Cardiac Comorbidities In Patients Research Articles

Systematic review and meta-analysis of prevalence of undiagnosed major cardiac comorbidities in COPD.

It is often stated that heart disease is underdiagnosed in COPD. Evidence for this statement comes from primary studies, but these have not been synthesised to provide a robust estimate of the burden of undiagnosed heart disease. A systematic review of studies using active diagnostic techniques to establish the prevalence of undiagnosed major cardiac comorbidities in patients with COPD was carried out. MEDLINE, Embase, Scopus and Web of Science were searched for terms relating to heart failure (specifically, left ventricular systolic dysfunction (LVSD), coronary artery disease (CAD) and atrial fibrillation), relevant diagnostic techniques and COPD. Studies published since 1980, reporting diagnosis rates using recognised diagnostic criteria in representative COPD populations not known to have heart disease were included. Studies were classified by condition diagnosed, diagnostic threshold used and whether participants had stable or exacerbated COPD. Random-effects meta-analysis of prevalence was conducted where appropriate. In general, prevalence estimates for undiagnosed cardiac comorbidities in COPD had broad confidence intervals, with significant study heterogeneity. Most notably, a prevalence of undiagnosed LVSD of 15.8% (11.1-21.1%) was obtained when defined as left ventricular ejection fraction <50%. Undiagnosed CAD was found in 2.3-18.0% of COPD patients and atrial fibrillation in 1.4% (0.3-3.5%). Further studies using recent diagnostic advances, and investigating therapeutic interventions for patients with COPD and heart disease are needed.

Sleep disturbance in adults with chronic pruritic dermatoses is associated with increased C-reactive protein levels

Pruritus is a common symptom that can significantly reduce quality of life through sleep disruption. To examine features of disturbed sleep in patients with chronic pruritic dermatoses and test the hypothesis that systemic inflammation may serve as a biomarker for impaired sleep in these patients. Cross-sectional analysis of the National Health and Nutrition Examination Survey investigating systemic inflammation using C-reactive protein (CRP) levels. Logistic regression was used to compare patients with and without sleep disturbances, adjusting for demographics (model 1) and medical comorbidities (model 2). Chronic pruritic dermatoses were associated with multiple sleep disturbances, including nighttime awakenings (model 1: odds ratio [OR], 1.646; 95% confidence interval [CI], 1.031-2.627; model 2: OR, 1.329; 95% CI, 0.888-1.989) and early morning awakening (model 1: OR, 1.669, 95% CI, 1.118-2.493; model 2: OR, 1.582; 95% CI, 1.008-2.481). Mean CRP levels were 52.8% higher among patients with pruritic dermatoses reporting trouble sleeping compared with those who did not (0.663 vs 0.434mg/dL; P=.034). Trouble sleeping was also positively correlated with CRP levels (β=0.142, P=.025). Potential recall bias among participants. In addition to confirming sleep disturbances with pruritic dermatoses, we found these disturbances are more likely to present with elevated CRP levels. Clinicians should consider the potential risk for sleep-related and cardiac comorbidities in patients diagnosed with itchy skin conditions.

