Abstract 17423: Impact of Hypertriglyceridemia on ST-Elevation Myocardial Infarction Outcomes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mehmet Yildiz ◽  
Christian Schmidt ◽  
Santiago Garcia ◽  
Ross Garberich ◽  
Larissa I Stanberry ◽  
...  
Keyword(s):  
Systems Of Care ◽  
All Cause Mortality ◽  
History Of ◽  
St Elevation ◽  
Premature Cad ◽  
The Mean ◽  
Heart Center ◽  
Study Participants ◽  
Event Rates ◽  
The Impact

Introduction: There has been conflicting data regarding the impact of hypertriglyceridemia (HTG) on STEMI outcomes, including reports of a “lipid paradox” defined as lower event rates in patients with HTG. Therefore, the association between HTG and outcomes in STEMI deserves further investigation especially given the results of REDUCE-IT trial. Methods: A prospective, multicenter database of the Midwest STEMI Consortium was examined. The Midwest STEMI Consortium is a unique association of 4 large STEMI systems of care: Iowa Heart Center, Minneapolis Heart Institute Foundation, Prairie Cardiovascular, and The Christ Hospital. We included all consecutive STEMI patients between age of 40 and 75. Those with missing TG levels were excluded (23%). We compared 3 groups of TG levels: normal (<150 mg/dl), moderate (150 to 499 mg/dl), and severe (>500 mg/dl) for MACE (death, MI, or stroke) and all-cause mortality. Results: Of 6492 consecutive STEMI patients from 03/2003 to 01/2020, 3760 (58%) met inclusion criteria. The mean (SD) age was 59.1 ± 9.2 and male gender was predominant (76%). A little over one-third of the study participants had moderate HTG (35%). Patients with higher TG levels had lower HDL levels and increased rates of history of premature CAD, DM, and HTN (Table). Moderate HTG was not a risk factor for MACE or all-cause mortality. Severe HTG was significantly associated with increased in-hospital (p=0.016) but not 1-year all-cause mortality (p=0.21) (Figure). Conclusions: In STEMI patients, higher TG levels were associated with increased in-hospital but not 1-year all-cause mortality.

scholarly journals Prediction of clinical outcomes of patients treated with percutaneous coronary intervention for ST-Elevation myocardial infarction using familial history of premature coronary artery disease

2018 ◽  
Vol 6 (4) ◽  
pp. 172-178
Author(s):  
Bahram Sohrabi ◽  
Ahmad Separham ◽  
Hadi Habibolahi ◽  
Elgar Enamzadeh ◽  
Behnaz Ghamari ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Family History ◽  
Clinical Outcomes ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
History Of ◽  
St Elevation ◽  
Premature Cad ◽  
The Mean ◽  
One Year

Introduction: ST-elevation myocardial infarction (STEMI) is a relatively common cause of mortality among patients. The effects of risk factors as predictors of mortality in patients has been shown in different studies. The present study was performed aiming to evaluate the association between a family history of premature coronary artery diseases (CADs) with clinical outcomes among patients treated with percutaneous coronary intervention (PCI) for STEMI. Methods: This descriptive-analytical study was conducted in Shahid Madani Hospital of Tabriz University of Medical Sciences, Tabriz, Iran, on 200 patients with STEMI with a PCI. 100 out of these 200 patients had a family history of premature CAD. Patients were followed up within 48 hours after PCI, as well as one year after admission, and the secondary outcomes including myocardial infarction (MI), heart failure, ventricular arrhythmias (VAs), pulmonary edema, and death were evaluated. Results: The mean age of the patients with positive and negative family history of premature CAD was 56.37 ± 8.20 and 61.72 ± 7.42 years, respectively. The mean age of the patients with a family history of a premature CAD was significantly lower than that of patients without a family history of a premature CAD (P = 0.001). There was no significant difference in the frequency of CAD risk factors, angiographic findings, and its complications, ST-segment resolution and frequency of secondary outcomes during 48 hours and one year after admission between the study groups (P > 0.050). Conclusion: The present study showed that a family history of premature CAD does not predict the clinical outcomes in patients treated with PCI for STEMI which should be validated across future studies.

