Abstract P323: Cardiac Rehabilitation is Associated With Decreased Mortality in HIV Patients With Cardiovascular Disease

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Justin M Bachmann ◽  
Suman Kundu ◽  
Kaku So-Armah ◽  
Amy Justice ◽  
Jason Sico ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Hiv Status ◽  
Hiv Patients ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Cox Proportional Hazard Models ◽  
One Year

Background: Human immunodeficiency virus (HIV+) patients are at high risk for cardiovascular disease (CVD). While cardiac rehabilitation (CR) reduces mortality in uninfected (HIV-) patients with CVD, there are no specific data on CR use in CVD patients with HIV. Methods: We analyzed data on 7650 veterans (28.4% HIV+) eligible for CR from the Veterans Aging Cohort Study, an observational cohort of HIV+ and HIV- veterans. CR eligibility was defined as a hospitalization for acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, or cardiac valve surgery from 2003-2012, identified using ICD9 and CPT codes. CR use was ascertained from VA and non-VA facilities within one year of discharge from the index CVD hospitalization using CPT codes. We evaluated the association between CR and mortality after adjusting for age, eligibility diagnosis, race, sex, and comorbidities using Cox proportional hazard models. Results: CR use was low in HIV+ and HIV- veterans (9.1% vs. 9.6%, respectively, p=0.06). Among the 7650 CR eligible veterans, there were 2211 deaths over 25,715 person-years of follow-up. Mortality rates were higher among those who did not receive CR, regardless of HIV status (Figure). In adjusted models stratified by HIV status, CR was associated with a significant reduction in mortality for HIV+ (hazard ratio [HR] 0.39, 95% confidence interval [CI] 0.26-0.59) and HIV- veterans (HR 0.52, 95% CI 0.42-0.65). Among those receiving CR, HIV was not associated with an increased risk of mortality (Figure) even after adjusting for confounders (HR 1.01, 95% CI 0.63-1.61). Conclusions: CR utilization in both HIV+ and HIV- veterans is low. Participation in CR programs is associated with a significant reduction in mortality, regardless of HIV status. When CR is utilized, however, the risk of mortality is the same for HIV+ and HIV- veterans. CR may be particularly important for reducing mortality in HIV+ patients with CVD.

scholarly journals Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies

2021 ◽  
Vol 10 (10) ◽  
pp. 2151
Author(s):  
Rita Pavasini ◽  
Matteo Tebaldi ◽  
Giulia Bugani ◽  
Elisabetta Tonet ◽  
Roberta Campana ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Pooled Analysis ◽  
Coronary Syndrome ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Short Term Mortality

Whether contrast-associated acute kidney injury (CA-AKI) is only a bystander or a risk factor for mortality in older patients undergoing percutaneous coronary intervention (PCI) is not well understood. Data from FRASER (NCT02386124) and HULK (NCT03021044) studies have been analysed. All patients enrolled underwent coronary angiography. The occurrence of CA-AKI was defined based on KDIGO criteria. The primary outcome of the study was to test the relation between CA-AKI and 3-month mortality. Overall, 870 older ACS adults were included in the analysis (mean age 78 ± 5 years; 28% females). CA-AKI occurred in 136 (16%) patients. At 3 months, 13 (9.6%) patients with CA-AKI died as compared with 13 (1.8%) without it (p < 0.001). At multivariable analysis, CA-AKI emerged as independent predictor of 3-month mortality (HR 3.51, 95%CI 1.05–7.01). After 3 months, renal function returned to the baseline value in 78 (63%) with CA-AKI. Those without recovered renal function (n = 45, 37%) showed an increased risk of mortality as compared to recovered renal function and no CA-AKI subgroups (HR 2.01, 95%CI 1.55–2.59, p = 0.009 and HR 2.71, 95%CI 1.45–5.89, p < 0.001, respectively). In conclusion, CA-AKI occurs in a not negligible portion of older MI patients undergoing invasive strategy and it is associated with short-term mortality.

