Comorbid Cardiovascular Disease Research Articles

Changes in Healthcare Spending Attributable to High Deductible Health Plan Offer Among Enrollees with Comorbid Substance Use Disorder and Cardiovascular Disease.

The rise in prevalence of high deductible health plans (HDHPs) in the United States may raise concerns for high-need, high-utilization populations such as those with comorbid chronic conditions. In this study, we examine changes in total and out-of-pocket (OOP) spending attributable to HDHPs for enrollees with comorbid substance use disorder (SUD) and cardiovascular disease (CVD). We used de-identified administrative claims data from 2007 to 2017. SUD and CVD were defined using algorithms of ICD 9 and 10 codes and HEDIS guidelines. The main outcome measures of interest were spending measure for all non-SUD/CVD-related services, SUD-specific services, and CVD-specific services, for all services and medications specifically. We assessed both total and OOP spending. We used an intent-to-treat two-part model approach to model spending and computed the marginal effect of HDHP offer as both the dollar change and percent change in spending attributable to HDHP offer. Our sample included 33,684 enrollee-years and was predominantly white and male with a mean age of 53 years. The sample had high demonstrated substantial healthcare utilization with 94% using any non-SUD/CVD services, and 84% and 78% using SUD and CVD services, respectively. HDHP offer was associated with a 17.0% (95% CI = [0.07, 0.27] increase in OOP spending for all non-SUD/CVD services, a 21.1% (95% CI = [0.11, 0.31]) increase in OOP spending for all SUD-specific services, and a 13.1% (95% CI = [0.04, 0.23]) increase in OOP spending for all CVD-specific services. HDHP offer was also associated with a significant increase in OOP spending on non-SUD/CVD-specific medications and SUD-specific medications, but not CVD-specific medications. This study suggests that while HDHPs do not change overall levels of annual spending among enrollees with comorbid CVD and SUD, they may increase the financial burden of healthcare services by raising OOP costs, which could negatively impact this high-need and high-utilization population.

Cardiac interventions on total knee arthroplasty: a national inpatient sample-based analysis.

Comorbid cardiovascular diseases have been associated with poor outcomes in total knee arthroplasty (TKA); however, our understanding of TKA with prior cardiac treatment procedures has largely been undocumented. In this study, we examined TKA patients who had undergone different cardiac interventions that addressed their condition. The purpose was to characterize and compare outcomes for a growing patient population not yet analyzed. The 2016-2019 Nationwide Inpatient Sample database was queried for 558,256 patients who had TKA (ICD-10CM). Backgrounds significant for pacemaker [PM] (n = 8025), coronary artery bypass [CABG] (n = 12,683), heart valve surgery [HV] (n = 4125), or coronary stent [CS] (n = 19,483) were compared against those without, across demographics, admission information, and various complications. Cardiac interventions were associated with increased age, male gender, length of stay, and cost of care. CABG, and Stent groups had more diabetics, but HV had significantly fewer (p = 0.008). PM and HV had significantly less tobacco use and, in addition to CABG, less obesity. Postoperatively, mortality was elevated in the PM [Odds ratio (OR) 2.89, p = 0.008], CABG (OR 2.53, p = 0.006) and CS group (OR 1.94, p = 0.018), but not HV. Myocardial infarctions were elevated in the CABG (OR 3.874) and CS group (OR 5.11) (p < 0.001). PM, HV, and CS had increased odds of periprosthetic fracture by 2.15-fold (p < 0.001), 2.09-fold (p < 0.001), 1.29-fold (p = 0.011) respectively. HV saw increased periprosthetic mechanical complications (OR 1.48, p = 0.006). CABG increased the odds of deep surgical site infection 14.23-fold and CS 9.22-fold (p < 0.001). Postoperative pneumonia was increased in PM, CABG, and CS groups (OR 2.15,), (OR 2.21,), (OR 1.64,) (p < 0.001). Patients who have undergone cardiac intervention are generally at risk for adverse stays. Furthermore, risk factors and complications vary between the groups. Our analysis emphasizes the importance of individualized medical care and as a basis for electing and informing patients for TKA.

Metabolic Abnormalities Following Tirzepatide Monotherapy in Japanese Patients with Type 2 Diabetes: A Phase 3 SURPASS J-mono Post Hoc Analysis.

