Abstract 19486: Does the Association Between Adherence to Statin Medications and Mortality Depend on the Measurement Approach? A Retrospective Cohort Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
MHD Wasem Alsabbagh ◽  
Dean Eurich ◽  
Lisa Lix ◽  
Thomas Wislon ◽  
David F Blackburn
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Repeated Measures ◽  
Retrospective Cohort ◽  
Summary Measure ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
Statin Adherence ◽  
Optimal Adherence

Background: Optimal adherence to statin medications is associated with reduced mortality rates. However, it is not clear if the estimated benefits of statin adherence are influenced by the method used to measure adherence. Objective: To contrast the association between all-cause mortality and statin adherence when two different measurement approaches are used: (i.e., fixed summary measurement versus repeated measurement). Methods: A retrospective cohort study was conducted using administrative data from Saskatchewan, Canada between 1994 and 2008. Eligible individuals received a statin prescription following discharge from a hospitalization for acute coronary syndrome (ACS). Adherence was measured using proportion of days covered (PDC) expressed either as: 1) a fixed summary measure, or 2) as a repeatedly measured covariate. Cox proportional hazards models were used to test the association between each adherence measure and mortality after covariate adjustment. Results: Among 9,051 eligible individuals, optimal adherence (≥80%) modeled with a fixed summary measure was not associated with mortality (adjusted HR 0.97, 95% CI 0.86 to 1.09). In contrast, optimal adherence defined by the repeated measures approach was associated with a 25% reduction in the risk of death (adjusted HR 0.75, 95% CI 0.67 to 0.85). Conclusions: Unlike summary measure, the repeated measures approach appears to provide a significant reduction of all-cause mortality of adherence to statins. This effect may be a result of the repeated measures approach being more sensitive, or more prone to survival bias. Therefore, we recommend comparing different measurement approaches whenever possible.

Abstract P609: Restarting Anticoagulant Therapy After Intracranial Hemorrhage With Atrial Fibrillation: A Nationwide Retrospective Cohort Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Dong Hoon Shin ◽  
Jaehun Jung ◽  
Gi Hwan Bae
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Lower Risk ◽  
Retrospective Cohort ◽  
Antiplatelet Agents ◽  
Risk Of Death ◽  
Hemorrhagic Events ◽  
All Cause Mortality ◽  
Severe Hemorrhage

Background: Atrial fibrillation (AF) should be treated with anticoagulants to prevent stroke and systemic embolism. Resuming anticoagulation after intracerebral hemorrhage (ICH) poses a clinical conundrum. The absence of evidence-based guidelines to address this issue has led to wide variations in restarting anticoagulation after ICH. This study aimed to evaluate the risks and benefits of anticoagulation therapy on all-cause mortality, severe thromboembolism, and severe hemorrhage and compare the effect of novel direct oral anticoagulants (NOACs) with warfarin on post-ICH mortality in patients with AF. Methods: This retrospective cohort study was performed using health insurance claim data obtained between 2002 and 2017 from individuals with newly developed ICH with comorbid AF. We excluded participants aged < 40 years and those with traumatic ICH, subdural hemorrhage, or subarachnoid hemorrhage. The primary endpoint was all-cause mortality, and the secondary endpoints were severe thrombotic and hemorrhagic events. Anticoagulants, antiplatelet agents, and non-users were analyzed for survival with propensity score matching. Results: Among 6735 participants, 1743 (25.9%) and 1690 (25.1%) used anticoagulants and antiplatelet agents, respectively. Anticoagulant (HR, 0.321; 95% CI, 0.264-0.390; P < 0.0001) or antiplatelet users (HR, 0.393; 95% CI, 0.330-0.468; P < 0.0001) had a lower risk of all-cause mortality than non-users. However, there was no difference between the two drug users (HR, 1.183; 95% CI, 0.94-1.487; P = 0.152; reference: anticoagulant). The risk of acute thrombotic events, although not hemorrhagic events, was significantly lower in anticoagulant users than in antiplatelet users. In addition, anticoagulation between 6 to 8 weeks post-ICH showed a tendency of the lowest risk of death. Further, NOACs were associated with a lower risk of all-cause mortality than warfarin. Conclusions: Our results showed that in patients with AF, resuming anticoagulants between 6 and 8 weeks after ICH improved all-cause mortality, severe thromboembolism, and severe hemorrhage. Further, compared with warfarin, NOAC had additional benefits.

scholarly journals Associations of statin adherence and lipid targets with adverse outcomes in myocardial infarction survivors: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e054893
Author(s):  
Rosemary Brown ◽  
Jim Lewsey ◽  
Sarah Wild ◽  
Jennifer Logue ◽  
Paul Welsh
Keyword(s):  
Myocardial Infarction ◽  
Cohort Study ◽  
Clinical Practice ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Secondary Outcome ◽  
All Cause Mortality ◽  
Clinical Records ◽  
Statin Adherence ◽  
Cvd Mortality

