Effect Of Baseline Variables Research Articles

Thrombectomy in Patients With Ischemic Stroke Without Salvageable Tissue on CT Perfusion.

Computed tomography perfusion (CTP) imaging is regularly used to guide patient selection for mechanical thrombectomy (MT). However, the effect of MT in patients without salvageable tissue on CTP has not been investigated. The purpose of this study was to assess the effect of MT in patients with stroke without perfusion mismatch profiles. This observational study analyzed patients with ischemic stroke consecutively treated between March 1, 2015, and January 31, 2022, triaged by multimodal-computed tomography undergoing MT. CTP lesion-core mismatch profiles were defined using a mismatch volume/ratio of ≥10 mL/1.2, respectively. The primary end point was the rate of functional independence at 90 days, defined as the modified Rankin Scale score of 0 to 2. Recanalization was evaluated with the modified Thrombolysis in Cerebral Infarction scale. The effect of baseline variables on functional outcome was assessed using multivariable logistic regression analysis. Outcomes of patients with and without CTP-mismatch profiles were compared using 1:1 propensity score matching. Of 724 patients who met the inclusion criteria of this retrospective observational study, 110 (15%) patients had no CTP mismatch and were analyzed. The median age was 74 (interquartile range, 62-80) years and 53% were women. Successful recanalization (modified Thrombolysis in Cerebral Infarction score, ≥2b) was achieved in 66% (73) and associated with functional independence at 90 days (adjusted odds ratio, 7.33 [95% CI, 1.22-43.70]; P=0.03). A significant interaction was observed between recanalization and age, as well as the extent of infarction, indicating MT to be most effective in patients <70 years and with a baseline Alberta Stroke Program Early Computed Tomography Score range between 3 and 7. These findings remained stable after propensity score matching, analyzing 152 matched pairs with similar rates of functional independence between patients with and without CTP-mismatch profiles (17% versus 23%; P=0.42). In patients without CTP-mismatch profiles defined according to the EXTEND (Extending the Time for Thrombolysis in Emergency Neurological Deficits) criteria, recanalization was associated with improved functional outcomes. This effect was associated with baseline Alberta Stroke Program Early Computed Tomography Score and age, but not with the time from onset to imaging.

Investigating Relationships Among Self-Efficacy, Mood, and Anxiety Using Digital Technologies: Randomized Controlled Trial.

Digital tools assessing momentary parameters and offering interventions in people's daily lives play an increasingly important role in mental health research and treatment. Ecological momentary assessment (EMA) makes it possible to assess transient mental health states and their parameters. Ecological momentary interventions (EMIs) offer mental health interventions that fit well into individuals' daily lives and routines. Self-efficacy is a transdiagnostic construct that is commonly associated with positive mental health outcomes. The aim of our study assessing mood, specific self-efficacy, and other parameters using EMA was 2-fold. First, we wanted to determine the effects of daily assessed moods and dissatisfaction with social contacts as well as the effects of baseline variables, such as depression, on specific self-efficacy in the training group (TG). Second, we aimed to explore which variables influenced both groups' positive and negative moods during the 7-day study period. In this randomized controlled trial, we applied digital self-efficacy training (EMI) to 93 university students with elevated self-reported stress levels and daily collected different parameters, such as mood, dissatisfaction with social contacts, and specific self-efficacy, using EMA. Participants were randomized to either the TG, where they completed the self-efficacy training combined with EMA, or the control group, where they completed EMA only. In total, 93 university students participated in the trial. Positive momentary mood was associated with higher specific self-efficacy in the evening of the same day (b=0.15, SE 0.05, P=.005). Higher self-efficacy at baseline was associated with reduced negative mood during study participation (b=-0.61, SE 0.30, P=.04), while we could not determine an effect on positive mood. Baseline depression severity was significantly associated with lower specific self-efficacy over the week of the training (b=-0.92, SE 0.35, P=.004). Associations between higher baseline anxiety with higher mean negative mood (state anxiety: b=0.78, SE 0.38, P=.04; trait anxiety: b=0.73, SE 0.33, P=.03) and lower mean positive mood (b=-0.64, SE 0.28, P=.02) during study participation were found. Emotional flexibility was significantly enhanced in the TG. Additionally, dissatisfaction with social contacts was associated with both a decreased positive mood (b=-0.56, SE 0.15, P<.001) and an increased negative mood (b=0.45, SE 0.12, P<.001). This study showed several significant associations between mood and self-efficacy as well as those between mood and anxiety in students with elevated stress levels, for example, suggesting that improving mood in people with low mood could enhance the effects of digital self-efficacy training. In addition, engaging in 1-week self-efficacy training was associated with increased emotional flexibility. Future work is needed to replicate and investigate the training's effects in other groups and settings. ClinicalTrials.gov NCT05617248; https://clinicaltrials.gov/study/NCT05617248.

