Pre-existing Risk Factors Research Articles

Prepregnancy Cardiovascular Disease Risk Factors and Adverse Pregnancy Outcomes in a Safety-Net Hospital.

Background: Many adverse pregnancy outcomes (APOs) are associated with elevated cardiovascular disease (CVD) risk. However, APO data in the context of pre-existing CVD risk factors, and from diverse populations, are limited. We assessed the occurrence of APOs among individuals with and without prepregnancy CVD risk factors, overall and by race/ethnicity. Methods: We conducted a retrospective study using electronic medical record data from a large urban safety-net hospital. Individuals with prenatal care and delivery between 2016 and 2018 at the hospital were included, and data from prenatal intake through the delivery hospitalization were captured. The exposure, prepregnancy CVD risk factors (hypertension, diabetes, tobacco use, and obesity), and the outcome, APOs (hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, low birth weight, and stillbirth), were identified from electronic medical records. Results: We identified 3760 unique delivering individuals, of whom 55.1% self-identified as Black non-Hispanic and 17% as Hispanic. Prepregnancy CVD risk factor prevalence was 45.6%, most commonly obesity (26.6%). APO prevalence was 35.6%, most commonly a hypertensive disorder of pregnancy (20.1%). Overall, 45.7% of APOs occurred in the absence of recognized prepregnancy CVD risk factors, representing 16.3% of the total sample. Among individuals without prepregnancy CVD risk factors, APO prevalence was 30.0% and did not vary by race/ethnicity. Conclusions: In this racially and ethnically diverse hospital-based sample, APOs were present in one in three parous individuals without prepregnancy CVD risk factors-a group with potentially elevated CVD risk who might otherwise be missed by traditional CVD risk factor screening.

Predictors of ibrutinib-associated atrial fibrillation: 5-year follow-up of a prospective study.

Ibrutinib-associated atrial fibrillation (IRAF) emerged among the adverse events of major interests in ibrutinib-treated patients as real-world studies showed a higher incidence compared to clinical trials. We prospectively analyzed predictors of IRAF in 43 single-center consecutive patients affected by chronic lymphocytic leukemia that started therapy with ibrutinib between 2015 and 2017. Key secondary endpoints were to describe the management of IRAF and survival outcomes. During a median follow-up period of 52months, we registered 45 CV events, with a total of 23 AF events in 13 patients (CI 30.0% (95% CI: 16.5-43.9)). Pre-existent cardiovascular risk factors, in particular hypertension, a previous history of AF and a high Shanafelt risk score emerged as predictors of IRAF. Baseline echocardiographic evaluation of left atrial (LA) dimensions confirmed to predict IRAF occurrence and cut-off values were identified in our cohort: 32mm for LA diameter and 18cm2 for LA area. No difference in progression free survival and overall survival emerged in patients experiencing IRAF. Following AF, anticoagulation was started in all eligible patients, and cardioactive therapy was accordingly modified. Echocardiography represents a highly reproducible and widespread tool to be included in the work-up of ibrutinib candidates; the identification of IRAF predictors represents a useful guide to clinical practice.

Application of Point-of-care Ultrasound for Screening Climbers at High Altitude for Pulmonary B-lines.

High-altitude pulmonary edema (HAPE) occurs as a result of rapid ascent to altitude faster than the acclimatization processes of the body. Symptoms can begin at an elevation of 2,500 meters above sea level. Our objective in this study was to determine the prevalence and trend of developing B-lines at 2,745 meters above sea level among healthy visitors over four consecutive days. We performed a prospective case series on healthy volunteers at Mammoth Mountain, CA, USA. Subjects underwent pulmonary ultrasound for B-lines over four consecutive days. We enrolled 21 male and 21 female participants. There was an increase in the sum of B-lines at both lung bases from day 1 to day 3, with a subsequent decrease from day 3 to day 4(P<0.001). By the third day at altitude, B-lines were detectable at base of lungs of all participants. Similarly, B-lines increased at apex of lungs from day 1 to day 3 and decreased on day 4 (P=0.004). By the third day at 2,745 meters altitude, B-lines were detectable in the bases of both lungs of all healthy participants in our study. We assume that increasing the number of B-lines could be considered an early sign of HAPE. Point-of-care ultrasound could be used to detect and monitor B-lines at altitude to facilitate early detection of HAPE, regardless of pre-existing risk factors.