scholarly journals Antiplatelet therapy and exodontia: far away from a definite conclusion

2016 ◽  
Vol 9 (6) ◽  
pp. 1
Author(s):  
Hamidreza Karimi-sari ◽  
Mohammad Saeid Rezaee-zavareh
Keyword(s):  
Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Antiplatelet Drug ◽  
Dental Management ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Dental Intervention ◽  
One Year ◽  
Focus Question ◽  
Teeth Extraction

Dear Editor;We read a review article about antiplatelet therapy and dental management in your journal (1). Kumar concluded that patients taking dual antiplatelet therapy has an increased risk for post-operative bleeding complications.The focus question of this article contains many other smeller questions. We recently answered one of these questions in our study; one tooth extraction is safe in patients taking aspirin and clopidogrel during one year after percutaneous coronary intervention (PCI) with stenting (2). But many questions remained without answer. Is two teeth extraction safe in these patients? What about more than two teeth extraction or in patients taking other antiplatelet drugs for other indications? What about other dental interventions? For answering each of these specific questions we need to design a prospective original study, with enough sample size, and comparing the results with a matched control group.Also there are many confounders for bleeding after exodontia (e.g. dentist's skill, type of antiplatelet drug and its manufacturing company, indication and duration of taking antiplatelet therapy, number and kind of extracted teeth, and dentist's skill) (2, 3). Controlling these confounders needs prospective studies focusing on specific group of patients. For example, patients taking unique dose and type of antiplatelet drug for a unique indication and duration, undergoing unique dental intervention by unique dentist. Then this result could be compared with a group of healthy subjects undergoing same dental intervention by the same dentist. So we do not have enough evidences to make a definite conclusion about what we should do in case of dental intervention for patients taking antiplatelet therapy. 

scholarly journals One-year Risks and Burdens of Incident Cardiovascular Disease in COVID-19: Cardiovascular Manifestations of Long COVID

2021 ◽  
Author(s):  
Ziyad Al-Aly ◽  
Benjamin Bowe ◽  
Yan Xie ◽  
Evan Xu
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Health ◽  
Acute Infection ◽  
Cerebrovascular Disorders ◽  
Cardiovascular Complications ◽  
Department Of Veterans Affairs ◽  
Increased Risk ◽  
Health And Disease ◽  
One Year ◽  
Incident Cardiovascular Disease

Abstract The cardiovascular complications of acute COVID-19 are well described; however, a comprehensive characterization of the post-acute cardiovascular manifestations of COVID-19 at one year has not been undertaken. Here we use the US Department of Veterans Affairs national healthcare databases to build a cohort of 151,195 people with COVID-19, 3,670,087 contemporary and 3,656,337 historical controls to estimate risks and 1-year burdens of a set of pre-specified incident cardiovascular outcomes. We show that beyond the first 30 days of infection, people with COVID-19 are at increased risk of incident cardiovascular disease spanning several categories including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure, and thromboembolic disease. The risks and burdens were evident among those who were non-hospitalized during the acute phase of the infection and increased in a graded fashion according to care setting of the acute infection (non-hospitalized, hospitalized, and admitted to intensive care). Taken together, our results provide evidence that risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial. Care pathways of people who survived the acute episode of COVID-19 should include attention to cardiovascular health and disease.

scholarly journals Cardiovascular Screening for the Asymptomatic Patient with Diabetes: More Cons Than Pros

2017 ◽  
Vol 2017 ◽  
pp. 1-19 ◽  
Author(s):  
Konstantinos Makrilakis ◽  
Stavros Liatis
Keyword(s):  
Medical Therapy ◽  
Coronary Atherosclerosis ◽  
Randomized Clinical Trials ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Morbidity And Mortality ◽  
Cvd Risk ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Revascularization Procedures

