Incidence Of All-cause Mortality Research Articles

Prevalence and prognosis of frailty in patients >70 years old with acute coronary syndrome referred to invasive angiography

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Rigshospitalet Research Foundation Background The number of older patients is increasing world-wide. Older patients have a higher risk of complications related to acute coronary syndrome (ACS) treatment and are more often frail. Yet, they are often missing in clinical trials, which leads to a knowledge gap in current guidelines when treating older ACS patients. Frailty scoring may be a better tool than conventional risk scores to assess prognosis. Previous studies have proposed that a patient’s biological age instead of chronological age could be used to better guide the treatment strategy in older ACS patients. Potentially frailty scoring can be used to decide a patient’s biological age. Purpose We wanted to investigate the prevalence of frailty in a consecutive population of ACS patients ≥70 years referred to invasive angiography at a tertiary centre. Furthermore, we wanted to investigate whether frail patients had a worse 12-month outcome compared to non-frail patients. Methods From September 2020 to September 2021 all patients ≥70 years referred to our institution with ACS were, when logistically possible, undergoing bedside frailty scoring using the clinical frailty scale (CFS). The CFS scoring was performed at the time of admission by nurses at the department. Patients were divided into three frailty groups depending on their CFS score: Robust (1-3), Vulnerable (4) and Frail (5-9). Patients were followed for 12 months. Results During the study period, 691 patients ≥70 years old with ACS were admitted. Of the 451 (65%) patients who had a frailty assessment, 70 (16%) patients were frail, 77 (17%) were vulnerable and 304 (67%) were robust. Frail and vulnerable patients were older (frail: 80.9 (5.6) years, vulnerable: 78.5 (5.7) years and robust: 76.7 (4.8) years, p<0.001), had more comorbidities, defined as a higher Charlson index score (frail: 4.5 [4.0-5.0], vulnerable: 4.0 [4.0-6.0] and robust: 4.0 [3.0-4.0], p<0.001) and longer hospitalisation (frail: 5 [3-9.2] days, vulnerable: 8 [3.5-14.0] days and robust: 5 [3-7] days, p=0.021). Furthermore, frail and vulnerable patients less frequently underwent revascularisation during their first admission (frail: 58.9%, vulnerable: 65.1% and robust: 77.9%, p<0.001). In 12-month follow-up, frail and vulnerable patients had a higher cumulated incidence of all-cause mortality compared to robust patients (p<0.001), figure 1. Frail patients had more than four times the risk of 12-month all-cause mortality compared to robust patients (HR 4.16 (2.12-8.15), p<0.001). The association remained significant after adjustment for age and comorbidities (HR 2.71 (1.30-5.64), p=0.008), as well as for GRACE score (HR 2.98 (1.50-5.90), p=0.002), table 1. Conclusion In patients ≥70 years old with ACS and referred to invasive angiography, frailty according to the CFS score had a prevalence of 16%. Frail and vulnerable patients had more than four times the risk of all-cause mortality in 12-month follow-up.

E-49 | Moderate to High Precise-DAPT Score Is Associated With Increased Risk of Bleeding and Mortality in a Predominantly Hispanic Population

Bleeding is a major complication for patients on dual anti-platelet therapy (DAPT) post percutaneous coronary intervention (PCI). Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score has been widely used inEurope for the prediction of bleeding during DAPT with a cut-off of ≥ 25 as high risk. We determined the predictive accuracy of PRECISE-DAPT scores in a predominantly Hispanic population. A retrospective single center cohort study was conducted with patients on DAPT post PCI between 2014 and 2021. PRECISE-DAPT score was assessed and classified into three categories (low: ≤17; moderate:18 to 24; high: ≥25). The primary endpoints were incidence of bleeding as evaluated using Bleeding Academic Research Consortium (BARC) ≥ 2 events and all-cause mortality. Kaplan Meier curve, log rank test and Cox proportional hazards models were performed. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal cut-offs. Out of 829 patients(age 62 ± 12 years, 66% males, 78% Hispanic), 46 (5.5%) had BARC ≥ 2 bleeding complications and 38 (4.5%) had deaths after PCI for a mean follow up of 2.8 ± 2.4 years. Compared with low PRECISE-DAPT risk score, moderate and high-risk scores were associated with increased risk of bleeding (3.18%, 10.22%, and 7.69 %, respectively, p=0.002). Similarly, in comparison with low score, moderate and high score groups had higher incidence of all-cause mortality (2.12%, 6.57%, and 7.69% respectively, p<0.001). In the adjusted analysis, the combined moderate and high scores predicted higher risk of bleeding (hazard ratio [HR] 2.89; 95%CI: 1.47-5.71, p=0.002) and all-cause mortality (HR 5.78, 95%CI 2.41-13.83, p <.0001). A cut-off value ≥19 of the PRECISE-DAPT score classified bleeding (AUC=0.63; 95%CI: 0.55-0.71) and all-cause mortality (AUC=0.68; 95%CI: 0.60-0.77). Our results suggest moderate to high PRECISE-DAPT score was associated with the increased risk of bleeding and mortality in patients with DAPT post PCI in a predominantly Hispanic population with an optimal cut-off of ≥19 instead of 25.

