Higher All-cause Mortality Research Articles

Intubation Practices in Community Emergency Departments

This study analyzes emergency medicine airway management trends and outcomes among community emergency departments. A multicenter, retrospective chart review was conducted on 11,475 intubations from 15 different community emergency departments between January 1, 2015, and December 31, 2022. Data collected included patient's age, sex, rapid sequence intubation medications, use of cricoid pressure, method of intubation, number of attempts, admission diagnosis, and all-cause mortality rates. Active cardiopulmonary resuscitation occurred in 11.4% of intubations. When rapid sequence intubation was employed, the most frequently used induction agents were etomidate (91.6%), propofol (4.3%), and ketamine (4.1%). From 2015 to 2022, the use of rocuronium (versus succinylcholine) increased from 33.9% to 61.9%, a difference of 28% (95% confidence interval [CI] 21.1% to 34.9%). During the same period, video laryngoscopy (versus direct laryngoscopy) increased from 27.4% to 77.7%, a difference of 50.3% (95% CI 44.2% to 56.4%). Only 46% of intubations used cricoid pressure. Physicians had a first-pass success rate of 80.5% and a failure rate of 0.2%. The most common documented admission diagnoses among intubated patients were respiratory etiologies (27.8%), neurologic causes (21.4%), and sepsis (16.0%). All-cause mortality rates were high for intubated patients at 24 hours (19.7%), 7 days (29.4%), 30 days (38.4%), and 1 year (45.4%). Physicians intubating in community emergency departments have similar rates of first-pass success and failure seen in academic Level-1 trauma centers despite treating medically sick patients with high all-cause mortality rates. Dramatic shifts in choice of paralytic and method for intubation were seen.

Unveiling the Prognostic Power of HRR in ICU-Admitted COPD Patients: A MIMIC-IV Database Study.

This study sought to examine the potential relationship between Hemoglobin/Red Cell Distribution Width Ratio (HRR) and the all-cause mortality risk in critically ill patients with chronic obstructive pulmonary disease (COPD). In a retrospective analysis of the MIMIC-IV database, patients were divided into two groups based on a specific HRR threshold. Propensity score matching (PSM) was employed to address covariate imbalances. Logistic regression models was used to examine the association between HRR and mortality. A restricted cubic spline (RCS) model was employed to visualize the association between HRR and mortality. Receiver Operating Characteristic (ROC) curves were utilized to assess the predictive capability of HRR, and Decision Curve Analysis (DCA) was conducted for clinical evaluation. Furthermore, subgroup analyses were performed to explore potential variations within specific cohorts. A comprehensive analysis identified a total of 1,061 patients. The threshold value established for HRR is 5.395 g/L/%. Following the application of PSM, the matched cohort comprised 544 patients. Both the original and matched cohorts exhibited higher rates of all-cause mortality and extended hospital stays among individuals with low HRRs. Logistic regression analyses demonstrated that HRR is an independent risk factor of mortality. The RCS analysis demonstrated a significant linear relationship between HRR and mortality. The ROC curves yielded values of 0.58 for the original cohort and 0.60 for the matched cohort. DCA analysis indicated that HRR is clinically valuable. Subgroup analyses further validated the robustness of these core findings. A lower HRR is positively associated with all-cause mortality in critically ill patients with COPD.

Long-Term Risk of Acute Myocardial Infarction in Patients With a Transient Ischemic Attack: A Danish Nationwide Cohort Study.

Sparse information regarding the long-term risk of acute myocardial infarction (MI) following a transient ischemic attack (TIA) emphasizes further research to guide preventive strategies and risk stratification in patients with a TIA. We conducted a nationwide cohort study to investigate the 5-year risk of MI and all-cause mortality in patients with a first-time TIA. Patients with a first-time TIA were identified in the Danish Stroke Registry (2013-2020), matched on age, sex, and calendar year (1:4) with the general population and (1:1) with patients with first-time ischemic stroke. The 5-year risks of MI and all-cause mortality were estimated by the Aalen-Johansen and Kaplan-Meier estimators. The groups were compared using Cox regression, while adjusting for cardiovascular comorbidities. We identified 21 743 patients with TIA, 86 972 matched individuals from the general population, and 21 743 matched control patients with ischemic stroke. Median age was 70 (25th to 75th percentile, 60-78) years; 52% were male. Comorbidity burden was the lowest in general population controls, intermediate in patients with TIA, and the highest in patients with ischemic stroke. The 5-year risk of MI was 2.0% in patients with TIA, 1.5% in the general population (P<0.001), and 2.2% in the ischemic stroke population (P<0.001). After adjustment, these differences in MI rate were similar (TIA versus general population; hazard ratio, 0.99 [95% CI, 0.98-1.02] and TIA versus ischemic stroke; hazard ratio, 0.99 [95% CI, 0.96-1.01]). The 5-year risk of mortality was 17.0% in patients with TIA compared with 14.0% in the general population (P<0.001) and 27.0% in ischemic stroke population (P<0.001). The differences in mortality persisted following adjustments for patients with TIA versus general population (hazard ratio, 1.25 [95% CI, 1.19-1.31]) and for patients with TIA versus ischemic stroke (hazard ratio, 0.43 [95% CI, 0.41-0.46]). Patients with first-time TIA had a low 5-year incidence of MI, which was not significantly different from that of the general population and patients with first-time ischemic stroke after adjustments for comorbidities. However, patients with TIA had a 25% higher all-cause mortality rate than the general population, which was not readily explained by MI risk. Hence, the findings do not endorse the need to raise further awareness regarding MI in patients with TIA.

