Abstract 11737: Heart Failure Patients Who Have Knowledge About Their Disease but Don’t Perform Self-Care Have Worse Clinical Outcomes

Introduction: Both knowledge and self-care are related to outcomes of heart failure (HF) patients. Some HF patients do not perform self-care even if they have knowledge about the disease and might be in need for special interventions. We aimed at describing characteristics of those patients and assessing their clinical outcomes. Methods: A total of 163 HF outpatients were enrolled (age 64, 70% male, NYHA I or II, 95%) and followed for 2 years. HF self-care risk score was calculated by counting the number of poor adherence to five self-care behaviors (medication, a low-sodium diet, exercise, daily weighing, and help-seeking behavior) (range, 0-6). Knowledge was assessed with a Japanese HF knowledge scale (range, 0-15). Subsequently, we classified patients into 4 groups (A-D) as shown in figure. We analyzed patient’s characteristics in group C (poor self-care but good knowledge) by ANOVA and Chi-square test. To assess clinical outcomes we used Kaplan-Meier method and Cox regression analysis. Results: The mean HF self-care risk score was 3.1±1.6 and the mean knowledge score was 10.9±2.9. In total, 45 patients (28%) were classified into Group C [76% male, mean B-type natriuretic peptide (BNP) levels, 164 pg/mL]. Compared with other groups, patients in Group C were likely to be younger (61±13 vs. 65±11 years, p=0.059). Their self-care scores did not correlate with their knowledge scores (p=0.99). During a 2-year follow-up period, 29 patients (18%) had HF hospitalization and/or cardiac death, with a significant higher rate in Group C (30%, Fig, p=0.04). After adjustment for age, BNP, and medical therapy, patients in Group C had 2.8 times higher risk of poor outcomes than other groups (hazard ratio=2.80, p=0.01). Conclusions: One-third of patients have HF knowledge but they do not perform self-care, and they have worse outcomes compared with other groups. Further study is necessary to examine those patients in more detail and to provide support for them to put knowledge into action.

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Incidence and Survival Trends of Bladder Rhabdomyosarcoma:A SEER-based Analysis of 125 Cases

10.21203/rs.3.rs-19828/v1 ◽

2020 ◽

Author(s):

Pin Li ◽

Huixia Zhou ◽

Hualin Cao ◽

Tao Guo ◽

Weiwei Zhu ◽

...

Keyword(s):

Prognostic Factors ◽

Survival Time ◽

Clinical Outcomes ◽

Cox Regression ◽

Survival Curve ◽

Clinicopathological Characteristics ◽

Chi Square ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Significant Factors

Abstract Background To elucidate the bladder rhabdomyosarcoma clinicopathological characteristics and reveal the prognostic factors. Methods We screened data from SEER database (1975-2016) stratified by age group, evaluated the differences between groups with Chi-square and Fisher’s test, conducted the Kaplan-Meier survival analysis and plotted the survival curve. The significant factors were brought into Cox regression analysis and calculated the HR(95%CI). Results About half of the patients who develop bladder RMS will be younger than 2 years of age. Embryonal RMS account for 76% of all histopathology types. Age at diagnosis more than 16-y (HR=6.595,95%CI:3.62-12.01, p=7.04e-10), NOT embryonal rhabdomyosarcoma (HR=3.61, 95%CI:1.99-6.549, p =4.1e-06), without radiotherapy combined or surgery alone (HR=4.382, 95%CI:1.99-6.549, p =2.4e-05) and not performed the surgery (HR=2.982,95%CI:1.263-7.039, p =0.0126) were negatively correlated with 5-year survival time, while race( p =0.341), whether performed the lymphadenectomy( p =0.722) showed no influence on survival time. Cox regression results show that age, histology, SEER stage, treatment combined or alone influence the clinical outcomes. Conclusions We demonstrated the demographic and characteristic of bladder rhabdomyosarcoma, identified and excluded the prognostic factors for the 5-year overall survival and clinical outcomes.

