Presence Of Congestive Heart Failure Research Articles

Retrospective evaluation of the utility of shock index to determine the presence of congestive heart failure in dogs with myxomatous mitral valve disease (2019-2021): 98 cases.

To calculate the shock index (SI) in dogs with myxomatous mitral valve disease (MMVD) and to evaluate its use to predict the presence of congestive heart failure (CHF). Retrospective study. Small animal university veterinary teaching hospital. Ninety-eight dogs with MMVD and 20 healthy dogs as part of a control group. Heart rate (HR) and systolic blood pressure (SBP) were recorded, and SI was calculated by dividing HR by SBP for each dog. The mean (SD) HR, SBP, and SI were 123/min (32.6), 147mmHg (21.5), and 0.86 (0.3), respectively, for dogs with MMVD and 98/min (20.9), 145mmHg (18.7), and 0.68 (0.13), respectively, for control dogs. Dogs with MMVD had a significantly higher HR compared with control dogs (P<0.01), and an elevation in HR was seen as the severity of MMVD increased. Dogs in stage B2 and C/D MMVD had a significantly higher SI value compared with control dogs (P=0.04 and P<0.01, respectively). SI was significantly higher in dogs in stage C/D MMVD compared with dogs in stage B2 MMVD (P<0.01). Ten of 98 (10%) dogs had an arrhythmia. HR, SBP, and SI were not significantly different between dogs with and without arrhythmias (P=0.13, P=0.57, and P=0.07, respectively), but significantly more dogs with CHF had an arrhythmia (P=0.01). SI (area under the curve [AUC]: 0.98) and HR (AUC: 0.95) were excellent indicators for the presence of CHF. An optimal SI cutoff value ≥1.1 had 92% sensitivity and 95% specificity for predicting the presence of CHF, and an optimal HR cutoff value of ≥157/min had 92% sensitivity and 93% specificity for the prediction of CHF. When there are compatible clinical signs, SI values ≥1.1 may suggest the presence of CHF in dogs with MMVD.

Risk Factors for Atrial Fibrillation in the Dog: A Systematic Review.

Different risk factors for atrial fibrillation (AF) development have been identified in numerous studies on humans, but this information is less clearly available on the dog. The aim of this systematic review is to determine the risk factors for AF in the dog. Following the PRISMA 2020 guidelines, we conducted a comprehensive search using the Web of Science and Scopus databases for articles reporting on cases of spontaneously occurring AF in dogs. The level of evidence was assessed using the Evidence Quality Grading System of the National Institute of Health. One thousand forty-three studies were initially identified, and twenty of them were included in this systematic review involving 2,359,275 dogs, of which 4807 showed spontaneously occurring AF. Genetics, for the Irish Wolfhound, increased body weight, and left atrial enlargement were the main risk factors for the development of AF in dogs with different cardiac diseases, particularly myxomatous mitral valve disease (MMVD) and dilated cardiomyopathy (DCM). However, some differences were found between these two cardiac diseases regarding additional risk factors. In particular, the presence of congestive heart failure and echocardiographic evidence of increased left atrial pressure or the presence of right atrial enlargement emerged as risk factors in dogs with MMVD or DCM, respectively. Furthermore, significant differences in risk factors were observed between dogs and humans. In particular, advanced age and male sex are not reliable indicators of an increased risk of AF in dogs.

Totally Thoracoscopic Ablation in Patients With Recurrent Atrial Fibrillation After Catheter Ablation.

The objective of this study was to evaluate the efficacy and safety of totally thoracoscopic ablation (TTA) in patients with recurrent atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA). From February 2012 to May 2020, 460 patients who underwent TTA were classified into two groups: CA (presence of RFCA history, n = 74) and nCA groups (absence of RFCA history, n = 386). Inverse probability of treatment weighting (IPTW) analyses were used to adjust for confounders. The primary endpoint was freedom from the composite of AF, typical atrial flutter, atypical atrial flutter and any atrial tachyarrhythmia, lasting more than 30 seconds during the follow-up. All patients were followed up at 3, 6, and 12 months via electrocardiogram and 24-hour Holter monitoring. Bilateral pulmonary vein isolation (PVI) was conducted in all patients and the conduction block tests were confirmed. In the CA group, difficult PVI occasionally occurred due to structural changes, such as pericardial adhesion and fibrosis of the pulmonary venous structure, caused by a previous catheter ablation. Early complications such as stroke and pacemaker insertion were not different between the two groups. The normal sinus rhythm was maintained in 70.1% (317/460) patients after a median follow-up period of 38.1 months. The IPTW-weighted Kaplan-Meier curves revealed that freedom from AF events at 5 years was 68.4% (95% confidence interval, 62.8-74.5) in the nCA group and 31.2% (95% confidence interval, 16.9-57.5) in the CA group (P < 0.001). In IPTW-weighted Cox regression, preoperative left atrial diameter, persistent or long-standing AF, the presence of congestive heart failure and catheter ablation history were associated with AF events. Patients in the CA group showed a higher recurrence rate of AF than those in the nCA group, while TTA was safely performed in both the groups.