The presence of metabolic abnormalities in patients with type 2 diabetes (T2D) increases the risk of cardiovascular disease and other comorbidities. This analysis compared the effects of tirzepatide (5, 10, and 15mg) and dulaglutide 0.75mg on the prevalence of metabolic abnormalities in Japanese patients with T2D. This was a post hoc analysis of SURPASS J-mono, a multicenter, randomized, double-blind, active-controlled, parallel-group, phase 3 trial that compared the efficacy and safety of tirzepatide monotherapy (5, 10, and 15mg) to dulaglutide 0.75mg in Japanese patients with T2D. Thresholds for abnormalities were based on the Japanese criteria for metabolic syndrome. Proportions of participants meeting a composite endpoint (visceral fat accumulation measured by waist circumference plus two or more of dyslipidemia, hypertension, or hyperglycemia) or individual component thresholds were calculated at baseline and week 52 for the overall population and for baseline body mass index (BMI) subgroups (< 25, 25 to < 30, and ≥ 30kg/m2). Of 636 randomized participants, 431 (67.8%) met the composite endpoint at baseline, with similar findings observed across treatment arms. At week 52, the proportion of participants on treatment that met the composite endpoint was 31.7%, 23.0%, and 14.2% in the tirzepatide 5-, 10-, and 15-mg arms, respectively, and 56.5% in the dulaglutide arm (p < 0.001). A higher proportion met the composite endpoint at baseline in the BMI 25 to < 30 and ≥ 30kg/m2 subgroups (73.2-79.3%) compared with the < 25kg/m2 subgroup (45.3%), with reductions observed across all BMI subgroups treated with tirzepatide. The proportion of participants with individual metabolic abnormalities showed similar trends to those observed for the composite endpoint. Tirzepatide was consistently superior to dulaglutide across all assessments. Tirzepatide reduced the prevalence of multiple metabolic abnormalities, indicating tirzepatide may have metabolic benefit in Japanese patients with T2D. ClinicalTrials.gov, NCT03861052.

ФУНКЦИОНАЛЬНОЕ СОСТОЯНИЕ ЭНДОТЕЛИЯ У БОЛЬНЫХ ПСОРИАЗОМ

Abstract. Introduction. Psoriasis is an independent risk factor for cardiovascular diseases, accompanied by an increased risk of mortality from cardiovascular diseases, as compared with the population, which is mainly associated with chronic systemic inflammation (increased levels of C-reactive protein, fibrinogen, and homocysteine) and with the accumulation of conventional cardiovascular risk factors, such as dyslipidemia, obesity, decreased physical activity, and arterial hypertension. There are only few studies evaluating the link between psoriasis, inflammation, and cardiovascular disease. Our aim was to study the relationship between pro-inflammatory mediators and the endothelium functional state indicators of the in patients with psoriasis. Materials and Methods. We examined 116 patients with verified psoriasis, aged 19-62 years. The control group consisted of 25 comparably aged and practically healthy individuals. The diagnosis was made considering the psoriasis clinical form, stage, seasonality, type, and severity. All patients underwent a standard laboratory and instrumental examination. The levels of pro-inflammatory markers (IL-6, VEGF,CRPvh) were determined by enzyme-linked immunosorbent assay using commercial ELISA-BEST kits manufactured by OOO Vector-Best, Novosibirsk, Russia. The endothelial function was assessed by using the Biomedical ENDOTELIN test system by BioKhimMak JSC to measure the quantitative content of endothelin-1, a characteristic of the vasomotor function of endothelium, determined by ultrasound according to the method proposed by Celermajer D. et al. Results and Discussion. The study revealed a high incidence of the disease in people of working age and a slight predominance among male patients. In 55.2% of patients, classic atherosclerosis risk factors were identified: Arterial hypertension, smoking, low physical activity, alcohol abuse, and improper nutrition. 33.6% of patients were overweight; 24.1% had obesity I-II degree, and 39.7% with abdominal obesity. According to the findings of the study of pro-inflammatory markers in the blood serum, there is a significant increase in their levels as compared with the control group indicators, which correlates with the severity of psoriasis and a decrease in the ratio of IL-6/CRPvh. Endothelial dysfunction was characterized by a statistically significant increase in endothelin-1 and a significant increase in the content of vascular endothelial growth factor (VEGF) in the blood serum of psoriasis patients. Percentage increase in the brachial artery diameter on the endothelium-dependent stimulus was reduced and averaged 9.14% in the group of patients with psoriasis. Conclusion. A high comorbidity of psoriasis and cardiovascular diseases has been established. A significant increase in the levels of systemic immune inflammation mediators IL-6 and C-RBhv and a decrease in the ratio of IL-6/C-RPhvh were identified, which correlates with the severity of the disease and the presence of cardiovascular diseases. Vascular endothelium dysfunction is characterized by an increase in the content of ET-1 and VEGF in the blood serum and a decrease in the flow-mediated dilatation of the brachial artery.

Weight variation during androgen deprivation therapy in patients with localized prostate cancer: Data from two prospective randomized trials.