Long-term clinical outcomes of tricuspid valve replacement using bovine versus porcine valves: a nationwide population-based study.

The early and long-term clinical outcomes of bovine versus porcine tricuspid valve replacement (TVR) were compared based on the nationwide database from the National Health Insurance Service. Of 1464 patients who underwent TVR from 2002 to 2018 in Korea, 541 were enrolled after excluding mechanical TVR, re-TVR, complex congenital heart disease, Ebstein anomaly and age <19 years at operation. Bovine (group B) and porcine valves (group P) were used in 342 and 199 patients, respectively. The median follow-up duration was 4.1 years [interquartile range 1.2-9.0]. Inverse probability of treatment weighting analysis was performed for adjustment between the groups. Early and long-term clinical outcomes, including all-cause mortality, ischaemic stroke, haemorrhagic stroke, endocarditis and reoperation, were compared. In inverse probability of treatment weighting analysis, operative mortality and early clinical outcomes were comparable between the groups. The cumulative incidence of all-cause mortality demonstrated no significant differences between the groups [36.8% vs 38.0% at 5 years in group B versus group P; adjusted hazard ratio = 0.93; P = 0.617]. The cumulative incidence of cardiac death, ischaemic stroke, haemorrhagic stroke and endocarditis also demonstrated no significant differences between the groups (28.1% vs 25.9%, 7.1% vs 1.2%, 3.2% vs 4.2% and 9.7% vs 6.0% at 5 years in group B versus group P, respectively). However, the cumulative incidence of reoperation was higher in group B than in group P (20.2% vs 3.4% at 5 years in group B vs group P; adjusted hazard ratio = 4.76; P = 0.006). Early clinical outcomes and long-term outcomes, including all-cause mortality, cardiac death, ischaemic stroke, haemorrhagic stroke and endocarditis, were comparable between bovine and porcine TVRs. However, porcine valves demonstrated a lower cumulative incidence of reoperation than bovine valves.

Rate pressure product as a novel predictor of long-term adverse outcomes in patients after percutaneous coronary intervention: a retrospective cohort study

ObjectivesPrevious studies have suggested that heart rate and blood pressure play important roles in the development of adverse outcomes in patients with coronary artery disease (CAD) who underwent percutaneous coronary...

Maternal Hypertensive Disorder of Pregnancy and Mortality in Offspring From Birth to Young Adulthood: National Population-Based Cohort Study

ABSTRACT Worldwide, hypertensive disorders of pregnancy (HDPs) affect up to 10% of pregnancies. It has been associated with adverse pregnancy and birth outcomes, as well as diseases in the offspring later in life, such as metabolic syndrome, and neurodevelopmental and psychiatric disorders. It has been proposed that maternal HDPs may increase the susceptibility of offspring to disease through multiple pathways, such as placental dysfunction, a hypoxic-ischemic environment in pregnancy, abnormal inflammatory levels, and epigenetic changes. However, there is a scarcity of evidence to support this association. The aim of this study was to examine the association between maternal HDPs with mortality in offspring from birth to young adulthood. This was a population-based cohort study based on data from Danish national health registries. Included were all live births in Denmark between 1978 and 2018. Excluded were those with a birth weight &lt;500 g and gestational age at birth &lt;22 weeks and those who died on the day of birth. Live-born individuals were followed from the date of birth until the date of death, emigration, or December 31, 2018, whichever came first. Maternal HDP was categorized as eclampsia, preeclampsia, or hypertension. Overall, 4.2% of 2,437,718 live-born offspring were exposed prenatally to maternal HDP, including 2.8% exposed to preeclampsia or eclampsia and 1.4% to hypertension. During follow-up of up to 41 years (median, 19.4 [interquartile range 9.7–28.7] years), there were 781 deaths (58.94 per 100,000 person years) among offspring exposed to preeclampsia, 17 deaths (133.73 per 100,000) among those exposed to eclampsia, 223 deaths (44.38 per 100,000) among those exposed to hypertension, and 19,119 deaths (41.99 per 100,000) among those not exposed to HDP. The HDP-exposed cohort had a higher cumulative incidence of all-cause mortality than the nonexposed cohort (2.06% [95% confidence interval {CI}, 1.82%–2.34%] vs 1.69% [95% CI, 1.65%–1.73%]), a 0.37% difference (95% CI, 0.11%–0.64%). The HDP-exposed cohort also had a 26% higher risk (hazard ratio, 1.26 [95% CI, 1.18–1.34]) of all-cause mortality than nonexposed offspring. The risks of all-cause mortality were 29% in those exposed to preeclampsia (1.29 [95% CI, 1.20–1.38]), 118% in those exposed to eclampsia (2.88 [95% CI, 1.79–4.63]), and 12% in those exposed to hypertension (1.12 [95% CI, 0.98–1.28]). There were increased risks for cause-specific mortality in the HDP-exposed cohort, including from digestive diseases (2.09 [95% CI, 1.27–3.43]); conditions originating in the perinatal period (2.04 [95% CI, 1.81–2.30]); endocrine, nutritional, and metabolic diseases (1.56 [95% CI, 1.08–2.27]); and cardiovascular diseases (1.52 [95% CI, 1.08–2.13]). In conclusion, maternal HDP was associated with increased risks of all-cause mortality, as well as cause-specific deaths, including digestive diseases; conditions originating in the perinatal period; endocrine, nutritional, and metabolic diseases; and cardiovascular disease.