ObjectivesTo examine associations between statin adherence and lipid target achievement in myocardial infarction (MI) survivors, and their associations with mortality and recurrent MIs.DesignRetrospective cohort study using linked clinical records within the National Health Service Greater Glasgow and Clyde (NHS GGC) Data Safe Haven.SettingRoutine clinical practice in the NHS GGC area between January 2009 and July 2017.ParticipantsPatients ≥18 years who experienced a non-fatal MI hospital admission (ICD10: I21, I22) between January 2009 and July 2014 (n=11 031), followed up from the date of MI admission until July 2017 or death, whichever occurred first.Primary and secondary outcome measuresStatin adherence was estimated using encashed prescriptions and lipid results from routine biochemistry data. Primary lipid and statin adherence targets were LDL ≤1.8 mmol/L and adherence ≥50%, and were related to all-cause death, deaths due to cardiovascular disease (CVD) (ICD10: I00–I99 as the underlying cause), and recurrent MI in unadjusted models and models adjusting for age, sex, socioeconomic deprivation and year of MI.ResultsOver 4.5 years follow-up, 76% achieved LDL ≤1.8 mmol/L, and 84.5% had average adherence ≥50%. Patients with adherence <50% had an increased risk of not meeting LDL ≤1.8 mmol/L, in adjusted models (OR 2.03, 95% CI 1.78 to 2.31, p<0.0001). In univariable models, not meeting LDL ≤1.8 mmol/L was associated with increased risks of all-cause mortality (HR 1.27, 95% CI 1.16 to 1.39, p<0.0001) and CVD mortality (HR 1.29, 95% CI 1.11 to 1.51, p=0.0013). Adherence <50% was associated with increased risks of all-cause mortality (HR 1.58, 95% CI 1.44 to 1.74, p<0.0001) and CVD mortality (HR 1.60, 95% CI 1.36 to 1.88, p<0.0001). Adjustment for confounders did not abrogate these associations. Neither exposure was associated with recurrent MIs.ConclusionsNon-achievement of lipid and adherence targets are associated with increased risks of all-cause and CVD mortality. Further work is required to optimise their use to improve outcomes in clinical practice.

scholarly journals Community-acquired bacteraemia in COVID-19 in comparison to influenza A and influenza B: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Julinha M. Thelen ◽  
A. G. ( Noud) Buenen ◽  
Marjan van Apeldoorn ◽  
Heiman F. Wertheim ◽  
Mirjam H. A. Hermans ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Culture ◽  
The Netherlands ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Influenza A ◽  
Blood Cultures ◽  
Influenza B ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Background During the coronavirus disease 2019 (COVID-19) pandemic in the Netherlands it was noticed that very few blood cultures from COVID-19 patients turned positive with clinically relevant bacteria. This was particularly evident in comparison to the number of positive blood cultures during previous seasonal epidemics of influenza. This observation raised questions about the occurrence and causative microorganisms of bacteraemia in COVID-19 patients, especially in the perspective of the widely reported overuse of antibiotics and the rising rate of antibiotic resistance. Methods We conducted a retrospective cohort study on blood culture results in influenza A, influenza B and COVID-19 patients presenting to two hospitals in the Netherlands. Our main outcome consisted of the percentage of positive blood cultures. The percentage of clinically relevant blood cultures, isolated bacteria and 30-day all-cause mortality served as our secondary outcomes. Results A total of 1331 viral episodes were analysed in 1324 patients. There was no statistically significant difference (p = 0.47) in overall occurrence of blood culture positivity in COVID-19 patients (9.0, 95% CI 6.8–11.1) in comparison to influenza A (11.4, 95% CI 7.9–14.8) and influenza B patients (10.4, 95% CI 7.1–13.7,). After correcting for the high rate of contamination, the occurrence of clinically relevant bacteraemia in COVID-19 patients amounted to 1.0% (95% CI 0.3–1.8), which was statistically significantly lower (p = 0.04) compared to influenza A patients (4.0, 95% CI 1.9–6.1) and influenza B patients (3.0, 95% CI 1.2–4.9). The most frequently identified bacterial isolates in COVID-19 patients were Escherichia coli (n = 2) and Streptococcus pneumoniae (n = 2). The overall 30-day all-cause mortality for COVID-19 patients was 28.3% (95% CI 24.9–31.7), which was statistically significantly higher (p = <.001) when compared to patients with influenza A (7.1, 95% CI 4.3–9.9) and patients with influenza B (6.4, 95% CI 3.8–9.1). Conclusions We report a very low occurrence of community-acquired bacteraemia amongst COVID-19 patients in comparison to influenza patients. These results reinforce current clinical guidelines on antibiotic management in COVID-19, which only advise utilization of antibiotics when a bacterial co-infection is suspected.

