Abstract 15678: In Patients Treated With Immune Checkpoint Inhibitors, Myocarditis is Infrequent Compared With Other Cardiovascular Events

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Judith A Hsia ◽  
Jessica Thurston ◽  
Lavanya Kondapalli ◽  
Ronni Miller ◽  
Rita Dale ◽  
...  
Keyword(s):  
Heart Failure ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Coronary Revascularization ◽  
International Classification Of Diseases ◽  
Alaskan Native ◽  
University Of Colorado ◽  
Before And After ◽  
Classification Of Diseases ◽  
The University

Introduction: Cardiotoxicity with immune checkpoint inhibitor (ICI) treatment has predominantly focused on myocarditis, which has been estimated to affect ~1% of treated patients. To contextualize myocarditis risk in relation to other cardiovascular (CV) events, we explored reporting of myocarditis, heart failure, arterial and venous thrombotic events in ICI-treated cancer patients. Methods: Data from adults treated with ICI between January 2011 and April 2019 were extracted by the University of Colorado enterprise health data warehouse which draws from electronic medical records and claims data. Medical conditions were determined by International Classification of Diseases (ICD) code; analyses was descriptive. Results: Among 1813 ICI-treated patients, mean age (SD) was 62.5 (13.5 years), 41% were women, 90% were white, 6% Hispanic, 2% black, 1% Asian, <1% American Indian/Alaskan native or native Hawaiian/Pacific islander and 1% multiple race. Prior to ICI initiation, 48% had hypertension, 16% diabetes, 11% were current smokers, 46% former smokers, 11% had estimated glomerular filtration rate <60 ml/min/1.73m 2 and 17% reported prior coronary revascularization. The most commonly treated malignancies were melanoma (40%) and lung cancer (31%). 47% of patients received pembrolizumab and 42% received nivolumab, the most often administered ICIs during this time period. Both before and after ICI administration, venous thromboembolism (VTE) and heart failure were the most frequently reported CV events (Figure). After initiation of ICI, myocardial infarction (MI) and stroke were reported for 54 (3.0%) and 73 (4.0%) patients, respectively. Myocarditis was more common after ICI than before ICI initiation (1 vs 9 patients [0.1%vs 0.5%]) but was infrequent compared with other CV events. Conclusions: Arterial and venous thrombotic events and heart failure were much more common than myocarditis in patients treated with ICI.

scholarly journals Risk and predictors of heart failure in sarcoidosis in a population-based cohort study from Sweden

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319129
Author(s):  
Marios Rossides ◽  
Susanna Kullberg ◽  
Johan Grunewald ◽  
Anders Eklund ◽  
Daniela Di Giuseppe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
General Population ◽  
Strong Predictor ◽  
Strong Association ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Clinical Predictors ◽  
Cox Models ◽  
Classification Of Diseases

ObjectivesPrevious studies showed a strong association between sarcoidosis and heart failure (HF) but did not consider risk stratification or risk factors to identify useful aetiological insights. We estimated overall and stratified HRs and identified risk factors for HF in sarcoidosis.MethodsSarcoidosis cases were identified from the Swedish National Patient Register (NPR; ≥2 International Classification of Diseases-coded visits, 2003–2013) and matched to general population comparators. They were followed for HF in the NPR. Treated were cases who were dispensed ≥1 immunosuppressant ±3 months from the first sarcoidosis visit (2006–2013). Using Cox models, we estimated HRs adjusted for demographics and comorbidity and identified independent risk factors of HF together with their attributable fractions (AFs).ResultsDuring follow-up, 204 of 8574 sarcoidosis cases and 721 of 84 192 comparators were diagnosed with HF (rate 2.2 vs 0.7/1000 person-years, respectively). The HR associated with sarcoidosis was 2.43 (95% CI 2.06 to 2.86) and did not vary by age, sex or treatment status. It was higher during the first 2 years after diagnosis (HR 3.7 vs 1.9) and in individuals without a history of ischaemic heart disease (IHD; HR 2.7 vs 1.7). Diabetes, atrial fibrillation and other arrhythmias were the strongest independent clinical predictors of HF (HR 2.5 each, 2-year AF 20%, 16% and 12%, respectively).ConclusionsAlthough low, the HF rate was more than twofold increased in sarcoidosis compared with the general population, particularly right after diagnosis. IHD history cannot solely explain these risks, whereas ventricular arrhythmias indicating cardiac sarcoidosis appear to be a strong predictor of HF in sarcoidosis.

