Abstract 20635: Dipeptidyl-Peptidiase 4 Inhibitors and the Risk of Heart Failure - A Nationwide Case-Crossover Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yi-Cheng Chang ◽  
Chia-Hsuin Chang ◽  
Jou Wei Lin ◽  
Lee-Ming Chuang ◽  
Mei-Shu Lai
Keyword(s):  
Heart Failure ◽  
Crossover Study ◽  
Index Date ◽  
Control Period ◽  
Hypoglycemic Agents ◽  
Dpp4 Inhibitors ◽  
Case Crossover ◽  
Increased Risk ◽  
Case Period ◽  
And Control

Introduction: Dipeptidyl-peptidiase 4 (DPP4) inhibitors, a new type of oral hypoglycemic agents, have been widely used in the treatment of type 2 diabetes mellitus (DM). However, recent studies showed that the use of DPP4 inhibitors, especially saxagliptin, could be associated with an increased risk of heart failure (HF). Methods: We conducted a retrospective case-crossover study by identifying DM patients aged 20 years and above hospitalized for HF between 2009 and 2011 from Taiwan National Health Insurance Database. Diagnosis codes from inpatient claims databases were used to ascertain the index date of hospitalization. For each patient, we defined case period as 1 to 30 days before the index date and control period as 91 to 120 days before the index date. The use of DPP4 inhibitors during the case and control periods were identified from the pharmacy claims database. Odds ratios (OR) and 95% confidence intervals (CIs) were estimated by a conditional logistic regression model. Results: A total of 47,506 patients hospitalized for HF (48.2% mean and 51.8% women) was included in the analysis (mean age: 72.7±12.4 years). Among them, 2,874 patients (6.05%) used sitagliptin in the case period, and 2,318 (4.88%) did in the control period. Use of other DPP4 inhibitors, i.e., saxagliptin and vildagliptin, was rare. The analysis of the discordant medication in the two periods showed that sitagliptin use was associated with an increased risk of HF (OR: 2.85, 95% CI: 2.46-3.30). Additional analyses using different time frames as the control period showed similar results. In contrast, there was no increased risk for HF in the use of sulfonylureas or metformin. Conclusions: The nationwide case-crossover study demonstrated that sitagliptin was associated with an increased risk of hospitalization for HF. Further studies are needed to examine whether the potential risk of HF is a class effect of DPP4 inhibitors.

scholarly journals Changes in drinking as predictors of changes in sickness absence: a case-crossover study

2017 ◽  
Vol 72 (1) ◽  
pp. 61-67 ◽  
Author(s):  
Jenni Ervasti ◽  
Mika Kivimäki ◽  
Jaana Pentti ◽  
Jaana I Halonen ◽  
Jussi Vahtera ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Sickness Absence ◽  
Control Period ◽  
Heavy Drinking ◽  
Short Term ◽  
Case Crossover ◽  
Increased Risk ◽  
Case Period ◽  
Drinking Session

BackgroundWe investigated whether changes in alcohol use predict changes in the risk of sickness absence in a case-crossover design.MethodsFinnish public sector employees were surveyed in 2000, 2004 and 2008 on alcohol use and covariates. Heavy drinking was defined as either a weekly intake that exceeded recommendations (12 units for women; 23 for men) or having an extreme drinking session. The responses were linked to national sickness absence registers. We analysed the within-person relative risk of change in the risk of sickness absence in relation to change in drinking. Case period refers to being sickness absent within 1 year of the survey and control period refers to not being sickness absent within 1 year of the survey.ResultsPeriods of heavy drinking were associated with increased odds of self-certified short-term (1–3 days) sickness absence (multivariable-adjusted OR 1.21, 95% CI 1.07 to 1.38 for all participants; 1.62, 95% CI 1.19 to 2.21 for men and 1.15, 95% CI 1.00 to 1.33 for women). A higher risk of short-term sickness absence was also observed after increase in drinking (OR=1.27, 95% CI 1.07 to 1.52) and a lower risk was observed after decrease in drinking (OR=0.83, 95% CI 0.69 to 1.00). Both increase (OR=1.38, 95% CI 1.21 to 1.57) and decrease (OR=1.27, 95% CI 1.19 to 1.43) in drinking were associated with increased risk of long-term (>9 days) medically certified all-cause sickness absence.ConclusionIncrease in drinking was related to increases in short-term and long-term sickness absences. Men and employees with a low socioeconomic position in particular seemed to be at risk.