scholarly journals Comparative Risk of Incidence and Clinical Outcomes of COVID-19 among Proton Pump Inhibitor and Histamine-2 Receptor Antagonist Users: A Nationwide Retrospective Cohort Study

2021 ◽  
Author(s):  
Jimyung Park ◽  
Seng Chan You ◽  
Jaehyeong Cho ◽  
Chan Hyuk Park ◽  
Woon Shin ◽  
...  
Keyword(s):  
Cohort Study ◽  
South Korea ◽  
Receptor Antagonist ◽  
Clinical Outcomes ◽  
Respiratory Disease ◽  
Proton Pump ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Large Scale ◽  
All Cause Mortality

Abstract Background: This study aimed to evaluate incidence risk and severe clinical outcomes in COVID-19 disease among short-term users of acid-suppressants in South Korea.Methods: This retrospective cohort study, conducted using a nationwide claims database for South Korea, used data from patients with COVID-19 tested between January 1 and May 15, 2020. Patients aged over 18 years and prescribed proton pump inhibitors (PPI) or histamine-2 receptor antagonist (H2RA) for more than 7 days were identified. Primary outcome was COVID-19 while secondary outcomes were all-cause mortality, hospitalization with respiratory disease, or intensive respiratory intervention. Large-scale propensity scores were used to match patients, while the Cox proportional hazard model was utilized to evaluate any association between exposure and outcome(s). The risk estimates were calibrated by using 123 falsification endpoints.Results: We identified 26,166 PPI users and 62,117 H2RA users. After propensity score matching, compared to H2RA use, PPI use was not significantly associated with lower risk of COVID-19 (calibrated hazard ratio [HR], 0.81 [95% confidence interval (CI), 0.30–2.19]); moreover, PPI use was not associated with adverse clinical outcomes in COVID-19, namely, hospitalization with respiratory disease (calibrated HR, 0.88 [95% CI, 0.72–1.08]), intensive respiratory interventions (calibrated HR, 0.92 [95% CI, 0.46–1.82]), except for all-cause mortality (calibrated HR, 0.54 [95% CI, 0.31–0.95]).Conclusions: In this study, we found that the PPI user was not associated with risk of COVID-19 compared to H2RA users. There was no significant relationship between severe clinical outcomes of COVID-19 and exposure to PPI compared with H2RA, except for all-cause mortality.

scholarly journals 360-Degree Complex Primary Reconstruction Using Porous Tantalum Cages for Adult Degenerative Spinal Deformity

2018 ◽  
Vol 9 (6) ◽  
pp. 613-618
Author(s):  
Joseph S. Butler ◽  
Darren F. Lui ◽  
Karan Malhotra ◽  
Maria L. Suarez-Huerta ◽  
Haiming Yu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Spinal Deformity ◽  
Retrospective Cohort Study ◽  
Repeated Measures ◽  
Retrospective Cohort ◽  
Perioperative Complications ◽  
Porous Tantalum ◽  
Radiographic Outcomes ◽  
Related Quality ◽  
Health Related

Study Design: Retrospective cohort study. Objective: To assess both implant performance and the amount of correction that can be achieved using multilevel anterior lumbar interbody fusion (ALIF). Methods: Retrospective cohort study (n = 178) performed over a 4-year period. Surgical variables examined included blood loss, operative time, perioperative complications, and secondary/revision procedures. Follow-up radiographic assessment was performed to record implant-related problems. Radiographic parameters were examined pre- and postoperatively. Health-related quality of life (HRQOL) outcome measures were collected preoperatively and at 6 weeks, 6 months, 1 year, and 2 years postoperatively. Descriptive and comparative statistical analysis, using paired-sample t test and repeated-measures analysis of variance (rANOVA), was performed. Results: Lumbar lordosis increased from 42° ± 17° preoperatively to 55° ± 11° postoperatively ( P < .001). The visual analog scale back pain mean score improved from 8.3 ± 1.5 preoperatively to 2.6 ± 2.4 at 2 years ( P < .001). The mean Oswestry Disability Index improved from 69.5 ± 21.5 preoperatively to 19.9 ± 15.2 at 2 years ( P < .001). The EQ-5D mean score improved from 0.2 ± 0.2 preoperatively to 0.8 ± 0.1 at 2 years ( P = .02). There were no neurological, vascular, or visceral approach–related injuries reported. No rod breakages and no symptomatic nonunions occurred. There was one revision procedure performed for fracture. Conclusions: The use of porous tantalum cages as part of a 360-degree fusion to treat adult degenerative spinal deformity has been demonstrated to be a safe and effective strategy, leading to good clinical, functional, and radiographic outcomes in the short term.

scholarly journals Glucose variability and the risks of stroke, myocardial infarction, and all-cause mortality in individuals with diabetes: retrospective cohort study