Abstract TP198: Periodontitis Enhances Cerebral Microhemorrhage Development In A Mouse Model Of Hypertension

Introduction: Periodontitis is a highly prevalent disorder that is increasingly recognized as a risk factor for cerebrovascular disease. In this study we examined the role of periodontitis in the development of cerebral microvascular disease. Methods: Hypertension was induced in aged (17 months old) male C57BL/6J mice via infusion of angiotensin II (ATII) at 1000 ng/kg/min via Alzet pump over 4 weeks. Periodontitis was induced by giving P. gingivalis -LPS (20 μg in 2 μL) injections between the first and second maxillary molars on both the right and left sides twice a week for six weeks. At end of six weeks, we collected mouse brains (N=5 each for Hypertension, Periodontitis, Hypertension + Periodontitis, and Control) and performed standard histology using Prussian blue staining to detect cerebral microhemorrhages (CMH) formation at 20x magnification. The average number, total area, and size of Prussian blue-positive deposits were quantified. Results: ATII-induced hypertension in animals (Systolic blood pressure: 113±2 mmHg to 156±3 mmHg, mean+SE, p&lt;0.0001; Diastolic blood pressure: 82±2 mmHg to 119±3 mmHg, p&lt;0.0001). Presence of hypertension produced significant increase in number of CMH compared to controls (1.97±0.29 per cm 2 vs. 1.24±0.20 per cm 2 , p&lt;0.05). Presence of periodontitis did not alter the number of microhemorrhages (1.68±0.13 per cm 2 vs.1.97±0.29 per cm 2 ). However, size of microhemorrhages doubled in the presence of periodontitis with hypertension (10.58±2.55 μm 2 per cm 2 vs. 5.05±1.15 μm 2 per cm 2 , p&lt;0.05). Conclusions: In this mouse model of ATII-induced hypertension, periodontitis appears to increase size of CMH rather than induce development of new lesions. These findings suggest a role for periodontitis in cerebrovascular disease by modifying and exacerbating pre-existing stroke risk factors rather than acting as an independent risk factor.

A real-world study to assess the association of cardiovascular adverse events (CVAEs) with ibrutinib as first-line (1L) treatment for patients with chronic lymphocytic leukaemia (CLL) in the United States.

Ibrutinib, a Bruton's tyrosine kinase inhibitor, is often used as first-line (1L) treatment of chronic lymphocytic leukaemia (CLL); however, it is associated with an increased risk for cardiovascular adverse events (CVAEs). This real-world study adds to existing literature by simultaneously investigating the correlation between pre-existing CV risk factors and the relative cardiotoxicity of ibrutinib vs other therapies in CLL/small lymphocytic lymphoma (SLL). Using a real-world database, the risk of subsequent CVAEs (any CVAE, atrial fibrillation [AF], or hypertension) were compared among patients who received 1L ibrutinib monotherapy or another type of non-ibrutinib therapy, grouped as intensive (IT) or non-intensive therapy (NIT). Each patient's baseline CV risk was estimated using the Framingham risk score. Inverse probability treatment weighting was incorporated into a logistic regression model to reduce baseline imbalance. Results showed ibrutinib was significantly associated with higher risk of CVAEs regardless of baseline CV risk. Compared with IT, odds ratios of any CVAE, hypertension, or AF were 2.61, 3.66, and 3.02, respectively vs 1.88, 2.13, and 2.46, respectively, with NIT. Sensitivity analyses confirmed the findings were robust. These results suggest clinical caution should be taken when selecting ibrutinib for patients with CLL/SLL, especially in those with high baseline CV risk.

Association between Smoking Cessation and the Risk of Cholangiocarcinoma and Ampulla of Vater Cancer: A Nationwide Cohort Study

