Prevalence and Prognostic Value of Heart Failure Stages: An Elderly Inpatient Based Cohort Study

Background: The prevalence and prognostic value of heart failure (HF) stages among elderly hospitalized patients is unclear.Methods: We conducted a prospective, observational, multi-center, cohort study, including hospitalized patients with the sample size of 1,068; patients were age 65 years or more, able to cooperate with the assessment and to complete the echocardiogram. Two cardiologists classified all participants in various HF stages according to 2013 ACC/AHA HF staging guidelines. The outcome was rate of 1-year major adverse cardiovascular events (MACE). The Kaplan–Meier method and Cox proportional hazards models were used for survival analyses. Survival classification and regression tree analysis were used to determine the optimal cutoff of N-terminal pro-brain natriuretic peptide (NT-proBNP) to predict MACE.Results: Participants' mean age was 75.3 ± 6.88 years. Of them, 4.7% were healthy and without HF risk factors, 21.0% were stage A, 58.7% were stage B, and 15.6% were stage C/D. HF stages were associated with worsening 1-year survival without MACE (log-rank χ2 = 69.62, P < 0.001). Deterioration from stage B to C/D was related to significant increases in HR (3.636, 95% CI, 2.174–6.098, P < 0.001). Patients with NT-proBNP levels over 280.45 pg/mL in stage B (HR 2; 95% CI 1.112–3.597; P = 0.021) and 11,111.5 pg/ml in stage C/D (HR 2.603, 95% CI 1.014–6.682; P = 0.047) experienced a high incidence of MACE adjusted for age, sex, and glomerular filtration rate.Conclusions : HF stage B, rather than stage A, was most common in elderly inpatients. NT-proBNP may help predict MACE in stage B.Trial Registration: ChiCTR1800017204; 07/18/2018.

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Sleep Timing May Predict Congestive Heart Failure: A Community‐Based Cohort Study

Journal of the American Heart Association ◽

10.1161/jaha.120.018385 ◽

2021 ◽

Vol 10 (6) ◽

Author(s):

Bin Yan ◽

Ruohan Li ◽

Jiamei Li ◽

Xuting Jin ◽

Fan Gao ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Cohort Study ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Health Study ◽

Sleep Timing ◽

Cox Proportional Hazards Models ◽

Increased Risk

Background Previous studies have suggested that sleep timing is associated with cardiovascular risk factors. However, there is no evidence on the relationship between sleep timing and congestive heart failure (CHF). We aimed to examine this relationship in this study. Methods and Results We recruited 4765 participants (2207 men; mean age, 63.6±11.0 years) from the SHHS (Sleep Heart Health Study) database in this multicenter prospective cohort study. Follow‐up was conducted until the first CHF diagnosis between baseline and the final censoring date. Sleep timing (bedtimes and wake‐up times on weekdays and weekends) was based on a self‐reported questionnaire. Cox proportional hazard models were constructed to investigate the association between sleep timing and CHF. During the mean follow‐up period of 11 years, 519 cases of CHF (10.9%) were reported. The multivariable Cox proportional hazards models revealed that participants with weekday bedtimes >12:00 am (hazard ratio [HR], 1.56; 95% CI, 1.15–2.11; P =0.004) and from 11:01 pm to 12:00 am (HR, 1.25; 95% CI, 1.00–1.56; P =0.047) had an increased risk of CHF compared with those with bedtimes from 10:01 pm to 11:00 pm . After stratified analysis, the association was intensified in participants with a self‐reported sleep duration of 6 to 8 hours. Furthermore, wake‐up times >8:00 am on weekdays (HR, 1.53; 95% CI, 1.07–2.17; P =0.018) were associated with a higher risk of incident CHF than wake‐up times ≤6:00 am . Conclusions Delayed bedtimes (>11:00 pm ) and wake‐up times (>8:00 am ) on weekdays were associated with an increased risk of CHF.

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The Role of Blood Pressure in Carotid Plaque Incidence: Interactions With Body Mass Index, Age, and Sex-Based on a 7-Years Cohort Study

Frontiers in Physiology ◽

10.3389/fphys.2021.690094 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jian Liu ◽

Xuehua Ma ◽

Xue-Ling Ren ◽

Hong Xiao ◽

Leyuan Yan ◽

...