296 Background: In prostate cancer (PCa) treated with androgen deprivation therapy (ADT) and radiotherapy (RT), limited prospective data exist regarding weight variation during ADT. Using our prospective data from two phase III trials we compare the magnitude of weight variation during different duration of ADT. Methods: 400 patients (pts) with intermediate risk PCa received 6 months of ADT (Bicalutamide 1 month (m) and Goserelin 10,8 mg x 2), and 630 pts with high-risk PCa were treated with 18 or 36m of ADT (Bicalutamide 1m and Goserelin 10,8 mg x 6 or 12). Pts’ weights were measured at baseline then at each Goserelin dose. 463/1030 pts were excluded from the analysis: 90 no or incomplete ADT, 127 no initial weight and 246 no weight at the end of ADT. Regular patient weighing was available in 567/1030 pts (55%) from whom 250, 191 and 124 received, respectively, 6, 18 or 36m of ADT. Pt’s characteristics and weights were compared with Kruskal-Wallis and Chi squared test between groups of ADT. Multivariable logistic regression was performed to assess predictors of weight gain over 2 kg. Variables included were duration of ADT, age ≥65 vs. &lt; 65 and baseline comorbidities (cardiovascular disease, diabetes, chronic obstructive pulmonary disease, hypertension). Results: Comparing weights between the beginning and the end of ADT, 375/567 (66.1%) pts gained and 192/567 (33.9%) lost weight. The mean ± SD weight gain at the end of ADT was significantly higher in pts receiving 18m of ADT (1.98 ± 4.05) or 36m (2.38 ± 5.15) compared to pts receiving only 6m (0.98 ± 3.10, p=0.003). As ADT duration increased (6, 18 or 36m), weight gain over 2 kg (34.1% vs. 48.2% vs. 53.2%, p&lt;0.001) and over 4 kg (12.7% vs. 26.2% vs. 36.3%, p&lt;0.001) significantly increased. In multivariable logistic regression, predictors of weight gain over 2 kg were 18m ADT [OR=1.85 (1.25-2.74), p=0.002] and 36m ADT [OR=2.23 (1.43-3.48), p&lt;0.001] compared to 6m ADT and non-diabetic pts (OR=2.13 (1.28-3.54), p=0.003). Age was not a factor. In the 375 pts who gained weight, the rate of patients that gained 0.1 to 2 kg, 2.1 to 4 kg and more than 4 kg were respectively (47.2%, 33.1% and 19.6%) in the 163 receiving 6m ADT, (30.3%, 32.6% and 37.1%) in 132 pts receiving 18m ADT, and (17.6%, 26.3% and 56.4%) in the 80 pts receiving 36m ADT. In the 192 pts who lost weight, the rate of patients that lost 0.1 to 2 kg, 2.1 to 4 kg and more than 4 kg were respectively (62.9%, 21.3% and 15.6%) in 89 receiving 6m ADT, (50.8%, 27.1% and 22.1%) in 59 pts receiving 18m ADT and (59.1%, 15.9% and 25%) in 44 pts receiving 36m ADT. Conclusions: ADT is not associated with weight gain in all pts. Based on our prospective data, one third of pts lose weight at the end of ADT. However, weight gain above 2 kg or 4 kg increases with ADT duration and non-diabetics pts, regardless of age. Weight monitoring in pts receiving ADT should be done regularly and pts counseled accordingly.

Cardiovascular medications and overall survival in metastatic hormone-sensitive prostate cancer.

75 Background: The assessment of comorbid cardiovascular disease can predict health outcomes and may risk-stratify patients for adverse events and death. Current methods used to estimate patient risk, such as the Charlson Comorbidity Index (CCI), are based on International Classification of Diseases (ICD) codes, which are a poor indicator of severity and complexity of comorbid disease. Alternatively, the number of cardiovascular drugs could be an efficient tool for estimating patient risk. In this study, we examined the relationship between cardiovascular medications and survival in patients being treated for metastatic hormone-sensitive prostate cancer (mHSPC). Methods: A nationwide retrospective observational study of US Veterans with de novo mHSPC in the Veterans Health Administration between 2011-2021 with at least 1 prescription medicine of any class. We determined the number of cardiovascular drugs from Anatomic Therapeutic Chemical (ATC) drug class C prescribed in the year prior up to 14 days before initiation of treatment. Multivariable logistic regression and Cox proportional hazard modeling was used to assess the association between number of drugs with overall survival (OS) while accounting for important covariates including age, body-mass index (BMI), prostate specific antigen (PSA), CCI, race, and weight change. Results: Among 7,875 veterans, a median (IQR) of 2 (1-4) unique cardiovascular medications were filled in the year prior to treatment. The mean age was 74.3 years (SD 10.0) with a median CCI of 3 (3-6). Age was associated with increased number of cardiac medicines with a mean of 1.6 drugs in &lt;60 years, 2.2 drugs in 60-69, 2.5 drugs in 70-80, and 2.5 drugs in 80+ years (p&lt;0.001). Increased number of medications was associated with decreased OS using the Kaplan-Meier method (p&lt;0.001, see table). After adjusting for age, race, BMI, weight change, PSA, and CCI, the number of medications was independently associated with increased mortality with an adjusted hazard ratio (aHR) of 1.05 (1.03-1.06) for each additional cardiac drug. Increased mortality was observed in patients treated with 2 or more cardiac drugs (see table). Conclusions: The number of cardiovascular medications is associated with decreased survival in veterans undergoing treatment for mHSPC, even after accounting for important covariates including age, BMI, PSA, and CCI. The assessment of cardiovascular medications may provide a simple and reliable tool to estimate comorbid disease and survival in patients with cancer. [Table: see text]