Diabetes mellitus is associated with an increased risk of coronary heart disease (CHD) morbidity and mortality. Although it frequently coexists with other cardiovascular disease (CVD) risk factors, it confers an increased risk for CVD events on its own. Coronary atherosclerosis is generally more aggressive and widespread in people with diabetes (PWD) and is frequently asymptomatic. Screening for silent myocardial ischaemia can be applied in a wide variety of ways. In nearly all asymptomatic PWD, however, the results of screening will generally not change medical therapy, since aggressive preventive measures, such as control of blood pressure and lipids, would have been already indicated, and above all, invasive revascularization procedures (either with percutaneous coronary intervention or coronary artery bypass grafting) have not been shown in randomized clinical trials to confer any benefit on morbidity and mortality. Still, unresolved issues remain regarding the extent of the underlying ischaemia that might affect the risk and the benefit of revascularization (on top of optimal medical therapy) in ameliorating this risk in patients with moderate to severe ischaemia. The issues related to the detection of coronary atherosclerosis and ischaemia, as well as the studies related to management of CHD in asymptomatic PWD, will be reviewed here.

Association Between Increased Hospital Reimbursement for Cardiac Rehabilitation and Utilization of Cardiac Rehabilitation by Medicare Beneficiaries

2021 ◽  
Vol 14 (3) ◽  
Author(s):  
Dana R. Fletcher ◽  
Gary K. Grunwald ◽  
Catherine Battaglia ◽  
P. Michael Ho ◽  
Richard C. Lindrooth ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Time Window ◽  
Artery Bypass ◽  
Cost Effective ◽  
Coronary Intervention ◽  
Guideline Recommendation ◽  
Annual Growth Rate ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Percentage Points

Background: Although cardiac rehabilitation (CR) is a Class I Guideline recommendation, and has been shown to be a cost-effective intervention after a cardiac event, it has been reimbursed at levels insufficient to cover hospital operating costs. In January 2011, Medicare increased payment for CR in hospital outpatient settings by ≈180%. We evaluated the association between this payment increase and participation in CR of eligible Medicare beneficiaries to better understand the relationship between reimbursement policy and CR utilization. Methods: From a 5% Medicare claims sample, we identified patients with acute myocardial infarction, coronary artery bypass surgery, percutaneous coronary intervention, or cardiac valve surgery between January 1, 2009 and September 30, 2012, alive 30 days after their event, with continuous enrollment in Medicare fee-for-service, Part A/B for 4 months. Trends and changes in CR participation were estimated using an interrupted time series approach with a hierarchical logistic model, hospital random intercepts, adjusted for patient, hospital, market, and seasonality factors. Estimates were expressed using average marginal effects on a percent scale. Results: Among 76 695 eligible patients, average annual CR participation was 19.5% overall. In the period before payment increase, adjusted annual participation grew by 1.1 percentage points (95% CI, 0.48–2.4). No immediate change occurred in CR participation when the new payment was implemented. In the period after payment increase, on average, 20% of patients participated in CR annually. The annual growth rate in CR participation slowed in the post-period by 1.3 percentage points (95% CI, −2.4 to −0.12) compared with the prior period. Results were somewhat sensitive to time window variations. Conclusions: The 2011 increase in Medicare reimbursement for CR was not associated with an increase in participation. Future studies should evaluate whether payment did not reach a threshold to incentivize hospitals or if hospitals were not sensitive to reimbursement changes.