Prevalence and Incidence of Heart Failure Among Urban Patients in China: A National Population-Based Analysis

2021 ◽  
Author(s):  
Hua Wang ◽  
Ke Chai ◽  
Minghui Du ◽  
Shengfeng Wang ◽  
Jian-Ping Cai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Large Scale ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Unique Identifier ◽  
Classification Of Diseases ◽  
Per Capita ◽  
Mean Cost ◽  
Incident Cases

Background: Large-scale and population-based studies of heart failure (HF) incidence and prevalence are scarce in China. The study sought to estimate the prevalence, incidence, and cost of HF in China. Methods: We conducted a population-based study using records of 50.0 million individuals ≥25 years old from the national urban employee basic medical insurance from 6 provinces in China in 2017. Incident cases were individuals with a diagnosis of HF (International Classification of Diseases code, and text of diagnosis) in 2017 with a 4-year disease-free period (2013–2016). We calculated standardized rates by applying age standardization to the 2010 Chinese census population. Results: The age-standardized prevalence and incidence were 1.10% (1.10% among men and women) and 275 per 100 000 person-years (287 among men and 261 among women), respectively, accounting for 12.1 million patients with HF and 3.0 million patients with incident HF ≥25 years old. Both prevalence and incidence increased with increasing age (0.57%, 3.86%, and 7.55% for prevalence and 158, 892, and 1655 per 100 000 person-years for incidence among persons who were 25–64, 65–79, and ≥80 years of age, respectively). The inpatient mean cost per-capita was $4406.8 and the proportion with ≥3 hospitalizations among those hospitalized was 40.5%. The outpatient mean cost per-capita was $892.3. Conclusions: HF has placed a considerable burden on health systems in China, and strategies aimed at the prevention and treatment of HF are needed. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: ChiCTR2000029094.

Abstract 12563: Retrospective Analysis of Cardiovascular Events With the Use of Immune Checkpoint Inhibitors

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tushar Tarun ◽  
Brian P Bostick ◽  
Deepa Baswaraj ◽  
Nishchayjit Basra ◽  
Meeshal Khan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Retrospective Analysis ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Multiple Organ ◽  
Fulminant Myocarditis ◽  
Organ Systems ◽  
History Of

Introduction: Immune checkpoint inhibitors have emerged as a promising, novel therapy for multiple malignancies. Immune-related adverse reactions pose a serious concern with use of these agents and reportedly involve multiple organ systems, notably cardiotoxicity. Early identification and management of these adverse events is essential in the prevention of morbidity and mortality. Hypothesis: Immune checkpoint inhibitors cause multiple cardiotoxic effects, and patients with prior cardiac history have a higher likelihood of cardiotoxicity. Methods: 1. A retrospective analysis of 150 patients was performed who had received immunotherapy with either the cytotoxic T lymphocyte associated antigen 4 inhibitors (CTLA4) or with the programmed cell death inhibitors (PD1) or programmed death-ligand 1 (PD-L1) inhibitors for a period of two years at a Tertiary health Care from 7/1/2016-6/30/2018. 2. Patients' cardiac diagnoses prior to the initiation of therapy were noted and included, including history of heart failure, coronary artery disease, atrial fibrillation, and sudden cardiac arrest. 3. Patients’ clinic visits and hospitalizations with admitting and discharge diagnosis, electrocardiogram, echocardiogram, troponin T, and NT-proBNP were reviewed. Results: 6% of patients had new onset heart failure (both preserved and reduced), 1.3% had evidence of myocardial infarction, 2% had new atrial fibrillation with rapid ventricular rate, and 0.6% had fulminant myocarditis. Of patients with new cardiac events, 60% had a history of cardiac disease, which was significantly higher than in patients without (p< 0.05). There were no age or sex differences between the groups with and without cardiotoxicity. Conclusion: Immunotherapy with immune checkpoint inhibitors have broadened the horizon for treatment of multiple solid and hematological malignancies. Nonetheless, new adverse effects on multiple organ systems, specifically cardiac involvement, occur with these therapies, which are important and potentially detrimental toxicities. Patients with a history of prior cardiovascular disease have higher likelihood to develop cardiotoxicity.

