scholarly journals Association Between PM2.5 and Daily Hospital Admissions for Heart Failure: A Time-Series Analysis in Beijing

2018 ◽  
Vol 15 (10) ◽  
pp. 2217 ◽  
Author(s):  
Man Li ◽  
Yao Wu ◽  
Yao-Hua Tian ◽  
Ya-Ying Cao ◽  
Jing Song ◽  
...  
Keyword(s):  
Heart Failure ◽  
Time Series ◽  
Degrees Of Freedom ◽  
Hospital Admissions ◽  
Scientific Evidence ◽  
Poisson Model ◽  
Sensitivity Analyses ◽  
Calendar Time ◽  
Medical Claim ◽  
Increased Risk

There is little evidence that acute exposure to fine particulate matter (PM2.5) impacts the rate of hospitalization for congestive heart failure (CHF) in developing countries. The primary purpose of the present retrospective study was to evaluate the short-term association between ambient PM2.5 and hospitalization for CHF in Beijing, China. A total of 15,256 hospital admissions for CHF from January 2010 to June 2012 were identified from Beijing Medical Claim Data for Employees and a time-series design with generalized additive Poisson model was used to assess the obtained data. We found a clear significant exposure response association between PM2.5 and the number of hospitalizations for CHF. Increasing PM2.5 daily concentrations by 10 μg/m3 caused a 0.35% (95% CI, 0.06–0.64%) increase in the number of CHF admissions on the same day. We also found that female and older patients were more susceptible to PM2.5. These associations remained significant in sensitivity analyses involving changing the degrees of freedom of calendar time, temperature, and relative humidity. PM2.5 was associated with significantly increased risk of hospitalization for CHF in this citywide study. These findings may contribute to the limited scientific evidence about the acute impacts of PM2.5 on CHF in China.

scholarly journals Why do frail patients with chronic heart failure die and become hospitalised?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Sze ◽  
P Pellicori ◽  
J Zhang ◽  
J Weston ◽  
A.L Clark
Keyword(s):  
Heart Failure ◽  
Cause Of Death ◽  
Hospital Admissions ◽  
Average Length ◽  
Significant Proportion ◽  
Length Of Hospital Stay ◽  
Clinical Frailty Scale ◽  
Frail Patients ◽  
Increased Risk

Abstract Background Frailty is common in patients with heart failure (HF) and is associated with increased morbidity and mortality. A better understanding of the causes of hospitalisations and death in frail patients might help to tailor interventional strategies for these at-risk patients. Purpose We studied the cause of death and hospitalisations in ambulatory patients with HF and frailty. Methods We assessed frailty using the clinical frailty scale (CFS) in consecutive HF patients attending a routine follow-up visit. Those with CFS ≥5 were classified as frail. Mortality and hospitalisations were ascertained from medical records (updated systematically using an NHS electronic database), discharge letters, autopsy reports and death certificates. We studied the primary cause of death and hospitalisations within one year of enrolment. Results 467 patients (67% male, median (IQR) age 76 (69–82) years, median (IQR) NT-proBNP 1156 (469–2463) ng/L) were enrolled. 206 (44%) patients were frail. Frail patients were more likely to not receive or receive suboptimal doses of ACEi/ARB and Beta-blockers; while non-frail patients were more likely to be treated with optimal doses. At 1-year follow up, there were 56 deaths and 322 hospitalisations, of which 46 (82%) and 215 (67%) occurred in frail patients. Frailty was associated with an increased risk of all-cause mortality (HR (95% CI): 4.27 (2.60–7.01)) and combined mortality/ hospitalisation (HR (95% CI): 2.85 (2.14–3.80)), all p<0.001. 57% (n=26) of frail patients died of cardiovascular causes (of which 58% were due to HF progression); although deaths due to non-cardiovascular causes (43%, n=20), especially severe infections, were also common (26%, n=12). (Figure 1) The proportion of frail patients who had non-elective hospital admissions within 1 year was more than double that of non-frail patients (46% (n=96) vs 21% (n=54); p<0.001). Compared to non-frail patients, frail patients had more recurrent (≥2) hospitalisations (28% (n=59) vs 9% (n=24); p<0.001) but median (IQR) average length of hospital stay was not significantly different (frail: 6 (4–11) vs non-frail: 6 (2–12) days, p=0.50). A large proportion of hospitalisations (64%, n=137) in frail patients were due to non-cardiovascular causes (of which 34%, 30% and 20% were due to infections, falls and comorbidities respectively). Of cardiovascular hospitalisations (36%, n=78), the majority were due to decompensated HF (67%, n=46). (Figure 1) Conclusion Frailty is common in patients with HF and is associated with an increased risk of mortality and recurrent hospitalisations. A significant proportion suffered non-cardiovascular deaths and hospitalisations. This implies that interventions targeted at HF alone can only have limited impact on outcomes in frail patients. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals The Bi-directional Impact of Two Chronic Illnesses: Heart Failure and Diabetes – A review of the Epidemiology and Outcomes