Case-Crossover Study of Burkholderia cepacia Complex Bloodstream Infection Associated with Contaminated Intravenous Bromopride

2010 ◽  
Vol 31 (05) ◽  
pp. 516-521 ◽  
Author(s):  
Ianick Souto Martins ◽  
Flávia Lúcia Piffano Costa Pellegrino ◽  
Andrea d'Avila Freitas ◽  
Marisa da Silva Santos ◽  
Giovanna lanini d'Alemeida Ferraiuoli ◽  
...  
Keyword(s):  
Crossover Study ◽  
Burkholderia Cepacia ◽  
Control Period ◽  
Bloodstream Infections ◽  
University Hospital ◽  
Burkholderia Cepacia Complex ◽  
Microbiological Analysis ◽  
Strain Typing ◽  
Case Crossover ◽  
Case Period

Objective. To investigate an outbreak of healthcare-associated Burkholderia cepacia complex (BCC) primary bloodstream infections (BCC-BSI). Design and Setting. Case-crossover study in a public hospital, a university hospital and a private hospital in Rio de Janeiro, Brazil, from March 2006 to May 2006. Patients. Twenty-five patients with BCC-BSI. Design. After determining the date BCC-BSI symptoms started for each patient, 3 time intervals of data collection were defined, each one with a duration of 3 days: the case period, starting just before BCC-BSI symptoms onset; the control period, starting 6 days before BCC-BSI symptoms onset; and the washout period, comprising the 3 days between the case period and the control period. Exposures evaluated were intravascular solutions and invasive devices and procedures. Potential risk factors were identified by using the McNemar χ2 adjusted test. Cultures of samples of potentially contaminated solutions were performed. BCC strain typing was performed by pulsed-field gel electrophoresis using Spel. Results. The statistical analysis revealed that the use of bromopride and dipyrone was associated with BCC-BSI. A total of 21 clinical isolates from 17 (68%) of the 25 patients and an isolate obtained from the bromopride vial were available for strain typing. Six pulsotypes were detected. A predominant pulsotype (A) accounted for 11 isolates obtained from 11 patients (65%) in the 3 study hospitals. Conclusion. Our investigation, using a case-crossover design, of an outbreak of BCC-BSI infections concluded it was polyclonal but likely caused by infusion of contaminated bromopride. The epidemiological finding was validated by microbiological analysis. After recall of contaminated bromopride vials by the manufacturer, the outbreak was controlled.

scholarly journals Clinician-recalled quoted speech in electronic health records and risk of suicide attempt: a case–crossover study

BMJ Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. e036186
Author(s):  
Lasantha Jayasinghe ◽  
André Bittar ◽  
Rina Dutta ◽  
Robert Stewart
Keyword(s):  
Suicide Attempt ◽  
Electronic Health Records ◽  
Crossover Study ◽  
Control Period ◽  
Mental Healthcare ◽  
Health Records ◽  
Case Crossover ◽  
Case Period ◽  
Time Periods ◽  
Electronic Health

ObjectiveClinician narrative style in electronic health records (EHR) has rarely been investigated. Clinicians sometimes record brief quotations from patients, possibly more frequently when higher risk is perceived. We investigated whether the frequency of quoted phrases in an EHR was higher in time periods closer to a suicide attempt.DesignA case–crossover study was conducted in a large mental health records database. A natural language processing tool was developed using regular expression matching to identify text occurring within quotation marks in the EHR.SettingElectronic records from a large mental healthcare provider serving a geographic catchment of 1.3 million residents in South London were linked with hospitalisation data.Participants1503 individuals were identified as having a hospitalised suicide attempt from 1 April 2006 to 31 March 2017 with at least one document in both the case period (1–30 days prior to admission) and the control period (61–90 days prior to admission).Outcome measuresThe number of quoted phrases in the control as compared with the case period.ResultsBoth attended (OR 1.05, 95% CI 1.02 to 1.08) and non-attended (OR 1.15, 95% CI 1.04 to 1.26) clinical appointments were independently higher in the case compared with control period, while there was no difference in mental healthcare hospitalisation (OR 0.99, 95% CI 0.98 to 1.01). In addition, there was no difference in the levels of quoted text between the comparison time periods (OR 1.09, 95% CI 0.91 to 1.30).ConclusionsThis study successfully developed an algorithm to identify quoted speech in text fields from routine mental healthcare records. Contrary to the hypothesis, no association between this exposure and proximity to a suicide attempt was found; however, further evaluation is warranted on the way in which clinician-perceived risk might be feasibly characterised from clinical text.