Cardiometabolic risk factors and clinical course of liver cirrhosis.

The global prevalence of Metabolic Dysfunction-Associated Liver Disease is dramatically increasing with the diffusion of cardiometabolic risk factors (CMRFs). The aim of the present study was to assess the natural course of liver cirrhosis, in terms of decompensation, development of hepatocellular carcinoma and mortality, in relation to the presence of CMRFs (type 2 diabetes mellitus, obesity, arterial hypertension, low HDL levels, hypertriglyceridemia). 667 patients with liver cirrhosis (50 with CMRFs and without non-metabolic aetiological factors, 167 with non-metabolic aetiological factors and without CMRFs, and 450 with both non-metabolic aetiological factors and at least one CMRF) followed at the University and General Hospital of Padua, Italy, from 1998 to 2022, were included. No difference in the occurrence of cirrhosis decompensating events and development of hepatocellular carcinoma was observed, whereas patients in the metabolic or mixed group had 4-3-fold higher all-cause mortality and significantly lower 3-years survival compared to patients in the non-metabolic group, despite a better liver function at enrolment. Hypertriglyceridemia and low HDL levels were the less prevalent CMRFs, but those associated with the highest risk of cirrhosis decompensation. Hypertriglyceridemia was also associated with an increased risk of mortality. Arterial hypertension was associated with a reduced risk of cirrhosis decompensation, but a higher risk of mortality. Compared to patients without CMRFs, those with CMRFs had similar rates of liver cirrhosis decompensation but higher overall mortality. Hypertriglyceridemia was associated with a high risk of both liver decompensation and death.

Association Between Homocysteine and All-Cause Mortality Among Osteoarthritis Patients: A Cohort Study from the NHANES Database.

This study explored the association between serum Hcy level and the all-cause mortality among osteoarthritis (OA) patients. This cohort study included patients diagnosed as OA from the National Health and Nutrition Examination Survey (NHANES) 1999-2006. Abbott Homocysteine assay, a fully automated fluorescence polarization immunoassay (FPIA) method, was used to measure the level of serum Hcy. Covariates included sociodemographic information, lifestyles, history of diseases and medications were extracted from the database. The weighted univariate, multivariate Cox proportional hazard models and restricted cubic splines (RCS) were utilized to explore the association between Hcy level and all-cause mortality in OA patients, with hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses based on different age, gender, duration of OA, complications and C-reactive protein (CRP) were further assessed by this association. Totally 1384 OA patients were included in this study, of which 817 (59.03%) died by 31 December 2019. After adjusting all covariates, high Hcy level was associated with the high all-cause mortality among OA patients (HR=1.31, 95%CI: 1.02-1.67), especially in females (HR=1.43, 95%CI: 1.07-1.91), aged >60 years (HR=1.49, 95%CI: 1.14-1.94), duration of OA >10 years (HR=1.40, 95%CI: 1.01-1.95), with the history of hypertension (HR=1.37, 95%CI: 1.03-1.80), without the history of diabetes (HR=1.36, 95%CI: 1.01-1.82) or CRP >0.29 mg/l (HR=1.51, 95%CI: 1.04-2.19). High serum Hcy level was associated with high risk of all-cause mortality in OA patients. Our results suggest that serum Hcy is a promising biomarker for the prognosis of OA patients.

Health outcomes in chronic kidney disease patients with cognitive impairment or dementia - a global collaborative analysis