Abstract WP193: Clinical Profile Of Patients With Non-cardioembolic Ischemic Stroke Or Transient Ischemic Attack Benefiting Most From Dual Antiplatelet Therapy

Introduction: The clinical profile of patients with non-cardioembolic ischemic stroke (IS) or transient ischemic attack (TIA) who benefit from dual antiplatelet therapy (DAPT) is not well established. The aim of this study is to identify those characteristics in this population. Methods: We performed a study-level random effects meta-analysis of major randomized controlled clinical trials comparing DAPT to monotherapy antiplatelet treatment (MAPT). Efficacy and safety outcomes were rates of recurrent stroke and major hemorrhage. Baseline demographic and clinical characteristics were recorded. Pooled statistics were calculated as odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed by I 2 . The effects of baseline variables on the log odds ratio of efficacy and safety outcomes for MAPT and DAPT were determined by meta-regression analyses. Results: The analysis included 19 studies (N=76407; 50% on DAPT). There were no differences in baseline characteristics between the groups, except for a higher prevalence of previous antiplatelet use in the MAPT arm (OR=1.07; p=0.04). DAPT decreased the odds of recurrent stroke (OR, 0.74, 95% CI, 0.65-0.85, I 2 =66%) and increased odds of major hemorrhage (OR, 1.51, 95% CI, 1.11-2.07, I 2 =76%). In meta-regression analysis, both DAPT and MAPT benefitted patients irrespective of their baseline characteristics, except for patients with increased stroke severity (as measured by NIHSS at presentation) which reduced the risk of recurrent stroke in the DAPT group (r 2 =16%, p&lt;0.05), but not in the MAPT group (p&gt;0.05). Risk of major hemorrhage was increased in patients with history of congestive heart failure (DAPT: OR= -0.001, p=0.02; MAPT: OR= -0.001, p=0.02) and in those with prior antiplatelet use (DAPT: OR= -0.001, p=0.02; MAPT: OR= -0.001, p=0.02). Conclusions: MAPT and DAPT reduce the risk of recurrent stroke irrespective of baseline characteristics. However, DAPT, but not MAPT, benefits patients with increased stroke severity. History of congestive heart failure and prior use of antiplatelet have a modest incremental effect in the risk of major hemorrhage.

The five year outcome of major depression: Effects of baseline variables and type of treatment

BackgroundDepression is commonly a relapsing or chronic disorder. Long-term outcome is therefore important. We report on the outcome of major depression five years after receiving treatment with medication or psychotherapy. Methods472 patients were treated in three consecutive randomised controlled trials in one clinical research centre. 298 were followed up at five years. Of these, 106 patients were treated with medications, while the remaining 192 were given psychotherapy. The a priori outcome measure was mood symptoms in the two years prior to the assessment. ResultsThe majority (56%) of patients had no depressive symptoms in the prior two years. One third (32%) had fluctuating depression, while 12% were chronic depressed. Predictors of outcome were few; baseline severity, suicidality, personality pathology, and type of treatment. Those receiving medication did somewhat worse, even when adjusted for this group's higher depression severity, suicidality and personality pathology at baseline. ConclusionsLong-term depressive symptoms are common after evidence-based treatment, although over half the patients appear to recover. Psychotherapy may be superior to medication in reducing the level of symptoms in the longer term. Personality remains one of the few baseline predictors of long-term outcome.

