilled nursing facility (10.1 vs 4.5%, p<0.001). Women were less likely to have an electrical cardioversion (12.4 vs 18.4%, p<0.001) or AF ablation performed (5 vs 10%, p<0.001) and had a higher mortality than men (0.95 vs 0.75%, p<0.001). Conclusion: Women are hospitalized with AF later in life than men, with the greatest burden in female octogenarians. There is a high prevalence of depression among this cohort. While they have fewer comorbidities, women appear to be more symptomatic from AF and more debilitated upon discharge. Despite this, women are less likely than men to have procedures commonly used to treat AF and are more likely to die during hospitalization.

scholarly journals AGE AND GENDER DIFFERENCES IN ATRIAL FIBROSIS IN PATIENTS WITH ATRIAL FIBRILLATION

2015 ◽  
Vol 65 (10) ◽  
pp. A472 ◽  
Author(s):  
Nazem Akoum ◽  
Christian Mahnkopf ◽  
Gagandeep Kaur ◽  
Eugene Kholmovski ◽  
Nassir Marrouche
Keyword(s):  
Atrial Fibrillation ◽  
Gender Differences ◽  
Atrial Fibrosis ◽  
Age And Gender ◽  
Age And Gender Differences ◽  
And Gender

scholarly journals 897. Prevalence of Candida auris at Body Sites, Characterization of Skin Microbiota, and Relation of Chlorhexidine Gluconate (CHG) Skin Concentration to C. auris Detection Among Patients at a High-Prevalence Ventilator-Capable Skilled Nursing Facility (vSNF) with Established CHG Bathing

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S25-S26 ◽  
Author(s):  
Mary K Hayden ◽  
Thelma E Dangana ◽  
Rachel D Yelin ◽  
Michael Schoeny ◽  
Pamela B Bell ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Skin Microbiome ◽  
Body Site ◽  
Candida Auris ◽  
Candida Spp ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Mechanically Ventilated ◽  
High Prevalence ◽  
High Concentrations

Abstract Background vSNF patients are at high risk of colonization and infection with C. auris. CHG bathing has been used as an intervention to reduce nosocomial transmission of multi-drug-resistant organisms, but its effect on C. auris is unclear. Methods We studied a 70-bed ventilator ward in a 300-bed vSNF in Chicago, IL with a high prevalence of C. auris and established CHG bathing. Swab samples were collected from patients for culture, microbiome analysis, and CHG skin concentration testing (Table 1). Results We collected 2,467 samples (950 culture, 950 microbiome, 567 CHG) from 57 patients during 2 surveys conducted January–March 2019. Forty-six (81%) patients had C. auris cultured from ≥1 body site. Mean (±SD) age was 59 (±14) years, 40% were women, 70% were African American, mean (±SD) Charlson score was 3 (±2). Patients colonized with C. auris were more likely to be mechanically ventilated (50% vs. 0%, P < 0.001), have a gastrostomy tube (78% vs. 27%, P < 0.001) or have urinary catheter (72% vs. 23%, P = 0.01) than noncolonized patients. Frequency of C. auris isolation varied among 10 body sites tested (P < 0.001); colonization of anterior nares (41%) and hands (40%) was detected most often (Figure 1). By ITS1 analysis, all isolates were members of the C. auris South American clade. Skin microbiome sequencing confirmed culture Results. While Malassezia is the dominant genera observed in healthy volunteers and patients in this vSNF, C. auris was observed to dominate the fungal community of multiple skin sites, including nares, hands, inguinal, toe web (Figure 2). Other Candida spp. were also identified on the skin of patients in the current study, but at lower relative abundance. CHG was detected on skin of 52 (91%) patients (median CHG concentration 19.5 µg/mL; IQR 4.9–78.1 µg/mL). In a mixed-effects model controlling for body site and multiple measurements per patient, odds of C. auris detection by culture were less at CHG concentrations ≥625 µg/mL than at lower concentrations (Figure 3; OR 0.25, 95% CI: 0.10–0.66; P = 0.005). Conclusion Frequent C. auris colonization of vSNF patients’ anterior nares and hands suggests that nasal decolonization and patient hand hygiene are potential options to reduce C. auris transmission. High concentrations of CHG may be needed to suppress C. auris on skin. Disclosures All Authors: No reported Disclosures.

