Five-year All-cause Mortality Research Articles

Reevaluating Normal-Flow Low-Gradient Severe Aortic Stenosis: Clinical Phenotypes and Outcomes in Severe Aortic Stenosis Among TAVR Patients.

Aortic stenosis (AS) is a complex condition with various hemodynamic subtypes, each with distinct clinical profiles and outcomes. This study aimed to assess the characteristics and outcomes of different AS phenotypes based on flow and gradient patterns. In this retrospective cohort study, we included 930 patients who underwent transcatheter aortic valve replacement (TAVR) for severe symptomatic AS at Mayo Clinic sites from 2012-2017. Patients were classified into three groups: high gradient (HG), low-flow low-gradient (LFLG), and normal-flow low-gradient (NFLG). Baseline clinical, echocardiographic, and computed tomography (CT) characteristics, including aortic valve area (AVA), aortic valve calcium score (AVCS), left ventricular ejection fraction (LVEF), and the prevalence of tricuspid regurgitation (TR) and atrial fibrillation were analyzed. One- and five-year all-cause mortality outcomes were compared using Kaplan-Meier analysis and Cox proportional hazards models. The final cohort included 273 patients in the NFLG group (29.4%), 563 in the HG group (60.5%), and 94 in the LFLG group (10.1%). After reevaluation and careful review of the echocardiograms, 41 NFLG patients were reclassified into the LFLG group. LFLG patients had the highest prevalence of atrial fibrillation/flutter (60%) and TR (17%). AVCS was significantly lower in NFLG compared to HG and LFLG groups. One-year mortality was highest in the LFLG group (17.4%), followed by HG (13.9%) and NFLG (10.9%), but the difference was not statistically significant (p=0.2). Five-year mortality rate was higher in the LFLG group (55.6%) compared to NFLG (47.2%) and HG (47.9%) but did not reach statistical significance (p=0.2). LFLG AS is associated with more comorbidities and higher mortality compared to HG and NFLG groups, though differences in mortality were not statistically significant. The NFLG group, after close review and reclassification, showed the least significant AS. Randomized trials are needed to clarify the prognosis and management of NFLG AS.

Multilevel Disparities of Sex-Differentiated Human Papilloma Virus-Positive Oropharyngeal Cancers in the United States.

Objectives: This study used multilevel social determinants of health (SDoH) models to determine how SDoH influence different sexes of patients diagnosed with HPV-positive oropharyngeal squamous cell cancers (OPSCC) across the US. Methods: This was a retrospective cohort study assessing HPV-confirmed patients with oropharyngeal squamous cell cancers from 2010 to 2018 using census-level Yost Index socioeconomic status (SES) score and rurality-urbanicity measures alongside individual-level race-ethnicity while stratifying by biological sex. Age-adjusted multivariate regressions were performed for survival, treatment receipt, and delay of treatment initiation (of 3+ months). Results: Across 14,076 OPSCC-HPV-positive patients, delay of treatment uniquely featured positive predictors for males of black race-ethnicity (OR, 2.07; 95% CI, 1.68-2.54) and poor Yost SES (1.43; 1.24-1.65). Five-year all-cause mortality uniquely showed positive predictors of females of black race-ethnicity (2.74; 1.84-4.71) and of males with poor Yost SES (1.98; 1.79-2.19). Three-year all-cause mortality shared positive predictors across sexes but were exacerbated in females of black race-ethnicity (2.50; 1.82-3.44) compared to males (2.23; 1.91-2.60); this was reversed for poor Yost SES (male, 1.92, 1.76-2.10; female, 1.60, 1.32-1.95). Surgery showed negative predictors of black race-ethnicity that displayed worsened effects in females (0.60, 0.44-0.79) versus males (0.75, 0.66-0.86). First-line radiation receipt uniquely featured negative predictors for males of black race-ethnicity (0.73; 0.62-0.86) with poor Yost SES (0.74; 0.68-0.82). Conclusions: Comprehensive models of multilevel SDoH displayed exacerbated disparity effects of community-level SES in males and black race-ethnicity among female HPV-positive OPSCC patients. These objective comparisons of specific SDoH factors inform providers and policy direction on how to strategically target the most pertinent SDoH factors affecting a rapidly growing cancer population.

Early and Late Aortic-Related Mortality and Rupture After Fenestrated-Branched Endovascular Aortic Repair of Thoracoabdominal Aortic Aneurysms: A Prospective Multicenter Cohort Study.