The Effect of Medical Cooperation in the CKD Patients: 10-Year Multicenter Cohort Study.

While chronic kidney disease (CKD) is one of the most important contributors to mortality from non-communicable diseases, the number of nephrologists is limited worldwide. Medical cooperation is a system of cooperation between primary care physicians and nephrological institutions, consisting of nephrologists and multidisciplinary care teams. Although it has been reported that multidisciplinary care teams contribute to the prevention of worsening renal functions and cardiovascular events, there are few studies on the effect of a medical cooperation system. We aimed to evaluate the effect of medical cooperation on all-cause mortality and renal prognosis in patients with CKD. One hundred and sixty-eight patients who visited the one hundred and sixty-three clinics and seven general hospitals of Okayama city were recruited between December 2009 and September 2016, and one hundred twenty-three patients were classified into a medical cooperation group. The outcome was defined as the incidence of all-cause mortality, or renal composite outcome (end-stage renal disease or 50% eGFR decline). We evaluated the effects on renal composite outcome and pre-ESRD mortality while incorporating the competing risk for the alternate outcome into a Fine-Gray subdistribution hazard model. The medical cooperation group had more patients with glomerulonephritis (35.0% vs. 2.2%) and less nephrosclerosis (35.0% vs. 64.5%) than the primary care group. Throughout the follow-up period of 5.59 ± 2.78 years, 23 participants (13.7%) died, 41 participants (24.4%) reached 50% decline in eGFR, and 37 participants (22.0%) developed end-stage renal disease (ESRD). All-cause mortality was significantly reduced by medical cooperation (sHR 0.297, 95% CI 0.105-0.835, p = 0.021). However, there was a significant association between medical cooperation and CKD progression (sHR 3.069, 95% CI 1.225-7.687, p = 0.017). We evaluated mortality and ESRD using a CKD cohort with a long-term observation period and concluded that medical cooperation might be expected to influence the quality of medical care in the patients with CKD.

Failure of Early Mycological Clearance in HIV-Negative Cryptococcal Meningitis.

Negative cerebrospinal fluid (CSF) cultures at 2 weeks after antifungal treatment (early mycological clearance [EMC]) should be a treatment goal of cryptococcal meningitis (CM). However, EMC in human immunodeficiency virus (HIV)-negative patients with CM is poorly understood. We conducted a retrospective review of medical records and 1-year follow-up of 141 HIV-negative patients with CM with an initial positive CSF culture for Cryptococcus neoformans. Multivariate logistic regression was performed to analyze clinical features and laboratory and CSF findings of patients with CM with different EMC statuses. Random forest models were used to predict failure of EMC. All-cause mortality and clinical functional status were analyzed. Of 141 patients, 28 (19.9%) had EMC failure. The 1-year mortality rate was 5.7% (8/141). Multivariate analysis showed that non-amphotericin B (AmB)-based regimens, baseline log10 Cryptococcus count/mL, baseline CSF opening pressure (CSF-OP) >30 cm H2O, and baseline serum creatinine were significantly associated with EMC failure. A parsimonious predictive rule given by the decision tree identified patients with CM with non-AmB-based therapy and baseline CSF-OP >30 cm H2O as being at high risk of EMC failure. Incidence of all-cause mortality, the follow-up modified Rankin Scale, and Karnofsky performance status scores were not significantly related to EMC. EMC failure in HIV-negative CM is attributed to non-AmB-based therapy and is associated with log10 Cryptococcus count/mL and CSF-OP >30 cm H2O at baseline. Because of the small number of deaths, we are not able to comment on whether or not EMC is associated with mortality.