2015 ◽  
Vol 1 (1) ◽  
pp. 8 ◽  
Author(s):  
Patrick Campbell ◽  
Selim Krim ◽  
Hector Ventura ◽  
◽  
◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Hospital Admissions ◽  
Chronic Illnesses ◽  
Morbidity And Mortality ◽  
Developing Heart ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
The Us ◽  
Failure Experience

Heart failure and diabetes mellitus contribute significantly to the morbidity and mortality of the US population. The combined economic impact on the US health care system reaches nearly $300 billion. Much of this cost stems from the frequent hospital admissions and direct cost of managing the two diseases. The presence of diabetes significantly increases the risk of developing heart failure compared to the general population and diabetics with heart failure experience significantly higher mortality. Patients with heart failure have a high incidence of insulin resistance and are at increased risk of developing diabetes mellitus. Traditionally these two chronic illnesses have been managed in relative isolation. However the adverse effects of each disease has significant impact on the other. The combination of heart failure and diabetes mellitus significantly increases the morbidity and mortality compared to either in isolation. This paper reviews the epidemiology and impact of the bidirectional effects of these two chronic illnesses.

Kardiale Ereignisse nach Antibiotika-Behandlung bei Krankenhauspatienten mit ambulant erworbener Pneumonie

2019 ◽  
Vol 7 (4) ◽  
pp. 198-199
Author(s):  
Stefan Krüger
Keyword(s):  
Heart Failure ◽  
Myocardial Ischemia ◽  
Cardiac Event ◽  
Empirical Therapy ◽  
Cluster Randomized Trial ◽  
Sensitivity Analyses ◽  
Beta Lactam ◽  
Cardiac Events ◽  
Confounding Bias ◽  
Increased Risk

Background: Guidelines recommend macrolides and fluoroquinolones in patients hospitalized with communityacquired pneumonia (CAP), but their use has been associated with cardiac events. We quantified associations between macrolide and fluoroquinolone use and cardiac events in patients hospitalized with CAP in non-ICU wards.Methods: This was a post-hoc analysis of a cluster-randomized trial as a cohort study; including patients with a working diagnosis of CAP admitted to non-ICU wards without a cardiac event on admission. We calculated causespecific hazard ratio's (HR's) for effects of time-dependent macrolide and fluoroquinolone exposure as compared to beta-lactam monotherapy on cardiac events, defined as new or worsening heart failure, arrhythmia, or myocardial ischemia during hospitalization.Results: Cardiac events occurred in 146 (6.9%) of 2107 patients, including heart failure (n = 101, 4.8%), arrhythmia (n = 53, 2.5%), and myocardial ischemia (n = 14, 0.7%). These occurred in 11 of 207 (5.3%), 18 of 250 (7.2%), and 31 of 277 (11.2%) patients exposed to azithromycin, clarithromycin, and erythromycin for at least one day, and in 9 of 234 (3.8%), 5 of 194 (2.6%), and 23 of 566 (4.1%) exposed to ciprofloxacin, levofloxacin, and moxifloxacin, respectively. HR's for erythromycin, compared to beta-lactam monotherapy, on any cardiac event and heart failure were 1.60 (95% CI 1.09;2.36) and 1.89 (95% CI 1.22;2.91), respectively. HR's for levofloxacin and moxifloxacin, compared to beta-lactam monotherapy, on any cardiac event were 0.40 (95% CI 0.18;0.87)and 0.56 (95% CI 0.36;0.87), respectively. Findings remained consistent after adjustment for confounders and/or in a sensitivity analysis of radiologically confirmed CAP (n = 1604, 76.1%).Conclusions: Among patients with CAP hospitalized to non-ICU wards, erythromycin use was associated with a 68% increased risk of hospital-acquired cardiac events, mainly heart failure. Levofloxacin and moxifloxacin were associated with a lower risk of heart failure. Although our study does not fully exclude confounding bias, findings remained largely unchanged in crude, adjusted, and sensitivity analyses. These findings may caution the use of erythromycinas empirical therapy in these patients.Trial registration: The original trial was retrospectively registered under ClinicalTrials.gov Identifier NCT01660204 on August 8th, 2012.