Risk factors for esophagitis after hypofractionated palliative (chemo) radiotherapy for non-small cell lung cancer

IntroductionEsophagitis influences quality of life and might cause treatment interruption and hospitalization. Previous studies of risk factors focused on curative treatment for non-small cell lung cancer (NSCLC), which often involves concomitant chemoradiation (CRT). Given the uncertainty around extrapolation of dose constraints, we analyzed risk factors in patients treated with hypofractionated palliative regimens.Patients and methodsA retrospective review of 106 patients treated with palliative radiotherapy or CRT between 2009 and 2017 was performed. Inclusion criteria: prescribed total dose 30–54 Gy, dose per fraction 2.5–4 Gy, esophageal dose > 1 Gy. Uni- and multivariate analyses were performed in 97 eligible patients to identify predictive factors for acute esophagitis grade ≥ 1 (CTCAE 5.0).ResultsForty percent of patients were treated with 15 fractions of 2.8 Gy (42 Gy) and 28% also received chemotherapy according to the CONRAD study regimen (induction and concomitant Carboplatin/Vinorelbine) published by the Norwegian Lung Cancer Group. Thirty-four percent were treated with 10 fractions of 3 Gy. Stage IV NSCLC was present in 47%. Esophagus Dmax was 39 Gy (population median) and Dmean 15 Gy. Overall 31% of patients developed esophagitis (26% grade 2–3, no grade 4–5). Several dosimetric parameters correlated with the risk of esophagitis (Dmax, Dmean, D5cc, V20, V30, V35, V40). Dmax outperformed other dosimetric variables in multivariate analysis. Furthermore, concomitant chemotherapy significantly increased the risk of esophagitis, while oral steroid medication reduced it. In patients with Dmax ≥40 Gy a reduced Dmean (≤20 Gy) was beneficial.ConclusionIn order to reduce esophagitis after hypofractionated palliative treatment lower doses than those recommended in curative NSCLC settings are preferable. Besides esophageal dose, CRT is the main risk factor for esophagitis. Additional work is needed to confirm that steroids are able to modify the risk (or to rule out confounding effects of baseline variables not included in our database).

Abstract P5-06-13: Factors associated with twenty-year (y) risks of breast cancer-specific mortality (BCSM) for locally-advanced breast cancer (LABC) in the surveillance, epidemiology, and end results (SEER) registry

