scholarly journals Prediction of Ischemic Heart Disease and Stroke in Survivors of Childhood Cancer

2018 ◽  
Vol 36 (1) ◽  
pp. 44-52 ◽  
Author(s):  
Eric J. Chow ◽  
Yan Chen ◽  
Melissa M. Hudson ◽  
Elizabeth A.M. Feijen ◽  
Leontien C. Kremer ◽  
...  
Keyword(s):  
Heart Disease ◽  
High Risk ◽  
Ischemic Heart Disease ◽  
Childhood Cancer ◽  
Area Under The Curve ◽  
Risk Groups ◽  
Ischemic Heart ◽  
Risk Scores ◽  
Individual Risk ◽  
Survivors Of Childhood Cancer

Purpose We aimed to predict individual risk of ischemic heart disease and stroke in 5-year survivors of childhood cancer. Patients and Methods Participants in the Childhood Cancer Survivor Study (CCSS; n = 13,060) were observed through age 50 years for the development of ischemic heart disease and stroke. Siblings (n = 4,023) established the baseline population risk. Piecewise exponential models with backward selection estimated the relationships between potential predictors and each outcome. The St Jude Lifetime Cohort Study (n = 1,842) and the Emma Children’s Hospital cohort (n = 1,362) were used to validate the CCSS models. Results Ischemic heart disease and stroke occurred in 265 and 295 CCSS participants, respectively. Risk scores based on a standard prediction model that included sex, chemotherapy, and radiotherapy (cranial, neck, and chest) exposures achieved an area under the curve and concordance statistic of 0.70 and 0.70 for ischemic heart disease and 0.63 and 0.66 for stroke, respectively. Validation cohort area under the curve and concordance statistics ranged from 0.66 to 0.67 for ischemic heart disease and 0.68 to 0.72 for stroke. Risk scores were collapsed to form statistically distinct low-, moderate-, and high-risk groups. The cumulative incidences at age 50 years among CCSS low-risk groups were < 5%, compared with approximately 20% for high-risk groups ( P < .001); cumulative incidence was only 1% for siblings ( P < .001 v low-risk survivors). Conclusion Information available to clinicians soon after completion of childhood cancer therapy can predict individual risk for subsequent ischemic heart disease and stroke with reasonable accuracy and discrimination through age 50 years. These models provide a framework on which to base future screening strategies and interventions.

scholarly journals Individual Prediction of Heart Failure Among Childhood Cancer Survivors

2015 ◽  
Vol 33 (5) ◽  
pp. 394-402 ◽  
Author(s):  
Eric J. Chow ◽  
Yan Chen ◽  
Leontien C. Kremer ◽  
Norman E. Breslow ◽  
Melissa M. Hudson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Childhood Cancer ◽  
Cancer Diagnosis ◽  
Prediction Models ◽  
Wilms Tumor ◽  
Area Under The Curve ◽  
Risk Groups ◽  
Childhood Cancer Survivors ◽  
Risk Scores ◽  
Individual Risk

Purpose To create clinically useful models that incorporate readily available demographic and cancer treatment characteristics to predict individual risk of heart failure among 5-year survivors of childhood cancer. Patients and Methods Survivors in the Childhood Cancer Survivor Study (CCSS) free of significant cardiovascular disease 5 years after cancer diagnosis (n = 13,060) were observed through age 40 years for the development of heart failure (ie, requiring medications or heart transplantation or leading to death). Siblings (n = 4,023) established the baseline population risk. An additional 3,421 survivors from Emma Children's Hospital (Amsterdam, the Netherlands), the National Wilms Tumor Study, and the St Jude Lifetime Cohort Study were used to validate the CCSS prediction models. Results Heart failure occurred in 285 CCSS participants. Risk scores based on selected exposures (sex, age at cancer diagnosis, and anthracycline and chest radiotherapy doses) achieved an area under the curve of 0.74 and concordance statistic of 0.76 at or through age 40 years. Validation cohort estimates ranged from 0.68 to 0.82. Risk scores were collapsed to form statistically distinct low-, moderate-, and high-risk groups, corresponding to cumulative incidences of heart failure at age 40 years of 0.5% (95% CI, 0.2% to 0.8%), 2.4% (95% CI, 1.8% to 3.0%), and 11.7% (95% CI, 8.8% to 14.5%), respectively. In comparison, siblings had a cumulative incidence of 0.3% (95% CI, 0.1% to 0.5%). Conclusion Using information available to clinicians soon after completion of childhood cancer therapy, individual risk for subsequent heart failure can be predicted with reasonable accuracy and discrimination. These validated models provide a framework on which to base future screening strategies and interventions.