456 Sleep disturbances in chronic pruritic dermatoses are associated with increased C-reactive protein levels

Pruritus is a common symptom that can significantly reduce quality of life often through sleep disruption. We sought to investigate the features of disturbed sleep in patients with chronic pruritic dermatoses and test the hypothesis that increased systemic inflammation may serve as a biomarker for impaired sleep in these patients. We conducted a cross-sectional analysis of the National Health and Nutrition Examination Survey data. Odds ratios (OR), 95% confidence intervals (95%CI), and p-values using logistic regression were calculated weighted to the US Census data. Model 1 was adjusted for demographic factors (sex, age, race, education, marital status, income) while model 2 was adjusted for medical comorbidities (age, sex, allergy history, heart disease, body mass index). Chronic pruritic dermatoses were associated with waking up during the night (Model 1: OR=1.646, 95%CI [1.031-2.627], p=0.038; Model 2: OR=1.329, 95%CI [0.888-1.989], p=0.031), waking up too early in the morning (Model 1: OR=1.669, 95%CI [1.118-2.493], p=0.016 ; Model 2: OR=1.582, 95%CI [1.008-2.481], p=0.046), feeling overly sleepy during the day (Model 1: OR=1.786, 95%CI [1.144-2.789], p=0.014; Model 2: OR=1.664 , 95%CI [1.073-2.581], p=0.026), and not getting enough sleep (Model 1: OR=1.603 , 95%CI [1.049-2.450], p=0.032; Model 2: OR=1.598, 95%CI [1.064-2.399], p=0.027). Mean C-reactive protein (CRP) levels were 52.8% higher among pruritic dermatoses patients reporting trouble sleeping compared to those who did not (0.663 vs 0.434 mg/dL; p=0.034). Pruritic dermatoses were also positively correlated with CRP levels with a β coefficient of 0.142 (p=0.025). In addition to confirming sleep disturbances with pruritic dermatoses, we found that sleep disturbances are more likely to present with elevated CRP levels. Thus, clinicians should consider the potential risk for sleep-related and cardiac comorbidities in patients diagnosed with itchy skin conditions.

Morphological overview of cardiovascular comorbidities in chronic obstructive pulmonary disease: Frank's sign

ObjectiveCardiovascular diseases are the most common and important comorbidities in patients with chronic obstructive pulmonary disease (COPD). Literature indicates that there may be a relationship between diagonal earlobe crease (DELC) and coronary artery disease (CAD). Accordingly, the present study aimed to assess the relationship with DELC and cardiac comorbidities in patients with COPD during routine physical examination. Materials and MethodsIn this prospective cohort study, we evaluated the demographic data, pulmonary function test (PFT) results, lipid profile, oxygen saturation, and the presence of DELC in patients with COPD and control subjects. ResultsDELC was diagnosed in 155 (62%) of COPD patients and these patients had a higher prevalence of CAD (p = 0.044). Moreover, DELC was diagnosed in 135 men (68.5%) and 20 (37.7%) women in the COPD group (p<0.001) and in 39 (48.8%) men and 14 (56.0%) women in the control group (p = 0.527). On the other hand, CAD was diagnosed in 18% of patients with early-stage COPD (n = 104) and in 30.8% of patients with late-stage COPD (n = 146) (p = 0.041). The sensitivity and specificity of DELC positivity in predicting CAD were 80.65% and 44.15% in COPD patients, respectively. ConclusionThe presence of cardiac comorbidities in COPD patients may play a vital role in the severity of the disease, exacerbations, and may also reduce the treatment response. Accordingly, an earlobe examination of patients with COPD may be useful in predicting the presence of cardiac comorbidities with high sensitivity.

Cardiac Co-morbidities in Patients with Chronic Obstructive Pulmonary Disease: Prospective Observational Study

Cardiac Co-morbidities in Patients with Chronic Obstructive Pulmonary Disease: Prospective Observational Study

Chronic Obstructive Pulmonary Disease and Cardiac Diseases. An Urgent Need for Integrated Care.

Chronic obstructive pulmonary disease (COPD) is a global health issue with high social and economic costs. Concomitant chronic cardiac disorders are frequent in patients with COPD, likely owing to shared risk factors (e.g., aging, cigarette smoke, inactivity, persistent low-grade pulmonary and systemic inflammation) and add to the overall morbidity and mortality of patients with COPD. The prevalence and incidence of cardiac comorbidities are higher in patients with COPD than in matched control subjects, although estimates of prevalence vary widely. Furthermore, cardiac diseases contribute to disease severity in patients with COPD, being a common cause of hospitalization and a frequent cause of death. The differential diagnosis may be challenging, especially in older and smoking subjects complaining of unspecific symptoms, such as dyspnea and fatigue. The therapeutic management of patients with cardiac and pulmonary comorbidities may be similarly challenging: bronchodilators may have cardiac side effects, and, vice versa, some cardiac medications should be used with caution in patients with lung disease. The aim of this review is to summarize the evidence of the relationship between COPD and the three most frequent and important cardiac comorbidities in patients with COPD: ischemic heart disease, heart failure, and atrial fibrillation. We have chosen a practical approach, first summarizing relevant epidemiological and clinical data, then discussing the diagnostic and screening procedures, and finally evaluating the impact of lung-heart comorbidities on the therapeutic management of patients with COPD and heart diseases.

