Assessing joint spatial autocorrelations between mortality rates due to cardiovascular conditions in South Africa

South Africa is experiencing an increasing burden of noncommunicable diseases (NCDs). There is evidence of co-morbidity of several NCDs at small geographical areas in the country. However, the extent to which this applies to joint spatial autocorrections of NCDs is not known. The objective of this study was to derive and quantify multivariate spatial autocorrections for NCDrelated mortality in South Africa. The study used mortality attributable to cerebrovascular, ischaemic heart failure and hypertension captured by the country’s Department of Home Affairs for the years 2001, 2007 and 2011. Both univariate and pairwise spatial clustering measures were derived using observed, empirical Bayes smoothed and age-adjusted standardised mortality rates. Cerebrovascular and ischaemic heart co-clustering was significant for the years 2001 and 2011. Cerebrovascular and hypertension co-clustering was significant for the years 2007 and 2011, while hypertension and ischaemic heart co-clustering was significant for the year 2011. Co-clusters of cerebrovascular-ischaemic heart disease are the most profound and located in the south-western part of the country. It was successfully demonstrated that bivariate spatial autocorrelations can be derived for spatially dependent mortality rates as exemplified by mortality rates attributed to three cardiovascular conditions. The identified co-clusters of spatially dependent health outcomes may be targeted for an integrated intervention and monitoring programme.

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A Comparison Between Selected Noncommunicable Disease Mortality Rates Between 2010 and 2016 Among Selected Southern African Countries

International Quarterly of Community Health Education ◽

10.1177/0272684x20916588 ◽

2020 ◽

Vol 41 (2) ◽

pp. 119-123 ◽

Cited By ~ 1

Author(s):

T. J. Ellapen ◽

M. Barnard ◽

G. L. Strydom ◽

K. M. Masime ◽

Y. Paul

Keyword(s):

Diabetes Mellitus ◽

South Africa ◽

Respiratory Diseases ◽

Mortality Rates ◽

Noncommunicable Disease ◽

Noncommunicable Diseases ◽

African Countries ◽

Death Rates ◽

Chronic Respiratory Diseases ◽

Disease Mortality

Researchers have identified cancer, diabetes mellitus, cardiovascular, and respiratory diseases as being the principal pathologies of increased aged standardized death rates (ASDRs) among noncommunicable diseases (NCDs). The objective of this study was to compare the change in the ASDR of these principal NCDs between the years 2010 and 2016 in Botswana, Mozambique, Namibia, South Africa, and Zimbabwe. ASDR data were collected from the 2016 Global Health Estimate. Among the selected Southern African countries for both 2010 and 2016, the order of prevalence of NCDs linked to increased ASDR was cardiovascular diseases (both cardiac and stroke), cancer, diabetes mellitus, and chronic respiratory diseases. The percentage of the total number of NCDs linked to increased ASDR in relation to total deaths increased from 43.8% (in 2010) to 51.0% (in 2016) from ( p < .0001). The percentage of principal NCDs in relation to total ASDR increased from 33.0% (in 2010) to 38.2% (in 2016; p < .0001).

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Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews

BMC Public Health ◽

10.1186/s12889-020-09855-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Pawel Posadzki ◽

Dawid Pieper ◽

Ram Bajpai ◽

Hubert Makaruk ◽

Nadja Könsgen ◽

...

Keyword(s):