The potential interaction between chemosensitivity and the development of cardiovascular disease in obstructive sleep apnea

ObjectivesChemosensitivity is an essential part of the pathophysiological mechanisms of obstructive sleep apnea (OSA). Not only does OSA have a certain relationship with the comorbidity of cardiovascular disease (CVD) but also chemosensitivity plays a crucial role in the development of CVD. This study aims to investigate the potential interaction between chemosensitivity and the development of CVD in OSA. MethodsA total of 169 participants with suspected OSA were included. Data were gathered on the parameters of polysomnography and baseline clinical features. Peripheral chemosensitivity was evaluated by employing the rebreathing test. The lifetime CVD risk was computed using the China-PAR (Prediction for atherosclerotic CVD Risk in China) risk equation. ResultsAfter controlling for covariates, participants with chemosensitivity levels in the second and fifth quantiles tended to hold an increased proportion of high lifetime CVD risk (OR 10.90, 95%CI [2.81–42.28]; OR 6.78, 95%CI [1.70–27.05], respectively). The diagnosis of OSA would significantly increase the 10-year and lifetime CVD risks in participants with low chemosensitivity, while no such differences were found in participants with high chemosensitivity. ConclusionHigher lifetime CVD risk was associated with participants who had greater peripheral chemosensitivity. In terms of the CVD outcomes, adult patients with a relatively low level of chemosensitivity may be primarily related to their diagnosis of OSA, whereas adult patients with a relatively high level of chemosensitivity may be more strongly associated with their elevated levels of chemosensitivity rather than OSA.

A review of research progress on the comorbidity of sarcopenia and cardiovascular diseases in the elderly

A review of research progress on the comorbidity of sarcopenia and cardiovascular diseases in the elderly

Incidence Rate of Cardiovascular Events in Rheumatoid Arthritis: An Observational Cohort Study in Saudi Arabia.

Rheumatoid arthritis (RA) doubles the morbidity of cardiovascular disease (CVD) and leads to a 50% increase in mortality compared to the general population. This study aims to estimate the CVD incidence among RA patients in Saudi Arabia (SA), vital for assessing CVD burdens within this group. This retrospective study took place at two centers in the Eastern Province of SA, including all adult RA patients who visited the rheumatology clinic from 2016 to 2021 and were prescribed disease-modifying antirheumatic drugs (DMARDs). CVD incidence was determined by the diagnosis of ischemic heart disease (IHD), stroke/transient ischemic attack (TIA), venous thromboembolism (VTE), heart failure (HF), and arrhythmia post-RA diagnosis. Additional data collected included demographics, CVD risk factors, comorbidities, RA-related factors, and medication usage. The study comprised 651 patients, 80.5% of whom were females with an average age of 51. The overall CVD incidence was 11.2 per 1000 person-years, with males experiencing five times more incidents than females. The prevalence of CVD risk factors included 18.7% with hypertension, 7.8% with hyperlipidemia, 18.9% with diabetes, and 42.9% with obesity. Significant predictors of CVD were male gender and RA duration, with adjusted odds ratios (aOR) of 3.17 (95% CI 1.10 to 9.14, P=0.033) and 64.81 (95% CI 3.68 to 1140.6, P=0.004), respectively. This unique study from SA examined the CVD incidence in RA patients, identifying long disease duration and male gender as significant predictors. Effective reduction of CVD risk in RA patients requires aggressive management of modifiable risk factors and regular risk assessments.

Patient Perspectives of the Impact of Psoriatic Disease on Quality-of-Life in India: Sub-analysis from the Global Psoriasis and Beyond Survey.

Psoriatic disease (PsD), including plaque psoriasis (PsO) and psoriatic arthritis (PsA), comprises a wide spectrum of manifestations and significantly impacts quality-of-life (QoL). Here, we assessed patients' understanding of PsO and PsA as a systemic disease, its impact on their physical and emotional well-being, and patients' experiences with healthcare professionals for shared treatment decision-making. The Global Psoriatic Disease and Beyond Survey was a cross-sectional, qualitative, online survey conducted on patients with moderate-to-severe PsO with/without concomitant PsA. This analysis reports findings from Indian patients. Of the 261 surveyed patients, 27% with PsO reported concomitant PsA, of whom 89% reported PsA severity as moderately or highly active. Overall, 92% had heard the term "PsD," and 90% knew their condition was a systemic disease. Few were aware of PsD manifestations (palmoplantar psoriasis, 49%; nail psoriasis, 43%; axial symptoms, 40%; PsA, 34%) and comorbidities (cardiovascular disease, 33%; obesity, 30%; diabetes, 28%). Eighty-nine percent of patients indicated their skin problems had a "very-large" to "extreme-large" impact on QoL. Ninety-seven percent of patients experienced discrimination and stigmatization from others. Eighty-one percent of patients were not involved in deciding treatment goals. Few (PsO, 6%; PsA, 9%) patients were dissatisfied with current treatment; ≥50% patients reported incomplete relief of skin symptoms (PsO) and joint symptoms (PsA) as the reason for dissatisfaction. Lack of awareness of the manifestations and comorbidities associated with PsD and poor QoL highlights the need for patient education, shared treatment decision-making, and a multidimensional approach to PsD management in India.