Drug-coated balloons for the treatment of stent edge restenosis.

Drug-coated balloon (DCB) is a device for treating patients with in-stent restenosis; however, there are scant data on its efficacy for stent edge restenosis (SER). This study aimed to investigate the clinical outcomes of DCB use for treating SER compared with new-generation drug-eluting stent (DES) implantation. From December 2013 to January 2019, patients who underwent DES implantation or DCB for SER were enrolled. Clinical outcomes were analyzed, and propensity score with matching was conducted. The primary outcome was target-vessel revascularization (TVR). The secondary outcomes were the incidence of all-cause mortality, major adverse cardiovascular events (MACE), and target lesion revascularization (TLR). A total of 291 patients with SER were included: 160 were treated with DCB, and 131 with new-generation DES. DCB treatment for SER treatment was associated with a lower risk of TVR than DES [hazard ratio, 0.549; 95% confidence interval (CI), 0.339-0.891] at a median follow-up of 1080 days (interquartile range; 729-1080 days). Propensity score matching (PSM) was performed to adjust for baseline clinical and lesion characteristics. After PSM, no significant difference in the risk of TVR was observed (hazard ratio, 0.965; 95% CI, 0.523-1.781). Similarly, the risk for all-cause death (hazard ratio, 0.507; 95% CI, 0.093-2.770), MACE (hazard ratio: 0.812; 95% CI, 0.451-1.462), and TLR (hazard ratio: 0.962; 95% CI, 0.505-1.833) were comparable between the two groups. DCB treatment efficacy for SER was similar to that of new-generation DES after PSM. DCB is a significant alternative to obtain comparable results with new-generation DES for the treatment of SER.

Independent and interactive effect of sedentary time and physical activity on risk of all-cause mortality: A prospective cohort study.

Sedentary behavior (SB) and physical inactivity have been associated with an increased risk of all-cause mortality. Evidence in China is scarce, and it is unclear whether physical activity (PA) attenuates or even eliminates the harmful effects of prolonged SB in the Chinese population. We conducted a prospective cohort study of 17 084 Chinese adults. PA and sitting time (ST) were assessed using the IPAQ. Cox proportional hazards models were used to estimate the risk of PA and ST with all-cause mortality. Interaction plots were used to visualize the interaction effects. During a median follow-up of 6.01 years, a total of 1106 deaths occurred. PA level was inversely associated with the incidence of all-cause mortality, while ST showed a detrimental association (all ptrend < 0.05). In the stratified analysis, ST was associated with all-cause mortality in the low PA, while the association was attenuated in the moderate PA group: the HRs (95% CI) comparing ST of 4-8, 8-11, and ≥11 to <4h/day were 1.15 (0.73-1.81), 1.55 (0.92-2.59), and 2.70 (1.52-4.80), respectively. In the high PA group, no significant association was found across all ST levels. In the joint analysis, compared with the high PA and ST <4h/day, the harmful effect was found only in the combined low PA and moderate PA groups with ST ≥11 h/day (HR:2.71, 95% CI:1.69-4.35). In addition, a significant interaction association was found. Our study, based on a prospective cohort, suggests that the detrimental effect of ST on all-cause mortality is attenuated or eliminated by high PA levels in the Chinese population.

Malnutrition according to the GLIM criteria with kidney dysfunction is associated with increased mortality in hospitalized patients with cardiovascular disease: A retrospective cohort study

Background & Aims Cardiovascular disease (CVD) is a significant cause of mortality and rising healthcare costs, involving numerous chronic and nutritional risk. Although several studies have reported that malnutrition based on the Global Leadership Initiative on Malnutrition (GLIM) criteria is associated with mortality in patients with CVD, they have not evaluated this association in terms of malnutrition severity (moderate or severe). Furthermore, the relationship between malnutrition combined with renal dysfunction, a risk factor for death in CVD patients, and mortality has not been previously evaluated. Thus, we aimed to assess the association between malnutrition severity and mortality, as well as malnutrition status stratified by kidney function and mortality, in patients hospitalized due to CVD events. Methods This single-centre, retrospective cohort study included 621 patients with CVD aged ≥18 years admitted to Aichi Medical University between 2019 and 2020. The relationship between nutritional status based on the GLIM criteria (without malnutrition, moderate malnutrition, or severe malnutrition) and the incidence of all-cause mortality was evaluated by multivariable Cox proportional hazards models. Results Patients with moderate and severe malnutrition were significantly more prone to mortality than those without malnutrition (adjusted hazard ratio [HR] of patients without, with moderate, and with severe malnutrition: 1.00 [reference], 1.94 [1.12–3.35], and 2.63 [1.53–4.50], respectively). Furthermore, we found the highest all-cause mortality rate in patients with malnutrition and a lower estimated glomerular filtration rate (eGFR <30 mL/min/1.73m2) (adjusted HR, 10.1; confidence interval, 3.90–26.4) than in patients without malnutrition and normal eGFR (eGFR ≥60 mL/min/1.73m2). Conclusions The present study indicated that malnutrition according to the GLIM criteria was associated with increased all-cause mortality in patients with CVD, and malnutrition associated with kidney dysfunction was associated with a higher risk of mortality. These findings provide clinically relevant information to identify high mortality risk in patients with CVD and highlight the need for giving careful attention to malnutrition with kidney dysfunction among patients with CVD.