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Abstract 15220: Development of a Prediction Model for Atrial Fibrillation in Patients With Heart Failure and Preserved Ejection Fraction: Secondary Analysis of Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (topcat) Trial

Circulation ◽

10.1161/circ.142.suppl_3.15220 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Khaled Elkholey ◽

Zain Ul Abideen Asad ◽

Lampros Papadimitriou ◽

Udho THADANI ◽

Stavros Stavrakis

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

High Risk ◽

Ejection Fraction ◽

Risk Score ◽

Cox Regression ◽

Risk Groups ◽

Preserved Ejection Fraction ◽

Cox Regression Analysis ◽

Increased Risk

Background: Atrial fibrillation (AF) is a common comorbidity in heart failure with preserved ejection fraction (HFpEF) and portends an increased risk of cardiovascular events. We sought to identify predictors and develop a risk score of incident AF among patients with HFpEF. Methods: This was an exploratory, post-hoc analysis of the TOPCAT trial. Patients without known AF were included. Cox regression was used to identify independent predictors of incident AF. A risk score was derived from the weighed sum of the regression coefficients of each independent risk factor in the final model using Cox regression analysis. Results: A total of 2174 patients (mean age 67.0±9.4 years; female 55%) without known AF at baseline were included. During a median follow-up of 3 years, 102 (4.7%) patients developed new onset AF. Diabetes (HR=2.1, 95% CI 1.4-3.1; p=0.0002), peripheral arterial disease (HR=2.0, 95% CI 1.2-3.4; p=0.006), elevated (>144meq/dL) sodium (HR=2.1, 95% CI 1.4-3.1; p=0.0002) independently predicted incident AF, whereas current use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was protective (HR=0.61, 95% CI 0.38-0.99, p=0.048). Based on the simplified risk score which included these 4 variables, annualized AF incidence rates were 0.8%, 1.8%, and 3.6% in the low (score=0), intermediate (score=1 or 2), and high-risk (score >2) groups, respectively (log rank P<0.0001; Figure). Compared to the low risk group, the intermediate and high risk groups had a 2.5-fold and 5-fold increase in the risk of incident AF, respectively (HR=2.5, 95% CI 1.5-4.0, p=0.0003 and HR=4.9, 95% CI 2.9-9.4, p<0.0001, respectively). Model discrimination was good (c-statistic=0.67; 95% CI 0.61-0.72). Conclusions: A simplified risk score derived from clinical and laboratory characteristics predicts incident AF in patients with HFpEF and, upon further validation, may be used clinically for risk stratification or for AF screening in high risk groups. Figure

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Potential Causes and Implications of Low Target Therapeutic Ratio in Warfarin-Treated Patients for Thrombosis Prophylaxis: A Single-Center Experience

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029617695484 ◽

2017 ◽

Vol 24 (3) ◽

pp. 536-541 ◽

Cited By ~ 1

Author(s):

Halil Atas ◽

Ahmet Anıl Sahin ◽

Dilek Barutçu Atas ◽

Murat Sunbul ◽

Alper Kepez ◽

...

Keyword(s):

Regression Analysis ◽

Renal Dysfunction ◽

Clinical Outcomes ◽

Warfarin Therapy ◽

Cox Regression ◽

Thrombosis Prophylaxis ◽

Cox Regression Analysis ◽

Tertiary Center ◽

The Mean

Time in therapeutic range (TTR) of international normalized ratio is crucial for the safety and efficacy of anticoagulation with warfarin and it is influenced by many factors. There are limited data about the quality of warfarin therapy and its effects on clinical outcomes in Turkey. The aim of this study is to demonstrate the quality of anticoagulant therapy with warfarin and evaluate the parameters that affect the quality of warfarin therapy. A total of 170 patients with atrial fibrillation (AF; mean age: 62.2 ± 13.3; 69.2% female) treated with warfarin were included in this study. The mean follow-up period was 20 ± 8.4 months. The mean TTR levels of all patients were found to be 54.2% ± 21.4%. The TTR levels were similar in patients with valvular AF (VAF) and nonvalvular AF (NVAF). Logistic regression analysis revealed that elderly, heart failure (HF), and renal dysfunction were independent predictors of lower TTR. There were no significant differences between the VAF and NVAF subgroups regarding the incidence of mortality, stroke, and myocardial infarction. Cox regression analysis revealed that HF, coronary artery disease, and renal dysfunction were independent predictors of clinical outcomes in addition to lower TTR. Our results provide data regarding the quality of anticoagulation with warfarin from a single tertiary center in Istanbul, Turkey. The questions remain in seeking quality improvement in anticoagulation.

