scholarly journals Clinical Profile and One Year Outcome of Atrial Fibrillation- A Prospective Cohort Study

2020 ◽  
Author(s):  
Praveen Satheesan ◽  
Veena Felix ◽  
Alummoottil George Koshy
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Tertiary Care ◽  
Good Control ◽  
Coronary Syndrome ◽  
One Year ◽  
The Impact

Introduction: Atrial Fibrillation (AF) is the most common arrhythmia in clinical practice and imposes a great burden on health care resources. There is limited data regarding the impact of AF in our population. Aim: To estimate the mortality and Major adverse Cardiovascular events {(MACE)- Acute Coronary Syndrome (ACS), Stroke, Cardiac death} in AF patients in a tertiary care centre in South India. Materials and Methods: This prospective cohort study included all patients >18 years with newly diagnosed or previously documented evidence of AF in Electrocardiography (ECG). Transient reversible causes and critically ill patients were excluded. Total of 346 patients were recruited and prospectively, followed-up at 1, 3, 6 and 12 months for development of MACE, anticoagulation status, Prothrombin Time (PT), International Normalised Ratio (INR) and major bleeding events. Baseline data including clinical parameters, comorbidities and appropriate investigations such as ECG and Echocardiogram (ECHO) parameters were collected with a structured questionnaire and analysed at one year using appropriate statistical tests. Results: Average age was 60.5 years (SD 11.5 years) and majority (74.6%) were between 50-75 years. Females were more (59.5% vs 40.5%). Most common AF risk factor was Hypertension (44.5%) followed by Rheumatic Heart Disease (RHD) in 27.2% of AF patients. AF was classified as permanent in 42.2%, persistent in 23.1% and paroxysmal in 34.7%. Valvular AF was present in 26.6% and non-valvular AF in 73.4%. At one year, 17 patients were lost to follow-up. CHA2DS2VASc score of ≥2 was present in 65.1%. During one year follow-up the MACE rate was 26.7% (ischemic stroke in 9.4%, ACS in 2.7% and cardiac mortality in 14.6 %). Mean time in Therapeutic Range (TTR) was 28.12%. TTR >60% (good control) was present in only 9.2%. Conclusion: AF continues to be a significant arrhythmia causing substantial morbidity and mortality. Non-valvular AF was thrice as common as valvular AF. Though 3/4th of the patients were on oral anticoagulants, <10% had their INR under good control which contributed to the higher events. To improve the outcomes in AF patients, treatment of risk factors and optimal anticoagulation plays a crucial role.

Long-term predictors of remission in patients treated for medication-overuse headache at a specialized headache center: A prospective cohort study

Cephalalgia ◽  
2016 ◽  
Vol 38 (2) ◽  
pp. 265-273 ◽  
Author(s):  
Jasna J Zidverc-Trajkovic ◽  
Tatjana Pekmezovic ◽  
Zagorka Jovanovic ◽  
Aleksandra Pavlovic ◽  
Milija Mijajlovic ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Predictive Values ◽  
One Year ◽  
The One

Objective To evaluate long-term predictors of remission in patients with medication-overuse headache (MOH) by prospective cohort study. Background Knowledge regarding long-term predictors of MOH outcome is limited. Methods Two hundred and forty MOH patients recruited from 2000 to 2005 were included in a one-year follow-up study and then subsequently followed until 31 December 2013. The median follow-up was three years (interquartile range, three years). Predictive values of selected variables were assessed by the Cox proportional hazard regression model. Results At the end of follow-up, 102 (42.5%) patients were in remission. The most important predictors of remission were lower number of headache days per month before the one-year follow-up (HR-hazard ratio = 0.936, 95% confidence interval (CI) 0.884–0.990, p = 0.021) and efficient initial drug withdrawal (HR = 0.136, 95% CI 0.042–0.444, p = 0.001). Refractory MOH was observed in seven (2.9%) and MOH relapse in 131 patients (54.6%). Conclusions Outcome at the one-year follow-up is a reliable predictor of MOH long-term remission.

scholarly journals P143: A prospective cohort study characterizing 30-day recurrent emergency department visits for hyperglycemia

