Mortality in Graves’ orbitopathy is increased and influenced by gender, age and pre-existing morbidity: a nationwide Danish register study

Introduction It is unclear whether the excess mortality associated with Graves’ disease differs between individuals with Graves’ orbitopathy (GO) or without (GD). Subjects and methods A nationwide, register-based cohort study in which all adult Danes diagnosed with GD (n = 28 461) and GO (n = 3965) between 1995 and 2012 were matched for age and gender with four control subjects. Median follow-up time was 7.9 years (range 0–17.5). Mortality risk in GO patients compared to the control population and compared to GD patients was calculated using Cox regression analyses, adjusting for pre-existing morbidity using the Charlson score. Results Adjusted mortality in Graves’ disease overall (GD + GO) was significantly increased compared to that in the background population (HR = 1.18 (95% confidence interval: 1.15–1.21)). In GD and GO separately, adjusted mortality was also significantly higher than that in their respective control populations (HR: 1.19 (1.16–1.22) and HR: 1.23 (1.12–1.35) respectively). However, mortality in GO compared to that in GD was decreased (HR: 0.64 (0.59–0.69)), although this difference attenuated after adjustment for pre-existing morbidity, age and gender. Both GD and GO males had a significantly higher mortality than those in females. For GO, but not for GD, mortality risk was the highest in the youngest and decreased with increasing age. Conclusions GD and GO were associated with increased mortality, especially in males. In GO, but not in GD patients, there was an inverse relationship between age and mortality. Surprisingly, and in need of further study, mortality was not higher in GO than that in GD individuals.

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The association of tissue doppler E/e' ratio with poor survival is modified by gender and is attenuated with advanced age

European Heart Journal ◽

10.1093/eurheartj/ehab724.012 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

Y Wasserstrum ◽

R Gilead ◽

R Kuperstein ◽

S Ben-Zekry ◽

O Vatury ◽

...

Keyword(s):

Cox Regression ◽

Mitral Annulus ◽

Tissue Doppler ◽

Outcome Data ◽

Poor Survival ◽

Age And Gender ◽

Risk Of Death ◽

Increased Risk ◽

And Gender

Abstract Introduction Contemporary guidelines recommend a universal cutoff of 14 for the ratio between early mitral flow wave and early diastolic mitral annulus velocity measured by tissue doppler (E/e' ratio). While age-dependent normal E/e' values have been suggested, outcome data is lacking. Purpose We sought to evaluate the modification effect of age and gender on the prognostic value of the E/e' ratio. Methods Consecutive patients who underwent echocardiographic evaluation between 2009 and 2021 (N=104,315) in a single tertiary cardiovascular center. Patients with left or right ventricular dysfunction, any significant valvular disease, structural heart disease or evidence of pulmonary hypertension were excluded. Cancer and mortality data were available for all subjects from national registries. Patients with a metastatic malignancy at baseline or during follow up were excluded. Cox regression models were applied. Results Overall, 44,541 patients were included in the final analysis. Mean age was 55±17, 59% were male and 63% of the exams were performed in an outpatient setting. An elevated E/e' ratio above 14 was documented in 2,598 (7%) patients. During a median follow-up of 5.7 (IQR 2.8–9.1) years, 5,015 (11.3%) patients died. Kaplan Meier survival analysis demonstrated that the cumulative probability of death at 6 years was 23.4% (21.6–25.3) among patients with elevated E/e' ratio compared with 9.7% (9.3–10.0) among patients with E/e'<14 (p Log rank <0.001). This difference was less significant as age progressed (figure 1). Multivariate cox-regression model yielded consistent results such that an elevated E/e' ratio was associated with 2.66-fold increased risk of death during follow up (95% CI 2.44–2.89, p<0.001), and there was a decline in the increased risk and significant as age advanced in both genders (figure 2). Interaction analysis was significant for both gender and age such the association of elevated E/e' ratio with poor survival was more significant among men compared with women and among young vs. older subjects. Among women, elevated E/e' was associated with 2.4-fold increased risk of death versus 2.7-fold increased risk among men. Similarly, the hazard ratio for death associated with elevated E/e' was 2.29 (95% CI 1.74–3.02), 1.8 (95% CI 1.5–2.1), 1.13 (95% CI 0.97–1.31) and 1.07 (95% CI 0.92–1.25) for the age groups of <60, 60–70, 70–80 and >80, respectively. In a sensitivity analysis, similar findings were seen in when excluding patients with mild hypertrophy (maximal wall thickness >12mm) and without any mitral annulus calcification. Conclusion In apparently normal hearts, an elevated E/e' ratio is independently associated with increased mortality. This association is more pronounced among men and is attenuated with increased age. This study supports the need for gender-specific and age-specified outcome data with respect to measures of diastolic dysfunction. FUNDunding Acknowledgement Type of funding sources: None. Survival by age and gender groups E/e' >14 and mortality by age and gender