Does a Modified Frailty Index Predict 30-day Complications After Long-Bone Nonunion or Malunion Surgery?

To assess the ability of a modified frailty index (mFI-5) score, which includes the presence of congestive heart failure, hypertension, chronic obstructive pulmonary disease, diabetes, and nonindependent functional status, and to identify patients at increased risk of complications after surgical treatment of long-bone nonunions/malunions. Retrospective. Hospitals participating in the 2005-2018 American College of Surgeons National Surgical Quality Improvement Program. Patients in the American College of Surgeons National Surgical Quality Improvement Program database with upper extremity and lower extremity fractures were enrolled. Surgical repair of nonunions/malunions of upper and lower extremity long bones. Postoperative complications after long-bone nonunion/malunion surgery. Respective univariate analysis of the 2964 UE [1786 (60.3%) with mFI-5 of 0 and 386 (13.0%) with mFI-5 ≥2] and 3305 LE [1837 (55.6%) with mFI-5 of 0 and 498 (15.1%) with mFI-5 ≥2] showed that increasing mFI-5 score was associated with medical complications, extended longer length of stay, adverse discharge, and readmission. Binomial logistic regression showed that UE patients with mFI-5 ≥2 had increased risk of wound complications [odds ratio (OR) 2.512, 95% (confidence interval) CI: 1.037-6.086, P = 0.041), adverse discharge (OR 1.735, 95% CI: 1.204-2.499, P = 0.003), and unplanned readmission (OR 2.102, 95% CI: 1.038-4.255, P = 0.039), while LE patients with mFI-5 ≥2 had an increased risk of medical complications (OR 1.847, 95% CI: 1.307-2.610, P = 0.001), cumulative morbidity (OR 1.835, 95% CI: 1.342-2.510, P < 0.001), extended longer length of stay (OR 1.809, 95% CI: 1.233-2.654, P = 0.002), and adverse discharge (OR 1.841, 95% CI: 1.394-2.432, P < 0.001). mFI-5 score ≥2 is associated with significant increase in postoperative complications after surgical repair of long-bone nonunions/malunions. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Differences in Left Ventricular Enlargement Secondary to Chronic Volume Loading Between English Springer Spaniels and Two Similar Sporting Breeds

IntroductionEnglish springer spaniels have larger, rounder ventricles than most other breeds. How this geometry impacts responses to volume overload remains unknown. We compared left ventricular size between English springer spaniels and two similarly sized sporting breeds (Border collies and Labrador retrievers) in naturally occurring chronic left ventricular volume loading conditions (mitral regurgitation and patent ductus arteriosus [PDA]) to examine whether differences in remodelling responses exist between these breeds. Animals, materials and methodsWe searched records for cases of mitral regurgitation and PDA in three breeds. We recorded age, sex, presence of congestive heart failure (CHF), body weight and specific echocardiographic variables. We compared normalised measures of left ventricular size between breeds. Cases with CHF were further examined as a separate group. ResultsOne-hundred-and-ninety-one dogs were included: 110 with degenerative mitral valve disease, 42 with mitral dysplasia and 39 with PDA. One third of all cases had CHF. All measures of left ventricular size were larger in English springer spaniels in mitral regurgitation cases (P<0.001), whereas PDA cases did not differ. English springer spaniels with PDA resulting in CHF had larger systolic dimensions and volumes than similarly affected non-English Springer Spaniel dogs (P=0.003). ConclusionsEnglish springer spaniels have greater left ventricular dimensions when exposed to chronic mitral regurgitation, compared with Border collies and Labrador retrievers, but not when exposed to volume overload from a PDA. English springer spaniels differ in their left ventricular morphology from two other sporting breeds, supporting previous studies that they have a unique cardiac morphotype.

Abstract 15721: Gender Differences in Temporal Trends and Outcomes of Pulmonary Arterial Hypertension-Related Hospitalizations in the US

