Abstract 12714: Early Repolarization With J-Point Elevation Predicts Mortality in the Hispanic Female Population

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Eric Shulman ◽  
Philip Aagaard ◽  
Faraj Kargoli ◽  
Steve Lener ◽  
John Fisher ◽  
...  
Keyword(s):  
Cox Proportional Hazards Model ◽  
Hispanic Population ◽  
Early Repolarization ◽  
Female Population ◽  
Risk Of Death ◽  
Increased Risk ◽  
Social Security Death Index ◽  
Significant Difference ◽  
The Impact ◽  
Overall Mortality

Introduction: Early repolarization (ER) is associated with an increased risk of sudden cardiac death (SCD). However, the impact of ER may not be uniform across race and gender. An analysis from the Biracial Atherosclerosis Risk in Communities Study showed that ER was associated with SCD risk in Caucasians and highest in female Caucasians, while a study from Northern California found no association between cardiovascular mortality and ER in African Americans. Although Hispanics are the second largest segment of the population, little is known about the prevalence or prognostic implications of ER in this group. We investigated possible associations between automated ECG ER readings, defined as J-point elevation with ST segment elevation and overall mortality. Methods: ECG and EMR databases from a regional medical center from a largely Hispanic population were interrogated. Inclusion criteria included Hispanic ethnicity, age over 18 from 2000-2011. Outcomes were assessed using a Cox Proportional Hazards model with data from the Social Security Death Index. Results: There were n=34,354 Hispanics of which n=544 (1.6%) had ER. When controlling for age, gender, height/weight, systolic/diastolic BP, PR, QRS, QTc, heart rate, ejection fraction, CAD, CHF, myocardial infarction, DM, and malignancy there was no significant difference in mortality between overall subjects with and without ER (HR: 1.15, 95% CI: 0.89-1.50, p=0.294). However, significant interactions were present between gender and ER. In a multivariate regression model, ER was significantly predictive of overall mortality in females (HR: 1.91, 95% CI: 1.24-2.90, p=0.003), but not in males (HR: 0.88, 95% CI: 0.63-1.23, p=0.456) (Figure 1). Conclusions: ER is not associated with an increased risk of death in the overall Hispanic population; however, there is a higher risk of overall mortality in female population. ER may be more complex than initially suspected, which emphasizes a need for additional research.

Abstract 16004: The Prognostic Value of Automatically Detected Early Repolarization - A Focus on Hispanics

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Philip Aagaard
Keyword(s):  
African Americans ◽  
Smoking Status ◽  
Prognostic Significance ◽  
Cox Proportional Hazards Model ◽  
Early Repolarization ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Significant Difference ◽  
St Segments

Introduction: Early repolarization (ER) associated with sudden cardiac death is based on the presence of >1mm J-point elevations in inferior and/or lateral leads with horizontal/downsloping ST-segments. Automated ECG readings of early repolarization (AER) obtained in clinical practice, on the other hand, are defined by ST segment elevation (ascending/upsloping ST-segments) in addition to J-point elevation. Nonetheless, such automated readings may cause alarm. Methods: We therefore assessed the prevalence and prognostic significance of AER in 238,456 individuals aged 18-75 years. The study was performed at a tertiary medical center serving a racially diverse urban population with a large proportion of Hispanics (43%). The first recorded ECG of each individual during 2000-2012 was included. Patients with ventricular paced rhythm or acute coronary syndrome at the time of acquisition were excluded from the analysis. All automated ECG interpretations were reviewed for accuracy by a board certified cardiologist. The primary endpoint was death during a median follow up of 8.0±2.6 years. Results: AER was present in 3,450 (1.6%) subjects. The prevalence varied significantly with race: African Americans 2.2%, Caucasians 0.9%, and Hispanics 1.5% (p<0.01), and sex: male 2.4% vs. female 0.6% (p<0.001). In a Cox-proportional Hazards model (Figure 1) controlling for age, smoking status, heart rate, QTc, systolic blood pressure, LDL-cholesterol, BMI, and CAD, there was no significant difference in mortality regardless of race or sex (RR 0.98 (95% CI: 0.89-1.07). This was true even if J-waves were present. Conclusion: The prevalence of AER in Hispanics was intermediate to that of African Americans and Caucasians. This ECG finding was not associated with an increased risk of death, regardless of race or sex, and should not trigger additional diagnostic testing.