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S116
Author(s):  
J. Yan ◽  
D. Azzam ◽  
M. Columbus ◽  
K. Van Aarsen
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Diabetes Management ◽  
Care Delivery ◽  
Tertiary Care ◽  
Emergency Department Visits ◽  
Local Health

Introduction: Hyperglycemic emergencies, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), often recur in patients who have poorly controlled diabetes. Identification of those at risk for recurrent hyperglycemia visits may improve health care delivery and reduce ED utilization for these patients. The objective of this study was to prospectively characterize patients re-presenting to the emergency department (ED) for hyperglycemia within 30 days of an initial ED visit. Methods: This is a prospective cohort study of patients ≥18 years presenting to two tertiary care EDs (combined annual census 150,000 visits) with a discharge diagnosis of hyperglycemia, DKA or HHS from Jul 2016-Nov 2018. Trained research personnel collected data from medical records, telephoned patients at 10-14 days after the ED visit for follow-up, and completed an electronic review to determine if patients had a recurrent hyperglycemia visit to any of 11 EDs within our local health integration network within 30 days of the initial visit. Descriptive statistics were used where appropriate to summarize the data. Results: 240 patients were enrolled with a mean (SD) age of 53.9 (18.6) years and 126 (52.5%) were male. 77 (32.1%) patients were admitted from their initial ED visit. Of the 237 patients (98.8%) with 30-day data available, 55 (23.2%) had a recurrent ED visit for hyperglycemia within this time period. 21 (8.9%) were admitted on this subsequent visit, with one admission to intensive care and one death within 30 days. For all patients who had a recurrent 30-day hyperglycemia visit, 22/55 (40.0%) reported having outpatient follow-up with a physician for diabetes management within 10-14 days of their index ED visit. 7/21 (33.3%) patients who were admitted on the subsequent visit had received follow-up within the same 10-14 day period. Conclusion: This prospective study builds on our previous retrospective work and describes patients who present recurrently for hyperglycemia within 30 days of an index ED visit. Further research will attempt to determine if access to prompt follow-up after discharge can reduce recurrent hyperglycemia visits in patients presenting to the ED.

scholarly journals Long term impact on lung function of patients with moderate and severe COVID-19. A prospective cohort study

2021 ◽  
Author(s):  
Sonia Qureshi ◽  
Nosheen Nasir ◽  
Naveed Haroon Rashid ◽  
Naveed Ahmed ◽  
Zoya Haq ◽  
...  
Keyword(s):  
Cohort Study ◽  
Lung Function ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
List Type ◽  
Long Term Impact ◽  
Study Participants ◽  
The Impact

AbstractIntroductionA significant number of patients continue to recover from COVID-19; however, little is known about the lung function capacity among survivors. We aim to determine the long-term impact on lung function capacity in patients who have survived moderate or severe COVID-19 disease in a resource-poor setting.Methods and analysisThis prospective cohort study will include patients aged 15 years and above and have reverse transcriptase-polymerase chain reaction (RT-PCR) positive for COVID 19 (nasopharyngeal or oropharyngeal). Patients with a pre-existing diagnosis of obstructive or interstitial lung disease, lung fibrosis and cancers, connective tissue disorders, autoimmune conditions affecting the lungs, underlying heart disease, history of syncope and refuse to participate will be excluded. Pulmonary function will be assessed using spirometry and diffusion lung capacity for carbon monoxide (DLCO) at three- and six-months interval. A chest X-ray at three and six-month follow-up and CT-chest will be performed if clinically indicated after consultation with the study pulmonologist or Infectious Disease (ID) physician. Echocardiogram (ECHO) to look for pulmonary hypertension at the three months visit and repeated at six months if any abnormality is identified initially. Data analysis will be performed using standard statistical software.Ethics and disseminationThe proposal was reviewed and approved by ethics review committee (ERC) of the institution (ERC reference number 2020-4735-11311). Informed consent will be obtained from each study participant. The results will be disseminated among study participants, institutional, provincial and national level through seminars and presentations. Moreover, the scientific findings will be published in high-impact peer-reviewed medical journals.Strengths and Limitations of this study-The study has the potential to develop context-specific evidence on the long-term impact on lung function among COVID-19 survivors-Findings will play key role in understanding the impact of the disease on vital functions and help devise rehabilitative strategies to best overcome the effects of disease-This is a single-center, study recruiting only a limited number of COVID-19 survivors-The study participants may loss-to-follow up due to uncertain conditions and disease reemergence

scholarly journals Long-Term Symptoms among Hospitalized COVID-19 Patients 48 Weeks after Discharge—A Prospective Cohort Study