Abstract Background and hypothesis Mild cognitive impairment and dementia (CI) are common in patients with chronic kidney disease (CKD). We aim to clarify whether and how CKD and CI coexistence increases adverse health outcomes. Methods This retrospective observational cohort study was conducted on CKD patients (stages 3-5) from the TriNetX platform. CKD patients with and without pre-existing CI were included from 115 healthcare organizations (HCOs), and their outcomes were compared. The two cohorts were propensity score matched (PSM) for age, sex, ethnicity, comorbidities, body mass index (BMI), blood parameters and medications. The proportional hazard assumption was tested with a 95% confidence interval. Kaplan-Meier was used to calculate survival probability. Outcomes were included from 1 day after the CKD diagnosis until ten years afterwards. Results We identified 533 772 CKD patients, and 8 184 had co-existent CI. Two cohorts of 8 170 PSM patients each were generated. The mean age was 60.5±7.0 years, the estimated glomerular filtration rate (eGFR) was 52.1±19 ml/min. Mean follow-up was 23.2 months. CKD patients with CI had higher all-cause mortality (18.5% vs 12.6%), higher risk of cerebrovascular disease (11.3% vs 6.9%), transient cerebral ischemic attacks (2.7% vs 1.6%), hypotension (16.5%-12.5%), malnutrition (6.7% vs 4.0%), pneumonia (10.7% vs. 7.9%), urinary infections (13.2% vs. 9.3%), encephalopathy (9.9% vs 5.0%), mood disorders (13.6% vs 9.7%), psychosis (9.8% vs 4.6%), epilepsy (4.3% vs 1.5%). Higher use of antidepressants (26.3% vs 16.3%), anticonvulsants (19.5% vs 15.1%), antipsychotics (18.6 vs 9.1%), anticholinesterase (5.6% vs 0.1%), and benzodiazepines (30.6% vs 26.6%) was noted in those with CI. All these findings were statistically significant. Conclusion Despite the limitations of a retrospective study, real-world data demonstrates that concomitant CI is a decisive risk factor for higher mortality and increased adverse outcomes in patients with CKD. These results highlight the need for routine comprehensive cognitive assessments in patients at any stage of CKD.

Early safety after TAVR according to VARC-3 criteria: incidence, predictors, and clinical impact.

The Valve Academic Research Consortium (VARC)-3 definition of the early safety (ES) composite endpoint after transcatheter aortic valve replacement (TAVR) lacks clinical validation. The aim of this study was to determine the incidence, predictors, and clinical impact of ES after TAVR as defined by VARC-3 criteria. We performed a multicenter study including 10 078 patients with severe aortic stenosis undergoing transarterial TAVR. According to VARC-3 criteria, ES at 30 days was defined as freedom from all-cause mortality, stroke, VARC type 2-4 bleeding, major vascular, access-related, or cardiac structural complications, acute kidney injury stages 3-4, moderate or severe aortic regurgitation, new permanent pacemaker implantation, and surgery or intervention related to the device. Baseline, procedural, and follow-up data were prospectively collected in a dedicated database. ES was achieved in 6598 patients (65.5%). The main factors associated with a lack of ES were the occurrence of type 2-4 bleeding (18.9%), and new pacemaker implantation (13.6%). Advanced age, peripheral artery disease, chronic kidney disease, and balloon postdilation were associated with an increased risk of no-ES (P < .01 for all). Failure to achieve ES was associated with higher all-cause mortality up to 1-year after TAVR (HR, 3.17; 95%CI, 2.76-3.65; P < .001). VARC-3 ES was not achieved in up to one-third of contemporary TAVR patients, which was associated with worse mid-term outcomes. The factors associated with increased risk were advanced age, baseline comorbidities, and some procedural features (postdilation). These findings highlight the importance of continued efforts to minimize the risk of TAVR-related procedural complications.

Association of serum alkaline phosphatase levels with bone mineral density, osteoporosis prevalence, and mortality in US adults with osteoporosis: evidence from NHANES 2005-2018.

The evidence regarding the association between serum T-ALP, BMD and osteoporosis prevalence in general population is incomplete, and limited evidence is available concerning its association with mortality among individuals with osteoporosis. The study investigated the association of serum T-ALP with BMD and osteoporosis prevalence in the general population, and examined its association with mortality in individuals with osteoporosis. All participants were adults from the NHANES (2005-2018), and mortality data were obtained from the National Death Index up to December 31, 2019. Firstly, the association of serum T-ALP with BMD and osteoporosis risk was assessed using linear regression model, subgroup analysis, analysis of covariance and weighted logistic regression model, respectively. Secondly, survival analysis including Kaplan-Meier curves, Cox proportional hazards models, and restricted cubic spline regression models were utilized to analyze the relationship between serum T-ALP levels and mortality risk. The study included 13,724 participants aged 18 to 85years, and 944 were diagnosed with osteoporosis, among whom 221 died during a median of 133months follow-up. Totally, elevated serum T-ALP was significantly associated with low BMD in femoral neck and lumbar spine, and the results exhibited consistency across diverse age, genders, races, and BMI subgroups. Moreover, for each 1 SD increase in T-ALP, there was a 0.5% increase in the prevalence of osteoporosis [OR (95%CI): 1.005 (1.005, 1.005), p < 0.001]. Among individuals with osteoporosis, for every 1 SD increase in T-ALP, the all-cause mortality increased by 0.4% [HR (95%CI):1.004 (1.002, 1.006), p < 0.001]. Meanwhile, comparing participants with highest serum T-ALP levels (> 79IU/L) to those with lowest levels (< 53IU/L) further raised the prevalence of osteoporosis [OR (95%CI):1.292 (1.021, 1.636), p = 0.033] and all-cause mortality [HR (95% CI):1.232 (1.041, 1.459), p = 0.015]. Based on a representative sample of US adults, elevated serum T-ALP levels were found to be significantly associated with both reduced BMD and an increased risk of osteoporosis across all participants, as well as with a higher all-cause mortality in individuals with osteoporosis.