Risk of stroke in patients with Chagas cardiomyopathy is associated with depressed LV function but not with LV myocardial fibrosis or apical aneurysm: a study using cardiovascular magnetic resonance

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Schmidt ◽  
H Turin Moreira ◽  
G.J Volpe ◽  
M.F Braggion Santos ◽  
J.A Marin Neto
Keyword(s):  
Atrial Fibrillation ◽  
Magnetic Resonance ◽  
Myocardial Fibrosis ◽  
Age And Gender ◽  
Chagas Cardiomyopathy ◽  
History Of ◽  
And Gender ◽  
Apical Aneurysm ◽  
Normal Lvef

Abstract Background Chronic Chagas cardiomyopathy (CCC) is classically related to higher occurrence of thromboembolic events, especially stroke, particularly in patients with atrial fibrillation (AF). However, risk factors for stroke in patients with CCC but no atrial fibrillation have not been well established. Purpose We aimed to assess the relationship between left ventricular (LV) structure and function, as evaluated with cardiac magnetic resonance (CMR), with stroke in individuals with CCC. Methods We prospectively collected data from 141 patients with CCC who underwent CMR from October 2009 to December 2013 and who were thereafter followed for a median period of 6.8 years. The outcome was the occurrence of stroke during the follow-up period. The only exclusion criteria were history of previous stroke, AF or use of oral anticoagulant (OAC) at the time of CMR. CMR-derived LV parameters were: LV ejection fraction (LVEF), extension of LV myocardial fibrosis, assessed by late gadolinium enhancement, and presence of LV apical aneurysm. LVEF was classified as follows: (I) normal ≥55%; (II) mid-range &lt;55% and ≥40%; and (III) reduced &lt;40%. Age and gender were covariates in the adjusted Cox proportional hazard model. Results Of the initial 141 CCC participants, 25 subjects were excluded due to previous stroke (n=2), history of AF (n=11), or use of OAC (n=12). The remaining 116 individuals had a mean age of 56±14 years, 51% women. Normal, mid-range and reduced LVEF were found in 48 (41%), 43 (37%), and 25 (22%) patients, respectively. Myocardial fibrosis was detected in 79 of 111 (71%) subjects in whom the detection method was feasible. The extension of LV fibrosis was evaluated as a median of 4.6% [interquartile range: 0–10]. LV apical aneurysm was identified in 36 (31%) patients. During the follow-up (median 6.8 years), stroke was reported in 9 participants. In the univariate analysis, reduced LVEF was significantly associated with higher risk of stroke compared to normal LVEF (HR: 9.2, 95% CI: 1.8–48.4), while there was no significant difference between mid-range and normal LVEF (HR: 1.2, 95% CI: 0.2–8.2). The association of reduced LVEF and stroke remained significant in the multivariable model, adjusted for age and gender (HR: 12.6, 95% CI: 1.9–83.2). Kaplan-Meier curves are presented in figure 1 (logrank p-value &lt;0.001). Neither the extension of LV myocardial fibrosis (HR: 1.0, 95% CI: 0.9–1.1) nor the presence of LV apical aneurysm (HR: 1.9, 95% CI: 0.5–7.2) was related to higher risk of stroke. Conclusion In patients with CCC, reduced LVEF assessed by CMR, but not LV fibrosis or presence of apical aneurysm, was a significant predictor of stroke. Funding Acknowledgement Type of funding source: None

Predictive Factors of Depression Among Relatives of Brain-Dead Persons: A Descriptive Correlational Study

2020 ◽  
pp. 003022282097480
Author(s):  
Kourosh Amini ◽  
Mahnaz Rahmani ◽  
Masoumeh Asgari ◽  
Ramazan Fallah
Keyword(s):  
Brain Death ◽  
Predictive Factors ◽  
First Year ◽  
Age And Gender ◽  
High Prevalence ◽  
Prevalence Of Depression ◽  
Dependent Variables ◽  
And Gender ◽  
Low Educated ◽  
The Unemployed

This study aimed to determine the predictive factors of depression among relatives of person deceased by brain death. In this study, 106 first-degree relatives of people who died of due to brain death were studied. Of the study units, 72.64% had levels of depression (severe, moderate, and mild). Among the dependent variables concerning deceased person, age and gender of the deceased were significantly correlated with the depression of their relatives. Among the variables concerning relatives, low level of education, unemployment and time elapsed after brain death have significant role in the incidence or prediction of their depression (p < 0.05). The results indicated a high prevalence of depression among relatives of men aged 30–50 who died because of brain death. It is recommended to consider this fact in planning to care relatives, especially among the low-educated, the unemployed and experiencing the first year of death, of people deceased by brain death.

scholarly journals P970 Significant differences in atrial structural and functional parameters leading to differing mechanisms of atrial fibrillation in athletes compared to non-athletes

