Impact Of Cardiovascular Events Research Articles

Impact of cardiovascular events and major bleeding in mortality in patients with atrial fibrillation and active lung cancer: data from a multicentre, retrospective, observational study

Abstract Background Lung cancer has a poor prognosis for most patients, as it is frequently diagnosed in advanced tumour stages. Real world observational data on the impact of major cardiovascular events (MACE) and major bleedings (MB) in the prognosis of patients with atrial fibrillation (AF) and active lung cancer are very limited. Purpose Our aim was to investigate the impact of MACE and MB in mortality in this population. Methods We used data from CANAC-FA Registry (Active Cancer and AF, in Spanish, CÁNcer ACtivo y Fibrilación Auricular), an observational, multicentre, retrospective study. The medical records of all subjects attended at the outpatient oncology clinics solely or mainly attending lung cancer patients from January 1st, 2017 to December 31st, 2019 in five tertiary university hospitals in the south of Spain were reviewed. The first visit to the oncology clinic with AF diagnosis during the first year after the lung cancer detection was considered the basal visit. Follow up period ended at December 31st, 2021. MACE (hospital admission for cardiovascular causes) and MB (International Society of Thrombosis and Haemostasis definition) were registered, and impact on survival was assessed for the whole series and according to tumour stage. Results Among 6984 patients, 269 presented active lung cancer and AF (3.9%). Mean age was 71±8 years, and 91% were male. Tumour stage was I, II, III and IV in 11%, 11%, 34% and 45% of the study sample, respectively. Anticoagulants were prescribed to 84% of the patients. After up to 46 months of maximum follow-up, 33 patients presented 40 MACE (13 heart failure admissions, 9 pulmonary embolisms, 5 strokes, 5 severe symptomatic arrhythmias, 4 deep vein thrombosis, 2 transient ischemic attacks, 2 systemic embolisms and 1 acute coronary syndrome), 16 patients had a MB and 186 died. However, two years’ mortality was similar in those patients with MACE or MB in follow-up versus those without them, in the whole of series (79% versus 73%, p=0.79, figure A), and in those with advanced cancer stages (III-IV, 89% versus 85%, p=0.39, figure B). In spite of that, in those patients with early tumour stages (I-II), two years’ mortality was significantly higher in those who suffered MACE or MB than in those free of both of them (85% versus 25%, p=0.01, figure C), and this difference remained after adjusting by other independent predictors of mortality (Hazard Ratio 11.08 [2.69-45.58], p=0.001). Conclusions In patients with AF and active lung cancer, patients with MACE and MB in follow up had similar mortality than those without them in the subgroup with advanced cancer stages. However, mortality was significantly higher in patients with these complications versus those without them in the subgroup with early cancer stages. This information could be useful for individualizing therapeutic efforts in this population.Impact of events in survival

Impact of cardiovascular events on primary and hospital care costs: findings from UK Biobank study

Abstract Background Need for primary and secondary healthcare increases following cardiovascular disease (CVD) events but there is no data on comparative increases in costs. Purpose To estimate annual primary care and hospital inpatient costs associated with key CVD and other adverse events using the UK Biobank (UKB) individual participant data. Methods UKB participants with linked primary care data (192,983 participants) or hospital inpatient episodes data (all 501,807 participants) contributed data to this study. The three categories of primary care services (patient consultations, diagnostic and monitoring tests, prescription medications), and hospital episodes were costed (2020 UK£) using the NHS England reference costs. Annual primary care costs and, separately, annual hospital inpatient costs were modelled as functions of participant characteristics at entry (socio-demographic, clinical, prior diseases) and time-updated first occurrences of myocardial infarction, stroke, coronary revascularization, incident cancer, incident diabetes, vascular death and non-vascular death during follow-up (p-value <0.01 in stepwise covariate selection). One-part generalized linear regression model (GLM) with Poisson distribution and identity link function was used for primary care costs, and two-part model was used for inpatient costs (part 1: logistic regression models probability of incurring costs; part 2: GLM with Poisson distribution and identity link function models costs conditional on incurring any). Separate models were fitted among participants with and without previous CVD at entry into UKB. Results Most adverse events were associated with excess primary care and hospital inpatient costs. Compared to people without previous CVD, people with previous CVD had on average larger excess primary care and hospital inpatient costs in years with myocardial infarction, stroke and vascular death; but similar excess costs in years with other events. Among both people without and with previous CVD, the excess annual primary care costs were less than 7% of the excess annual hospital inpatient costs for vascular events (Table). However, following diabetes diagnosis the excess annual primary care costs were higher than the excess annual hospital inpatient costs (Table). Conclusions These excess primary and hospital care costs associated with CVD events could inform assessments of interventions and policies to reduce CVD risks in UK. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme, UK Medical Research Council (MRC), British Heart Foundation

Impact of cardiovascular events on mortality and progression of renal dysfunction in a Queensland CKD cohort.