373 Historical Use of Substances for Insomnia Impacts Current Beliefs about Hypnotic Medications

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A148-A149
Author(s):  
Jessica Dietch ◽  
Norah Simpson ◽  
Joshua Tutek ◽  
Isabelle Tully ◽  
Elizabeth Rangel ◽  
...  
Keyword(s):  
Prescription Medication ◽  
Stepped Care ◽  
Future Research ◽  
Prescription Medications ◽  
Over The Counter ◽  
Multiple Treatment ◽  
History Of ◽  
Study Participants ◽  
Beliefs About Medications ◽  
The Impact

Abstract Introduction The purpose of the current study was to examine the relationship between current beliefs about hypnotic medications and historical use of prescription hypnotic medications or non-prescription substances for sleep (i.e., over the counter [OTC] medications, alcohol, and cannabis). Methods Participants were 142 middle age and older adults with insomnia (M age = 62.9 [SD = 8.1]; 71.1% female) enrolled in the RCT of the Effectiveness of Stepped-Care Sleep Therapy In General Practice (RESTING) study. Participants reported on history of substances they have tried for insomnia and completed the Beliefs about Medications Questionnaire-Specific with two subscales assessing beliefs about 1) the necessity for hypnotics, and 2) concerns about potential adverse consequences of hypnotics. Participants were grouped based on whether they had used no substances for sleep (No Subs, 11.6%), only prescription medications (Rx Only, 9.5%), only non-prescription substances (NonRx Only, 26.6%), or both prescription and non-prescription substances (Both, 52.3%). Results Sixty-one percent of the sample had used prescription medication for sleep and 79% had used non-prescription substances (74% OTC medication, 23% alcohol, 34% cannabis). The greater number of historical substances endorsed, the stronger the beliefs about necessity of hypnotics, F(1,140)=23.3, p&lt;.001, but not about concerns. Substance groups differed significantly on necessity beliefs, F(3,1)=10.68, p&lt;.001; post-hocs revealed the Both group had stronger beliefs than the No and NonRx Only groups. Substance groups also differed significantly on the concerns subscale, F(3,1)=6.68, p&lt;.001; post-hocs revealed the NonRx Only group had stronger harm beliefs than the other three groups. Conclusion The majority of the sample had used both prescription and non-prescription substances to treat insomnia. Historical use of substances for treating insomnia was associated with current beliefs about hypnotics. Individuals who had used both prescription and non-prescription substances for sleep in the past had stronger beliefs about needing hypnotics to sleep at present, which may reflect a pattern of multiple treatment failures. Individuals who had only tried non-prescription substances for sleep may have specifically sought alternative substances due to concerns about using hypnotics. Future research should seek to understand the impact of treatment history on engagement in and benefit from non-medication-based treatment for insomnia. Support (if any) 1R01AG057500; 2T32MH019938-26A1

scholarly journals Patterns of Sequelae in Women with a History of Localized Breast Cancer: Results from the French VICAN Survey

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1161
Author(s):  
Lidia Delrieu ◽  
Liacine Bouaoun ◽  
Douae El Fatouhi ◽  
Elise Dumas ◽  
Anne-Deborah Bouhnik ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Latent Class ◽  
Early Stage ◽  
Current Analysis ◽  
Functional Pain ◽  
Cognitive Sequelae ◽  
History Of ◽  
The Mean ◽  
Study Participants ◽  
Changes Over Time