R2CHA2DS2-VA Predictsthe Cardiovascular Risk after Carotid Endarterectomy

R2CHA2DS2-VA score has been used to predict short and long-term outcomes in many cardiovascular diseases. This study aims to validate the R2CHA2DS2-VA score as a long-term major adverse cardiovascular events (MACE) predictor after carotid endarterectomy (CEA). Secondary outcomes were also assessed regarding the incidence of all-cause mortality, acute myocardial infarction (AMI), major adverse limb events (MALE), and acute heart failure (AHF). From January 2012 to December 2021, patients (n=205) from a Portuguese tertiary care and referral center that underwent CEA with regional anesthesia (RA) for carotid stenosis (CS) were selected from a previously collected prospective database, and a posthoc analysis was performed. Demographics and comorbidities were registered. Clinical adverse events were assessed 30 days after the procedure and in the subsequent long-term surveillance period. Statistical analysis was performed by the Kaplan-Meier method and Cox proportional hazards regression. Of the patients enrolled, 78.5% were males with a mean age of 70.44±8.9years. Higher scores of R2CHA2DS2-VA were associated with long-term MACE (adjusted hazard ratio (aHR) 1.390; 95% confidence interval (CI) 1.173-1.647); and mortality (aHR 1.295; 95% CI 1.08-1.545). This study demonstrated the potential of the R2CHA2DS2-VA score to predict long-term outcomes, such as AMI, AHF, MACE, and all-cause mortality, in a population of patients submitted to carotid endarterectomy.

Effect of Prosthesis-Patient Mismatch on Long-Term Clinical Outcomes After Bioprosthetic Aortic Valve Replacement

BackgroundProsthesis-patient mismatch (PPM) is common following surgical aortic valve replacement (SAVR). ObjectivesThe purpose of this study was to quantify the impact of PPM on all-cause mortality, heart failure hospitalization, and reintervention following bioprosthetic SAVR. MethodsThis observational nationwide cohort study from SWEDEHEART (Swedish Web system for Enhancement and Development of Evidence based care in Heart disease Evaluated According to Recommended Therapies) and other national registers included all patients who underwent primary bioprosthetic SAVR in Sweden from 2003 to 2018. PPM was defined according to the Valve Academic Research Consortium 3 criteria. Outcomes were all-cause mortality, heart failure hospitalization, and aortic valve reintervention. Regression standardization was used to account for intergroup differences and to estimate cumulative incidence differences. ResultsWe included 16,423 patients (no PPM: 7,377 [45%]; moderate PPM: 8,502 [52%]; and severe PPM: 544 [3%]). After regression standardization, the cumulative incidence of all-cause mortality at 10 years was 43% (95% CI: 24%-44%) in the no PPM group compared with 45% (95% CI: 43%-46%) and 48% (95% CI: 44%-51%) in the moderate and severe PPM groups, respectively. The survival difference at 10 years was 4.6% (95% CI: 0.7%-8.5%) and 1.7% (95% CI: 0.1%-3.3%) in no vs severe PPM and no vs moderate PPM, respectively. The difference in heart failure hospitalization at 10 years was 6.0% (95% CI: 2.2%-9.7%) in severe vs no PPM. There was no difference in aortic valve reintervention in patients with or without PPM. ConclusionsIncreasing grades of PPM were associated with long-term mortality, and severe PPM was associated with increased heart failure. Moderate PPM was common, but the clinical significance may be negligible because the absolute risk differences in clinical outcomes were small.