Coronary artery calcium score as independent risk factor of obstructive coronary artery disease.

Aim: To prove an independence of CAC score comparatively to conventional risk factors such as age, and dyslipidemia especially in patients under forty years of age. Materials and Methods: Thirty-four asymptomatic adult patients with no prior established atherosclerotic cardiovascular disease, diabetes mellitus or severe comorbidities, except of complex clinical examination, underwent CT scan with evaluation of coronary artery calcium score. Results: The average total cholesterol level in the group was (5.62±1.02) mmol/l, indicating the presence of dyslipidemia. The average HDL level was (1.26±0.24) mmol/l, suggesting an average risk of atherosclerosis. The average LDL levels were within the borderline range at (3.63±1.01) mmol/l. The average triglyceride level was within the safe range at (1.93±1.08) mmol/l. The atherogenicity coefficient indicated a moderate risk of atherosclerosis with an average value of 3.64±1.31. The average coronary artery calcium score was 56.71±143.85, indicating minor plaques and a moderate risk of coronary artery disease. Correlation analysis revealed no significant correlation between age and the CAC score (r=0.1, p>0.05). However, reliable direct correlation of weak strength was found between the CAC score and LDL level (r=0.35, p<0.05). Direct correlations of weak strength were also observed between age and the levels of total cholesterol, LDL and the atherogenicity coefficient (r=0.43, 0.49, 0.42 respectively, p<0.05). Conclusions: Coronary artery calcium score is a valuable screening tool for identifying potential obstructive coronary artery disease, not only for individuals aged forty and above, but also for younger asymptomatic patients.

Post-operative delirium in different age groups and subtypes: a systematic review of case reports.

To explore the clinical presentations and outcomes among different ages and subtypes of post-operative delirium patients. Systematic review of Published Cases. We comprehensively searched PubMed, EMBASE, and MEDLINE for published case reports of post-operative delirium up to April 2023. The systematic review has been registered with PROSPERO. Two researchers independently conducted unblinded reviews of the full-text articles. This study included 116 patients with post-operative delirium. Compared to post-operative delirium patients aged 65 and above, those between 18 and 65 years old have lower rates of a history of hypertension, cardiovascular disease and urinary system disorder comorbidities, as well as higher usage rates of fentanyl analogs and lorazepam. Additionally, these patients exhibit lower incidences of anemia and renal failure, along with a lower mortality rate. Compared to post-operative delirium patients aged 65 and above, those under 18 years old have a higher rate of fentanyl analog usage and a higher incidence of post-operative delirium following neurological surgeries. Among the hypoactive, hyperactive, and mixed subtypes, the reasons for surgery, such as cardiovascular diseases, reproductive system diseases, and neurological disorders, significantly varied among these three subtypes. Furthermore, substance abuse history and medication usage patterns also significantly varied among these three subtypes. Our investigation has revealed noteworthy insights into post-operative delirium in different patient populations. Notably, age emerged as a pivotal factor. Compared to elderly patients (≥65 years), those aged 18 to 65 demonstrate better prognosis. Additionally, patients younger than 18 years with post-operative delirium have a higher incidence of delirium following neurosurgical procedures compared to those elderly patients. Additionally, a strong association was found between a history of substance abuse and hyperactive delirium. Variations in drug use patterns were observed across different subtypes. Importantly, post-operative delirium patients younger than 18 years, as well as those aged 18 to 65 with mixed-subtype delirium, exhibited similar high mortality rates as elderly patients. This underscores the need for increased attention to post-operative delirium patients under 65 and highlights the necessity of rapid identification and early intervention for these populations at risk of poor outcomes. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023473383, Identifier [Registration ID: CRD 42023473383].