Fenestrated-branched endovascular aortic repair (FB-EVAR) has been used as a minimally invasive alternative to open surgical repair to treat patients with thoracoabdominal aortic aneurysms (TAAAs). The aim of this study was to evaluate aortic-related mortality (ARM) and aortic aneurysm rupture after FB-EVAR of TAAAs. Patients enrolled in 8 prospective, nonrandomized, physician-sponsored investigational device exemption studies between 2005 and 2020 who underwent elective FB-EVAR of asymptomatic intact TAAAs were analyzed. Primary end points were ARM, defined as any early mortality (30 days or in hospital) or late mortality from aortic rupture, dissection, organ or limb malperfusion attributable to aortic disease, complications of reinterventions, or aortic rupture. Secondary end points were early major adverse events, TAAA life-altering events (defined as death, permanent spinal cord injury, permanent dialysis, or stroke), all-cause mortality, and secondary interventions. A total of 1109 patients were analyzed; 589 (53.1%) had extent I-III and 520 (46.9%) had extent IV TAAAs. Median age was 73.4 years (interquartile range, 68.1-78.3 years); 368 (33.2%) were women. Early mortality was 2.7% (n=30); congestive heart failure was associated with early mortality (odds ratio, 3.30 [95% CI, 1.22-8.02]; P=0.01). Incidence of early aortic rupture was 0.4% (n=4). Incidence of early major adverse events and TAAA life-altering events was 20.4% (n=226) and 7.7% (n=85), respectively. There were 30 late ARMs; 5-year cumulative incidence was 3.8% (95% CI, 2.6%-5.4%); older age and extent I-III TAAAs were independently associated with late ARM (each P<0.05). Fourteen late aortic ruptures occurred; 5-year cumulative incidence was 2.7% (95% CI, 1.2%-4.3%); extent I-III TAAAs were associated with late aortic rupture (hazard ratio, 5.85 [95% CI, 1.31-26.2]; P=0.02). Five-year all-cause mortality was 45.7% (95% CI, 41.7%-49.4%). Five-year cumulative incidence of secondary intervention was 40.3% (95% CI, 35.8%-44.5%). ARM and aortic rupture are uncommon after elective FB-EVAR of asymptomatic intact TAAAs. Half of the ARMs occurred early, and most of the late deaths were not aortic related. Late all-cause mortality rate and the need for secondary interventions were 46% and 40%, respectively, 5 years after FB-EVAR. URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02089607, NCT02050113, NCT02266719, NCT02323581, NCT00583817, NCT01654133, NCT00483249, NCT02043691, and NCT01874197.

Optimal medical therapy, clinical outcome and its predictors in patients with acute coronary syndrome after discharge with secondary prevention medications at University of Gondar Comprehensive Specialized Hospital, North West Ethiopia, 2023: A retrospective follow-up study

BackgroundThe life-threatening diseases known as ACS (acute coronary syndrome) continue to produce considerable rates of morbidity and mortality despite breakthroughs in therapy. The study determined clinical outcome and its predictors in patients at the University of Gondar Comprehensive and Specialized Hospital (UOGCSH), North West Ethiopia.Design, setting, and participantsA retrospective cohort study design was employed at UOGCSH from January 31, 2018 to February 1, 2023. The hospital used a systematic random sampling procedure to select study participants from the medical records of patients in chronic cardiac follow-up clinics.Main outcome measuresExposures were optimal medical therapy (OMT) versus non-optimal medical therapy collected from May to August 2023. Descriptive and analytical statistics were employed to compare study groups. A binary logistic regression model was employed to identify candidate variables for further analysis. Cox's proportional hazard model and log-rank test were employed, with a P-value < 0.05 used to evaluate statistical significance. A five-year all-cause mortality after discharge estimate was displayed by using Kaplan–Meier curves.ResultsAmong 422 patients with ACS [mean age, 61.56 (SD = 9.686) years; 54.7% male], of whom only 59.2% (250) received optimal medical therapy at discharge. Age ≥ 65, atrial fibrillation, chronic kidney diseases, and cardiogenic shock were negative independent predictors of optimal medical therapy. On the other hand, male sex was independently associated with the use of optimal medical therapy. All-cause mortality occurred in 16.6% (n = 70) and major adverse cardiac events occurred in 30.8% (n = 130) of patients with a 95% CI of 0.132–0.205 and 0.264–0.355, respectively. Multivariate analyses indicated that OMT was significantly associated with reduced all-cause mortality (aHR: 0.431, 95% CI: 0.222–0.835; P = 0.013).ConclusionThis study revealed that the use of preventive OMT in patients discharged with acute coronary syndrome was associated with a reduction in all-cause mortality. However, the use of this OMT is suboptimal.

The long-term impact of increased red blood cell distribution width detected during hospitalization for heart failure.

Aim: We determined the long-term role of increased RDW (red blood cell distribution width) detected during cardiac decompensation.Methods: We followed 3697 patients [mean age 71.4years (±SD 10.1), 59.1% males] hospitalized for acute heart failure (HF) and assessed the five-year all-cause mortality risk associated with tertiles of RDW.Results: Patients with RDW in the top tertile showed roughly twofold higher 5-year mortality risk than those in the bottom tertile. The association remained significant not only after adjustments for potential covariates but even if we excluded patients who deceased during the first year of follow-up [HRR 1.76 (95% CIs:1.42-2.18), p<0.0001].Conclusion: The high degree of anisocytosis represents an independent predictor of poor prognosis in HF patients, even long-term after an acute manifestation.