scholarly journals Economic Crisis and Amenable Mortality in Spain

2018 ◽  
Vol 15 (10) ◽  
pp. 2298 ◽  
Author(s):  
Andreu Nolasco ◽  
Pamela Pereyra-Zamora ◽  
Elvira Sanchis-Matea ◽  
Nayara Tamayo-Fonseca ◽  
Pablo Caballero ◽  
...  
Keyword(s):  
Economic Crisis ◽  
Socioeconomic Indicators ◽  
Positive Health ◽  
Mortality Trends ◽  
Risk Of Death ◽  
Amenable Mortality ◽  
Increased Risk ◽  
Vulnerability Indicators ◽  
The Impact ◽  
Overall Mortality

Background: Both overall mortality and avoidable mortality have decreased in recent years in most European countries. It has become clear that less privileged socioeconomic groups have an increased risk of death. In 2008, most countries went into a severe economic recession, whose effects on the health of the population are still ongoing. While on the one hand, some evidence associates the economic crisis with positive health outcomes (pro-cyclical effect), on the other hand, some other evidence suggests that the economic crisis may pose serious public health problems (counter-cyclical effect), which has given rise to controversy. Objectives: To describe the evolution of overall mortality and amenable mortality in Spain between 2002–2007 (before the economic crisis) and 2008–2013 (during the economic crisis), nationally and by province, as well as to analyse trends in the risks of death and their association with indicators of the impact of the crisis. Methods: Ecological study of overall mortality and amenable mortality describing the evolution of the risks of death between 2002–2007 and 2008–2013. Age Standardised Rates were calculated, as well as their percentage change between periods. The association between percentage changes and provincial indicators of the impact of the crisis was analysed. Amenable mortality was studied both overall and categorised into five groups. Results: Amenable mortality represented 8.25% of overall mortality in 2002–2007, and 6.93% in 2008–2013. Age Standardised Rates for overall mortality and global amenable mortality generally declined, with the sharpest decline in amenable mortality. Decreases in overall mortality and amenable mortality were directly related to vulnerability indicators. The most significant decreases were registered in ischaemic heart disease, cerebrovascular disease, and other amenable causes. The relationship with vulnerability indices varied from direct (cancer) to inverse (hypertensive disease). Conclusions: Amenable mortality shows a more significant decrease than overall mortality between both study periods, albeit unevenly between provinces causes of death. Higher vulnerability indicators entail greater declines, although this trend varied for different causes. Mortality trends and their relationship with socioeconomic indicators in a situation of crisis must be conducted cautiously, taking into consideration a possible pro-cyclical effect.

scholarly journals Outcome of hospitalisation for COVID-19 in patients with Interstitial Lung Disease: An international multicentre study.

2020 ◽  
Author(s):  
Gisli Jenkins ◽  
Tom Drake ◽  
Annemarie B Docherty ◽  
Ewan Harrison ◽  
Jennifer Quint ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Function ◽  
Lung Disease ◽  
Primary Outcome ◽  
Secondary Analysis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Co Morbidity ◽  
The Impact ◽  
Overall Mortality

Rationale: The impact of COVID-19 on patients with Interstitial Lung Disease (ILD) has not been established. Objectives: To assess outcomes following COVID-19 in patients with ILD versus those without in a contemporaneous age, sex and comorbidity matched population. Methods: An international multicentre audit of patients with a prior diagnosis of ILD admitted to hospital with COVID-19 between 1 March and 1 May 2020 was undertaken and compared with patients, without ILD obtained from the ISARIC 4C cohort, admitted with COVID-19 over the same period. The primary outcome was survival. Secondary analysis distinguished IPF from non-IPF ILD and used lung function to determine the greatest risks of death. Measurements and Main Results: Data from 349 patients with ILD across Europe were included, of whom 161 were admitted to hospital with laboratory or clinical evidence of COVID-19 and eligible for propensity-score matching. Overall mortality was 49% (79/161) in patients with ILD with COVID-19. After matching ILD patients with COVID-19 had higher mortality (HR 1.60, Confidence Intervals 1.17-2.18 p=0.003) compared with age, sex and co-morbidity matched controls without ILD. Patients with a Forced Vital Capacity (FVC) of <80% had an increased risk of death versus patients with FVC ≥80% (HR 1.72, 1.05-2.83). Furthermore, obese patients with ILD had an elevated risk of death (HR 1.98, 1.13−3.46). Conclusions: Patients with ILD are at increased risk of death from COVID-19, particularly those with poor lung function and obesity. Stringent precautions should be taken to avoid COVID-19 in patients with ILD.