Breast cancer (BC) remains complex for women both physically and psychologically. The objectives of this study were to (1) assess the evolution of the main sequelae and treatment two and five years after diagnosis in women with early-stage breast cancer, (2) explore patterns of sequelae associated with given sociodemographic, clinical, and lifestyle factors. The current analysis was based on 654 localized BC patients enrolled in the French nationwide longitudinal survey “vie après cancer” VICAN (January–June 2010). Information about study participants was collected at enrollment, two and five years after diagnosis. Changes over time of the main sequelae were analyzed and latent class analysis was performed to identify patterns of sequelae related to BC five years after diagnosis. The mean age (±SD) of study participants at inclusion was 49.7 (±10.5) years old. Six main classes of sequelae were identified two years and five years post-diagnosis (functional, pain, esthetic, fatigue, psychological, and gynecological). A significant decrease was observed for fatigue (p = 0.03) and an increase in cognitive sequelae was reported (p = 0.03). Two latent classes were identified—functional and esthetic patterns. Substantial sequelae remain up to five years after BC diagnosis. Changes in patient care pathways are needed to identify BC patients at a high risk.

Tracheobronchial Foreign Bodies: The Impact of a Postgraduate Educational Program on Diagnosis, Morbidity, and Treatment

PEDIATRICS ◽  
1982 ◽  
Vol 70 (1) ◽  
pp. 96-98
Author(s):  
Marc Puterman ◽  
Rafael Gorodischer ◽  
Alberto Leiberman
Keyword(s):  
Educational Program ◽  
Foreign Bodies ◽  
Final Diagnosis ◽  
Physician Performance ◽  
Postgraduate Educational ◽  
Before And After ◽  
History Of ◽  
The Mean ◽  
Hospital Days ◽  
The Impact

Aspirated foreign bodies (FBs) may remain undetected and cause serious complications. As part of a postgraduate educational program, results of a local survey were presented to the local medical staff in order to increase its awareness of this diagnostic possibility. The present study was carried out in order to evaluate the management of children with tracheobronchial FBs during two 2-year periods, before and after teaching sessions held in December 1976. In comparison with the previous two years during the 1977-1978 period, the percentage of cases in which a positive history of aspiration was obtained increased from 47.6% to 84.0%; the mean number of hospitalizations due to tracheobronchial FBs decreased from 1.9 to 1.04 per infant, and the mean number of hospital days required for final diagnosis decreased from 17.6 to 5.3. The postgraduate educational program had a positive effect on physician performance and patient care.

Outcomes for hospitalized cancer patients with COVID-19 during the height of pandemic in New York City.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10572-10572
Author(s):  
Amelia Sawyers ◽  
Margaret Chou ◽  
Paul Johannet ◽  
Nicholas Gulati ◽  
Yingzhi Qian ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Cancer Patients ◽  
York City ◽  
Measurable Disease ◽  
All Cause Mortality ◽  
History Of ◽  
The Impact ◽  
History Of Cancer ◽  
Active Cancer

10572 Background: Several reports have suggested that cancer patients are at increased risk for contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and suffering worse coronavirus disease 2019 (COVID-19) outcomes. However, little is known about the impact of cancer status on presentation and outcome. Here, we report on the association between cancer status and survival in hospitalized patients who tested positive for SARS-CoV-2 during the height of pandemic in New York City. Methods: Of the 6,724 patients who were hospitalized at NYU Langone Health (3/16/20 - 7/31/20) and tested positive for SARS-CoV-2, 580 had either active cancer (n = 221) or a history of cancer (n = 359). Patients were classified as having active malignancy if they either received treatment within six months of their COVID-19 diagnosis or they had measurable disease documented at the time of their hospitalization. Patients were categorized as having a history of cancer if there was no evidence of measurable disease or there were no treatments administered within six months of their COVID-19 diagnosis. We compared the baseline clinicodemographic characteristics and hospital courses of the two groups, and the relationship between cancer status and the rate of admission to the intensive care unit (ICU), use of invasive mechanical ventilation (IMV), and all-cause mortality. Results: There was no differences between the two groups in their baseline laboratory results associated with COVID-19 infection, incidence of venous thromboembolism, or incidence of severe COVID-19. Active cancer status was not associated with the rate of ICU admission ( P = 0.307) or use of IMV ( P = 0.236), but was significantly associated with worse all-cause mortality in both univariate and multivariate analysis with ORs of 1.48 (95% CI: 1.04-2.09; P = 0.028) and 1.71 (95% CI: 1.12-2.63; P = 0.014), respectively. Conclusions: Active cancer patients had worse survival outcomes compared to patients with a history of cancer despite similar COVID-19 disease characteristics in the two groups. Our data suggest that cancer care should continue with minimal interruptions during the pandemic to bring about response and remission as soon as possible. Additionally, these findings support the growing body of evidence that malignancy portends worse COVID-19 prognosis, and demonstrate that the risk may even apply to those without active disease.