Development and validation of a prediction model for kidney failure in long-term survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10047-10047
Author(s):  
Natalie Lucy Wu ◽  
Yan Chen ◽  
Bryan V. Dieffenbach ◽  
Nan Li ◽  
Matthew J. Ehrhardt ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Cancer Diagnosis ◽  
Kidney Failure ◽  
Prediction Models ◽  
Wilms Tumor ◽  
Risk Groups ◽  
Risk Scores ◽  
Individual Risk ◽  
C Statistic ◽  
Survivors Of Childhood Cancer

10047 Background: Kidney failure (need for dialysis or kidney transplantation, or death due to kidney disease) is a rare but serious late effect for survivors of childhood cancer. We aimed to develop a model using demographic and treatment characteristics to predict individual risk of kidney failure among five-year survivors of childhood cancer. Methods: CCSS survivors without kidney failure at five years after cancer diagnosis (n = 25,483) were assessed for subsequent kidney failure by age 40. Outcomes were self-reported and corroborated by the Organ Procurement and Transplantation Network and the National Death Index. A sibling cohort (n = 5045) served as a comparator. Piecewise exponential models with backward selection estimated the relationships between potential predictors and kidney failure and were converted to integer risk scores. Additional results from the St. Jude Lifetime Cohort Study (SJLIFE, n = 2490) and the National Wilms Tumor Study (NWTS, n = 6760) validated the models. Results: Among CCSS survivors, 204 developed late kidney failure. We developed a model with sex, race/ethnicity, age at cancer diagnosis, nephrectomy, exposure to specific chemotherapy, any abdominal radiation, presence of genitourinary anomalies, and early-onset hypertension (Table). Risk scores achieved an area under the curve (AUC) and concordance (C) statistic of 0.65 and 0.68 for kidney failure by age 40. Validation cohort AUC and C statistics were 0.83/0.86 for SJLIFE (8 cases) and 0.61/0.63 for NWTS (91 cases). An alternative model with specific chemotherapy doses and kidney-specific radiation dosimetry had similar AUC and C statistic (0.67/0.70). Integer risk scores were collapsed to form statistically distinct low (score <3; 87 cases of 17,326), moderate (score 3-5; 63 cases of 4667), and high (score 6+; 18 cases of 401) risk groups. These groups corresponded to cumulative incidences in CCSS of kidney failure by age 40 of 0.6% (95% CI 0.4-0.7%), 2.3% (95% CI 1.6-3.2%), and 9.4% (95% CI 4.4-16.7%), compared with 0.2% (95% CI 0.1-0.5%) among siblings. Conclusions: Using readily available information, we were able to identify low, moderate, and high risk groups for developing kidney failure following treatment for childhood cancer. These prediction models may help guide screening and interventional strategies for higher risk survivors.[Table: see text]

scholarly journals Opportunistic Assessment of Ischemic Heart Disease Risk Using Abdominopelvic Computed Tomography and Medical Record Data: a Multimodal Explainable Artificial Intelligence Approach

2021 ◽  
Author(s):  
Juan M Zambrano Chaves ◽  
Akshay S Chaudhari ◽  
Andrew L Wentland ◽  
Arjun D Desai ◽  
Imon Banerjee ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Risk Assessment ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Medical Record ◽  
Disease Risk ◽  
Tissue Level ◽  
Ischemic Heart ◽  
Risk Scores ◽  
Imaging Biomarkers

AbstractCurrent risk scores for predicting ischemic heart disease (IHD) risk—the leading cause of global mortality—have limited efficacy. While body composition (BC) imaging biomarkers derived from abdominopelvic computed tomography (CT) correlate with IHD risk, they are impractical to measure manually. Here, in a retrospective cohort of 8,197 contrast-enhanced abdominopelvic CT examinations undergoing up to 5 years of follow-up, we developed improved multimodal opportunistic risk assessment models for IHD by automatically extracting BC features from abdominal CT images and integrating these with features from each patient’s electronic medical record (EMR). Our predictive methods match and, in some cases, outperform clinical risk scores currently used in IHD risk assessment. We provide clinical interpretability of our model using a new method of determining tissue-level contributions from CT along with weightings of EMR features contributing to IHD risk. We conclude that such a multimodal approach, which automatically integrates BC biomarkers and EMR data can enhance IHD risk assessment and aid primary prevention efforts for IHD.