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P0386OUTCOMES OF PAUCI-IMMUNE CRESCENTIC GLOMERULONEPHRITIS BASED ON THE INTERNATIONAL HISTOPATHOLOGICAL CLASSIFICATION AND RECENTLY PROPOSED RENAL RISK SCORE IN ADULTS: A SINGLE CENTER STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0386 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Pallav Gupta ◽

Satyendra Dharamdasani ◽

Devinder Singh Rana ◽

A K Bhalla ◽

Ashwani Gupta

Keyword(s):

Risk Score ◽

Crescentic Glomerulonephritis ◽

Cox Regression ◽

Interstitial Fibrosis ◽

Tubular Atrophy ◽

Cox Regression Analysis ◽

Histopathological Classification ◽

Kaplan Meier ◽

The Mean ◽

Risk Categories

Abstract Background and Aims Pauci-immune crescentic glomerulonephritis is rare form of glomerulonephritis that frequently presents as rapidly progressive renal failure. The histopathological classification proposed by Berden a decade earlier described difference in the outcomes of patients in the focal, crescentic, mixed and sclerotic category with best prognosis for focal and worst for sclerotic group. The newly proposed renal risk score (Brix SR at al.) takes into account both the histopathological parameters (% of normal glomeruli, tubular atrophy and interstitial fibrosis) and clinical parameter (eGFR) which influence outcome in these patients. Present study was undertaken to determine outcomes of pauci-immune crescentic glomerulonephritis based on both of these prognostic systems and also to determine effect of individual risk factors on renal outcome. Method 64 patients diagnosed as pauci-immune crescentic glomerulonephritis from January 2013 to December 2018 were retrospectively analyzed. There histopathological slides were reviewed for percentage normal glomeruli, extent of interstitial fibrosis and tubular atrophy and biopsies were also grouped according to histopathological classification into focal, crescentic, mixed and sclerotic categories. The clinical parameters including serum creatinine, eGFR at time of biopsy and follow-up, and status of ANCA positivity were obtained from electronic records. Renal biopsies were scored based on renal risk score depending on the % of normal glomeruli (>25%,10-25% and <10%), percentage of tubular atrophy and interstitial fibrosis(≤25%,>25%) and eGFR(>15ml/min,≤15ml/min) into 3 risk categories. Results There were 61 adult patients and 3 pediatric patients. Two patient with insufficient glomeruli (<7) on biopsy and 8 patients without follow-up were excluded. A total of 51 adult patients were included of which 28 were male and 23 females. The mean age was 51.2±15.7 years. The mean serum creatinine at the time of biopsy was 7.05±4.57 mg/dl and the mean eGFR was 13.6±12.16 ml/min/1.73m2. There were 33 ANCA positive and 18 ANCA negative(35%) cases. Distribution of patients according to Berden’s histopathological classification was focal(4), crescentic(29), mixed(12) and sclerotic(6). The distribution of patients into risk categories based on renal risk score was low(8),medium(23) and high(20). Univariate Cox regression analysis showed that eGFR at biopsy (p 0.024), % IFTA (p 0.001) and % normal glomeruli in biopsy (p 0.023) are predictors of ESRD. Multivariate Cox regression analysis including age, eGFR, % IFTA and % normal glomeruli in biopsy also confirmed IFTA (p<0.001) and % normal glomeruli in biopsy (p 0.018) as significant predictors of ESRD. When % normal glomeruli was replaced by Berden’s histopathological classed it didn’t reach statistical significance to predict ESRD. Kaplan-Meier survival analysis for histological categories showed best renal survival in focal group and worst in sclerotic group (Log-Rank p=0.046). Kaplan-Meier analysis for the renal risk categories showed best survival in low risk group followed by medium and high risk groups respectively (Log-Rank p=0.002). Kaplan-Meier survival analysis was also done for percentage of normal glomeruli, IFTA and renal function. Conclusion In our study of Pauci-immune crescentic glomerulonpehritis ANCA was negative in 35% cases. Percentage of normal glomeruli, IFTA and eGFR at time of biopsy were important histopathological and clinical risk factors influencing renal survival in these patients. Results of our study validate that recently proposed renal risk score is a better predictor of survival (p=0.002) as compared to histological classification proposed by Berden (p=0.046).