Introduction: There is limited data on the gender differences in the trend of hospitalizations related to PAH and associated outcomes in the US Methods: We queried the National Inpatient Sample from 2010 to 2019 to identify PAH admissions using international classification of diseases (ICD) codes 416.0 (ICD-9) and I27.0 (ICD-10) Results: 20,513 hospitalizations with PAH as the primary diagnosis was analyzed during the study period. There were 13,928 women (67.9%) and 6,584 (32.1%) men. The mean age among women (SD) and men (SD) were 66 years (16) and 65 years (17) respectively. Between 2010 and 2019, PAH hospitalization rates declined in both women (13.5% vs. 8.5%], P &lt; 0.001) and men (14.2% vs. 8.3%, P = 0.027. The overall mortality rate was higher in men compared with women (6.6% vs. 5.7%, P = 0.015. Though crude mortality rates declined for the total population, this was statistically significant only among women (6.7% vs.5.6%, P = 0.011). On adjusted multivariate analysis, factors associated with increased odds of inpatient mortality among women were age 45 - 64 years (OR 1.62, 95% CI 1.11 - 2.37, P = 0.013) and &gt; 65 years (OR 2.36, 95% CI 1.57 - 3.55, P&lt;0.001) compared with age 18-44 years. Black (OR 1.44, 95% CI 1. 13 - 1.78, P &lt; 0.001) and Hispanic race/ethnicity (OR 1.06, 95% CI 1.02 - 1.51, P = 0.037), compared with White race/ethnicity. Comorbidities and in-hospital complications associated with increased mortality were chronic kidney disease, acute pulmonary embolism (PE), and acute respiratory failure (ARF). Among men, age &gt; 65 years (OR 3.28, 95% CI 1.68 - 6.41, P = 0.001), Black (OR 1.9, 95% CI 1.36 - 2.91, p &lt; 0.001) and Hispanic race/ethnicity (OR 1.21, 95% CI 1.08 - 1.78, P = 0.021), compared with White race/ethnicity were associated with increased odds of mortality. The presence of congestive heart failure and complications of acute PE, ARF, acute ischemic stroke, and atrial fibrillation were also associated with increased mortality. Conclusions: From 2010 to 2019 in the US, PAH-related hospitalization rates decreased in both women and men while mortality only decreased among women. Men were more likely to die during hospitalization compared with women. Older age and Black and Hispanic race/ethnicity were associated with higher mortality in both women and men.

Abstract 10998: Pulmonary Artery Pulsatility Measured by Cardiac Magnetic Resonance Imaging in Over 42,000 Participants Reveals Novel Genetic Risk Loci

Introduction: Pulmonary artery (PA) hemodynamics are important predictors of mortality. However, genetic mechanisms underlying increased PA stiffness in diseases such as pulmonary hypertension are poorly understood, and targeted therapies are limited. Evaluation of PA hemodynamics frequently requires invasive right heart catheterization, limiting large-scale studies. This study leveraged cardiac magnetic resonance (CMR) imaging to non-invasively determine and characterize PA pulsatility, an established measure of pulmonary vascular compliance. Methods and Results: A deep-learning neural network was implemented to determine PA pulsatility, defined as the relative cross-sectional area change from diastole to systole, in 42,774 UK Biobank participants (intraclass correlation 0.94-0.96 compared with human readers). The mean (SD) PA pulsatility was 0.36 (0.11), and pulsatility decreased by 0.035 for every decade increase in age. Reduction in pulsatility by 0.1 was associated with the presence of congestive heart failure (OR 1.55 [95% CI 1.37-⁠1.76]), chronic obstructive pulmonary disease (OR 1.41 [1.29-⁠1.53]), or diabetes (OR 1.18 [1.13-⁠1.23]), and PA pulsatility was associated with increased all-cause mortality (HR 1.13 [1.03-1.23]) after adjusting for age and sex and excluding those with CHF or COPD (Fig A-B). A genome-wide association study of 40,496 participants identified loci on chromosomes 2 (top SNP: rs6738973) and 10 (rs2077218) associated with PA pulsatility at genome-wide significance ( p &lt; 5 х 10 –8 ; Fig C). Integrative fine-mapping analyses identified PKDCC and PLCE1 among likely effector genes. Conclusions: This is the first population-based epidemiologic and genomics study of PA pulsatility. Decreased PA pulsatility is associated with advanced age, increased rates of comorbidities, and higher mortality. The genes PKDCC and PLCE1 are among likely effectors of PA pulsatility and warrant further functional investigation.

Association between first-line monotherapy with metformin and the risk of atrial fibrillation (AMRAF) in patients with type 2 diabetes