Introduction: The association between smoking cessation and intrahepatic and extrahepatic cholangiocarcinoma (iCCA and eCCA) risk is unclear. Furthermore, the association in individuals with preexisting risk factors is unknown. We aimed to investigate the association between smoking status (especially smoking cessation) and CCA risk according to individuals’ glycemic status. Methods: In this nationwide cohort study, 9,520,629 adults without cancer who underwent national health screening by the Korean National Health Insurance Service in 2009 were followed up through 2018. The hazard ratios (HRs) and 95% confidence intervals (CIs) for CCA were estimated after adjusting for potential confounders. Results: During the 78.3 person-years of follow-up, 16,236 individuals were newly diagnosed with CCA. Quitters had a significantly lower risk of iCCA and eCCA compared to current smokers in all glycemic status groups (all p < 0.01). The HRs (95% CIs) for iCCA in current smokers and quitters were 1.33 (1.24–1.43) versus 0.98 (0.90–1.06) in individuals with normoglycemia, 1.49 (1.37–1.63) versus 1.17 (1.06–1.28) in individuals with prediabetes, and 2.15 (1.96–2.37) versus 1.58 (1.42–1.75) in individuals with diabetes, compared to never-smokers with normoglycemia. Current smokers with diabetes or prediabetes had a synergistically increased risk of iCCA (all p < 0.01). However, quitters with diabetes and prediabetes had an iCCA risk comparable to that of never-smokers. Analysis of eCCA yielded similar results. Smoking was not independently associated with the risk of the ampulla of Vater cancer. However, smoking combined with diabetes or prediabetes was associated with an increased risk of the ampulla of Vater cancer (all p < 0.05). Conclusion: Smoking cessation was associated with a reduced risk of CCA, despite the synergistically increased risk in current smokers with diabetes and prediabetes. Our findings suggest a crucial opportunity to reduce the risk of CCA. More individualized and intensive cancer prevention education is needed against CCA.

Risk of Venous Thromboembolism Among Individuals who Frequently Travel by Flight for Work

Many research studies have found that venous thromboembolism is common among frequent travellers in all form mainly air travel. Few Indian studies in acute care settings had also mentioned travel history as an important element. Nowadays a section of corporate employees are frequent flyers in India. Hence, we conducted a pilot project to assess and analyze the risk category among these employees. A snowball sampling was used as a sampling technique. The data collection method was done using a google survey link. An anonymous questionnaire link with a unique code of four digit inserted by the participants, had been circulated among the identified study participants. Out of the total 30 respondents, 13 (43.3%) were at high risk, 8(26.7%) at medium risk and 9 (30%) at low-risk categories of venous thromboembolism development. Pre-existing risk factors and post-travel observation (within 8 weeks of flight travel) were recorded and analysed with SPSS 22 version. Family history was significantly associated with risk category of the employees with chi-square (χ²) value of 22.46 (p&lt;0.05). For high-risk category employees, the venous thromboembolism risk was increased by 44 times (OR 44, 95% CI 3.4-573.4) and for medium-risk category employees 13 times (OR 13.3, 95% CI 1.07-166.4) with the history of infectious disease exposure. Overall presence of certain pre-existing clinical parameters (like heart disease, congenital heart disease, varicose veins, pregnancy, exposure to infectious disease) were significantly associated with a chi-square (χ²) value of 6.09 (p&lt;0.05). Further knowledge level and practice level of these frequent corporate flyers had a statistically significant association with their risk category. This paved the way to develop holistic need-based guidelines covering all relevant key aspects of venous thromboembolism including the head-neck-foot exercise to prevent venous thromboembolism while flying.

Approach to acute psychosis in older adults.

Approach to acute psychosis in older adults.

Clinical scenarios-based guide for tofacitinib in rheumatoid arthritis.

Tofacitinib was the first Janus kinase inhibitor to be approved for the treatment of rheumatoid arthritis (RA), and there is a large body of data to inform the efficacy and safety of this drug for patients at different places in their treatment journeys and with diverse demographics and characteristics. Here, we summarize tofacitinib clinical efficacy and safety data from some clinical trials, post hoc analyses, and real-world studies, which provide evidence of the efficacy of tofacitinib in treating patients with RA at various stages of their treatment journeys, and with differentiating baseline characteristics, such as age, gender, race, and body mass index. In addition, we review the safety data available from different patient subpopulations in the tofacitinib clinical development program, real-world data, and findings from the ORAL Surveillance post-marketing safety study that included patients aged ⩾50 years with pre-existing cardiovascular risk factors. The available efficacy and safety data in these subpopulations can enable better discussions between clinicians and patients to guide informed decision-making and individualized patient care.