Physical Activity ◽

Health Outcomes ◽

Systematic Reviews ◽

Effect Size ◽

Methodological Quality ◽

Prediction Interval ◽

Mortality Rates ◽

Noncommunicable Diseases ◽

Cochrane Library

Abstract Background Sedentary lifestyle is a major risk factor for noncommunicable diseases such as cardiovascular diseases, cancer and diabetes. It has been estimated that approximately 3.2 million deaths each year are attributable to insufficient levels of physical activity. We evaluated the available evidence from Cochrane systematic reviews (CSRs) on the effectiveness of exercise/physical activity for various health outcomes. Methods Overview and meta-analysis. The Cochrane Library was searched from 01.01.2000 to issue 1, 2019. No language restrictions were imposed. Only CSRs of randomised controlled trials (RCTs) were included. Both healthy individuals, those at risk of a disease, and medically compromised patients of any age and gender were eligible. We evaluated any type of exercise or physical activity interventions; against any types of controls; and measuring any type of health-related outcome measures. The AMSTAR-2 tool for assessing the methodological quality of the included studies was utilised. Results Hundred and fifty CSRs met the inclusion criteria. There were 54 different conditions. Majority of CSRs were of high methodological quality. Hundred and thirty CSRs employed meta-analytic techniques and 20 did not. Limitations for studies were the most common reasons for downgrading the quality of the evidence. Based on 10 CSRs and 187 RCTs with 27,671 participants, there was a 13% reduction in mortality rates risk ratio (RR) 0.87 [95% confidence intervals (CI) 0.78 to 0.96]; I2 = 26.6%, [prediction interval (PI) 0.70, 1.07], median effect size (MES) = 0.93 [interquartile range (IQR) 0.81, 1.00]. Data from 15 CSRs and 408 RCTs with 32,984 participants showed a small improvement in quality of life (QOL) standardised mean difference (SMD) 0.18 [95% CI 0.08, 0.28]; I2 = 74.3%; PI -0.18, 0.53], MES = 0.20 [IQR 0.07, 0.39]. Subgroup analyses by the type of condition showed that the magnitude of effect size was the largest among patients with mental health conditions. Conclusion There is a plethora of CSRs evaluating the effectiveness of physical activity/exercise. The evidence suggests that physical activity/exercise reduces mortality rates and improves QOL with minimal or no safety concerns. Trial registration Registered in PROSPERO (CRD42019120295) on 10th January 2019.

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Valvular Heart Disease in Heart Failure

International Cardiovascular Forum Journal ◽

10.17987/icfj.v10i0.453 ◽

2017 ◽

Vol 10 ◽

Author(s):

Giuseppe Rosano

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Valvular Heart Disease ◽

Severe Aortic Stenosis ◽

Clinical Status ◽

Heart Team ◽

Hybrid Procedures ◽

Increased Risk ◽

Co Morbidity ◽

Patients With Heart Failure

Structural valvular heart disease may be the cause of heart failure or may worsen the clinical status of patients with heart failure. Heart failure may also develop in patients treated with valve surgery. Patients with heart failure with valvular heart disease are at increased risk of events including sudden cardiac death. Before considering intervention (surgical or percutaneous) all patients should receive appropriate medical and device therapy taking into account that vasodilators must be used with caution in patients with severe aortic stenosis. Numerous percutaneous and/or hybrid procedures have been introduced in the past few years and they are changing the management of valvular heart disease. In patients with heart failure and valvular heart disease, either primary or functional, the whole process of decision-making should be staged through a comprehensive evaluation of the risk– benefit ratio of different treatment strategies and should be made by a multidisciplinary ‘heart team’ with a particular expertise in valvular heart disease. The heart team should include heart failure cardiologists, cardiac surgeons/structural valve interventionists, imaging specialists, anaesthetists, geriatricians and intensive care specialists. This article will review recent developments and distill practical guidance in the management of this important heart failure co-morbidity.

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Heterogeneous trends in burden of heart disease mortality by subtypes in the United States, 1999-2018: observational analysis of vital statistics

BMJ ◽

10.1136/bmj.m2688 ◽

2020 ◽

pp. m2688 ◽

Cited By ~ 1

Author(s):

Nilay S Shah ◽

Rebecca Molsberry ◽

Jamal S Rana ◽

Stephen Sidney ◽

Simon Capewell ◽

...

Keyword(s):

United States ◽

Heart Failure ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Hypertensive Heart Disease ◽

Mortality Rates ◽

Ischemic Heart ◽

Percentage Change ◽

Annual Percentage Change ◽

Disease Mortality

Abstract Objective To describe trends in the burden of mortality due to subtypes of heart disease from 1999 to 2018 to inform targeted prevention strategies and reduce disparities. Design Serial cross sectional analysis of cause specific heart disease mortality rates using national death certificate data in the overall population as well as stratified by race-sex, age, and geography. Setting United States, 1999-2018. Participants 12.9 million decedents from total heart disease (49% women, 12% black, and 19% <65 years old). Main outcome measures Age adjusted mortality rates (AAMR) and years of potential life lost (YPLL) for each heart disease subtype, and respective mean annual percentage change. Results Deaths from total heart disease fell from 752 192 to 596 577 between 1999 and 2011, and then increased to 655 381 in 2018. From 1999 to 2018, the proportion of total deaths from heart disease attributed to ischemic heart disease decreased from 73% to 56%, while the proportion attributed to heart failure increased from 8% to 13% and the proportion attributed to hypertensive heart disease increased from 4% to 9%. Among heart disease subtypes, AAMR was consistently highest for ischemic heart disease in all subgroups (race-sex, age, and region). After 2011, AAMR for heart failure and hypertensive heart disease increased at a faster rate than for other subtypes. The fastest increases in heart failure mortality were in black men (mean annual percentage change 4.9%, 95% confidence interval 4.0% to 5.8%), whereas the fastest increases in hypertensive heart disease occurred in white men (6.3%, 4.9% to 9.4%). The burden of years of potential life lost was greatest from ischemic heart disease, but black-white disparities were driven by heart failure and hypertensive heart disease. Deaths from heart disease in 2018 resulted in approximately 3.8 million potential years of life lost. Conclusions Trends in AAMR and years of potential life lost for ischemic heart disease have decelerated since 2011. For almost all other subtypes of heart disease, AAMR and years of potential life lost became stagnant or increased. Heart failure and hypertensive heart disease account for the greatest increases in premature deaths and the largest black-white disparities and have offset declines in ischemic heart disease. Early and targeted primary and secondary prevention and control of risk factors for heart disease, with a focus on groups at high risk, are needed to avoid these suboptimal trends beginning earlier in life.