Abstract 3631: Elevated In-hospital Glucose Level, and not Known History of Diabetes Mellitus, Predicts 30-day Mortality Following Acute ST-elevation Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Abhinav Goyal ◽  
Rafael Diaz ◽  
Hertzel C Gerstein ◽  
Rizwan Afzal ◽  
Shamir R Mehta ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Assessment ◽  
Glucose Level ◽  
Early Death ◽  
Glucose Levels ◽  
Assessment Guidelines ◽  
History Of ◽  
Acute Mi ◽  
St Elevation ◽  
The Impact

Introduction: According to clinical risk assessment guidelines, a history of diabetes mellitus (DM) portends poor outcomes following acute MI. Elevated in-hospital glucose levels also predict early mortality in acute MI patients, but the degree to which glucose levels and diabetic history independently predict post-MI mortality is unclear. Methods and Hypothesis: We analyzed data from the combined cohort of the CREATE-ECLA and OASIS-6 randomized trials that evaluated the impact of glucose-insulin-potassium (GIK) infusion versus no infusion on 30-day mortality in 22,943 patients hospitalized with acute ST-elevation MI. We calculated the average in-hospital glucose level for each patient (mean of the admission, 6-hour, and 24-hour glucose levels). Logistic regression was performed to determine whether average glucose level and history of DM remained significant mortality predictors after adjusting for age, sex, and GIK allocation. Results: Glucose data were recorded in 22,860 (99.6%) patients; 10,050 (44%) had an average in-hospital glucose level ≥ 8 mmol/L (144 mg/dL), of whom 65% did not have known prior DM. Among patients with glucose >8 mmol/L, 30-day mortality rates were similar in patients with and without known DM (Figure ). In-hospital glucose, but not history of DM, was a significant multivariable predictor of mortality (Table). Conclusions: By considering only history of DM and not in-hospital glucose levels, risk assessment guidelines for acute MI overlook a large proportion of patients at high risk for early death. Therefore, clinicians should emphasize elevated glucose levels in addition to history of DM as a risk marker in patients with acute MI.

Inequalities after STEMI in National Health Service: is there really a postcode lottery?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Ferreira ◽  
R Baptista ◽  
A.I Ribeiro ◽  
A Freitas ◽  
J.A Ferreira ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Demographic Data ◽  
Socioeconomic Deprivation ◽  
Survival Models ◽  
All Cause Mortality ◽  
Observational Cohort ◽  
St Elevation ◽  
Socioeconomic Differentials ◽  
The Impact ◽  
Geographical Accessibility