Physician volume and discontinuation of rituximab during lymphoma treatment.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6593-6593
Author(s):  
Scott F. Huntington ◽  
Jessica B. Long ◽  
Jessica R. Hoag ◽  
Rong Wang ◽  
Amer M Zeidan ◽  
...  
Keyword(s):  
Relative Risk ◽  
Cox Proportional Hazards Model ◽  
Adjusted Relative Risk ◽  
Dependent Manner ◽  
Early Discontinuation ◽  
Risk Of Death ◽  
Systemic Treatments ◽  
Increased Risk ◽  
Provider Volume ◽  
The Impact

6593 Background: Despite the high complexity of cancer therapies, studies evaluating provider-level volume and outcomes of systemic treatments are lacking. As rituximab was the first approved monoclonal immunotherapy, and has the potential for severe infusion reactions, we hypothesize that low provider volume is associated with early rituximab discontinuation. Methods: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results -Medicare data.Individuals 66+ years old with B cell non-Hodgkin lymphoma (NHL) diagnosed during 2004-2011 and 1+ rituximab claims were included. A provider was assigned to each patient-rituximab initiation using Medicare claims. We used a 12-month lookback from each initiation to categorize provider volume (0, 1-2, or 3+ rituximab initiations) in the prior year. Our primary outcome was early discontinuation, defined as receipt of 1-2 rituximab cycles within 180 days of initiation. We used a modified Poisson regression to account for provider level correlation and estimated the relative risk of early discontinuation in patients with 6+ months of follow up after rituximab initiation. A Cox proportional hazards model was used to measure the impact of discontinuation on overall survival. Results: A total of15,110 patients (median age: 75 years) initiated rituximab with 2,684 providers. The majority (70.4%) initiated rituximab in conjunction with chemotherapy and 1,146 (7.6%) experienced early rituximab discontinuation. Provider experience with rituximab during the previous 12 months was associated with early discontinuation in a dose-dependent manner (adjusted relative risk [aRR]: 1.57, [95% confidence interval [CI]:1.35-1.83], p < .001 for 0 vs 3+ initiations; aRR: 1.19 [95% CI:1.03-1.37], p = .02 for 1-2 vs. 3+ initiations). In addition, rituximab discontinuation was associated with a higher risk of death (adjusted hazard ratio: 1.39 [95% CI:1.28-1.52], p < .001). Conclusions: Lower physician volume is associated with increased risk of early discontinuation in older adults initiating rituximab for NHL. Due to the association between early discontinuation and mortality, physician volume may be an important factor in providing high quality NHL care.

A real-world comparison of multi-modality therapies in locally advanced gastro-esophageal junction (GEJ) cancers.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 96-96
Author(s):  
Haider Samawi ◽  
Derek Tilley ◽  
Patricia A. Tang ◽  
Jennifer L. Spratlin ◽  
Richard M. Lee-Ying ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Proportional Hazards Model ◽  
Locally Advanced ◽  
Treatment Selection ◽  
Cox Proportional Hazards Model ◽  
Rank Test ◽  
Routine Practice ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