2021 ◽  
Vol 10 (22) ◽  
pp. 5298
Author(s):  
Martin Mølhave ◽  
Steffen Leth ◽  
Jesper Damsgaard Gunst ◽  
Søren Jensen-Fangel ◽  
Lars Østergaard ◽  
...  
Keyword(s):  
Cohort Study ◽  
Infectious Diseases ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
University Hospital ◽  
Follow Up Studies ◽  
One Year ◽  
Term Data

Follow-up studies of COVID-19 survivors have been performed to characterize persistence of long-term symptoms, but data are scarce on one year of follow-up. This study provides data from 48 weeks of follow-up after discharge. All patients discharged from the Department of Infectious Diseases at Aarhus University Hospital, Denmark between 1 March and 1 July 2020 were followed for 48 weeks. In total, 45 of 66 eligible patients were interviewed after 48 weeks. The median age was 57 (IQR 51–70) years, the majority were female (53%) and Caucasian (87%). Median BMI was 28.1 (IQR 24.8–32.6) kg/m2. One or more comorbidities were registered among 62% of the patients. In total, 39 out of 45 (87%) interviewed patients reported persistence of at least one symptom 48 weeks after hospitalization with COVID-19. Most frequently reported symptoms were fatigue, dyspnea, and concentration difficulties. This study provides new long-term data following COVID-19, contributing to the accumulating data of COVID-19 sequelae. Many patients suffer long-term sequelae and further research is urgently needed to gain further knowledge of the duration and therapeutic options.

scholarly journals P162: Patient-important outcomes in hyperglycemia after discharge from the emergency department: a prospective cohort study

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S114-S115
Author(s):  
J. W. Yan ◽  
L. Siddiqi ◽  
K. Van Aarsen ◽  
M. Columbus ◽  
K. M. Gushulak
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Healthcare Provider ◽  
Prospective Cohort Study ◽  
Burden Of Disease ◽  
Prospective Cohort ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Post Discharge

Introduction: Hyperglycemic emergencies, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), carry significant morbidity for individuals even after discharge. The objective of this study was to describe the patient-important outcomes and burden of disease for emergency department (ED) patients with hyperglycemia after discharge from hospital. Methods: This was a prospective cohort study of patients 18 years presenting to two tertiary care EDs (combined annual census 150,000 visits) with a discharge diagnosis of hyperglycemia, DKA or HHS over a 15-month period (Jul 2016-Oct 2017). During the ED visit, consent was obtained for a telephone follow-up call to determine patient-important outcomes. Trained research personnel collected data from medical records and completed a 14 day telephone follow-up using a standardized questionnaire to determine medication changes, missed days of school or work, and repeat admissions or visits to a healthcare provider. Descriptive statistics were used where appropriate to summarize the data. Results: Thus far, 172 patients have been enrolled in our study. Mean (SD) age is 53.9 (19.3) years and 97 (56.4%) are male. 65 (37.8%) patients were admitted from their initial ED visit. Of the 125 patients (72.7%) providing post-discharge outcomes, 75 (60.0%) required an adjustment to their diabetes medications or insulin. 21 (16.8%) patients missed days of school or work for a median (IQR) duration of 3.5 (1.3, 7.0) days. 85 (68.0%) saw another healthcare provider within a 14 day period, 45 (36.0%) saw their family physician, and 34 (27.2%) saw an internist or endocrinologist. 9 (7.2%) were seen again in the ED, 5 of these patients required admission to hospital. There was one death that occurred within the follow-up period. Conclusion: This prospective study builds on our previous retrospective work and demonstrates that visits for hyperglycemia carry a significant burden of disease beyond what may be seen in a single ED encounter. Further research will attempt to identify the factors that may be predictive of adverse outcomes in hyperglycemic patients presenting to the ED.

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