scholarly journals Fatal opioid overdoses during and shortly after hospital admissions in England: A case-crossover study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (10) ◽  
pp. e1003759
Author(s):  
Dan Lewer ◽  
Brian Eastwood ◽  
Martin White ◽  
Thomas D. Brothers ◽  
Martin McCusker ◽  
...  
Keyword(s):  
Drug Use ◽  
Hospital Admission ◽  
Crossover Study ◽  
Hospital Admissions ◽  
Conditional Logistic Regression ◽  
Early Discharge ◽  
Odds Ratios ◽  
Drug Poisoning ◽  
Case Crossover ◽  
Increased Risk

Background Hospital patients who use illicit opioids such as heroin may use drugs during an admission or leave the hospital in order to use drugs. There have been reports of patients found dead from drug poisoning on the hospital premises or shortly after leaving the hospital. This study examines whether hospital admission and discharge are associated with increased risk of opioid-related death. Methods and findings We conducted a case-crossover study of opioid-related deaths in England. Our study included 13,609 deaths between January 1, 2010 and December 31, 2019 among individuals aged 18 to 64. For each death, we sampled 5 control days from the period 730 to 28 days before death. We used data from the national Hospital Episode Statistics database to determine the time proximity of deaths and control days to hospital admissions. We estimated the association between hospital admission and opioid-related death using conditional logistic regression, with a reference category of time neither admitted to the hospital nor within 14 days of discharge. A total of 236/13,609 deaths (1.7%) occurred following drug use while admitted to the hospital. The risk during hospital admissions was similar or lower than periods neither admitted to the hospital nor recently discharged, with odds ratios 1.03 (95% CI 0.87 to 1.21; p = 0.75) for the first 14 days of an admission and 0.41 (95% CI 0.30 to 0.56; p < 0.001) for days 15 onwards. 1,088/13,609 deaths (8.0%) occurred in the 14 days after discharge. The risk of opioid-related death increased in this period, with odds ratios of 4.39 (95% CI 3.75 to 5.14; p < 0.001) on days 1 to 2 after discharge and 2.09 (95% CI 1.92 to 2.28; p < 0.001) on days 3 to 14. 11,629/13,609 deaths (85.5%) did not occur close to a hospital admission, and the remaining 656/13,609 deaths (4.8%) occurred in hospital following admission due to drug poisoning. Risk was greater for patients discharged from psychiatric admissions, those who left the hospital against medical advice, and those leaving the hospital after admissions of 7 days or more. The main limitation of the method is that it does not control for time-varying health or drug use within individuals; therefore, hospital admissions coinciding with high-risk periods may in part explain the results. Conclusions Discharge from the hospital is associated with an acute increase in the risk of opioid-related death, and 1 in 14 opioid-related deaths in England happens in the 2 weeks after the hospital discharge. This supports interventions that prevent early discharge and improve linkage with community drug treatment and harm reduction services.

scholarly journals The Role of Stroke as a Trigger for Incident Venous Thromboembolism: Results from a Population-based Case-Crossover Study

TH Open ◽  
2019 ◽  
Vol 03 (01) ◽  
pp. e50-e57
Author(s):  
Vânia Morelli ◽  
Joakim Sejrup ◽  
Birgit Småbrekke ◽  
Ludvig Rinde ◽  
Gro Grimnes ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Acute Stroke ◽  
Crossover Study ◽  
Conditional Logistic Regression ◽  
Population Based ◽  
Red Blood Cell Transfusion ◽  
Odds Ratios ◽  
Case Crossover ◽  
Increased Risk