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Association of depression and gender with mortality in old age

The British Journal of Psychiatry ◽

10.1192/bjp.177.4.336 ◽

2000 ◽

Vol 177 (4) ◽

pp. 336-342 ◽

Cited By ~ 101

Author(s):

R. A. Schoevers ◽

M. I. Geerlings ◽

A. T. F. Beekman ◽

B. W. J. H. Penninx ◽

D. J. H. Deeg ◽

...

Keyword(s):

Mortality Risk ◽

Older Persons ◽

Excess Mortality ◽

Psychotic Depression ◽

Mild Depression ◽

Men And Women ◽

Risk Of Death ◽

And Gender ◽

Depressive Syndromes

BackgroundThe association between depression and increased mortality risk in older persons may depend on the severity of the depressive disorder and gender.AimsTo investigate the association between major and mild depressive syndromes and excess mortality in community-living elderly men and women.MethodDepression (Geriatric Mental State AGECAT) was assessed in 4051 older persons, with a 6-year follow-up of community death registers. The mortality risk of neurotic and psychotic depression was calculated after adjustment for demographic variables, physical illness, cognitive decline and functional disabilities.ResultsA total of 75% of men and 41% of women with psychotic depression had died at follow-up. Psychotic depression was associated with significant excess mortality in both men and women. Neurotic depression was associated with a 1.67-fold higher mortality risk in men only.ConclusionsIn the elderly, major depressive syndromes increase the risk of death in both men and women, but mild depression increases the risk of death only in men.

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Associations between CD160 polymorphisms and autoimmune thyroid disease: a case-control study

BMC Endocrine Disorders ◽

10.1186/s12902-021-00810-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Weiwei He ◽

Jing Zhao ◽

Xuerong Liu ◽

Sheli Li ◽

Kaida Mu ◽

...

Keyword(s):