Abstract 134: Implementation of Home-Based Cardiac Rehabilitation in the VA

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
David W Schopfer ◽  
Nirupama Krishnamurthi ◽  
Hui Shen ◽  
Mary A Whooley
Keyword(s):  
Cardiac Rehabilitation ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
The United States ◽  
Medical Centers ◽  
The United Kingdom ◽  
Home Based ◽  
Percutaneous Coronary ◽  
The Us ◽  
Va Hospitals

Objective: Referral to cardiac rehabilitation (CR) is one of nine performance measures for patients with ischemic heart disease (IHD), but fewer than 20% of eligible patients participate in the United States. Home-based CR programs (available in the United Kingdom, Australia, and Canada) have similar effects on morbidity and mortality as traditional (facility-based) CR, but they are not currently available or reimbursed in the US. We sought to determine whether implementing home-based programs could increase CR participation among patients with IHD. Methods: Using electronic health records from 134 VA medical centers, we identified 106,277 veterans hospitalized for acute myocardial infarction, percutaneous coronary intervention or coronary artery bypass grafting between 2010 and 2015. We compared the proportion of eligible patients who participated in CR at 13 VA hospitals that offered referral to either home-based CR or facility-based CR vs. 121 VA hospitals that offered referral to only facility-based CR (usual care). Results: The number of VA medical centers offering home-based CR increased from 2 in 2010 to 13 in 2015. Among the 20,949 eligible patients hospitalized at VA medical centers that implemented home-based CR between 2010 and 2015, CR participation increased from 11% to 26% (Figure). Among the 85,328 eligible patients hospitalized at VA medical centers that did not offer home-based CR, CR participation increased from only 8% to 11%. Conclusion: Among eligible patients with IHD, participation in CR more than doubled at VA medical centers that implemented home-based CR programs between 2010 and 2015, whereas participation increased by only 3% at VA medical centers that did not implement home-based CR programs. Home-based CR is an effective way of engaging patients who may otherwise decline to participate in CR.

scholarly journals To jump or not to jump? A multicentre propensity-matched study of sequential vein grafting of the heart

2019 ◽  
Vol 29 (2) ◽  
pp. 201-208 ◽  
Author(s):  
Jens K Skov ◽  
Hans-Henrik Kimose ◽  
Jacob Greisen ◽  
Carl-Johan Jakobsen
Keyword(s):  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Study Groups ◽  
Confidence Limits ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Early Graft ◽  
Matched Study ◽  
Early Graft Failure

AbstractOBJECTIVESIn this propensity-matched study we investigated the outcome after grafting with either a single vein or a sequential vein grafting strategy. Outcomes were primarily risk of reintervention and death in the short, intermediate and long term (10 years).MATERIALSIn the period from 2000 to 2016, data from 24 742 patients undergoing coronary artery bypass grafting were extracted from the Western Denmark Heart Registry, where data are registered perioperatively. We used a propensity-matched study in which the study groups were matched on parameters primarily from the EuroSCORE. The numbers of patients in both groups after matching were 3380.RESULTSSingle grafts resulted in significantly more postoperative bleeding and were more time-consuming. No differences were seen regarding in-hospital events such as stroke, acute myocardial infarction, dialysis or arrhythmias. After 30 days, patients in the jump graft group showed an increased rate of reintervention due to ischaemia after adjusting for confounding factors [hazard ratio (HR) 2.08, 95% confidence interval 1.01–4.34]. In addition, after adjusting for known confounders, sequential grafts were found to increase the risk of mortality at 6 months (HR 1.51, 95% confidence limits 1.07–2.11) and 5 years (HR 1.23, 95% confidence limits 1.04–1.46).CONCLUSIONSThis propensity-matched analysis suggested, although discretely, that a jump graft as a grafting strategy is associated with a slightly increased risk of mortality and early graft failure and that a single grafting strategy to the coronary arteries should be preferred when feasible.

scholarly journals Cholesterol and Egg Intakes, and Risk of Hypertension in a Large Prospective Cohort of French Women

Nutrients ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1350
Author(s):  
Conor-James MacDonald ◽  
Anne-Laure Madika ◽  
Fabrice Bonnet ◽  
Guy Fagherazzi ◽  
Martin Lajous ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Population Based ◽  
Dietary History ◽  
Egg Consumption ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Cholesterol Intake ◽  
Cox Proportional Hazard Models ◽  
Diet History Questionnaire ◽  
Meta Analyses

