scholarly journals Clinical Outcomes among Hemodialysis Patients with Atrial Fibrillation: A Korean Nationwide Population-based Study

2019 ◽  
Author(s):  
Yeunmi Kang ◽  
Hyung Yun Choi ◽  
Young Eun Kwon ◽  
Ji Hyeon Shin ◽  
Eun Mi Won ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Hemorrhagic Stroke ◽  
National Health Insurance System ◽  
All Cause Mortality

Abstract Background: The number of patients requiring dialysis is increasing worldwide, and the atrial fibrillation (AF) prevalence among hemodialysis (HD) patients is higher than in the general population. There have been no studies of Korean AF patients undergoing HD investigating how AF affects outcomes, for example, in terms of all-cause mortality, hospitalization, and stroke events. We conducted a large-scale retrospective cohort study with data from the National Health Insurance System (NHIS) to determine how AF affects these outcomes. Methods: In 2013, the Health Insurance Review and Assessment (HIRA) service, a Korean national health insurance scheme, collected data from 21,839 HD patients for evaluating the adequacy of dialysis centers. All-cause mortality, hospitalization, and stroke events were compared between patients with and without AF. Sub-analyses compared these outcomes between patients receiving and not receiving warfarin. Results: Cox regression analysis found that AF was a significant risk factor for death from any cause (HR, 1.356; 95% CI, 1.222-1.506, P < 0.001), hospitalization (HR, 1.323; 95% CI, 1.225-1.430, P < 0.001), and hemorrhagic stroke (HR, 1.500; 95% CI, 1.050-2.141, P = 0.026). AF was not significantly associated with an increased risk of ischemic stroke. The use of warfarin was significantly associated with hemorrhagic stroke incidence (HR, 1.593; 95% CI, 1.075-2.360, P = 0.020), while there was no significant correlation between warfarin treatment and all-cause mortality, hospitalization, and ischemic stroke. Conclusions: This cohort study of Korean dialysis patients showed that AF was a risk factor for multiple outcomes among HD patients.

scholarly journals Hyperlipidemia Is a Risk Factor of Adhesive Capsulitis: Real-World Evidence Using the Taiwanese National Health Insurance Research Database

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712098680
Author(s):  
Jr-Yi Wang ◽  
Chen-Kun Liaw ◽  
Chi-Chang Huang ◽  
Tsan-Hon Liou ◽  
Hui-Wen Lin ◽  
...  
Keyword(s):  
Risk Factor ◽  
Health Insurance ◽  
Propensity Score ◽  
National Health Insurance ◽  
National Health ◽  
Glenohumeral Joint ◽  
Adhesive Capsulitis ◽  
Small Sample ◽  
Research Database ◽  
Statin Use

Background: Patients with adhesive capsulitis are evaluated for pain and progressive contracture of the glenohumeral joint. Whether endocrine, immune, or inflammatory processes are involved in its definite pathogenesis is still under debate. Some cross-sectional studies with a small sample size have noted that hyperlipidemia is a possible risk factor for frozen shoulders. Purpose/Hypothesis: The purpose was to conduct a longitudinal population-based study to investigate the risk of adhesive capsulitis among patients with hyperlipidemia. It was hypothesized that patients with hyperlipidemia would have a higher risk of adhesive capsulitis and that the use of statin drugs could reduce the rate. Study Design: Cohort study; Level of evidence, 3. Methods: Using data from the National Health Insurance Research Database (NHIRD) of Taiwan, the authors obtained the records of patients with hyperlipidemia who received a diagnosis between 2004 and 2005 and were followed up until the end of 2010. The control cohort comprised age- and sex-matched patients without hyperlipidemia. Propensity score matching was performed for the other comorbidities. A Cox multivariate proportional hazards model was applied to analyze the risk factors of adhesive capsulitis. The hazard ratio (HR) and adjusted HR were estimated between the study and control cohorts after adjustment for confounders. The effects of statin use on adhesive capsulitis risk were also analyzed. Results: The NHIRD records of 28,748 patients and 114,992 propensity score–matched controls were evaluated. A higher incidence rate of adhesive capsulitis was revealed in the hyperlipidemia cohort, with a crude HR of 1.70 (95% CI, 1.61-1.79; P < .001) and adjusted HR of 1.50 (95% CI, 1.41-1.59; P < .001). Patients with hyperlipidemia who used a statin still had higher crude and adjusted HRs compared with controls. Statin use did not exert protective effects on patients with hyperlipidemia. Conclusion: Patients with hyperlipidemia had a 1.5-fold higher risk of adhesive capsulitis than did healthy controls. Statin use did not provide protection against adhesive capsulitis in patients with hyperlipidemia.

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