Clinical Profile and In-Hospital Outcome of COVID-19 Infection among Patients with Cardiovascular Disease: A Cross-Sectional Study

Introduction: Coronary heart disease, hypertension, heart failure, diabetes, and other cardiovascular diseases (CVDs) increase the disease severity and in-hospital mortality among patients with COVID-19. Methods: This is a hospital-based study assessing the effects of CVD on the in-hospital outcomes in patients admitted with COVID-19. Clinical characteristics and in-hospital outcomes were studied in patients with cardiovascular risk factors and underlying CVD. Results: A total of 108 covid positive patients had an underlying cardiovascular disease/s in various forms with a mean age of 60.69±16.24 years and 55.6% were male. Hypertension and diabetes mellitus were the commonest cardiovascular risk factors. Among these patients, acute decompensated heart failure and cardiac arrhythmia commonly atrial fibrillation were the common cardiac complications. The in-hospital mortality rate was 16.67%. Those who died due to cardiac involvement was 18.2% in comparison to 14.3% of the patients who did not have cardiac involvement, although this could not reach statistical significance. The most common cause of death was multiorgan failure resulting in 44.5% of all cause of death followed by acute respiratory distress syndrome accounting 27.8% and refractory cardiogenic shock with 22.2% involvement. Among those who died vs those who survived length of hospital stay was significantly longer in death group (13.6 days vs 9.11 days, p=0.002) Conclusion: In patients hospitalized with COVID-19, pre-existing established cardiovascular risk factors and CVD appear to be important contributors to mortality. The involvement of multiorgan predisposes COVID-19 patients to accentuated risk of mortality.

PREDISPOSING FACTORS FOR PUERPERAL ENDOMETRITIS

Objectives: To show how to prevent puerperal endometritis. Methodology: This is an integrative literature review with a descriptive and exploratory approach, carried out from October 2022 to December 2022 based on a bibliographic survey in the scientific databases of virtual health libraries: Latin American Literature and Caribbean Health Sciences (LILACS), Nursing Database (BDENF) and International Health Sciences Literature (MEDLINE). Thus, a thorough reading of the titles and abstracts was carried out, highlighting 15 studies, and after reading them in full, 7 articles were chosen to compose the final sample. Results and Discussion: From the analysis of the literature, it was evidenced that cesarean delivery is the main factor for triggering puerperal infections and that, through all the pre-existing risk factors, preventive measures must be adopted by the entire team multidisciplinary approach, antiseptic techniques must be performed correctly, adherence to humanized childbirth is paramount and must be advocated as an essential factor, hand washing, ongoing education for the health team, use of sterile materials and the use of Individual Protection are forms of prevention that will minimize the risks of Puerperal Infections in all their pre-delivery, intraoperative and postoperative phases. Final Considerations: The study showed that the nursing professional can provide important assistance for the prevention of Puerperal Infections, and that the multidisciplinary and interdisciplinary team of collaborators must act systematically in the process of reporting any adverse event. And that a set of actions performed correctly and effectively can prevent cases of Puerperal Infections.&#x0D;

Diazoxide for Neonatal Hyperinsulinemic Hypoglycemia and Pulmonary Hypertension.

Hypoglycemia in neonates is associated with long-term neurodevelopmental effects. Hyperinsulinemic hypoglycemia (HH) is the most common cause of persistent hypoglycemia in neonatal intensive care units. Diazoxide is the only medication that is currently recommended for treatment of HH in neonates. However, the use of diazoxide in neonates is associated with pulmonary hypertension as an adverse effect. In this article, we review the literature on the mechanism of action and adverse effects with the use of diazoxide in neonatal hyperinsulinism. We then present a case series of neonates treated with diazoxide in our neonatal intensive care unit over a 5-year period. Among 23 neonates who received diazoxide, 4 developed pulmonary hypertension and 1 died. All infants who developed pulmonary hypertension were born preterm at less than 36 weeks gestation and had pre-existing risk factors for pulmonary hypertension. HH in preterm neonates, with pre-existing pulmonary hypertension or with risk factors for pulmonary hypertension requires thoughtful management.