Clinical outcomes in women and men with small aortic annuli undergoing transcatheter aortic valve implantation: A multicenter, retrospective, propensity score-matched comparison

BackgroundSex-specific characteristics in patients with aortic stenosis and small annuli undergoing transcatheter aortic valve implantation (TAVI) might affect clinical outcomes and hemodynamics. MethodsTAVI-SMALL 2 international retrospective registry included 1378 patients with severe aortic stenosis and small annuli (annular perimeter <72 mm or area < 400 mm2) treated with transfemoral TAVI at 16 high-volume centers between 2011 and 2020. Women (n = 1233) were compared with men (n = 145). One-to-one propensity score (PS) matching resulted in 99 pairs. Primary endpoint was incidence of all-cause mortality. Incidence of pre-discharge severe prosthesis-patient mismatch (PPM) and its association with all-cause mortality were investigated. Binary logistic and Cox regression were performed to adjust the treatment effect for PS quintiles. ResultsIncidence of all-cause mortality at a median follow-up of 377 days did not differ between sex in the overall (10.3 vs. 9.8%, p = 0.842) and PS-matched (8.5 vs. 10.9%, p = 0.586) populations. After PS matching, pre-discharge severe PPM was numerically higher in women vs. men (10.2 vs. 4.3%), even though no evidence of a difference was found (p = 0.275). Within the overall population, women with severe PPM suffered a higher incidence of all-cause mortality when compared to those with less than moderate PPM (log-rank p = 0.024) and less than severe PPM (p = 0.027). ConclusionsNo difference in all-cause mortality at medium-term follow-up was observed between women and men with aortic stenosis and small annuli undergoing TAVI. Incidence of pre-discharge severe PPM was numerically higher in women than men, and it was associated with increased all-cause mortality in women.

Low-density lipoprotein cholesterol to apolipoprotein B ratio predicts mortality and cardiovascular events in peritoneal dialysis patients.

The ratio of low-density lipoprotein cholesterol (LDL-C)/apolipoprotein B (apo B) is associated with all-cause mortality and cardiovascular events in chronic kidney disease patients. The aim of this study was to investigate the association between the LDL-C/apo B ratio (LAR) and all-cause mortality and cardiovascular events in peritoneal dialysis (PD) patients. A total of 1199 incident PD patients were enrolled from November 1, 2005 to August 31, 2019. The LAR was used to divide the patients into two groups by X-Tile software and restricted cubic splines using 1.04 as the cutoff. The incidence of all-cause mortality and cardiovascular events at follow-up was compared according to LAR. Of the 1199 patients, 58.0% were men, the mean age was 49.3 ± 14.5years, 225 patients had a history of diabetes, and 117 patients had prior cardiovascular disease. During the follow-up period, 326 patients died, and 178 patients experienced cardiovascular events. After full adjustment, a low LAR was significantly associated with HRs for all-cause mortality of 1.37 (95% CI 1.02-1.84, P = 0.034) and for cardiovascular events of 1.61 (95% CI 1.10-2.36, P = 0.014). This study suggests that a low LAR is an independent risk factor for all-cause mortality and cardiovascular events in PD patients, indicating that the LAR may provide significant information when assessing all-cause mortality and cardiovascular risks.

Study Level Meta-Analysis of Transcatheter Aortic Valve Implantation With the ACURATE neo Self-Expanding Transcatheter Heart Valve.

The ACURATE neo transcatheter aortic valve is a self-expanding device. Several studies have investigated safety and efficacy, but meta-analysis and pooled data are lacking. We aimed to provide a comprehensive systematic review and meta-analysis on the clinical outcomes of transcatheter aortic valve implantation with the ACURATE neo valve. A systematic literature search for eligible records was conducted. The primary endpoint was device success as designated by Valve Academic Research Consortium-2 criteria. The secondary endpoints (time frame: 30 days) were all-cause mortality, stroke, myocardial infarction, need for new permanent pacemaker, major vascular complications, major bleeding, acute kidney injury stage II or III, and paravalvular regurgitation grade moderate or severe (II or III). Our search yielded a total of 355 records, 20 of those (n = 5858 ACURATE neo receivers) were included in our meta-analysis. Device success was achieved in 94.5% (95% confidence interval [CI], 91.4-96.5%) of the patients. The 30-day all-cause mortality incidence proportion was 1.8% (95% CI, 1.3-2.4%). New pacemaker implantation was required in 7.7% (95% CI, 6.4-9.2%) of the patients, stroke occurred in 1.9% (95% CI, 1.6-2.3%), myocardial infarction in 0.5% (95% CI, 0.3-0.7%), major bleeding in 5.0% (95% CI, 3.9-6.5%), major vascular complication in 5.6% (95% CI, 4.0-7.8%), acute kidney injury stage ≥2 in 2.5% (95% CI, 1.8-3.4%), and paravalvular leak grade ≥moderate was observed in 4.3% (95% CI, 3.0-6.2%). Balloon predilatation and postdilatation incidence was 93.9% (95% CI, 87.0-97.3%) and 43.2% (95% CI, 37.9-48.6%), respectively. ACURATE neo appears to be safe and effective in our analysis with high device success incidence, low mortality, and low new pacemaker implantations.