Five-Year Outcomes of Measured and Predicted Prosthesis-Patient Mismatch following Transcatheter Aortic Valve Implantation

BackgroundData on the long-term outcomes of prosthesis-patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) remain controversial. ObjectivesThe aim of this study was to investigate the incidence and clinical outcomes of measured PPM (PPMM) and predicted PPM (PPMP) in patients undergoing TAVI. MethodsThis is a retrospective analysis of 3,016 patients who underwent TAVI at a large Healthcare System between 2012 and 2021. Effective orifice area indexed to body surface area (EOAi) was measured at discharge using the continuity equation. EOAi was predicted according to the published predictive tables for each model and size of the valve. Primary endpoint was 5-year survival rate. ResultsMean age was 80 years and 55.6% were male. The mean STS risk score was 4.66%. 74.9% of patients received a BEV and 25.1% received a SEV. The incidence of severe PPM was markedly lower when defined by predicted vs. measured EOAi (0.8% vs. 6.3%, P < 0.001) and when assessed in SEV vs. BEV (5.3% vs. 6.6%, p= 0.02). Neither severe PPMp nor severe PPMM was associated with 5-year mortality (HR=1.26, 95% CI= 0.96-1.66, p=0.095; HR=1.03, 95% CI= 0.42-2.49, p=0.954, respectively), irrespective of the presence of high residual pressure gradient. Neither BEV nor SEV was associated with an increased 5-year mortality, irrespective of PPM definition or severity. ConclusionsIn this large healthcare system analysis, neither severe PPMP nor severe PPMM was associated with five-year all-cause mortality. There was no difference between BEV and SEV in terms of mortality, irrespective of the definition or severity of PPM.

Neutrophil to lymphocyte ratio and five-year mortality in patients with acute ischemic stroke

BackgroundPrevious studies linked neutrophil to lymphocyte ratio (NLR) with short-term mortality after acute ischemic stroke (AIS), but its relationship with long-term mortality remains unclear. This study investigates the association between NLR and five-year mortality in AIS patients. MethodWe analyzed 416 AIS patients from April 2012 to January 2016 at Zhangjiagang TCM Hospital. Admission NLR was divided into quartiles: Q1 (<2.00), Q2 (2.00–3.05), Q3 (3.06–5.46), and Q4 (≥5.46). We assessed 5-year all-cause and vascular mortality using Kaplan-Meier, Cox regression, and receiver operating characteristic (ROC) curve analyses. ResultsOver five years, 134 (32.2 %) all-cause deaths and 114 (27.4 %) vascular deaths occurred. Elevated NLR was significantly associated with increased risks of all-cause and vascular mortality. Multivariate Cox analysis identified stroke history (HR: 1.57, 95 % CI 1.08–2.30), baseline National Institutes of Health Stroke Scale (NIHSS) score (HR: 1.09, 95 % CI 1.05–1.12), and NLR (HR: 1.09, 95 % CI 1.05–1.12) as independent risk factors for all-cause mortality. These factors also predicted 5-year vascular mortality: stroke history (HR: 1.65, 95 % CI 1.10–2.49), NIHSS score (HR: 1.10, 95 % CI 1.06–1.13), and NLR (HR: 1.08, 95 % CI 1.05–1.10). NLR quartiles were significantly linked to both outcomes: all-cause mortality HRs were Q2 (1.87, 95 % CI 1.00–3.51), Q3 (2.40, 95 % CI 1.31–4.39), Q4 (2.77, 95 % CI 1.47–5.24), P for trend = 0.001; vascular mortality HRs were Q2 (1.76, 95 % CI 0.88–3.55), Q3 (2.34, 95 % CI 1.14–4.40), Q4 (2.57, 95 % CI 1.28–5.16), P for trend = 0.002. Kaplan-Meier survival analysis revealed significantly higher mortality rates in higher NLR quartiles (log-rank p < 0.001). ROC analysis identified optimal NLR cutoff values of 3.42 for predicting 5-year all-cause mortality (AUC 0.689) and 3.51 for vascular-cause mortality (AUC 0.700), with moderate sensitivity and specificity. ConclusionsHigher NLR at admission was linked with five-year all-cause mortality and mortality attributed explicitly to vascular causes in AIS patients.

Additive interaction of disability with chronic conditions on mortality risk in middle-aged and older adults in Spain

BackgroundDisability and chronic diseases are prevalent conditions associated with mortality, but little information is available on their potential synergistic effects. ObjectiveThis study aimed to describe additive interactions between disability and chronic diseases on mortality risk in middle-aged and older adults. MethodsA representative cohort of 22,800 community-dwelling Spanish people aged 50 years or older were interviewed for disability with the Global Activity Limitation Indicator and specific chronic diseases in the 2011–12 and 2014 National Health Surveys and subsequently followed up for mortality. Five-year all-cause mortality risks were standardized in each disability-by-comorbidity category through inverse probability weighting. We computed interaction contrasts as the departure of the standardized risk difference for people with both conditions from the sum of the standardized risk differences for those with any single condition. ResultsThe baseline prevalence of disability was 35.1 % (95 % confidence interval [CI] 34.4 %, 35.9 %). There was compelling evidence of synergistic effects of disability with chronic liver disease, heart diseases other than myocardial infarction, cancer, and cerebrovascular disease, with large positive interaction contrasts (95 % CIs) of 106.7 (−16.4, 229.9), 45.7 (6.9, 84.5), 45.1 (−15.0, 105.2), and 42.9 (−41.0, 126.9) excess deaths per 1000 persons. Less clear synergistic responses were observed for other comorbidities. We found some evidence of antagonism for osteoporosis, with a negative interaction contrast of −18.0 (95 % CI −82.2, 46.2) deaths per 1000 persons. ConclusionGiven the high mortality risk in people with disability, the study of its synergistic effects with target comorbidities can provide relevant information regarding preventive measures.