BackgroundType 2 diabetes (T2D) has a strong association with atrial fibrillation (AF) which increases risk of thromboembolic events, heart failure, and frequent hospitalizations. Metformin is the first-line medication for T2D with proposed anti-inflammatory, pro-metabolic, and cardio-protective benefits. Our objective was to investigate if initial therapy with metformin is associated with reduced incidence of AF in comparison to other non-insulin anti-hyperglycemic agents in patients with newly diagnosed T2D. MethodsThis retrospective cohort analysis included adults with a new diagnosis of T2D who were started on monotherapy (except insulin) between 2007 and 2017, without prior anti-hyperglycemic agent use, history of arrhythmias, or estimated GFR (eGFR) ≤ 30 ml/min. A multivariate analysis was performed using a fine-gray regression competing risk analysis to control for confounding variables after which pooled hazard ratios and 95 % confidence intervals were reported. Patients were followed until the end of study date, development of AF, addition of more anti-hyperglycemic agents, or death, whichever occurred first. ResultsAmong 4584 metformin initiators compared to 1080 non-metformin monotherapy initiators, 10-year cumulative incidence of AF in metformin group was 5.2 % as compared to 8.1 % with other agents which was not statistically significant. Competing risk analysis did not demonstrate reduced rates of AF with metformin use (HR 0.92, 95 % CI 0.69 to 1.21; P = 0.55). Increased age and the presence of congestive heart failure were associated with significantly higher risk of AF in both groups (HR: 1.29, 95 % CI: 1.21 to 1.37; P ≤ 0.001; HR: 2.73, 95 % CI: 1.62 to 4.61; P ≤ 0.001, respectively). ConclusionInitiation of metformin as a first line monotherapy for T2D, when compared to other non-insulin monotherapies, was not associated with decreased risk of developing AF in this retrospective observational study.

401-P: Development of Predictive Models for Health Care Outcomes of Patients with Chronic Kidney Disease and Type 2 Diabetes

Progression of chronic kidney disease (CKD) is associated with increased risk of cardiovascular or renal events that contribute to increasing healthcare costs. The purpose of this study was to develop predictive models for rapid progression of CKD, days out of the home, and high costs for patients with both CKD and type 2 diabetes (T2D) . This retrospective observational cohort study used administrative claims data for patients with CKD (stage 3-4) and T2D aged 65-89 years enrolled in a Humana Medicare Advantage Prescription Drug plan 1/1/2012-12/31/2017. Patients were enrolled ≥1 year pre-index and followed up to one year post-index. Outcomes included rapid progression of CKD (&amp;gt;1 decrease in estimated glomerular filtration rate [eGFR] &amp;gt;5 mL/min/1.73m2 per year) , days out of the home (days spent out of their residence [e.g., hospital]; ≥2% days out of the home) and high costs (75-90th and &amp;gt;90th percentiles) post-index. Pre-index demographic and clinical characteristics, selected based on the LASSO technique, were included in logistic regression models to generate parameter estimates and model performance statistics. We identified 169,876 patients with CKD stage 3-4 and T2D. The C-statistics for the models ranged from 0.694 to 0.745. Lower initial eGFR led to incrementally higher risk for more days out of the home and high costs. Patients with urinary albumin to creatinine ratio (UACR) ≥300 mg/g had three times increased risk for rapid progression of CKD, 57% higher risk of more days out of the home, and, among those in the 75-90th cost percentile, had 38% higher costs than patients with UACR&amp;lt;30 mg/g. The presence of congestive heart failure, anemia, or higher pre-index utilization (≥5 physician visits) increased the risk for all outcomes. The predictive models developed in this study can be potentially used as decision support tools for clinicians and payers, and the risk scores from these models can be applied to future outcomes studies focused on patients with T2D and CKD. Disclosure R. Nair: None. M.K. Pasquale: Consultant; Bayer AG. T. Evers: Employee; Bayer AG. M.M. Cockrell: Employee; Humana. Stock/Shareholder; Humana. A. Gay: Employee; Bayer AG. R. Singh: None. N. Schmedt: Employee; Bayer AG. Funding This study was funded by Bayer.

Evaluating the Incidence and Risk Factors Associated With Mild and Severe Hypoglycemia in Insulin-Treated Type 2 Diabetes

ObjectivesThis study to assess the incidence rates and risk factors of hypoglycemia in a wide real-life sample of patients with insulin-treated type 2 diabetes mellitus. MethodsIn a prospective epidemiological study, data from 817 subjects were collected from medical records and via interviews. Over a 3-month period, hypoglycemic episodes were recorded via self-measurement of glucose levels at least twice daily. Cox proportional and negative binomial multivariable models were applied to estimate adjusted and unadjusted hazard ratios and incidence rate ratios of hypoglycemic events. ResultsOf the 817 patients, 52.9% experienced hypoglycemia, 38.1% had only nonsevere episodes, and 14.8% had at least 1 severe episode. Total events per patient-year were estimated at 13.3 (±24.8), with 11.8 (±21.6) and 1.4 (±4.7) being nonsevere and severe, respectively. History of hypoglycemia and severe hypoglycemia were consistent risk factors of hypoglycemia. Intensification of therapy was associated with higher incidence rates, whereas the effect on the hazard rates was more moderate. Longer duration of insulin therapy and the presence of congestive heart failure were associated with a higher risk of developing and frequency of hypoglycemia. Hypoglycemia awareness was found to independently affect only mild hypoglycemia. ConclusionsHypoglycemia is a common complication in patients with insulin-treated type 2 diabetes mellitus. The risk factors of developing hypoglycemia are to some extent different from those of the frequency of hypoglycemic episodes. Particular attention is required for patients with recurrent hypoglycemic events and on intensive antidiabetic therapy.