CAREGIVING FOR PEOPLE WITH DEMENTIA DURING THE PANDEMIC: A SCOPING REVIEW

Abstract Background The COVID-19 pandemic has had a large impact on the roles and responsibilities of caregivers for older adults with dementia. An increasing number of studies have examined the unique challenges faced by caregivers during this time, including extended work hours, anxiety around contracting COVID-19, and adhering to public health guidelines. Informal caregivers may also face greater strain on their personal lives during lockdown. Objective: To conduct a scoping review to examine factors impacting well-being of caregivers of older adults with dementia during the first year of the COVID-19 pandemic. Method: We conducted a PubMed search using the terms “COVID-19,” “older adults,” and “caregiving” or “caregiver.” Sixty-seven papers were identified published between June 2020 and December 2021. Results All papers identified were cross-sectional and conducted after the pandemic began and prior to the availability of COVID-19 vaccines. Articles highlighted increasing burdens such as financial and physical stress, as well as worsened psychological wellbeing through increased anxiety and depression among caregivers during the pandemic. Additionally, themes of protective factors on wellbeing in the form of social connection and telehealth interventions emerged. Discussion: Limitations to our review include lack of longitudinal information on caregiver experience to better identify broad impacts on caregiver well-being. Studies not only identified new, pandemic-related risk factors for caregiver burden, but also a heightened effect of pre-existing risk factors (e.g. income, living situation, gender) on burden. Caregiver psychiatric outcomes reflect the overall population’s increase in mental illness since the start of the pandemic.

LAPAROSCOPIC MESH EXPLANTATION FOR MESH INFECTIONS FOLLOWING INTRA PERITONEAL ON-LAY MESHPLASTY (IPOM): A CASE SERIES

The introduction of synthetic mesh has become the standard of care in the management of abdominal wall hernias [1,2]. However, the slightest of breach in the sterility chain can lead to mesh infection and biolm formation which often requires a prolonged stay in hospital with long term use of antibiotics and need for multiple interventions. Incidence of mesh infection is dependent on both Intra-operative events as well as pre-existing modiable risk factors in the patient. Mesh infection can present as abscess, chronic discharging sinus and sepsis [1] However, in most cases, mesh explantation is required. In this paper, we present a series of 5 patients who underwent laparoscopic mesh explantation following IPOM mesh infection with good outcomes.

Chimeric Antigen Receptor T Cells: Toxicity and Management Considerations

Chimeric Antigen Receptor T Cells: Toxicity and Management Considerations

Epidemiological Profile of Mold Infections in Coronavirus Disease 2019 Patients

Background: Coronavirus disease 2019 (COVID-19) has predisposed to secondary fungal infections, particularly when it is associated with varied comorbidities and immunocompromised situations. Materials and methods: We performed a retrospective clinico-epidemiological evaluation on 45 patients with a history of COVID-19 who presented with clinical features of fungal infections and their association with preexisting comorbid risk factors. The clinico-demographic information of the patients was obtained using a pro forma. Samples from representative clinical sites were collected, like respiratory secretions, pus, or tissue samples from nasal cavities and paranasal sinuses. These samples were processed as per the standard mycological procedures and the fungal isolates, so obtained, were identified according to their culture and microscopic characteristics. Results: The median time interval for the appearance of clinical features of fungal infections from the time of COVID-19 diagnosis was 17 days. Diabetes mellitus (DM) (84.44%) was found to be the leading comorbidity. History of administration of glucocorticoids was noted in 62.22% of the patients. The most frequent presentation was rhinosinusitis in 86.67% of the individuals. Different kinds of molds were isolated in 73.33% of the specimens, with Mucorales (78.89%) being the dominant one. The 32 admitted patients were managed by antifungal therapy and/or surgery. A total of nine patients did not respond to the treatment and succumbed to the disease. Conclusion: Though the true prevalence of these mold infections is not known, but timely diagnosis and management are extremely important in view of their high mortality.

Ectopic pregnancy risk factors in infertile patients: a 10-year single center experience

The present retrospective study included both intrauterine insemination and in vitro assisted reproductive technologies (ART) procedures performed from January 2009 to December 2018 at a tertiary-care Fertility Centre. The purpose was to assess the incidence of ectopic pregnancy (EP) in infertile population who undergoes ART and to identify any risk factor impacting the occurrence of EP after ART. Among 27,376 cycles, 7352 pregnancies were achieved, of which 132 were EPs, the 1.80% (95% CI 1.5–2.1) of all pregnancies. In fresh embryo transfer cycles, a history of prior pelvic adhesions showed the greatest impact on the incidence of EP (aOR 2.49 95% CI 1.53–4.07 p < 0.001). Other factors associated with EP incidence were also identified, such as female age, basal FSH, the transfer of blastocyst embryos and difficulties during the embryo transfer procedure. In frozen embryo transfer cycles, the only factor influencing the incidence of EP was anti Müllerian hormone (AMH) serum concentration (aOR 0.81 95% CI 0.65–1.00, p = 0.048). To conclude, the incidence of EP observed was comparable to that reported after natural conception. On the other hand, pre-existing risk factors, traditionally more common in infertile population, appeared to influence the incidence of EP and should thus be modified if possible.