Hashimoto’S Thyroiditis ◽

Autoimmune Thyroid Disease ◽

Additive Model ◽

Hashimoto's Thyroiditis ◽

Graves Disease ◽

Dominant Model ◽

Regression Analyses ◽

Age And Gender ◽

Autoimmune Thyroid ◽

And Gender

Abstract Background Recent researches suggest that the CD160/HVEM/LIGHT/BTLA signaling pathway may contribute to the pathogeneses of autoimmune diseases, but the relationship between CD160 polymorphisms and autoimmune thyroid disease (AITD) has not been reported yet. This study aimed to evaluate the associations between CD160 polymorphisms and AITD. Methods A total of 1017 patients with AITD (634 Graves’ disease and 383 Hashimoto’s thyroiditis) and 856 unrelated healthy controls were recruited into our study. Odds ratios (ORs) with 95% confidence interval (95%CI) were calculated through logistic regression analyses. The CD160 SNPs were detected using Hi-SNP high-throughput genotyping. Results There was a statistically significant difference between Graves’ disease patients and the control group with respect to both the genotype distribution (P = 0.014) and allele frequency of rs744877 (P = 0.034). A significant association of CD160 rs744877 with AITD was observed before adjusted age and gender under a dominant model (OR = 0.79, 95%CI 0.66–0.95; P = 0.013) and an additive model (OR = 0.77, 95%CI 0.64–0.94, P = 0.008), and was also observed after adjusted age and gender under a dominant model (OR = 0.78, 95%CI 0.65–0.95; P = 0.011) and an additive model (OR = 0.76, 95%CI 0.63–0.93, P = 0.007). A significant association of rs744877 with Graves’ disease was observed under an allele model (OR = 0.84, 95%CI 0.71–0.98, P = 0.027), a dominant model (OR = 0.74, 95%CI 0.60–0.91; P = 0.005), and an additive model (OR = 0.72, 95%CI 0.58–0.90, P = 0.004). Multivariate logistic regression analyses suggested that the association remained significant after adjustment for age and gender. However, rs744877 was not related to Hashimoto’s thyroiditis. Furthermore, CD160 rs3766526 was not significantly related to either Graves’ disease or Hashimoto’s thyroiditis. Conclusion This is the first identification of the association of CD160 rs744877 with Graves’ disease. Our findings add new data to the genetic contribution to Graves’ disease susceptibility and support the crucial role of the CD160/HVEM/LIGHT/BTLA pathway in the pathogenesis of Graves’ disease.

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Associations Between CD160 Polymorphisms and Autoimmune Thyroid Disease: A Case-Control Study

10.21203/rs.3.rs-117461/v1 ◽

2020 ◽

Author(s):

Weiwei He ◽

Jing Zhao ◽

Xuerong Liu ◽

Sheli Li ◽

Kaida Mu ◽

...

Keyword(s):

Logistic Regression ◽

Thyroid Disease ◽

Autoimmune Thyroid Disease ◽

Additive Model ◽

Graves Disease ◽

Dominant Model ◽

Regression Analyses ◽

Age And Gender ◽

Autoimmune Thyroid ◽

And Gender

Abstract Background/AimsRecent researches suggest that the CD160/HVEM/LIGHT/BTLA signaling pathway may contribute to the pathogeneses of autoimmune diseases, but the relationship between CD160 polymorphisms and autoimmune thyroid disease (AITD) has not been reported yet. This study aimed to evaluate the associations between CD160 polymorphisms and AITD.MethodsA total of 1017 patients with AITD (634 Graves' disease and 383 Hashimoto's thyroiditis) and 856 unrelated healthy controls were recruited into our study. Odds ratios (ORs) with 95% confidence interval (95%CI) were calculated through logistic regression analyses. The CD160 SNPs were detected using Hi-SNP high-throughput genotyping. ResultsThere was a statistically significant difference between Graves' disease patients and the control group with respect to both the genotype distribution (P=0.014) and allele frequency of rs744877 (P=0.034). A significant association of CD160 rs744877 with AITD was observed before adjusted age and gender under a dominant model (OR= 0.79, 95%CI 0.66-0.95; P= 0.013) and an additive model (OR= 0.77, 95%CI 0.64-0.94, P=0.008), and was also observed after adjusted age and gender under a dominant model (OR= 0.78, 95%CI 0.65-0.95; P= 0.011) and an additive model (OR= 0.76, 95%CI 0.63-0.93, P=0.007). A significant association of rs744877 with Graves' disease was observed under an allele model (OR= 0.84, 95%CI 0.71-0.98, P=0.027), a dominant model (OR= 0.74, 95%CI 0.60-0.91; P= 0.005), and an additive model (OR= 0.72, 95%CI 0.58-0.90, P=0.004). Multivariate logistic regression analyses suggested that the association remained significant after adjustment for age and gender. However, rs744877 was not related to Hashimoto's thyroiditis. Furthermore, CD160 rs3766526 was not significantly related to either Graves' disease or Hashimoto's thyroiditis.ConclusionThis is the first identification of the association of CD160 rs744877 with Graves' disease. Our findings add new data to the genetic contribution to Graves' disease susceptibility and support the crucial role of the CD160/HVEM/LIGHT/BTLA pathway in the pathogenesis of Graves' disease.