30-day to 10-year mortality rates following total hip arthroplasty: a meta-analysis of the last decade (2011-2021).

Mortality after total hip arthroplasty (THA) is a rare but devastating complication. This meta-analysis aimed to: (1) determine the mortality rates at 30 days, 90 days, 1 year, 5 years and 10 years after THA; (2) identify risk factors and causes of mortality after THA. Pubmed, MEDLINE, Cochrane, EBSCO Host, and Google Scholar databases were queried for studies reporting mortality rates after primary elective, unilateral THA. Inverse-proportion models were constructed to quantify the incidence of all-cause mortality at 30 days, 90 days, 1 year, 5 years and 10 years after THA. Random-effects multiple regression was performed to investigate the potential effect modifiers of age (at time of THA), body mass index, and gender. A total of 53 studies (3,297,363 patients) were included. The overall mortality rate was 3.9%. The 30-day mortality was 0.49% (95% CI; 0.23-0.84). Mortality at 90 days was 0.47% (95% CI, 0.38-0.57). Mortality increased exponentially between 90 days and 5 years, with a 1-year mortality rate of 1.90% (95% CI, 1.22-2.73) and a 5-year mortality rate of 9.85% (95% CI, 5.53-15.22). At 10-year follow-up, the mortality rate was 16.43% (95% CI, 1.17-22.48). Increasing comorbidity indices, socioeconomic disadvantage, age, anaemia, and smoking were found to be risk factors for mortality. The most commonly reported causes of death were ischaemic heart disease, malignancy, and pulmonary disease. All-cause mortality remains low after contemporary THA. However, 1 out of 10 patients and 1 out of 6 patients were deceased after 5 years and 10 years of THA, respectively. As expected, age, but not BMI or gender, was significantly associated with mortality.

Efficacy and safety of sacubitril/valsartan in patients with acute decompensated heart failure: a systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Sacubitril/Valsartan is the cornerstone in the treatment of heart failure with reduced ejection fraction (HFrEF). However, there is limited data on their risk-benefit in patients with acute heart failure requiring hospitalizations. Methods A comprehensive and relevant search of randomized controlled trials (RCT) and cohort studies were conducted examining the use of Sacubitril/Valsaratan in patients hospitalized for heart failure compared to patients using an angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). Outcome measures for all-cause mortality, renal worsening function and hyperkalemia were extracted and analyzed using a random effects model via Review Manager V5.4. Results Three studies were included in the meta-analysis with 5,113 subjects analyzed. There was a higher rate of all-cause mortality in the ACE inhibitors/ARBs group, which was statistically significant (RR 0.65 [95%CI: 0.51-0.83], I²=0, p=0.0007). There were no significant differences in worsening renal function (RR 0.91 [95%CI: 0.78-1.06], I²=0, p=0.24) and hyperkalemia (RR 1.04 [95%CI: 0.78-1.37], I²=0, p=0.81) between Sacubitril/Valsartan and ACEi/ARB groups. Conclusion Sacubitril/Valsartan and ACE inhibitors/ARBs have similar rates of worsening renal function and hyperkalemia among heart failure patients in acute decompensation. However, ACE inhibitors/ARBs had a higher incidence of all-cause mortality, which suggests Sacubitril/Valsartan may be a preferable heart failure regimen in patients with acute decompensated heart failure.

The Burden of Surviving Childhood Medulloblastoma: A Population-Based, Matched Cohort Study in Ontario, Canada.

Survivors of childhood medulloblastoma suffer from substantial late effects. We characterized these sequelae using real-world health services data in a population-based cohort of medulloblastoma survivors. All 5-year medulloblastoma survivors diagnosed age < 18 years between 1987 and 2015 in Ontario, Canada, were identified and matched 1:5 with population controls. Index date was 5 years from latest pediatric cancer event. Linkage to provincial administrative health data allowed for comparison of cumulative incidences of several adverse outcomes. Two hundred thirty survivors, 81.3% of whom had received craniospinal irradiation, were matched with 1,150 controls. The 10-year postindex cumulative incidence of all-cause mortality was 7.9% (95% CI, 3.9 to 11.8) in survivors versus 0.6% (95% CI, 0.1 to 1.1) in controls (hazard ratio [HR], 21.5; 95% CI, 9.8 to 54.0). The cumulative incidence of stroke was higher in survivors (4.8%; 95% CI, 2.2 to 9.0) compared with controls (0.1; 95% CI, 0.01 to 0.7; HR, 45.6; 95% CI, 12.8 to 289.8). Hearing loss requiring an amplification device was present in 24.9% (95% CI, 18.8 to 31.4) of survivors versus 0.3% (95% CI, 0.1 to 1.0) of controls (HR, 96.3; 95% CI, 39.7 to 317.3). Disability support prescription claims were submitted by 44.5% (95% CI, 37.1 to 51.6) of survivors versus 5.5% (95% CI, 4.2 to 7.1) of controls (HR, 10.0; 95% CI, 7.3 to 13.6). Female survivors were significantly less likely to deliver a liveborn child compared with controls (HR, 0.2; 95% CI, 0.1 to 0.7). Survivors of medulloblastoma have significant long-term medical sequelae, increased all-cause mortality, and are frequently dependent on disability supports. Efforts to reduce the toxicity of current therapy, specifically incorporating molecularly informed risk stratification to spare low- and intermediate-risk survivors the toxicity of treatment, are urgently needed. These findings should prompt a re-evaluation of our current treatment approaches where research focused on late-effect interventions should be prioritized.