Obesity: A Major Factor in Diabetes

Obesity is currently recognized as a significant risk factor contributing to the onset of diabetes, presenting a substantial challenge to public health worldwide. This abstract provides a concise overview of the intricate relationship between obesity and diabetes, with a specific focus on the impact of excess body weight on insulin resistance and beta-cell dysfunction. These two mechanisms serve as the primary contributors to the development of diabetes. The abstract delves into the complex interplay between adipose tissue, insulin signaling, and inflammation, elucidating the underlying mechanisms by which obesity exacerbates insulin resistance. Additionally, the role of visceral adiposity, genetic factors, and lifestyle modifications are explored within the context of obesity-related diabetes. The abstract also highlights the adverse health consequences associated with obesity-related diabetes, particularly the heightened risk of cardiovascular disease and other comorbidities. Acknowledging these detrimental effects strengthens the urgency in addressing this widespread issue. Consequently, the abstract briefly outlines the various effective management strategies available to combat obesity-related diabetes, including weight loss interventions, pharmacotherapy, and bariatric surgery. In conclusion, the abstract underscores the necessity of adopting a comprehensive and multidisciplinary approach in tackling both obesity and diabetes. Prevention measures are emphasized as a crucial component in alleviating the burden posed by these two interrelated health conditions. By implementing proactive strategies, it is possible to mitigate the escalating prevalence of obesity-related diabetes and enhance public health outcomes.

Characteristics and susceptibility pattern of catheter-associated urinary tract infections (CAUTI) bacteria in Indonesia: A study in a national reference hospital of Sumatra region 2020-2021.

Catheter-associated urinary tract infection (CAUTI) is defined as a urinary tract infection associated with catheter placement for more than two consecutive days. Hence, antibiotic resistance in the context of CAUTIs represents a substantial challenge. The aim of this study was to present the characteristics of patients with CAUTI and the susceptibility pattern of CAUTI bacteria in the national reference hospital of the Sumatra region of Indonesia. A cross-sectional study was conducted at H. Adam Malik General Hospital, Medan, Indonesia, from 2020 to 2021, using a total sampling. All CAUTI patients included were on catheterization and diagnosed based on the Centers for Disease Control and Prevention (CDC) guidelines. The patient's urine culture and antibiotic susceptibility test were carried out on the patient's admitted urine sample for further assessment. Identification of bacteria, antibiotic susceptibility test, and the extended-spectrum beta-lactamase (ESBL) test for Escherichia coli and Klebsiella pneumoniae were conducted using the VITEK-2 Compact. A total of 74 CAUTI patients were included in the study, 59.5% were female, 54.1% were 46-65 years old, and a third had cardiovascular disease comorbidities (33.8%). A total of 83 CAUTI-associated bacteria were isolated. The majority were Gram-negative bacteria (74.7%), and the most bacteria isolated was E. coli (31.3%), followed by K. pneumoniae, Enterococcus faecalis, Acinetobacter baumannii, and Enterococcus faecium. The ESBL test was positive mostly in K. pneumoniae (100%) and E. coli (76.9%). CAUTI-associated E. coli was susceptible to tigecycline, meropenem, ertapenem, nitrofurantoin, and gentamicin. The isolated K. pneumoniae was susceptible to tigecycline, meropenem, ertapenem, and amikacin. While E. faecalis showed susceptibility to tigecycline, nitrofurantoin, vancomycin, imipenem, linezolid, ampicillin, piperacillin/tazobactam, amoxicillin/clavulanic acid, ampicillin/sulbactam, and piperacillin.

The association between testosterone deficiency and nocturia: Insights from The National Health and Nutrition Examination Survey data set.

To examine the association between testosterone deficiency (TD) and nocturia in males, with specific attention to age and cardiovascular disease (CVD) comorbidity. This cross-sectional study utilized the National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2016, assessing 6137 adult male participants. TD was defined by a serum total testosterone (TT) concentration less than 300 ng/dL. Nocturia was determined based on participants'responses to a standard NHANES question regarding the frequency of urination during the night. The study observed a significant association between TD and nocturia (adjusted odds ratio [95% confidence interval] = 1.211 [1.060-1.384], p = 0.005). Moreover, a U-shape pattern was noted in the relationship between serum TT concentration and the relative odds of nocturia. Subgroup analysis revealed a robust correlation between TD and nocturia in those over 60 years old, and those with hypertension, dyslipidemia, and CVDs. Our findings suggest a positive correlation between TD and nocturia, particularly among elderly individuals with CVD. This association underscores the potential therapeutic significance of addressing TD in the management of nocturia. Furthermore, longitudinal studies are needed to establish a causal relationship between TD and nocturia.