scholarly journals Increased frequency of anti-Ma2 encephalitis associated with immune checkpoint inhibitors

2019 ◽  
Vol 6 (6) ◽  
pp. e604 ◽  
Author(s):  
Alberto Vogrig ◽  
Marine Fouret ◽  
Bastien Joubert ◽  
Géraldine Picard ◽  
Véronique Rogemond ◽  
...  
Keyword(s):  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Clinical Presentation ◽  
Limbic Encephalitis ◽  
Checkpoint Inhibitors ◽  
Antibody Detection ◽  
Paraneoplastic Neurologic Syndrome ◽  
Clinical Difference ◽  
Clinical Syndromes ◽  
Before And After

ObjectiveTo report the induction of anti–Ma2 antibody–associated paraneoplastic neurologic syndrome (Ma2-PNS) in 6 patients after treatment with immune checkpoint inhibitors (ICIs). We also analyzed (1) patient clinical features compared with a cohort of 44 patients who developed Ma2-PNS without receiving ICI treatment and (2) the frequency of neuronal antibody detection before and after ICI implementation.MethodsRetrospective nationwide study of all patients with Ma2-PNS developed during ICI treatment between 2017 and 2018.ResultsOur series of patients included 5 men and 1 woman (median age, 63 years). The patients were receiving nivolumab (n = 3), pembrolizumab (n = 2), or a combination of nivolumab and ipilimumab (n = 1) for treatment of neoplasms that included lung (n = 4) and kidney (n = 1) cancers and pleural mesothelioma (n = 1). Clinical syndromes comprised a combination of limbic encephalitis and diencephalitis (n = 3), isolated limbic encephalitis (n = 2), and a syndrome characterized by ophthalmoplegia and head drop (n = 1). No significant clinical difference was observed between our 6 patients and the overall cohort of Ma2-PNS cases. Post-ICI Ma2-PNS accounted for 35% of the total 17 Ma2-PNS diagnosed in our center over the 2017–2018 biennium. Eight cases had been detected in the preceding biennium 2015–2016, corresponding to a 112% increase of Ma2-PNS frequency since the implementation of ICIs in France. Despite ICI withdrawal and immunotherapy, 4/6 patients died, and the remaining 2 showed a moderate to severe disability.ConclusionsWe show a clear association between ICI use and increased diagnosis of Ma2-PNS. Physicians need to be aware that ICIs can trigger Ma2-PNS because clinical presentation can be challenging.

scholarly journals Anxiety and Depression in Patients With Retinitis Pigmentosa

2020 ◽  
pp. 247412642093645
Author(s):  
Patrick Le ◽  
Michelle Nguyen ◽  
Thoai Vu ◽  
Diem-Phuong Dao ◽  
Daniel Olson ◽  
...  
Keyword(s):  
Retinitis Pigmentosa ◽  
Medical Records ◽  
International Classification Of Diseases ◽  
Anxiety And Depression ◽  
Retrospective Case ◽  
Comorbid Anxiety ◽  
Potential Association ◽  
Chronic Progressive Disease ◽  
Classification Of Diseases ◽  
The University

Purpose: Retinitis pigmentosa (RP) is a chronic progressive disease with no curative treatments. Understanding the variables involved with improving patients’ quality of life is important in managing this population. The literature investigating the relationship of anxiety and depression with RP relies on the analysis of smaller subset populations of patients with RP, and no study has quantified the effect size of the potential association. This study aims to elucidate and quantify the association between RP, anxiety, and depression. Methods: A retrospective case-control study was conducted of 6 093 833 medical records within the University of North Carolina Hospital and outpatient clinic system from July 1, 2004, to August 30, 2019. Patients with a diagnosis of RP, anxiety, and depression were identified within the Carolina Data Warehouse for Health by International Classification of Diseases, Ninth and Tenth Revision codes. Results: From the base population of 6 093 833 patients' medical records, 690 patients were diagnosed with RP, 253 065 with anxiety, and 232 541 with depression. Patients with RP have an odds ratio, adjusted for sex and age, of 4.915 (95% CI, 4.035-5.987) for having comorbid anxiety, 5.609 (95% CI, 4.622-6.807) for comorbid depression, and 4.130 (95% CI, 3.187-5.353) for comorbid anxiety and depression. Conclusions: Patients with RP have a higher prevalence of anxiety and depression, with increased odds of approximately 5 to 6 times for also carrying a diagnosis of anxiety or depression and about 4 times for carrying diagnoses of anxiety and depression compared with the general population.