Keyword(s):

Blood Pressure ◽

Cohort Study ◽

Carotid Plaque ◽

Prognostic Value ◽

Proportional Hazards ◽

Linear Trend ◽

Cox Proportional Hazards ◽

Age And Gender ◽

Cox Proportional Hazards Models ◽

And Gender

Background: Although high blood pressure (BP) is a risk factor for carotid plaque, its long-term prognostic value might be underestimated due to its confounding interactions with BMI, age, and gender. Therefore, we conducted a 7-year prospective cohort study to evaluate the prognostic value of BP for the incidence of carotid plaque.Methods: The subjects enrolled in 2011 were free of carotid plaque at baseline and were followed up in 2018. Multivariate Cox proportional-hazards models were used to evaluate the association between BP and carotid plaque incidence.Results: During the follow-up study, the incidence of carotid plaque was 36.5%. The significant positive linear trend showed that subjects with higher BP levels at baseline were more likely to develop carotid plaques at the end. Especially in the female subpopulation, after confounders being adjusted, the carotid plaque was associated with higher BP (adjusted HR 1.52, 95% CI 1.02–2.26), pulse pressure (PP) (adjusted HR 1.15, 95% CI 0.76–1.75), and mean arterial pressure (MAP) (adjusted HR 1.44, 95% CI 1.00–2.08). The adjusted HRs of hypertension, PP, and MAP (HR 27.71, 95% CI 2.27–338.64; HR 14.47, 95% CI 1.53–137.18; HR 9.97, 95% CI 1.29–77.28) were significantly higher after the potential antagonistic interactions between BP categorical indicators and age being adjusted, respectively.Conclusion: High BP indicators might be associated with higher HRs of carotid plaque after adjusting interactions between BP indicators and BMI, age, and gender, which suggests that the incidence of carotid plaque in female adults with high BP indicators might increase significantly with the increase of age.

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Risk of depressive disorders after tobacco smoking cessation: a retrospective cohort study in Fukuoka, Japan

BMJ Open ◽

10.1136/bmjopen-2018-025124 ◽

2019 ◽

Vol 9 (3) ◽

pp. e025124 ◽

Cited By ~ 1

Author(s):

Takako Fujita ◽

Akira Babazono ◽

Yumi Harano ◽

Peng Jiang

Keyword(s):

Smoking Cessation ◽

Cohort Study ◽

Survival Analysis ◽

Retrospective Cohort ◽

Depressive Disorders ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Proportional Hazards Models ◽

Cox Proportional Hazards Models ◽

Significant Difference

ObjectiveWe sought to examine the effect of smoking cessation on subsequent development of depressive disorders.DesignThis was a retrospective cohort study.MethodsWe used administrative claim and health check data from fiscal years 2010 to 2014, obtained from the largest health insurance association in Fukuoka, Japan. Study participants were between 30 and 69 years old. The end-point outcome was incidence of depressive disorders. Survival analysis and Cox proportional hazards models were conducted. The evaluated potential confounders were sex, age, standard monthly income and psychiatric medical history.ResultsThe final number of participants was 87 255, with 7841 in the smoking cessation group and 79 414 in the smoking group. The result of survival analysis showed no significant difference in depressive disorders between the two groups. The results of Cox proportional hazards models showed no significant difference by multivariate analysis between participants, including users of smoking cessation medication (HR 1.04, 95% Cl 0.89 to 1.22) and excluding medication use (HR 0.97, 95% Cl 0.82 to 1.15).ConclusionsThe present study showed that there were no significant differences with respect to having depressive disorders between smoking cessation and smoking groups. We also showed that smoking cessation was not related to incidence of depressive disorders among participants, including and excluding users of smoking cessation medication, after adjusting for potential confounders. Although the results have some limitations because of the nature of the study design, our findings will provide helpful information to smokers, health professionals and policy makers for improving smoking cessation.

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A cohort study of dietary fibre intake and menarche

Public Health Nutrition ◽

10.1079/phn2002261 ◽

2002 ◽

Vol 5 (2) ◽

pp. 353-360 ◽

Cited By ~ 40

Author(s):

Malcolm M Koo ◽

Thomas E Rohan ◽

Meera Jain ◽

John R McLaughlin ◽

Paul N Corey

Keyword(s):

Cohort Study ◽

Dietary Intake ◽

Dietary Fibre ◽

Lower Risk ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Age At Menarche ◽