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Ttrimetyllysine and risk of new-onset atrial fibrillation in two large norwegian cohorts

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.242 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

MM Svenningsson ◽

I Dhar ◽

GFT Svingen ◽

EKR Pedersen ◽

D Nilsen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Angina Pectoris ◽

Coronary Angiography ◽

Stable Angina ◽

Cox Regression ◽

Health Study ◽

Stable Angina Pectoris ◽

Age And Gender ◽

And Gender ◽

New Onset

Abstract Funding Acknowledgements Type of funding sources: None. Background/Aim Increased plasma trimetyllysine (TML), a methylated amino acid, has recently been linked to higher risk of acute myocardial infarction (AMI). TML is also a precursor of trimethylamine-N oxide (TMAO), which has been linked to increased cardiovascular risk, including that of atrial fibrillation (AF). We investigated the association between TML and new-onset AF in two large Norwegian cohorts. Methods The primary cohort consisted of 6396 participants in the community-based Hordaland Health Study (HUSK). The validation cohort consited of 2027 patients who underwent coronary angiography due to suspected stable angina pectoris in the Western Norway Coronary Angiography Cohort (WECAC). Information on new-onset AF was obtained by linking patient data to Norwegian public health registries. Risk associations were explored by Cox regression. Results During median (25th-75th percentile) follow-up of 10.9 (10.6-11.3) and 7.0 (6.3-8.6) years, 560 (8.8%) patients in the HUSK and 210 (10.4%) in the WECAC was diagnosed with AF. In the HUSK, the age and gender adjusted HR (95 % CI) for the 4th vs. 1st plasma TML quartiles 1.84 (1.37-2.48) p < 0.001. In multivariable models the association was only slightly attenuated. Correspondingsly, the age and gender adjusted HR (95% CI) for the 4th vs. 1st TML quartiles in the WECAC was 1.48 (0.96-2.27) p = 0.07. Testing for collinearity between TMAO and TML revealed variance inflation factors between 1.0-1.1 in HUSK and WECAC, thus ruling out collinearity. Conclusion Plasma TML was associated with new-onset AF among subjects from the general population, and the relationship was independent from established AF risk factors. A similar trend was also seen in patients with suspected stable angina pectoris, strengthening our findings, which motivate further studies to explore potential pathophysiological relationships between one-carbon metabolism and cardiac arrhythmias

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Risk of infective endocarditis among patients with tetralogy of fallot

European Heart Journal ◽

10.1093/ehjci/ehaa946.2171 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E Havers-Borgersen ◽

J.H Butt ◽

M Groening ◽

M Smerup ◽

G.H Gislason ◽

...

Keyword(s):