96 Background: Trials show that addition of systemic therapy and/or radiation to surgery improves survival in GEJ cancers. However, the different regimens have not been directly compared. We examined population-based outcomes of 3 treatments: 1) neoadjuvant carboplatin and paclitaxel plus radiation (CROSS); 2) perioperative epirubicin, cisplatin, and fluoropyrimidine (MAGIC); and 3) cisplatin and fluoropyrimidine with radiation (CisFP). Methods: We reviewed patients diagnosed with GEJ cancer from 2005 to 2015 who received CROSS, MAGIC, or CisFP at 2 tertiary, 4 regional, and 11 community cancer centers in Alberta, Canada. Survival was assessed with Kaplan-Meier curves and compared with the log-rank test. A Cox proportional hazards model was constructed to evaluate the impact of treatment on overall survival (OS). Results: 331 patients were identified. Median age was 63 (IQR 56-69) years and 86% were men. CROSS was used in 217 (65%) cases followed by CisFP in 72 (22%) and MAGIC in 42 (13%). Age, sex, and stage were not associated with treatment selection (all p > 0.05), but a higher proportion of CROSS and CisFP patients had adenocarcinoma (86% and 85%, respectively) compared to MAGIC patients (41%) ( p < 0.01). CROSS and MAGIC correlated with higher surgical resection rates when compared to CisFP (82% vs. 79% vs. 50%, respectively, p < 0.01). Median OS favored CROSS and MAGIC rather than CisFP, but this was not statistically significant (29 vs. 34 vs. 20 months, respectively, p= 0.17). Adjusting for confounders, OS remained similar for MAGIC (HR 0.8, 95%CI 0.5-1.3, p= 0.36) and CisFP (HR 0.7, 95%CI 0.5-1.1, p= 0.10) when compared to CROSS. In addition, age > 65, advanced stage, and lack of surgical resection were associated with increased risk of death (HR 1.5, 95%CI 1.1-2.0, p= 0.02, HR 2.2, 95%CI 1.2-3.9, p< 0.01 and HR 4.1, 95%CI 2.8-5.9, p< 0.01, respectively). Conclusions: OS was similar across all 3 regimens, but outcomes were inferior to those seen in original trials. This observation suggests that GEJ patients in routine practice are different from study participants or that treatment selection may be driven by factors other than trial eligibility criteria.

scholarly journals Impact of Interstitial Pneumonia on the Survival and Risk Factors Analysis of Patients with Hematological Malignancy

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Wei-Liang Chen ◽  
Yu-Tzu Tsao ◽  
Tsun-Hou Chang ◽  
Tsu-Yi Chao ◽  
Woei-Yau Kao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Interstitial Pneumonia ◽  
Cox Regression ◽  
Hematological Malignancy ◽  
Prognostic Indicator ◽  
Risk Of Death ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

Background. The emergence of interstitial pneumonia (IP) in patients with hematological malignancy (HM) is becoming a challenging scenario in current practice. However, detailed characterization and investigation of outcomes and risk factors on survival have not been addressed.Methods. We conducted a retrospective study of 42,584 cancer patients covering the period between 1996 and 2008 using the institutional cancer registry system. Among 816 HM patients, 61 patients with IP were recognized. The clinical features, laboratory results, and histological types were studied to determine the impact of IP on survival and identify the profile of prognostic factors.Results. HM patients with IP showed a significant worse survival than those without IP in the 5-year overall survival (P=0.027). The overall survival showed no significant difference between infectious pneumonia and noninfectious interstitial pneumonia (IIP versus nIIP) (P=0.323). In a multivariate Cox regression model, leukocyte and platelet count were associated with increased risk of death.Conclusions. The occurrence of IP in HM patients is associated with increased mortality. Of interest, nIIP is a prognostic indicator in patients with lymphoma but not in patients with leukemia. However, aggressive management of IP in patients with HM is strongly advised, and further prospective survey is warranted.

scholarly journals Medication Use Evaluation of Dronedarone in Comparison to Amiodarone

2016 ◽  
Vol 7 (4) ◽  
Author(s):  
Adam Corey ◽  
Nita Johnston
Keyword(s):  
Conflicts Of Interest ◽  
Normal Sinus Rhythm ◽  
Statistical Significance ◽  
Medication Use ◽  
Clinical Decision ◽  
Female Population ◽  
Risk Of Death ◽  
Normal Sinus ◽  
Increased Risk ◽  
Significant Difference

Amiodarone is the most effective rhythm-control for atrial fibrillation, but produces serious potential side effects. Dronedarone was designed to eliminate amiodarone toxicities, but increased the risk of mortality in clinical trials. This medication use evaluation compares one year of dronedarone use with a matched cohort of amiodarone patients at a single hospital in Greensboro, NC. Forty-eight patients were included with an average age of 71.8 years and 37.5% female population. No significant difference was found for the primary composite outcome of death, myocardial infarction, stroke, and systemic embolism (OR = 2.4, p = 0.148). Likewise, no statistical significance was demonstrated between the two groups for QTc prolongation, hypothyroidism, liver dysfunction or maintenance of normal sinus rhythm. In conclusion, the clinical decision process demonstrated no increased risk of death or other adverse events in the use of dronedarone. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties   Type: Student Project