Association of abnormal P-wave parameters with all-cause mortality in diffuse large B-cell lymphoma

Patients diagnosed with diffuse large B-cell lymphoma (DLBCL) are at increased risk of developing atrial fibrillation (AF). Abnormal P-wave parameters (PWPs) have been identified as independent predictors of AF, however, their prognostic significance in DLBCL patients remains unknown. Newly diagnosed DLBCL patients from January 2015 to August 2022 were retrospectively included in this study. Patients were devided as with abnormal PWPs or without it. Primary outcome was the all-cause mortality. The median duration of follow-up was 16.3 months. The Kaplan‒Meier method and multivariable COX proportional hazards regression models were used to analyze the relationship between PWPs and all-cause mortality. Logistic regression analyses were performed to identify risk factors associated with PWPs. A total of 374 newly diagnosed DLBCL patients were included, of whom 137 patients exhibited abnormalities in PWPs. Compared to the group with normal PWPs, patients with PWPs abnormalities had a higher proportion of males (p = 0.001), elevated levels of blood urea nitrogen (p = 0.038) and blood creatinine (p = 0.005), and a higher rate of all-cause mortality (p = 0.001). PWPs, particularly P-wave duration (p = 0.017) and P-wave terminal force in lead V1 (PTFV1) (p = 0.001), were independently correlated with all-cause mortality in DLBCL patients. Furthermore, male patients exhibited a higher susceptibility to abnormal PWPs (p = 0.001). PWPs, particularly P-wave duration and PTFV1, serve as simple yet effective prognostic indicators for all-cause mortality in DLBCL patients. Consequently, vigilant monitoring of PWPs, particularly in male patients, is warranted to accurately evaluate the prognosis of DLBCL.

Higher Serum Alkaline Phosphatase is Risk for Death and Fracture: A Nationwide Cohort Study of Japanese Dialysis Patients.

Monitoring of serum alkaline phosphatase (ALP) is recommended in the management of chronic kidney disease (CKD)-mineral bone disorder (MBD) because of associations with poor outcome among dialysis patients. However, such associations may have changed with several advances in the management of CKD-MBD over the last decade. Baseline data for 241,670 dialysis patients (mean age, 69 ± 12 years; male, 65.9%; median dialysis duration, 68 months) were extracted from a nationwide dialysis registry in Japan at the end of 2019. Outcomes, including all-cause and cardiovascular (CV) mortality and hip fracture, were evaluated using the registry at the end of 2020 and 2021. All-cause mortality was assessed using Cox regression analysis, whereas CV mortality and new hip fracture were assessed using competing-risks regression analysis. Multiple imputation for missing values was performed. Within the 2-year study period, a total of 40,449 patients (16.7%) died, including 13,562 (5.6%) CV deaths. Of the 168,836 patients with no history of hip fracture at the end of 2019, 4,136 (2.4%) suffered hip fracture within 2 years. Higher serum ALP was independently associated with higher all-cause and CV mortality and new hip fracture, but the association with CV mortality was marginal (hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.18-1.24; sub-HR [SHR] 1.07, 95%CI 1.03-1.12; and SHR 1.28, 95%CI 1.19-1.38, respectively). There is a linier association between serum ALP and all-cause mortality among the lower- parathyroid hormone (PTH) group, whereas lower serum ALP tended to have higher all-cause mortality than intermediate serum ALP among patients in the higher-PTH group. Higher serum ALP was independently and linearly associated with higher all-cause and CV mortality and new hip fracture in Japanese dialysis patients. Higher serum ALP and higher intact PTH were synergistic in increasing all-cause and CV mortality but not with new hip fracture.

Prognostic Influence of Lung Compliance in Patients with Cardiogenic Shock and Invasive Mechanical Ventilation.