γ-Gammaglutamyl transferase predicts all-cause mortality within three-year intervals in patients undergoing peritoneal dialysis

Objectives Peritoneal dialysis (PD) serves as a vital renal replacement therapy for patients with end-stage kidney disease (ESKD). γ-Gamma-glutamyl transferase (γ-GGT) is a recognized predictor of oxidative stress and mortality. This study aimed to assess the prognostic significance of γ-GGT in predicting all-cause and cardiovascular mortality among PD patients. Methods A retrospective study was conducted, enrolling 640 PD patients from a single center. The one-year, three-year, and five-year mortality rates for all causes and cardiovascular causes were evaluated. Kaplan–Meier survival analysis and multivariate Cox regression analysis were performed. Results Within five years of initiating PD, the observed all-cause mortality rates at one, three, and five years were 11.72%, 16.09%, and 23.44%, while cardiovascular mortality rates were 2.97%, 7.34%, and 11.09%, respectively. Lower γ-GGT levels were associated with decreased all-cause mortality during one-, three-, and five-year follow-ups, along with reduced cardiovascular mortality in the first and third years, as indicated by Kaplan–Meier analysis on median γ-GGT groupings. Multivariate Cox regression analysis showed significantly decreased hazard ratios (HRs) for one- to five-year all-cause mortality and cardiovascular mortality in the lower γ-GGT group compared to higher groups. However, when sex differences were eliminated using separate tertile groupings for males and females, only the one- and three-year all-cause mortality rates demonstrated significantly reduced hazard ratios (HRs) in the lower γ-GGT groups. Conclusion This retrospective study suggests that γ-GGT levels have prognostic significance in predicting one- and three-year all-cause mortality among PD patients when accounting for sex differences.

Associations Between Estimated Pulse Wave Velocity and Five-Year All-Cause Mortality in Patients with Atherosclerotic Cardiovascular Disease with and without Standard Modifiable Risk Factors: Evidence From NHANES 1999-2016.

The study aimed to analyze the associations between estimated pulse wave velocity (ePWV) and 5-year mortality in atherosclerotic cardiovascular disease (ASCVD) patients with and without standard modifiable risk factors (SMuRFs), which included smoking status, hypertension, diabetes, and hypercholesterolemia. The present retrospective cohort study utilized data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016. Patients with ASCVD who completed both the questionnaire survey and serum testing were included. Patients were categorized into the ≥1 SMuRF group if they had at least one SMuRF, while those without any SMuRFs were classified into the SMuRF-less group. The ePWV, which was calculated using the age and mean blood pressure, was evenly divided into three categories: low (Q1), medium (Q2), and high (Q3). Multivariable weighted Cox proportional-hazard regression analyses were utilized to explore the risk factors associated with 5-year mortality in patients with and without SMuRFs. And restricted cubic spline curve (RCS) was used to assess their nonlinear correlation. A total of 1901 patients with ASCVD were included in the study. For the patients in ≥1 SMuRF group, the Q3 group included patients who were older, with a higher proportion of males, more comorbidities, and a lower body mass index than the Q1 group (P<0.05). The Cox proportional-hazard regression model results revealed, the Q3 group had a higher risk of 5-year mortality than the Q1 group [hazard ratio (HR) 4.30, 95% confidence interval (CI) (2.66, 6.95), P<0.001]. RCS demonstrated a linear trend between high level of ePWV and decreased risks of mortality. Similar results were observed in the SMuRF-less group [HR 10.62, 95% CI (1.22, 92.06), P=0.032]. A high level of ePWV signified a higher risk of 5-year mortality in ASCVD patients with and without SMuRFs.

Identification and outcomes of KDIGO-defined chronic kidney disease in 1.4 million U.S. Veterans with heart failure.