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Clinical outcomes in focal versus extensive micropapillary bladder cancer at the time of diagnostic transurethral resection.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.317 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 317-317

Author(s):

Daniel Levi Willis ◽

Mario Fernandez ◽

Rian J. Dickstein ◽

Charles Guo ◽

Bogdan Czerniak ◽

...

Keyword(s):

Bladder Cancer ◽

Multivariate Analysis ◽

Clinical Outcomes ◽

Median Survival ◽

Transurethral Resection ◽

Cox Regression ◽

Univariate Analysis ◽

Chi Square ◽

Cox Regression Analysis ◽

Bcg Therapy

317 Background: It has been postulated that the outcome of patients with micropapillary bladder cancer (MPBC) is dependent on the extent of MPBC component relative to conventional urothelial carcinoma. Herein, we reviewed the clinical outcomes of patients with MPBC and evaluated the outcomes based on extent of disease in the transurethral resection (TUR) specimen. Methods: An IRB-approved institutional review of our bladder cancer database identified 255 patients with MPBC. Dedicated GU pathologists at our institution quantified MPBC as being "focal" or "extensive" in 201 patients, who form the basis of this report. Univariate analysis was performed with the chi square test and the Kaplan-Meier estimator, while multivariate analysis was performed using Cox Regression analysis. Results: Overall, 127 (63%) patients were reported as having focal MPBC and 74 (37%) patients had extensive micropapillary histology. Survival analysis demonstrated that patients with focal MPBC had a greater overall median survival of 54 mo. vs. 22 mo. for those with extensive MPBC (p=0.002). The extent of MPBC also correlated with cT stage as extensive MPBC was seen with higher stage disease (p=0.035). When stratified by cT stage, patient survival correlated with the extent of MPBC such that median survival for focal versus extensive MPBC was 122 vs. 62 mo. for cT1 (p=0.04), 54 vs. 22 mo. for cT2 (p=0.008), and 12 vs. 4 mo. for cT3 patients (p=0.017). In the cT1 cohort, patients with extensive MPBC were 2.3 times more likely to have disease progression on BCG therapy than those with focal disease (p=0.02). Extensive MPBC in the TUR specimen was also associated with higher rates of clinical lymph node metastasis (34% vs. 19%, p=0.018). The association of the extent of MPBC with overall survival remained significant after multivariate analysis with other prognostic variables including lymphovascular invasion and clinical T stage (p=0.05). Conclusions: The extent of micropapillary architecture in the TUR specimen is associated with stage of tumor at presentation. However, even when controlling for stage, patients with "extensive" MPBC on TUR specimen have independently worse outcomes compared to those with focal MPBC.

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Abstract 9658: Generation Differences in Long-Term Clinical Outcomes in Diabetic Patients After PCI Across POBA-, BMS- and DES-Era

Circulation ◽

10.1161/circ.130.suppl_2.9658 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ryo Naito ◽

Katsumi Miyauchi ◽

Hirokazu Konishi ◽

Shuta Tsuboi ◽

Manabu Ogita ◽

...