There is limited data regarding the influence of lung compliance on the outcome of patients with cardiogenic shock (CS). Thus, a registry study was conducted to assess the prognostic influence of lung compliance in invasively ventilated patients with CS. Hospital records for consecutive invasively ventilated CS-patients from June 2019 to May 2021 were collected into a prospective registry. Our study evaluated the prognostic influence of lung compliance on 30-day all-cause mortality. Statistical analyses comprised t-tests, analysis of variance (ANOVA), Kruskal-Wallis-tests, Spearman's correlation, Kaplan-Meier survival analyses, and Cox regression. A total of 141 patients with CS requiring invasive mechanical ventilation were included. Stratification by quartiles revealed that patients with the lowest lung compliance (≤23.8 mL/cmH2O) experienced the highest mortality rates (77.1% vs. 66.7% vs. 48.6% vs. 51.4%; log-rank p = 0.018) both overall and among the subgroup of CS-patients with cardiac arrest (80% vs. 74% vs. 53% vs. 59%; log-rank p = 0.037). After stratifying by the median, patients with lung compliance <30.4 mL/cmH2O demonstrated a significantly higher 30-day all-cause mortality compared to those above this threshold (71.8% vs. 50.0%; log-rank p = 0.007) for both the overall cohort and the cardiac arrest subgroup (77.2% vs. 55.9%; log-rank p = 0.008). Multivariable adjustment confirmed that lung compliance <30.4 mL/cmH2O was significantly associated with increased 30-day all-cause mortality in the entire cohort (hazard ratio [HR] = 1.698; 95% CI 1.085-2.659; p = 0.021). Notably, this association was not significant in CS-patients with cardiac arrest (HR = 1.523; 95% CI 0.952-2.438; p = 0.080). Additionally, those with lung compliance below the median experienced fewer ventilator-free days (p = 0.003). In invasively ventilated CS-patients, low lung compliance was associated with higher all-cause mortality and fewer ventilator-free days at 30 days. NCT05575856, https://clinicaltrials.gov/study/NCT05575856.

Effect of basic activities of daily living independence on home discharge and long-term outcomes in patients hospitalized with heart failure.

Patients hospitalized for heart failure (HF) experience impairments in functional status, primarily affecting basic activities of daily living (ADL). We investigated the independent effect of functional status for ADL on patient-centered outcomes (i.e., home discharge) and conventional clinical outcomes in HF. We analyzed 2936 consecutive hospitalized patients with HF from a prospective multicenter registry. The functional status of ADL was assessed before discharge by using the Barthel index (BI). Patients were categorized into the lower BI group (≤85; the lowest tertile) and higher BI group (>85). We evaluated the risk-adjusted association between BI and non-home discharge, as well as the two-year all-cause mortality. Exploratory subgroups included patients categorized by age, sex, HF hospitalization, left ventricular ejection fraction, body mass index, and estimated glomerular filtration rate (eGFR). Of the participants (age: 79 [69-85] years; 41.1% women), 86.3% were discharged home. A lower BI was independently associated with non-home discharge (OR: 5.12, 95% CI 3.86-6.80) and higher all-cause mortality rates (HR: 1.96, 95% CI 1.58-2.45). Two-year cardiac and non-cardiac mortality rates were higher in the lower BI group; however, the proportion of cardiac causes in two-year deaths did not differ between the lower and higher BI groups (48.8% vs. 49.5%, P=0.891). Subgroup analyses consistently demonstrated an association between two-year mortality and lower BI; however, this association was stronger among patients with a higher eGFR (P-value for interaction=0.004). A lower BI was independently associated with non-home discharge and higher mortality rates because of cardiac- and non-cardiac-related causes in hospitalized patients with HF.

Relationship of serum calcium concentration with chronic kidney disease and mortality in type 2 diabetes mellitus patients: evidence from the NHANES 1999-2018.

This study aims to explore the relationship of serum calcium (Ca) concentration with diabetic kidney disease (DKD) and all-cause mortality among type 2 diabetes mellitus (T2DM) patients using National Health and Nutrition Examination Surveys (NHANES). Data of T2DM patients aged ≥ 40 years were screened from the NHANES database from 1999 to 2018. The outcomes were the risk of DKD diagnosed by urine albumin-to-creatinine ratio (UACR) ≥ 30 mg/g or estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 and the risk of all-cause mortality ascertained by linkage to National Death Index (NDI) records through 31 December 2019. The weighted univariate and multivariate logistic regression model and cox proportional hazard model were utilized to explore the relationships of serum Ca concentration with DKD and all-cause mortality, respectively, with odds ratios (ORs), hazard ratios (HRs) and 95% confidence interval. The relationships were further explored stratified by age, gender, body mass index (BMI), the duration of T2DM, and the history of cardiovascular disease (CVD), cancer and DKD. Totally, 6595 T2DM patients were included. Of these patients, 2441 (37.01%) had DKD and 1868 (28.32%) deaths occurred over a mean follow-up of 104.50 (± 1.61) months. In fully adjusted model, we observed high serum Ca concentration was associated with high risk of DKD (OR = 1.45, 95% CI 1.18-1.77) and high all-cause mortality risk (HR = 1.33, 95% CI 1.16-1.52). These relationships remained significant after performing subgroup analyses. The Restricted cubic spline curves shown that linear correlations were observed between serum Ca concentration and DKD as well as all-cause mortality (P < 0.05). Elevated serum Ca concentration may predict the high risk of DKD and poor prognosis in T2DM patients, and future large-scale and well-designed prospective cohort study is needed to explore the association of serum Ca concentration and DKD and prognosis in T2DM patients.