AbstractStroke is associated with a short-term increased risk of subsequent venous thromboembolism (VTE). It is unclear to what extent this association is mediated by stroke-related complications that are potential triggers for VTE, such as immobilization and infection. We aimed to investigate the role of acute stroke as a trigger for incident VTE while taking other concomitant VTE triggers into account. We conducted a population-based case-crossover study with 707 VTE patients. Triggers were registered during the 90 days before a VTE event (hazard period) and in four preceding 90-day control periods. Conditional logistic regression was used to estimate odds ratios with 95% confidence intervals (CIs) for VTE according to triggers. Stroke was registered in 30 of the 707 (4.2%) hazard periods and in 6 of the 2,828 (0.2%) control periods, resulting in a high risk of VTE, with odds ratios of 20.0 (95% CI: 8.3–48.1). After adjustments for immobilization and infection, odds ratios for VTE conferred by stroke were attenuated to 6.0 (95% CI: 1.6–22.1), and further to 4.0 (95% CI: 1.1–14.2) when other triggers (major surgery, red blood cell transfusion, trauma, and central venous catheter) were added to the regression model. A mediation analysis revealed that 67.8% of the total effect of stroke on VTE risk could be mediated through immobilization and infection. Analyses restricted to ischemic stroke yielded similar results. In conclusion, acute stroke was a trigger for VTE, and the association between stroke and VTE risk appeared to be largely mediated by immobilization and infection.

scholarly journals Spatial Variability of Heat-Related Mortality in Barcelona from 1992–2015: A Case Crossover Study Design

2020 ◽  
Vol 17 (7) ◽  
pp. 2553
Author(s):  
Vijendra Ingole ◽  
Marc Marí-Dell’Olmo ◽  
Anna Deluca ◽  
Marcos Quijal ◽  
Carme Borrell ◽  
...  
Keyword(s):  
Crossover Study ◽  
Study Design ◽  
Risk Ratio ◽  
Urban Climate ◽  
Mortality Data ◽  
Natural Mortality ◽  
Risk Of Death ◽  
Case Crossover ◽  
Increased Risk ◽  
Hot Days

Numerous studies have demonstrated the relationship between summer temperatures and increased heat-related deaths. Epidemiological analyses of the health effects of climate exposures usually rely on observations from the nearest weather station to assess exposure-response associations for geographically diverse populations. Urban climate models provide high-resolution spatial data that may potentially improve exposure estimates, but to date, they have not been extensively applied in epidemiological research. We investigated temperature-mortality relationships in the city of Barcelona, and whether estimates vary among districts. We considered georeferenced individual (natural) mortality data during the summer months (June–September) for the period 1992–2015. We extracted daily summer mean temperatures from a 100-m resolution simulation of the urban climate model (UrbClim). Summer hot days (above percentile 70) and reference (below percentile 30) temperatures were compared by using a conditional logistic regression model in a case crossover study design applied to all districts of Barcelona. Relative Risks (RR), and 95% Confidence Intervals (CI), of all-cause (natural) mortality and summer temperature were calculated for several population subgroups (age, sex and education level by districts). Hot days were associated with an increased risk of death (RR = 1.13; 95% CI = 1.10–1.16) and were significant in all population subgroups compared to the non-hot days. The risk ratio was higher among women (RR = 1.16; 95% CI= 1.12–1.21) and the elderly (RR = 1.18; 95% CI = 1.13–1.22). Individuals with primary education had similar risk (RR = 1.13; 95% CI = 1.08–1.18) than those without education (RR = 1.10; 95% CI= 1.05–1.15). Moreover, 6 out of 10 districts showed statistically significant associations, varying the risk ratio between 1.12 (95% CI = 1.03–1.21) in Sants-Montjuïc and 1.25 (95% CI = 1.14–1.38) in Sant Andreu. Findings identified vulnerable districts and suggested new insights to public health policy makers on how to develop district-specific strategies to reduce risks.