Abstract Background and purpose Failure to address the impact of social determinants of health attenuates efficacy of proven prevention recommendations, namely because important considerations related to socioeconomic disadvantage are not captured by existing cardiovascular disease (CDV) risk stratification methods. We aimed to assess how socioeconomic determinants influence recurrent MI and all-cause death after myocardial infarction (MI) in Portugal. Methods We conducted a retrospective, observational cohort study, including all patients with a ST-elevation MI (STEMI) admitted to and discharged alive from an intensive cardiac care unit between 2004 and 2017 (n=1809). The median (interquartile range) follow-up was 6 (4–9) years. We used survival models to assess the relationship between their municipal (i) income by purchasing power per capita (PPC), (ii) geographical accessibility to health care, (iii) illiteracy, iv) residential socioeconomic deprivation and recurrent MI and all-cause mortality. To assess residential socioeconomic deprivation, each individual's residential postcode was matched to the recently validated Portuguese version of European Deprivation Index (EDI). The index was categorized into quintiles (Q1-least deprived to Q5-most deprived). Results The mean age was 64±14 years; 74% were male. Regarding individual socioeconomic variables, PPC (HR 1.19; 95% CI 0.97–1.47 for Tertile 1 vs Tertile 2; HR 1.28; 95% CI 1.04–1.56 for Tertile 1 vs Tertile 3 and HR 1.07; 95% CI 0.85–1.34 for Tertile 2 vs Tertile 3) and medical appointments in primary health centers per inhabitant (HR 0.90; 95% CI 0.75–1.09 for Tertile 1 vs Tertile 2; HR 1.23; 95% CI 0.95–1.61 for Tertile 1 vs Tertile 3 and HR 1.37; 95% CI 1.06–1.76 for Tertile 2 vs Tertile 3) were predictors of all-cause mortality, but not recurrent MI; however, in multivariate analysis adjusted for sex, age and ejection fraction, this association was no longer significant (HR 1.00; 95% CI 0.99–1.00 and, HR 1.00; 95% CI 0.89–1.17, respectively). Additionally, no evident association between illiteracy and all-cause mortality or MI was present. Concerning EDI, demographic data was similar among the quintiles (Table 1). Although EDI quintiles were not associated with all-cause mortality (HR 1.17; 95% CI 0.82–1.66 for Q5 vs Q1), the EDI was an independent predictor of recurrent MI (Figure 1). On multivariate analysis, adjusted for age, sex, hypertension, diabetes and LDL cholesterol, the HR for the most deprived (Q5) to the least deprived (Q1) quintile was 1.91 (95% CI 1.05–3.49) for MI. Conclusions Our study shows clear socioeconomic differentials in cardiovascular outcomes in patients with STEMI which suggests that accounting for socioeconomic deprivation might improve risk prediction and therefore disease prognosis. Funding Acknowledgement Type of funding source: None

scholarly journals Impact of non-cystic fibrosis bronchiectasis on critically ill patients in Korea: a retrospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Youngmok Park ◽  
Seung Hyun Yong ◽  
Ah Young Leem ◽  
Song Yee Kim ◽  
Sang Hoon Lee ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Odds Ratio ◽  
Negative Impact ◽  
Icu Mortality ◽  
Chest Computed Tomography ◽  
Lower Survival Rate ◽  
All Cause Mortality ◽  
Hospital Stays ◽  
The Mean ◽  
The Impact

AbstractThis study investigated the impact of bronchiectasis on patients admitted to the intensive care unit (ICU) at a hospital in Korea. Patients with bronchiectasis were diagnosed using results of chest computed tomography performed before ICU admission. The severity of bronchiectasis was based on the number of affected lobes, and patients with ≥ 3 bronchiectatic lobes were classified into the severe bronchiectasis group. Overall, 823 patients were enrolled. The mean age was 66.0 ± 13.9 years, and 63.4% were men. Bronchiectasis and severe bronchiectasis were present in 148 (18.0%) and 108 (13.1%) patients, respectively. The increase in the number of bronchiectatic lobes was related to the rise in ICU mortality (P for trend = 0.012) and in-hospital mortality (P for trend = 0.004). Patients with severe bronchiectasis had higher odds for 28-day mortality [odds ratio (OR) 1.122, 95% confidence interval (CI) 1.024–1.230], ICU mortality (OR 1.119, 95% CI 1.023–1.223), and in-hospital mortality (OR 1.208, 95% CI 1.092–1.337). The severe bronchiectasis group showed lower overall survival (log-rank P < 0.001), and the adjusted hazard ratio was 1.535 (95% CI 1.178–2.001). Severe bronchiectasis had a negative impact on all-cause mortality during ICU and hospital stays, resulting in a lower survival rate.