scholarly journals Cost-Effectiveness of the International Late Effects of Childhood Cancer Guideline Harmonization Group Screening Guidelines to Prevent Heart Failure in Survivors of Childhood Cancer

2020 ◽  
Vol 38 (33) ◽  
pp. 3851-3862 ◽  
Author(s):  
Matthew J. Ehrhardt ◽  
Zachary J. Ward ◽  
Qi Liu ◽  
Aeysha Chaudhry ◽  
Anju Nohria ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
High Risk ◽  
Childhood Cancer ◽  
Late Effects ◽  
Cost Effective ◽  
Risk Groups ◽  
Low Risk ◽  
Moderate Risk ◽  
Survivors Of Childhood Cancer

PURPOSE Survivors of childhood cancer treated with anthracyclines and/or chest-directed radiation are at increased risk for heart failure (HF). The International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) recommends risk-based screening echocardiograms, but evidence supporting its frequency and cost-effectiveness is limited. PATIENTS AND METHODS Using the Childhood Cancer Survivor Study and St Jude Lifetime Cohort, we developed a microsimulation model of the clinical course of HF. We estimated long-term health outcomes and economic impact of screening according to IGHG-defined risk groups (low [doxorubicin-equivalent anthracycline dose of 1-99 mg/m2 and/or radiotherapy < 15 Gy], moderate [100 to < 250 mg/m2 or 15 to < 35 Gy], or high [≥ 250 mg/m2 or ≥ 35 Gy or both ≥ 100 mg/m2 and ≥ 15 Gy]). We compared 1-, 2-, 5-, and 10-year interval-based screening with no screening. Screening performance and treatment effectiveness were estimated based on published studies. Costs and quality-of-life weights were based on national averages and published reports. Outcomes included lifetime HF risk, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs). Strategies with ICERs < $100,000 per QALY gained were considered cost-effective. RESULTS Among the IGHG risk groups, cumulative lifetime risks of HF without screening were 36.7% (high risk), 24.7% (moderate risk), and 16.9% (low risk). Routine screening reduced this risk by 4% to 11%, depending on frequency. Screening every 2, 5, and 10 years was cost-effective for high-risk survivors, and every 5 and 10 years for moderate-risk survivors. In contrast, ICERs were > $175,000 per QALY gained for all strategies for low-risk survivors, representing approximately 40% of those for whom screening is currently recommended. CONCLUSION Our findings suggest that refinement of recommended screening strategies for IGHG high- and low-risk survivors is needed, including careful reconsideration of discontinuing asymptomatic left ventricular dysfunction and HF screening in low-risk survivors.

Factors Affecting Relevance of Tele-ECG Systems Application to High Risk for Future Ischemic Heart Disease Events Patients Group

2008 ◽  
Vol 14 (4) ◽  
pp. 345-349 ◽  
Author(s):  
Giedrius Vanagas ◽  
Remigijus Žaliūnas ◽  
Rimantas Benetis ◽  
Rimvydas Šlapikas
Keyword(s):  
Heart Disease ◽  
High Risk ◽  
Ischemic Heart Disease ◽  
Ischemic Heart ◽  
Factors Affecting