Obstructive Sleep Apnea In An Indian Population: A Cross Sectional Study

BACKGROUND: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder, associated with impaired ventilation during sleep and disruption of sleep; which is defined on the basis of nocturnal and daytime symptoms as well as sleep study findings. It’s associated with certain risk factors, namely – obesity, male sex, advancing age, hypertension, chronic consumption of alcohol and sedatives, along with positive family history. Any unexplained systemic or pulmonary hypertension, new-onset arrhythmias, polycythemia, personality and mood changes (including depression, anxiety), or cognitive defects are often linked to sleep disturbances and OSA. AIMS: Consequently, this study had 2 primary aims that were intended to be achieved by certain objectives: To screen an apparently healthy adult Indian population for prevalence of OSA amidst them, by – assessing the cardinal predisposing factors;and appraising extent of daytime sleepiness, fatigue and sleep status of volunteers. To significantly curb the incidence of OSA, by – counselling affected individuals to remodel their modus vivendi, and creating awareness amongst general public. METHODS: Subsequent to procuring assent from the Institutional Ethics Committee, for this cross-sectional, time-based study (of 3 months), a multiple-choice questionnaire was responded by 1078 Indian adults. Considering the specific target population of each, this questionnaire was an amalgamation of the three standard, subjective, clinical tools, namely: Berlin Questionnaire (BQ), STOP-BANG Questionnaire (SBQ), Epworth Sleepiness Scale (ESS). Responses were thoroughly and discretely analyzed, using the elementary Microsoft 365 Excel, in tandem with IBM SPSS ver29. Suggested appropriate lifestyle changes to those seemingly affected with OSA, by reaching out through the affiliated email address (thesleepperils@gmail.com). OSA Awareness campaigns organized for the general public. RESULTS: According to the data collected (margin of error ±3% at 95% confidence interval), 11.78% and 5.75% of the participants were found highly vulnerable to OSA, using the BQ and SBQ tools, respectively. ESS depicted that more than one-fourth of the participants are susceptible to OSA. In congruence with similar studies conducted across the globe, this research has also concluded that males are significantly more prone to OSA than females. CONCLUSION: The public health impact of obstructive sleep apnea is escalating, particularly in developing countries like India, because of increasing urbanization leading to sedentary lifestyles, and its potential contribution to the worsening rates of cardiovascular disease, diabetes and other co-morbidities. Identifying and addressing lifestyle and behavioral factors as well as comorbidities that may be exacerbating OSA, by budding clinicians is a must for a comprehensive management of obstructive sleep apnea. Consequently, the ultimate aim of this study was to diagnose obstructive sleep apnea at an early stage; along with analyzing the national burden of the ailment.

Cardiovascular comorbidities and their prognostic value in small cell lung cancer patients with chemoradiotherapy.

Small cell lung cancer (SCLC) is an extremely malignant subtype of lung cancer because of its high potential for metastases. Cardiac invasion of SCLC is a serious concern that may lead to systemic embolism or tract obstruction. It has aroused much concern that cardiovascular comorbidities may significantly affect the survival of SCLC patients and their treatment decisions. We consecutively recruited 772 small cell lung cancer (SCLC) patients between January 2011 and December 2018 from 4 cancer specialty hospitals in China. Only newly diagnosed primary cancer inpatients were included. Univariable and multivariable adjusted Cox proportional hazard models were conducted to evaluate the risk factors associated with mortality. Hazard ratios (HRs) for mortality and corresponding 95% confidence intervals (95% CIs) were calculated. The prevalence of cardiovascular diseases (CVDs) was 34.6% in all SCLC patients. Log-rank analysis presented statistically significant differences in median survival time (MST) between patients with CVD and without CVD in all SCLC patients (9.0months vs. 15.0months, P = 0.005) and patients with chemotherapy only (12.0months vs. 18.0months, P = 0.048). Pericardial effusion (HR 1.671, 95% CI 1.082-2.580, P = 0.021) and heart failure (HR 1.752, 95% CI 1.290-2.379, P < 0.001) were independent risk factors associated with mortality in all SCLC patients. VTE is related to poorer prognosis in patients with chemotherapy only (HR 5.558, 95% CI 1.335-23.135, P = 0.018) and chemoradiotherapy (HR 3.057, 95% CI 1.270-7.539, P = 0.013). Comprehensive management of CVD comorbidities is of vital importance for the long-term prognosis of SCLC patients.

Prevalence of Covid-19 and Associated Co-Morbidities at a Tertiary Hospital in Eastern Nepal

Introduction: COVID-19 (coronavirus disease) manifests as asymptomatic, mild, or severe pneumonia-like symptoms. COVID-19 patients with diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), hypertension, malignancies, HIV, and other comorbidities could develop a life-threatening condition.&#x0D; Objectives: To identify the various comorbid illnesses in COVID-19-positive patients along with its baseline characteristics in a tertiary hospital in eastern Nepal.&#x0D; Methodology: A one-month observational study carried out in RT-PCR positive COVID-19 patients in Birat Medical College and Hospital (BMCTH) Molecular Laboratory from June to July 2021. All the data was entered in a pre-structured proforma. The data was then further entered and analyzed by using Microsoft Excel 2014.&#x0D; Result: There were 354 (22.77%) RT-PCR positive COVID-19 cases and 1200 (77.22%) RT-PCR negative COVID-19 cases. More than half of the COVID-19 positive patients were males 211(59.60%). The most common symptoms were fever (92.3%), cough (83.5%) and tiredness (81.23%). Psycho-social stress such as anxiety, depression and insomnia 123 (34.74%) were common comorbidities followed by diabetes 91(25.70%) and hypertension 72(20.33%).&#x0D; Conclusion: COVID-19 patients were mostly between the 20-30 years of age group. Fever, cough, and throat pain were the commonest presenting symptoms.