scholarly journals Economic Modeling of Heart Failure Telehealth Programs: When Do They Become Cost Saving?

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Sheena Xin Liu ◽  
Rui Xiang ◽  
Charles Lagor ◽  
Nan Liu ◽  
Kathleen Sullivan
Keyword(s):  
Heart Failure ◽  
Cost Saving ◽  
Hospital Admissions ◽  
Clinical Performance ◽  
Cost Savings ◽  
Time Frame ◽  
Economic Modeling ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Life Year Gain

Telehealth programs for congestive heart failure have been shown to be clinically effective. This study assesses clinical and economic consequences of providing telehealth programs for CHF patients. A Markov model was developed and presented in the context of a home-based telehealth program on CHF. Incremental life expectancy, hospital admissions, and total healthcare costs were examined at periods ranging up to five years. One-way and two-way sensitivity analyses were also conducted on clinical performance parameters. The base case analysis yielded cost savings ranging from$2832 to$5499 and 0.03 to 0.04 life year gain per patient over a 1-year period. Applying telehealth solution to a low-risk cohort with no prior admission history would result in$2502 cost increase per person over the 1-year time frame with 0.01 life year gain. Sensitivity analyses demonstrated that the cost savings were most sensitive to patient risk, baseline cost of hospital admission, and the length-of-stay reduction ratio affected by the telehealth programs. In sum, telehealth programs can be cost saving for intermediate and high risk patients over a 1- to 5-year window. The results suggested the economic viability of telehealth programs for managing CHF patients and illustrated the importance of risk stratification in such programs.

scholarly journals Impact of abolishing prescription fees in Scotland on hospital admissions and prescribed medicines: an interrupted time series evaluation

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e021318 ◽  
Author(s):  
Andrew James Williams ◽  
William Henley ◽  
John Frank
Keyword(s):  
Diabetes Mellitus ◽  
Time Series ◽  
Hospital Admissions ◽  
Intervention Group ◽  
Interrupted Time Series ◽  
Sensitivity Analyses ◽  
Sufficient Evidence ◽  
Its Analysis ◽  
General Practices ◽  
Prescribed Medicines

