Abstract 15693: Comorbidities in Heart Failure: A Population-Based Case-control Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Alanna M Chamberlain ◽  
Cynthia M Boyd ◽  
Sheila M Manemann ◽  
Shannon M Dunlay ◽  
Yariv Gerber ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Chronic Conditions ◽  
Population Based ◽  
Chronic Obstructive ◽  
Diagnostic Code ◽  
Obstructive Pulmonary Disease ◽  
Comorbidity Burden ◽  
Artery Disease

Background: Whether age alone explains the comorbidity burden in heart failure (HF) is unclear. In particular, differences in the burden of co-morbid conditions in HF patients compared to population controls has not been well documented. Methods: The prevalence of 17 chronic conditions defined by the US Department of Health and Human Services were obtained in 1746 incident HF patients from 2000-2010 and controls matched 1:1 on sex and age from Olmsted County, MN. Conditions were ascertained requiring 2 occurrences of a diagnostic code. Logistic regression determined associations of each condition with HF. Results: Among the 1746 matched pairs (mean age 76.2 years, 43.5% men), the prevalence was higher in HF cases for all conditions (p<0.05) except dementia and osteoporosis. After adjusting for all conditions, hypertension, coronary artery disease, arrhythmia, asthma, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, hepatitis, and substance abuse were significantly more common in HF (figure). More than a 2-fold increased odds of hepatitis, arrhythmia, and coronary artery disease was observed among HF cases. Arrhythmia (34.2%), hypertension (31.1%), and coronary artery disease (27.8%) had the largest attributable risk of HF; for example, assuming a causal relationship, if arrhythmias were eliminated, 34% of HF would be avoided. Conclusions: Compared to age- and sex-matched controls, HF patients have a higher prevalence of many chronic conditions, indicating the excess comorbidity in HF is not due to age alone. Some cardiovascular conditions, including arrhythmia, coronary artery disease, and hypertension were more common in HF. Of the non-cardiovascular conditions, hepatitis had the strongest association with HF and was an unanticipated finding that deserves additional investigation. It is important to understand comorbidities as they play a key role in the excess mortality and healthcare utilization experienced by HF patients.

Abstract P108: Comorbidity Burden in Atrial Fibrillation: A Population-Based Case-Control Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Alanna M Chamberlain ◽  
Margaret C Byrne ◽  
Alvaro Alonso ◽  
Bernard J Gersh ◽  
Sheila M Manemann ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Congestive Heart Failure ◽  
Coronary Artery ◽  
Chronic Conditions ◽  
Diagnostic Code ◽  
Comorbidity Burden ◽  
Artery Disease ◽  
Population Controls

Background: Differences in the prevalence and duration of co-morbid conditions in atrial fibrillation (AF) patients compared to population controls have not been well documented. Methods: The prevalence and duration of 17 chronic conditions defined by the US Department of Health and Human Services, as well as anxiety, obesity, and smoking status, was obtained in a random sample of 1430 patients with incident AF from 2000-2010 and 1430 controls from Olmsted County, MN. Controls were matched to cases 1:1 on sex and age (within 5 years). Chronic conditions were ascertained electronically requiring 2 occurrences of a diagnostic code; the duration of each condition (up to 25 years) was calculated. Logistic regression determined associations of each condition with AF after adjustment for all other conditions. Results: Among the 1430 matched pairs (median age 76 years, 48.6% men), the prevalence of chronic conditions was higher in AF cases compared to controls for all conditions except asthma, dementia, depression, hepatitis, and osteoporosis (figure). However, the duration of the conditions were similar in AF compared to controls, except for hypertension (median duration 12.3 and 9.9 years in AF cases and controls, respectively; p=0.002). After adjusting for all other conditions, obesity, hypertension, congestive heart failure, coronary artery disease, chronic kidney disease, and chronic obstructive pulmonary disease remained significantly more common in AF compared to controls (figure). Conditions with the largest attributable risk of AF were hypertension (25.4%), coronary artery disease (17.7%), and congestive heart failure (12.3%). Conclusions: AF patients have a higher prevalence of many chronic conditions compared to population controls. However, besides hypertension, these comorbidities do not develop earlier in AF. Nevertheless, the excess comorbidity burden in AF is important to characterize and understand as it may partly explain the excess mortality and healthcare utilization experienced by AF patients.

Additional Topics: Neuraxial and Anticoagulation

2018 ◽  
pp. 261-266
Author(s):  
Ruchir Gupta
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Coronary Artery Disease ◽  
Congestive Heart Failure ◽  
Coronary Artery ◽  
Postoperative Pain ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Post Dural Puncture Headache ◽  
Artery Disease

In this chapter several topics related to neuraxial anesthesia and anticoagulation are discussed. Subtopics include use of neuraxial technique in patients with coronary artery disease, congestive heart failure, or chronic obstructive pulmonary disease. Use of heparin and patient-controlled epidural analgesia is also discussed. The mechanism of action for warfarin (Coumadin) is discussed, as are ways of reversing its effects. Also discussed is whether to use an epidural in a patient with HELLP syndrome. Treatments for patients with post-dural puncture headache (PDHD) are presented. Placement of an epidural catheter for postoperative pain is discussed, and instructions for performing spinal technique are given. Each scenario is presented as a short, three- to four-question additional topic.