Relative Hazard ◽

Component Level ◽

Cox Proportional Hazards Models

AbstractObjective:To evaluate the influence of dietary fibre on menarche in a cohort of pre-menarcheal girls.Design:Prospective cohort study.Setting:Ontario, Canada.Subjects:Free-living pre-menarcheal girls (n = 637), 6 to 14 years of age.Methodology:Information on dietary intake, physical activity and date of menarche was collected at baseline and was updated annually by self-administered questionnaires for three years. Cox proportional hazards models were used to evaluate the association between dietary fibre and menarche, adjusting for age at entry to the study and potential confounders.Results:A higher intake of energy-adjusted dietary fibre was associated with a lower risk of (i.e. a later age at) menarche (relative hazard 0.54, 95% confidence interval (CI) 0.31–0.94 for highest vs. lowest quartile, P for trend = 0.027). At the fibre component level, a higher intake of energy-adjusted cellulose was associated with a lower risk of menarche (relative hazard 0.45, 95% CI 0.26–0.76, P for trend = 0.009).Conclusions:The findings are consistent with the hypothesis that pre-menarcheal dietary intake can influence menarche.

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Title: Risk factors for severe disease in patients admitted with COVID-19 to a hospital in London, England: a retrospective cohort study

10.1101/2020.09.24.20200337 ◽

2020 ◽

Author(s):

Jack W Goodall ◽

Thomas A N Reed ◽

Maddalena Ardissino ◽

Paul Bassett ◽

Ashley M Whittington ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Proportional Hazards ◽

Severe Disease ◽

Cox Proportional Hazards ◽

Hospitalized Patients ◽

Reactive Protein ◽

Global Pandemic ◽

Northwick Park Hospital ◽

Observational Cohort

COVID-19 has caused a major global pandemic and necessitated unprecedented public health restrictions in almost every country. Understanding risk factors for severe disease in hospitalized patients is critical as the pandemic progresses. This observational cohort study aimed to characterize the independent associations between the clinical outcomes of hospitalized patients and their demographics, comorbidities, blood tests and bedside observations. All patients admitted to Northwick Park Hospital, London, United Kingdom between 12 March and 15 April 2020 with COVID-19 were retrospectively identified. The primary outcome was death. Associations were explored using Cox proportional hazards modelling. The study included 981 patients. The mortality rate was 36.0%. Age (adjusted hazard ratio (aHR) 1.53), respiratory disease (aHR 1.37), immunosuppression (aHR 2.23), respiratory rate (aHR 1.28), hypoxia (aHR 1.36), Glasgow Coma Score <15 (aHR 1.92), urea (aHR 2.67), alkaline phosphatase (aHR 2.53), C-reactive protein (aHR 1.15), lactate (aHR 2.67), platelet count (aHR 0.77) and infiltrates on chest radiograph (aHR 1.89) were all associated with mortality. These important data will aid clinical risk stratification and provide direction for further research.

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U-Shaped Association of Serum Uric Acid With All-Cause and Cause-Specific Mortality in US Adults: A Cohort Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz068 ◽

2019 ◽

Vol 105 (3) ◽

pp. e597-e609 ◽

Cited By ~ 1

Author(s):

Lihua Hu ◽

Guiping Hu ◽

Benjamin Ping Xu ◽

Lingjuan Zhu ◽

Wei Zhou ◽

...

Keyword(s):

Uric Acid ◽

Cohort Study ◽

Serum Uric Acid ◽

Inflection Point ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Proportional Hazards Models ◽

Cox Proportional Hazards Models ◽

Specific Mortality ◽

The Relationship

Abstract Background In addition to the controversy regarding the association of hyperuricemia with mortality, uncertainty also remains regarding the association between low serum uric acid (SUA) and mortality. We aimed to assess the relationship between SUA and all-cause and cause-specific mortality. Methods This cohort study included 9118 US adults from the National Health and Nutrition Examination Survey (1999-2002). Multivariable Cox proportional hazards models were used to evaluate the relationship between SUA and mortality. Our analysis included the use of a generalized additive model and smooth curve fitting (penalized spline method), and 2-piecewise Cox proportional hazards models, to address the nonlinearity between SUA and mortality. Results During a median follow-up of 5.83 years, 448 all-cause deaths occurred, with 100 cardiovascular disease (CVD) deaths, 118 cancer deaths, and 37 respiratory disease deaths. Compared with the reference group, there was an increased risk of all-cause, CVD, cancer, and respiratory disease mortality for participants in the first and third tertiles of SUA. We further found a nonlinear and U-shaped association between SUA and mortality. The inflection point for the curve was found at a SUA level of 5.7 mg/dL. The hazard ratios (95% confidence intervals) for all-cause mortality were 0.80 (0.65-0.97) and 1.24 (1.10-1.40) to the left and right of the inflection point, respectively. This U-shaped association was observed in both sexes; the inflection point for SUA was 6 mg/dL in males and 4 mg/dL in females. Conclusion Both low and high SUA levels were associated with increased all-cause and cause-specific mortality, supporting a U-shaped association between SUA and mortality.