ObjectivesTo identify whether the abolition of prescription fees in Scotland resulted in: (1) Increase in the number (cost to NHS) of medicines prescribed for which there had been a fee (inhaled corticosteroids). (2) Reduction in hospital admissions for conditions related to those medications for which there had been a fee (asthma or chronic obstructive pulmonary disease (COPD))—when both are compared with prescribed medicines and admissions for a condition (diabetes mellitus) for which prescriptions were historically free.DesignNatural experimental retrospective general practice level interrupted time series (ITS) analysis using administrative data.SettingGeneral practices, Scotland, UK.Participants732 (73.6%) general practices across Scotland with valid dispensed medicines and hospital admissions data during the study period (July 2005–December 2013).InterventionReduction in fees per dispensed item from April 2008 leading to the abolition of the fee in April 2011, resulting in universal free prescriptions.Primary and secondary outcomesHospital admissions recorded in the Scottish Morbidity Record – 01 Inpatient (SMR01) and dispensed medicines recorded in the Prescribing Information System (PIS).ResultsThe ITS analysis identified marked step reductions in adult (19–59 years) admissions related to asthma or COPD (the intervention group), compared with older or young people with the same conditions or adults with diabetes mellitus (the counterfactual groups). The prescription findings were less coherent and subsequent sensitivity analyses found that both the admissions and prescriptions data were highly variable above the annual or seasonal level, limiting the ability to interpret the findings of the ITS analysis.ConclusionsThis study did not find sufficient evidence that universal free prescriptions was a demonstrably effective or ineffective policy, in terms of reducing hospital admissions or reducing socioeconomic inequality in hospital admissions, in the context of a universal, publicly administered medical care system, the National Health Service of Scotland.

scholarly journals The effect of outdoor air pollution on the risk of hospitalisation for bronchiolitis in infants: a systematic review

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5352 ◽  
Author(s):  
Charlotte King ◽  
Jamie Kirkham ◽  
Daniel Hawcutt ◽  
Ian Sinha
Keyword(s):  
Systematic Review ◽  
Air Pollution ◽  
Time Series ◽  
Hospital Admissions ◽  
Positive Association ◽  
World Health ◽  
Gaseous Pollutants ◽  
Eligibility Criteria ◽  
Relevant Effect ◽  
Increased Risk

Objective To systematically review the evidence around the effect of ambient levels of particulate and gaseous pollutants, and the risk of hospitalisation with bronchiolitis for infants under two years of age. Design Systematic review of observational epidemiological studies including cohort, time series, case crossover and case control study designs. Data sources Medline, Scopus, and Web of Science searched to November 2017 with no language restrictions. Eligibility criteria Studies investigating impact of air pollution levels on particulate pollutants (diameter <2.5 μm (PM2.5) or <10 μm (PM10) and gaseous pollutants (nitrogen dioxide (NO2), sulphur dioxide (SO2), carbon monoxide (CO), ozone (O3)) on hospital admission for bronchiolitis. Main outcome measure Risk of hospitalisation from bronchiolitis. Results Eight studies were eligible for review. Long term exposure to PM2.5 may be associated with increased risk of hospitalisation for bronchiolitis. SO2 may also be associated with hospitalisation, but results for other pollutants are inconsistent between studies. In three of the five studies that showed a positive association between air pollutants and hospitalisation, measured concentrations were below World Health Organization (WHO) recommended levels. Conclusions Certain particulate and gaseous pollutants may have a clinically relevant effect on hospital admissions for bronchiolitis in children below age two years old. Large cohort or time series studies are needed to examine this possible association. Protocol The protocol can be found at PROSPERO (CRD42017080643).

scholarly journals Cardiac Abnormalities in COVID-19 Patients: Should a Cardiac Echocardiogram be Routine?

2021 ◽  
Author(s):  
Carina Ramalho ◽  
Mariana Almeida ◽  
Francisco Gomes ◽  
Magda Silva ◽  
Silvia Rodrigues
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Heart Disease ◽  
Left Ventricle ◽  
Cardiac Function ◽  
Ischaemic Heart Disease ◽  
Scientific Evidence ◽  
Thromboembolic Events ◽  
Systemic Embolization ◽  
Increased Risk

Current scientific evidence shows that SARS-CoV-2 infection is associated with an increased risk of thromboembolic events. In patients with ischaemic heart disease and heart failure, thrombi of the left ventricle can increase patient mortality, mainly due to the risk of systemic embolization. Given the hypercoagulable state associated with COVID-19, such events may be more likely. We describe a patient hospitalized for congestive heart failure and SARS-CoV-2 infection who was diagnosed with a thrombus in the left ventricle. After the thrombus was identified on echocardiography and treated with anticoagulation, it completely resolved and cardiac function improved.