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Trivedi ◽  
G Claessen ◽  
L Stefani ◽  
D Flannery ◽  
P Brown ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Endurance Athletes ◽  
Healthy Controls ◽  
Age And Gender ◽  
History Of ◽  
And Gender

Abstract Background/Introduction: There is an increased incidence of atrial fibrillation (AF) in endurance athletes. We sought to evaluate the likely mechanistic basis for this phenomenon. Methods 36 endurance athletes in sinus rhythm, with a previous history of AF (ATH-AF) were compared to age and gender matched endurance athletes with no prior history of AF (ATH), non athletes with paroxysmal AF (NONATH-AF) and age and gender matched healthy controls (CONTROL). A detailed transthoracic echocardiogram was performed with all groups in sinus rhythm, with detailed left atrial (LA) and left ventricular (LV) measurements, including strain analysis. Results All athletes had increased LA and LV size when compared with healthy controls (Table 1). Non athletes with paroxysmal AF had increased LA size when compared with controls. However, indexed LA/LV ratio was preserved in athletes and similar to healthy individuals, whilst AF patients had significantly increased LA/LV ratio. Athletes with AF had higher e’ velocity and lower E/e’, whereas e’ was reduced and E/e’ elevated in non-athlete AF patients. Athletes had impaired LA reservoir and contractile strain, and reduced LV global longitudinal strain (GLS) compared with healthy controls. Conclusions Compared to healthy controls, athletes have reduced LA and LV strain, with preserved LV diastolic function and LA/LV ratio. In contrast, altered diastolic function with differential increase in LA volume was observed in AF patients. The increased risk of AF in athletes is likely mediated by different mechanistic processes other than an atrial myopathy consequent to diastolic dysfunction as observed in non-athletes with AF. Table 1. LA and LV parameters Parameter ATH-AF ATH NONATH-AF CONTROL P value LVEDV indexed (ml/m2) 84 ± 12 79 ± 14 57 ± 10 51 ± 13 &lt;0.001 LVESV indexed (ml/m2) 35 ± 6 34 ± 7 25 ± 8 27 ± 33 0.02 LV ejection fraction (%) 58 ± 4 56 ± 4 56 ± 10 58 ± 8 0.586 LV global longitudinal strain (%) 19.2 ± 1.7 18.9 ± 2.1 21 ± 3.1 21.7 ± 2.9 &lt;0.001 e’ vel (cm/s) 10 ± 2 10 ± 3 8 ± 2 9 ± 2 0.007 E/e’ 5.7 ± 1.3 5.9 ± 1.8 9.1 ± 3.3 7.5 ± 1.5 &lt;0.001 LAV max indexed (ml/m2) 45 ± 11 43 ± 12 38 ± 11 27 ± 8 &lt;0.001 Indexed LAV/LVEDV ratio 0.5 ± 0.1 0.6 ± 0.2 0.7 ± 0.2 0.5 ± 0.1 &lt;0.001 LA reservoir strain (%) 27.2 ± 4.8 28.2 ± 3.7 27.9 ± 8.4 33.2 ± 7.0 &lt;0.001 LA conduit strain (%) 14.2 ± 4.5 14.4 ± 4.0 14.9 ± 5.5 16.6 ± 6.3 0.182 LA contractile strain (%) 13.0 ± 3.1 13.8 ± 3.6 13.0 ± 5.1 16.6 ± 3.1 &lt;0.001 LV = left ventricular, LAV = left atrial volume, LA = left atrial

Bilateral middle cerebral artery occlusions treated with simultaneous bilateral thrombectomy: an approach to multivessel occlusions

2021 ◽  
Vol 14 (5) ◽  
pp. e237965
Author(s):  
Katty Wu ◽  
Kurt A Yaeger ◽  
Christopher Paul Kellner ◽  
Hazem Shoirah
Keyword(s):  
Heart Failure ◽  
Patient Outcome ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Acute Ischaemic Stroke ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
History Of ◽  
Patient’S History

The scarcely described phenomenon of acute ischaemic stroke due to bilateral large vessel occlusions and limited reports of its treatment raises the question about the best method for revascularisation. We present a simultaneous bilateral thrombectomy method on a patient with acute bilateral middle cerebral artery occlusions. This technique resulted in successful vessel recanalisation within 35 min without haemorrhagic complications—deeming the method both safe and effective. Patient outcome was unfavourable, complicated by the patient’s history of heart failure and other cardiac-related problems. Patient is residing at a skilled nursing facility with maximal assistance.

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

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