scholarly journals Prevalence and Associated Factors of Hypertension among Civil Servants Working in Arba Minch Town, South Ethiopia

2016 ◽  
Vol 5 (4) ◽  
pp. 375
Author(s):  
Aschenaki Kalssa ◽  
Gistane Ayele ◽  
Alemu Tamiso ◽  
Tadele Girum
Keyword(s):  
Cross Sectional Study ◽  
Civil Servants ◽  
Global Public Health ◽  
Cross Sectional ◽  
History Of ◽  
Public Health Challenge ◽  
Family History Of Hypertension ◽  
The Mean ◽  
Study Participants ◽  
Structured Questionnaire

Despite Hypertension is a global public health challenge and a leading modifiable risk factor for cardiovascular disease and death attention was not given in developing countries. Therefore measuring the prevalence and identifying predictors of Hypertension is very important. Institution based cross sectional study design was employed from March–April, 2016 by taking 319 randomly selected civil servants working in in Arba Minch town. Data was collected using structured questionnaire and standardized instruments for physical examination by 5 trained nurses. SPSS version 20 was used for data analysis. Bi-variable and Multivariate logistic regression was employed for analysis of risk factors. The mean SBP and DBP of study participants were 120.87 + 14.15 mmHg and 80.28 + 8.8 mmHg, respectively. The prevalence of hypertension was found to be 27.8% (95% CI = 22.9-32.7%). Civil servants of age 50 years and above [AOR = 13.3], age 40-49 years [AOR = 5], age 30-39 years [AOR = 3.5], abdominal obesity [AOR=12.2], general obesity [AOR = 4.2], stress status [AOR = 12.3], current alcohol drink [AOR = 3.3], ex-drinker [AOR = 8.9] and family history of hypertension [AOR = 5.6] were found to be significantly associated with hypertension. The prevalence indicates that it is hidden epidemic in this population; therefore for screening and risk reduction program are needed.

scholarly journals Prevalence and Associated Factors of Hypertension among Civil Servants Working in Arba Minch Town, South Ethiopia

2016 ◽  
Vol 5 (4) ◽  
pp. 375
Author(s):  
Aschenaki Kalssa ◽  
Gistane Ayele ◽  
Alemu Tamiso ◽  
Tadele Girum
Keyword(s):  
Cross Sectional Study ◽  
Civil Servants ◽  
Global Public Health ◽  
Cross Sectional ◽  
History Of ◽  
Public Health Challenge ◽  
Family History Of Hypertension ◽  
The Mean ◽  
Study Participants ◽  
Structured Questionnaire

Despite Hypertension is a global public health challenge and a leading modifiable risk factor for cardiovascular disease and death attention was not given in developing countries. Therefore measuring the prevalence and identifying predictors of Hypertension is very important. Institution based cross sectional study design was employed from March–April, 2016 by taking 319 randomly selected civil servants working in in Arba Minch town. Data was collected using structured questionnaire and standardized instruments for physical examination by 5 trained nurses. SPSS version 20 was used for data analysis. Bi-variable and Multivariate logistic regression was employed for analysis of risk factors. The mean SBP and DBP of study participants were 120.87 <span style="text-decoration: underline;">+</span> 14.15 mmHg and 80.28 <span style="text-decoration: underline;">+</span> 8.8 mmHg, respectively. The prevalence of hypertension was found to be 27.8% <br /> (95% CI = 22.9-32.7%). Civil servants of age 50 years and above <br /> [AOR = 13.3], age 40-49 years [AOR = 5], age 30-39 years [AOR = 3.5], abdominal obesity [AOR=12.2], general obesity [AOR = 4.2], stress status [AOR = 12.3], current alcohol drink [AOR = 3.3], ex-drinker [AOR = 8.9] and family history of hypertension [AOR = 5.6] were found to be significantly associated with hypertension. The prevalence indicates that it is hidden epidemic in this population; therefore for screening and risk reduction program are needed.

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