scholarly journals An electronic health records cohort study on heart failure following myocardial infarction in England: incidence and predictors

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e018331 ◽  
Author(s):  
Johannes M I H Gho ◽  
Amand F Schmidt ◽  
Laura Pasea ◽  
Stefan Koudstaal ◽  
Mar Pujades-Rodriguez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Electronic Health Records ◽  
Hospital Admissions ◽  
Sensitivity Analyses ◽  
Mortality Data ◽  
Care Hospital ◽  
Health Records ◽  
Primary Care Hospital ◽  
Electronic Health

ObjectivesTo investigate the incidence and determinants of heart failure (HF) following a myocardial infarction (MI) in a contemporary cohort of patients with MI using routinely collected primary and hospital care electronic health records (EHRs).MethodsData were used from the CALIBER programme, linking EHRs in England from primary care, hospital admissions, an MI registry and mortality data. Subjects were eligible if they were 18 years or older, did not have a history of HF and survived a first MI. Factors associated with time to HF were examined using Cox proportional hazard models.ResultsOf the 24 479 patients with MI, 5775 (23.6%) developed HF during a median follow-up of 3.7 years (incidence rate per 1000 person-years: 63.8, 95% CI 62.2 to 65.5). Baseline characteristics significantly associated with developing HF were: atrial fibrillation (HR 1.62, 95% CI 1.51 to 1.75), age (per 10 years increase: 1.45, 1.41 to 1.49), diabetes (1.45, 1.35 to 1.56), peripheral arterial disease (1.38, 1.26 to 1.51), chronic obstructive pulmonary disease (1.28, 1.17 to 1.40), greater socioeconomic deprivation (5th vs 1st quintile: 1.27, 1.13 to 1.41), ST-segment elevation MI at presentation (1.19, 1.11 to 1.27) and hypertension (1.16, 1.09 to 1.23). Results were robust to various sensitivity analyses such as competing risk analysis and multiple imputation.ConclusionIn England, one in four survivors of a first MI develop HF within 4 years. This contemporary study demonstrates that patients with MI are at considerable risk of HF. Baseline patient characteristics associated with time until HF were identified, which may be used to target preventive strategies.

scholarly journals Pergolide Associated Cardiac Valvulopathy Based on Ontario Administrative Data

2008 ◽  
Vol 35 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Cindy Zadikoff ◽  
Minh Duong-Hua ◽  
Kathy Sykora ◽  
Connie Marras ◽  
Anthony Lang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
Hospital Admissions ◽  
Population Based ◽  
Hazard Ratio ◽  
Exposure Effect ◽  
Increased Risk ◽  
Secondary Objective

Introduction:Pergolide is an ergot derived dopamine agonist that is widely used for the treatment of Parkinson’s disease. Studies have found an association between pergolide and valvular heart abnormalities although there is still much to be learned about the clinical significance of the valvular changes, who is at risk, and whether there is duration of exposure effect.Objective:To assess the long term risk of hospital admissions for valvular heart disease (VHD) or congestive heart failure (CHF, a clinically overt outcome of VHD) in new users of pergolide compared to new users of levodopa. The secondary objective was to assess whether there are any characteristics that can predict who is at higher risk of developing this outcome.Design:Retrospective, population-based cohort study.Setting:Ontario, Canada.Subjects:Ontario residents aged 66 and older, newly started on treatment with either pergolide or levodopa.Outcomes:Admission to hospital with the most responsible diagnosis of congestive heart failure or valvular heart disease.Results:The risk for admission for valvular heart disease or congestive heart failure were higher in those with 1-4 years exposure to pergolide compared with no exposure to pergolide (VHD: hazard ratio 2.4, p = 0.04; CHF: hazard ratio 1.6, p =0.02). No such pattern was found with exposure to levodopa.Conclusion:Our study demonstrates that treatment with pergolide is associated with a higher risk of hospital admission for valvular heart disease or congestive heart failure and that this risk is greater in those with 1-4 years exposure than in those with less exposure. We did not find an increased risk beyond four years.

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