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Da Young Lee ◽  
Kyungdo Han ◽  
Sanghyun Park ◽  
Ji Hee Yu ◽  
Ji A. Seo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
The Elderly ◽  
Glucose Variability ◽  
All Cause Mortality ◽  
Nationwide Observational Study ◽  
The Impact

Abstract Background Previous research regarding long-term glucose variability over several years which is an emerging indicator of glycemic control in diabetes showed several limitations. We investigated whether variability in long-term fasting plasma glucose (FG) can predict the development of stroke, myocardial infarction (MI), and all-cause mortality in patients with diabetes. Methods This is a retrospective cohort study using the data provided by the Korean National Health Insurance Corporation. A total of 624,237 Koreans ≥ 20 years old with diabetes who had undergone health examinations at least twice from 2005 to 2008 and simultaneously more than once from 2009 to 2010 (baseline) without previous histories of stroke or MI. As a parameter of variability of FG, variability independent of mean (VIM) was calculated using FG levels measured at least three times during the 5 years until the baseline. Study endpoints were incident stroke, MI, and all-cause mortality through December 31, 2017. Results During follow-up, 25,038 cases of stroke, 15,832 cases of MI, and 44,716 deaths were identified. As the quartile of FG VIM increased, the risk of clinical outcomes serially increased after adjustment for confounding factors including duration and medications of diabetes and the mean FG. Adjusted hazard ratios (95% confidence intervals) of FG VIM quartile 4 compared with quartile 1 were 1.20 (1.16–1.24), 1.20 (1.15–1.25), and 1.32 (1.29–1.36) for stroke, MI and all-cause mortality, respectively. The impact of FG variability was higher in the elderly and those with a longer duration of diabetes and lower FG levels. Conclusions In diabetes, long-term glucose variability showed a dose–response relationship with the risk of stroke, MI, and all-cause mortality in this nationwide observational study.

scholarly journals 56-61: A Clinical Risk Score to Predict All-Cause Mortality in Patients Receiving Cardiac Resynchronization Therapy: A Retrospective Cohort Study

EP Europace ◽  
2016 ◽  
Vol 18 (suppl_1) ◽  
pp. i48-i48
Author(s):  
Ghanshyam Palamaner Subash Shantha ◽  
Hardik Doshi ◽  
Ward Chad ◽  
Musab Alqasrawi ◽  
Alexander Bolton ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiac Resynchronization Therapy ◽  
Risk Score ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cardiac Resynchronization ◽  
Clinical Risk Score ◽  
Resynchronization Therapy ◽  
Clinical Risk ◽  
All Cause Mortality

scholarly journals Follow-up of incidental pulmonary nodules and association with mortality in a safety-net cohort

Diagnosis ◽  
2019 ◽  
Vol 6 (4) ◽  
pp. 351-359 ◽  
Author(s):  
Jonathan S. Lee ◽  
Sarah Lisker ◽  
Eric Vittinghoff ◽  
Roy Cherian ◽  
David B. McCoy ◽  
...  
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Pulmonary Nodules ◽  
Safety Net ◽  
Mortality Rates ◽  
All Cause Mortality ◽  
Multivariable Models

Abstract Background Though incidental pulmonary nodules are common, rates of guideline-recommended surveillance and associations between surveillance and mortality are unclear. In this study, we describe adherence (categorized as complete, partial, late and none) to guideline-recommended surveillance among patients with incidental 5–8 mm pulmonary nodules and assess associations between adherence and mortality. Methods This was a retrospective cohort study of 551 patients (≥35 years) with incidental pulmonary nodules conducted from September 1, 2008 to December 31, 2016, in an integrated safety-net health network. Results Of the 551 patients, 156 (28%) had complete, 87 (16%) had partial, 93 (17%) had late and 215 (39%) had no documented surveillance. Patients were followed for a median of 5.2 years [interquartile range (IQR), 3.6–6.7 years] and 82 (15%) died during follow-up. Adjusted all-cause mortality rates ranged from 2.24 [95% confidence interval (CI), 1.24–3.25] deaths per 100 person-years for complete follow-up to 3.30 (95% CI, 2.36–4.23) for no follow-up. In multivariable models, there were no statistically significant associations between the levels of surveillance and mortality (p > 0.16 for each comparison with complete surveillance). Compared with complete surveillance, adjusted mortality rates were non-significantly increased by 0.45 deaths per 100 person-years (95% CI, −1.10 to 2.01) for partial, 0.55 (95% CI, −1.08 to 2.17) for late and 1.05 (95% CI, −0.35 to 2.45) for no surveillance. Conclusions Although guideline-recommended surveillance of small incidental pulmonary nodules was incomplete or absent in most patients, gaps in surveillance were not associated with statistically significant increases in mortality in a safety-net population.

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