Abstract Background: Patients (pts) with LABC have a high risk of early recurrence and death. The risk of late BCSM in pts with LABC is unclear. Recent studies have shown that the risk of BCSM persists beyond 5 y (Pan, NEJM 2017); however, pts with LABC as well as those with hormone receptor (HR)-negative disease have not been studied. The aims of this study were to report on population-based long-term risks of BCSM, and the risks of BCSM conditional on having survived 5 y, among pts with LABC. In addition, we aimed to identify factors associated with late deaths from breast cancer. Methods: We evaluated women with LABC (T3 or T4 [any N] or N3 [any T], M0 disease), diagnosed between 1990 and 2005, reported to SEER. HR status was known for all pts, but HER2 was unavailable. Pts with another primary tumor either before or after breast cancer were excluded. The dependent outcome is based on the cause-of-death recode variable from SEER (which can include disease or treatment-related deaths). Patients with non-cancer cause of deaths were censored. We used Kaplan-Meier analyses to determine the effect of baseline variables on cumulative risks of BCSM, estimated the annual rate of events per 100 person-years, and performed unadjusted Fine and Gray regressions for T3/T4 pts and for N3 pts stratified by HR status. Results: We included 24,082 pts (median follow-up = 7.16 y). Of all breast cancer deaths, the proportion that occurred after 5 y was 46% for HR+ vs 13% for HR- (p&amp;lt;0.001), the proportion after 10 y was 13% vs 2% respectively (p&amp;lt;0.001). The table shows risks of BCSM by HR, N and T status, and annual event rates. The cumulative risk of BCSM in y 5-20 ranged from 10.2% in HR- T3/T4,N0 to 59.4% in HR+ T3/T4,N3. Conditional on having survived 5 y, unadjusted hazards of BCSM among T3/T4 pts were the following: T3/T4 HR+ N3 vs N0 (Hazard ratio [HzR] 3.9; 95% confidence interval [CI], 3.4-4.5); T3/T4 HR- N3 vs N0 (HzR 3.6; 95% CI, 2.7-4.7). Unadjusted hazards of BCSM among N3 pts were the following: N3 HR+ T4 vs T1 (HzR 1.5; 95% CI, 1.3-1.8); N3 HR- T4 vs T1 (HzR 1.8; 95% CI, 1.3-2.7). Conclusions: Among pts with LABC, event rates within 5 y are high, in both HR+ and HR- pts. Beyond 5 y, BCSM still depends on traditional clinicopathologic factors and more late events occur in HR+ disease than in HR- disease. The observed late events lead to an extremely high cumulative risk of BCSM by y 20 in both HR+ and HR- LABC. BCSMAll-cause mortality% Event-FreeAnnual rate (%)Cumulative risk (%)Cumulative risk (%)at 5 yat 10 yy 5-&amp;lt;10y 10-&amp;lt;15y 15-20y 5-20y 0-20y 0-20HR status among N3HR+N366.345.57.85.03.554.970.179.2HR-N338.931.04.70.91.027.371.878.0Nodal status among T3/T4HR+N090.281.82.01.40.617.125.256.6N179.866.53.72.41.431.245.164.0N271.251.86.54.13.148.163.176.2N356.936.99.06.03.459.476.983.8HR-N075.571.31.20.30.710.232.251.0N156.449.32.80.80.418.554.167.1N238.831.54.41.21.428.172.180.8N328.820.86.80.91.034.681.285.1Tumor size among N3 onlyHR+T175.956.76.04.32.647.660.271.0T268.446.18.14.94.156.370.179.7T361.740.98.55.83.758.974.781.0T449.730.910.26.32.660.280.288.3HR-T151.141.54.30.81.527.062.769.4T241.934.83.81.00.722.967.775.9T333.325.75.30.70.626.275.479.0T424.616.28.81.43.060.590.393.9 Citation Format: Jose P Leone, Bernardo A Leone, Michael J Hassett, Julieta Leone, Rachel A Freedman, Sara M Tolaney, Eric P Winer, Carlos T Vallejo, Nancy U Lin. Factors associated with twenty-year (y) risks of breast cancer-specific mortality (BCSM) for locally-advanced breast cancer (LABC) in the surveillance, epidemiology, and end results (SEER) registry [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-06-13.

Anticholinergic medications for reducing drooling in children with developmental disability.