Abstract 12529: Sex-Specific Mortality Associated With High Left Ventricular Ejection Fraction After ST-segment Elevation Myocardial Infarction

Introduction: Using sex-specific cutoffs, high left ventricular ejection fraction (LVEF) is associated with increased mortality in women but not in men with chronic coronary syndromes. Purpose: To explore the association between LVEF and mortality after an acute coronary syndrome in women and men. Methods: Using population-derived sex-specific LVEF cutoffs, we compared characteristics and outcomes of 1,953 ST-segment Elevation Myocardial Infarction (STEMI) patients (1,399 men and 554 women) presenting at Minneapolis Heart Institute between 2003 and 2020. Patients who had a follow-up LVEF measurement available within 2 months of the index hospitalization were included in the analysis. Sex specific cutoffs for post STEMI LVEF were a) for men, &gt;70% (high), 47-70% (normal), &lt;47% (low); b) for women, &gt;72% (high), 50-72% (normal), &lt;50% (low). Standard cutoffs were: &gt;65% (high), 55-65% (normal), &lt;55% (low). Results: When comparing high vs normal vs low LVEF, 1-year mortality was 0% vs 0.8% vs 4.4% in men ( P log-rank &lt;0.001) and 13.3% vs 2.2% vs 3.4% in women ( P log-rank =0.03) (Figure). Five-year mortality was 0% vs 5.1% vs 12% in men ( P log-rank &lt;.001) and 13.3% vs 11.4% vs 19.9% in women ( P log-rank =0.18). The findings were not replicated when standard LVEF cutoffs were used (1-year mortality in women was 6.1% vs 2.5% vs 2.5%, P log-rank =0.33). After adjustment for baseline variables and comorbidities (age, diabetes, dyslipidemia, hypertension, history of MI, door-to-balloon time less than 90 minutes, and the presence of congestive heart failure), high LVEF was associated with 1-year mortality when compared with normal LVEF in women (HR, 10.83; 95% CI, 1.94-60.57, P =0.007). Landmark analysis showed that among women alive beyond 1 year, 5-year mortality was 0% vs 9.4% vs 16.1%, P log-rank =0.31. Conclusion: High LVEF after STEMI using sex-specific cutoffs is associated with lower 1-year survival in women but not in men.

Clearing the Congestion: Chest Radiography and BNP to Rule-out Congestive Heart Failure.

Ruling out congestive heart failure (CHF) is clinically important in Emergency Department (ED) patients. Normal serum brain natriuretic peptide (BNP) represents an important reference standard for excluding CHF. Results of chest radiographs (CXR) are also considered and, when discordant with BNP levels, may result in a clinical dilemma. The present study was designed to elucidate factors associated with CHF on CXR in an ED cohort with normal BNP. All adults at our urban health system's EDs who underwent CXR within 24 hours and had a normal BNP (<300 pg/mL) within 24 hours of CXR were retrospectively identified. Of these, 0.9% (8/862) had equivocal CXRs and was excluded. Demographics, comorbidities, CXR report results for CHF, and portable technique were noted. Logistic regression was used to assess factors that are associated with the presence of CHF on CXR. The study cohort comprised 854 patients (433 men, mean age 60.99±15.30) with normal BNP; 91.5% (781/854) had no CHF on CXR and 8.5% (73/854) had CHF. Patients with CHF on CXR had a higher body mass index (32.9 vs. 29.8 kg/m 2 , P =0.0205) were more likely to have a history of CHF or diabetes with complications (OR: 2.72 and 2.53, respectively), had higher serum BNP levels (median 164 vs. 98 pg/mL, P =4.91×10 -5 ), and underwent portable examination more frequently (86.3% vs. 57.5%, OR: 4.65). Normal serum BNP was concordant with CXR results, adding diagnostic confidence in ruling out CHF in a large majority of ED patients. A higher body mass index, history of CHF, and diabetes with complications and portable CXR technique were associated with CHF on CXR among the minority with normal BNP.

The efficacy and safety of novel classes of glucose-lowering drugs for cardiovascular outcomes: a network meta-analysis of randomised clinical trials.