AimCardiovascular events (CVE) are common co‐morbidities amongst patients with chronic kidney disease (CKD). The impact of CVE on the subsequent pattern and rate of deterioration of kidney function is not well described.MethodsA retrospective cohort study of 1123 Royal Brisbane and Women's Hospital patients enrolled in the CKD.QLD registry from May 2011 to August 2017 was undertaken. Participants CVE data and renal function (eGFR CKD‐EPI) were extracted from clinical records. Participants who ultimately started kidney replacement therapy (KRT) were imputed an eGFR of 8 mL/min/1.73 m2 at the date of the first KRT treatment. Annualized percentage delta eGFR was used to explore the association between CVE and rate of renal deterioration. Mortality was ascertained through electronic health records.ResultsThere were 235 CVE events amongst 222 participants over a period of 6 years. One hundred and forty‐four participants experienced ischaemic heart disease (IHD), 51 participants had stroke, 40 participants had peripheral vascular disease (PVD) and 13 participants had more than one event. CVE were associated with significantly shorter time to death in participants who experienced one CVE compared with those without a CVE (1901.2 days vs 2259 days [P < .05]). However, there was no significant change in the absolute mean delta eGFR between participants with CVE and without CVE after adjustment for age (3.8 mL/min/1.73 m2 vs 3.8 mL/min/1.73 m2 [P = .9]). Furthermore, there was no significant difference in the progression to KRT in participants with CVE compared with participants without CVE (1315 days and 1052 days (P = .46).ConclusionCardiovascular events are associated with increased mortality in the CKD cohort. They were not associated with accelerated deterioration of kidney function.

Abstract 11653: Prognostic Value of Combination of Flow-Mediated Vasodilation and Nitroglycerine-Induced Vasodilation

Introduction: Flow-mediated vasodilation (FMD) as an index of endothelium-dependent vasodilation and nitroglycerine-induced vasodilation as an index of endothelium-independent vasodilation in the brachial artery using high-resolution ultrasound are useful for assessing vascular function. Some studies have shown that endothelial function assessed by FMD can serve as an independent predictor of cardiovascular events. Previously, we reported that nitroglycerine-induced vasodilationcan be used as a marker for identifying patients with advanced atherosclerosis. The purpose of this study was to determine the prognostic impact of cardiovascular events between FMD and FMD combined with nitroglycerine-induced vasodilation. Methods and Results: We measured FMD and nitroglycerine-induced vasodilation in 402 subjects (mean age, 58±17 years), including patients with cardiovascular diseases. We assessed the associations between FMD combined with nitroglycerine-induced vasodilation and cardiovascular events (death from cardiovascular causes, myocardial infarction, stroke, and revascularization). During a median period of 32.3 months (interquartile range, 17.1 to 49.1 months) of follow-up, 15 subjects died (5 from cardiovascular causes), 3 myocardial infarction, 7 stroke, and 26 revascularization. The receiver operating characteristic curve analysis revealed that FMD alone predicts cardiovascular events with an area under curve of 0.67. FMD combined with nitroglycerine-induced vasodilation predicts cardiovascular events with an area under curve of 0.70. FMD &lt; median value of 3.9% and nitroglycerine-induced vasodilation &lt; median value of 12.2% were associated with increased cardiovascular event. After adjustment for age, sex, body mass index, cardiovascular risk factors, below median FMD and nitroglycerine-induced vasodilation group remained a strong independent indicator of cardiovascular events (hazard ratio, 4.95; 95 percent confidence interval, 1.65 to 21.43; P=0.002). Conclusions: These findings suggest that the combination of FMD and nitroglycerine-induced vasodilation measurement could more accurately predict cardiovascular events than FMD alone.

Impact of Cardiovascular Events on Change in Quality of Life and Utilities in Patients After Myocardial Infarction: A VALIANT Study (Valsartan In Acute Myocardial Infarction)

The objective of this study was to determine the impact of nonfatal cardiovascular (CV) events on changes in health-related quality of life (HRQL). There is limited understanding of the impact of nonfatal CV events on long-term changes in HRQL in survivors ofmyocardial infarction (MI). The VALIANT (Valsartan In Acute Myocardial Infarction) trial enrolled 14,703 patients post-MI complicated by Killip class II or higher (scale measuring heart failure severity post-MI ranging from class I to IV) and/or reduced ejection fraction. The HRQL substudy included 2,556 (17.4%) patients who completed the EQ-5D with 5 questions, with responses mapped to utility weight on a scale of 0 to 1 and a visual analog scale (VAS) ranging from 0 (worst) to 100 (best) imaginable health state. EQ-5D was administered at baseline and 6, 12, 20, and 24 months. The trajectory of EQ-5D scores was developed by using linear mixed effects regression models with calculation of deviation from this trajectory after nonfatal CV events. Patients who died before the next EQ-5D assessment were excluded. Over a 2-year period, 597 patients experienced a nonfatal CV event and survived to have another EQ-5D assessment. Their baseline EQ-5D scores were lower than patients without a subsequent nonfatal CV event (VAS 61.0 ± 19 vs 68.2 ± 18 [p< 0.001] and US-based utility score 0.76 ± 0.22 vs 0.83 ± 0.17 [p< 0.001]). These patients with CVevents experienced a trajectory-adjusted 6.6 point decrease (p< 0.001) in VAS scores and a 0.07 decrease (p<0.001) in utility score after the nonfatal CV event. MI survivors suffering a CV event experienced significantly worse HRQL than their previous trajectory, suggesting that generic instruments can be responsive to nonfatal events. Reduction in nonfatal CV events may affect longitudinal changes in HRQL.

Impact of Cardiovascular Events on Residual Renal Function during the First Year of Peritoneal Dialysis

Impact of Cardiovascular Events on Residual Renal Function during the First Year of Peritoneal Dialysis