Impact of moderate or severe mitral and tricuspid valves regurgitation after transcatheter aortic valve replacement

BackgroundTricuspid regurgitation (TR) and mitral regurgitation (MR) are common valvular conditions encountered in patients undergoing transcatheter aortic valve replacement (TAVR). This retrospective study investigates the impact of moderate or severe TR and MR on all-cause mortality in one-year post-TAVR patients. MethodsConsecutive patients who underwent TAVR at the 3 academic tertiary care centers in our health system between 2012 and 2018 were identified. Patients were stratified into 2 groups based on valvular regurgitation severity: moderate/severe MR vs. no/mild MR, and moderate/severe TR vs. no/mild TR. Primary outcome was all-cause mortality at 1-year and 5-year follow up, and secondary outcome was in-hospital death. Logistic regression analysis was conducted to assess the relationship between moderate/severe MR or TR and all-cause mortality at 1-year and 5-year follow-up. ResultsWe included a total of 1,071 patients who underwent TAVR with mean age 80.9 ± 8.6 years, 97% white, and 58.3% males. Moderate or severe MR group included 52 (4.88%) patients while mild or no MR group included 1,015 (95.12%) patients. There was no significant difference between both groups in TAVR procedure success rate (100% vs. 97.83%, p=0.283), in-hospital mortality (0 vs. 1.08%, p=0.450), or mortality at 1-year follow up (15.38% vs. 14.09%, p=0.794). At 5-year follow up, moderate/severe MR group had higher mortality (61.4% vs. 49.5%, p=0.046). In multivariable logistic regression analysis, moderate or severe MR did not show significant correlation with all-cause mortality at 1-year and 5-year follow up. Moderate or severe TR group included 86 (8.03%) patients while mild or no TR group included 985 (91.97%) patients. There was no difference between both groups in TAVR procedure success (98.8% vs. 97.9%, p=0.54) or in-hospital mortality (0% vs. 1.1%, p=0.33). At 1-year follow up, patients with moderate or severe TR had higher mortality (26.7% vs. 13.2%, p=0.001) compared to patients with mild or no TR. Same finding was noted with extended follow up at 5-years (68.3% vs. 48.7%, p<0.001). In multivariable cox regression analysis, moderate/severe TR was associated with higher all-cause mortality at 1-year (OR 1.94, 95% CI [01.09, 3.44], p=0.0.023) and at 5-year (OR 1.46, 95% CI [1.092, 1.952], p=0.0.011) follow up. Patients with combined moderate/severe MR and TR have even higher mortality compared to either moderate/severe valve regurgitation alone or mild/no valve regurgitation at 5-year follow up. ConclusionAt long term follow up, moderate/severe TR, but not MR, is associated with higher mortality in patients underwent TAVR. Combined moderate/severe TR and MR had even worse mortality. Careful assessment of multi-valvular heart disease prior to the procedure is warranted.

Abstract 4134957: Survival and Cardiac Recovery in Pediatric Dilated Cardiomyopathy: A Long-term Cohort Study of Risk Factors, Prognosis, and Health Outcomes Followed into Adulthood

Background: Dilated cardiomyopathy (DCM) is the most common cause of pediatric heart failure (HF), but there is limited literature on its long-term prognosis and treatment outcomes. We examined risk factors for long-term morbidity and mortality and outcomes of care in childhood-onset DCM. Methods: Electronic medical records from a tertiary care pediatric hospital (SickKids, Toronto, Canada) were used to retrospectively follow children ages 0–18 years with DCM from January 1, 2001 to July 1, 2017. Provincial healthcare administrative data was used to monitor outcomes recorded outside of SickKids, following patients during the same time period and into adulthood (age &gt;18 years) until August 31, 2023. We compared DCM cases, with or without echocardiographic recovery (LVEDD z score &lt; 2 and LVEF ≥ 55%), and controls matched on sex, age, and urban/rural residence on a range of health and health service outcomes. Primary outcomes included all-cause mortality, heart transplant (HT), and inpatient admission for HF. Among cases, Cox proportional hazards regression with backwards selection was used to identify demographic, disease, and treatment characteristics associated with each primary outcome, with candidate variables selected based on univariate analysis and clinical judgment. Results: We studied 156 patients with DCM and 780 controls for a median of 14.8 years. Median age at the end of follow-up was 16.2 years. Compared with controls, DCM cases had higher rates of all-cause death, HT, and HF admission (all P &lt;0.001), as well as chronic kidney disease ( P &lt;0.001) and diabetes ( P =0.002). Compared to cases with recovered DCM (n=53), non-recovered cases had higher rates of death, HT, and HF admission (all P &lt;0.001). On multivariable analysis, beta blockers were associated with reduced mortality risk (HR 0.343, 95% CI 0.162–0.727). Using any HF medication (HR 0.205, 95% CI 0.102–0.412) and living in an urban versus a rural area (HR 0.166, 95% CI 0.048–0.573) decreased HT risk. Idiopathic (HR 4.16, 95% CI 1.42–12.2) or sarcomeric mutation-related (HR 9.86, 95% CI 2.30–42.3) DCM were associated with higher HT risk than myocarditis-related DCM. Conclusions: While childhood DCM is associated with long-term adverse health and increased health care utilization, patients who recover have improved morbidity and mortality. Treatment (e.g. medication or access to urban specialist care) was associated with lower mortality and HT risk in DCM.