DIAGNOSTICS, TREATMENT, ASSOCIATED CARDIOVASCULAR AND CONCOMITANT NON-CARDIAC DISEASES IN PATIENTS WITH DIAGNOSIS OF “ATRIAL FIBRILLATION” IN REAL OUTPATIENT PRACTICE (ACCORDING TO DATA OF REGISTRY OF CARDIOVASCULAR DISEASES, RECVASA)

Aim. To study the structure of risk factors and associated cardiovascular and concomitant non-cardiac diseases in patients with atrial fibrillation (AF) on the base of the data of registry, and to estimate diagnostics and treatment quality in real outpatient practice in the Ryazan region with high cardiovascular mortality rate. Material and methods. A total of 3690 patients with AF, arterial hypertension (HT), ischemic heart disease (IHD) and chronic heart failure (CHF) consulted by general practitioners and cardiologists in three outpatient clinics of Ryazan, were enrolled into the outpatient REgistry of CardioVAScular diseAses (RECVASA). 530 of 3690 (14.4%) patients had the "atrial fibrillation" diagnosis in their outpatient charts: 175 (33.0%) men, 355 (67.0%) women, and mean age – 72.3±10.1 years. Results. Permanent, paroxysmal or persistent forms of AF were indicated in outpatient charts of 43.2%, 26.4% and 24.7% of 530 AF patients, respectively, and 5.7% of outpatient charts did not specify AF form. All the AF patients had associated cardiovascular diseases (HT and/or IHD and/or CHF). The history of myocardial infarction, stroke and diabetes was revealed in 20.2%, 14.9% and 21.1% of patients, respectively. Revealed level of diagnostics did not satisfy adequate standard of examination with such cardiac pathology. Prescription of necessary drugs of some groups was insufficient, although indications existed. At the time of being included into the registry only 15.2% of AF patients received cardio-vascular drugs at a privileged price compared to 39.2% in the preceding years (p&lt;0.05). AF diagnosis was confirmed in 84.2% of 76 randomly selected patients at its validation. Conclusion. The RECVASA research revealed high incidence of cardiac comorbidity in patients with the AF, underestimation of cardiovascular risk factors, insufficient use of diagnostic tests and prescription of some drug groups recommended by national and international guidelines.

Multidetector computed tomography assessment of cardiac comorbidity in patients with chronic obstructive pulmonary disease

Cardiac comorbidity is one of the most important prognostic factors in lung disease, especially in chronic obstructive pulmonary disease (COPD). The imaging techniques available for the study of this systemic manifestation concomitant with COPD include heart catheterization, transthoracic echocardiography, and magnetic resonance imaging. Multidetector computed tomography (MDCT) represents a significant advance in this field because it enables the acquisition of simultaneous studies of the cardiopulmonary anatomy that go beyond anatomic and morphologic analysis to include a functional approach to this condition. In this article, we review the practical aspects necessary to evaluate cardiac comorbidity in patients with COPD, both from the point of view of pulmonary hypertension and of the analysis of ventricular dysfunction and coronary heart disease.

Cardiac Event Rates in Patients with Newly Diagnosed and Relapsed Multiple Myeloma in US Clinical Practice.