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What is the effect of lockdown upon hospitalisation due to COVID-19 amongst patients from a heart failure registry?

10.1101/2021.02.26.21252336 ◽

2021 ◽

Author(s):

hani abobakr essa ◽

Sophia brousas ◽

Isabel whybrow-huppatz ◽

thomas salmon ◽

rajiv sankaranarayanan

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Frailty Index ◽

Initial Assessment ◽

Co Morbidity ◽

Obesity Hypertension ◽

The Uk ◽

The Impact ◽

Frailty Score

Introduction: Coronavirus disease 2019 (COVID-19) is associated with a high risk of mortality especially in patients with cardiovascular conditions such as heart failure. The UK government announced a national lockdown last year to curb the spread of the virus. We conducted this study primarily to ascertain the impact of lockdown upon the incidence of COVID-19 hospitalisation amongst patients with a known diagnosis of heart failure (HF) Methods: This was a retrospective cohort study of 1097 patients from our HF registry who had presented with acute decompensated HF in 2018 and 2019. Incidence and outcomes of hospitalisation due to COVID-19 were analysed in this cohort both during the 1st UK lockdown as well as after the lockdown period. Co-morbidities, frailty index, clinical features, blood results, and heart failure treatments were compared between the 2 groups (COVID versus no-COVID) and between the group of patients who died versus survivors. Results: 50 out of 801 surviving (6.2%) HF patients required hospitalisation due to COVID-19 from March to November 2020; 24 patients (3.1%) during the first lockdown and 26 (3.5%) in the post-lockdown period; p=0.7. In comparison to patients not hospitalised with COVID-19 (no-COVID group), there was a significantly higher prevalence of co-morbidities amongst HF patients who were hospitalised with COVID-19, such as hypertension (p<0.001), diabetes (p=0.005), ischaemic heart disease (p=0.01) and increased body mass index. 30 day mortality amongst HF patients hospitalised due to COVID-19 was 52%. Rockwood Frailty Score ≥6 (OR 6.530695 % CI:1.8958 to 22.4961; p=0.003) and diabetes (OR 3.82;95% CI 1.13 to 12.95; p=0.03) were independent predictors of 30 day mortality. Conclusion: Our data suggests that the incidence of hospitalisation due to COVID-19 was similar both during as well as post lockdown amongst patients from our HF registry. HF patients with cardiovascular co-morbidities such as obesity, hypertension, diabetes and ischaemic heart disease have a higher risk of hospitalisation due to COVID-19. Diabetes and Rockwood Frailty score are independent predictors of short term mortality. Co-morbidity and frailty scores should be incorporated during initial assessment to help risk-prediction.

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PM212 Rheumatic Heart Disease Co-Morbidity in Heart Failure, Atrial Fibrillation and Stroke Among Adult Aboriginal Western Australians: Need for Service Strengthening

Global Heart ◽

10.1016/j.gheart.2016.03.370 ◽

2016 ◽

Vol 11 (2) ◽

pp. e106

Author(s):

J. Katzenellenbogen ◽

F. Sanfilippo ◽

M. Knuiman ◽

M. Hobbs ◽

T.H.K. Teng ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Co Morbidity ◽

Rheumatic Heart

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Burden of Heart Failure Patients in a Tertiary Level Cardiac Hospital

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v28i1.4640 ◽

1970 ◽

Vol 28 (1) ◽

pp. 24-29 ◽

Cited By ~ 1

Author(s):

M Kabiruzzaman ◽

FN Malik ◽

N Ahmed ◽

M Badiuzzaman ◽

SR Choudhury ◽

...