scholarly journals Leveraging Shannon Entropy to Validate the Transition between ICD-10 and ICD-11

Entropy ◽  
2018 ◽  
Vol 20 (10) ◽  
pp. 769 ◽  
Author(s):  
Donghua Chen ◽  
Runtong Zhang ◽  
Xiaomin Zhu
Keyword(s):  
Shannon Entropy ◽  
Information Gain ◽  
International Classification Of Diseases ◽  
Validation Methods ◽  
Coding Systems ◽  
Precise Mapping ◽  
Before And After ◽  
Classification Of Diseases ◽  
Icd 10

This study aimed to propose a mapping framework with entropy-based metrics for validating the effectiveness of the transition between International Classification of Diseases 10th revision (ICD-10)-coded datasets and a new context of ICD-11. Firstly, we used tabular lists and mapping tables of ICD-11 to establish the framework. Then, we leveraged Shannon entropy to propose validation methods to evaluate information changes during the transition from the perspectives of single-code, single-disease, and multiple-disease datasets. Novel metrics, namely, standardizing rate (SR), uncertainty rate (UR), and information gain (IG), were proposed for the validation. Finally, validation results from an ICD-10-coded dataset with 377,589 records indicated that the proposed metrics reduced the complexity of transition evaluation. The results with the SR in the transition indicated that approximately 60% of the ICD-10 codes in the dataset were unable to map the codes to standard ICD-10 codes released by WHO. The validation results with the UR provided 86.21% of the precise mapping. Validation results of the IG in the dataset, before and after the transition, indicated that approximately 57% of the records tended to increase uncertainty when mapped from ICD-10 to ICD-11. The new features of ICD-11 involved in the transition can promote a reliable and effective mapping between two coding systems.

scholarly journals Socioeconomic Burden of Rising Methamphetamine-Associated Heart Failure Hospitalizations in California From 2008 to 2018

2021 ◽  
Author(s):  
Susan X. Zhao ◽  
Andres Deluna ◽  
Kate Kelsey ◽  
Clifford Wang ◽  
Aravind Swaminathan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Planning ◽  
Statistical Significance ◽  
Negative Control Group ◽  
International Classification Of Diseases ◽  
Negative Control ◽  
Control Group ◽  
Public Health Response ◽  
Classification Of Diseases ◽  
Age Adjusted Rates

BACKGROUND: Methamphetamine-associated cardiomyopathy/heart failure (MethHF) is an increasingly recognized disease entity in the context of a rising methamphetamine (meth) epidemic that most severely impacts the western United States. Using heart failure (HF) hospitalization data from the Office of Statewide Health Planning and Development, this study aimed to assess trend and disease burden of MethHF in California. METHODS: Adult patients (≥18 years old) with HF as primary hospitalization diagnosis between 2008 and 2018 were included in this study. The association with Meth (MethHF) and those without (non-MethHF) were determined by meth-related International Classification of Diseases -based secondary diagnoses. Statistical significance of trends in age-adjusted rates of hospitalization per 100 000 adults were evaluated using nonparametric analysis. RESULTS: Between 2008 and 2018, 1 033 076 HF hospitalizations were identified: 42 565 were MethHF (4.12%) and 990 511 (95.88%) were non-MethHF. Age-adjusted MethHF hospitalizations per 100 000 increased by 585% from 4.1 in 2008 to 28.1 in 2018, while non-MethHF hospitalizations decreased by 6.0% from 342.3 in 2008 to 321.6 in 2018. The rate of MethHF hospitalization increase more than doubled that of a negative control group with urinary tract infection and meth-related secondary diagnoses (7.82-fold versus 3.48-fold, P <0.001). Annual inflation–adjusted hospitalization charges because of MethHF increased by 840% from $41.5 million in 2008 to $390.2 million in 2018, as compared with an 82% increase for all HF hospitalization from $3.503 billion to $6.376 billion. Patients with MethHF were significantly younger (49.64±10.06 versus 72.20±14.97 years old, P <0.001), predominantly male (79.1% versus 52.4%, P <0.001), with lower Charlson Comorbidity Index, yet they had longer length of stay, more hospitalizations per patient, and more procedures performed during their stays. CONCLUSIONS: MethHF hospitalizations increased sharply during the study period and contributed significantly to the HF hospitalization burden in California. This emerging HF phenotype, which engenders considerable financial and societal costs, calls for an urgent and concerted public health response to contain its spread.