Increased Risk of Heart Failure in Elderly Patients Treated with Beta-Blockers After AV Node Ablation.

Controversy exists regarding the indication of beta-blockers (BB) in different scenarios in patients with cardiovascular disease. We sought to evaluate the effect of BB on survival and heart failure (HF) hospitalizations in a sample of pacemaker-dependent patients after AV node ablation to control ventricular rate for atrial tachyarrhythmias. A retrospective study including consecutive patients that underwent AV node ablation was conducted in a single center between 2011 and 2019. The study's primary endpoints were the incidence of all-cause mortality, first HF hospitalization and the cumulative incidence of subsequent hospitalizations for HF. Competing risk analyses were employed. A total of 111 patients with a mean age of 73.9 years were included in the study. After a median follow-up of 45.5 months, 43 patients had died (38.7%) and 31 had been hospitalized for HF (27.9%). The recurrent HF hospitalization rate was 74/1000 patients/year. Patients treated with BB had a non-significant trend to higher mortality rates and a higher risk of recurrent HF hospitalizations (incidence rate ratio 2.23, 95% confidence interval 1.12-4.44; p = 0.023). After an AV node ablation, the use of BB is associated with an increased risk of HF hospitalizations in a cohort of elderly patients.

Association between the risk of heart failure hospitalization and end-stage renal disease with digoxin usage in patients with cardiorenal syndrome: A population-based study.

The management of the coexistence of heart disease and kidney disease is increasingly challenging for clinicians. Chronic kidney disease (CKD) is not only a prevalent comorbidity of patients with heart failure but has also been identified as a noteworthy risk factor for all-cause mortality and poor clinical outcomes. Digoxin is one of the commonest treatments for heart disease. There are few trials investigating the role of digoxin in patients with cardiorenal syndrome (CRS). This study aims to examine the association between digoxin usage and clinical outcomes in patients with CRS in a nationwide cohort. We conducted a population-based study that included 705 digoxin users with CRS; each patient was age, sex, comorbidities, and medications matched with three non-users who were randomly selected from the CRS population. Cox proportional hazards regression analysis was conducted to estimate the effects of digoxin on the incidence of all-cause mortality, congestive heart failure (CHF) hospitalization, coronary artery disease (CAD) hospitalization, and end-stage renal disease (ESRD). The all-cause mortality rate was significantly higher in digoxin users than in non-users (adjusted hazard ratio [aHR] = 1.26; 95% confidence interval [CI] = 1.09-1.46, p = 0.002). In a subgroup analysis, there was significantly high mortality in the 0.26-0.75 defined daily dose (DDD) subgroup of digoxin users (aHR = 1.49; 95% CI = 1.23-1.82, p<0.001). Thus, the p for trend was 0.013. With digoxin prescription, the CHF hospitalization was significantly higher [subdistribution HR (sHR) = 1.17; 95% CI = 1.05-1.30, p = 0.004], especially in the >0.75 DDD subgroup (sHR = 1.19; 95% CI = 1.01-1.41, p = 0.046; p for trend = 0.006). The digoxin usage lowered the coronary artery disease (CAD) hospitalization in the > 0.75 DDD subgroup (sHR = 0.79; 95% CI = 0.63-0.99, p = 0.048). In renal function progression, more patients with CRS entered ESRD with digoxin usage (sHR = 1.34; 95% CI = 1.16-1.54, p<0.001). There was a significantly greater incidence of ESRD in the < 0.26 DDD and 0.26-0.75 DDD subgroups of digoxin users (sHR = 1.32; 95% CI = 1.06-1.66, p = 0.015; sHR = 1.44; 95% CI = 1.18-1.75; p for trend<0.001). Digoxin should be prescribed with caution to patients with CRS.