scholarly journals Falls among patients with hypertension - preliminary study

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
N Swiatoniowska-Lonc ◽  
E Jaciow ◽  
J Polanski ◽  
B Jankowska-Polanska
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
High Risk ◽  
Ischemic Heart Disease ◽  
Beta Blockers ◽  
The Elderly ◽  
Ischemic Heart ◽  
Risk Of Falling ◽  
Risk Of Falls ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background. Falls among the elderly are a major cause of injury, significant disability and premature death. Hypotension is a potential risk factor for falls in older adults, especially patients with hypertension (HTN) taking antihypertensive drugs. Furthermore, the cardiovascular benefit of treatment of hypertension in older patients is clear, findings from observational studies have raised concerns that antihypertensive therapies in the elderly might also induce adverse effects, including injurious falls.  In spite of the large number of issues related to this topic, the analysis of the causes of falls is insufficient. The aim of the study was to assess the frequency of falls and the impact of selected variables on the occurrence of risk of falls among patients with HTN. Material and methods. 100 patients, including 55 women, with HTN (mean age 69.4 ± 3.29 years) were enrolled into the study. The Tinetti test was used to assess the risk of falls. Sociodemographic and clinical data were obtained from the hospital register. Results. 89% of patients had a high risk of falls and 11% were prone to falls. The average number of falls during the last year in the study group was 1.86 ± 2.82 and in 30% of cases the fall was the cause of hospitalization. Single-factor analysis of the influence of selected variables on the risk of falls showed that higher values of SBP (-0.27; p = 0.007), DBP (-0.279; p = 0.005) and younger age of patients decrease the risk of falls (-0.273; p = 0.006). The linear regression model showed that independent predictors increasing the risk of falling are: use of diuretics (β=4.192; p &lt; 0.001), co-occurrence of ischemic heart disease (β=4.669; p = 0. 007) and co-occurrence of heart failure (β=3.494; p = 0.016), and predictors reducing the risk of falling patients with hypertension are: the use of beta-blockers (β= -4.033; p = 0.013) and higher DBP value (β= -0.123; p = 0.016). Conclusions. Patients with HTN have a high risk of falling. Independent determinants increasing the risk of falling patients with HTN are the use of diuretics and the co-occurrence of ischemic heart disease or heart failure, while beta-blockers and a higher DBP value are factors reducing the risk of falling. Fall risk assessment and implementation of fall prevention should be carried out in everyday practice.

scholarly journals Characteristics and predictors of hospitalization and death in the first 9,519 cases with a positive RT-PCR test for SARS-CoV-2 in Denmark: A nationwide cohort

2020 ◽  
Author(s):  
Mette Reilev ◽  
Kasper Bruun Kristensen ◽  
Anton Pottegård ◽  
Lars Christian Lund ◽  
Jesper Hallas ◽  
...  
Keyword(s):  
Heart Disease ◽  
High Risk ◽  
Ischemic Heart Disease ◽  
Chronic Diseases ◽  
Strong Predictor ◽  
Population Based ◽  
Ischemic Heart ◽  
Fatal Disease ◽  
Accurate Identification ◽  
Wide Range

AbstractObjectiveTo provide population-level knowledge on individuals at high risk of severe and fatal coronavirus disease 2019 (COVID-19) in order to inform targeted protection strategies in the general population and appropriate triage of hospital contacts.Design, Setting, and ParticipantsNationwide population-based cohort of all 228.677 consecutive Danish individuals tested (positive or negative) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA from the identification of the first COVID-19 case on February 27th, 2020 until April 30th, 2020.Main Outcomes and MeasuresWe examined characteristics and predictors of inpatient hospitalization versus community-management, and death versus survival, adjusted for age-, sex- and number of comorbidities.ResultsWe identified 9,519 SARS-CoV-2 PCR-positive cases of whom 78% were community-managed, 22% were hospitalized (3.2% at an intensive care unit) and 5.5% had died within 30 days. Median age varied from 45 years (interquartile range (IQR) 31-57) among community-managed cases to 82 years (IQR 7589) among those who died. Age was a strong predictor of fatal disease (odds ratio (OR) 14 for 70-79-year old, OR 26 for 80-89-year old, and OR 82 for cases older than 90 years, when compared to 50-59-year old and adjusted for sex and number of comorbidities). Similarly, the number of comorbidities was strongly associated with fatal disease (OR 5.2, for cases with ≥4 comorbidities versus no comorbidities), and 82% of fatal cases had at least 2 comorbidities. A wide range of major chronic diseases were associated with hospitalization with ORs ranging from 1.3-1.4 (e.g. stroke, ischemic heart disease) to 2.2-2.7 (e.g. heart failure, hospital-diagnosed kidney disease, chronic liver disease). Similarly, chronic diseases were associated with mortality with ORs ranging from 1.2-1.3 (e.g. ischemic heart disease, hypertension) to 2.4-2.7 (e.g. major psychiatric disorder, organ transplantation). In the absence of comorbidities, mortality was relatively low (5% or less) in persons aged up to 80 years.Conclusions and RelevanceIn this first nationwide population-based study, increasing age and number of comorbidities were strongly associated with hospitalization requirement and death in COVID-19. In the absence of comorbidities, the mortality was, however, lowest until the age of 80 years. These results may help in accurate identification, triage and protection of high-risk groups in general populations, i.e. when reopening societies.

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