Infective Endocarditis ◽

Tetralogy Of Fallot ◽

Valve Replacement ◽

Pulmonary Valve ◽

Cox Regression ◽

Pulmonary Valve Replacement ◽

Varying Coefficients ◽

Background Population ◽

Increased Risk

Abstract Introduction Patients with tetralogy of Fallot (ToF) are considered at high risk of infective endocarditis (IE) as a result of altered hemodynamics and multiple surgical and interventional procedures including pulmonary valve replacement (PVR). The overall survival of patients with ToF has increased in recent years. However, data on the risk of adverse outcomes including IE are sparse. Purpose To investigate the risk of IE in patients with ToF compared with controls from the background population. Methods In this nationwide observational cohort study, all patients with ToF born in 1977–2017 were identified using Danish nationwide registries and followed from date of birth until occurrence of an outcome of interest (i.e. first-time IE), death, or end of study (July 31, 2017). The comparative risk of IE among ToF patients versus age- and sex-matched controls from the background population was assessed. Results A total of 1,156 patients with ToF were identified and matched with 4,624 controls from the background population. Among patients with ToF, 266 (23.0%) underwent PVR during follow-up. During a median follow-up time of 20.4 years, 38 (3.3%) patients and 1 (0.03%) control were admitted with IE. The median time from date of birth to IE was 10.8 years (25th-75th percentile 2.8–20.9 years). The incidence rates of IE per 1,000 person-years were 2.2 (95% confidence interval (CI) 1.6–3.0) and 0.01 (95% CI 0.0001–0.1) among patients and controls, respectively. In multivariable Cox regression models, in which age, sex, pulmonary valve replacement, and relevant comorbidities (i.e. chronic renal failure, diabetes mellitus, presence of cardiac implantable electronic devices, other valve surgeries), were included as time-varying coefficients, the risk of IE was significantly higher among patients compared with controls (HR 171.5, 95% CI 23.2–1266.7). Moreover, PVR was associated with an increased risk of IE (HR 3.4, 95% CI 1.4–8.2). Conclusions Patients with ToF have a substantial risk of IE and the risk is significantly higher compared with the background population. In particular, PVR was associated with an increased risk of IE. With an increasing life-expectancy of these patients, intensified awareness, preventive measures, and surveillance of this patient group are advisable. Figure 1. Cumulative incidence of IE Funding Acknowledgement Type of funding source: None

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POS0141 ACTIVE SCREENING FOR GOUT IDENTIFIES A LARGER CARDIOVASCULAR POPULATION AT HIGH MORTALITY RISK

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1872 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 282.2-282

Author(s):

S. Ruiz-Simón ◽

I. Calabuig ◽

M. Gomez-Garberi ◽

M. Andrés

Keyword(s):

High Mortality ◽

Mortality Risk ◽

Cardiovascular Events ◽

Cox Regression ◽

Field Studies ◽

High Mortality Risk ◽

Active Screening ◽

Tertiary Centre ◽

All Cause Mortality

Background:We have recently revealed by active screening that about a third of gout cases in the cardiovascular population is not registered in records [1], highlighting the value of field studies.Objectives:To assess whether gout screening in patients hospitalized for cardiovascular events may also help identify patients at higher risk of mortality after discharge.Methods:A retrospective cohort field study, carried out in 266 patients admitted for cardiovascular events in the Cardiology, Neurology and Vascular Surgery units of a tertiary centre in Spain. The presence of gout was established by records review and face-to-face interview, according to the 2015 ACR/EULAR criteria. The occurrence of mortality during follow-up and its causes were obtained from electronic medical records. The association between gout and subsequent mortality was tested using Cox regression models. Whether covariates affect the gout-associated mortality was also studied.Results:Of 266 patients recruited at baseline, 17 were excluded due to loss to follow-up (>6mo), leaving a final sample of 249 patients (93.6%). Thirty-six cases (14.5% of the sample) were classified as having gout: twenty-three (63.9%) had a previously registered diagnosis, while 13 (36.1%) had not and was established by the interview.After discharge, the mean follow-up was 19.9 months (SD ±8.6), with a mortality incidence of 21.6 deaths per 100 patient-years, 34.2% by cardiovascular causes.Gout significantly increased the risk of subsequent all-cause mortality, with a hazard ratio (HR) of 2.01 (95%CI 1.13 to 3.58). When the analysis was restricted to gout patients with registered diagnosis, the association remained significant (HR 2.89; 95%CI 1.54 to 5.41).The adjusted HR for all-cause mortality associated with gout was 1.86 (95% CI 1.01-3.40). Regarding the causes of death, both cardiovascular and non-cardiovascular were numerically increased.Secondary variables rising the mortality risk in those with gout were age (HR 1.07; 1.01 to 1.13) and coexistent renal disease (HR 4.70; 1.31 to 16.84), while gender, gout characteristics and traditional risk factors showed no impact.Conclusion:Gout was confirmed an independent predictor of subsequent all-cause mortality in patients admitted for cardiovascular events. Active screening for gout allowed identifying a larger population at high mortality risk, which may help tailor optimal management to minimize the cardiovascular impact.References:[1]Calabuig I, et al. Front Med (Lausanne). 2020 Sep 29;7:560.Disclosure of Interests:Silvia Ruiz-Simón: None declared, Irene Calabuig: None declared, Miguel Gomez-Garberi: None declared, Mariano Andrés Speakers bureau: Grunenthal, Menarini, Consultant of: Grunenthal, Grant/research support from: Grunenthal