Abstract 4134569: Palliative care needs assessment by integrated palliative care outcome scale in hospitalized heart failure patients: an observational study

Background and purpose: Patients with heart failure (HF) have a high burden of palliative care needs (PCN) and a worse prognosis that is not lower than cancer. The Integrated Palliative Care Outcome Scale (IPOS) is a scale that evaluates PCN in illness patients, mostly in cancer. Purpose: To evaluate the PCN in hospitalized heart failure patients by IPOS and its relation with patients’ characteristics and mortality. Methodology: A cross-sectional study was conducted on 160 HF hospitalized patients in Vietnam, who were evaluated by IPOS, including questions using a 5-point Likert scale (0 [best]–4 [worst] points) about physical symptoms (10 items), emotional symptoms (4 items), and communication and practical issues (3 items). Patients were determined to have PCN if having ≥ two items with 4 points or ≥ 3 items with ≥ 3 points. Results and discussions: Mean age: 69,57 ± 11,95 years, male: 68.75%, mean LVEF: 44.19 ±16.11%, and NT-proBNP level: 9107.3 ± 30459.1ng/L, the percentage of patients with PCN was 59.38%. The majority of patients had moderate levels (2 points) of dyspnea (38.13%), weakness (35.0%), and low levels (0 or 1 point) of other physical symptoms. Moderate levels (2 points) were the most common in the patient’s anxiety (43.13%) and family anxiety (51.25%), feeling at peace (40.0%), sharing feelings (55.0%), enough information (45.0%), and practical issue (45.0%). Having PCN was significantly correlated to the duration of heart failure, eGFR, and usage of intravenous medication but not related to heart failure severity (NYHA class, LVEF, NT-ProBNP level) and other characteristics (age, gender, residency, educational levels, occupation). Having PCN was independently associated with higher all-cause mortality after discharge with follow-up for one year (P = 0.037). Conclusions: Hospitalized patients with HF had multi-dimensional symptom burdens in moderate levels. PCN was not related to HF severity but correlated to duration of heart failure, eGFR, and usage of intravenous medication. Having PCN was independently associated with mortality after discharge.

Five‐year outcomes with self‐expanding versus balloon‐expandable TAVI in patients with left ventricular systolic dysfunction

The importance of transcatheter heart valve (THV) design on clinical outcome in patients with aortic stenosis (AS) and left ventricular (LV) systolic dysfunction remains unknown. We aimed to compare 5-year outcomes of patients with severe AS and reduced LV ejection fraction (LVEF), undergoing transcatheter aortic valve implantation (TAVI) with balloon-expandable vs. self-expanding THVs. In a retrospective analysis from the Bern TAVI registry, patients with LVEF <50% who underwent TAVI with either balloon-expandable or self-expanding THVs were included. A 1:1 propensity-score matching was performed to account for baseline differences between groups. A total of 759 patients were included between August 2007 and December 2022, and propensity-score matching resulted in 134 pairs. Technical success was achieved in over 85% of patients, and was similar in both groups. Self-expanding THVs were associated with a lower mean transvalvular gradient (7.1 ± 3.7 mmHg vs. 9.9 ± 4.3 mmHg; P < .001) and a higher incidence of ≥mild-to-moderate paravalvular regurgitation (36.3% vs. 11.3%; P < .001) compared to balloon-expandable THVs. At 5 years, patients treated with a self-expanding THV had higher all-cause mortality than those with a balloon-expandable THV (67.8% vs. 55.8%, HRadjusted: 1.44; 95% CI: 1.02-2.03; P = .037). There were no significant differences in other clinical outcomes up to 5 years between groups. In the setting of LV systolic dysfunction, patients treated with a self-expanding THV had higher risk of 5-year mortality compared to patients treated with a balloon-expandable THV. https://www. gov. NCT01368250.

The association of preoperative serum free fatty acid levels with survival in breast cancer patients