To determine: the effectiveness of three anticholinergic medications in reducing drooling in children with developmental disabilities (such as cerebral palsy, intellectual disability, and autism spectrum disorder), the frequency and nature of side effects, and their impact on treatment discontinuation. After prescription of benzhexol hydrochloride, glycopyrrolate, or scopolamine patches at a tertiary saliva control clinic, all carers of 110 consecutive, eligible patients were recruited over a 5-year period. They provided data for 52weeks, or until drug discontinuation, on compliance, drooling, adverse effects, and reasons for cessation. We evaluated and compared best drooling response, side effects, and drug cessation rates using survival analysis, and the effect of baseline variables on the discontinuation rate using proportional hazards regression. Among 110 participants (71 males, 39 females; mean age 8y 5mo [SD 4y 3mo], range 1y 11mo-18y 11mo), benzhexol, glycopyrrolate, and scopolamine were prescribed 81, 62, and 17 times respectively, with respective response rates of 85%, 75%, and 65%. Poor head control and poor oromotor function were predictive of poor response. Side effects frequently prompted drug cessation in males more than females (hazard ratio 1.8 [95% confidence interval 1.0-3.2], p=0.048). Glycopyrrolate had the fewest side effects. Benzhexol, glycopyrrolate, and scopolamine reduce drooling, but improvement is offset by adverse side effects. Overall, glycopyrrolate performs best. In drooling, glycopyrrolate produced the greatest improvement with fewer side effects compared with benzhexol and scopolamine. Poor head control and poor oromotor function were associated with poor response. Medication side effects were common and often led to treatment discontinuation. Behavioural issues instigated cessation of benzhexol more often in males than females.

Factors associated with twenty-year (y) risks of breast cancer-specific mortality (BCSM) in the Surveillance, Epidemiology, and End Results (SEER) Registry.

540 Background: Most reports describing the risk of late relapse in breast cancer have been based on selected patients (pts) enrolled into clinical trials. The aims of this study were to report on population-based long-term risks of BCSM, and the risks of BCSM conditional on having survived 5 y. Additionally, we aimed to identify factors associated with late deaths from breast cancer. Methods: Using SEER data, we identified women with breast cancer (T1-T2, N0-N2, M0) between 1990-2005, with one primary cancer in their lifetime, and known hormone receptor (HR) status. We used Kaplan-Meier analyses to determine the effect of baseline variables on cumulative risks of BCSM, we estimated annual rate of events per 100 person-years, and performed Cox regression stratified by HR status. Results: We included 202,080 pts (median follow-up = 12.25 y). Of all breast cancer deaths, the proportion after 5 y was 65% for HR+ vs 28% for HR- (p &lt; 0.001). The table shows risks of BCSM by HR and N status, and annual event rates. The cumulative risk of BCSM in y 5-20 ranged from 7.9% in HR-N0 to 38% in HR+N2. Among HR+ pts, adjusted risks of BCSM conditional on having survived 5 y were higher for T2 vs T1a (Hazard ratio [HzR] 3.3, p &lt; 0.001), N2 vs N0 (HzR 3.5, p &lt; 0.001), age at diagnosis (dx) &gt; 64 y vs &lt; 50 y (HzR 1.4, p &lt; 0.001), black race vs white (HzR 1.3, p &lt; 0.001) and grade III vs I (HzR 2.3, p &lt; 0.001). For HR- pts, adjusted risks of BCSM conditional on having survived 5 y were higher for T2 vs T1a (HzR 2.0, p &lt; 0.001), N2 vs N0 (HzR 2.8, p &lt; 0.001) and age at dx &gt; 64 y vs &lt; 50 y (HzR 1.6, p &lt; 0.001). Conclusions: For HR+ breast cancer, risks of BCSM remain high beyond 5 y from dx and depend on T-N status, age, race and grade. In HR- breast cancer, the risk of BCSM is highest within 5 y from dx; however, risks beyond 5 y are still considerable and depend on T-N status and age. Our results underscore the need for better adjuvant therapies in both HR+ and HR- breast cancer. [Table: see text]

Importance of Measuring Hand and Foot Function Over the Disease Course in Rheumatoid Arthritis: An Eight‐Year Follow‐Up Study