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Association of household secondhand smoke exposure and mortality risk in patients with heart failure

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-1269-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Xin He ◽

Jingjing Zhao ◽

Jiangui He ◽

Yugang Dong ◽

Chen Liu

Keyword(s):

Heart Failure ◽

Mortality Risk ◽

Secondhand Smoke ◽

Proportional Hazards ◽

Univariate Analysis ◽

Cox Proportional Hazards ◽

Heart Failure Patients ◽

Cox Proportional Hazards Models ◽

Patients With Heart Failure ◽

Shs Exposure

Abstract Background Secondhand smoke (SHS) exposure is a well-established cardiovascular risk factor, yet association between SHS and prognosis of heart failure remains uncertain. Method Data were obtained from the US National Health and Nutrition Examination Surveys III from 1988 to 1994. Currently nonsmoking adults with a self-reported history of heart failure were included. Household SHS exposure was assessed by questionnaire. Participants were followed up through December 31, 2011. Cox proportional-hazards models were used to assess the association of household SHS exposure and mortality risk. Potential confounding factors were adjusted. Results Of 572 currently nonsmoking patients with heart failure, 88 were exposed to household SHS while 484 were not. There were totally 475 deaths during follow-up. In univariate analysis, household SHS was not associated with mortality risk (hazard ratio [HR]: 0.98, 95% confidence interval [CI]: 0.76–1.26, p = 0.864). However, after adjustment for demographic variables, socioeconomic variables and medication, heart failure patients in exposed group had a 43% increase of mortality risk compared with those in unexposed group (HR: 1.43, 95% CI: 1.10–1.86, p = 0.007). Analysis with further adjustment for general health status and comorbidities yielded similar result (HR: 1.47, 95% CI: 1.13–1.92, p = 0.005). Conclusion Household SHS exposure was associated with increased mortality risk in heart failure patients.

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Use of single polymorphism arrays (SNP-A) to modify prognostic scoring systems for myelodysplastic syndromes.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.6521 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 6521-6521

Author(s):

Manojkumar Bupathi ◽

Paul Elson ◽

Visconte Valeria ◽

Fabiola Traina ◽

Christine O' Keefe ◽

...

Keyword(s):

Prognostic Value ◽

Proportional Hazards ◽

Uniparental Disomy ◽

Scoring Systems ◽

Risk Groups ◽

Cox Proportional Hazards ◽

Clinical Factors ◽

Cox Proportional Hazards Models ◽

Revised Definitions ◽

Endpoint Data

6521 Background: MDS are hematologic neoplasms characterized by dysplasia and cytopenias. Two commonly used risk stratifications, IPSS (Greenberg et al Blood 1997) and IPSS-R are based on clinical factors (marrow blasts, number of cytopenias and genetic abnormalities determined by conventional karyotyping), with the IPSS based on 4 cytogenetic risk groups and the IPSS-R based on 5 cytogenetic risk groups defined by Schanz et al JCO 2012. A drawback to metaphase cytogenetics (MC) is its inability to detect small cryptic chromosomal defects and uniparental disomy (UPD). SNP-A can identify these small cytogenetic lesions/UPD and has been shown to be of prognostic value in MDS. The goal of this investigation was to determine if SNP-A detected defects could be used to refine the IPSS and IPSS-R. Methods: SNP-A karyotyping was performed as previously described (Tiu et al, Blood, 2011). We reviewed data from 327 patients idenfitying SNP-A results, MC, and the IPSS/IPSS-R-related clinical factors were identified. Overall survival (OS) measured from the date of sampling for SNP-A karyotyping was the primary endpoint. Data were analyzed using Cox proportional hazards models. Results: SNP-A lesions not detected by MC were grouped as 1) none or only gains/losses; 2) UPD only or gains+losses but no UPD; and 3) UPD+other defects. The frequencies/median os in months (mo) of the groups were: 66%/20.0, 23%/12.7 and 11%/5.8, respectively, p<.0001 for OS. Combining the SNP-A groups with MC resulted in revised definitions of cytogenetic risk that had better discrimination than the underlying models; and when combined with the relevant clinical factors resulted in refined IPSS (IPSSSNP-A) and IPSS-R (IPSS-RSNP-A) risk stratifications (Table). Conclusions: Detection of chromosomal gains, losses, and UPD by SNP-A has prognostic value in MDS and can be used to refine current risk stratifications. [Table: see text]