Keyword(s):

Clinical Outcomes ◽

Cox Regression ◽

Major Adverse Cardiovascular Events ◽

Diabetic Patients ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

The Mean ◽

Negative Predictor ◽

Fatal Myocardial Infarction

Introduction: PCI has evolved with technological advance, improvement of operators’ techniques and medical therapy for secondary prevention. Despite these improvements, diabetes remains a negative predictor. To date, little is known regarding improvement of clinical outcomes in diabetic patients with PCI. We examined a temporal trend of long-term clinical outcomes in diabetic cohort across the different generations. Hypothesis: We hypothesized that clinical outcomes would improve with advances of PCI. Methods: We analyzed data of diabetic patients with PCI in Juntendo University from 1984 to 2010. The patients were divided into three groups according to the procedure data (POBA-era; January 1984 - December 1997, BMS-era; January 1998 - July 2004 and DES-era; August 2004 - February 2010). Primary endpoint was a composite of major adverse cardiovascular events including all-cause mortality, non-fatal myocardial infarction, non-fatal stroke and revascularization. Results: A total of 1544 patients were examined (POBA-era; 374, BMS-era; 494 and DES-era; 676). The mean age was higher in DES-era. A higher prevalence of hypertension and dyslipidemia was observed in DES-era. The success rate of PCI was lower among the patients in POBA-era. Kaplan-Meier estimation for 3-year MACE was significantly different among the eras (Figure 1). Multivariable Cox regression analysis showed that DES-era was a predictor for long-term MACE (DES- vs BMS era; HR 0.50, 95%, CI 0.38 - 0.66, P < 0.001, DES- vs POBA-era; HR 1.60, 95% CI 0.34-27.9, P = 0.6). Conclusions: Long-term clinical outcomes in diabetic patients who underwent PCI were more favorable in DES-era, despite the higher risk profiles.

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Association Between Depression and Clinical Outcomes in Patients With Hypertrophic Cardiomyopathy

Journal of the American Heart Association ◽

10.1161/jaha.120.019071 ◽

2021 ◽

Author(s):

Hui‐Lin Hu ◽

Hao Chen ◽

Chun‐Yan Zhu ◽

Xin Yue ◽

Hua‐Wei Wang ◽

...

Keyword(s):

Heart Failure ◽

Hypertrophic Cardiomyopathy ◽

Clinical Outcomes ◽

Cox Regression ◽

Cox Regression Analysis ◽

Diagnostic And Statistical Manual ◽

Kaplan Meier ◽

Increased Risk ◽

Artery Disease ◽

The Impact

Background Hypertrophic cardiomyopathy (HCM) is considered to be the most common cause of sudden death in young people and is associated with an elevated risk of mood disorders. Depression has emerged as a critical risk factor for development and progression of coronary artery disease; however, the association between depression and HCM outcomes is less clear. We sought to examine the impact of depression on clinical outcomes in patients with HCM. Methods and Results Between January 2014 and December 2017, 820 patients with HCM were recruited and followed for an average of 4.2 years. End points were defined as sudden cardiac death (SCD) events and HCM‐related heart failure events. A Chinese version of the Structured Clinical Interview followed the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and was used to diagnose depression. During the follow‐up period, SCD events occurred in 75 individuals (21.8 per 1000 person‐years), and HCM‐related heart failure events developed in 149 individuals (43.3 per 1000 person‐years). Kaplan–Meier cumulative incidence curves showed a significant association of depression disorders with SCD events (log‐rank P =0.001) and HCM‐related heart failure events (log‐rank P =0.005). A multivariate Cox regression analysis indicated that depression was an independent predictor of SCD events and HCM‐related heart failure events (41.9 versus 21.7 per 1000 person‐years; adjusted hazard ratio [HR], 1.9; 95% CI, 1.6–2.3; P <0.001; and 69.9 versus 38.6 per 1000 person‐years; HR, 1.8; 95% CI, 1.6–2.1; P <0.001, respectively). Conclusions Depression is common among patients with HCM. The diagnosis of depression is significantly and independently associated with an increased risk of SCD events and heart failure events in patients with HCM.