Background and objectivesSerum free fatty acids (FFA) are associated with various types of cancer. However, the prognostic value of preoperative serum FFA levels and breast cancer (BC) remains unclear. This study aimed to elucidate the specific relationship between FFA levels and BC outcomes.MethodsA retrospective review was conducted on 4133 patients with BC admitted to Sun Yat-sen Memorial Hospital from January 2015 to October 2021. Preoperative serum FFA levels were detected by the enzymatic endpoint method. The relationship between serum FFA levels and clinical characteristics was analyzed based on FFA interquartile range. Restricted cubic splines and multivariate Cox regression analyses were used to assess the relationship between preoperative serum FFA levels and overall survival (OS) in patients with BC. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated.ResultsAccording to the FFA interquartile range, FFA levels were significantly correlated with OS (years) (p < 0.001). Restricted cubic spline analysis might reveal a U-shaped relationship between preoperative serum FFA levels and OS, after adjusting for other variables. According to the cutoff points for FFAs, multivariate Cox regression analyses showed that patients with low FFA levels (≤ 250 µmol/L) had higher rates of all-cause mortality and cancer-specific mortality than those with high FFA levels (530–700 µmol/L) in the total population and patients with a BMI of 18.5–24.0 kg/m2. A trend was observed indicating that elevated FFA levels (≥ 715 µmol/L) were associated with worse prognosis; however, this association failed to reach statistical significance.ConclusionsThere might be a nonlinear U-shaped relationship between preoperative serum FFA levels and survival in breast cancer patients, with lower FFA levels associated with worse OS. The effect of elevated FFA levels on prognosis requires further investigation.

Platelet count has a U-shaped association with mortality in hemodialysis patients

Our previous manuscript showed that thrombocytopenia predicts all-cause mortality in Chinese hemodialysis (HD) patients. Based on the role of platelets in coagulation, clot formation, and systemic inflammation, we speculate that high platelets increase risk of thrombo-embolic events, hence the mortality. However, research evidence is currently lacking. Therefore, we utilized data from a very large international cohort study to explore the association of platelet counts with mortality and cardiovascular (CV) death in hemodialysis (HD) patients. International data from 396 facilities enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phase 5 (2012–2015) were analyzed. Participants were divided into 3 groups according to their platelet counts (low: <100, normal: 100–300, high: >300*109). Associations between platelet counts and all-cause and CV mortality were analyzed using Cox regression, adjusted for confounders. There were 13,631 patients with median age of 65 years old. Males accounted for 61.2%. Mean platelet count was 205*109/L overall and ranged from 173 *109/L in China to 227 *109/L in Sweden. Overall, 2,348 (17.2%) patients died and 1017 (7.5%) died from CV disease. Both low (HR:1.48, 95% CI 1.21–1.80, p < 0.001) and high (HR:1.17, 95% CI 1.00- 1.35, p = 0.044) platelet counts were associated with higher all-cause mortality after adjustment for covariates; results for CV death were consistent. Platelet count has a U-shaped association with all-cause and CV mortality in HD patients, and thus may be used as an outcome predictor that is readily available among HD patients.

Alcohol and mortality in Mexico: prospective study of 150 000 adults

Alcohol consumption is a leading cause of premature death globally, but there is no large-scale prospective evidence from Mexico. The Mexico City Prospective Study recruited 150 000 adults aged 35 years or older between 1998 and 2004. Participants were followed up until Oct 1, 2022 for cause-specific mortality. Cox regression in those with no self-reported chronic disease at entry (adjusted for age, sex, district, education, physical activity, smoking, and diabetes) was used to relate baseline-reported alcohol consumption (never, former, occasional [less than monthly], and regular [at least monthly, split into <70, ≥70 to <140, ≥140 to <210, and ≥210 g/week]) to mortality at ages 35-74 from all causes, and from a pre-specified alcohol-related set of underlying causes. Heavy episodic drinking (normally consuming >5 [men] or >4 [women] drinks on a single occasion) and type of preferred drink were also examined. Among 138 413 participants aged 35-74 years at recruitment, 21 136 (15%) were regular alcohol drinkers (14 863 [33%] men, 6273 [7%] women), of whom 13 383 (63%) favoured spirits and 6580 (31%) favoured beer. During follow-up, there were 13 889 deaths at ages 35-74 years, including 3067 deaths from the pre-specified alcohol-related causes. Overall, J-shaped associations with mortality were observed. Compared with occasional drinkers, those with baseline-reported consumption ≥210 g/week had 43% higher all-cause mortality (rate ratio [RR] 1·43 [95% CI 1·30-1·56]) and nearly three times the mortality from the pre-specified alcohol-related causes (2·77 [2·39-3·20]). Death from liver disease was strongly related to alcohol consumption; the RR comparing regular drinkers of ≥140 g/week with occasional drinkers was 4·03 (3·36-4·83). Compared with occasional light drinking, occasional heavy episodic drinking was associated with 20% higher alcohol-related mortality (1·20 [1·06-1·35]), and regular heavy episodic drinking was associated with 89% higher alcohol-related mortality (1·89 [1·67-2·15]). Drinks with alcohol percentages higher than spirits were associated with the greatest increased mortality risk, even after accounting for the total alcohol consumed. In this Mexican population, higher alcohol consumption, episodic drinking, and very high percentage alcoholic products were all associated with increased mortality. Wellcome Trust, the Mexican Health Ministry, the National Council of Science and Technology for Mexico, Cancer Research UK, British Heart Foundation, and the UK Medical Research Council. For the Spanish translation of the abstract see Supplementary Materials section.