scholarly journals ’Who Cares?' The experiences of caregivers of adults living with heart failure, chronic obstructive pulmonary disease and coronary artery disease: a mixed methods systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e020927 ◽  
Author(s):  
Miriam Catherine Noonan ◽  
Jennifer Wingham ◽  
Rod S Taylor
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Chronic Obstructive Pulmonary Disease ◽  
Coronary Artery Disease ◽  
Mixed Methods ◽  
Coronary Artery ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Artery Disease

ObjectiveTo assess the experiences of unpaid caregivers providing care to people with heart failure (HF) or chronic obstructive pulmonary disease (COPD) or coronary artery disease (CAD).DesignMixed methods systematic review including qualitative and quantitative studies.Data sourcesDatabases searched: Medline Ebsco, PsycInfo, CINAHL Plus with Full Text, Embase, Web of Science, Ethos: The British Library and ProQuest. Grey literature identified using: Global Dissertations and Theses and Applied Sciences Index and hand searches and citation checking of included references. Search time frame: 1 January 1990 to 30 August 2017.Eligibility criteria for selecting studiesInclusion was limited to English language studies in unpaid adult caregivers (>18 years), providing care for patients with HF, COPD or CAD. Studies that considered caregivers for any other diagnoses and studies undertaken in low-income and middle-income countries were excluded. Quality assessment of included studies was conducted by two authors.Data analysis/synthesisA results-based convergent synthesis was conducted.ResultsSearches returned 8026 titles and abstracts. 54 studies—21 qualitative, 32 quantitative and 1 mixed method were included. This totalled 26 453 caregivers who were primarily female (63%), with median age of 62 years. Narrative synthesis yielded six concepts related to caregiver experience: (1) mental health, (2) caregiver role, (3) lifestyle change, (4) support for caregivers, (5) knowledge and (6) relationships. There was a discordance between paradigms regarding emerging concepts. Four concepts emerged from qualitative papers which were not present in quantitative papers: (1) expert by experience, (2) vigilance, (3) shared care and (4) time.ConclusionCaregiving is life altering and complex with significant health implications. Health professionals should support caregivers who in turn can facilitate the recipient to manage their long-term condition. Further longitudinal research exploring the evolution of caregiver experiences over time of patients with chronic cardiopulmonary conditions is required.Trial registration numberCRD42016053412

scholarly journals Biological effects of ticagrelor over clopidogrel in patients with stable coronary artery disease and chronic obstructive pulmonary disease

2017 ◽  
Vol 117 (06) ◽  
pp. 1208-1216 ◽  
Author(s):  
Gianluca Campo ◽  
Francesco Vieceli Dalla Sega ◽  
Rita Pavasini ◽  
Giorgio Aquila ◽  
Francesco Gallo ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Endothelial Function ◽  
Pulmonary Disease ◽  
Primary Endpoint ◽  
Stable Coronary Artery Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Artery Disease

SummaryPatients with SCAD and concomitant COPD are at high risk of cardiovascular adverse events, due to chronic inflammation, responsible of endothelial dysfunction, oxidative stress and heightened platelet reactivity (PR). The objective of this randomised clinical trial was to test if ticagrelor is superior to clopidogrel in improving endothelial function in patients with stable coronary artery disease (SCAD) and concomitant chronic obstructive pulmonary disease (COPD). Forty-six patients with SCAD and COPD undergoing percutaneous coronary intervention (PCI) were randomly assigned to receive clopidogrel (n=23) or ticagrelor (n=23) on top of standard therapy with aspirin. The following parameters were assessed at baseline and after 1 month: i) rate of apoptosis and ii) nitric oxide (NO) levels in human umbilical vein endothelial cells (HUVECs), iii) levels of reactive oxygen species (ROS) in peripheral blood mononuclear cell, iv) 29 cytokines/chemokines, v) on-treatment PR. The primary endpoint of the study was the 1-month rate of HUVECs apoptosis. The rate of apoptosis after 1 month was significantly lower in patients treated with ticagrelor (7.4 ± 1.3% vs 9.3 ± 1.5%, p<0.001), satisfying the pre-specified primary endpoint. In the ticagrelor arm, levels of NO were higher (10.1 ± 2.2 AU vs 8.5 ± 2.6 AU, p=0.03) while those of ROS (4 ± 1.8 AU vs 5.7 ± 2.8 AU, p=0.02) and P2Y12 reactivity units (52 ± 70 PRU vs 155 ± 62 PRU, p<0.001) were lower. There were no differences in cytokines/chemokines levels and aspirin reactivity units between groups. In patients with SCAD and COPD undergoing PCI, ticagrelor, as compared to clopidogrel is superior in improving surrogate markers of endothelial function and on-treatment PR (ClinicalTrials.gov, NCT02519608).Supplementary Material to this article is available online at www.thrombosis-online.com.

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