scholarly journals Cardiotoxicity associated with immune checkpoint inhibitors: A retrospective analysis of patients at an academic tertiary care center

2020 ◽  
Author(s):  
Nida Waheed ◽  
Michael G. Fradley ◽  
David DeRemer ◽  
Ahmad Mahmoud ◽  
Chintan P. Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Anticancer Agents ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Care Center ◽  
Tertiary Care ◽  
Data Repository ◽  
Tertiary Care Center ◽  
Pericardial Disease

Abstract Background Immune checkpoint inhibitors (ICIs) are a novel class of anticancer agents that have demonstrated clinical response for both solid and hematological malignancies. ICIs are associated with development of immune-related adverse events including cardiotoxicity. We estimated the incidence of ICI-related cardiotoxicity in patients treated with ICIs at a large, tertiary care center. Methods All patients with a cancer diagnosis who received any ICI treatment in the University of Florida’s Integrated Data Repository from 2011-2017 were included. Cardiotoxicity was defined as a new ICD diagnosis code for cardiomyopathy, heart failure, arrhythmia, heart block, pericardial disease, or myocarditis after initiation of ICI treatment. Results Of 102,701 patients with a diagnosis of malignancy, 424 patients received at least one ICI. Sixty-two (14.6%) patients were diagnosed with at least one possible form of cardiotoxicity after initiation of ICI therapy. Of the 374 patients receiving one ICI, 21 (5.6%) developed heart failure. Of the 49 patients who received two ICIs sequentially, three (6.1%) developed heart failure and/or cardiomyopathy. Cardiotoxicity was diagnosed at a median of 63 days after initial ICI exposure. One patient developed myocarditis 28 days after receiving nivolumab. Mortality in those who developed ICI-attributable cardiotoxicity was higher compared to those who did not (66.1% vs. 41.4%, odds ratio=2.77, 1.55-4.95, p=0.0006). Conclusions This study suggests that the incidence of ICI-related cardiotoxicity may be higher than previously reported.

scholarly journals Genetic epidemiological characteristics of a Hungarian subpopulation of patients with Huntington’s Disease

2021 ◽  
Author(s):  
Katalin Despotov ◽  
Dénes Zádori ◽  
Gábor Veres ◽  
Katalin Jakab ◽  
Gabreilla Gárdián ◽  
...  
Keyword(s):  
Huntington's Disease ◽  
Huntington’S Disease ◽  
Age Of Onset ◽  
Disease Onset ◽  
International Classification Of Diseases ◽  
Medical Database ◽  
Classification Of Diseases ◽  
Reduced Penetrance ◽  
The University ◽  
Epidemiological Characteristics

Abstract Background: Recent advances in therapeutic options may prevent deterioration related to Huntington’s disease (HD), even at the pre-symptomatic stage. Be that as it may, a well-characterized patient population is essential for screening and monitoring outcome. Accordingly, the aim of this study was to describe the characteristics of a Hungarian subpopulation of HD patients and mutation carriers diagnosed at the University of Szeged. Methods: We conducted a search for International Classification of Diseases (ICD) code G10H0 in the local medical database for the period of 1 January 1998 to 31 December 2018. Results: We identified 90 HD cases (male: 45, female: 45) and 34 asymptomatic carriers (male: 15, female: 19). The median age of onset was 45 years (range: 16-79). There were 3 cases of juvenile onset (3.3%), and 7 of late disease onset (7.8%). The median repeat length was 43 (range: 36-70) for the pathological and 19 for the non-pathological alleles (range: 9-35). 17.5% of the pathological alleles were in the decreased penetrance range, while 7% of non-pathological alleles were intermediate. Conclusions: The genetic and clinical features of the population examined in the present study were in line with the previous Hungarian study, as well as with international literature. The exceptions were the higher ratio of reduced penetrance and intermediate alleles.

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