Several cardiovascular outcome trials on sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been released recently, including trials enrolling patients with congestive heart failure (CHF) and chronic kidney disease (CKD). Comparisons of the efficacy and safety of SGLT2i, glucagon-like peptide-1 receptor agonists (GLP-1RA) and dipeptidyl peptidase-4 inhibitors (DPP-4i) thus require an update. Assessments in patient subgroups, i.e., as stratified by age or the presence of CHF, CKD or atherosclerotic cardiovascular disease (ASCVD), are also currently lacking. We searched the PubMed, Embase and Cochrane databases for relevant studies published up until 5 December 2020. RCTs comparing SGLT2i, GLP-1RA and DPP-4i with placebo (or other controls) or with each other with cardiovascular (CV) or renal outcomes were eligible for inclusion. The primary efficacy endpoint was 3-point major adverse cardiovascular events (3P-MACE), which are defined as CV death, non-fatal myocardial infarction and non-fatal ischaemic stroke. All-cause mortality, hospitalisation for heart failure (HHF) and composite renal outcomes were also analysed. Pre-specified subgroup analyses of 3P-MACE were also performed. A total of 21 trials with 170,930 participants were included in this network meta-analysis. Both GLP-1RA and SGLT2i were associated with lower risks of 3P-MACE than placebo (RR 0.89, 95% CI 0.84, 0.94 and RR 0.88, 95% CI 0.83, 0.94, respectively). GLP-1RA and SGLT2i were also associated with lower risks of 3P-MACE than DPP-4i (RR 0.89, 95% CI 0.82, 0.98 and RR 0.89, 95% CI 0.81, 0.97, respectively). A comparison between SGLT2i and GLP-1RA demonstrated no difference in their risks of 3P-MACE (RR 0.99, 95% CI 0.91, 1.08). Only GLP-1RA was associated with a lower risk of stroke compared with placebo (RR 0.85, 95% CI 0.76, 0.94). SGLT2i is superior to GLP-1RA in reducing HHF (RR 0.76, 95% CI 0.68, 0.84) and renal outcomes (RR 0.78, 95% CI 0.65, 0.93). Subgroup analyses indicated that the benefits of SGLT2i and GLP-1RA were more pronounced in elderly patients, white and Asian patients, those with established ASCVD and those with longer durations of diabetes mellitus and worse glycaemic control. SGLT2i and GLP-1RA are superior to DPP-4i in terms of CV and renal outcomes. GLP-1RA is the only drug class that reduces the risk of stroke. SGLT2i is superior in reducing HHF and renal outcomes. Therefore, the choice between SGLT2i and GLP-1RA should be individualised according to patient profiles. CRD42020206600.

Diabetes-associated nephropathy and obesity influence COVID-19 outcome in type 2 diabetes patients

ABSTRACT Coronavirus disease 2019 has rapidly spread around the globe and various comorbidities, such as diabetes have been recognized as risk factors for an unfavorable outcome. We analyzed a cohort of COVID-19 patients (n = 75) treated at a German community hospital. With a focus on diabetes mellitus, we evaluated the impact of distinct comorbidities on the COVID-19 disease course. The duration of hospital stay was prolonged if diabetes was present. An older age was associated with a poor outcome. The percentage of non-survivors increased in the presence of congestive heart failure or chronic kidney disease. In the group of diabetes patients, mortality was increased if any organ complication was present and diabetic nephropathy or the combination of obesity plus diabetes were by far the most important risk factors. Taken together, an older age, congestive heart failure, and chronic kidney disease significantly influenced COVID-19 disease course and survival. Diabetic nephropathy or the combination of obesity plus diabetes had the strongest impact on patients’ outcome.

Особливості клінічного перебігу та чинники, пов’язані з короткотерміновим прогнозом у хворих з тромбоемболією легеневої артерії

The aim – to study the clinical, anamnestic and instrumental parameters associated with short-term prognosis in patients with pulmonary embolism (PE). Materials and methods. This study was conducted from September 1, 2019 to December 31, 2020 on the basis of the city clinical hospital. The preliminary analysis included 187 patients with acute pulmonary embolism. The study found that 25 (13.3 %) patients died within 30 days (group I): 19 (76.0 %) patients belonged to a high risk of predicted early death and 6 (24.0 %) – to intermediate-high risk. For further analysis, a comparison group (group II) was formed and included 106 (56.7 %) patients who survived within 30 days of the onset of an acute episode of PE: 54 (50.9 %) patients belonged to high risk, 52 (49.1 %) – to intermediate high risk. All patients with pulmonary embolism received anticoagulant therapy according to the current ESC guidelines. Results. The average age of patients in group I was 69.08 ± 14.15 years and was significantly higher than in group II: 65.25 ± 13.29 (p = 0.0169). The proportion of high-risk patients was significantly greater in the І group, the proportion of patients of intermediate-high risk was significantly greater in group II (p = 0.0409). The incidence of classes IV and V according to the PESI index, assessed in patients of intermediate-high risk, was the same in both groups, while patients with the PESI index class III prevailed in group II (p = 0.0380). The risk factors for venous thromboembolism occurred more frequently in patients of group I, i.e. congestive heart failure (p = 0.0065) and obesity (p = 0.0482). Conclusions. There is a high mortality rate within 30 days (13.3 %) in hospitalized patients with acute PE, including 26 % of high-risk patients and 10.3 % of intermediate-high risk. Age over 65 years, the presence of congestive heart failure and obesity are independent factors that, according to uni- and multivariate logistic regression analysis, are associated with poor short-term prognosis in patients with PE. Key words: pulmonary embolism, venous thromboembolism, short-term prognosis, anticoagulant therapy.