According to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline, the definition of chronic kidney disease (CKD) requires the presence of abnormal kidney structure or function for >3 months with implications for health. CKD in patients with heart failure (HF) has not been defined using this definition, and less is known about the true health implications of CKD in these patients. The objective of the current study was to identify patients with HF who met KDIGO criteria for CKD and examine their outcomes. Of the 1 419 729 Veterans with HF not receiving kidney replacement therapy, 828 744 had data on ≥2 ambulatory serum creatinine >90 days apart. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (n = 185 821) or urinary albumin-to-creatinine ratio (uACR) >30 mg/g (n = 32 730) present twice >3 months apart. Normal kidney function (NKF) was defined as eGFR ≥60 ml/min/1.73 m2, present for >3 months, without any uACR >30 mg/g (n = 365 963). Patients with eGFR <60 ml/min/1.73 m2 were categorized into four stages: 45-59 (n = 72 606), 30-44 (n = 74 812), 15-29 (n = 32 077), and <15 (n = 6326) ml/min/1.73 m2. Five-year all-cause mortality occurred in 40.4%, 57.8%, 65.6%, 73.3%, 69.7%, and 47.5% of patients with NKF, four eGFR stages, and uACR >30mg/g (albuminuria), respectively. Compared with NKF, hazard ratios (HR) (95% confidence intervals [CI]) for all-cause mortality associated with the four eGFR stages and albuminuria were 1.63 (1.62-1.65), 2.00 (1.98-2.02), 2.49 (2.45-2.52), 2.28 (2.21-2.35), and 1.22 (1.20-1.24), respectively. Respective age-adjusted HRs (95% CIs) were 1.13 (1.12-1.14), 1.36 (1.34-1.37), 1.87 (1.84-1.89), 2.24 (2.18-2.31) and 1.19 (1.17-1.21), and multivariable-adjusted HRs (95% CIs) were 1.11 (1.10-1.12), 1.24 (1.22-1.25), 1.46 (1.43-1.48), 1.42 (1.38-1.47), and 1.13 (1.11-1.16). Similar patterns were observed for associations with hospitalizations. Data needed to define CKD using KDIGO criteria were available in six out of ten patients, and CKD could be defined in seven out of ten patients with data. HF patients with KDIGO-defined CKD had higher risks for poor outcomes, most of which was not explained by abnormal kidney structure or function. Future studies need to examine whether CKD defined using a single eGFR is characteristically and prognostically different from CKD defined using KDIGO criteria.

Excess mortality and its causes among older adults with schizophrenia versus those with bipolar disorder and major depressive disorder: a 5-year prospective multicenter study.

Excess mortality observed in people with schizophreniamay persist in later life. The specific causes of increased mortality observed in older adults with schizophrenia and the potential influence of psychotropic medications remain partly unknown. We compared 5-year mortality and its causes of older adults with schizophrenia to bipolar disorder (BD) or major depressive disorder (MDD). We used a 5-year prospective cohort, including 564 older inpatients and outpatients with schizophrenia, BD or MDD (mean age: 67.9years, SD = 7.2years). Causes of death were cardiovascular disorder (CVD) mortality, non-CVD disease-related mortality (e.g., infections), suicide, and unintentional injury. The primary analysis was a multivariable logistic model with inverse probability weighting (IPW) to reduce the effects of confounders, including sociodemographic factors, duration and severity of the disorder, and psychiatric and non-psychiatric comorbidity. Five-year all-cause mortality among older participants with schizophrenia and with BD or MDD were 29.4% (n = 89) and 18.4% (n = 45), respectively. Following adjustments, schizophrenia compared to MDD or BD was significantly associated with increased all-cause mortality (AOR = 1.35; 95%CI = 1.04-1.76; p = 0.024) and cardiovascular mortality (AOR = 1.50; 95%CI = 1.13-1.99; p = 0.005). These associations were significantly reduced among patients taking antidepressants [interaction odds ratio (IOR) = 0.42; 95%CI = 0.22-0.79; p = 0.008 and IOR = 0.39: 95%CI = 0.16-0.94; p = 0.035, respectively]. Schizophrenia was associated with higher mortality compared to BD or MDD. Cardiovascular diseases explained most of this excess mortality. Exploratory analyses suggested that psychotropic medications did not influence this excess mortality, except for antidepressants, which were associated with significantly reduced between-group difference in all-cause and cardiovascular mortality.

Utility of prescription-based comorbidity indices for predicting mortality among Australian men with prostate cancer

BackgroundDrug prescription registries has become an alternative data source to hospital admission databases for measuring comorbidities. However, the predictive validity of prescription-based comorbidity measures varies based on the population under investigation and outcome of interest. We aimed to determine which prescription-based index of comorbidity has most utility in Australian men with prostate cancer. MethodsWe studied 25,414 South Australian men diagnosed with prostate cancer between 2003 and 2019 from state-wide administrative linked datasets. The Rx-Risk index, Chronic Disease Score (CDS), Drug Comorbidity Index (DCI) and Pharmaceutical Prescribing Profile (P3) with one year lookback period from prostate cancer diagnosis were evaluated. The predictive ability of each index to determine all-cause deaths within two and five years of prostate cancer diagnosis was compared using the c-statistic from flexible parametric survival models, adjusting for age, socioeconomic status and year of prostate cancer diagnosis. ResultsThe Rx-Risk index performed better in predicting two-year (c-statistic = 0.818) and five-year (c-statistic = 0.784) all-cause mortality than P3, CDS and DCI. Including comorbidity measures as continuous scores resulted in a better performance than including them as categories. Grouping scores into four categories (≤0, >0 - ≤1, >1 - ≤2, and >2) resulted in better performance and calibration than using fewer categories. ConclusionRx-Risk was validated in Australia and reflects Australian prescribing patterns. It showed better predictive performance for mortality in our study, with a modest improvement over P3, CDS and DCI. For research with prostate cancer populations, we recommend the use of drug-based comorbidity indices that have been validated in a similar population.