Proton pump inhibitor-related headaches: A nationwide population-based case-crossover study in Taiwan

Cephalalgia ◽  
2014 ◽  
Vol 35 (3) ◽  
pp. 203-210 ◽  
Author(s):  
Jen-Feng Liang ◽  
Yung-Tai Chen ◽  
Jong-Ling Fuh ◽  
Szu-Yuan Li ◽  
Tzeng-Ji Chen ◽  
...  
Keyword(s):  
Proton Pump Inhibitor ◽  
Crossover Study ◽  
Proton Pump ◽  
Conditional Logistic Regression ◽  
Population Based ◽  
Female Patients ◽  
Case Crossover ◽  
Increased Risk ◽  
Tension Type Headaches ◽  
Acute Headache

Background Headaches resulting from proton pump inhibitor (PPI) use could cause discontinuation of PPI in as many as 40% of patients who experience such headaches. Previous studies focusing on acute headache risk from PPI use are rare and limited to clinical trials of a single PPI. Objectives To investigate the association between PPI use and headache with a nationwide population-based case-crossover study. Methods Records containing the first diagnosis of any headache, including migraine and tension-type headaches, were retrieved from Taiwan National Health Insurance Database (1998–2010). We compared the rates of PPI use for cases and controls during time windows of 7, 14, and 28 days. The adjusted self-matched odds ratios (ORs) and 95% confidence intervals (CIs) from a conditional logistic regression model were used to determine the association between PPI use and headache. Results Overall, 314,210 patients with an initial diagnosis of any headache during the study period were enrolled. The adjusted ORs for headache risk after PPI exposure were calculated for three time periods (within 7 days = 1.41, p = 0.002, 95% CI 1.14–1.74; within 14 days = 1.36, p < 0.001, 95% CI 1.16–1.59; within 28 days = 1.20, p = 0.002, 95% CI 1.07–1.35). Subgroup analyses showed female patients had an increased risk of headache. Among PPIs, lansoprazole and esomeprazole had the highest risks of headache incidence, which were similar to that of nitrates. Conclusion PPI usage is associated with an increased risk for acute headache. Female patients and use of lansoprazole or esomeprazole present the greatest risks of headache.

scholarly journals Cardiovascular disease in women with breast cancer – a nationwide cohort study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie Jakobsen ◽  
Christophe Kolodziejczyk ◽  
Morten Sall Jensen ◽  
Peter Bo Poulsen ◽  
Humma Khan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Pulmonary Embolism ◽  
Cohort Study ◽  
Heart Disease ◽  
Index Date ◽  
Hospital Records ◽  
Pulmonary Heart Disease ◽  
Increased Risk

Abstract Background There is increasing concern about cardiovascular disease (CVD) after breast cancer (BC). The aim of this study was to estimate the prevalence of different types of CVD in women diagnosed with BC compared to cancer-free controls as well as the incidence of CVD after BC diagnosis. Methods We performed a cohort study based on data from national registries covering the entire Danish population. We followed 16,505 cancer-naïve BC patients diagnosed from 2003 to 2007 5 years before and up to 10 years after BC diagnosis compared to 165,042 cancer-free controls. Results We found that 15.6% of BC patients were registered with at least one CVD diagnosis in hospital records before BC diagnosis. Overall, BC patients and controls were similar with regard to CVD comorbidity before BC diagnosis. After BC diagnosis, the incidence of all CVD diagnoses combined was significantly higher in BC patients than controls up to approximately 6 years after the index date (BC diagnosis). After 10 years, 28% of both BC patients and controls (without any CVD diagnosis up to 5 years before the index date) had at least one CVD diagnosis according to hospital records. However, the incidence of heart failure, thrombophlebitis/thrombosis and pulmonary heart disease including pulmonary embolism remained higher in BC patients than controls during the entire 10-year follow-up period. After 10 years, 2.7% of BC patients compared to 2.5% of controls were diagnosed with heart failure, 2.7% of BC patients compared to 1.5% of controls were diagnosed with thrombophlebitis/thrombosis, and 1.5% of BC patients compared to 1.0% of controls were diagnosed with pulmonary heart disease according to hospital records. Furthermore, we found that the risk of heart failure and thrombophlebitis/thrombosis was higher after chemotherapy. Conclusions Focus on CVD in BC patients is important to ensure optimum treatment with regard to BC as well as possible CVD. Strategies to minimise and manage the increased risk of heart failure, thrombophlebitis/thrombosis and pulmonary heart disease including pulmonary embolism in BC patients are especially important.

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