AbstractAbstract 2916 Background:Factors contributing to cardiac comorbidity in patients, typically elderly, with multiple myeloma (MM) include age-related cardiac risks as well as disease related factors such as amyloid infiltration, hyperviscosity, A-V shunting and chronic anemia (McBride, 1988; Robin, 2008; Inanir, 1998). Cardiac effects, associated with anthracycline therapy and transplant, have been reported with alkylating agents (myopericarditis, acute cardiomyopathy), immunomodulatory drugs (IMiDs) (arrhythmias, myocardial infarction) and proteasome inhibitors (congestive heart failure [CHF]) (Kyle, 2003; Chow, 2011; Revlimid PI 2012; Velcade PI 2012; Singhal S, 2011). Estimating the frequency of cardiac adverse events (AEs) in MM patients would help in understanding the magnitude of these risks and would provide context for rates of observed AEs. To our knowledge, this is the first analysis to examine the incidence and prevalence of cardiac AEs in patients with MM. Methods:We conducted a retrospective cohort study in the US using the MarketScan® commercial and Medicare supplemental insurance claims database from January 1, 2006 to December 31, 2011. Adult patients were included with a MM diagnosis following 6 months of continuous enrollment (baseline period) and no gaps in insurance coverage >31 days. Newly diagnosed MM patients were analyzed separately from patients with relapsed MM, defined as patients previously treated with ≥3 regimens (bortezomib, IMiDs, and alkylating agents or anthracyclines). Study entry date for newly diagnosed patients was the MM diagnosis date and, for the relapsed patients, the date patients’ met the criteria of having received ≥3 regimens. Diagnosis, procedure and treatment codes (ICD-9, HCPCS, and NDC) were used to classify patients. The study period was defined as the duration from study entry date to study end (i.e., December 31, 2011 or the end of continuous enrollment or prescription drug coverage). Cardiac AEs were captured separately for inpatient, outpatient, and any site of care, and included any cardiac event, CHF, ischemic heart disease (IHD), and arrhythmias. Cardiac events present during baseline were identified as comorbidities. Results:N=32,193 patients met inclusion criteria, the majority were newly diagnosed. The mean time on study ranged from 12 to 18 months (max 5 yrs). The mean age was 63 yrs, and approximately 50% of subjects were male. Cardiac comorbidities were common; nearly two-thirds of patients had baseline cardiac events, of which arrhythmias and IHD were most frequent. While on study, the incidence of any cardiac AE was 72% for newly diagnosed and 71% for relapsed patients. The most common cardiac events during the study period were arrhythmias, IHD, and CHF. In general, event rates were similar between newly diagnosed and relapsed patients (Table 1).Table 1Cardiac AEs in newly diagnosed and relapsed MM patientsNewly Diagnosed MM N = 22,076Relapsed MM N = 1,723% with baseline eventEvent1 on study, % (PY)Inpatient event on study, % (PY)% with baseline eventEvent1 on study, % (PY)Inpatient event on study, % (PY)Any cardiac event63%72% (1,538/1,000)31% (285/1,000)65%71% (1,924/1,000)37% (482/1,000)Cardiac arrhythmia14%24% (214/1,000)11% (87/1,000)17%29% (359/1,000)15% (156/1,000)IHD14%19% (164/1,000)7% (52/1,000)10%14% (159/1,000)5% (49/1,000)CHF8%15% (116/1,000)8% (59/1,000)9%15% (161/1,000)9% (87/1,000)Cardiomyopathy3%5% (35/1,000)2% (14/1,000)3%5% (54/1,000)3% (27/1,000)Conduction disorders2%4% (29/1,000)1% (10/1,000)2%4% (41/1,000)2% (16/1,000)1inpatient or outpatient; PY: Person-Yrs (AE rate /1,000 PYs) Conclusions:This retrospective study provides the first estimates of cardiac AE rates in a large population of MM patients, both newly diagnosed and relapsed, in a clinical practice setting in the US. During the study period, regardless of treatment stage of disease, nearly three quarters of MM patients experienced a cardiac AE. These results demonstrate a high prevalence of cardiac comorbidities and occurrence of cardiac events in MM patients, especially arrhythmias and heart failure, regardless of relapse status and type of anti-MM treatment. Disclosures:Kistler:Onyx: Consultancy, Research Funding. Rajangam:Onyx: Employment. Faich:Onyx: Consultancy, Research Funding. Lanes:Onyx: Consultancy, Research Funding.

Valoración de la comorbilidad cardíaca en pacientes con enfermedad pulmonar obstructiva crónica mediante tomografía computarizada multidetector

Cardiac comorbidity is one of the most important prognostic factors in lung disease, especially in chronic obstructive pulmonary disease (COPD). The imaging techniques available for the study of this systemic manifestation concomitant with COPD include heart catheterization, transthoracic echocardiography, and magnetic resonance imaging. Multidetector computed tomography (MDCT) represents a significant advance in this field because it enables the acquisition of simultaneous studies of the cardiopulmonary anatomy that go beyond anatomic and morphologic analysis to include a functional approach to this condition. In this article, we review the practical aspects necessary to evaluate cardiac comorbidity in patients with COPD, both from the point of view of pulmonary hypertension and of the analysis of ventricular dysfunction and coronary heart disease.