To assess function using the Signals of Functional Impairment (SOFI) instrument over 8 years, to study clinical variables associated with the change, and to study change over time of the SOFI items. In total, 1,223 patients with early rheumatoid arthritis (RA) from the Better Anti-Rheumatic Farmacotherapy (BARFOT) cohort (mean ± SD age 56.9 ± 15.4 years, 67% women) were included in the analysis. Data from baseline and from 1 and 8 years were studied. The SOFI instrument includes measures of range of motion in the hand, shoulder/arm, and lower extremity (range 0-44, best to worst). The effects of baseline variables (sociodemographic, disease activity, joint destruction, and function) on change in SOFI scores were studied by linear regression analysis. During the first year, the improvement in mean ± SD SOFI scores was 2.7 ± 5.7 (P < 0.001). Worse scores in the Disease Activity Score in 28 joints and Health Assessment Questionnaire score at baseline were associated with this improvement (r2 ≤ 0.11). During the next 7 years, the deterioration in SOFI scores was mean ± SD 1.5 ± 4.9 (P < 0.001). Based on change scores, we found that finger flexion, pincer grip, and toe-standing were the most important items to measure, explaining 58-61% of the total SOFI score, and these items were also associated with radiographic changes at the 8-year follow-up. Function as assessed with SOFI scores improved during the first year in patients with early RA, but it deteriorated slowly thereafter. Impaired hand and foot function was associated with joint destruction at the 8-year follow-up. Measures of hand and foot function will complement self-reported and medical data, both in clinical work and in long-term research studies.

Cancers of unknown primary diagnosed during hospitalization: a population-based study

BackgroundCancers of Unknown Primary (CUP) are the 3-4th most common causes of cancer death and recent clinical guidelines recommend that patients should be directed to a team dedicated to their care. Our aim was to inform the care of patients diagnosed with CUP during hospital admission.MethodsDescriptive study using hospital admissions (Scottish Morbidity Record 01) linked to cancer registrations (ICD-10 C77-80) and death records from 1998 to 2011 in West of Scotland, UK (population 2.4 m). Cox proportional hazards models were used to assess effects of baseline variables on survival.ResultsSeven thousand five hundred ninety nine patients were diagnosed with CUP over the study period, 54.4% female, 67.4% aged ≥ 70 years, 36.7% from the most deprived socio-economic quintile. 71% of all diagnoses were made during a hospital admission, among which 88.6% were emergency presentations and the majority (56.3%) were admitted to general medicine. Median length of stay was 15 days and median survival after admission 33 days. Non-specific morphology, emergency admission, age over 60 years, male sex and admission to geriatric medicine were all associated with poorer survival in adjusted analysis.ConclusionsPatients with a diagnosis of CUP are usually diagnosed during unplanned hospital admissions and have very poor survival. To ensure that patients with CUP are quickly identified and directed to optimal care, increased surveillance and rapid referral pathways will be required.

Analysis of electrical and mechanical left atrial properties in patients with persistent atrial fibrillation

The study of left atrial (LA) mechanical function during atrial fibrillation (AFib) can provide valuable information, particularly if such profiling is related to the cavity electrical substrate and conveys prognostic information. To assess if there is any relation between LA mechanical and electrical asynchrony and if such evaluation can be of interest in stratifying AFib patients. 50 patients with persistent AFib who underwent electrical cardioversion (CV) were evaluated with pre-CV atrial electrograms (AEGs). Electrical asynchrony was classified according to Wells' patterns of AEGs, ranging from most organized (I) to most dispersed (III) one. LA mechanical asynchrony was addressed by transthoracic 2D-speckle-tracking echo and quantified according to time-to-peak standard deviation (TP-SD) of wall strains and their peak values (PS) before CV, after 24h, at 1month. Pre-CV a linear, inverse relation between TP-SD and PS (p<0.001) and a direct linear relation between TP-SD and Wells' classes (p=0.04) were observed. With sinus rhythm TP-SD decreased (p=0.023) and PS increased (p<0.001), suggesting improved LA mechanical milieu. A multivariate analysis, testing the effects of baseline variables in predicting post-CV recurrence of AFib, revealed that amount of TP-SD variation pre/24h post-CV was the only independent predictor at 6months (p=0.046). Speckle tracking-derived LA parameters can describe LA wall forces during AFib, categorizing the asynchronous mechanistic profile of AFib that correlates with the degree of the dispersed LA electrical activity. The amount of changes in LA mechanical asynchrony pre/post-CV seems to have prognostic relevance in predicting SR maintenance.