Perinatal mental health and COVID-19: Navigating a way forward.

The COVID-19 pandemic and its aftermath have increased pre-existing inequalities and risk factors for mental disorders in general, but perinatal mental disorders are of particular concern. They are already underdiagnosed and undertreated, and this has been magnified by the pandemic. Access to services (both psychiatric and obstetric) has been reduced, and in-person contact has been restricted because of the increased risks. Rates of perinatal anxiety and depressive symptoms have increased. In the face of these challenges, clear guidance in perinatal mental health is needed for patients and clinicians. However, a systematic search of the available resources showed only a small amount of guidance from a few countries, with a focus on the acute phase of the pandemic rather than the challenges of new variants and variable rates of infection. Telepsychiatry offers advantages during times of restricted social contact and also as an additional route for accessing a wide range of digital technologies. While there is a strong evidence base for general telepsychiatry, the particular issues in perinatal mental health need further examination. Clinicians will need expertise and training to navigate a hybrid model, flexibly combining in person and remote assessments according to risk, clinical need and individual patient preferences. There are also wider issues of care planning in the context of varying infection rates, restrictions and vaccination access in different countries. Clinicians will need to focus on prevention, treatment, risk assessment and symptom monitoring, but there will also need to be an urgent and coordinated focus on guidance and planning across all organisations involved in perinatal mental health care.

The lockdown generation: Facing multiple crises in education and the labour market

The aim of this article is to analyse the impact of both the latest education system reforms in Poland and the COVID-19 pandemic on the educational trajectories and the labour market situation of vulnerable youth. &#x0D; To fully grasp the complexity of the current circumstances we start with a review of research on the so-called “lockdown generation”, i.e. young people who, as a result of the pandemic, have had their participation in education and vocational training hindered for a long time due to political decisions on school closures and online education. These analyses are complemented by individual interviews with relevant stakeholders. &#x0D; The results of the analyses conducted so far show the disturbing effects of the current political changes and global crises on the trajectories and labour market entry of groups that are habitually considered as the most at risk of educational exclusion. &#x0D; We discuss the greatest barriers and new inequalities created by the current accumulation of adverse external contextual factors and pre-existing risk factors at the individual and meso levels, as well as possible systemic measures of support for young people.

Acute Mesenteric Ischemia: Preexisting Comorbidity Determines Short-Term Outcome and Quality of Life in Long-Term Survivors

Introduction: Acute mesenteric ischemia (AMI), either arterial or venous, is still a devastating disease with poor prognosis. It is unknown, whether AMI is associated with impaired quality of life (QoL) in long-term survivors. Material and Methods: This retrospective analysis includes 64 patients with occlusive arterial or venous mesenteric ischemia treated operatively between 2008 and 2016 at the University Medical Center Rostock. Short-term outcome with focus on comorbidities was measured by the Charlson comorbidity index (CCI) an instrument that operationally measures comorbidity based on 17 clinical parameters including age. Operative outcome in view of enterostomy placement and long-term outcome measured as QoL by the EQ-5D in the long-term survivors were evaluated. The EQ-5D is a standardized, self-reported five-dimension QoL questionnaire built to provide a simple and generic measure of health. Results: Thirty-day mortality was 60.9%, and in-hospital mortality was 70.3% (n = 45). No patient was discharged with a stoma. Patients with a primary anastomosis after the initial operation for AMI had a high leak rate of 27% (4/15 patients) compared to no dehiscence in the group of patients who had secondary anastomosis during second or third laparotomy. The long-term survivors had significantly lower CCI compared to the 45 nonsurvivors (median 4 [3, 4, 5, 6] vs. 6 [4, 5, 6, 7]). All long-term survivors had QoL assessment. QoL score was significantly impaired compared to an age- and sex-matched reference population. This impairment was not due to disease-specific sequelae such as presence of stool deviation or intestinal failure but due to preexisting risk factors as shown by an inverse relation between the CCI and QoL score. Conclusion: Herein, we show for the first time that long-term QoL in patients with AMI is impaired but this impairment is not due to disease-specific aspects but rather general risk factors underlying the presence of a higher level of comorbidities at the time of AMI.