Abstract 12580: Impact of Zero Coronary Artery Calcium on Downstream Cardiac Testing

Introduction: While coronary artery calcium scoring (CAC) has emerged as a useful tool for cardiovascular disease (CVD) risk prediction, its impact on downstream resource use remains unclear, especially in those with zero CAC. The purpose of this study was to determine the relationship between zero CAC and downstream use of cardiac procedures. Methods: Consecutive CAC scores from two academic hospitals in Toronto, Canada, from 2011 - 2019, were linked to population-based databases. Subjects with zero calcium without previous CVD were subsequently propensity score-matched with a non-CAC-tested control group for age, sex, CVD risk factors and comorbidities relevant to receipt of testing. Downstream cardiac testing, myocardial infarction (MI), stroke, and congestive heart failure (CHF) hospitalizations were compared between the two groups. Results were analyzed using descriptive statistics and Cox proportional hazards regression models. Results: 4,884 patients (Mean 56.8y, SD 11.3) underwent CAC scoring, of whom 2,709 (55.5%) had zero CAC (Mean 52.9y, SD 10.6, 55.4% women). Compared to those not tested at 90 days, zero CAC subjects had similar graded exercise stress test (GXT) (72 tests vs 60, p = 0.29), stress echocardiography (40 vs 32, p = 0.34) and myocardial perfusion imaging (MPS) (26 vs 37, p = 0.15), but higher cardiac MRI (CMR) (48 vs 7, p &lt; 0.001) use. At 3.4 years, GXT (HR 1.24, 95% CI 1.14 - 1.35), stress echocardiography (HR 1.80, 95% CI 1.59 - 2.05) and CMR (HR 3.40, 95% CI 2.55 - 4.53) use was higher in the zero CAC group, whereas MPS (HR 1.08, 95% CI 0.97 - 1.21) and catheterization (HR 1.14, 95% CI 0.91 - 1.44) were similar and PCI (HR 0.59, 95% CI 0.35 - 0.98) and CABG (HR 0.14, 95% CI 0.03 - 0.61) were lower. There was an approximately 5-fold lower rate of MI (HR 0.22, 95% CI 0.10 - 0.51) in the zero CAC group at 3.4 years and no difference in stroke (HR 0.98, 95% CI 0.46 - 2.05) or CHF hospitalizations (HR 1.15, 95% CI 0.53 - 2.48). Conclusion: Zero CAC was associated with higher use of some non-invasive cardiac testing, similar use of catheterization, and reduced PCI, CABG and AMI when compared to a propensity score-matched control group. The results support the utility of a zero CAC in limiting invasive procedures while maintaining an association with reduced cardiac events.

Abstract 14623: SGLT2 Inhibitors versus Sulfonylureas as Add-On Therapy to Metformin in Type 2 Diabetes: A Systematic Review and Meta-Analysis

Background: Traditionally, in patients with type 2 diabetes mellitus (T2DM) poorly controlled on metformin sulfonylureas were used as add-on therapy. Sodium glucose cotransporter 2 inhibitors (SGLT2i) have emerged as novel antidiabetic agents that have also shown improvement in cardiovascular outcomes. Aim: To conduct a meta-analysis comparing SGLT2i with sulfonylureas as add-on therapy to metformin in patients with poorly controlled type 2 diabetes mellitus (T2DM). Methods: We conducted a comprehensive search of PubMed, EMBASE, and Cochrane Library up till March 2023, to identify studies comparing SGLT2i versus sulfonylureas as add-on therapy to metformin in patients with poorly controlled T2DM (regardless of the presence of comorbid cardiovascular disease). Effect estimates were pooled using a random-effects model, and reported as risk ratios (RR) for dichotomous outcomes, and mean differences (MD) for continuous outcomes, along with 95% confidence intervals (CIs) for each. Results: Eleven studies met the inclusion criteria, all reporting mortality outcomes. Metformin-SGLT2i significantly reduced all-cause mortality (RR=0.76 [0.60, 0.95]; p=0.02; Figure ) and myocardial infarction (RR: 0.65 [0.47, 0.89]; p=0.008), in comparison to metformin-sulfonylureas. Metformin-SGLT2i was also associated with a significantly greater reduction in HbA1c (MD: -0.10% [-0.17 - -0.03]; p=0.004), fasting plasma glucose (MD: -0.55 [-0.69 - -0.41]; p&lt;0.001), systolic blood pressure (MD: -4.77 mmHg [-5.39, -4.16]; p&lt;0.001), and weight (MD: -4.57 kg [-4.74, -4.39]; p&lt;0.00), compared with metformin-sulfonylurea. Moreover, metformin-SGLT2i was associated with a significantly lower risk of hypoglycemic events (RR=0.13 [0.10-0.17]; p&lt;0.001). Conclusion: In patients with poorly controlled T2DM on metformin, addition of SGLT2i may yield superior outcomes compared with sulfonylureas.