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Depression as a risk factor for the development of rheumatoid arthritis: a population-based cohort study

RMD Open ◽

10.1136/rmdopen-2018-000670 ◽

2018 ◽

Vol 4 (2) ◽

pp. e000670 ◽

Cited By ~ 12

Author(s):

Isabelle A Vallerand ◽

Ryan T Lewinson ◽

Alexandra D Frolkis ◽

Mark W Lowerison ◽

Gilaad G Kaplan ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Future Research ◽

Health Improvement ◽

Proportional Hazards Models ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

Antidepressant Use

ObjectivesMajor depressive disorder (MDD) is associated with increased levels of systemic proinflammatory cytokines, including tumour necrosis factor alpha. As these cytokines are pathogenic in autoimmune diseases such as rheumatoid arthritis (RA), our aim was to explore on a population-level whether MDD increases the risk of developing RA.MethodsA retrospective cohort study was conducted using The Health Improvement Network (THIN) database (from 1986 to 2012). Observation time was recorded for both the MDD and referent cohorts until patients developed RA or were censored. Cox proportional hazards models were used to determine the risk of developing RA among patients with MDD, accounting for age, sex, medical comorbidities, smoking, body mass index and antidepressant use.ResultsA cohort of 403 932 patients with MDD and a referent cohort of 5 339 399 patients without MDD were identified in THIN. Cox proportional hazards models revealed a 31% increased risk of developing RA among those with MDD in an unadjusted model (HR=1.31, 95% CI 1.25 to 1.36, p<0.0001). When adjusting for all covariates, the risk remained significantly increased among those with MDD (HR=1.38, 95% CI 1.31 to 1.46, p<0.0001). Antidepressant use demonstrated a confounding effect that was protective on the association between MDD and RA.ConclusionMDD increased the risk of developing RA by 38%, and antidepressants may decrease this risk in these patients. Future research is necessary to confirm the underlying mechanism of MDD on the pathogenesis of RA.

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Higher postoperative plasma EV PD-L1 predicts poor survival in patients with gastric cancer

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-002218 ◽

2021 ◽

Vol 9 (3) ◽

pp. e002218

Author(s):

Gaopeng Li ◽

Guoliang Wang ◽

Fenqing Chi ◽

Yuqi Jia ◽

Xi Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Prognostic Value ◽

Proportional Hazards ◽

Prognostic Indicator ◽

High Plasma ◽

Cox Proportional Hazards ◽

Serum Biomarkers ◽

Poor Survival ◽

Term Survival ◽

Cox Proportional Hazards Models

BackgroundThe satisfactory prognostic indicator of gastric cancer (GC) patients after surgery is still lacking. Perioperative plasma extracellular vesicular programmed cell death ligand-1 (ePD-L1) has been demonstrated as a potential prognosis biomarker in many types of cancers. The prognostic value of postoperative plasma ePD-L1 has not been characterized.MethodsWe evaluated the prognostic value of preoperative, postoperative and change in plasma ePD-L1, as well as plasma soluble PD-L1, in short-term survival of GC patients after surgery. The Kaplan-Meier survival model and Cox proportional hazards models for both univariate and multivariate analyzes were used. And the comparison between postoperative ePD-L1 and conventional serum biomarkers (carcinoembryonic antigen (CEA), cancer antigen 19–9 (CA19-9) and CA72-4) in prognostic of GC patients was made.ResultsThe prognostic value of postoperative ePD-L1 is superior to that of preoperative ePD-L1 on GC patients after resection, and also superior to that of conventional serum biomarkers (CEA, CA19-9 and CA72-4). The levels of postoperative ePD-L1 and ePD-L1 change are independent prognostic factors for overall survival and recurrence free survival of GC patients. High plasma level of postoperative ePD-L1 correlates significantly with poor survival, while high change in ePD-L1 level brings the significant survival benefit.ConclusionsThe level of plasma postoperative ePD-L1 could be considered as a candidate prognostic biomarker of GC patients after resection.

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