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Association between Attention-Deficit Hyperactivity Disorder in childhood and schizophrenia later in adulthood

European Psychiatry ◽

10.1016/j.eurpsy.2013.06.004 ◽

2014 ◽

Vol 29 (4) ◽

pp. 259-263 ◽

Cited By ~ 54

Author(s):

S. Dalsgaard ◽

P.B. Mortensen ◽

M. Frydenberg ◽

C.M. Maibing ◽

M. Nordentoft ◽

...

Keyword(s):

Cox Regression ◽

Normal Population ◽

Children With Adhd ◽

Hyperactivity Disorder ◽

Follow Up Study ◽

Background Population ◽

Hazard Ratios ◽

Central Register ◽

Risk Ratios

AbstractPurpose:To estimate the risk of schizophrenia in adulthood among children and adolescents with ADHD compared to the background population.Subjects/materials and methods:Two hundred and eight youths with ADHD (183 boys; 25 girls) were followed prospectively. Diagnoses of schizophrenia were obtained from The Danish Psychiatric Central Register. The relative risk (RR) of schizophrenia for cases with ADHD, compared to the normal population, was calculated as risk ratios. Hazard ratios (HR's) by Cox regression were calculated in the predictor analyses.Results:Mean age for ADHD cases at follow-up was 31.1 years. Schizophrenia diagnoses were given to 3.8% of these cases. Compared to the general population, RR of schizophrenia in cases with ADHD was 4.3 (95% CI 1.9–8.57).Discussion and conclusion:This prospective follow-up study found children with ADHD to be at higher risk of later schizophrenia than controls. If replicated, these results warrant increased focus on the possible emergence symptoms of schizophrenia or schizophreniform psychosis during clinical follow-up of patients with ADHD.

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QOLP-08. THE LANDSCAPE OF EPILEPSY ASSOCIATED WITH DIFFUSELY INFILTRATIVE GLIOMAS

Neuro-Oncology ◽

10.1093/neuonc/noab196.729 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi184-vi184

Author(s):

Michael Drumm ◽

Jessica Templer ◽

Omar Bushara ◽

Dusten Unruh ◽

Jordain Walshon ◽

...

Keyword(s):