Weight Loss Induced by Antiobesity Medications and All-Cause Mortality Among Patients With Knee or Hip Osteoarthritis.

The current guidelines recommend weight loss for patients with overweight or obesity and knee or hip osteoarthritis (OA); however, there is a paucity of data on the relation of weight loss to death among patients with OA. We aimed to examine the relation of the rate of weight loss induced by antiobesity medications over one year to all-cause mortality among patients with overweight or obesity and knee or hip OA. Using the IQVIA Medical Research Database, we identified people with overweight or obesity and knee or hip OA. We emulated analyses of a hypothetical target trial to assess the effect of slow-to-moderate (2%-10%) or fast (≥10%) weight loss induced by the initiation of antiobesity medications within one year on all-cause mortality and secondary outcomes over five years' follow-up. Among 6,524 participants, the five-year all-cause mortality rates were 5.3%, 4.0%, and 5.4% for weight gain or stable, slow-to-moderate weight loss, and fast weight loss arms, respectively. Compared with the weight gain or stable arm, hazard ratios of all-cause mortality were 0.72 (95% confidence interval [CI] 0.56-0.92) for the slow-to-moderate weight loss arm and 0.99 (95% CI 0.67-1.44) for the fast weight loss arm. We found dose-response protective effects of weight loss on incident hypertension, type 2 diabetes, and venous thromboembolism but a slightly higher risk of cardiovascular disease, albeit not statistically significant, in the fast rate of weight loss arm than in the weight gain or stable arm and no significant relations of weight loss to the risk of cancer. In this population-based study, a slow-to-moderate, but not fast, rate of weight loss induced by antiobesity medications is associated with a lower risk of all-cause mortality in people with overweight or obesity and knee or hip OA.

Left atrial pump strain predicts long-term mortality in patients undergoing transcatheter aortic valve implantation

Abstract Introduction Speckle-tracking echocardiography is an increasingly important tool for assessing aortic stenosis (AS). Left atrial reservoir (LARS) and pump strain (LAPS) were studied for their association with long-term mortality in AS patients undergoing transcatheter aortic valve implantation (TAVI). Purpose To investigate left atrial function assessed by LARS and LAPS and its association with all-cause mortality during long-term follow-up after TAVI. Methods From our prospective AS cohort study, 198 patients with severe AS were identified who underwent TAVI and had a comprehensive preinterventional echocardiographic examination allowing full target analysis. Five-year all-cause mortality was defined as the endpoint. Results Left atrial volume index (LAVI) was increased (mean (SD): 46.9 ml/m2 (±16.5)) and left atrial deformation impaired (LARS (21.7% (±6.9); LAPS (-9.5% (±4.5)), while left ventricular ejection fraction (LVEF) (56.7% (±11.5)) was preserved in the study population. Over a follow-up time of five years, 49 patients (24.7%) died. LARS and LAPS were more impaired in non-survivors (20.0% (±6.5) and -8.1% (±4.0), respectively; Figure) than in survivors (22.3% (±6.9); P=0.042 and -9.9% (±4.5), respectively; P=0.014; Figure), while LAVI did not differ (P=0.248). Univariable Cox regression models demonstrated that LAPS was associated with mortality (P=0.014), while LARS was not (P=0.066) (Table A). In bivariable and multivariable models, the association of LAPS with mortality was independent of LVEF and LAVI, and inclusion of LAPS improved the fitness (≤2) of these models (Table B). Furthermore, the improvement in ≤2 was significant for all models (ANOVA P=0.012, P=0.013, and P=0.015, respectively). Conclusion LAPS was associated with long-term mortality after TAVI, while LARS and LAVI were not. The association of LAPS was independent of LVEF and LAVI and showed potential incremental value for assessment of outcome association. Hence, LAPS may be useful for predicting long-term outcome after TAVI.

Incidence and management of multiple native valvular heart disease in patients undergoing TAVR: Impact of staged valvular interventions on outcomes