Association between hTERT Polymorphisms and Female Papillary Thyroid Carcinoma

2019 ◽  
Vol 14 (3) ◽  
pp. 268-279
Author(s):  
Ying Liu ◽  
Zhi Li ◽  
Xinyue Tang ◽  
Min Li ◽  
Feng Shi
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Genome Wide Association Study ◽  
Papillary Thyroid ◽  
Clinicopathologic Characteristics ◽  
Female Population ◽  
Genome Wide ◽  
Increased Risk ◽  
Significant Difference ◽  
Thyroid Cancer Risk

Background: A previous genome-wide association study showed that hTERT rs10069690 and rs2736100 polymorphisms were associated with thyroid cancer risk. Objective: This study further investigated the association between increased risk and clinicopathologic characteristics for Papillary Thyroid Carcinoma (PTC) and hTERT polymorphisms rs10069690 or rs2736100 in a Chinese female population. Methods: The hTERT genotypes of 276 PTC patients and 345 healthy subjects were determined with regard to SNPs rs10069690 and rs2736100. The association between these SNPs and the risk of PTC and clinicopathologic characteristics was investigated by logistic regression. Results: We found a significant difference between PTC and rs10069690 (Odds Ratio (OR) = 1.515; P = 0.005), but not between PTC and rs2736100. When the analysis was limited to females, rs10069690 and rs2736100 were both associated with increased risk for PTC in female individuals (OR = 1.647, P = 0.007; OR = 1.339, P = 0.041, respectively). Further haplotype analysis revealed a stimulative effect of haplotypes TC and CA of TERT rs10069690-rs2736100, which increased risk for PTC in female individuals (OR = 1.579, P = 0.014; OR = 0.726, P = 0.025, respectively). Furthermore, the heterozygote A/C of rs2736100 showed significant difference for age (OR = 0.514, P = 0.047). Conclusion: Our finding suggests that hTERT polymorphisms rs10069690 and rs2736100 are associated with increased risk for PTC in Chinese female population and rs2736100 may be related to age. Consistent with US20170360914 and US20170232075, they are expected to be a potential molecular target for anti-cancer therapy.

scholarly journals Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

2011 ◽  
Vol 114 (2) ◽  
pp. 283-292 ◽  
Author(s):  
Laurent G. Glance ◽  
Andrew W. Dick ◽  
Dana B. Mukamel ◽  
Fergal J. Fleming ◽  
Raymond A. Zollo ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Noncardiac Surgery ◽  
Pulmonary Complications ◽  
Wound Complications ◽  
Severe Anemia ◽  
Thromboembolic Complications ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

Gastrostomy Tubes Placed in Children With Neurologic Impairment: Associated Morbidity and Mortality

2021 ◽  
pp. 088307382110001
Author(s):  
Jody L. Lin ◽  
Joseph Rigdon ◽  
Keith Van Haren ◽  
MyMy Buu ◽  
Olga Saynina ◽  
...  
Keyword(s):  
Severe Pneumonia ◽  
Sensitivity Analyses ◽  
Tube Placement ◽  
Composite Outcome ◽  
Eligibility Criteria ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Neurologic Impairment ◽  
Increased Risk ◽  
The Impact

Background: Gastrostomy tube (G-tube) placement for children with neurologic impairment with dysphagia has been suggested for pneumonia prevention. However, prior studies demonstrated an association between G-tube placement and increased risk of pneumonia. We evaluate the association between timing of G-tube placement and death or severe pneumonia in children with neurologic impairment. Methods: We included all children enrolled in California Children’s Services between July 1, 2009, and June 30, 2014, with neurologic impairment and 1 pneumonia hospitalization. Prior to analysis, children with new G-tubes and those without were 1:2 propensity score matched on sociodemographics, medical complexity, and severity of index hospitalization. We used a time-varying Cox proportional hazard model for subsequent death or composite outcome of death or severe pneumonia to compare those with new G-tubes vs those without, adjusting for covariates described above. Results: A total of 2490 children met eligibility criteria, of whom 219 (9%) died and 789 (32%) had severe pneumonia. Compared to children without G-tubes, children with new G-tubes had decreased risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.39-0.55) but increased risk of the composite outcome (HR 1.21, CI 1.14-1.27). Sensitivity analyses using varied time criteria for definitions of G-tube and outcome found that more recent G-tube placement had greater associated risk reduction for death but increased risk of severe pneumonia. Conclusion: Recent G-tube placement is associated with reduced risk of death but increased risk of severe pneumonia. Decisions to place G-tubes for pulmonary indications in children with neurologic impairment should weigh the impact of severe pneumonia on quality of life.

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