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P-Cresyl Sulfate Is a Valuable Predictor of Clinical Outcomes in Pre-ESRD Patients

BioMed Research International ◽

10.1155/2014/526932 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Cheng-Jui Lin ◽

Chi-Feng Pan ◽

Chih-Kuang Chuang ◽

Fang-Ju Sun ◽

Duen-Jen Wang ◽

...

Keyword(s):

Clinical Outcomes ◽

Cardiovascular Event ◽

Cox Regression ◽

Medical Center ◽

Serum Biochemistry ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Valuable Marker ◽

Valuable Predictor

Background/Aims. Previous studies have reported p-cresyl sulfate (PCS) was related to endothelial dysfunction and adverse clinical effect. We investigate the adverse effects of PCS on clinical outcomes in a chronic kidney disease (CKD) cohort study.Methods. 72 predialysis patients were enrolled from a single medical center. Serum biochemistry data and PCS were measured. The clinical outcomes including cardiovascular event, all-cause mortality, and dialysis event were recorded during a 3-year follow-up.Results. After adjusting other independent variables, multivariate Cox regression analysis showed age (HR: 1.12,P=0.01), cardiovascular disease history (HR: 6.28,P=0.02), and PCS (HR: 1.12,P=0.02) were independently associated with cardiovascular event; age (HR: 0.91,P<0.01), serum albumin (HR: 0.03,P<0.01), and PCS level (HR: 1.17,P<0.01) reached significant correlation with dialysis event. Kaplan-Meier analysis revealed that patients with higher serum p-cresyl sulfate (>6 mg/L) were significantly associated with cardiovascular and dialysis event (log rankP=0.03, log rankP<0.01, resp.).Conclusion. Our study shows serum PCS could be a valuable marker in predicting cardiovascular event and renal function progression in CKD patients without dialysis.

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Predicting long-term cardiovascular outcomes of patients with acute myocardial infarction using soluble ST2

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2019-0062 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Mustafa Umut Somuncu ◽

Belma Kalayci ◽

Ahmet Avci ◽

Tunahan Akgun ◽

Huseyin Karakurt ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Cox Regression ◽

High Serum ◽

Major Adverse Cardiovascular Events ◽

Lower Systolic Blood Pressure ◽

Cox Regression Analysis ◽

Killip Class ◽

Target Vessel Revascularization

AbstractBackgroundThe increase in soluble suppression of tumorigenicity 2 (sST2) both in the diagnosis and prognosis of heart failure is well established; however, existing data regarding sST2 values as the prognostic marker after myocardial infarction (MI) are limited and have been conflicting. This study aimed to assess the clinical significance of sST2 in predicting 1-year adverse cardiovascular (CV) events in MI patients.Materials and methodsIn this prospective study, 380 MI patients were included. Participants were grouped into low sST2 (n = 264, mean age: 60.0 ± 12.1 years) and high sST2 groups (n = 116, mean age: 60.5 ± 11.6 years), and all study populations were followed up for major adverse cardiovascular events (MACE) which are composed of CV mortality, target vessel revascularization (TVR), non-fatal reinfarction, stroke and heart failure.ResultsDuring a 12-month follow-up, 68 (17.8%) patients had MACE. CV mortality and heart failure were significantly higher in the high sST2 group compared to the low sST2 group (15.5% vs. 4.9%, p = 0.001 and 8.6% vs. 3.4% p = 0.032, respectively). Multivariate Cox regression analysis concluded that high serum sST2 independently predicted 1-year CV mortality [hazard ratio (HR) 2.263, 95% confidence interval (CI) 1.124–4.557, p = 0.022)]. Besides, older age, Killip class >1, left anterior descending (LAD) as the culprit artery and lower systolic blood pressure were the other independent risk factors for 1-year CV mortality.ConclusionsHigh sST2 levels are an important predictor of MACE, including CV mortality and heart failure in a 1-year follow-up period in MI patients.

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