Abstract Background Multiple valvular heart disease (VHD) is a prevalent condition among patients undergoing TAVR. Previous studies have reported increased one-year mortality in TAVR patients with concomitant mitral (MR) and tricuspid regurgitation (TR). However, the long-term impact of multiple VHD on TAVR outcomes is not known. Moreover, most studies investigating additional VHD either focus on the evaluation of MR or TR, without a head-to-head comparison of VHD. Finally, it is not known whether an additional staged transcatheter valvular intervention for concomitant VHD may improve outcomes. Purpose Our Aim was to evaluate the incidence of multiple VHD in a real-world TAVR cohort, to assess and compare the impact of concomitant severe MR and TR on outcomes at one and five years after TAVR, and to examine the rate and impact of a staged edge-to-edge intervention for concomitant VHD. Methods The study cohort included 2058 patients with severe aortic stenosis undergoing TAVR between February 2014 and May 2022. All patients have been screened for additional staged valvular intervention. Clinical endpoints included one- and five-year mortality following TAVR. Results A concomitant severe VHD was observed in 168 (8.2%) patients undergoing TAVR, of whom 68 (3.3%) patients had a severe TR and 100 (4.9%) had a severe MR. A moderate TR was seen 240 (11.7%) patients, whereas a moderate MR was detectable in 477 (23.2%) patients. An additional staged edge-to-edge valvular intervention was performed in 20 (1.0%) and 37 (1.8%) patients due to a severe TR and MR, respectively. The overall one- and five-year all-cause mortality rates were 11.2% and 27.3% following TAVR. The one-year all-cause mortality was significantly higher in patients with a concomitant severe VHD (17.9%) as compared to patients with mild/no VHD (9.0%, p&amp;lt;0.01). Of interest, the highest one-year mortality was observed in patients with a concomitant severe TR (20.6%), followed by patients with a severe MR (16.0%) and mild/no VHD (9.0%, p&amp;lt;0.01), Figure 1. This difference was sustained for up to five years after TAVR (Figure 2 A, p&amp;lt;0.01). An additional staged edge-to-edge valvular intervention was associated with decreased one-year mortality rate as compared to patients with a persistent severe VHD (5.2% vs 18.9%, p=0.02). This association was sustainable over the follow-up period of five years (Figure 2 B, p&amp;lt;0.01). Multivariate regression analyses revealed that a concomitant severe TR (OR: 2.53 [95% CI: 1.42 – 4.50], p&amp;lt;0.01) was independently associated with the mortality following TAVR. Conclusion Severe concomitant VHD was associated with an increased one- and five-year mortality following TAVR. In this context, a severe TR appears to be associated with a higher mortality rate as compared to a severe MR. A staged edge-to-edge valvular intervention for concomitant VHD may improve outcomes in these patients and should be critically evaluated in patients with persistent severe VHD after TAVR.Figure 1Figure 2

Five-year outcomes of coarctoplasty with stent in the paediatric population, results from a retrospective single-centre cohort with centrally-adjudicated outcomes

Abstract Background Stenting is being increasingly used as a therapeutic option for coarctation of aorta (CoA) in paediatric patients. Although the short and mid-term outcomes are well-documented, data on long-term results are scant. Purpose The current study aimed to determine the long-term safety and efficacy of aortic coarctation stenting via centrally-adjudicated outcomes. Methods The present study is a retrospective cohort conducted at a large tertiary cardiovascular centre. All patients aged up to 15 years who had undergone de novo stenting for CoA between 2006 and 2017 were recruited. Both immediate and 5-year outcomes were investigated. Immediate outcomes, including procedural and in-hospital, were retrieved from electronic medical records, re-analysed, and finally adjudicated by the clinical event committee (CEC). The rates of five-year recoarctation, stent fracture, aneurysmal/pseudoaneurysmal formation, and all-cause mortality were reported as the main long-term outcomes. The first three mentioned outcomes were adjudicated only in patients with available predefined appropriate imaging follow-up tests (Figure 1). Patients who had available recorded 5-year clinical visits and those who answered the phone interview were evaluated for the 5-year mortality. Results A total of 274 patients (98 [35.8%] were female with median [interquartile range] age of 9 [6-12] years) who underwent de novo coarctoplasty with stent were included. Procedural success was achieved in 251 (91.6%) of the patients. Immediate complications were observed in a total of 24 (8.75%) as follows: There were 1 (0.3%) stent migration, 3 (1.1%) small, non-expanding non-flow-limiting aortic wall injuries, and 2 (0.7%) ischemic strokes. Also, there were 18 (6.6%) major vascular access complications, the most common of which was acute limb ischemia in 8 (2.9%) patients, followed by 5 (1.8%) pseudoaneurysms, 3 (1.1%) retroperitoneal haemorrhages, 1 (0.3%) arteriovenous fistula, and 1 (0.3%) large hematoma. A total of 4 (1.4%) in-hospital mortality occurred. The 5-year cumulative incidence of stent fracture, recoarctation of the aorta, and aneurysm/pseudoaneurysm of the aorta were 17/100 (17%), 73/154 (48%), and 8/101 (7.92%), respectively. Five-year all-cause mortality occurred in 4/251 (1.6%) (Table 1). Conclusion In our study, coarctoplasty with stent was safe and effective in the paediatric population during long-term follow-up. Developmental changes in childhood resulting in stent-size mismatch are suggested as a potential aetiology for a high re-intervention rate. Of note, re-intervention was safe and effective.Figure 1Table 1

Abstract 11667: Red Cell Indices and Long-Term Prognosis of Heart Failure Patients