Tumor Progression ◽

Similar Pattern ◽

Cox Regression ◽

Idh Mutation ◽

Prior Work ◽

Regression Analyses ◽

Course Of Disease ◽

Kaplan Meier ◽

Extent Of Surgical Resection

Abstract Seizures are among the most prevalent co-morbidities associated with glioma, and pose a serious threat to patients. Our prior work showed that IDH mutation (IDHmut) was associated with much greater seizure frequency at the time of initial glioma diagnosis. However, less is known about the variables that contribute to seizure risk throughout the course of disease. We therefore collected data from 247 patients with grade 2–4 glioma, and determined seizure risk using Kaplan-Meier survival probabilities and multivariable cox regression analyses. Median follow-up of IDH wildtype (IDHwt) and IDHmut glioma patients was 15 months and 36 months, respectively. Incidence of pre-operative seizures for IDHwt and IDHmut patients was 75/168 (45%) and 60/79 (76%), and incidence of post-operative seizures was 70/168 (42%) and 43/79 (54%), respectively. Patients who had a pre-operative seizure had a shorter time to their first post-operative seizure than patients who never had a pre-operative seizure in both IDHwt (P< 0.0001) and IDHmut (P= 0.039) cohorts. Among IDHmut glioma patients, those with subtotal resections developed post-operative seizures faster (median time to first seizure= 9.9 months) than those with gross-total resections (median not reached) (P= 0.0005), but a similar pattern was not observed in IDHwt glioma patients (P= 0.20). Those with IDHmut astrocytomas more quickly developed post-operative seizures (median= 11.1 months), compared to those with IDHwt astrocytomas (24.9 months) or IDHmut oligodendrogliomas (median not reached) (P= 0.033). Tumor progression closely followed post-operative seizures in patients with IDHwt gliomas when either their first post-operative seizure occurred longer than 6 months following resection, or when their post-operative seizures worsened in quality. These data suggest the best predictors of post-operative seizures are as follows: the presence of pre-operative seizures; extent of surgical resection; IDHmut status. These data will help clinicians better manage glioma patients by identifying those at greatest risk of seizures.

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Abstract 16247: Methamphetamine Use Predicts Worse Prognosis in a Safety Net Heart Failure Population

Circulation ◽

10.1161/circ.142.suppl_3.16247 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Anjali B Thakkar ◽

Yifei Ma ◽

Teresa Wang ◽

Alexandra Teng ◽

Rebecca Scherzer ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery ◽

San Francisco ◽

Cox Regression ◽

Bypass Graft ◽

Safety Net ◽

High Risk Population ◽

Age And Gender ◽

Safety Net Hospital ◽

And Gender

Background: Methamphetamine (MA) use is rising, and overdose deaths have increased by 500% in San Francisco since 2008. MA use is associated with heart failure (HF); yet, cardiovascular (CV) outcomes in this population have not been described. Methods: We performed a retrospective case-control study of HF patients at a safety net hospital in San Francisco. Between January 2001-June 2019, 1771 HF patients with MA use were matched by age and gender to 3542 HF patients without MA use. We examined age and gender-adjusted associations of MA use with likelihood of index HF admission and 30-day readmission (HF and all-cause), and used demographic-adjusted Cox regression model with competing risks to compare hazard rates associated with MA use over the 18-year study period. Results: At time of HF diagnosis, mean age was 52 years and 77% were male. Patients with MA use were significantly more likely than non-MA users to be black (49.1% vs 33.0%), and to have comorbid conditions including HIV (14.5% vs 4.7%), pulmonary hypertension (11.1% vs 7.7%), hypertension (82.0% vs 77.6%), and cocaine use (58.0% vs 14.7%). Despite similar rates of coronary artery disease, myocardial infarction, and diabetes, HF patients with MA use were less likely to have percutaneous coronary intervention (6.1% vs 8.2%) or coronary artery bypass graft (0.8% vs 1.4%), p<0.05 for all. Compared to HF patients without MA use, HF patients with MA use had higher rates of index HF hospitalizations (36.0% vs 21.7%, adjusted odds ratio 2.04, 95% CI 1.80-2.32, p<0.01), 30-day HF readmission (12.2% vs 6.4%, adjusted hazard ratio (aHR) 1.87, 95% CI 1.31-2.67, p<0.01) and 30-day all cause readmission (20.9% vs 14.3%, aHR 1.46, 95% CI 1.14-1.88, p<0.01). Exposure to MA was associated with higher likelihood of death during the study period, regardless of hospitalizations (22.4% vs 15.1%, aHR=1.17, 95% CI 1.03-1.33, p<0.01). Conclusions: In our study, HF patients with MA use were more likely to be admitted for an index HF admission; subsequently, they were also more likely to be readmitted within 30 days. Regardless of hospitalization risk, individuals with MA use had higher likelihood of death. Further study to understand the clinical and socioeconomic factors driving worse outcomes in this high-risk population is needed.

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