Evaluation of Cardiac Comorbidities in Patients with Metastatic Breast Cancer Receiving Doxorubicin-Based and Non-Doxorubicin-Based Chemotherapy.

Abstract Background: Some metastatic breast cancer (MBC) treatments are associated with cardiac toxicity. Real-world data regarding baseline cardiac comorbidities in patients with MBC prior to chemotherapy initiation are scarce. Such information would be useful in guiding treatment decisions. This study aims to describe the cardiac comorbidity profile of patients with MBC initiating doxorubicin-based (DOX) versus non-doxorubicin-based (Non-DOX) chemotherapy regimens from a managed-care perspective.Methods: Medical claims from the Ingenix Impact National Managed Care Database between 07/2002 and 06/2008 were analyzed. Patients included were aged ≥ 18 years, and had ≥ 2 diagnoses for breast cancer as well as ≥ 1 diagnosis for metastatic site within 12 months of chemotherapy initiation. Cardiac comorbidities [hypertension (HTN), cardiac arrhythmia (CAr), coronary artery disease (CAD), congestive heart failure (CHF), and myocardial infarction (MI)] were evaluated within 6 months prior to chemotherapy initiation. Patients were categorized based on receipt of DOX vs. Non-DOX-based chemotherapy.Results: A total of 12,345 patients (Non-DOX: 7,023, DOX: 5,322) formed the study population. Compared with the DOX group, the Non-DOX group was slightly older. Both groups reported a significant proportion of patients with cardiac comorbidities prior to chemotherapy, with significantly greater proportions reported in the Non-DOX group. Mean age (SD)HTNCArCADCHFMINon-DOX (n=7,023)56.9 (10.6)35.7%11.8%5.5%3.5%1.3%DOX (n=5,322)52.1 (9.1)30.8%8.1%3.3%2.0%0.5%P-value&amp;lt;.001&amp;lt;.001&amp;lt;.001&amp;lt;.001&amp;lt;.001&amp;lt;.001 Conclusions: Cardiac comorbidities were commonly reported in women with MBC prior to chemotherapy, with significantly greater proportions reported in the Non-DOX group. Such information is useful to healthcare professionals when considering potential interventions for patients with MBC. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2078.

Cardiac cormorbidities in women with metastatic breast cancer treated with doxorubicin-based and non-doxorubicin-based chemotherapy

1052 Background: Observational data are sparse regarding cardiac comorbidities in patients with metastatic breast cancer (MBC) newly initiated on chemotherapy. As some MBC treatments are associated with cardiac toxicity, such information would be useful in guiding treatment decisions. The objective of this analysis was to understand the frequency of cardiac comorbidities in MBC patients prior to chemotherapy initiation based on the Medicare 5% standard analytical file (SAF). Methods: The Medicare 5% SAF was used to investigate claims for women with breast neoplasm and &gt; 1 distant metastatic site (based on ICD-9 diagnosis codes) that subsequently received chemotherapy (based on claims with a chemotherapy J code). Cardiac comorbidities [hypertension (HTN), coronary artery disease (CAD), myocardial function (MI), and congestive heart failure (CHF)] prior to initial chemotherapy were reported as non-mutually exclusive categories. The index quarter was based on chemotherapy initiation that occurred between 7/2001 and 12/2006. Patients were categorized based on receipt of non doxorubicin-based chemotherapy (non-DOX) vs DOX-based chemotherapy. Results: The study included 2,587 women with MBC that received cytotoxic chemotherapy subsequent to the diagnosis of MBC. The mean age was higher in the non-DOX group. Both groups reported a significant proportion of patients with cardiac comorbidities prior to chemotherapy, with greater proportions reported in the non-DOX group (table). Conclusions: Cardiac comorbidities were commonly reported in women with MBC prior to chemotherapy. Such information is useful to health care professionals when considering potential interventions for patients with MBC. [Table: see text] [Table: see text]

Decoding cryptogenic cardioembolism

Decoding cryptogenic cardioembolism