748 Effect of baseline variables on acute urinary retention and surgery related to benign prostatic hyperplasia in men from the combination of avodart and tamsulosin (CombAT) study

748 Effect of baseline variables on acute urinary retention and surgery related to benign prostatic hyperplasia in men from the combination of avodart and tamsulosin (CombAT) study

Progression to chronic atrial fibrillation after pacing: the Canadian Trial of Physiologic Pacing

OBJECTIVESThis study examined the effect of physiologic pacing on the development of chronic atrial fibrillation (CAF) in the Canadian Trial Of Physiologic Pacing (CTOPP).BACKGROUNDThe role of physiologic pacing to prevent CAF remains unclear. Small randomized studies have suggested a benefit for patients with sick sinus syndrome. No data from a large randomized trial are available.METHODSThe CTOPP randomized patients undergoing first pacemaker implant to ventricular-based or physiologic pacing (AAI or DDD). Patients who were prospectively found to have persistent atrial fibrillation (AF) lasting greater than or equal to one week were defined as having CAF. Kaplan-Meier plots for the development of CAF were compared by log-rank test. The effect of baseline variables on the benefit of physiologic pacing was evaluated by Cox proportional hazards modeling.RESULTSPhysiologic pacing reduced the development of CAF by 27.1%, from 3.84% per year to 2.8% per year (p = 0.016). Three clinical factors predicted the development of CAF: age ≥74 years (p = 0.057), sinoatrial (SA) node disease (p < 0.001) and prior AF (p < 0.001). Subgroup analysis demonstrated a trend for patients with no history of myocardial infarction or coronary disease (p = 0.09) as well as apparently normal left ventricular function (p = 0.11) to derive greatest benefit.CONCLUSIONSPhysiologic pacing reduces the annual rate of development of chronic AF in patients undergoing first pacemaker implant. Age ≥74 years, SA node disease and prior AF predicted the development of CAF. Patients with structurally normal hearts appear to derive greatest benefits.

Mortality in the Jerusalem 70-year-olds longitudinal study: does nifedipine have a role?

Short-acting nifedipine was found to be associated with increased mortality in elderly patients in some studies. We examined effects of long-acting nifedipine in a longitudinal study of Jerusalem 70 year olds (448 participants). After follow-up of 6.5 years (1990-1996) 70 subjects died. We examined the effects of baseline variables on total mortality. Hypertensives had higher mortality than normotensives, 21.2% versus 13.8%, p = 0.01. Diuretic-treated patients (n = 72), mostly hypertensive (n = 71), had significantly higher mortality than non-diuretic-treated patients (n = 375), 45.5% versus 14.1%; p < 0.001. Although nifedipine-treated patients had a higher prevalence of coronary heart disease diagnosis than diuretic-treated patients (52% versus 35%), their relative risk of mortality was 0.8 (CI 0.4-1.4) of that of diuretic-treated patients. A multiple logistic regression model, including gender, systolic blood pressure, creatinine, cholesterol, diagnosis of congestive heart failure, cardiovascular arrest, diabetes, previous myocardial infarction, physical activity, nifedipine, other calcium channel and beta blockers and diuretics, found only serum creatinine and diuretic therapy associated with total mortality, p = 0.004 and p < 0.02, respectively. When interaction terms were added to account for drug combinations, diuretic therapy lost significance, but the combination of diuretics and beta blockers (probably representing a more severe form of hypertension) became significant, p = 0.03. Long acting nifedipine is not associated with increased mortality in elderly hypertensives.