Quantifying the Impact of Comorbidities on Outcomes Following Surgery for Osteoporotic Vertebral Compression Fractures

Abstract Introduction Studies have shown that osteoporotic patients are more likely to have medical or surgical complications postoperatively. In this study, we determine the predictive value of various comorbidities on the likelihood of postoperative complications, mortality, and 30-day readmission following cement augmentation for osteoporotic vertebral compression fractures (OVCFs). Materials and Methods A retrospective analysis of the American College of Surgeons National Surgery Quality Improvement Project (ACS-NSQIP) database from 2007 to 2014 identified 1979 patients who met inclusion criteria. A multivariate logistic regression analysis was utilized to determine the relationship between various comorbidities and perioperative mortality, postoperative complications, and 30-day readmission rates. Results A history of cerebrovascular accident (CVA), coagulopathy, diminished preoperative functional status, and/or an American Society of Anesthesiologists (ASA) class &gt; 2 were statistical predictors of postoperative complications. CVA generated the highest odds ratio among these comorbidities (OR = 5.36, p = 0.02 for minor complications; OR = 4.60 p = 0.05 for major complications). Among the 15 comorbidities considered, steroid use (OR =1.81; p = 0.03) and an ASA class &gt; 2 (OR = 14.65; p = 0.01) were the only ones that were correlated with mortality; an ASA class &gt; 2 had a particularly strong effect on the likelihood of mortality (OR = 14.65). Chronic obstructive pulmonary disorder (COPD), obesity, significant weight loss, and an ASA class &gt; 2 were correlated with 30-day readmissions. Congestive heart failure (CHF), diabetes, dialysis, hypertension, or smoking was not correlated with adverse postoperative outcomes. Conclusion Of the 15 comorbidities considered in this study, four were statistically associated with increased rates of postoperative complications, two were associated with increased mortality, and four were associated with increased rates of readmission at 30 days. The presence of CHF, diabetes mellitus (DM), hypertension, ascites, renal failure, or smoking were not associated with the adverse outcomes studied. Level of Evidence III.

A retrospective evaluation of the indications, complications, and outcomes associated with epicardial pacemakers in 20 cats from a single institution

IntroductionThe objective of this retrospective study was to describe the indications, complications, and long-term outcomes in a group of cats that received an epicardial pacing (EP) system. AnimalsTwenty client-owned cats. Materials and methodsMedical records were reviewed for signalment, presenting complaint, primary electrocardiogram (ECG) diagnosis, presence of structural heart disease, presence of congestive heart failure (CHF), presence of major or minor complications, and survival time. ResultsThe majority of cats were presented for syncope (n = 11), and the most common ECG diagnosis was advanced second-degree atrioventricular block (n = 9). Fifteen cats (15/20, 75%) had one or more major or minor complications. One cat died in the perioperative period as a result of a major complication. None of the variables evaluated were associated with a statistically significant increase in the occurrence of major or minor complications. The most common major complication was loss of ventricular capture (seven instances in six cats), which was successfully treated in all cases by increasing pacemaker output or replacing both the lead and the pulse generator. The most common minor complications were arrhythmias (n = 7) and sensing issues (n = 8). The overall median survival time (MST) was 948 days. No statistical difference in survival time was identified between cats that experienced a major complication and those that did not. ConclusionsAlthough complications were common in this feline population after EP, major and minor complications were successfully treated.

Acute Pulmonary Embolism at Tanta University Hospital: Single Centre Registry

Background: Pulmonary embolism (PE) is a major cause of morbidity and mortality worldwide, and has significant negative impacts on quality of life, healthcare costs, and longevity. Registries have been created to record ‘real-life’ clinical features and management of patients with PE.&#x0D; Aim: We aimed to describe a comprehensive view of the clinical presentation, demographic data, treatment modalities and short-term outcome at hospital discharge and 3 months after discharge for patients presented with acute pulmonary embolism at Tanta university hospital to improve the level of care of those patients.&#x0D; Methods: This study was conducted on 150 patients with confirmed acute PE presented to Tanta university hospitals. The study duration was 1 year from April 2019 to May 2020.&#x0D; Results: We focused on a group of common risk factors for PE and determined prevelance of each in our enrolled patients, we found increase some risk factors obesity and bed rest &gt; 3 days were the most prevalent risk factors followed by active cancer, estrogen use and lower limb fracture. Symptoms in this study are near to other registries and ESC guidelines 2019 with the commonest symptom was dyspnea and chest pain and the least symptom was hemoptysis. Certain ECG signs more prevalent in our patients and these signs related to RV strain with sinus tachycardia the commonest sign followed by S1Q3T3 sign and the least was right axis deviation.&#x0D; Conclusion: Presence of active cancer and patients with high risk stratification were independent predictors of mortality. Other factors associated with increased mortality were impaired RV systolic function, high PESI score, presence of RBBB in ECG and presence of congestive heart failure. Increased risk of bleeding in male patients with intermediate high or high risk category especially those received UFH and fibrinolytic therapy. Previous history of VTE was independent predictors of VTE recurrence.