Keyword(s):

Heart Failure ◽

Risk Factor ◽

Heart Disease ◽

Ischaemic Heart Disease ◽

Demographic Data ◽

Cross Sectional Study ◽

City Hospital ◽

Cross Sectional ◽

Heart Failure Patients ◽

Co Morbidity

Objective: Heart failure (HF) has become an increasingly frequent cause of hospital admission and carries a poor prognosis. There is a paucity of data in Indo-Asians particularly in Bangladesh on characteristics of heart failure patients. The purpose of this study was to determine the etiological factors and co-morbidity of hospitalized heart failure patients. Method: A hospital based cross sectional study was done at a tertiary cardiac hospital in Dhaka city. Hospital medical records of 14009 patients admitted between January 2005 and August 2006 were reviewed and 1970 patients with the diagnosis of HF were identified. Relevant etiological information and socio demographic data were abstracted from the hospital record files. Result: About one-seventh of total hospital admitted patient had HF. Mean age (SD) was 54.1 (15.3) years. Majority (35.79%) had ischaemic heart disease (IHD) as the principal etiological factor but this frequently coexisted with a history of hypertension (46.8%). Hypertension was considered the primary risk factor of HF in 29.14% of cases. Hypertension alone and in coexistence with other etiology was found in 48.07% (947) cases. Diabetes Mellitus (DM) co-existed with IHD in 41.4% (292) and it (32.64%) was found more prevalent in Dilated Cardiomyopathy (DCM) patient with HF. Conclusions: The mean age of hospitalized HF patients is remarkably lower than other related studies done abroad. The single most common etiology for HF is ischemic heart disease in this population. Hypertension is the most common risk factor. Measures to prevent ischaemic heart disease and control of risk factors are essential to prevent premature onset of HF. DOI: 10.3329/jbcps.v28i1.4640 J Bangladesh Coll Phys Surg 2010; 28: 24-29

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Thyroid replacement therapy, thyroid stimulating hormone concentrations, and long term health outcomes in patients with hypothyroidism: longitudinal study

BMJ ◽

10.1136/bmj.l4892 ◽

2019 ◽

pp. l4892 ◽

Cited By ~ 8

Author(s):

Rasiah Thayakaran ◽

Nicola J Adderley ◽

Christopher Sainsbury ◽

Barbara Torlinska ◽

Kristien Boelaert ◽

...

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Health Outcomes ◽

Ischaemic Heart Disease ◽

Fragility Fractures ◽

Thyroid Stimulating Hormone ◽

Hazard Ratio ◽

All Cause Mortality ◽

Ischaemic Attack

AbstractObjectiveTo explore whether thyroid stimulating hormone (TSH) concentration in patients with a diagnosis of hypothyroidism is associated with increased all cause mortality and a higher risk of cardiovascular disease and fractures.DesignRetrospective cohort study.SettingThe Health Improvement Network (THIN), a database of electronic patient records from UK primary care.ParticipantsAdult patients with incident hypothyroidism from 1 January 1995 to 31 December 2017.ExposureTSH concentration in patients with hypothyroidism.Main outcome measuresIschaemic heart disease, heart failure, stroke/transient ischaemic attack, atrial fibrillation, any fractures, fragility fractures, and mortality. Longitudinal TSH measurements from diagnosis to outcomes, study end, or loss to follow-up were collected. An extended Cox proportional hazards model with TSH considered as a time varying covariate was fitted for each outcome.Results162 369 patients with hypothyroidism and 863 072 TSH measurements were included in the analysis. Compared with the reference TSH category (2-2.5 mIU/L), risk of ischaemic heart disease and heart failure increased at high TSH concentrations (>10 mIU/L) (hazard ratio 1.18 (95% confidence interval 1.02 to 1.38; P=0.03) and 1.42 (1.21 to 1.67; P<0.001), respectively). A protective effect for heart failure was seen at low TSH concentrations (hazard ratio 0.79 (0.64 to 0.99; P=0.04) for TSH <0.1 mIU/L and 0.76 (0.62 to 0.92; P=0.006) for 0.1-0.4 mIU/L). Increased mortality was observed in both the lowest and highest TSH categories (hazard ratio 1.18 (1.08 to 1.28; P<0.001), 1.29 (1.22 to 1.36; P<0.001), and 2.21 (2.07 to 2.36; P<0.001) for TSH <0.1 mIU/L, 4-10 mIU/L, and >10 mIU/L. An increase in the risk of fragility fractures was observed in patients in the highest TSH category (>10 mIU/L) (hazard ratio 1.15 (1.01 to 1.31; P=0.03)).ConclusionsIn patients with a diagnosis of hypothyroidism, no evidence was found to suggest a clinically meaningful difference in the pattern of long term health outcomes (all cause mortality, atrial fibrillation, ischaemic heart disease, heart failure, stroke/transient ischaemic attack, fractures) when TSH concentrations were within recommended normal limits. Evidence was found for adverse health outcomes when TSH concentration is outside this range, particularly above the upper reference value.

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