Purpose: The relationship between egg and cholesterol intakes, and cardiovascular disease is controversial. Meta-analyses indicate that egg consumption is associated with increased cardiovascular disease and mortality, but reduced incidence of hypertension, a major risk factor for cardiovascular disease. This study aims to investigate the associations between consumption of egg and cholesterol, and hypertension risk in a cohort of French women. Methods: We used data from the E3N cohort study, a French prospective population-based study initiated in 1990. From the women in the study, we included those who completed a detailed diet history questionnaire, and who did not have prevalent hypertension or cardiovascular disease at baseline, resulting in 46,424 women. Hypertension cases were self-reported. Egg and cholesterol intake was estimated from dietary history questionnaires. Cox proportional hazard models with time-updated exposures were used to calculate hazard ratios. Spline regression was used to determine any dose–respondent relationship. Results: During 885,321 person years, 13,161 cases of incident hypertension were identified. Higher cholesterol consumption was associated with an increased risk of hypertension: HRQ1–Q5 = 1.22 [1.14:1.30], with associations similar regarding egg consumption up to seven eggs per week: HR4–7 eggs = 1.14 [1.06:1.18]. Evidence for a non-linear relationship between hypertension and cholesterol intake was observed. Conclusions: Egg and cholesterol intakes were associated with a higher risk of hypertension in French women. These results merit further investigation in other populations.

Advance care planning (ACP) prior to hematopoeitic stem cell transplantation (HSCT) in patients with cancer is associated with improved survival

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9026-9026 ◽  
Author(s):  
F. R. Loberiza ◽  
A. K. Ganti ◽  
J. O. Armitage ◽  
P. J. Bierman ◽  
R. G. Bociek ◽  
...  
Keyword(s):  
Life Support ◽  
Living Will ◽  
Power Of Attorney ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Diagnosis Of Cancer ◽  
Advance Care ◽  
Will Power ◽  
One Year ◽  
After Cancer

9026 Background: HSCT carries an increased risk of mortality. Thus, patients are encouraged to have ACP. However, discussions about ACP is not a casual process since it may elicit undue anxiety to the patients and their families. Anecdotally, pts fear that discussion of the possibility of death is inconsistent with hoping for the best outcome. We therefore compared the outcomes of pts with or without ACP who received HSCT for cancer. Methods: ACP was defined as having living will, power of attorney for health care, or life-support instructions conducted prior to transplant. ACP were reviewed in pts who were at least 19 yo and received first allogeneic or autologous HSCT for cancer between 2001 and 2003. Pts were classified into: 1) No ACP, 2) ACP prior to cancer dx, 3) ACP after cancer dx but prior to HSCT. Multivariate analysis (MVA) was done to evaluate the relative risk of mortality at 1 year according to ACP while adjusting for other prognostic factors. Results: 343 pts were included in the study: 172 (50%) did not have ACP, while 171 (50%) pts had ACP. Of those with ACP, 127 pts (74%) were available for review. Characteristics were similar between pts with and without reviewable ACP. 28 pts had ACP prior to cancer dx, 87 had ACP prior to HSCT, while 12 had ACP after HSCT. 64% of pts with ACP had both power of attorney and a living will, 16% had a living will alone and 19% had power of attorney alone. Older pts (p <0.001) and Caucasians (p = 0.04) were more likely to have ACP. MVA were confined to the 172 pts with no ACP and 115 who had ACP before HSCT and showed that pts with ACP prior to HSCT had a significantly lower risk of mortality (see table ). Conclusions: Despite a diagnosis of cancer and hospitalization for HSCT, only 50% of patients had engaged in ACP. ACP at any time before HSCT was associated with higher one-year survival. Engagement in ACP is not necessarily inconsistent with hoping for the best outcome in HSCT. Further study is warranted to explore the reasons for engaging or not in ACP. No significant financial relationships to disclose. [Table: see text]

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