Utilization of CMS pre-ESRD Kidney Disease Education services and its associations with the home dialysis therapies.

Kidney Disease Education (KDE) has been shown to improve informed dialysis selection and home dialysis use, two long-held but underachieved goals of US nephrology community. In 2010, the Center for Medicare and Medicaid Services launched a policy of KDE reimbursements for all Medicare beneficiaries with advanced chronic kidney disease. However, the incorporation of KDE service in real-world practice and its association with the home dialysis utilization has not been examined. Using the 2016 US Renal Data System linked to end-stage renal disease (ESRD) and pre-ESRD Medicare claim data, we identified all adult incident ESRD patients with active Medicare benefits at their first-ever dialysis during the study period (1 January 2010 to 31 December 2014). From these, we identified those who had at least one KDE service code before their dialysis initiation (KDE cohort) and compared them to a parsimoniously matched non-KDE control cohort in 1:4 proportions for age, gender, ESRD network, and the year of dialysis initiation. The primary outcome was home dialysis use at dialysis initiation, and secondary outcomes were home dialysis use at day 90 and anytime through the course of ESRD. Of the 369,968 qualifying incident ESRD Medicare beneficiaries with their first-ever dialysis during the study period, 3469 (0.9%) received KDE services before dialysis initiation. African American race, Hispanic ethnicity, and the presence of congestive heart failure and hypoalbuminemia were associated with significantly lower odds of receiving KDE services. Multivariate analyses showed that KDE recipients had twice the odds of initiating dialysis with home modalities (15.0% vs. 6.9%; adjusted odds ratio (aOR):95% confidence interval (CI) 2.0:1.7-2.4) and had significantly higher odds using home dialysis throughout the course of ESRD (home dialysis use at day 90 (17.6% vs. 9.9%, aOR:CI 1.7:1.4-1.9) and cumulatively (24.7% vs. 15.1%, aOR:CI 1.7:1.5-1.9)). Utilization of pre-ESRD KDE services is associated with significantly greater home dialysis utilization in the incident ESRD Medicare beneficiaries. The very low rates of utilization of these services suggest the need for focused systemic evaluations to identify and address the barriers and facilitators of this important patient-centered endeavor.

Evaluating trajectories of statin adherence after a motivational interviewing intervention

ObjectiveThe objective of the current study was to compare postintervention adherence trajectories with preintervention trajectories for those receiving a telephonic motivational interviewing (MoI) intervention to determine predictors associated with each distinct postintervention trajectory and any association between pre- and postintervention trajectories. DesignRetrospective study design using group-based trajectory modeling. Settings and participantsA telephonic MoI intervention was conducted by trained student pharmacists to improve statin adherence in a Medicare Advantage plan. Four preintervention adherence trajectories were previously identified: rapid decline (RD), gradual decline (GD), gaps in adherence (GA), and adherent and were used to customize the MoI intervention. Patients from the 3 nonadherent preintervention trajectories were randomized to control or intervention groups and were followed for 6 months from the date of MoI intervention. Outcome measuresGroup-based trajectory modeling was performed to identify 3 relevant postintervention trajectories. Descriptive statistics were used to assess differences in pre- and postintervention adherence trajectories. Multinomial logistic regression was conducted to determine predictors associated with each identified postintervention trajectory. ResultsThere were 152 intervention patients and 304 randomly selected controls. The prominent postintervention trajectories that were identified differed from the preintervention trajectories and were (1) GD (17.2%), (2) adherent (61.9%), and (3) discontinuation (20.9%). Among the intervention group, more patients in the GA preintervention trajectory (58.65%) moved to the adherent trajectory postintervention than those in the RD and GD preintervention trajectories. Furthermore, the predictors associated with the postintervention trajectories included MoI intervention, prescriber specialty, presence of diabetes, presence of congestive heart failure, Centers for Medicare & Medicaid Services risk score, and preintervention trajectories. ConclusionThe postintervention adherence trajectory patterns differed from the preintervention trajectory patterns with many patients moving into an adherent trajectory especially among those receiving the intervention.