Introduction: It has been demonstrated that some properties of red blood cells also play a role in the etiology of cardiovascular diseases and their complications. Hypothesis: We determined to what extent red blood cell indices observed during hospitalization for heart failure (HF) affect the long-term prognosis of these patients. Methods: We followed 3697 patients [mean age 71.4 years (±SD10.1), 59.1% males] hospitalized for decompensated HF between 2010-20. In the multivariate model, we assessed the five-year all-cause mortality risk associated with red cell distribution width (RDW), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), and hemoglobin concentration (dichotomized by tertiles). Results: Kaplan-Meier survival curves comparing the tertiles of red cell indices are in Figure. Patients with RDW in the top tertile showed roughly two-fold higher 5-year mortality risk than those in the bottom tertile; increased risk we also observed in the middle tertile of RDW. This association remained significant even after complex adjustments for individual characteristics (age, gender, ejection fraction, HF etiology, history of malignancy, revascularization, hypertension, diabetes, LDL, atrial fibrillation, and glomerular filtration) as well as treatments (furosemide, beta-blockers, RAS blockers, MRA′s, statins). [HRR 1.83 (95% CIs: 1.53-2.18), p&lt;0.0001, 3 rd versus 1 st ; 1.42 (95%CIs: 1.19-1.68), p&lt;0.0001, 2 nd versus 1 st ] Similarly, we observed increased mortality risk in the bottom tertile of MCHC [HRR 1.34 (95%CIs:1.14-1.59), p=0.001, 1 st versus 3 rd ( fully adjusted)] or hemoglobin [HRR 1.37 (95%CIs: 1.15-1.62), p&lt;0.0001]. In contrast, MCV did not show any additive mortality risk. Conclusions: High degree of anisocytosis and low red cell status of hemoglobin represents independent indicators of poor prognosis in heart failure patients, even long-term after an acute manifestation.

Evaluation of the contribution of county characteristics to the rural mortality disparity in cancer.

173 Background: Rural disparities in cancer outcomes have been widely evaluated, but limited evidence is available to characterize what characteristics of rural environments contribute to the increased risk of poor outcomes. Therefore, we propose to estimate the mediating effects of county characteristics on the relationship between urban/rural status and mortality among patients with cancer, identify county profiles, and determine problematic county profiles alongside rural settings. Methods: Patients with cancers (known to be associated with rural disparities) between 2000 and 2016 were assessed using Surveillance, Epidemiology and End Results data. We then linked these data to the 2010 County Health Rankings (CHR) which ranks US counties into quartiles within their state based on measures of health: morbidity, mortality, health behaviors, physical environment, socioeconomic status, clinical care environment. We dichotomized each domain as least healthy (quartiles 3 and 4) and most healthy (quartiles 1 and 2). Rurality was defined using the 2010 Rural-Urban Commuting Codes. Using mediation analyses, we estimated 1) the direct contribution of rurality to five-year all-cause and cancer-specific mortality and 2) the contribution of the rural effect indirectly through each CHR domain. We then used latent class analysis to identify county groupings based on rankings. Using flexible parametric survival models, we estimated the hazard of mortality associated with class membership, rurality and the interaction between rurality and class. Results: Among the 757,655 patients representing 596 counties, 51% were female, the most frequent diagnoses were breast and prostate (21%, respectively), 52% were diagnosed with localized disease, and 54% were diagnosed between 55y and 65y. When setting the mediator at least healthy (quartiles 3 and 4) premature death, clinical care, and physical environment, the rural patients had 17.9% to 20.2% less survival time compared to those in rural counties. Of this, 4.1% to 12.6% of the total excess risk was mediated by these characteristics. Three county classes were identified: Class 1 (28%) had consistently poor rankings, Class 2 (32%) had moderate rankings but poor clinical care, and Class 3 (41%) had consistently high rankings except for physical environment. Patients living in rural-high risk counties (class 1 and 2) saw higher all-cause mortality than those in urban-lower risk counties (reference class 3; HR, 1.04, 95%CI 1.01-1.08 and 1.07, 95%CI, 1.03-1.11). Conclusions: County characteristics mediated the relationship between rurality and mortality among patients with cancer. Counties with poor rankings had increased mortality risks regardless of rurality; however, the poor rankings elevated the mortality risk for those in rural counties. Access to care and physical environment may be actionable points of intervention in the pathway from rurality to mortality.

Five-Year Follow-Up After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis and Concomitant Coronary Artery Disease: A Single-Center Experience.

There is no consensus on the impact of coronary artery disease in patients undergoing transcatheter aortic valve implantation. Therefore, the objective of this study was, in a single-center setting, to evaluate the five-year outcome of transcatheter aortic valve implantation patients with or without coronary artery disease. All transcatheter aortic valve implantation patients between 2009 and 2019 were included and grouped according to the presence or absence of coronary artery disease. The primary endpoint, five-year all-cause mortality, was evaluated using Cox regression adjusted for age, sex, procedure years, and comorbidities. Comorbidities interacting with coronary artery disease were evaluated with interaction tests. In-hospital complications was the secondary endpoint. In total, 176 patients had aortic stenosis and concomitant coronary artery disease, while 170 patients had aortic stenosis only. Mean follow-up was 2.2±1.6 years. There was no difference in the adjusted five-year all-cause mortality between transcatheter aortic valve implantation patients with and without coronary artery disease (hazard ratio 1.00, 95% confidence interval 0.59-1.70, P=0.99). In coronary artery disease patients, impaired renal function, peripheral arterial disease, or ejection fraction < 50% showed a significant interaction effect with higher five-year all-cause mortality. No significant differences in complications between the groups were found. Five-year mortality did not differ between transcatheter aortic valve implantation patients with or without coronary artery disease. However, in patients with coronary artery disease and impaired renal function, peripheral arterial disease, or ejection fraction < 50%, we found significantly higher five-year all-cause mortality.